To understand the Fort Worth area, and the 'road to the west' (Abilene, Wichita Falls, and west Texas), it is necessary to look at Texas history and see how two towns (Fort Worth and Dallas) sitting no more than 25 miles apart developed independently and with regulations that often make each town have more in common with Houston (250 miles away) than with each other. Early history has Dallas being settled along the larger fork of the Trinity River. Dallas developed into a textile and manufacturing city, with a transportation network linking the south with the gulf coast and forming part of the eastern industrial section of mid-America (Chicago to St. Louis to the port of New Orleans).

To the west, Fort Worth was founded as a fort to protect Dallas from the Spanish and Indian lands. This dynamic began the 'rivalry' for importance between the two cities. As years passed, the economies of each community developed as divergently as their beginnings. Dallas remained connected to the cotton and manufacturing industry. Fort Worth connected to cattle. Oil in the 1930's became one of the few common industries shared. But the discovery of oil only increased the divide. There were two oil baron families - the Bass family in Fort Worth and the Murchison family in Dallas.

In order to protect their respective communities, the two cities developed separate ordinances and systems that even today mandate how the cities provide services (e.g., the Wright Amendment). The result today is two very independent cities (in legislation and how business is conducted) which by the state constitution must be governed independently. Planning Councils and Administrative Agencies in Dallas and the north central Texas area continue to collaborate and coordinate at many levels. However, laws require each to create separate health delivery systems, and report to separate government agencies.

The major industry in north central Texas is cows. In addition to cattle, other livestock and agriculture businesses dominate the region. These industries bring many migrant workers in and out of the region throughout the year. The Tomas Rivera Center of Austin (a migrant services agency), estimates that approximately 180,000 migrants worked in the north central Texas area during 2004. Two other populations that affect the region's care, but are not included in area census and other data, are the regional incarcerated population (approximately 5,000 people) and the personnel who reside at the two large military bases - Dyess Air Force Base in Abilene and Sheppard Air Force Base in Wichita Falls. Together the bases add an additional 9,800 persons to the region who are not reflected in population studies.

From the 2000 US Census Bureau, the total population for north central Texas is close to 2.6 million. This does not include the 195,000 mentioned above. Of the 2 million people who live in the urban Fort Worth area, 62% are White, 19.7% are Hispanic, and 12.8% are African American. Gender is split evenly. About 11.5% live below the federal poverty level. The rural areas are predominately White (80+%) with 13% Hispanic and about 5% African American. Again, gender is split evenly and around 16% live below the federal poverty level.

According to epidemiologic profiles for 2007 by the Texas Department of State Health Services (DSHS), 4,577 people in north central Texas are known to be living with HIV/AIDS. With 2.6 million people in the area, this means that are nearly 180 people who are positive for every 100,000.

Since 1991, the North Central Texas HIV Planning Council has assessed and planned for the needs of HIV+ individuals, their families, and their caregivers. The Planning Council has been instrumental in bringing over $50 million of federal and state money to help pay for medications, medical visits, and other support services in the area.