Weekend Reads | A Closer Look at the King County Community Health Needs Assessment

by Kevin Schofield

This weekend's read is the latest edition of the "King County Community Health Needs Assessment," published by Public Health — Seattle & King County in cooperation with several local health care organizations. It is a compendium of statistics on the health issues facing the county's population, sliced and diced by various demographics.

The report begins in its "Executive Summary" by noting some of the things that are getting better or worse — and some of the "better" things might surprise you. For instance, both adult smoking and youth vaping have decreased dramatically in recent years. More good news: The rates of substance abuse and marijuana use among King County youth have also declined rapidly.

The list of things that are getting worse may not be so surprising, however. Among the findings: Life expectancy has dropped a bit, due at least in part to the COVID-19 pandemic and to drug-induced deaths, which have also increased in recent years. Domestic violence emergency department visits also increased by nearly 50% between 2020 and 2022. And the number of students who meet the public health recommendations for physical activity has dropped steadily since 2014. Also, the rate of incomplete vaccination coverage for kids aged 19—35 months is a ridiculously high 39.5% countywide, and almost 50% in the south end of the county.

The summary of the county's demographics alone is a fascinating read. We learn that between 2020 and 2022, King County went from 55% white to 53% — if that trend continues, then right now, in 2024, the county is on the cusp of no longer being majority white. And while the percentage of King County residents who identify as Black/African American has held steady at 7%, the under-18 population is 13% Black/African American.

There is an incredible wealth of data in this 152-page report, though like many government-produced documents, it is heavy on data presentation and light on analysis. In particular, it's poor at connecting the dots between disparate data points: The data is there, we just can't see how it fits together. For example, the report tells us that the Black/African American community is overrepresented among those with incomes below the federal poverty level, among the homeless population, and among those who don't live in a supportive neighborhood. They have a lower life expectancy and higher rates of hypertension, asthma, and diabetes. They have a higher rate of cigarette smoking but lower rates for vaping and illicit drug use — and despite that, they have a higher rate of drug-induced deaths. The Black community has higher rates of infant mortality and low birthweight. The food and nutrition statistics for the community are a confusing mix: high rates of food insecurity and participation in schools' free and reduced-cost lunch program, and high rates of adult and youth obesity — yet also the highest rate of vegetable consumption.

Another interesting demographic group that deserves more focus in the report is the segment of the population that identifies as "multiple races": about 7% of the county's population in 2022, and 8% of the population under age 18. This demographic has grown substantially over the past 20 years and is now equal in size to the county's Black/African American population. And the statistics for it are a complex mix that collectively looks nothing like any other segment of the population. Only 3.6% have limited English proficiency, compared with 10.8% countywide. They have lower-than-average rates of asthma, hypertension, and diabetes. On the other hand, they have an above-average amount of unmet medical needs due to cost, and below-average access to needed mental and behavioral services for children. The multi-race demographic has very high levels of depression among teens, but very low levels of suicidal ideation, domestic violence, and child abuse. They are close to proportionately represented among the homeless population, but they report almost no cold-related or heat-related illnesses (both of which are very prevalent among the county's homeless). It's a puzzle: This is an important, substantial, and growing part of our community that we simply don't understand. That makes it hard to meet their needs.

It's great that our county's public health department invests the resources to create such a comprehensive view of health-related statistics, broken out by demographics. The challenge, of course, is how they — and we — make use of the data to address needs and disparities. Not just for the Black and multi-race communities, but also for other groups that are usually overlooked, including the LGBTQ+ community and the American Indian/Alaska Native population, which tends to be so under-sampled in surveys like this one that there is little reliable data generated. The "King County Community Health Needs Assessment" is good, up to a certain point, but there is a lot more work needed to answer all of our urgent questions.

King County Community Health Needs Assessment 2024/2025

Featured image via Kwame Amo/Shutterstock.com.