COMMUNITY HEALTH NEEDS ASSESSMENT C H O I C E

COMMUNITY HEALTH NEEDS ASSESSMENT Grays Harbor, Lewis, Mason, Pacific and Thurston County March, 2014 P r e p a r e d b y C H O I C E Regional Health Network V1.2

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, 2013 Grays Harbor 73,200 [38 ppsm] Mason 61,800 [63 ppsm] Thurston 260,100 [349 ppsm] Washington State 6,882,400 [101 Persons per square mile] 270,000 250,000 230,000 210,000 190,000 Pacific 21,000 [22 ppsm] Lewis 76,200 [31 ppsm] 170,000 150,000 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 Thurston Rural counties Source: US Census. Washington State, Office of Financial Management,

DEMOGRAPHICS Percent by Age Category Pop 2013 Percent by Gender Thurston 22.7 63.9 13.4 260,100 Thurston Pacific 18.0 56.7 25.3 21,000 Pacific Mason 20.1 61.0 18.9 61,800 Mason Lewis 22.7 59.5 17.8 76,200 Lewis Grays Harbor 21.3 61.8 16.9 73,200 Grays Harbor WA 23.2 64.2 12.7 6,882,400 WA 0.0 20.0 40.0 60.0 80.0 100.0 48% 49% 49% 50% 50% 51% 51% 52% 52% < 18 18-64 65+ Source: US Census. County Health Rankings Race, Ethnicity Female Male

DEMOGRAPHICS (CONT.) By Race, Ethnicity Percent not proficient in English Thurston 7.4 78.4 African American Thurston Pacific Mason 8.3 8.2 84.0 82.6 American Indian/ Alaskan Native Asian Pacific Mason Percent that reports speaking English less than well Lewis 8.9 85.6 Native Hawaiian/ Other Pacific Islander Lewis Grays Harbor 8.9 81.1 Hispanic Grays Harbor WA 11.6 72.1 Non-hispanic white WA 0% 10% 20% 30% 0.0 1.0 2.0 3.0 4.0 5.0 Source: County Health Rankings Race, Ethnicity

EDUCATIONAL ATTAINMENT, 2012 Thurston 2.0% 4.3% 23.5% 28.3% 9.3% 20.0% 12.6% Pacific 5.7% 7.1% 32.4% 28.6% 9.6% 11.2% 5.4% Mason 3.8% 8.5% 29.3% 31.4% 10.0% 11.4% 5.7% Lewis 4.5% 9.5% 31.6% 28.2% 11.4% 8.6% 6.2% Grays Harbor 6.3% 8.5% 31.1% 29.2% 10.3% 10.5% 4.2% WA 4.1% 5.8% 23.8% 25.2% 9.6% 20.1% 11.4% 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: US Census, 2010-2012 American Community Survey 3-Year Estimates

GRADUATION RATES CLASS OF 2012, SCHOOL YEAR 2011-12 85.0 80.0 77.1 77.8 76.6 80.1 75.0 70.0 69.2 66.8 65.0 60.0 WA Grays Harbor Lewis Mason Pacific Thurston Source: Washington State, Office of Superintendent of Public Instruction

POVERTY ESTIMATE 2010-2012 35.0% 30.0% 30.7% 28.7% 26.2% 25.0% 20.0% 18.5% 17.9% 16.3% 15.0% 10.0% 5.0% 9.3% 7.8% 12.6% 8.6% 9.9% 7.8% 11.4% 6.6% 10.3% 9.8% 7.8% 5.7% 0.0% WA Grays Harbor Lewis Mason Pacific Thurston Source: 2010-2012 American Community Survey 3-Year Estimates Children Families Elders

MEDIAN HOUSEHOLD INCOME (DOLLARS) 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 WA Grays Harbor Lewis Mason Pacific Thurston 2007-2009 61,140 44,676 47,023 53,438 42,033 64,956 2010-2012 57,966 42,192 42,192 45,374 38,934 61,741 Source: U.S. Census Bureau, 2010-2012 American Community Survey

INCOME $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $0 WA Grays Harbor Lewis Mason Pacific Thurston Per capita money income Median household income Persons below poverty level 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Source: U.S. Census Bureau, State & County QuickFacts

Source: Washington State Employment Security Department, Local Unemployment Statistics UNEMPLOYMENT, 1991-2012 16.0% 14.0% 12.0 Unemployment, November 2013 11.3 10.4 10.4 12.0% 10.0 8.7 10.0% 8.0 8.0% 6.0% 6.0 6.5 6.5 4.0% 4.0 2.0% 2.0 0.0% WA Grays Harbor Lewis Mason Pacific Thurston 0.0 WA Grays Harbor Lewis Mason Pacific Thurston

DEMOGRAPHICS AND SOCIOECONOMIC STATUS - TRENDS & THEMES The five-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.

ACCESS TO HEALTH CARE

HEALTH PROFESSIONAL SHORTAGE AREAS JULY, 2013 Primary Care Mental Care Dental Care

CRITICAL ACCESS HOSPITALS Source: Washington State Department of Health, GIS

RURAL HEALTH CLINICS JANUARY 27, 2011

PRIMARY CARE PHYSICIANS, DENTIST AND MENTAL HEALTH PROVIDERS 2013 NUMBER OF FTES PER 100,000 POPULATION 100 90 80 70 60 50 40 30 20 10 0 82 70 94 60 63 50 39 41 42 43 23 27 28 8 4 8 WA Grays Harbor Lewis Mason Pacific Thurston No data 46 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 450 400 390 350 300 250 200 150 100 110 70 133 50 0 11 25 25 15 15 Source: Washington State Department of Health - Chars Reporting System

HEALTH INSURANCE COVERAGE, 2009-2010 PERCENT WHO REPORT HAVING HEALTH INSURANCE 100 90 80 82 95 77 93 97 79 79 92 89 84 95 70 70 60 50 40 30 20 10 0 WA Grays Harbor Lewis Mason Pacific Thurston Adults Children Source: Washington State Public Health Indicators US Census Bureau's Small Area Health Insurance Estimates (SAHIE)

UNINSURED ADULTS BY INCOME PERCENT WHO REPORT HAVING HEALTH INSURANCE Thurston Pacific Mason Lewis Grays Harbor WA 0 5 10 15 20 25 30 35 40 45 50 <=138% FPL All Incomes Source: US Census Bureau's Small Area Health Insurance Estimates (SAHIE), 2011

MEDICAID ELIGIBILITY, 2012 35.0% 30.0% 29.5% 29.8% 25.0% 22.0% 24.5% 25.7% 20.0% 18.8% 15.0% 10.0% 5.0% 0.0% WA Grays Harbor Lewis Mason Pacific Thurston Source: Washington State Department of Social and Health Services. Research & Data Analysis Division

MEDICAID ENROLLMENTS Jan, 2014 Thurston 3452 Pacific 789 Mason 949 Lewis 980 Grays Harbor 2012 0 500 1000 1500 2000 2500 3000 3500 4000 Source: WA HCA. Managed Care Monthly Enrollment Reports, Managed Care Enrollments by Program Type, Service Area, Organization and Program Report, 01/07/2014

ACCESS TO HEALTH CARE - TRENDS & THEMES There is unequal access to health care services throughout the region. Access is centered around population centers in Thurston, Lewis and Grays Harbor counties though there is some access to health care services throughout the region. With the exception of Thurston County, which more or less mirrors WA State, there are severe gaps in access to mental health and adult dentistry services throughout the region. Health insurance coverage by and large mirrors WA State performance throughout the region, however, a disproportionate number of poor are without health insurance.

HEALTH STATUS

LEADING CAUSES OF DEATH FOR RESIDENTS, 2010-2012 100.0% 90.0% 80.0% 31.7% 31.9% 28.0% 33.3% 28.2% 31.8% Causes of Death and ICD-10 Codes 70.0% 60.0% 50.0% 40.0% 30.0% 1.4% 1.7% 2.4% 3.3% 1.7% 2.5% 5.0% 3.4% 5.9% 6.6% 6.4% 4.4% 1.8% 1.2% 3.1% 5.2% 5.9% 7.6% 20.7% 24.9% 23.3% 1.9% 2.9% 2.6% 5.7% 6.7% 4.7% 18.5% 1.4% 1.8% 3.9% 1.4% 3.0% 6.3% 4.6% 7.0% 5.5% 0.7% 6.5% 30.3% 20.2% All Other Causes Influenza and Pneumonia (J10-J18) Chronic Liver Disease & Cirrhosis (K70,K73-K74) Diabetes Mellitus (E10-E14) Cerebrovascular Diseases (I60-I69) Chronic Lower Respiratory Diseases (J40-J47) Alzheimer's Disease (G30) Diseases of the Heart (I00-I09,I11,I13,I20-I51) 20.0% Malignant Neoplasms (C00-C97) 10.0% 23.8% 22.2% 23.9% 23.7% 20.4% 25.8% 0.0% WA Grays Harbor Lewis Mason Pacific Thurston Source: Center for Health Statistics, Washington State Department of Health, 12/2013.

LEADING CAUSES OF DEATH FOR THURSTON RESIDENTS, 2010-2012 AGE ADJUSTED RATE, PER 100,000 350 300 250 283.7 264.4 200 150 100 50 72.4 63.3 69.2 55.8 31.7 21.5 16.2 11.6 0 Major cardiovascular diseases Malignant neoplasms Alzheimer's disease All other causes Chronic lower respiratory diseases Accidents Diabetes mellitus 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 LEWIS RESIDENTS, 2010-2012 AGE ADJUSTED RATE, PER 100,000 400 350 300 250 200 150 100 50 0 Major cardiovascular diseases Malignant neoplasms Alzheimer's disease All other causes Chronic lower respiratory diseases Accidents Diabetes mellitus 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, 2012 Motor vehicle crash deaths 20.0 12,000 18.0 16.0 9,609 10,000 14.0 8,327 8,000 12.0 6,713 7,114 10.0 8.0 6.0 4.0 7.3 5,709 6.9 9.6 17.2 11.0 11.0 8.6 8.1 15.5 10.0 18.0 13.5 7.4 7.8 16.9 7.8 5,495 6.9 11.0 6,000 4,000 2,000 2.0 0.0 WA Grays Harbor Lewis Mason Pacific Thurston Crude Rate Age-Adj Motor vehicle Premature Death 0 Source: Washington State Department of Health & County Health Rankings Crude Rate: Rate per 1,000 population. 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, 2001-2010 AGE ADJUSTED RATE, PER 100,000 650 600 550 500 540 564 586 559 450 506 451 400 WA Grays Harbor Lewis Mason Pacific Thurston Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

HEALTH OUTCOMES - MORBIDITY 2013 5 4.5 19% 18% 19% 19% 20% 18% 4 16% 3.5 3 14% 13% 14% 12% 2.5 2 1.5 3.6 3.3 4.6 4.3 4.1 3.4 4.7 4.5 4.4 4.7 3.4 3.5 10% 8% 6% 1 4% 0.5 2% 0 WA Grays Harbor Lewis Mason Pacific Thurston Poor physical health days Poor mental health days Poor or fair health 0% Source: County Health Rankings Poor physical health days and poor mental health days: Average number in past 30 days. Poor or fair health: Percent of adults reporting poor or fair health

CHRONIC DISEASE PREVALENCE AMONG ADULTS Percent 60 50 40 30 29 27 40 51 49 47 45 42 39 39 35 34 34 35 29 27 33 38 Percent 18 16 14 12 10 8 10 8 13 16 8 11 10 9 9 9 8 14 13 8 10 8 20 6 5 5 10 4 2 0 WA Grays Harbor Lewis Mason Pacific Thurston 0 WA Grays Harbor Lewis Mason Pacific Thurston 1. Obesity 2. High Blood Pressure 3. High Cholesterol 1. Asthma 2. Diabetes 3. Heart Disease Source: Washington State Department of Health, Chronic Disease Profiles by County. WA Behavioral Risk Factor Surveillance System, 2009-2011

HOSPITALIZATION GRAYS HARBOR TOP TEN CAUSES, 2010-2012 Diagnosis Group - Male Symptoms Signs and Ill-Defined Diseases of the GenitoUrinary Neoplasms (140-239) Mental Disorders (290-319) Infectious and Parasitic Diseases Diseases of the Musculoskeletal Diseases of the Respiratory Injury and Poisoning (800-999) Diseases of the Digestive System Diseases of the Circulatory 0 500 1,000 1,500 2,000 2,500 3,000 Grays Harbor WA Diagnosis Group - Female Infectious and Parasitic Neoplasms (140-239) Mental Disorders (290-319) Diseases of the GenitoUrinary Diseases of the Respiratory Diseases of the Injury and Poisoning (800-999) Diseases of the Digestive Diseases of the Circulatory Complications of Pregnancy 0 1,000 2,000 3,000 4,000 5,000 Grays Harbor WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

HOSPITALIZATION THURSTON COUNTY TOP TEN CAUSES, 2010-2012 Diagnosis Group - Male Symptoms Signs and Ill-Defined Diseases of the GenitoUrinary Neoplasms (140-239) Mental Disorders (290-319) Infectious and Parasitic Diseases Diseases of the Musculoskeletal Diseases of the Respiratory Injury and Poisoning (800-999) Diseases of the Digestive System Diseases of the Circulatory 0 500 1,000 1,500 2,000 2,500 Thurston WA Diagnosis Group - Female Infectious and Parasitic Diseases Neoplasms (140-239) Mental Disorders (290-319) Diseases of the GenitoUrinary Diseases of the Respiratory Diseases of the Musculoskeletal Injury and Poisoning (800-999) Diseases of the Digestive System Diseases of the Circulatory System Complications of Pregnancy 0 1,000 2,000 3,000 4,000 5,000 Thurston WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

HOSPITALIZATION LEWIS COUNTY TOP TEN CAUSES, 2010-2012 Diagnosis Group - Male Symptoms Signs and Ill-Defined Diseases of the GenitoUrinary Neoplasms (140-239) Mental Disorders (290-319) Infectious and Parasitic Diseases Diseases of the Musculoskeletal Diseases of the Respiratory Injury and Poisoning (800-999) Diseases of the Digestive Diseases of the Circulatory 0 500 1,000 1,500 2,000 2,500 Lewis WA Diagnosis Group - Female Infectious and Parasitic Diseases Neoplasms (140-239) Mental Disorders (290-319) Diseases of the GenitoUrinary Diseases of the Respiratory Diseases of the Musculoskeletal Injury and Poisoning (800-999) Diseases of the Digestive System Diseases of the Circulatory Complications of Pregnancy 0 1,000 2,000 3,000 4,000 5,000 Lewis WA Source: Washington State Department of Health, Community Health Assessment Tool (CHAT). Rate per 100,000

LOW BIRTH WEIGHT, TEEN BIRTH RATE PERCENT 6.4 60 6.2 6.3 6.2 6.2 50 6.0 5.8 5.9 5.8 40 5.6 30 5.4 5.2 5.0 31 48 45 44 37 5.3 25 20 10 4.8 WA Grays Harbor Lewis Mason Pacific Thurston 0 Low birthweight Teen Birth Rate Source: County Health Rankings 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% 50% 40% 30% 34.2% 51.1% 39.7% 45.3% 40.9% 50.9% 31.5% 48.2% 24.0% 36.6% 28.6% 42.6% 20% 10% 0% WA Grays Harbor Lewis Mason Pacific Thurston 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 Mason County. 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.

RISK FACTOR BEHAVIORS

ADULTS: EXCESSIVE DRINKING, 2005-2011 25% 20% 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. 15% 10% 5% 0% WA Grays Harbor Lewis Mason Pacific Thurston Source: County Health Rankings Excessive drinking

TOBACCO USE, ADULT AND PREGNANT WOMEN 30.0% 25.0% 24.0% 26.0% 20.0% 21.1% 19.0% 18.1% 19.9% 21.0% 18.9% 18.0% 20.9% 15.0% 14.0% 15.0% 10.0% 5.0% 0.0% Grays Harbor Lewis Mason Pacific Thurston Statewide Smoking prevalence 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.

SMOKELESS TOBACCO, 2012 35% 30% 25% 12% 20% 14% 11% 15% 13% 10% 8% 7% 7% 8% 8% 5% 0% 5% 5% 6% 6% 8% 4% 3% 2% 3% WA Grays Harbor Lewis Mason Pacific Thurston 8th grade 10th grade 12th grade 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 26 25 20 22 27 19 22 21 21 18 26 24 15 10 5 0 WA Grays Harbor Lewis Mason Pacific Thurston 2007 2009 Source: Washington State Public Health Indicators

ADULT PHYSICAL ACTIVITY PERCENT OF ADULTS AGE 18+ WHO PHYSICAL ACTIVITY 80 70 60 62 62 66 66 61 69 67 55 53 62 63 67 50 40 30 20 10 0 WA Grays Harbor Lewis Mason Pacific Thurston 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 45 40 40 35 33 33 35 33 30 25 25 26 28 29 29 27 27 20 15 10 5 0 WA Grays Harbor Lewis Mason Pacific Thurston 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 30 25 26 20 20 20 17 17 19 16 15 12 13 12 13 13 10 5 0 WA Grays Harbor Lewis Mason Pacific Thurston 2007-2008 2009-2010 Source: Washington State Public Health Indicators

ADULTS RECEIVING RECOMMENDED CANCER SCREENINGS PERCENT OF ADULTS WHO HAD A TEST 90 80 78 76 76 74 75 74 79 77 78 70 67 67 67 67 63 66 68 60 54 56 50 40 30 20 10 0 WA Grays Harbor Lewis Mason Pacific Thurston Breast, 2010 Cervical, 2010 Colorectal 2008 Source: Washington State Public Health Indicators

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 70 60 73 72 60 60 63 64 56 62 63 70 74 72 50 40 30 20 10 0 WA Grays Harbor Lewis Mason Pacific Thurston 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, 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 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 Co.), while others are falling further behind (Mason Co.). Generally, rural counties underperform in comparison to Thurston Co. and the State as a whole. Overall, Mason and Grays Harbor counties are most challenged.

CHILD HEALTH

INFANT AND CHILD MORTALITY 1200.0 1000.0 800.0 Infant mortality: Crude mortality rate for deaths under age 1 Child mortality: Crude mortality rate for deaths under age 18 600.0 400.0 200.0 0.0 WA Grays Harbor Lewis Mason Pacific Thurston Infant mortality 489.5 483.8 489.5 1085.9 511.2 Child mortality 45.2 42.3 36.8 52.9 97.5 46.0 Source: County Health Rankings

EXPOSURE TO TOBACCO SMOKE, 12TH GRADERS, 2012 60.0% 54.2% 50.0% 40.0% 37.3% 43.8% 39.2% 40.6% 48.5% 37.9% 42.5% 46.7% 37.1% 39.3% 30.0% 26.4% 25.5% 31.6% 29.5% 26.9% 25.7% 20.0% 19.7% 10.0% 0.0% WA Grays Harbor Lewis Mason Pacific Thurston 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 50 45 40 35 30 24 21 Percent 25 20 16 16 15 16 15 10 5 0 10 13 5 6 6 8 1 2 2 1 10 WA Grays Harbor Lewis Mason Pacific Thurston 12 9 4 12 6 6th grade 8th grade 10th grade 12th 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 29 31 30 36 35 32 36 27 24 25 20 15 10 5 0 WA Grays Harbor Lewis Mason Pacific Thurston 2008 2010 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 Grays Harbor Lewis Mason Pacific Thurston 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% 30% 20% 10% 0% WA Grays Harbor Lewis Mason Pacific Thurston 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, but the other counties are on par with the State s overall performance in this area. Youth smoking rates across the region are in line with statewide rates, except for Grays Harbor and Mason County, where they are substantially elevated. Youth obesity rates are dropping in Pacific and Mason counties, but rising in Lewis and Grays Harbor counties. Lewis County in particular is quickly deteriorating. Thurston Co. is mirroring the statewide average.

INFECTIOUS DISEASES

HEALTH OUTCOMES 2012 HIV Rate Sexually transmitted infections 200 180 160 140 120 100 80 188 80 161 100 84 350 300 250 200 150 317 213 213 227 139 257 60 40 20 48 100 50 0 WA Grays Harbor Lewis Mason Pacific Thurston 0 WA Grays Harbor Lewis Mason Pacific Thurston 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 DECEMBER 31, 2012 PER 100,000 180.0 160.0 140.0 120.0 100.0 93.7 100.6 80.0 60.0 40.0 20.0 0.0 52.6 54.6 46.2 72.5 30.0 67.1 57.4 27.3 14.3 28.1 WA Grays Harbor Lewis Mason Pacific Thurston HIV (not AIDS) AIDS Source: Washington State Department of Health

SEXUALLY TRANSMITTED DISEASES, ALL CAUSES CRUDE RATE 2000-2002 AND 2010 2012 700 600 500 400 300 200 100 0 WA Grays Harbor Lewis Mason Pacific Thurston STD, All causes 2000-2002 2010-2012 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

SEXUALLY TRANSMITTED DISEASES, CHLAMYDIA CRUDE RATE 2000-2002 AND 2010 2012 600 500 514 499 400 407 370 321 300 200 242 147 124 217 132 184 207 100 0 WA Grays Harbor Lewis Mason Pacific Thurston 2000-2002 2010-2012 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

SEXUALLY TRANSMITTED DISEASES, HERPES CRUDE RATE 2000-2002 AND 2010 2012 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 WA Grays Harbor Lewis Mason Pacific Thurston 2000-2002 31.48 16.09 17.30 25.27 12.74 25.49 2010-2012 47.31 32.95 47.54 41.05 9.56 53.72 2000-2002 2010-2012 Source: Washington State Department of Health, Community Health Assessment Tool (CHAT)

TUBERCULOSIS, 2003-2012 AGE ADJUSTED RATE, PER 100,000 8 7 6 5 4 3 2 1 0 4.11 3.77 3.07 2.33 2.4 1.13 WA Grays Harbor Lewis Mason Pacific Thurston 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; however, Lewis County stands out with a more than 50% higher HIV infection rate than the country with the next highest infection rate (Pacific Co.). STD infection rates are lower than the State average across all counties with Pacific County showing the best performance (less than half the statewide infection rate), possibly due to a population that skews older. However, STD infection rates in our region have increased substantially between 2000 and 2012. TB infection rates are lower than the State average across all counties with Mason County showing the highest infection rate.

SOCIAL ENVIRONMENT

PHYSICAL ENVIRONMENT Thurston Pacific Mason Lewis Grays Harbor WA 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Fast food restaurants Limited access to healthy foods Access to recreational facilities Source: County Health Rankings Percent of all restaurants that are fast-food establishments Percent of population who are low-income and do not live close to a grocery store Rate of recreational facilities per 100,000 population

ALCOHOL & DRUG-RELATED ARRESTS 5 YEARS RATE 2007-2011 (AGE 18+) 12.00 10.00 9.75 8.72 8.00 7.68 6.00 4.00 4.98 5.90 4.75 4.88 4.47 5.45 3.91 6.63 3.07 2.00 0.00 WA Grays Harbor Lewis Mason Pacific Thurston Alcohol-Related Drug-related arrests Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention

DRUG INDUCED DEATHS 2003-2005 30 25 25 20 18 20 15 14 13 10 5 0 WA Grays Harbor Lewis Mason Pacific Thurston No data Source: Washington State Department of Health, Drug Abuse and Dependence

OPIOID RELATED DEATHS BY COUNTY OF RESIDENCE 2010-2012 - RATE PER 100,000 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 WA Grays Harbor Lewis Mason Pacific Thurston Heroin 2.8 2.6 3.2 2.1 2.9 1.0 Prescription 5.7 5.5 8.8 9.6 5.8 5.9 Total deaths 2010-2012 1796 18 28 22 6 54 Source: Washington State Department of Health

METH LABS 2000-2012 350 300 250 200 150 100 50 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Grays Harbor Lewis Mason Pacific Thurston Source: Washington State Department of Ecology, Clandestine Drug Lab and Dump Site Cleanup Activity

PROPERTY CRIME ARREST BY AGE GROUP 5 YEAR RATE 2007-2011. 18.00 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 WA Grays Harbor Lewis Mason Pacific Thurston 10-14 10-17 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 GRAYS HARBOR LEWIS MASON PACIFIC THURSTON WA 30 20 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% 23% 20% 17% 18% 17% 20% 17% 15% 10% 5% 0% WA Grays Harbor Lewis Mason Pacific Thurston 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 with a wide margin. Overall, crime rates across the region are showing the same falling trend as the State as a whole. However, Grays Harbor County s crime rate is notably elevated over the State average, whereas all other county s crime rates are below the State average. Drugs are a particular problem in Grays Harbor (recording almost twice the State average drug arrest rate) and Lewis County. Thurston County stands out with an alcohol related arrest rate well above the other counties with the exception of Grays Harbor County. However, alcohol related arrest rates are well below the State average for all counties. Grays Harbor and Pacific County record elevated rates of inadequate social/ emotional support for adults, whereas the other counties performance is in line with the statewide average.

COMMUNITY HEALTH NEEDS ASSESSMENT GRAYS HARBOR, LEWIS, MASON, PACIFIC AND THURSTON COUNTY CHOICE Regional Health Network March 2014