Objective 1: Assess population health needs

These indicators describe the size and characteristics of Washington’s population, including demographic groups that may experience difficult health risks, service needs, and barriers to care.

1. Population size and age structure
   1. What is the total population?
   2. What is the age and sex distribution of the population (pediatrics, working age, childbearing age, older adults)?
   3. What is the age dependency ratio across regions (ratio of children and older adults to working-age population)?
2. Race, ethnicity, and tribal affiliation
   1. What is the race and ethnic composition of the population?
   2. What percentage of the population identifies as American Indian or Alaskan Native or has tribal affiliation?
   3. What percentage of the population lives in tribal communities?
   4. What is the percentage of the population is foreign-born or immigrant within in the geographic regions?
3. Family and household structure
   1. What is the marital status distribution of the population?
   2. What percentage of households include children under 18?
   3. What percentage of households include young adults (ages 18 to 34) living with their parents?
   4. What percentage of older adults live alone or in households without potential caregivers?
   5. What percentage of households include unpaid caregivers providing care to older adults or individuals with disabilities?
4. Geographic distribution
   1. What is the percentage of the population living in urban, rural, and remote areas of the state?
   2. What percentage of the population lives in frontier or isolated regions across the state?
5. Language
   1. What languages are spoken at home?
   2. What percentage of the population has limited English proficiency across regions?
6. Disability
   1. What percentage of the population has a disability (physical, behavioral, or intellectual)?
7. Sex, sexual orientation and gender identity
   1. What is the sex distribution of the population?
   2. What is the distribution of sexual orientation and gender identity?
8. Education
   1. What is the educational attainment of the population?

Population change indicators identify long-term demographic trends that influence future health care demand.

1. Population growth and migration
   1. How is the overall population size and growth rate changing across regions?
   2. How is the age distribution of the population changing, particularly among children, working-age adults, and older adults?
   3. How are migration patterns affecting population growth or decline across regions (aging in place, in-migration, and out-migration)?
   4. What percentage of residents move within or between regions each year?
   5. How is the racial, ethnic, and tribal composition of the population changing across regions?
   6. How is the number of households with children, older adults, or multigenerational households changing?
2. Birth and fertility trends
   1. What are the birth and fertility patterns changing across geographic regions?
   2. What is the average age of first-time mothers?
3. Longevity and aging
   1. How is life expectancy changing across populations?
   2. Where is the population aging most rapidly?
   3. What is the projected growth of the population aged 65 and older, 75 and older, and 85 and older across regions?

Economic indicators include key social drivers that influence health outcomes and the ability of residents to access and afford care.

1. Income and economic security
   1. What are the average, median, and per-capita income levels?
   2. What percentage of the population lives below or near the Federal Poverty Level (138%, 150-400%)?
   3. What percentage of the population meets self-sufficiency or economic security standards?
   4. What percentage of the population live in areas of economic disadvantage?
   5. What is the cost of living across regions?
2. Public coverage and social support
   1. What percentage of the population is enrolled in Medicaid or is dually eligible for Medicare and Medicaid?
   2. What percentage of the population is eligible and participates in government social programs?
3. Housing
   1. What percentage of households own or rent their homes?
   2. What percentage of households spend more than 30% of income on housing costs?
   3. What percentage of households experience severe housing cost burden (spending more than 50% of income on housing)?
   4. Where are housing cost burdens increasing most rapidly across the state?
   5. Where are housing and food insecurity most prevalent?
   6. What percentage of older adults live in housing that supports aging in place (i.e., aging-ready)?
4. Employment
   1. What percentage of the population is unemployed or underemployed?
   2. What is the employment-to-population ratio?
   3. What is the long-term unemployment rate?
5. Digital connectivity and internet access
   1. What percentage of households have access to high-speed broadband or satellite internet service?
   2. What percentage of households report internet costs limits access to reliable service?

These indicators describe overall population health and highlight conditions contributing most to disease burden, disability, and mortality.

1. Mortality
   1. What are the leading causes of death and disability?
   2. Which populations experience the greatest disparities in mortality and health outcomes?
   3. What are the leading causes of premature mortality?
   4. What are the life expectancy trends across regions and populations?
2. Maternal and infant outcomes
   1. What are the maternal and infant mortality rates?
   2. What are the rates of severe maternal morbidity?
   3. What are the rates of preterm and low birth weight?
3. Chronic disease
   1. What are the cancer incidence rates by type and stage at diagnosis?
   2. What is the prevalence of major chronic diseases (e.g., diabetes, heart disease, stroke)?
4. Behavioral health
   1. What are the suicide rates?
   2. What is the prevalence of mental health conditions (e.g., depression)?
   3. What are the rates and patterns of substance use disorders and related harms (e.g., opioid overdose deaths)?
   4. What are the rates of drug overdose deaths?
5. Infectious disease
   1. What are the immunization rates among children and adults?
   2. What is the incidence of vaccine-preventable disease outbreaks?
   3. What are the trends and patterns of infectious disease outbreaks?
6. Health behaviors and injury
   1. What is the prevalence of health behavior risk behaviors (e.g., smoking, binge drinking)?
   2. What are the rates and severities of injuries?
7. Preventable health care utilization
   1. What are the hospitalization rates for ambulatory care-sensitive conditions?
   2. What percentage of emergency department visits are for non-emergent or primary care-treatable conditions?
   3. What are the emergency department visits rates per capita across regions and populations?
   4. What are the rates of preventable hospitals readmissions within 30 days?
   5. What are the rates of emergency department visits or hospitalizations related to behavioral health crises?
   6. How do preventable hospitalization rates differ across payer types?
   7. What percentage of residents report delaying or foregoing needed medical care?

These indicators help identify emerging trends that may increase demand for health services and highlight populations or regions where health outcomes are changing.

1. Demographic drivers of health care demand
   1. How are population aging trends affecting demand for chronic disease management, long-term care, and home-based services?
   2. How are changes in birth rates and maternal age affecting demand for prenatal, obstetric, and neonatal care?
   3. How are changes in the pediatric population affecting demand for pediatric primary care, behavioral health services, and preventive services?
   4. How are changes in household structure and caregiving availability affecting demand for formal health and long-term care services?
   5. How are migration patterns affecting regional demand for health services and provider availability?
   6. How are demographic trends affecting health care workforce supply and demand across regions?
2. Health disparities and population outcomes
   1. Where are health disparities widening across populations or regions?
   2. Where are health outcomes improving or worsening across populations?
   3. Where are health outcomes deteriorating most rapidly across populations or regions?
   4. Which populations experience the greatest differences in life expectancy, disease burden, or mortality?
   5. Where are avoidable deaths increasing or decreasing across populations?
3. Disease and behavioral health trends
   1. What behavioral health trends are increasing or emerging?
   2. Where is chronic disease prevalence increasing most rapidly?
   3. What conditions are contributing most to increases in health care utilization?
   4. Where are behavioral health conditions contributing to increased hospitalizations or emergency department visits?
   5. How are co-occurring behavioral health and physical health conditions affecting health care needs?
4. Prevention and public health trends
   1. Where are childhood immunization and vaccination rates declining most rapidly?
   2. Which populations have the lowest vaccination coverage?
   3. How are health risk behaviors changing across populations (e.g., smoking, binge drinking)?
5. Housing stability and housing-related health care needs
   1. How are housing affordability trends affecting the ability of residents to maintain stable housing, particularly among low-income households, older adults, and individuals with disabilities?
   2. How do housing instability and homelessness affect health care utilization, including emergency department visits, hospitalizations, and behavioral health crises?
   3. Where are housing shortages or lack of supportive housing options contributing to delays in hospital discharge or placement in community-based care settings?
   4. How does the availability and suitability of housing affect the ability of older adults and individuals with disabilities to remain safely in their homes?
   5. How do housing affordability and housing availability affect the recruitment and retention of the health care workforce across regions?
   6. How do poor housing conditions (such as overcrowding or environmental hazards) affect respiratory disease, injury risk, and other health outcomes?

These indicators help identify barriers to accessing services and gaps between population health needs and available health care resources.

1. Coverage and financing of care
   1. Where is government financing health care access?
   2. Where are tribal health systems providing health care?
   3. What is the distribution of health insurance coverage (Medicaid, Medicare, private, uninsured)?
   4. How is health insurance coverage changing across populations or regions?
2. Provider and facility capacity
   1. What is the ratio of health care providers to population across regions, including primary care, behavioral health, and specialty providers?
   2. How does the distribution of health care workforce affect access to care across regions?
   3. What percentage of providers are accepting new patients, and how does this vary by insurance type?
   4. What specialty care capacity is required to treat current chronic disease prevalence?
   5. Is primary care capacity sufficient to meet population needs?
   6. How many inpatient beds are needed to meet current and projected demand?
   7. What behavioral health infrastructure is needed based on population prevalence?
   8. Are there enough long-term care facilities and providers to meet demand?
   9. Where are perinatal providers located across regions?
3. Geographic access to service
   1. What is the average travel or drive times to different levels of care?
   2. How do health outcomes differ between rural or urban communities?
4. Timeliness and system performance
   1. What are the emergency department wait times and utilization patterns?
   2. How long are wait times for primary care?
   3. What is the prevalence of delayed or foregone care?
   4. What is the availability of after-hours care, urgent care, and same-day services across regions?
5. System alignment and care coordination
   1. Is trauma level designation aligned with regional injury burden?
   2. Where are there mismatches between health care needs and available services?
   3. What components of the health care system are needed to improve care coordination within regions?
   4. Which populations experience barriers to preventive care?