Highlights:
Introduction/Overview
Harbor Regional Health Community Hospital (HRHCH) is a 140-bed licensed acute care community hospital located in Aberdeen, Washington, the largest city in mostly rural Grays Harbor County. GHCH is designated by Medicare as a Sole Community Hospital (SCH). The SCH program was created by Congress to support small rural hospitals which "by reason of factors such as isolated location, weather conditions, travel conditions, or absence of other hospitals, is the sole source of inpatient hospital services reasonably available in a geographic area to Medicare beneficiaries”.
Demographics
The population is expected to grow much more slowly in the District/PSA and County than in the rest of the state between today and 2024 (2.2%, 2.6% and 6.2% respectively). Today, the percentage of the District and County’s population that is 65+ is already higher than the state (22% compared to 15.9%). It is also the cohort expected to continue to grow through 2024.
Social Determinants of Health
Social determinants of health—the conditions under which people are born, grow, live, work and play—greatly influence the health of a community and its residents. Graduation rates, housing affordability, income/poverty and race are all social determinants. Figure 5 shows that social and economic factors are more of a burden in Grays Harbor County than in many other areas of Washington State. This includes poverty and unemployment.
The Median Household Income in the District is 66% of that of the State ($46,650 vs. $70,116). Rates of poverty in the District (17.1%) are also higher than the County (16.0%) and are significantly above the state’s rate of 11.5%. In the past several years, both the District/PSA and the County’s unemployment rates have been in the range of 6.4% to 8.5%, about 50% higher than the state (4.2% to 5.5%). Like uninsured rates, unemployment rates across the state have also been significantly impacted by COVID-19, with Grays Harbor County currently experiencing an unemployment rate of 14%.
The District’s Health Status
The Robert Wood Johnson Foundation’s County Health Rankings compare counties within each state on more than 30 factors. Counties in each state are ranked according to summaries of a variety of health measures, and counties are ranked relative to the health of other counties in the same state. The 2017 and 2020 summary composite scores for Grays Harbor County are identified in Table 6. As the table shows, while there was improvement in the County’s Overall Health Factors ranking and specifically in clinical care and health behaviors, Grays Harbor County still ranks in the lowest quartile of Washington’s 39 total counties in both Overall Health Outcomes and Overall Health Factors and shows a worsening in length of life, quality of life and social and economic factors.
In 2018, Grays Harbor had the second highest death rate (827.1 per 100,000) in the state, second only to Pacific County (838 deaths per 100,000). This compares to the state rate of 664.5 per 100,000. As depicted in Figure 10, and consistent with the state, the leading causes of death in Grays Harbor County are cancer and heart disease. However, both cancer and heart disease death rates are significantly higher in the County than the state.
Health Risk Behaviors and Outcomes
District residents experience a greater burden of chronic diseases than the rest of Washington. As can be seen in Table 7, the self-reported rates of diabetes among County and District residents are over 39% higher than Washington State residents and obesity is 29% higher in the District than the State.
The most common behavioral contributors to chronic disease, morbidity or mortality include diet and activity patterns, the use of alcohol, drugs, tobacco, firearms, and motor vehicle accidents. Importantly, the social and economic costs related to these behaviors can all be greatly reduced by changes in an individual’s behaviors. Table 8 shows that Grays Harbor generally ranks significantly worse on health behaviors. Of note are Physical Inactivity (41% higher than State) and Teen Births (55% higher than State).
Higher teen birth rates in the County are of concern. Younger mothers are less likely to get prenatal care early in their pregnancies and their pregnancies are more likely to result in premature births and low birth-weight babies.
According to the Washington State Department of Health Center for Health Statistics, in 2018 11.5% of mothers in Grays Harbor County received late or no prenatal care compared to 6.5% statewide. Additionally, 6.3% of births were low birthweight compared to 5.3% statewide, and 12.4% of births were premature compared to 9.4%. Both the lack of prenatal care and birthweight correlate to poorer overall health over a person’s lifespan.
Behavioral Health and Substance Use
In the CDC’s BRFSS 5-year 2014-2018 estimates show that 25.12% of the service area reported being told they have a depressive disorder (including depression, major depression, dysthymia, or minor depression), compared to 22.05% for the state. Grays Harbor County experienced an overall suicide rate more than 25% higher than the State average for the 2013-2017-time frame.
With a 75% increase between the 2002-2004 timeframe and the 2016-2018 timeframe, Grays Harbor County now ranks fourth highest of all Washington Counties for all opioid fatalities, with a rate of 15.95 per 100,000 in 2016-2018, compared to 10.28 per 100,000 statewide. The County also ranks in the top 5 counties for heroin overdose deaths with a rate of 7.29 per 100,000 in 2016-2018.
Access to Care
The number of Primary Care Physicians per 100,000 in Grays Harbor County is considerably lower than Washington State’s at 34 versus 97 per 100,000 and U.S. Top Performers at 85 per 100,000. Healthcare access Grays Harbor ranks below the state on all 7 healthcare access measures developed and reported in 2020 by County Health Rankings. This includes an uninsured rate of almost 30% higher and 31% more preventable hospital stays per 100,000 Medicare enrollees.
Community Convening
this year, due to COVID, we chose to distribute an online survey to District/PSA and County leaders as well as to organizations that serve the vulnerable, including:
City Government Officials: Aberdeen, Cosmopolis, Westport, Montesano, and Hoquiam, GHCH Foundation, School Districts in Aberdeen, North Beach, and Ocosta, Grays Harbor County Public Health, Quinault Nation, Grays Harbor Community Foundation, GHCH Foundation, Grays Harbor County Emergency Management, Port of Grays Harbor, Behavioral Health Resources, Law Enforcement/Chief of Police of Aberdeen, Hoquiam, and Montesano, First Responders from Ocean Shores and Grays Harbor County Fire, YMCA of Grays Harbor, and State and Federal Representatives from the 24th Legislative and 6th Congressional Districts.
The vast majority of respondents concluded that GHCH’s 2017 priorities should continue to be priorities in the upcoming years with health promotion and education receiving the highest rating (88%) and economic development the lowest (but still at nearly 70% of respondents). 94% of respondents also thought health care access should be a priority.
When ranked compared to other priorities, Healthcare Access (69%) and Behavioral Health (56%) rose to the top, with Prevention and Management of Chronic Disease ranking in the top two for only 37.5% of respondents. Economic development ranked in the top two for only 25% of respondents.
2020-2022 CHNA Priorities
Based on the health needs in Grays Harbor County and the District, and after consideration of: 1) our resources and expertise, and 2) other community agencies and providers and their respective areas of expertise, resources and programming, HRHCH adopted the following CHNA priorities for 2020-2023:
1. Healthcare Access
2. Behavioral/Mental Health
3. Prevention and Management of Chronic Diseases
4. Economic Development
We are confident that we can lead our selected initiatives and demonstrate quantifiable improvements over time. While we will not lead in certain areas, we still intend to actively support, partner and advocate in other initiatives, especially those around housing insecurity and programs for residents living on the margins wherein we improve mental and physical wellbeing.