Health Services Desert: West Hill's Public Health Crisis

Words by Anne Althauser (Photos by Matt Mills McKnight)

It's 7:15am on a Monday morning and I need to get downtown by 8am for a meeting at Public Health – Seattle & King County (PHSKC). I'm weighing my transportation options as I check the weather: 35 minutes walking, 15 minutes by bike, or 25 minutes by bus. Overcast with a low chance of rain, I opt for a nice brisk walk on this Seattle fall morning. As I leave my apartment on Capitol Hill, within 2 blocks of my front door I pass the bus stop, a QFC grocery store, a Walgreen's pharmacy, yoga and dance studies, and a handful of cafes and coffee shops. Just 5 blocks away I walk past Group Health Capitol Hill Campus, where if I needed, I could visit an emergency room, family doctor, pharmacy, or any one of the 30 or so specialists on campus. I continue walking.

A few more minutes into my walk, I pass a natural health center, an acupuncturist and a co-op grocery store full of more fresh, local produce. I turn west and head down Madison, and am quickly greeted by what has previously been known as "Pill Hill" — home of Harborview Medical Center, Swedish Medical Center and Virginia Mason Medical Center. I wonder to myself why there are so many health care facilities within a one-mile radius, and how much farther most folks have to travel to use these services. I woke up today as a King County taxpayer and am benefiting from where this tax money is going. I have transportation, grocery and health care services all at my fingertips.

Ms. Bridgette Hempstead also woke up today as a King County taxpayer, about 10 miles south of where I did. Ms. Hempstead has lived in Skyway for 32 years, one of eight neighborhoods in an area collectively known as West Hill, where she remembers when there was a Country Doctor Community Clinic, a grocery store and a handful of small thriving businesses. She has to remember them simply because they are no longer there today. Instead, if Ms. Hempstead, or any other resident of the West Hill area, needed to access health care services, they would have to travel to Pill Hill or Renton.

In all of the West Hill area, there is not a single health clinic or doctor's office – save for the 1 chiropractor, 2 dentists, and 1 "naturopath" (locals report this as a medical marijuana store, not a health clinic). Looking a little closer, I found there are 7, soon to be 8, marijuana shops in the area (which is interesting for a couple reasons: first, because that's a lot of tax money going to the liquor control board that is not coming back to the community in the form of services, and second, there are only 2 marijuana shops in Renton, which has 6 times as many residents as West Hill). One resident points out that given the abundance of advertising for marijuana around the area, it's as if King County is advocating for this population to self-medicate. Another fun fact: residents in West Hill pay double the property taxes that residents in Bellevue pay.

While West Hill was once home to a Country Doctor Community Clinic and two pharmacies, all have since moved out of the area. To add to this, West Hill residents don't have easy access to fresh grocery items or quality restaurants either. One resident told me they just recently got a Grocery Outlet in Skyway – which she admits does not have the freshest nor highest quality product – and other than that, residents rely on the Ezell's, local deli, or gas station for prepared food options. If you're looking for healthy choices to feed your family, West Hill is not the place to look.

While just 10 miles southeast of downtown Seattle, and bordered by Renton and Tukwila, West Hill is considered unincorporated King County (though its residents have Seattle addresses). This primarily residential area – Bryn Mawr, Campbell Hill, Earlington, Hilltop, Lakeridge, Panorama View, Skycrest and Skyway – is home to 16,000 residents according to the most recent census. In an area this populated, we would expect to see basic health services offered. Hell, we'd expect to see basic amenities offered – and they're not. As Ms. Hempstead asked, "Does unincorporated mean unappreciated?"

While Ms. Hempstead has watched her community of Skyway receive negative press for years, she is quick to talk about how proud of a community it is – how they come together to respond to problems. For example, the day I met Ms. Hempstead, she was in the midst of planning a community health fair so that folks in the area will be able to – for one day only – get their flu shots and blood pressure checked.

RAYS (Renton Area Youth and Family Services)-operated Cynthia A. Green Family Center recently put out a survey to West Hill community members asking where folks go for health care services and what kinds of services they wish they could see in their own community. Surprising no one at the Center, people reported they go all over the place for services: from Carolyn Downs, Indian Health Board, Country Doctor and Group Health to Valley Medical Center. Every single survey respondent said they would see a doctor if one were available in their area and requested a variety of services from cooking classes, to help with depression, diabetes management, stroke prevention, cancer screening and stress.

We know health disparities exist in Seattle and King County. We can look at data, statistics, and color-coded maps that show us the differences in life expectancy between area codes (upwards of 10 years between South Seattle communities and neighborhoods on the East side). Before even writing this article I downloaded the data and looked at the health outcome comparisons between area codes. I know that funds were used to produce this data in order to inform future public health resource allocation, and yet nothing has come of it except for more plans and proposals for next steps.

As a public health professional I love data, but I love it for the action and decision-making it is can spur. But for a decade we have seen these same color-coded maps of King County showing dark red areas in the South End and bright blue areas in the North End, yet nothing seems to be changing. As a public health professional I also understand that health is determined by a variety of social factors, the biggest among them being race, environment and education.

This is my first time digging into the public health crisis in West Hill, and I am angry. I cannot imagine how Ms. Hempstead feels, having lived this reality for over 30 years now. Not only do Ms. Hempstead and her fellow community members feel anxiety about getting the services they need when they need them, but this long-term stress leads to increased cortisol levels in the body which are attributed to poorer health in the form of blood sugar imbalance and diabetes, weight gain and obesity, immune system suppression, cardiovascular disease and gastrointestinal problems – only adding to problems they may initially have.

This story of poor communities of color in food deserts that lack school funding and have poorer health outcomes is no new tale. As a society we're numb to these stories and think to ourselves, "I pulled myself up by my bootstraps, so can others," without taking a minute to think about the mordant cycle some communities are born into and the caustic conditions they're expected to survive in. As a society we believe in fairness and that we get what we deserve but why would a community ever deserve to live in such disrespect? As another farmer's market pops up somewhere near Fremont a mother from Skyway sits on the bus for an hour to get her diabetes management medication from a pharmacy, and we call that fair?

There are handfuls of community members in Skyway providing anecdotal stories for why they need more basic health care services where they live, yet King County can turn it's head to the evidence base and still not take action. When I asked about the most common health conditions in the areas, after giving me a list of common ailments, the director of the RAYS Cynthia A. Green Family Center, Morgan Wells commented, "You can just tell they don't feel good. Physically, emotionally, or spiritually." She added that she commonly hears people say, "I can't relax, I don't know how," when she recommends reducing stress levels. And how could they relax? Working and raising families with no local health or social service support, I wouldn't be able to relax either!

Wells and other West Hill community members recently met with the director of PHSKC, Patty Hayes, wherein RAYS and others asked about the possibility of bringing health care services to West Hill, something as little as a mobile van that could drive out there. Hayes was said to have responded along the lines of, "there is no ask that would be funded." Hayes then told Wells and the others that it'd be best to hold out for the Best Starts for Kids levy for any asks, but following up with Sheila Capistani, the woman in charge of implementing Best Starts for Kids, they were told the most likely thing to be funded in Skyway would be Play & Learn, an existing program at the Family Center two days a week. While the Best Starts for Kids levy explicitly states the county will put communities in the driver's seat of decision-making, it certainly does not seem they are prepared to follow through with that promise. Since this levy was just passed by voters, now is the time to continue putting pressure on King County to walk the walk.

As I sit with Ms. Hempstead and empathize with her countless trials and tribulations, I wonder to myself, what if this were the case for a different Seattle community? Say, a community of more white folks or higher median incomes? Would Madrona put up with this treatment from PHSKC? What about Ballard? Somehow, I highly doubt it.

The thought continued to anger me, so I turned to County Councilmember Larry Gossett and County Executive Dow Constantine to answer these questions for me. I contacted them and asked why West Hill has no health resources, what it would take to get resources in the area, their thoughts on the situation, and how the community can advocate for services. Within a speedy three weeks after contacting them for this information, I received a response back from the communications department at Public Health Seattle & King County and was informed of a few things happening in West Hill.

First, in 2014 King County launched a[nother] food initiative to increase access to healthy, affordable food by increasing the number of institutions purchasing healthy local foods, increasing the number of farmer's markets accepting SNAP, stocking food banks with more fruits and vegetables, and convening folks talking about poverty, transportation and "social justice" – aka King County's favorite buzzword since 2013.

Attending the 2016 Comprehensive Plan community comment meeting in early November in West Hill, the disconnect between county and community was made clear within minutes when Ivan Miller, Manager of the Comprehensive Plan, asked the fire house conference room full of people who was from Skyway, and who was from West Hill (the equivalent of asking "who's from Washington and who's from the United States?").

The response?: "They're the same!" (With mumblings of "how do you not know this?") Cheryl Markham, Strategic Policy Advisor for the Department of Community and Human Services Director's Office, stood up to talk about the health aspects of the comprehensive plan. She mentioned the social determinants of health and the county's focus on "equity" (again, buzzz), but then only spoke of expanding housing options as their way of addressing social determinants. Next, Julie West, Project Program Manager in Environmental Health General Administration talked about the county's plan to increase physical activity of West Hill folks by making it easier to walk, bike and enjoy parks. She also mentioned the Local Food Initiative, but again, did not mention any true upstream focus on social determinants of health (such as racism or education), or any plan to increase primary care availability in the area.

Most of what the county presented at the meeting drove me and more than a few residents to The Beachcomber, a local watering hole, afterwards in order to dull some pain. The email response I received days later from councilmember Larry Gossett about the lack of medical resources in the area was enough to drive me back.

"I'm aware that residents and community organizations in the Skyway/West Hill(sic) community have a strong desire for a community clinic, and it's reflected in the Skyway/West Hill Action Plan (SWAP) currently being promoted. While there are community clinics in Southeast Seattle and Renton available to West Hill residents, I know a clinic located in Skyway/West Hill would not only provide a valuable service for the residents, but also serve as a boost for the community as a whole. However, the capital costs associated with building a new facility or refurbishing an existing structure are one of the reasons we only have the number of clinics we do."

Gossett would go on to point out that the county has a projected budget shortfall of $40 million — even with the passing of the Best Start for Kids initiative. But I should "rest assured" that the county is doing all it can to spread its limited resources and "seek additional opportunities to provide all types of services in an equitable manner."

I couldn't help but wonder just how many clinics $210 million — the cost of the county's replacement youth jail – could construct (not at all suggesting that the collective health of roughly 14,000 people should be a higher priority than keeping 60 kids locked up on a nightly basis).

While we know public health is much more than simply health care, access to health care is a large part of public health. For many of us in King County, accessing health care is a non issue – there are clinics and hospitals within blocks of where we live, or at most, a quick bus or bike ride away. Unfortunately, not all King County taxpayers have equitable access to the care they need, and are expected instead to travel outside of their area for medical attention. One of the greatest cases of this local public health crisis is in West Hill, where it's not a question of demand for services, but more so political will and courage to make a change.

As I walk home from the county offices downtown back to my apartment tonight, I think of Ms. Hempstead. I have the responsibility as a public health professional to stand up for what I believe in and use whatever power and access to resources that I have been given based on my race, education, income, etcetera, to help undo this system of oppression that has kept others in the red zones of health disparities. We will not stand for this any longer; we will be calling the county in on this.

Endnote:

The public comment period for the 2016 Comprehensive Plan is open through January 6th, 2016. West Hill community member or not, we have a responsibility to keep the county accountable to their word and push for change we want to see!

Anne Althauser is a graduate of the University of Washington's School of Public Health and writes a regular public health column for the Emerald.