Cascade Pacific Action Alliance Regional Health Assessment

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1 Cascade Pacific Action Alliance Regional Health Assessment Cowlitz, Grays Harbor, Lewis, Mason, Pacific, Thurston and Wahkiakum County December, 2014 V.4

2 Thematic Areas Demographics and Socioeconomic Status Social Environment Access to Health Care Infectious Diseases Health Status Child Health Risk Factor Behaviors

3 Demographics and Socioeconomic Status

4 Population, 2014 Grays Harbor 73,300 [38 ppsm] Pacific 21,000 [23 ppsm] Mason 62,000 [65 ppsm] Thurston 264,000 [363 ppsm] Washington State 6,882,400 [101 Persons per square mile] Lewis 76,300 [32 ppsm] 300, , , , ,000 Wahkiakum 4,010 [15 ppsm] Cowlitz 103,700 [91 ppsm] Source: Washington State, Office of Financial Management, US Census 50, Cowlitz Thurston Rural counties Grays Harbor Lewis Mason Pacific Wahkiakum

5 Demographics Percent by Age category Pop 2014 Percent by Gender Wahkiakum ,010 Wahkiakum 49.7 Thurston ,000 Thurston 51.1 Pacific ,000 Pacific 49.8 Mason ,000 Mason 48.2 Lewis ,300 Lewis 49.9 Grays Harbor ,300 Grays Harbor 48.5 Cowlitz ,700 Cowlitz 50.5 WA ,968,170 WA < Female Male Source: US Census. County Health Rankings, 2014 Race, Ethnicity

6 Demographics By Race, Ethnicity Wahkiakum Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA Wahkiakum Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA African American Asian Hispanic American Indian/ Alaskan Native Native Hawaiian/ Other Pacific Islander Non-Hispanic white Source: County Health Rankings, 2014 Race, Ethnicity

7 Demographics - % Not Proficient in English Percent that reports speaking English less than well WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 0.0 Source: County Health Rankings, 2014 Race, Ethnicity

8 Educational Attainment, 2013 Population 25 years and over Wahkiakum* 2% 5% 35% 32% 10% 11% 6% Thurston 2% 4% 23% 28% 10% 20% 13% Pacific 5% 7% 32% 29% 9% 12% 6% Mason 3% 8% 31% 32% 9% 12% 5% Lewis 4% 9% 32% 28% 12% 9% 6% Grays Harbor 6% 8% 32% 29% 11% 10% 4% Cowlitz 3% 9% 31% 31% 10% 10% 6% WA 4% 6% 24% 25% 10% 20% 12% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less than 9th grade 9th to 12th grade, no diploma H.S. Diploma or GED Some college, no degree Associate's degree Bachelor's degree Graduate or professional degree Source: Source: American Community Survey 3-Year Estimates, table DP02. [*] American Community Survey 5-Year Estimates

9 Graduation Rates Class of 2013, School Year % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Continuing Rate Cohort dropout rate Graduation Rate Graduation Rate Cohort dropout rate Continuing Rate Source: Washington State, Office of Superintendent of Public Instruction

10 Poverty Estimate Children Families Elders No data 9.4% 8.2% 6.7% 12.2% 9.3% 12.5% 6.6% 10.3% 6.6% 11.5% 9.3% 8.6% 6.1% 8.8% 18.5% 23.9% 27.6% 20.6% 27.3% 30.2% 17.9% WA COWLITZ GRAYS HARBOR LEWIS MASON PACIFIC THURSTON WAHKIAKUM Source: American Community Survey 3-Year Estimates- CP03

11 Median Household Income (dollars) 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 $60,712 $58,592 $47,694 $47,283 $42,925 $42,289 $44,944 $42,342 $50,399 $45,964 $42,852 $36,052 $65,350 $60,207 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data Source: U.S. Census Bureau, American Community Survey 3-Year Estimates - CP03

12 Income 25% 70,000 20% 15% 13.9% 17.2% 19.8% 15.7% 17.4% 18.3% 12.9% 60,000 50,000 40,000 10% 30,000 20,000 5% 0% $30,432 $58,592 $23,332 $47,283 $21,254 $42,289 $22,051 $42,342 $23,399 $45,964 $21,574 $36,052 $28,670 $60,207 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Persons below poverty level Per capita money income Median household income No data 10,000 0 Source: U.S. Census Bureau, American Community Survey 3-Year Estimates - CP03

13 Unemployment, 2014 Historical Unemployment Rate seasonally adjusted Unemployment, September % 14% 12% 10% 8% 6% 4% 2% 0% WA Olympia MSA (Thurston) Longview MSA (Cowlitz) Source: Washington State Employment Security Department, Local Unemployment Statistics, Oct 2014

14 Demographics and Socioeconomic Status - Trends & Themes The seven-county region is not performing uniformly. Since the late 1990s, Thurston County population growth has continuously outpaced population growth in rural counties. There are significant disparities between the performance of Thurston County and the other rural counties in the region; Thurston County is consistently outperforming rural counties. Within the group of rural counties, there are variations in performance on different measures. By and large, Thurston County s performance statistics mirror those of the State of Washington. Overall, our region is less ethnically diverse than the State as a whole. Rural counties are less diverse in terms of race/ethnicity than Thurston county Historically unemployment is particularly high in rural counties

15 Access to Health Care

16 Health Professional Shortage Areas July, 2014 Primary Care Mental Care Dental Care Source: Washington State Department of Health, geographic information system (GIS)

17 Critical Access Hospitals Source: Washington State Department of Health, geographic information system (GIS), January 2013

18 Rural Health Clinics Source: Washington State Department of Health, geographic information system (GIS), January 27, 2011

19 Primary care Physicians, Dentist and Mental Health Providers 2014 Number of FTEs per 100,000 population WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Primary care physicians Dentists Mental health providers Source: County Health Rankings - Ratio of population to primary care physicians, dentist and mental health providers

20 Bed count by Hospital Bed count Willapa Harbor Hospital Summit Pacific Hospital St. John Medical Center 193 Providence St. Peter Hospital 390 Providence Centralia Hospital 133 Ocean Beach Hospital Morton General Hospital Mason General Hospital Grays Harbor Community Hospital 70 Capital Medical Center Source: Washington State Department of Health - Chars Reporting System

21 Health Insurance Coverage, Percent who report having health insurance WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Adults Children Source: Washington State Public Health Indicators US Census Bureau's Small Area Health Insurance Estimates (SAHIE)

22 Uninsured Adults by Income, 2012 Percent who report having health insurance Wahkiakum Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA <= 138% FPL All Incomes Source: US Census Bureau's Small Area Health Insurance Estimates (SAHIE), 2012

23 Medicaid Eligibility, % 30.0% 29.3% 29.5% 29.8% 25.0% 21.8% 24.5% 25.7% 22.2% 20.0% 18.8% 15.0% 10.0% 5.0% 0.0% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Department of Social and health Services. Research & Data Analysis Division

24 Enrollees in Medical Programs By County 35.0% 30.0% 30.8% 32.5% 31.9% 28.9% 25.8% 25.0% 23.8% 23.4% 21.2% 20.0% 15.0% 10.0% 5.0% 0.0% Total Enrolled 1,659,724 31,929 23,796 24,353 15,993 6,089 55, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: WA HCA. Managed Care Monthly Enrollment Reports, People Enrolled by County, Oct, 2014

25 Access to Health Care - Trends & Themes There is unequal access to health care services throughout the region. Access is centered around population centers in Cowlitz, Thurston, Lewis and Grays Harbor counties though there is some access to health care services throughout the region. Across primary care, dental and mental health the data shows our region performing lower than the state average Health insurance coverage in our region mirrors the State of Washington, however, a disproportionate number of poor are without health insurance.

26 Health Status

27 Leading Causes of Death for Residents, Death Rate per 100,000 age-adjusted Wahkiakum Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Major cardiovascular diseases Malignant neoplasms Alzheimer's disease Chronic lower respiratory diseases Accidents Diabetes mellitus Infectious and Parasitic Disease Intentional self-harm (suicide) Chronic liver disease and cirrhosis Influenza and pneumonia All other diseases Source: Washington State Department of Health, Community Health Assessment Tool (CHAT), Oct 2014

28 Leading Causes of Death for Thurston Residents, Age Adjusted Rate, per 100, Major cardiovascular diseases Malignant neoplasms Alzheimer's disease Chronic lower respiratory diseases Accidents Diabetes mellitus Infectious and Parasitic Disease Intentional selfharm (suicide) Chronic liver disease and cirrhosis Influenza and pneumonia WA Thurston Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

29 Leading Causes of Death for Cowlitz Residents, Age Adjusted Rate, per 100, Major cardiovascular diseases Malignant neoplasms Alzheimer's disease Chronic lower respiratory diseases Accidents Diabetes mellitus Infectious and Parasitic Disease Intentional selfharm (suicide) Chronic liver disease and cirrhosis Influenza and pneumonia WA Cowlitz Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

30 Leading Causes of Death for Lewis Residents, Age Adjusted Rate, per 100, Major cardiovascular diseases Malignant neoplasms Alzheimer's disease Chronic lower respiratory diseases Accidents Diabetes mellitus Infectious and Parasitic Disease Intentional selfharm (suicide) Chronic liver disease and cirrhosis Influenza and pneumonia WA Lewis Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

31 Death Rates, Age Adjusted Rate Motor Vehicle Premature Death 12,000 10, , , ,709 7,426 8,327 6, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 7,114 9,609 5,495 5,645 4,000 2,000 0 Source: Washington State Department of Health & County Health Rankings Age Adjusted Rate: Rate per 1,000 age-adjusted to U.S population. Does not include deaths where age is unknown. Premature Death: years of potential life lost before age 75 per 100,000 pop. Motor vehicle crash deaths per 100,000 population

32 Cancer Incidence, Age Adjusted Rate, per 100, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Age-Adjusted Rate Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

33 Health Outcomes - Morbidity Percent of adults reporting poor or fair health Wahkiakum 20 Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA Poor physical health days Poor mental health days Source: County Health Rankings Poor physical health days and poor mental health days: Average number in past 30 days.

34 Chronic Disease Prevalence Among Adults Percent Obesity 2. High Blood Pressure 3. High Cholesterol 25 Percent WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Asthma 2. Diabetes 3. Heart Disease WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Department of Health, Chronic Disease Profiles by County. WA Behavioral Risk Factor Surveillance System,

35 Hospitalization Cowlitz Top ten causes, Diagnosis Group - Male Diagnosis Group - Female Diseases of the genitourinary system Neoplasms Neoplasms Mental Illness Infectious and parasitic diseases Diseases of the genitourinary system Mental Illness Diseases of the musculoskeletal system and connective tissue Diseases of the respiratory system Diseases of the respiratory system Diseases of the musculoskeletal system and connective tissue Injury and poisoning Injury and poisoning Diseases of the digestive system Diseases of the digestive system Certain conditions originating in the perinatal period Diseases of the circulatory system ,000.01,200.01,400.01,600.0 Diseases of the circulatory system Certain conditions originating in the perinatal period Complications of pregnancy; childbirth; and the puerperium , , , , ,000.0 Cowlitz WA Cowlitz WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

36 Hospitalization Grays Harbor Top ten causes, Diagnosis Group - Male Diagnosis Group - Female Diseases of the genitourinary system Neoplasms Neoplasms Mental Illness Infectious and parasitic diseases Diseases of the genitourinary system Mental Illness Diseases of the musculoskeletal system and connective tissue Diseases of the respiratory system Diseases of the respiratory system Diseases of the musculoskeletal system and connective tissue Injury and poisoning Injury and poisoning Diseases of the digestive system Diseases of the digestive system Certain conditions originating in the perinatal period Diseases of the circulatory system Diseases of the circulatory system Certain conditions originating in the perinatal period Complications of pregnancy; childbirth; and the puerperium ,000.01,200.01,400.01,600.01, , , , , ,000.0 Grays Harbor WA Grays Harbor WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

37 Hospitalization Thurston County Top ten causes, Diagnosis Group - Male Diagnosis Group - Female Diseases of the genitourinary system Neoplasms Neoplasms Mental Illness Infectious and parasitic diseases Diseases of the genitourinary system Mental Illness Diseases of the musculoskeletal system and connective tissue Diseases of the respiratory system Diseases of the respiratory system Diseases of the musculoskeletal system and connective tissue Injury and poisoning Injury and poisoning Diseases of the digestive system Diseases of the digestive system Certain conditions originating in the perinatal period Diseases of the circulatory system Diseases of the circulatory system Certain conditions originating in the perinatal period Complications of pregnancy; childbirth; and the puerperium , , , , , , , ,000.0 Thurston WA Thurston WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

38 Hospitalization Lewis County Top ten causes, Diagnosis Group - Male Diagnosis Group - Female Diseases of the genitourinary system Neoplasms Neoplasms Mental Illness Infectious and parasitic diseases Diseases of the genitourinary system Mental Illness Diseases of the respiratory system Diseases of the musculoskeletal system and connective tissue Diseases of the respiratory system Diseases of the musculoskeletal system and connective tissue Injury and poisoning Injury and poisoning Diseases of the digestive system Diseases of the digestive system Diseases of the circulatory system Certain conditions originating in the perinatal period Diseases of the circulatory system Certain conditions originating in the perinatal period Complications of pregnancy; childbirth; and the puerperium ,000 1,200 1,400 1,600 1, ,000 1,500 2,000 2,500 3,000 3,500 Lewis WA Lewis WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

39 Low Birth Weight, Teen Birth Rate Percent of live births Births per 1,000 female, ages WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Low Birthweight Teen Birth rate No data 0 Source: County Health Rankings, 2014 Low birth weight is the percent of live births for which the infant weighed less than 2,500 grams (approximately 5 lbs., 8 oz.). Teen Birth Rate: number of births per 1,000 female population, ages 15-19

40 Medicaid Dental Utilization for ABCD Age Children Percentage of Children on Medicaid 0-5 Using Dental Services 60.0% 50.0% 40.0% 30.0% 20.0% 34.2% 51.1% 50.7% 21.7% 45.3% 39.7% 40.9% 50.9% 31.5% 48.2% 24.0% 36.6% 28.6% 42.6% 25.3% 37.4% 10.0% 0.0% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Health Care Authority, 2012

41 Health Status - Trends & Themes There is remarkable uniformity across the region in the leading causes of death. Across the region, malignant neoplasms (cancer) and major cardiovascular diseases/diseases of the heart are by far the two leading causes of death. Deaths from heart disease are notably elevated in Pacific and Lewis counties. In rural counties, deaths from motor vehicle accidents are well above the State average (e.g. in Mason County, the death rate from motor vehicle accidents is almost 100% higher than that for the entire State). Overall, rural counties report worse mental health and physical health status than mostly urban Thurston County, which again by and large mirrors the State s performance. Teen birthrates are significantly higher than the state average for all our rural counties.

42 Risk Factor Behaviors

43 Adults: Excessive Drinking, Excessive drinking reflects the percent of adults that report either binge drinking, defined as consuming more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as drinking more than one (women) or 2 (men) drinks per day on average WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: County Health Rankings Excessive drinking

44 Smoking: Adults and Pregnant Women 30% 25% 20% 24% 23% 23% 21% 25% 20% 19% 19% 22% 21% 19% 20% 15% 16% 12% 15% 10% 9% 5% 0% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Adult smoking Smoke during pregnancy Source: Washington State Department of Health. Tobacco Prevention and Control Program. Smoking prevalence: Behavioral Risk Factor Surveillance System (BRFSS) Smoke during pregnancy: 2009 Washington State Birth Certificates.

45 Smokeless Tobacco, % 8% 11% 14% 11% 7% 7% 13% 8% 8% 12th grade 10th grade 8th grade 5% 7% 3% 3% 6% 6% 8% 4% 5% 2% 3% No data WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Department of Health Healthy Youth Survey

46 Adult fruit/vegetable consumption Percent of adults age 18+ who report eating fruits and vegetables 5 or more times per day Axis Title WA Cowlitz Source: Washington State Public Health Indicators Grays Harbor Lewis Mason Pacific Thurston Wahkiakum

47 Adult physical activity Percent of adults age 18+ who report moderate physical activity WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Public Health Indicators

48 Adult Obesity Percent of adults age 18+ who have body mass index of 30 kg/m2 or more WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Public Health Indicators

49 Adults with unmet medical need Percent of adults age 18+ who report needing to see a doctor within the past year but could not due to cost WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Public Health Indicators

50 Adults Receiving Recommended Cancer Screenings Percent of adults who had a test, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Breast, 2012 Cervical, 2012 Colorectal 2012 Source: Washington State Public Health Indicators, 2014

51 Adults Dental Care, Percent of adults age 18+ who report visiting a dentist, dental hygienist or dental clinic within the past year WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Public Health Indicators

52 Risk Factors - Trends & Themes There is significant divergence within the region in terms of risk factors, not just between Thurston County and the other rural counties, but also between different rural counties: With the exception of Grays Harbor and Wahkiakum, all counties are performing better than the State as a whole with regard to excessive drinking. Tobacco use rates in all counties are higher than statewide with Mason, Cowlitz and Grays Harbor County rates being particularly elevated (more than 10% above State average). Some counties are showing improvements in physical activity and obesity rates (Lewis County), while others are falling further behind (Mason, Cowlitz Counties). Generally, rural counties underperform in comparison to Thurston County and the State as a whole. Overall, Mason and Grays Harbor Counties are most challenged.

53 Child Health

54 Infant and Child Mortality Infant mortality rate ( ): Rate of all infant deaths (within 1 year), per 1,000 live births. Child mortality rate ( ): Crude mortality rate for deaths under age 18 (per 100,000) WA Cowlitz Grays Harbor Infant mortality rate Lewis Mason Pacific Thurston Wahkiakum Child mortality rate No data Source: County Health Rankings, 2014

55 Exposure to Tobacco Smoke, 12th Graders, % 54.2% 50.0% 40.0% 30.0% 37.3% 25.5% 44.1% 43.8% 33.7% 40.6% 48.5% 31.6% 46.7% 37.1% 39.3% 25.7% 26.7% 26.7% 20.0% 44.4% 39.2% 37.9% 42.5% 19.7% 10.0% 26.4% 29.5% 26.9% 13.3% 0.0% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum* Exposed to secondhand smoke Smoke at Home Smoker in Car Source: Washington State Department of Health Healthy Youth Survey

56 Current Smoking Among Youth, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data 12th grade 10th grade 8th grade 6th grade Source: Washington State Department of Health Healthy Youth Survey During the past 30 days, on how many days did you: Smoke cigars, cigarillos, or little cigars? = 1+ days

57 Youth Obesity Percent of 10th graders in the top 15% BMI by reported height and weight, based on CDC growth charts WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data Source: Washington State Public Health Indicators

58 Youth Consuming 5 or More Servings of Fruit and Vegetables Per Day, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data 8th grade 10th grade 12th grade Source: Washington State Public Health Indicators

59 Youth Physically Active, 2012 Did Not Meet Recommendations for Physical Activity 70% 60% 50% 40% 53% 54% 49% 49% 46% 44% 42% 42% 43% 43% 41% 41% 39% 40% 38% 38% 46% 58% 45% 50% 45% 42% 40% 38% 39% 30% 31% 32% 20% 10% 0% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data 6th grade 8th grade 10th grade 12th grade Source: Washington State Department of Health Healthy Youth Survey

60 Child Health - Trends & Themes As with Risk Factors, there is no uniformity across the region with regard to child health: Infant mortality and to a lesser degree child mortality are a major problem in Pacific County, and a bit high in Cowlitz and Mason County, the other counties are on par with the State s overall performance in this area. Youth smoking rates are substantially elevated in Cowlitz, Grays Harbor and Mason County Youth obesity rates are dropping in Pacific county, but rising in Cowlitz, Lewis and Grays Harbor counties. Lewis and Cowlitz Counties obesity rate is quickly deteriorating. Thurston Co. is mirroring the statewide average.

61 Infectious Diseases

62 Health Outcomes 2013 HIV Rate Sexually transmitted infections Number of persons living with a diagnosis of human immunodeficiency virus (HIV) infection per 100,000 population STI rate is measured as chlamydia incidence (number of new cases reported) per 100,000 population. Source: County Health Rankings

63 People Living with HIV Disease by County As of Dec 31, 2013 Per 100, WA Cowlitz Co. Grays Harbor Co. Lewis Co. Mason Co. Pacific Co. Thurston Co. Wahkiakum Co. HIV (not AIDS) AIDS Source: Washington State Department of Health

64 Sexually Transmitted Diseases, All causes Crude Rate and per 100,000 population State Total Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

65 Sexually Transmitted Diseases, Chlamydia Crude Rate and per 100,000 population WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

66 Sexually Transmitted Diseases, Herpes Crude Rate and Herpes, initial genital infection WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

67 Tuberculosis, and Age Adjusted Rate, per 100, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

68 Infectious Diseases - Trends & Themes Across all three metrics areas, the region is performing better than the State as a whole: HIV infection rates are lower than the State average across all counties. STD infection rates are lower than the State average across rural counties. Cowlitz and Thurston showing higher rates; Pacific and Wahkiakum Counties showing good performances, possibly due to a population that skews older. However, STD infection rates in our region have increased substantially between 2003 and TB infection rates are lower than the State average across all counties, with the exception of Mason County which more closely mirrors the state.

69 Social Environment

70 Physical Environment Wahkiakum Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA 0% 10% 20% 30% 40% 50% 60% Fast food restaurants Limited access to healthy foods Access to recreational facilities Percent of all restaurants that are fast-food establishments Percent of population who are lowincome and do not live close to a grocery store Rate of recreational facilities per 100,000 population Source: County Health Rankings, 2013

71 Alcohol, Drug-Related and Violent Crime Arrests 5 years rate (Age 18+) per 1,000 adults Alcohol violations include all crimes involving driving under the influence, liquor law violations, and drunkenness. Drug law violations include all crimes involving sale, manufacturing, and possession of drugs. Violent crimes include all crimes involving criminal homicide, forcible rape, robbery, and aggravated assault. Simple assault is not defined as a violent crime WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Alcohol-Related Drug Law Violation Violent Crime Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention

72 Alcohol- or Drug-Related Deaths Rate per 100 deaths WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention

73 Opioid Related Deaths by County of Residence Rate per 100, WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data Prescription Heroin Source: Washington State Department of Health

74 Meth Labs Year Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Region WA Source: Washington State Department of Ecology - Clandestine Drug Lab and Dump Site Cleanup Activity

75 Property Crime Arrest by Age Group 5 years rate per 1,000 age group WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Age Age Age 18+ Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention

76 Crime by County Number of crimes committed per 1,000 residents COWLITZ WA GRAYS HARBOR LEWIS MASON PACIFIC THURSTON WAHKIAKUM Source: Washington State Office of Financial Management, Statistical Analysis Center

77 Inadequate Social Support, 2013 Percent of adults without social/emotional support WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: County Health Rankings

78 Social Environment - Trends & Themes In comparison to the State as a whole, access to healthy foods in the region is more limited with the notable exception of Mason County which outperforms the State average on this score by a wide margin. Overall, crime rates across the region are showing the same falling trend as the State. However Cowlitz County s crime rate is notably elevated over the State average. Drugs are a particular problem in Grays Harbor County. Alcohol related arrest rates are well below the State average for all counties. Cowlitz, Grays Harbor, Pacific, and Wahkiakum Counties record elevated rates of inadequate social/ emotional support for adults, whereas the other counties performance is in line with the statewide average.

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