Rural County Health Project, Pacific County, WA, University of Washington Coursework

2.  To understand key, high -
level county background
information
 To identify and prioritize
county health issues
 To identify additional
questions for community
leaders and stakeholder
 To explore strategies for one (VisitEveryCityinWashingtonState.com)
key county health
improvement issue

3.  Located in SE portion of Washington State,
population 20,900
(U.S. Bureau of the Census, 2010)
 Four incorporated cities
› Raymond, South Bend, Long Beach, Ilwaco
› Populations from 945 to 2,985
(U.S. Bureau of the Census, 2010)
 One primary route of three connecting
highways
› Rural winding roads, majority of county remote to
healthcare access

4. (www.co.pacific.wa.us)

5. Economic Indicator Pacific WA State
County
2009 unemployment rates 10.2 – 14.3% 8.9%
(U.S. Department of Labor, 2010)
Children living in poverty 23% 15%
(County Health Rankings, 2010)
Families living below the poverty level 9% 7%
(U.S. Bureau of the Census, 2000)
Median household income $31,209 $45,776
(U.S. Bureau of the Census, 2000)
Population with Medicaid coverage 22.9% 33.1%
(WA State Department of Social & Health Services, 2010)

6.  Classifications:
› RUCA code: Small Town and Isolated Rural
(Department of Health, 2001)
› Medically Underserved Area
(U.S. Department of Human and Health Services, 2010)
› Health Professional Shortage Area
 Primary Care
 Mental Health
(U.S. Department of Human and Health Services, 2010)

7.  Willapa Harbor Hospital, South Bend
› Level 5 Trauma Designation
› Critical Access
 Ocean Beach Hospital, Ilwaco
› No trauma designation
› Critical Access
 Neither hospital offer obstetric service,
closest obstetric services in adjacent Lewis
and Aberdeen counties
 50% of county more than 30 minutes from
acute care facility

8. (WA State Dept. of Health, 2006)

9.  Community Health Clinics
(Community Health Service, 2010)
› Cowlitz Family Health Center, Ocean Park
(Medical/Dental)
› Shoalwater Bay Indian Tribe, Tokeland
(Medical/Dental)
 Rural Health Clinics (WA State Dept of Health, 2009)
› Ocean Beach Medical Center, Ilwaco
› Naselle Clinic, Naselle
› Riverview Health Center, Raymond
› Pacific Family Health Center, South Bend

10. Shoalwater Bay Riverview
Indian Health Center
Tribe,(Medical/De (Medical)
ntal)
Pacific Family
Health Center
(Medical)
Cowlitz Family
Health Center
(Medical/Dental)
Naselle Clinic
(Medical)
Ocean Beach
Medical Center
(Medical)

11.  Willapa Behavioral Health
(WA State Department of Social and Health Services, 2010)
 Two locations:
› North county: Raymond
› South County: Long Beach

12.  University of Washington Telehealth
Services:
› Ocean Beach Hospital, Ilwaco
› Willapa Harbor Hospital, South Bend,
› Shoalwater Bay Tribe, Tokeland
 Rural telehealth services included:
› Surgical telementoring
› Medicine and cardiology grand rounds and
nursing video teleconferences
(University of Washington, 2005)

13. Health Indicator Pacific County WA State
Reported Chlamydia infectionsᵃ 1385/100,000 2277/100,000
Adult binge drinkingᵃ 15% 16%
Violent crime rateͨ 179/100,000 342/100,000
Access to healthy foodsͨ 50% 47%
Food service safetyᵃ 100% 93%
Reported child immunizationsᵃ 47% 42%
Children with health insuranceᵃ 96% 95%
Note: ᵃ Washington State Department of Health (2009)
ᵃ Washington State Department of Health (2006)
ͨCounty Health Rankings (2010)
ᵃU.S. Department of Health & Human Services (2009)
* Peer County Range

14. Health Indicator Pacific County WA State
Adult physical activityᵃ 27% 51%
Teen physical activityᵃ 42% 42%
Adult overweight/obeseᵃ 63% 61%
Teen overweightᵃ 33% 25%
Obesityᵃ 37.8% 24.2%
Adult cigarette smokingᵃ 27% 16%
Teen cigarette smokingᵃ 21% 15%
Teen alcohol useᵃ 40% 33%
Adult poor mental healthᵃ 16% 10%
Suicideᵃ 34.3 13.9-34.5*

15. Health Indicator Pacific County WA State
Motor vehicle crash death rateͨ 27/100,000 12/100,000
Child unintentional injury hospitalizationsᵃ 326/100,000 205/100,000
Mortality from unintentional injuryᵃ 54.1 30.2-58.1*
Influenza Vaccination (65 yrs or older)ᵃ 71% 72%
Infant mortalityᵃ 6.5% 3.3-9.5*
Post-neonatal infant mortalityᵃ 3.0% 0.0-5.0%*
Adults with unmet medical needᵃ 16% 14%
Adults with personal healthcare providerᵃ 76% 79%
Adult dental careᵃ 63% 74%
Adult with health insuranceᵃ 72% 84%

16. Adult and teen obesity
Adult and teen physical activity
Adult access to dental care

17.  Obesity/Physical Activities
› What types of outdoor activities are available?
› What programs exist to encourage physical
activity?
› What healthy food education or programs are
available or of interest to the community?
› What types of resources are desired by the
community to promote physical activity and
health foods?
› What existing resources can be strengthened or
advanced?
› What resources are need to build on existing
strengths, address barriers, or develop new
programs?

18.  Adult Dental Access
› What are the local resources for adult dental
care?
› What are your non-dental and emergency care
providers observing in adult dental issues?
› What are the known barriers to adult dental
care access?
› What resources are needed to increase adult
dental care access?
› If additional dental providers were available,
how could services be offered to increase
access?

20.  “Fit and Fun” model
(Rural Healthy People 2010 Project, Southwest Rural Health
Research Center, 2010)
 School and community-based fitness and
nutrition strategy
 Initially implemented in Gowanda, New
York in 1999
 Community collaboration with state rural
health network organization and five
community partners.

21.  Program Components
› Healthy Snack Taste Testing
› Healthy Choices Sticker Program
› Fitness Bucks
› Fit & Fun Relay Night
› Family Fit & Fun Night
 Recommended staffing:
› Part-time paid program
coordinator, public relations
coordinator, finance staff person
and clerical support (part-time).
› Volunteer program support

22.  Funding required
› Initial five-year foundation or other grant
funding recommended
 Program effectiveness
› Student selection of new foods, amount and
frequency of student daily physical activity,
and number of students and adults receiving
information/education and participating in
activities.

23.  Work with community to identify additional
environmental infrastructure to support and
encourage physical activity such as:
› Walking paths, bicycling paths, beach routes
 Identify and obtain foundation/grant funding
for completion of paved trails in north and
south county regions
(Pacific County Economic Development Council, 2009)

24.  Protocol for Assessing Community
Excellence in Environmental Health
(PACE-EH)
 Four major components with 13 subtasks
› Assess the community
› Define the Problem
› Take action
› Evaluation
(National Association of County and City Health Officials)

25.  Pacific County is a rural county with
majority of health indicators performing
worse than WA State comparison
 Selected Priority health issue: Adult and
teen obesity
 Recommended intervention: “Fit and
Fun” model (Southwest Rural Health
Research Center)

26. Community Health Services (2010). Health care authority funded community clinics in Washington State.
Retrieved from www.chs.hca.wa.gov/clinics.html
County Health Rankings (2010). Snapshot 2010: Pacific. Retrieved from http://
www.countyhealthrankings.corg/print/washington/pacific
Mapquest (2010). Pacific County, Washington. Retrieved from
http://www.mapquest.com/maps?city=Willapa&state=WA&country=US&latitude=46.674999&l
ongitude=-123.665001&geocode=CITY
Pacific County Economic Development Council (2009). Comprehensive development strategy for
Pacific County. Retrieved from http://www.pacificedc.org/Business/ 2009%20PCCEDS1.pdf
Southwest Rural Health Research Center (2010). Models for practice focus area: Educational and
community-based programs. Rural Healthy People 2010. Retrieved from
http://srph.tamhsc.edu/centers/rhp2010/html/education/fitfun.htm
University of Washington (2005). Telehealth services at the University of Washington: Current
telehealth activities and partner. Retrieved from http://depts.washington.edu/uwths/home
/present.php
U.S. Census Bureau (2000). Profile of General Demographic Characteristics. Retrieved from
http://factfinder.census.gov
U.S. Department of Labor, Bureau of Labor Statistics (2010). Local Area Unemployment Statistics.
Retrieved from http://data.bls.gov/PDQ/servlet/SurveyOutputServlet

27. U.S. Department of Health & Human Services (2009). Community Health Status Indicators. Retrieved
from http://communityhealth.hhs.gov
U.S. Department of Labor, Bureau of Labor Statistics (2010). Local Area Unemployment Statistics.
Retrieved from http://data.bls.gov/PDQ/servlet/SurveyOutputServlet
U.S Bureau of the Census (2010). http://quickfacts.census.gov/qfd/states/53/53049.html
Washington State Department of Health (2006). Access to Hospital-based Perinatal and Neonatal
Care. Retrieved from http://ww4.doh.wa.gov/gis/pdf/neon_tt.pdf
Washington State Department of Health, Rural Health Programs (2009). Federally Designated Rural
Health Clinics by County as of July 1, 2009. Retrieved from www.doh.gov/hsqa/ocrh/RHC
/Fed_DesignRHCs.pdf
Washington State Department of Social & Health Services (2007). DSHS Client Services, July 2006 –
June 2007). Retrieved from http://clientdata..rda.dshs.wa.gov
Washington State Department of Health (2009). Pacific County Public Health and Human Services
Department. Retrieved from http://www.doh.wa.gov/phip/khi/lphi/lhj/
pacific/access/access1.htm
Washington State Department of Social & Health Services (2010). Authorized community mental
health agencies. Retrieved from www.dshs.wa.gov/mentalhealth/timberlands.shtml