Embed Size (px)
Citation preview
King
Cou
nty
Com
mun
ity
Hea
lth N
eed
s A
sses
smen
t
2018
/201
9
3
A
ckn
ow
led
ge
me
nts
5
In
tro
du
ctio
n
1
3
Ex
ecu
tiv
e S
um
ma
ry
2
5
Co
mm
un
ity
Ide
nti
fie
d P
rio
riti
es
3
4
De
scri
pti
on
of
Co
mm
un
ity
5
3
Lif
e E
xp
ect
an
cy &
Le
ad
ing
Ca
use
s o
f D
ea
th
5
8
Ch
ron
ic Il
lne
sse
s
6
5
Acc
ess
to
He
alt
hca
re &
Use
of
Pre
ve
nti
ve
Se
rvic
es
7
2
Me
nta
l He
alt
h
7
5
Alc
oh
ol,
To
ba
cco
, Ma
riju
an
a, &
Oth
er
Dru
gs
8
0
Pre
gn
an
cy &
Bir
th
8
4
Ph
ysi
cal A
ctiv
ity,
Nu
trit
ion
, & W
eig
ht
9
0
Vio
len
ce &
Inju
ry P
rev
en
tio
n
9
4
En
d N
ote
s
9
8
Ap
pe
nd
ix A
: Me
tho
ds
-
Ide
nti
fica
tio
n o
f H
ea
lth
Ne
ed
s a
nd
Se
lect
ion
of
Ind
ica
tors
10
2
Ap
pe
nd
ix B
: Re
po
rt D
efi
nit
ion
s &
Str
uct
ure
10
7
Ap
pe
nd
ix C
: Ab
ou
t K
ing
Co
un
ty H
osp
ita
ls f
or
a H
ea
lth
ier
Co
mm
un
ity
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
2Con
tent
s
Pu
bli
c H
ea
lth
-Se
att
le &
Kin
g C
ou
nty
Glo
ria
Alb
etta
, Ka
ylin
Bo
lt, A
nn
e
Bu
her
, Lo
uis
e C
art
er, N
ad
ine
Ch
an
,
Susa
n H
ern
an
dez
, Jo
ie H
su, E
li K
ern
,
Susa
n K
inn
e, A
my
Lau
ren
t, J
ay
Ma
rsh
all,
Ala
sta
ir M
ath
eso
n, M
arg
uer
ite
Ro
,
Sara
Ja
ye S
an
ford
, Mik
e Sm
yser
, Lin
So
ng
,
Kim
Tip
pen
s, M
ari
ko T
oyo
ji, a
nd
Eva
Wo
ng
Ev
erg
ree
nH
ea
lth
Tris
ha
Wes
t a
nd
Su
san
Dys
on
CH
I F
ran
cisc
an
He
alt
h
Ka
thy
Sch
mid
t
St. E
lizab
eth
Ho
spit
alSt
. Fra
nci
s H
osp
ital
Hig
hlin
e M
ed
ical
Ce
nte
r R
eg
ion
al H
osp
ital
Ka
ise
r P
erm
an
en
te
Kim
Wic
klu
nd
an
d V
icto
ria
Ga
rcia
Mu
ltiC
are
He
alt
h S
yst
em
Lois
Ber
nst
ein
an
d K
rist
in G
ilma
n
Au
bu
rn M
ed
ical
Ce
nte
r C
ovi
ng
ton
Me
dic
al C
en
ter
Na
vo
s
Meg
an
Kel
ly
Ov
erl
ak
e M
ed
ica
l C
en
ter
Cyn
thia
Eic
hn
er
Se
att
le C
an
cer
Ca
re A
llia
nce
Ma
del
ine
Gra
nt
Se
att
le C
hil
dre
n’s
Eliz
ab
eth
“Ti
zzy”
Ben
net
t a
nd
La
ra S
im
Sw
ed
ish
Me
dic
al
Ce
nte
r
Sher
ry W
illia
ms
Bal
lard
Cam
pu
sC
he
rry
Hill
Cam
pu
s Fi
rst
Hill
Cam
pu
s Is
saq
uah
Cam
pu
s
UW
Me
dic
ine
Elis
e C
ha
yet
an
d T
racy
Go
od
ing
Har
bo
rvie
w M
ed
ical
Ce
nte
rN
ort
hw
est
Ho
spit
al &
Me
dic
al C
en
ter
UW
Me
dic
al C
en
ter
Val
ley
Me
dic
al C
en
ter
Vir
gin
ia M
aso
n
Ing
rid
Ou
gla
nd
Sel
lie
Wa
shin
gto
n S
tate
Ho
spit
al
Ass
oci
ati
on
Ch
elen
e W
hit
eake
r
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
3Ack
now
ledg
emen
ts
Ack
now
ledg
emen
tsC
ontin
ued
We
als
o w
ish
to
th
an
k
tho
se w
ho
pro
vid
ed
inp
ut
to t
his
re
po
rt:
Kin
g C
ou
nty
De
pa
rtm
en
t o
f C
om
mu
nit
y &
Hu
ma
n S
erv
ice
s
Bra
d F
ineg
oo
d
No
a K
ay
Ad
am
Sch
mid
Kin
g C
ou
nty
In
form
ati
on
Te
chn
olo
gy
– D
esi
gn
an
d
Civ
ic E
ng
ag
em
en
t
Wen
dy
Ga
ble
Co
llin
s
Lau
rel P
rest
on
Kin
g C
ou
nty
Ex
ecu
tiv
e O
ffice
–
Pe
rfo
rma
nce
, Str
ate
gy
an
d B
ud
ge
t
Ch
an
dle
r Fel
t
Pu
bli
c H
ea
lth
–
Se
att
le &
Kin
g C
ou
nty
YiC
ha
o C
ao
Nic
ola
s D
un
da
s
Sara
Glic
k
Na
zma
h H
asa
an
Julia
Ho
od
Blis
hd
a L
ace
t
Cla
ire
M. M
ag
ba
nu
a
Ing
rid
McD
on
ald
Na
ncy
McG
rod
er
Da
rren
Ro
ber
tso
n
Kir
sten
Wys
en
Pho
to c
red
its:
Co
ver,
Eli B
row
nel
l, N
ed A
hre
ns,
Ch
ildca
re
Res
ou
rces
Pg. 2
, Au
dra
Mu
lker
n
Pg. 3
, Mu
ltiC
are
Hea
lth
Sys
tem
Pg. 5
, FEE
ST
Pg. 1
3, A
ust
on
Ja
mes
Pg. 2
5, N
ed A
hre
ns
Pg. 3
4, L
ivin
g W
ell K
ent
Pg. 5
3, W
end
y D
ore
Pg. 5
8, T
ilth
Alli
an
ce
Pg. 6
5, A
ust
on
Ja
mes
Pg. 7
5, N
ed A
hre
ns
Pg. 9
0, S
eatt
le C
hild
ren
’s ©
201
7
Pg. 1
07, S
eatt
le C
hild
ren
’s ©
201
7
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
4
Sectio
n
Head
line
Gre
en
Fo
r the
firs
t tim
e, m
ore
th
an h
alf o
f Kin
g C
ount
y ch
ildre
n ar
e ch
ildre
n of
co
lor.
Th
is C
om
mu
nit
y H
ea
lth
Ne
ed
s A
sse
ssm
en
t
(CH
NA
) is
a K
ing
Co
un
ty H
osp
ita
ls f
or
a H
ea
lth
ier
Co
mm
un
ity
(H
HC
) co
lla
bo
rati
ve
pro
du
ct t
ha
t
fulfi
lls
Se
ctio
n 9
00
7 o
f th
e A
ffo
rda
ble
Ca
re A
ct.
In a
cco
rdan
ce w
ith
th
ose
re
qu
ire
me
nts
, th
e r
ep
ort
pre
sen
ts a
de
taile
d d
esc
rip
tio
n o
f th
e c
om
mu
nit
y,
anal
yse
s o
f d
ata
on
lif
e e
xp
ect
an
cy a
nd
le
ad
ing
cau
ses
of
de
ath
, an
d a
re
vie
w o
f le
vels
of
chro
nic
illn
ess
th
rou
gh
ou
t K
ing
Co
un
ty. I
n a
dd
itio
n, t
his
rep
ort
pro
vid
es
qu
anti
tati
ve in
form
atio
n a
bo
ut
add
itio
nal
co
mm
un
ity
he
alth
ne
ed
s th
at w
ere
ide
nti
fie
d b
y th
e H
HC
.
CO
MM
UN
ITY
IN
PU
T
Loca
l co
mm
un
ity
ne
ed
s as
sess
me
nts
, str
ate
gic
pla
ns,
and
re
po
rts
fro
m t
he
pas
t th
ree
ye
ars
we
re r
evi
ew
ed
to id
en
tify
co
mm
un
ity
he
alth
ne
ed
s an
d t
o p
rovi
de
con
text
to
th
e q
uan
tita
tive
dat
a p
rese
nte
d. K
ey
the
me
s th
at e
me
rge
d f
rom
th
ese
ass
ess
me
nts
of
com
mu
nit
y h
eal
th a
re p
rese
nte
d in
th
e C
om
mu
nit
y
Ide
nti
fie
d P
rio
riti
es
sect
ion
of
the
re
po
rt.
In a
dd
itio
n, t
his
ye
ar’s
sp
otl
igh
t o
n t
he
lesb
ian
, gay
,
bis
exu
al, t
ran
sge
nd
er,
and
qu
ee
r (L
GB
TQ)
com
mu
nit
ies
of
Kin
g C
ou
nty
will
exa
min
e t
he
he
alth
dis
par
itie
s
imp
acti
ng
th
ese
po
pu
lati
on
s. T
he
sp
otl
igh
t w
hic
h
will
be
re
leas
ed
as
an a
dd
en
du
m t
o t
his
re
po
rt w
ill
incl
ud
e a
nal
yse
s o
f B
eh
avio
ral R
isk
Fact
or
Surv
eill
ance
Syst
em
(B
RFS
S) s
urv
ey
dat
a fo
r th
e L
GB
ad
ult
po
pu
lati
on
; He
alth
y Yo
uth
Su
rve
y (H
YS)
dat
a fo
r th
e
LGB
sch
oo
l-ag
e p
op
ula
tio
n; a
nd
qu
alit
ativ
e fi
nd
ing
s
fro
m a
se
rie
s o
f lis
ten
ing
se
ssio
ns
wit
h L
GB
TQ y
ou
th
and
yo
un
g a
du
lts
thro
ug
ho
ut
the
co
un
ty, a
nd
ke
y
info
rman
t in
terv
iew
s w
ith
th
ou
gh
t le
ade
rs in
LG
BTQ
com
mu
nit
ies.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
13Ex
ecut
ive
Su
mm
ary
Exec
utiv
e
Sum
mar
yC
ontin
ued
KIN
G C
OU
NT
Y’S
CH
AN
GIN
G P
OP
UL
AT
ION
In t
he
pa
st t
hre
e y
ea
rs, K
ing
Co
un
ty h
as
ex
pe
rie
nce
d a
su
bst
an
tia
l g
row
th s
pu
rt –
in
po
pu
lati
on
an
d
div
ers
ity
. Fo
r th
e fi
rst
tim
e, m
ore
th
an h
alf
of
Kin
g C
ou
nty
ch
ildre
n a
re c
hild
ren
of
colo
r. Th
e p
op
ula
tio
n b
oo
m h
as
occ
urr
ed
in t
and
em
wit
h r
apid
ris
es
in t
he
co
st o
f h
ou
sin
g –
an
d in
ho
me
less
ne
ss.
As
ho
usi
ng
co
sts
sky
rock
ete
d, p
ov
ert
y h
as
be
com
e m
ore
co
nce
ntr
ate
d i
n S
ou
th R
eg
ion
wh
ere
, at
leas
t
un
til r
ece
ntl
y, h
ou
sin
g h
as b
ee
n m
ore
aff
ord
able
, esp
eci
ally
for
fam
ilie
s w
ith
ch
ildre
n. L
ife e
xpe
ctan
cy a
nd
a h
ost
of
oth
er
he
alth
ou
tco
me
s ar
e li
nke
d t
o in
com
e –
a li
nk
that
may
he
lp e
xpla
in w
hy
Sou
th R
eg
ion
re
sid
en
ts o
fte
n
exp
eri
en
ce p
oo
rer
he
alth
th
an r
esi
de
nts
of
oth
er
reg
ion
s. In
ad
dit
ion
, alt
ho
ug
h b
abie
s b
orn
in K
ing
Co
un
ty in
20
15
are
exp
ect
ed
to
live
lon
ge
r th
an t
ho
se b
orn
in 1
99
0, n
atio
nal
dat
a su
gg
est
th
at im
pro
vem
en
ts in
life
exp
ect
ancy
for
tho
se in
th
e t
op
inco
me
qu
arti
le a
re 2
.5 t
ime
s g
reat
er
than
for
tho
se in
th
e b
ott
om
inco
me
qu
arti
le,2
a d
iffe
ren
ce
that
, ove
r ti
me
, te
nd
s to
mag
nify
exi
stin
g d
isp
arit
ies.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
14
Sectio
n
Head
line
Gre
en
Exec
utiv
e
Sum
mar
yC
ontin
ued
Th
e p
op
ula
tio
n i
s a
gin
g: b
y 2
04
0 a
lmo
st
1 i
n 4
Kin
g C
ou
nty
re
sid
en
ts i
s p
roje
cte
d t
o b
e
ag
e 6
0 o
r o
lde
r –
up
fro
m 1
in
7 i
n 2
00
0.3
Th
e
fast
est
-gro
win
g s
eg
me
nt
will
be
th
ose
85
an
d o
lde
r.
Dis
abili
ty r
ate
s ar
e h
igh
est
for
old
er
adu
lts
(40
% in
Kin
g C
ou
nty
), an
d p
er-
pe
rso
n h
eal
thca
re e
xpe
nd
itu
res
for
adu
lts
age
65
an
d o
lde
r h
ave
his
tori
cally
be
en
5 t
ime
s g
reat
er
than
exp
en
dit
ure
s fo
r ch
ildre
n a
nd
3 t
ime
s g
reat
er
than
th
ose
for
wo
rkin
g-a
ge
ad
ult
s.4
He
alth
care
sys
tem
s n
ee
d t
o p
rep
are
for
this
imp
ort
ant
de
mo
gra
ph
ic s
hif
t w
ith
ad
eq
uat
e w
ork
forc
e c
apac
ity
and
acc
ess
ible
se
rvic
es.
AC
RO
SS
KIN
G C
OU
NT
Y O
VE
RA
LL
,
WH
AT
’S G
ET
TIN
G B
ET
TE
R?
Alt
ho
ug
h d
isp
ari
tie
s re
ma
in, t
hre
e c
ou
nty
-wid
e
succ
ess
es
sta
nd
ou
t. T
he
se im
pro
vem
en
ts o
ccu
rre
d
in t
he
co
nte
xt o
f su
pp
ort
ive
po
licy
chan
ge
s –
at
the
fed
era
l, st
ate
, co
un
ty, c
ity,
an
d/o
r sc
ho
ol l
eve
ls.
Si
nce
imp
lem
en
tati
on
of
the
Aff
ord
able
Car
e
Act
, he
alt
h i
nsu
ran
ce c
ov
era
ge
has
imp
rove
d
dra
mat
ical
ly –
for
all a
ge
s, r
acia
l/e
thn
ic g
rou
ps,
an
d
citi
es.
C
iga
rett
e s
mo
kin
g –
sti
ll th
e le
adin
g p
reve
nta
ble
cau
se o
f d
eat
h in
th
e U
nit
ed
Sta
tes
– h
as d
ecl
ine
d
acro
ss r
eg
ion
s, a
ge
gro
up
s, a
nd
rac
ial/
eth
nic
gro
up
s.
The
de
clin
e in
yo
uth
sm
oki
ng
was
acc
om
pan
ied
by
a
cou
nty
-wid
e d
ecl
ine
in y
ou
th s
ub
sta
nce
use
.
Fe
we
r st
ud
en
ts in
8th
, 10
th, a
nd
12
th g
rad
es
are
dri
nk
ing
su
ga
r-sw
ee
ten
ed
be
ve
rag
es
da
ily
,
mir
rori
ng
a n
atio
nal
tre
nd
am
on
g h
igh
sch
oo
l
stu
de
nts
.5
AC
RO
SS
KIN
G C
OU
NT
Y O
VE
RA
LL
,
WH
AT
’S F
AIL
ING
TO
IM
PR
OV
E O
R
GE
TT
ING
WO
RS
E?
Alt
ho
ug
h m
any
ind
icat
ors
sh
ow
ed
litt
le o
r n
o
imp
rove
me
nt,
th
e fo
llow
ing
hav
e s
pe
cial
re
leva
nce
for
he
alth
care
pro
vid
ers
:
In
th
e c
on
text
of
esc
alat
ing
ho
usi
ng
pri
ces,
stu
de
nt
ho
me
less
ne
ss i
n K
ing
Co
un
ty h
as m
ore
than
do
ub
led
sin
ce 2
00
8, r
eac
hin
g 8
,41
1 (
ne
arly
3%
of
en
rolle
d s
tud
en
ts)
in t
he
20
15
-16
sch
oo
l ye
ar. M
ore
than
hal
f o
f th
e s
tud
en
ts w
ere
in e
lem
en
tary
sch
oo
l
or
pre
-kin
de
rgar
ten
. In
ad
dit
ion
, th
e 2
01
7 P
oin
t-In
-
Tim
e C
ou
nt
ide
nti
fie
d 1
1,6
43
ind
ivid
ual
s e
xpe
rie
nci
ng
ho
me
less
ne
ss, 5
0%
of
wh
om
had
on
e o
r m
ore
dis
ablin
g c
on
dit
ion
s.
In
suffi
cie
nt
ph
ysi
cal
act
ivit
y is
ass
oci
ate
d w
ith
ob
esi
ty, w
hic
h in
tu
rn is
lin
ked
to
dia
be
tes
and
oth
er
chro
nic
dis
eas
es
(in
clu
din
g 4
in 1
0 c
ance
rs d
iag
no
sed
in t
he
Un
ite
d S
tate
s).6
Fe
we
r th
an 1
in 4
ad
ult
s an
d
you
th g
et
the
re
com
me
nd
ed
am
ou
nt
of
exe
rcis
e.
This
re
pre
sen
ts n
o c
han
ge
for
adu
lts,
an
d m
od
est
bu
t in
ade
qu
ate
imp
rove
me
nt
for
8th
, 10
th, a
nd
12
th
gra
de
rs, g
ive
n t
he
imp
ort
ance
of
ph
ysic
al a
ctiv
ity
to
he
alth
.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
15
Sectio
n
Head
line
Gre
en
Exec
utiv
e
Sum
mar
yC
ontin
ued
Th
e o
vera
ll o
be
sity
rat
e fo
r K
ing
Co
un
ty a
du
lts
has
be
en
flat
sin
ce 2
00
9 (
at m
ore
th
an 1
in 5
ad
ult
s).
Nat
ion
ally
, ad
ult
ob
esi
ty le
vels
ro
se fo
r d
eca
de
s,
stab
ilize
d b
etw
ee
n 2
00
3 a
nd
20
12
, th
en
ro
se a
gai
n
slig
htl
y fo
r w
om
en
.7 A
t 2
2%
, th
e 2
01
5 a
du
lt o
be
sity
rate
in K
ing
Co
un
ty w
as s
ign
ifica
ntl
y lo
we
r th
an t
he
Was
hin
gto
n s
tate
rat
e o
f 2
6%
, an
d t
he
nat
ion
al r
ate
of
29
% (
alth
ou
gh
th
e 2
01
1-2
01
5 r
ate
in S
ou
th R
eg
ion
mat
che
s th
e n
atio
nal
rat
e, a
t 2
9%
).8 F
or
Kin
g C
ou
nty
you
th, o
be
sity
has
he
ld s
tead
y ar
ou
nd
9%
sin
ce
20
04
exc
ep
t in
So
uth
Re
gio
n, w
he
re it
has
incr
eas
ed
.
In c
om
par
iso
n, h
igh
sch
oo
l stu
de
nts
nat
ion
ally
exp
eri
en
ced
a s
tead
y in
cre
ase
in o
be
sity
fro
m 1
99
9 t
o
20
13
, wh
ich
ap
pe
are
d t
o le
vel o
ff a
t a
hig
he
r ra
te -
14
%
in 2
01
5.
A
lth
ou
gh
ne
w d
ata
ab
ou
t fo
od
in
secu
rity
ha
ve
no
t b
ee
n c
oll
ect
ed
sin
ce 2
01
3, w
e k
no
w t
hat
use
of
foo
d a
ssis
tan
ce s
erv
ice
s is
oft
en
ass
oci
ate
d w
ith
foo
d
inse
curi
ty. B
y 2
01
6, p
arti
cip
atio
n in
th
e B
asic
Fo
od
pro
gra
m (
form
erl
y fo
od
sta
mp
s) h
ad n
ot
retu
rne
d t
o
pre
-re
cess
ion
leve
ls a
nd
was
incr
eas
ing
for
old
er
adu
lts,
esp
eci
ally
in S
ou
th R
eg
ion
. A s
imila
r p
atte
rn w
as fo
un
d
for
visi
ts t
o K
ing
Co
un
ty fo
od
ban
ks.
R
eg
ard
ing
me
nta
l h
ea
lth
, 30
% o
f yo
uth
re
po
rte
d
fee
ling
sad
or
ho
pe
less
for
2 o
r m
ore
co
nse
cuti
ve
we
eks
, to
th
e e
xte
nt
that
th
ey
sto
pp
ed
do
ing
so
me
of
the
ir u
sual
act
ivit
ies;
th
is h
as g
ott
en
wo
rse
sin
ce
20
04
in K
ing
Co
un
ty o
vera
ll, d
rive
n b
y in
cre
ase
s in
th
is
ind
icat
or
amo
ng
yo
uth
in S
ou
th R
eg
ion
. Am
on
g a
du
lts,
the
pe
rce
nta
ge
exp
eri
en
cin
g p
sych
olo
gic
al d
istr
ess
has
no
t ch
ang
ed
sin
ce t
he
last
re
po
rt.
D
rug
-re
late
d d
ea
ths,
esp
eci
ally
th
ose
re
late
d t
o
he
roin
an
d m
eth
amp
he
tam
ine
, in
cre
ase
d d
ram
atic
ally
be
twe
en
20
10
an
d 2
01
6.
HO
W I
S I
NC
OM
E L
INK
ED
TO
HE
AL
TH
?
De
spit
e o
ve
rall
im
pro
ve
me
nts
in
so
me
are
as,
we
fin
d c
on
sist
en
t in
com
e/p
ov
ert
y g
rad
ien
ts i
n
he
alt
h o
utc
om
es
(als
o o
fte
n r
efl
ect
ed
in r
acia
l/e
thn
ic
diff
ere
nce
s). M
any
of
the
se p
atte
rns
tell
a st
ory
in w
hic
h
ine
qu
itab
le a
cce
ss t
o c
are
an
d p
reve
nti
on
– e
spe
cial
ly
ear
ly in
life
– s
ets
th
e s
tag
e fo
r la
ter
he
alth
co
nce
rns.
The
follo
win
g s
ets
of
ind
icat
ors
sh
ow
ed
ro
bu
st li
nks
to m
eas
ure
s o
f e
con
om
ic p
rosp
eri
ty; u
sual
ly m
ed
ian
inco
me
or
ne
igh
bo
rho
od
po
vert
y (f
amily
eco
no
mic
dat
a w
ere
no
t av
aila
ble
for
me
asu
res
of
he
alth
-re
late
d
be
hav
iors
an
d o
utc
om
es
for
you
th).
Inco
me
Gra
die
nts
fo
r D
ete
rmin
an
ts o
f H
ea
lth
A
cce
ss t
o c
are
an
d u
se o
f p
rev
en
tiv
e s
erv
ice
s:
No
tab
le d
iffe
ren
ces
by
inco
me
incl
ud
ed
hea
lth
insu
ran
ce c
ove
rag
e (a
7-f
old
diff
ere
nce
be
twe
en
ad
ult
s
in h
igh
- an
d lo
w-p
ove
rty
ne
igh
bo
rho
od
s, e
ven
aft
er
imp
lem
en
tati
on
of
the
Aff
ord
able
Car
e A
ct);
hav
ing
un
met
med
ica
l nee
ds
du
e t
o c
ost
(8
-fo
ld d
iffe
ren
ce
be
twe
en
ad
ult
s in
th
e h
igh
est
an
d lo
we
st in
com
e t
iers
),
inco
mp
lete
ch
ildh
oo
d v
acc
ines
, me
eti
ng
scr
een
ing
gu
idel
ines
for
colo
rect
al c
an
cer
(ad
ult
s), h
avin
g h
ad a
den
tal v
isit
in t
he
pa
st y
ear
(ad
ult
s), a
nd
ha
vin
g d
enta
l
cari
es b
efo
re 3
rd g
rad
e (
you
ng
ch
ildre
n).
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
16
Sectio
n
Head
line
Gre
en
P
reg
na
ncy
, ch
ild
bir
th, a
nd
th
e fi
rst
ye
ars
of
life
: In
com
e d
iffe
ren
ces
favo
rin
g h
igh
er
inco
me
s
we
re fo
un
d fo
r ea
rly
an
d a
deq
ua
te p
ren
ata
l ca
re, l
ow
bir
th w
eig
ht,
an
d in
fan
t m
ort
alit
y.
A
du
lt p
hy
sica
l a
ctiv
ity
an
d w
eig
ht:
Ad
ult
s
in t
he
low
est
inco
me
tie
r w
ere
1.5
tim
es
as li
kely
to
be
ob
ese
as t
ho
se w
ith
th
e h
igh
est
inco
me
s, a
nd
hig
h-i
nco
me
ad
ult
s w
ere
1.6
tim
es
as li
kely
as
tho
se
wit
h t
he
low
est
inco
me
s to
mee
t p
hys
ica
l act
ivit
y
gu
idel
ines
.
To
ba
cco
: Ad
ult
s w
ith
th
e lo
we
st in
com
es
we
re
4 t
ime
s as
like
ly a
s th
ose
wit
h t
he
hig
he
st in
com
es
to
smo
ke c
iga
rett
es.
Inco
me
Gra
die
nts
fo
r H
ea
lth
Ou
tco
me
s
C
hro
nic
dis
ea
ses:
Ad
ult
s w
ith
th
e lo
we
st
inco
me
s w
ere
at
leas
t tw
ice
as
like
ly a
s th
ose
wit
h t
he
hig
he
st in
com
es
to h
ave
a d
isa
bili
ty, o
r d
iag
no
ses
of
dia
bet
es o
r a
sth
ma
.
M
en
tal
he
alt
h:
Ad
ult
s in
th
e lo
we
st in
com
e t
ier
we
re a
lmo
st 1
5 t
ime
s as
like
ly a
s h
igh
-in
com
e a
du
lts
to h
ave
exp
eri
en
ced
ser
iou
s p
sych
olo
gic
al d
istr
ess
in
the
pas
t m
on
th.
H
osp
ita
liza
tio
ns:
R
esi
de
nts
in h
igh
-po
vert
y
ne
igh
bo
rho
od
s w
ere
mo
st li
kely
to
be
ho
spit
aliz
ed
for
un
inte
nti
on
al i
nju
ries
an
d fo
r su
icid
e a
ttem
pts
.
L
ife
ex
pe
cta
ncy
an
d t
yp
es
of
can
cer:
Co
nsi
ste
nt
wit
h n
atio
nal
fin
din
gs,
Kin
g C
ou
nty
resi
de
nts
of
low
-po
vert
y n
eig
hb
orh
oo
ds
live
lon
ge
r
than
th
ose
in h
igh
-po
vert
y n
eig
hb
orh
oo
ds.
An
d
resi
de
nts
of
hig
h-p
ove
rty
ne
igh
bo
rho
od
s ar
e m
ost
like
ly t
o b
e d
iag
no
sed
wit
h lu
ng
an
d k
idn
ey
can
cers
(bo
th s
tro
ng
ly a
sso
ciat
ed
wit
h s
mo
kin
g, o
ne
of
the
inco
me
-lin
ked
be
hav
iora
l de
term
inan
ts o
f h
eal
th).
HO
W I
S P
LA
CE
RE
LE
VA
NT
TO
HE
AL
TH
?
Re
cen
t a
na
lyse
s a
lso
fo
un
d p
ers
iste
nt
(an
d
incr
ea
sin
g)
dis
pa
riti
es
by
ge
og
rap
hic
lo
cati
on
, or
pla
ce. W
e f
ocu
s p
rim
ari
ly o
n K
ing
Co
un
ty’s
So
uth
Re
gio
n, w
hic
h a
lso
has
th
e h
igh
est
co
nce
ntr
atio
n
of
po
vert
y, p
lus
dis
pro
po
rtio
nat
e r
ep
rese
nta
tio
ns
of
pe
op
le o
f co
lor
and
imm
igra
nts
(h
alf
of
wh
om
se
ttle
in
Sou
th R
eg
ion
), an
d s
ign
ifica
nt
ling
uis
tic
div
ers
ity.
On
e
in fo
ur
Sou
th R
eg
ion
ad
ult
s h
as a
bac
he
lor’s
de
gre
e,
com
par
ed
to
mo
re t
han
hal
f o
f ad
ult
s in
eac
h o
f th
e
cou
nty
’s o
the
r re
gio
ns.
No
t su
rpri
sin
gly
, a c
lose
loo
k at
Sou
th R
eg
ion
re
veal
s so
me
of
the
sam
e d
isp
arit
ies
that
em
erg
ed
wh
en
we
focu
sed
on
po
vert
y.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
17Ex
ecut
ive
Su
mm
ary
Con
tinue
d
Sectio
n
Head
line
Gre
en
De
term
ina
nts
of
He
alt
h b
y L
oca
tio
n
Acc
ess
to
ca
re a
nd
use
of
pre
ve
nti
ve
se
rvic
es:
Sou
th R
eg
ion
re
sid
en
ts h
ad t
he
low
est
rat
es
of
hea
lth
insu
ran
ce a
nd
an
nu
al d
enta
l vis
its
by
ad
ult
s, a
nd
th
e
hig
he
st r
ate
of
un
met
med
ica
l nee
ds
du
e t
o c
ost
.
Pre
gn
an
cy, c
hil
db
irth
, an
d t
he
firs
t y
ea
rs o
f li
fe:
Sou
th R
eg
ion
mo
the
rs w
ere
leas
t lik
ely
to
ge
t ea
rly
an
d a
deq
ua
te p
ren
ata
l ca
re; S
ou
th R
eg
ion
als
o h
ad
the
hig
he
st r
ate
s o
f in
fan
t m
ort
alit
y an
d in
com
ple
te
vacc
ines
. Als
o, t
he
pro
po
rtio
n o
f Ea
st R
eg
ion
mo
the
rs
ge
ttin
g e
arl
y a
nd
ad
equ
ate
pre
na
tal c
are
has
de
clin
ed
shar
ply
.
Ph
ysi
cal
act
ivit
y, w
eig
ht,
an
d n
utr
itio
n:
Dai
ly
con
sum
pti
on
of
sug
ar-s
we
ete
ne
d b
eve
rag
es
by
you
th
was
hig
he
st a
mo
ng
So
uth
Re
gio
n y
ou
th, a
nd
So
uth
Re
gio
n w
as t
he
on
ly r
eg
ion
wh
ere
yo
uth
ob
esi
ty w
as
ge
ttin
g w
ors
e.
Tob
acc
o: S
ou
th R
eg
ion
had
th
e h
igh
est
rat
e o
f ad
ult
smo
kin
g, a
nd
was
th
e o
nly
re
gio
n w
he
re t
he
co
un
ty-
wid
e d
ecl
ine
in a
du
lt s
mo
kin
g d
id n
ot
con
tin
ue
aft
er
20
06
.
He
alt
h O
utc
om
es
by
Lo
cati
on
Ch
ron
ic d
ise
ase
s: S
ou
th R
eg
ion
ad
ult
s h
ad t
he
cou
nty
’s h
igh
est
rat
es
of
dis
ab
ility
an
d d
iab
etes
, an
d
the
dia
bet
es r
ate
is r
isin
g in
So
uth
an
d E
ast
reg
ion
s.
The
re w
ere
no
re
gio
nal
diff
ere
nce
s fo
r ch
ild o
r ad
ult
asth
ma.
Me
nta
l h
ea
lth
: So
uth
Re
gio
n y
ou
th a
re in
cre
asin
gly
like
ly t
o e
xpe
rie
nce
dep
ress
ive
feel
ing
s.
Ho
spit
ali
zati
on
s a
nd
su
icid
e d
ea
ths:
Th
e r
ate
of
un
inte
nti
on
al i
nju
ry h
osp
ita
liza
tio
ns
is d
ecr
eas
ing
cou
nty
-wid
e. T
he
rat
e in
So
uth
Re
gio
n r
em
ain
s
hig
he
r th
an o
the
r re
gio
ns.
Th
e r
ate
of
suic
ide
dea
th is
incr
eas
ing
in S
ou
th R
eg
ion
.
An
alys
es
oft
en
sp
otl
igh
t So
uth
Re
gio
n a
s an
are
a o
f
con
cern
, in
par
t b
eca
use
of
con
cen
trat
ed
po
vert
y.
Dri
llin
g a
bit
de
ep
er
into
th
e m
ost
re
cen
t d
ata,
we
fin
d m
ean
ing
ful d
iffe
ren
ces
amo
ng
So
uth
Re
gio
n
ne
igh
bo
rho
od
s. F
or
exa
mp
le, w
hile
th
e r
ate
for
earl
y
an
d a
deq
ua
te p
ren
ata
l ca
re w
as b
elo
w t
he
co
un
ty
ave
rag
e in
mo
st S
ou
th K
ing
Co
un
ty n
eig
hb
orh
oo
ds
ne
ar t
he
I-5
co
rrid
or
(all
ne
igh
bo
rho
od
s in
Au
bu
rn,
Fed
era
l Way
, an
d K
en
t, 2
of
Re
nto
n’s
3 n
eig
hb
orh
oo
ds,
and
Se
aTac
/Tu
kwila
), So
uth
Re
gio
n n
eig
hb
orh
oo
ds
that
did
no
t d
iffe
r fr
om
th
e c
ou
nty
ave
rag
e in
clu
de
d
tho
se w
ith
Pu
ge
t So
un
d w
ate
rfro
nt
(Bu
rie
n, D
es
Mo
ine
s/N
orm
and
y P
ark,
Vas
ho
n Is
lan
d)
and
mo
re r
ura
l
are
as c
on
sid
era
bly
inla
nd
fro
m I-
5 (
Bla
ck D
iam
on
d/
Enu
mcl
aw/S
E C
ou
nty
, Co
vin
gto
n/M
aple
Val
ley,
Fair
wo
od
).
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
18Ex
ecut
ive
Su
mm
ary
Con
tinue
d
Sectio
n
Head
line
Gre
en
He
alt
h c
on
cern
s a
re n
ot
con
fin
ed
to
So
uth
Re
gio
n. F
or
exa
mp
le, t
he
pro
po
rtio
n o
f m
oth
ers
rece
ivin
g e
arl
y a
nd
ad
equ
ate
pre
na
tal c
are
in
East
Re
gio
n h
as d
ecl
ine
d s
ign
ifica
ntl
y si
nce
20
00
.
Acc
ord
ing
to
th
e m
ost
re
cen
t d
ata,
mo
the
rs in
Se
attl
e
and
No
rth
Re
gio
n w
ere
mo
re li
kely
th
an E
ast
Re
gio
n
mo
the
rs t
o g
et
earl
y a
nd
ad
equ
ate
pre
na
tal c
are
.
Clo
ser
exa
min
atio
n r
eve
ale
d t
hat
3 o
f th
e 1
4 K
ing
Co
un
ty n
eig
hb
orh
oo
ds
wit
h r
ate
s b
elo
w t
he
20
11
-
20
15
co
un
ty a
vera
ge
we
re in
Be
llevu
e. I
n a
no
the
r
de
par
ture
fro
m t
he
focu
s o
n S
ou
th R
eg
ion
, su
icid
e
ho
spit
aliz
ati
on
was
mo
st li
kely
for
resi
de
nts
of
Seat
tle
and
No
rth
Re
gio
n, a
nd
th
e E
ast
Re
gio
n r
ate
incr
eas
ed
sig
nifi
can
tly
fro
m 2
00
0 t
o 2
01
5.
HO
W A
RE
RA
CE
AN
D E
TH
NIC
ITY
RE
LE
VA
NT
TO
HE
AL
TH
?
Ra
cia
l a
nd
eth
nic
dis
pa
riti
es
in h
ea
lth
an
d
soci
al
ou
tco
me
s p
ers
ist
thro
ug
ho
ut
the
co
un
ty.
Pe
op
le o
f co
lor
in K
ing
Co
un
ty a
re m
ore
like
ly t
o b
e
un
insu
red
an
d t
o h
ave
po
or
he
alth
ou
tco
me
s. A
cro
ss
a n
um
be
r o
f h
eal
th a
nd
so
cial
ind
icat
ors
, bo
th w
hit
es
and
Asi
ans
fare
be
tte
r th
an o
the
rs.
Ho
we
ver,
nat
ion
al
dat
a su
gg
est
th
at t
he
ag
gre
gat
e c
ate
go
ry o
f “A
sian
s”
mas
ks d
isp
arit
ies
wit
hin
th
e A
sian
cat
eg
ory
. Th
ere
is a
larg
e b
od
y o
f e
vid
en
ce t
hat
de
mo
nst
rate
s d
isp
arit
ies
in h
eal
th o
utc
om
es,
par
ticu
larl
y fo
r So
uth
eas
t A
sian
s
com
par
ed
to
oth
er
Asi
an e
thn
icit
ies.
Th
is is
tru
e o
f
oth
er
race
s as
we
ll. F
or
exa
mp
le, e
xist
ing
dat
a d
o
no
t p
erm
it u
s to
dis
agg
reg
ate
So
mal
i, Et
hio
pia
n,
and
oth
er
em
erg
ing
Afr
ican
co
mm
un
itie
s fr
om
mu
lti-
ge
ne
rati
on
al A
fric
an-A
me
rica
n c
om
mu
nit
ies.
Ne
vert
he
less
, th
e p
rese
nce
of
dis
par
itie
s b
y ra
ce/
eth
nic
ity
un
de
rsco
re t
he
ne
ed
to
fu
rth
er
exp
lore
th
e
cau
ses
of
ine
qu
itie
s th
at r
esu
lt in
dis
par
ate
ou
tco
me
s
and
ide
nti
fy s
olu
tio
ns.
De
term
ina
nts
of
He
alt
h b
y R
ace
/Eth
nic
ity
A
cce
ss t
o c
are
an
d u
se o
f p
rev
en
tiv
e
serv
ice
s: A
lth
ou
gh
hea
lth
insu
ran
ce c
ove
rag
e h
as
imp
rove
d o
vera
ll, m
ost
co
mm
un
itie
s o
f co
lor
rem
ain
dis
pro
po
rtio
nat
ely
un
insu
red
. In
20
16
, His
pan
ic
adu
lts
we
re le
ast
like
ly o
f al
l rac
ial/
eth
nic
gro
up
s to
hav
e h
eal
thca
re c
ove
rag
e, w
ith
an
un
insu
red
rat
e
ne
arly
3 t
ime
s th
e c
ou
nty
ave
rag
e. B
lack
an
d H
isp
anic
resi
de
nts
we
re m
ost
like
ly t
o r
ep
ort
hav
ing
un
met
med
ica
l nee
ds
du
e t
o c
ost
.
P
reg
na
ncy
, ch
ild
bir
th, a
nd
th
e fi
rst
ye
ars
of
life
: A
me
rica
n In
dia
n/A
lask
a N
ativ
e, B
lack
, His
pan
ic,
and
Nat
ive
Haw
aiia
n/P
acifi
c Is
lan
de
r m
oth
ers
we
re
less
like
ly t
han
Asi
ans
and
wh
ite
s to
ge
t ea
rly
an
d
ad
equ
ate
pre
na
tal c
are
. Bla
ck a
nd
Am
eri
can
Ind
ian
/
Ala
ska
Nat
ive
infa
nts
exp
eri
en
ced
th
e h
igh
est
rat
es
of
low
bir
th w
eig
ht
and
infa
nt
mo
rta
lity.
Rat
es
of
low
bir
th w
eig
ht
amo
ng
Asi
an in
fan
ts w
ere
als
o h
igh
er
than
th
e c
ou
nty
ave
rag
e; h
ow
eve
r, th
ey
had
th
e
low
est
rat
es
of
infa
nt
mo
rta
lity.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
19Ex
ecut
ive
Su
mm
ary
Con
tinue
d
Sectio
n
Head
line
Gre
en
P
hy
sica
l a
ctiv
ity
, we
igh
t, a
nd
nu
trit
ion
: A
du
lt
ob
esit
y ra
tes
we
re lo
we
st fo
r A
sian
s an
d h
igh
est
for
Am
eri
can
Ind
ian
s/A
lask
a N
ativ
es;
am
on
g y
ou
th,
ob
esit
y ra
tes
we
re lo
we
st fo
r A
sian
s an
d w
hit
es
and
sig
nifi
can
tly
hig
he
r fo
r al
l oth
er
gro
up
s. A
sian
an
d
His
pan
ic y
ou
th w
ere
leas
t lik
ely
to
me
et
ph
ysic
al
act
ivit
y st
and
ard
s.
To
ba
cco
: A
mo
ng
8th
, 10
th, a
nd
12
th g
rad
ers
,
Am
eri
can
Ind
ian
/Ala
ska
Nat
ive
yo
uth
we
re
sig
nifi
can
tly
mo
re li
kely
th
an w
hit
e, B
lack
, His
pan
ic,
and
Asi
an y
ou
th t
o u
se t
ob
acc
o –
ne
arly
4 t
ime
s as
like
ly a
s A
sian
yo
uth
to
sm
oke
cig
are
tte
s.
He
alt
h O
utc
om
es
by
Ra
ce/E
thn
icit
y
C
hro
nic
dis
ea
ses:
Dia
bet
es r
ate
s am
on
g B
lack
adu
lts
we
re s
ign
ifica
ntl
y h
igh
er
than
th
e c
ou
nty
ave
rag
e a
nd
ne
arly
tw
ice
th
e r
ate
am
on
g A
sian
ad
ult
s.
The
rat
e o
f a
sth
ma
am
on
g A
me
rica
n In
dia
ns/
Ala
ska
Nat
ive
s is
4 t
ime
s th
at o
f A
sian
ad
ult
s.
M
en
tal
he
alt
h:
His
pan
ic, N
ativ
e H
awai
ian
/Pac
ific
Isla
nd
er,
Am
eri
can
Ind
ian
/Ala
ska
Nat
ive
, an
d m
ult
iple
-
race
yo
uth
we
re m
ore
like
ly t
han
Asi
an, B
lack
, an
d
wh
ite
yo
uth
to
exp
eri
en
ce d
epre
ssiv
e fe
elin
gs.
S
uic
ide
an
d h
om
icid
e d
ea
ths:
Su
icid
e d
eath
s
we
re h
igh
er
than
th
e c
ou
nty
ave
rag
e fo
r w
hit
es
and
Am
eri
can
Ind
ian
s/A
lask
a N
ativ
es
in K
ing
Co
un
ty.
Ho
mic
ide
de
ath
s, h
ow
eve
r, w
ere
mu
ch h
igh
er
for
Bla
ck r
esi
de
nts
th
an fo
r an
y o
the
r g
rou
p, a
t m
ore
th
an
5 t
ime
s th
e c
ou
nty
ave
rag
e.
L
ife
ex
pe
cta
ncy
, ca
use
s o
f d
ea
th, a
nd
ty
pe
s
of
can
cer:
At
86
.3 y
ear
s, li
fe e
xpe
ctan
cy is
hig
he
st
amo
ng
His
pan
ic a
nd
Asi
an r
esi
de
nts
; Nat
ive
Haw
aiia
n/
Pac
ific
Isla
nd
ers
(7
5.0
ye
ars)
hav
e t
he
low
est
life
exp
ect
ancy
of
all r
acia
l/e
thn
ic g
rou
ps
in K
ing
Co
un
ty.
All
raci
al/e
thn
ic g
rou
ps
shar
e h
ear
t d
ise
ase
an
d
can
cer
as t
he
to
p 2
cau
ses
of
de
ath
. Am
on
g t
ype
s o
f
can
cer,
live
r ca
nce
r is
mo
st c
om
mo
n a
mo
ng
Am
eri
can
Ind
ian
s/A
lask
a N
ativ
es;
pro
stat
e c
ance
r m
ost
pre
vale
nt
amo
ng
Bla
ck m
ale
s; c
erv
ical
can
cer
hig
he
st fo
r
His
pan
ic a
nd
Bla
ck w
om
en
. Bre
ast
can
cer
is h
igh
est
amo
ng
wh
ite
wo
me
n –
alt
ho
ug
h B
lack
wo
me
n a
re
mo
st li
kely
to
die
fro
m b
reas
t ca
nce
r. A
lth
ou
gh
th
e
nu
mb
ers
are
low
du
e t
o lo
w p
op
ula
tio
n s
ize
, Nat
ive
Haw
aiia
ns/
Pac
ific
Isla
nd
ers
hav
e s
trik
ing
ly h
igh
rat
es
of
bre
ast,
lun
g, c
olo
rect
al, a
nd
ute
rin
e c
ance
rs.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
20Ex
ecut
ive
Su
mm
ary
Con
tinue
d
Sectio
n
Head
line
Gre
en
SU
MM
AR
Y O
F H
EA
LT
H T
OP
ICS
De
term
ina
nts
of
He
alt
h
Acc
ess
to
Ca
re a
nd
Use
of
Pre
ve
nti
ve
Se
rvic
es:
Acc
ess
to
hea
lth
insu
ran
ce im
pro
ved
su
bst
anti
ally
afte
r im
ple
me
nta
tio
n o
f th
e A
ffo
rdab
le C
are
Act
(A
CA
),
and
in t
he
ye
ar a
fte
r A
CA
imp
lem
en
tati
on
few
er
adu
lts
rep
ort
ed
no
t b
ein
g a
ble
to
see
a d
oct
or
bec
au
se o
f
cost
. Ch
ildre
n w
ho
live
in h
igh
-po
vert
y n
eig
hb
orh
oo
ds
we
re le
ast
like
ly t
o h
ave
co
mp
lete
d t
he
va
ccin
ati
on
s
reco
mm
end
ed fo
r yo
un
g c
hild
ren
by
35
mo
nth
s. M
ore
than
1 in
3 a
du
lts
age
50
-75
fai
led
to
me
et
colo
rect
al
can
cer
scre
enin
g g
uid
elin
es. L
ow
-in
com
e a
du
lts
we
re
leas
t lik
ely
to
use
pre
ven
tive
se
rvic
es
such
as
colo
rect
al
can
cer
scre
en
ing
an
d r
egu
lar
den
tal v
isit
s. A
du
lts
in S
ou
th R
eg
ion
we
re le
ast
like
ly t
o r
ep
ort
se
ein
g a
de
nti
st in
th
e p
ast
year
– a
tre
nd
th
at is
ge
ttin
g w
ors
e,
bu
t o
nly
in S
ou
th R
eg
ion
. Ab
ou
t 4
in 1
0 K
ing
Co
un
ty
pre
sch
oo
lers
, kin
de
rgar
ten
ers
, an
d 2
nd
an
d 3
rd
gra
de
rs h
ad e
xpe
rie
nce
d d
enta
l ca
ries
. Wh
ite
ch
ildre
n
we
re le
ss li
kely
th
an c
hild
ren
of
all o
the
r ra
ces/
eth
nic
itie
s to
hav
e h
ad d
en
tal c
arie
s.
Pre
gn
an
cy, c
hil
db
irth
, an
d t
he
firs
t y
ea
rs o
f
life
: Se
ven
in 1
0 o
f K
ing
Co
un
ty’s
exp
ect
ant
mo
the
rs
rece
ive
d e
arl
y a
nd
ad
equ
ate
pre
na
tal c
are
, bu
t
sub
stan
tial
dis
par
itie
s b
y p
ove
rty
and
rac
e/e
thn
icit
y
pe
rsis
t. P
reg
nan
t w
om
en
in S
ou
th R
eg
ion
we
re
sig
nifi
can
tly
less
like
ly t
han
th
ose
in o
the
r re
gio
ns
to
ge
t e
arly
an
d a
de
qu
ate
pre
nat
al c
are
(6
7.3
%),
and
th
e
rate
of
earl
y a
nd
ad
equ
ate
pre
na
tal c
are
in E
ast
Re
gio
n
has
de
cre
ase
d s
ince
th
e la
st r
ep
ort
. Dis
par
itie
s in
bir
th
ou
tco
me
s re
po
rte
d in
20
15
/20
16
hav
e n
ot
dim
inis
he
d.
Ph
ysi
cal
Act
ivit
y, W
eig
ht,
& N
utr
itio
n:
Wh
ile t
he
pro
po
rtio
n o
f 8
th, 1
0th
, an
d 1
2th
gra
de
stu
de
nts
me
eti
ng
fed
era
l sta
nd
ard
s fo
r p
hys
ica
l act
ivit
y
has
incr
eas
ed
, fe
we
r th
an 1
in 4
stu
de
nts
me
t th
e
crit
eri
a –
th
e s
ame
rat
e a
s ad
ult
s (w
ho
sh
ow
ed
no
imp
rove
me
nt)
. Am
on
g e
ven
th
e h
igh
est
-in
com
e
adu
lts,
on
ly 2
6%
me
t fe
de
ral s
tan
dar
ds.
Alt
ho
ug
h
the
re w
ere
no
rac
ial/
eth
nic
diff
ere
nce
s am
on
g a
du
lts,
Asi
an a
nd
His
pan
ic s
tud
en
ts w
ere
leas
t lik
ely
to
me
et
ph
ysic
al a
ctiv
ity
stan
dar
ds.
Fo
r yo
uth
, ph
ysic
al a
ctiv
ity
did
no
t d
iffe
r b
y re
gio
n, b
ut
Sou
th R
eg
ion
ad
ult
s w
ere
sig
nifi
can
tly
less
like
ly t
o m
ee
t st
and
ard
s.
Alm
ost
1 in
10
Kin
g C
ou
nty
stu
de
nts
in 8
th, 1
0th
, an
d
12
th g
rad
es
we
re o
bes
e, w
ith
mal
es
and
stu
de
nts
wh
o id
en
tify
as
lesb
ian
, gay
, or
bis
exu
al h
avin
g r
ate
s
abo
ve t
he
co
un
ty a
vera
ge
. Stu
de
nt
ob
esi
ty r
ate
s h
ave
be
en
flat
sin
ce 2
00
4 o
r fa
llin
g in
all
reg
ion
s o
f th
e
cou
nty
exc
ep
t So
uth
Re
gio
n w
he
re it
is r
isin
g. A
du
lts
we
re m
ore
th
an t
wic
e a
s lik
ely
as
you
th t
o b
e o
be
se,
wit
h h
igh
est
rat
es
for
tho
se w
ith
th
e lo
we
st in
com
es,
Am
eri
can
Ind
ian
s/A
lask
a N
ativ
es
and
Bla
cks,
an
d t
ho
se
age
45
-64
. Un
like
yo
uth
, ob
esi
ty in
ad
ult
s d
id n
ot
diff
er
by
ge
nd
er
or
sexu
al o
rie
nta
tio
n.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
21Ex
ecut
ive
Su
mm
ary
Con
tinue
d
Sectio
n
Head
line
Gre
en
Fift
ee
n p
erc
en
t o
f yo
uth
re
po
rte
d d
rin
kin
g s
ug
ar-
swee
ten
ed b
ever
ag
es (S
SB) d
aily
. Fe
mal
es,
Asi
ans,
and
wh
ite
s re
po
rte
d t
he
low
est
rat
es
of
dai
ly S
SB
con
sum
pti
on
, wh
ile s
tud
en
ts in
So
uth
Re
gio
n w
ere
mo
st li
kely
to
dri
nk
sug
ary
be
vera
ge
s.
Tob
acc
o &
Oth
er
Dru
gs:
Cig
are
tte
smo
kin
g h
as
dro
pp
ed
for
you
th a
nd
ad
ult
s ac
ross
all
age
gro
up
s
and
re
gio
ns,
alt
ho
ug
h t
he
So
uth
Re
gio
n d
ecl
ine
for
adu
lts
has
sta
lled
sin
ce 2
00
6. A
mo
ng
bo
th y
ou
th a
nd
adu
lts,
Am
eri
can
Ind
ian
s/A
lask
a N
ativ
es
rep
ort
ed
th
e
hig
he
st r
ate
s. W
hile
th
ere
we
re n
o g
en
de
r d
iffe
ren
ces
amo
ng
yo
uth
, mal
e a
du
lts
we
re m
ore
like
ly t
han
fem
ale
s to
sm
oke
. Fo
r yo
uth
an
d a
du
lts,
th
ose
wh
o
ide
nti
fie
d a
s le
sbia
n, g
ay, o
r b
ise
xual
(LG
B)
we
re
mo
re li
kely
th
an h
ete
rose
xual
s to
sm
oke
cig
are
tte
s.
Co
mb
inin
g 8
th, 1
0th
, an
d 1
2th
gra
de
rs, o
nly
5%
smo
ked
cig
are
tte
s; fo
r 1
2th
gra
de
rs a
lon
e, 1
0%
rep
ort
ed
sm
oki
ng
. Ad
ult
s in
th
e lo
we
st in
com
e t
ier
we
re 4
tim
es
mo
re li
kely
to
sm
oke
th
an a
du
lts
wit
h t
he
hig
he
st in
com
es.
The
pro
po
rtio
n o
f 8
th, 1
0th
, an
d 1
2th
gra
de
rs w
ho
rep
ort
ed
usi
ng
alc
oh
ol,
ma
riju
an
a, p
ain
kille
rs (t
o g
et
hig
h) o
r a
ny
illic
it d
rug
s –
1 in
4 –
has
de
clin
ed
sin
ce
20
04
. As
wit
h o
the
r ri
sky
be
hav
iors
, yo
uth
su
bst
ance
use
incr
eas
ed
wit
h a
ge
, wit
h a
4-f
old
diff
ere
nce
be
twe
en
th
e r
ate
s fo
r 1
2th
gra
de
rs a
nd
8th
gra
de
rs.
Alt
ho
ug
h t
he
re w
ere
no
ge
nd
er
diff
ere
nce
s, s
ub
stan
ce
use
am
on
g L
GB
yo
uth
was
1.5
tim
es
the
rat
e fo
r
he
tero
sexu
al y
ou
th.
Kin
g C
ou
nty
dea
ths
rela
ted
to
pre
scri
pti
on
op
ioid
s
dro
pp
ed
fro
m 2
01
0 t
o 2
01
6. D
uri
ng
th
e s
ame
pe
rio
d,
de
ath
s re
late
d t
o h
ero
in m
ore
th
an d
ou
ble
d, a
nd
tho
se r
ela
ted
to
me
tham
ph
eta
min
e in
cre
ase
d m
ore
than
6-f
old
. Acc
ord
ing
to
a r
ece
nt
surv
ey,
he
roin
an
d
oth
er
op
iate
s w
ere
inje
ctio
n d
rug
use
rs’ d
rug
s o
f
cho
ice
; 20
% o
f re
spo
nd
en
ts h
ad e
xpe
rie
nce
d a
no
n-
fata
l ove
rdo
se in
th
e p
ast
year
. Alt
ho
ug
h a
lmo
st 8
ou
t
of
10
re
spo
nd
en
ts e
xpre
sse
d in
tere
st in
re
du
cin
g o
r
sto
pp
ing
op
ioid
use
, fe
we
r th
an 3
in 1
0 w
ere
cu
rre
ntl
y
in t
reat
me
nt.
He
alt
h O
utc
om
es
Lif
e e
xp
ect
an
cy a
nd
le
ad
ing
ca
use
s o
f d
ea
th:
An
infa
nt
bo
rn in
Kin
g C
ou
nty
in 2
01
5 c
an e
xpe
ct
to li
ve t
o a
ge
81
.9 –
lon
ge
r th
an in
mo
st p
arts
of
the
Un
ite
d S
tate
s, b
ut
no
diff
ere
nt
fro
m K
ing
Co
un
ty li
fe
exp
ect
ancy
in 2
00
9.
Wit
hin
th
e c
ou
nty
, diff
ere
nce
s
in li
fe e
xpec
tan
cy a
re li
nke
d t
o p
ove
rty
and
loca
tio
n
and
can
be
as
gre
at a
s 1
0 y
ear
s. S
imila
rly,
ag
e-a
dju
ste
d
dea
th r
ate
s, w
hic
h d
ecl
ine
d fo
r d
eca
de
s, p
late
aue
d
afte
r 2
01
0, p
oss
ibly
be
cau
se t
he
de
cre
ase
in d
eat
hs
fro
m c
ard
iova
scu
lar
dis
eas
e w
as o
ffse
t b
y in
cre
ase
s
in d
eat
hs
fro
m A
lzh
eim
er’s
dis
eas
e. C
ance
r an
d h
ear
t
dis
eas
e a
re s
till
the
lea
din
g c
au
ses
of d
eath
in K
ing
Co
un
ty. I
n c
hild
ho
od
an
d e
arly
ad
ult
ho
od
(yo
un
ge
r
than
45
), m
ale
s ar
e m
uch
mo
re li
kely
th
an fe
mal
es
to
die
. Th
ere
are
als
o n
ota
ble
dis
par
itie
s b
y n
eig
hb
orh
oo
d
po
vert
y.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
22Ex
ecut
ive
Su
mm
ary
Con
tinue
d
Sectio
n
Head
line
Gre
en
Ch
ron
ic I
lln
ess
es:
In K
ing
Co
un
ty 7
% o
f ad
ult
s
hav
e b
ee
n t
old
by
a d
oct
or
that
th
ey
hav
e d
iab
etes
.
Dis
par
itie
s b
y in
com
e, g
eo
gra
ph
y, a
nd
rac
e/e
thn
icit
y
we
re s
ub
stan
tial
: at
leas
t 1
0%
of
Bla
cks,
Am
eri
can
Ind
ian
s/A
lask
a N
ativ
es,
an
d N
ativ
e H
awai
ian
s/P
acifi
c
Isla
nd
ers
re
po
rte
d a
dia
be
tes
dia
gn
osi
s. D
iab
ete
s ra
tes
are
ris
ing
in S
ou
th a
nd
Eas
t R
eg
ion
s an
d fo
r H
isp
anic
s
and
wh
ite
s.
Seve
n p
erc
en
t o
f K
ing
Co
un
ty c
hild
ren
an
d 9
% o
f
adu
lts
had
ast
hm
a, a
lth
ou
gh
no
ag
e o
r re
gio
nal
diff
ere
nce
s w
ere
ide
nti
fie
d in
eit
he
r g
rou
p. A
lth
ou
gh
inco
me
was
no
t lin
ked
to
ch
ildh
oo
d a
sth
ma,
ad
ult
asth
ma
was
mo
st c
om
mo
n in
low
-in
com
e h
ou
seh
old
s.
Asi
ans
had
th
e lo
we
st r
ate
of
adu
lt a
sth
ma
-- t
he
on
ly
sig
nifi
can
t ra
cial
/eth
nic
diff
ere
nce
in e
ith
er
child
ren
or
adu
lts.
Be
twe
en
20
00
an
d 2
01
5, h
ow
eve
r, as
thm
a ra
tes
incr
eas
ed
on
ly fo
r w
hit
e a
du
lts.
In a
du
lts
on
ly, f
em
ale
s
we
re m
ore
like
ly t
han
mal
es
to h
ave
ast
hm
a. A
du
lts
wh
o id
en
tifi
ed
as
lesb
ian
, gay
, or
bis
exu
al w
ere
mo
re
like
ly t
han
he
tero
sexu
al a
du
lts
to s
uff
er
fro
m a
sth
ma.
The
lea
din
g c
au
ses
of a
du
lt h
osp
ita
liza
tio
n a
re
pre
gn
ancy
/ch
ildb
irth
, he
art
dis
eas
e, i
nju
rie
s, a
nd
me
nta
l illn
ess
. Mal
es
are
sti
ll m
ore
like
ly t
han
fem
ale
s
to b
e h
osp
ital
ize
d fo
r h
ear
t d
ise
ase
. Lea
din
g c
au
ses
of
ho
spit
aliz
ati
on
for
child
ren
are
re
spir
ato
ry in
fect
ion
s,
inju
rie
s, a
nd
me
nta
l illn
ess
.
The
to
p t
hre
e t
ype
s o
f ca
nce
r in
Kin
g C
ou
nty
are
lun
g,
pro
stat
e, a
nd
bre
ast
can
cer.
Nat
ive
Haw
aiia
ns/
Pac
ific
Isla
nd
ers
, Bla
cks,
an
d w
hit
es
had
th
e h
igh
est
rat
es
of
bre
ast,
pro
stat
e, c
olo
n, a
nd
lun
g c
ance
rs.
Me
nta
l H
ea
lth
: Th
e p
rop
ort
ion
of
you
th w
ith
dep
ress
ive
feel
ing
s h
as in
cre
ase
d a
cro
ss t
he
co
un
ty.
Rat
es
we
re h
igh
er
than
th
e c
ou
nty
ave
rag
e fo
r
fem
ale
an
d L
GB
stu
de
nts
, as
we
ll as
th
ose
wh
o li
ve in
Sou
th R
eg
ion
an
d t
ho
se w
ho
we
re H
isp
anic
, Nat
ive
Haw
aiia
n/P
acifi
c Is
lan
de
r, A
me
rica
n In
dia
n/A
lask
a
Nat
ive
an
d m
ult
iple
-rac
e. A
lth
ou
gh
th
e p
rop
ort
ion
of
Kin
g C
ou
nty
ad
ult
s w
ith
ser
iou
s p
sych
olo
gic
al d
istr
ess
was
co
nsi
de
rab
ly lo
we
r (4
%),
the
re w
as a
15
-fo
ld
diff
ere
nce
be
twe
en
th
e lo
we
st a
nd
hig
he
st in
com
e
gro
up
s an
d a
2-f
old
diff
ere
nce
be
twe
en
LG
B a
nd
he
tero
sexu
al a
du
lts.
Of
all r
acia
l/e
thn
ic g
rou
ps,
Asi
an
adu
lts
had
th
e lo
we
st r
ate
s o
f se
rio
us
psy
cho
log
ical
dis
tre
ss.
Vio
len
ce a
nd
In
jury
Pre
ve
nti
on
: H
osp
ita
liza
tio
n
for
un
inte
nd
ed in
juri
es w
as m
ost
like
ly fo
r m
ale
s,
for
adu
lts
age
65
an
d o
lde
r, fo
r re
sid
en
ts o
f h
igh
-
po
vert
y n
eig
hb
orh
oo
ds,
an
d fo
r re
sid
en
ts o
f So
uth
Re
gio
n. T
he
ove
rall
de
clin
e in
Kin
g C
ou
nty
su
icid
e
ho
spit
aliz
ati
on
s si
nce
20
00
mas
ks o
pp
osi
ng
re
gio
nal
tre
nd
s –
a s
ign
ifica
nt
incr
eas
e in
Eas
t R
eg
ion
an
d a
de
cre
ase
in S
ou
th R
eg
ion
. Su
icid
e h
osp
ital
izat
ion
rate
s w
ere
hig
he
st in
Se
attl
e a
nd
No
rth
Re
gio
n, l
ow
est
in E
ast
Re
gio
n. A
du
lts
age
18
-24
had
hig
he
r ra
tes
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
23Ex
ecut
ive
Su
mm
ary
Con
tinue
d
Sectio
n
Head
line
Gre
en
than
all
oth
er
age
gro
up
s, a
nd
ad
ult
s in
hig
h-p
ove
rty
ne
igh
bo
rho
od
s w
ere
alm
ost
tw
ice
as
like
ly a
s th
ose
in
low
-po
vert
y n
eig
hb
orh
oo
ds
to b
e h
osp
ital
ize
d a
fte
r a
suic
ide
att
em
pt.
Alt
ho
ug
h t
he
re w
ere
no
re
gio
nal
diff
ere
nce
s in
su
icid
e
dea
ths,
th
is r
ate
has
be
en
ris
ing
in S
ou
th R
eg
ion
sin
ce
20
00
. In
Kin
g C
ou
nty
, mal
es
we
re 3
tim
es
mo
re li
kely
than
fem
ale
s to
co
mm
it s
uic
ide
. Old
er
adu
lts
(ag
es
45
-
64
an
d 6
5+
) w
ere
mo
st li
kely
to
co
mm
it s
uic
ide
. Un
like
suic
ide
ho
spit
aliz
atio
ns,
su
icid
e d
eat
hs
did
no
t d
iffe
r
by
po
vert
y le
vel.
Kin
g C
ou
nty
’s m
ost
re
cen
t su
icid
e
rate
(1
2.2
pe
r 1
00
,00
0 p
op
ula
tio
n)
was
4.5
tim
es
the
rate
of
ho
mic
ide
s (2
.7 d
eat
hs
pe
r 1
00
,00
0).
Am
on
g
raci
al/e
thn
ic g
rou
ps,
wh
ite
s w
ere
mo
st li
kely
(1
3.8
pe
r
10
0,0
00
), w
hile
Asi
ans
(6.6
pe
r 1
00
,00
0)
and
Bla
cks
(7.4
pe
r 1
00
,00
0)
we
re le
ast
like
ly t
o c
om
mit
su
icid
e.
The
op
po
site
pat
tern
was
fou
nd
for
ho
mic
ide
de
ath
s,
wh
ere
th
e r
ate
for
Bla
ck r
esi
de
nts
was
14
.1 p
er
10
0,0
00
– m
ore
th
an 5
tim
es
the
co
un
ty a
vera
ge
.
Kin
g C
ou
nty
Co
mm
un
ity
He
alt
h
Ne
ed
s A
sse
ssm
en
t
20
18
/20
19
24Ex
ecut
ive
Su
mm
ary
Con
tinue
d
