Cascade Pacific Action Alliance Regional Health Assessment

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

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

Demographics and Socioeconomic Status

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] 300,000 250,000 200,000 150,000 100,000 Wahkiakum 4,010 [15 ppsm] Cowlitz 103,700 [91 ppsm] Source: Washington State, Office of Financial Management, US Census 50,000 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Cowlitz Thurston Rural counties Grays Harbor Lewis Mason Pacific Wahkiakum

Demographics Percent by Age category Pop 2014 Percent by Gender Wahkiakum 17.4 54.4 28.1 4,010 Wahkiakum 49.7 Thurston 22.4 63.5 14.0 264,000 Thurston 51.1 Pacific 18.0 55.7 26.4 21,000 Pacific 49.8 Mason 19.8 60.4 19.9 62,000 Mason 48.2 Lewis 22.7 58.9 18.4 76,300 Lewis 49.9 Grays Harbor 21.1 61.3 17.6 73,300 Grays Harbor 48.5 Cowlitz 23.4 59.7 16.9 103,700 Cowlitz 50.5 WA 23.0 63.8 13.2 6,968,170 WA 50.1 0.0 20.0 40.0 60.0 80.0 100.0 < 18 18-64 65+ 47.0 48.0 49.0 50.0 51.0 52.0 53.0 Female Male Source: US Census. County Health Rankings, 2014 Race, Ethnicity

Demographics By Race, Ethnicity Wahkiakum Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Wahkiakum 3.0 92.1 Thurston 7.4 78.4 Pacific 8.3 84.1 Mason 8.2 82.8 Lewis 8.9 85.7 Grays Harbor 8.9 81.1 Cowlitz 8.0 85.4 WA 11.5 72.1 0.0 5.0 10.0 15.0 20.0 25.0 30.0 African American Asian Hispanic American Indian/ Alaskan Native Native Hawaiian/ Other Pacific Islander Non-Hispanic white Source: County Health Rankings, 2014 Race, Ethnicity

Demographics - % Not Proficient in English Percent that reports speaking English less than well 4.0 4.0 3.5 3.0 2.5 2.4 2.6 2.7 2.6 2.0 1.5 1.0 1.3 1.6 0.5 0.0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 0.0 Source: County Health Rankings, 2014 Race, Ethnicity

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: 2011-2013 American Community Survey 3-Year Estimates, table DP02. [*] 2008-2012 American Community Survey 5-Year Estimates

Graduation Rates Class of 2013, School Year 2012-13 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Continuing Rate 11.0 8.8 17.1 12.2 15.1 7.8 8.9 7.9 Cohort dropout rate 13.0 11.3 15.9 17.0 12.2 27.9 13.5 13.2 Graduation Rate 76.0 79.9 67.0 70.8 72.7 64.3 77.6 78.9 Graduation Rate Cohort dropout rate Continuing Rate Source: Washington State, Office of Superintendent of Public Instruction

Poverty Estimate 2011-2013 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: 2011-2013 American Community Survey 3-Year Estimates- CP03

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 2008-2010 2011-2013 No data Source: U.S. Census Bureau, 2011-2013 American Community Survey 3-Year Estimates - CP03

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, 2011-2013 American Community Survey 3-Year Estimates - CP03

Unemployment, 2014 Historical Unemployment Rate seasonally adjusted Unemployment, September 2014 16% 14% 12% 10% 8% 6% 4% 2% 0% 10 9 8 7 6 5 4 3 2 1 0 5.7 7.0 8.8 8.3 7.2 7.6 5.4 7.7 WA Olympia MSA (Thurston) Longview MSA (Cowlitz) Source: Washington State Employment Security Department, Local Unemployment Statistics, Oct 2014

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

Access to Health Care

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

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

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

Primary care Physicians, Dentist and Mental Health Providers 2014 Number of FTEs per 100,000 population 250 200 150 100 50 0 82 225 188 156 140 153 121 95 74 66 66 53 63 65 44 45 51 58 50 26 33 33 34 0 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

Bed count by Hospital Bed count Willapa Harbor Hospital Summit Pacific Hospital 15 11 St. John Medical Center 193 Providence St. Peter Hospital 390 Providence Centralia Hospital 133 Ocean Beach Hospital Morton General Hospital Mason General Hospital 15 25 25 Grays Harbor Community Hospital 70 Capital Medical Center 110 0 50 100 150 200 250 300 350 400 Source: Washington State Department of Health - Chars Reporting System

Health Insurance Coverage, 2009-2010 Percent who report having health insurance 100 90 80 70 60 50 40 30 20 10 0 82 95 97 97 93 95 92 89 87 84 77 79 79 78 74 70 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)

Uninsured Adults by Income, 2012 Percent who report having health insurance Wahkiakum Thurston Pacific Mason Lewis Grays Harbor Cowlitz WA 19.2 18.0 24.2 22.9 22.3 24.6 20.1 19.5 33.0 37.0 37.2 38.0 36.3 38.3 39.2 41.5 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 <= 138% FPL All Incomes Source: US Census Bureau's Small Area Health Insurance Estimates (SAHIE), 2012

Medicaid Eligibility, 2012 35.0% 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

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 55,989 940 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: WA HCA. Managed Care Monthly Enrollment Reports, People Enrolled by County, Oct, 2014

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.

Health Status

Leading Causes of Death for Residents, 2011-2013 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 192.9 197.9 246.5 237.4 204.3 281.4 184.6 185.1 Malignant neoplasms 163.6 187.2 179.5 184.4 185.5 146.8 172.0 190.8 Alzheimer's disease 44.4 47.7 44.8 56.1 38.6 16.3 43.0 18.1 Chronic lower respiratory diseases 42.3 60.9 64.1 57.9 43.9 48.0 46.5 62.6 Accidents 38.2 54.9 48.4 40.2 56.7 53.6 39.4 88.8 Diabetes mellitus 22.4 40.3 27.5 22.7 18.4 30.0 21.2 37.7 Infectious and Parasitic Disease 15.5 18.0 21.0 17.5 16.4 11.6 13.4 34.6 Intentional self-harm (suicide) 14.3 14.0 20.2 12.6 16.4 19.0 16.3 47.4 Chronic liver disease and cirrhosis 11.2 15.2 18.7 12.0 15.0 13.5 9.5 0.0 Influenza and pneumonia 10.2 13.1 15.3 10.8 9.9 10.5 8.6 10.1 All other diseases 137.5 152.7 161.8 140.1 149.8 143.6 143.7 138.5 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT), Oct 2014

Leading Causes of Death for Thurston Residents, 2011-2013 Age Adjusted Rate, per 100,000 250.0 200.0 184.6 172.0 150.0 100.0 50.0 43.0 46.5 39.4 21.2 13.4 16.3 9.5 8.6 0.0 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)

Leading Causes of Death for Cowlitz Residents, 2011-2013 Age Adjusted Rate, per 100,000 250.0 200.0 197.9 187.2 150.0 100.0 50.0 47.7 60.9 54.9 40.3 18.0 14.0 15.2 13.1 0.0 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)

Leading Causes of Death for Lewis Residents, 2011-2013 Age Adjusted Rate, per 100,000 250.0 237.4 200.0 184.4 150.0 100.0 50.0 56.1 57.9 40.2 22.7 17.5 12.6 12.0 10.8 0.0 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)

Death Rates, 2011-2013 20.0 18.0 16.0 Age Adjusted Rate Motor Vehicle Premature Death 12,000 10,000 14.0 12.0 8,000 10.0 6,000 8.0 6.0 4.0 2.0 0.0 5,709 7,426 8,327 6,713 6.9 9.6 8.0 12.2 8.5 17.2 7.9 15.5 7.5 18.0 7.8 16.9 6.9 11.0 8.1 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. 2000 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

Cancer Incidence, 2002-2011 Age Adjusted Rate, per 100,000 650 600 550 500 450 400 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Age-Adjusted Rate 537.1 521.1 563.47 497.41 588.09 447.32 562.81 457.68 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

Health Outcomes - Morbidity 2014 5.0 4.5 4.0 3.5 3.0 Percent of adults reporting poor or fair health Wahkiakum 20 Thurston 14 2.5 Pacific 19 2.0 1.5 3.6 3.3 4.5 4.1 4.5 4.3 4.0 3.4 4.4 4.4 4.3 4.5 3.6 3.6 4.4 4.3 Mason Lewis 17 18 1.0 Grays Harbor 19 0.5 0.0 Cowlitz WA 14 18 0 5 10 15 20 25 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.

Chronic Disease Prevalence Among Adults Percent 55 50 45 40 35 30 27 29 40 45 35 35 35 42 49 34 34 29 51 47 39 39 35 45 27 33 38 32 39 52 1. Obesity 2. High Blood Pressure 3. High Cholesterol 25 Percent 20 18 16 14 12 10 8 6 10 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 16 15 14 13 13 12 12 11 11 11 10 10 9 9 9 8 8 8 8 8 7 5 5 1. Asthma 2. Diabetes 3. Heart Disease 4 2 0 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, 2009-2011

Hospitalization Cowlitz Top ten causes, 2011-2013 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 0.0 200.0 400.0 600.0 800.0 1,000.01,200.01,400.01,600.0 Diseases of the circulatory system Certain conditions originating in the perinatal period Complications of pregnancy; childbirth; and the puerperium 0.0 500.0 1,000.0 1,500.0 2,000.0 2,500.0 3,000.0 Cowlitz WA Cowlitz WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

Hospitalization Grays Harbor Top ten causes, 2011-2013 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 0.0 200.0 400.0 600.0 800.01,000.01,200.01,400.01,600.01,800.0 0.0 500.0 1,000.0 1,500.0 2,000.0 2,500.0 3,000.0 Grays Harbor WA Grays Harbor WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

Hospitalization Thurston County Top ten causes, 2011-2013 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 0.0 200.0 400.0 600.0 800.0 1,000.0 1,200.0 1,400.0 0.0 500.0 1,000.0 1,500.0 2,000.0 2,500.0 3,000.0 Thurston WA Thurston WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

Hospitalization Lewis County Top ten causes, 2011-2013 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 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 0 500 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

Low Birth Weight, Teen Birth Rate 6.8 50 Percent of live births 6.6 6.4 6.2 6.0 5.8 5.6 5.4 45 40 35 30 25 20 15 10 5 Births per 1,000 female, ages 15-19 5.2 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Low Birthweight 6.3 6.7 6.2 6.0 6.1 6.1 5.8 Teen Birth rate 30.3 46.7 46.0 43.8 44.1 36.8 24.2 29.5 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

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 2005 2012 Source: Health Care Authority, 2012

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.

Risk Factor Behaviors

Adults: Excessive Drinking, 2006-2012 25 20 15 16.9 18.6 21.5 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. 14 16.1 14.6 15.9 18.1 10 5 0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: County Health Rankings Excessive drinking

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) 2006-2012. Smoke during pregnancy: 2009 Washington State Birth Certificates.

Smokeless Tobacco, 2012 12% 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. 2012 Healthy Youth Survey

Adult fruit/vegetable consumption Percent of adults age 18+ who report eating fruits and vegetables 5 or more times per day 30 25 20 Axis Title 15 10 5 0 WA Cowlitz Source: Washington State Public Health Indicators Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 2007 26 18 20 27 22 21 26 23 2009 25 24 22 19 21 18 24 18

Adult physical activity Percent of adults age 18+ who report moderate physical activity 70 68 66 64 62 60 58 56 54 52 50 69 66 66 67 67 62 62 64 61 62 63 62 58 55 53 52 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 2007 2009 Source: Washington State Public Health Indicators

Adult Obesity Percent of adults age 18+ who have body mass index of 30 kg/m2 or more 40 40 38 37 36 35 35 34 33 33 33 32 30 28 26 25 26 28 29 29 27 27 28 24 23 22 20 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 2007-2008 2009-2010 Source: Washington State Public Health Indicators

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 28 26 24 22 20 18 16 14 12 10 26 23 18 20 20 19 17 17 17 16 14 13 12 12 13 13 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 2007-2008 2009-2010 Source: Washington State Public Health Indicators

Adults Receiving Recommended Cancer Screenings Percent of adults who had a test, 2012 85 83 83 82 80 77 79 77 75 70 65 60 67 72 72 64 67 69 72 67 60 70 62 63 61 65 70 73 60 66 55 50 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Breast, 2012 Cervical, 2012 Colorectal 2012 Source: Washington State Public Health Indicators, 2014

Adults Dental Care, 2008-2010 Percent of adults age 18+ who report visiting a dentist, dental hygienist or dental clinic within the past year 80 75 70 65 60 73 72 67 58 60 60 63 64 56 62 63 70 74 72 71 65 55 50 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 2008 2010 Source: Washington State Public Health Indicators

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.

Child Health

Infant and Child Mortality 120.0 100.0 80.0 Infant mortality rate (2002-2008): Rate of all infant deaths (within 1 year), per 1,000 live births. Child mortality rate (2007-2010): Crude mortality rate for deaths under age 18 (per 100,000) 97.5 60.0 40.0 45.2 55.8 42.3 36.8 52.9 46.0 20.0 0.0 5.3 6.0 4.8 4.3 6.5 5.6 WA Cowlitz Grays Harbor Infant mortality rate Lewis Mason Pacific Thurston Wahkiakum Child mortality rate No data Source: County Health Rankings, 2014

Exposure to Tobacco Smoke, 12th Graders, 2012 60.0% 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. 2012 Healthy Youth Survey

Current Smoking Among Youth, 2012 16 10 19 13 24 13 5 7 6 6 8 1 2 2 2 1 16 10 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 21 12 15 9 4 16 12 6 No data 12th grade 10th grade 8th grade 6th grade Source: Washington State Department of Health. 2012 Healthy Youth Survey During the past 30 days, on how many days did you: Smoke cigars, cigarillos, or little cigars? = 1+ days

Youth Obesity Percent of 10th graders in the top 15% BMI by reported height and weight, based on CDC growth charts 40 35 30 25 25 27 22 30 29 31 30 36 35 32 36 27 24 25 20 15 10 5 0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 2008 2010 No data Source: Washington State Public Health Indicators

Youth Consuming 5 or More Servings of Fruit and Vegetables Per Day, 2012 40 35 30 25 20 15 10 5 0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data 8th grade 10th grade 12th grade Source: Washington State Public Health Indicators

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. 2012 Healthy Youth Survey

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.

Infectious Diseases

Health Outcomes 2013 HIV Rate Sexually transmitted infections 250.0 200.0 191.3 166.8 400 350 300 340.8 377.6 295.1 267.1 372.2 150.0 250 100.0 107.6 83.1 102.4 87.7 200 150 187.5 150.3 50.0 46.8 100 81.2 50 0.0 0 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

People Living with HIV Disease by County As of Dec 31, 2013 Per 100,000 200 180 160 140 120 99.6 88.2 100 90.4 80 60 60.7 62.7 57.4 49.9 40 20 0 79.8 44.3 72.1 47.2 52.1 44.8 49.9 34.1 19.5 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

Sexually Transmitted Diseases, All causes Crude Rate 1999-2003 and 2003-2013 per 100,000 population 500 450 400 350 300 250 200 150 100 50 0 State Total Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 1999-2003 324.72 182.17 193.32 169.45 262.72 149.36 244.26 93.81 2009-2013 428.12 409.05 252.35 321.07 292.85 169.14 392.11 129.8 1999-2003 2009-2013 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

Sexually Transmitted Diseases, Chlamydia Crude Rate 1999-2003 and 2003-2013 per 100,000 population 400 350 300 250 200 150 100 50 0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 1999-2003 242.8 153.48 165.83 138.33 207.3 130.21 198.78 83.39 2009-2013 342.02 346.52 213.95 273.62 248.58 135.69 328.05 99.85 1999-2003 2009-2013 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

Sexually Transmitted Diseases, Herpes Crude Rate 2000-2002 and 2010 2012 70 Herpes, initial genital infection 60 50 40 30 20 10 0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 1999-2003 32.36 15.09 18.13 19.88 28.7 15.32 27 5.21 2009-2013 30.97 38.18 23.04 30.31 22.63 10.51 35.3 29.95 1999-2003 2009-2013 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

Tuberculosis, 1993-2002 and 2003-2012 Age Adjusted Rate, per 100,000 7 6 5 4 3 2 1 0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum 1993-2002 4.82 4.08 3.21 2.03 3.52 1.83 2.3 0 2003-2012 3.68 0.63 2.1 1.02 3.38 2.16 2.73 0 No data Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

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 2013. TB infection rates are lower than the State average across all counties, with the exception of Mason County which more closely mirrors the state.

Social Environment

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

Alcohol, Drug-Related and Violent Crime Arrests 5 years rate 2008-2012 (Age 18+) per 1,000 adults 10 9 8 7 6 5 4 3 2 1 9.09 4.19 1.54 6.23 5.17 2.32 6.63 7.46 1.49 4.42 5.71 4.20 3.70 1.91 1.97 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. 4.45 3.10 0.94 5.46 2.75 1.43 1.50 1.10 0 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

Alcohol- or Drug-Related Deaths 2008-2012 - Rate per 100 deaths 18 16 15.74 14 12 12.42 12.98 13.27 10.94 13.91 13.21 12.79 10 8 6 4 2 0 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

Opioid Related Deaths by County of Residence 2010-2012 - Rate per 100,000 18.0 16.0 14.0 12.0 10.0 9.1 3.2 2.1 8.0 6.0 4.0 2.0 0.0 2.8 2.6 2.9 1.0 9.6 8.8 8.0 5.7 5.5 5.8 5.9 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum No data Prescription Heroin Source: Washington State Department of Health

Meth Labs 2000-2012 350 1890 2000 300 250 1454 1693 1480 1341 1800 1600 1400 200 1200 150 100 50 0 809 390 237 184 186 95 46 84 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Region WA 1000 800 600 400 200 0 Source: Washington State Department of Ecology - Clandestine Drug Lab and Dump Site Cleanup Activity

Property Crime Arrest by Age Group 5 years rate 2008-2012 - per 1,000 age group 20 18 16 14 12 10 8 6 4 2 0 6.01 12.64 6.12 9.75 18.19 9.51 7.44 14.53 10.46 6.00 11.58 7.38 5.04 9.38 4.68 2.26 4.54 1.86 3.90 9.26 5.03 1.78 1.20 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Age 10-14 Age 10-17 Age 18+ Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention

Crime by County Number of crimes committed per 1,000 residents 80 70 60 50 40 30 20 10 COWLITZ WA GRAYS HARBOR LEWIS MASON PACIFIC THURSTON WAHKIAKUM 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source: Washington State Office of Financial Management, Statistical Analysis Center

Inadequate Social Support, 2013 Percent of adults without social/emotional support 25 20 17 22 23 18 17 20 17 21 15 10 5 0 WA Cowlitz Grays Harbor Lewis Mason Pacific Thurston Wahkiakum Source: County Health Rankings

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.