Community Health Assessment

Health Factors


There are a plethora of factors that influence a person’s overall health. The Health Rankings Model focuses on four main health factors that influence the future health of the county. The four factors include: Social and Economic Factors, Healthy Behaviors, Clinical Care, and Physical Environment (1). 

The remainder of this report will discuss the health indicators that make up the four Health Factors.

Social and Economic Factors

The Health Rankings Model estimates that 40% of our health is influenced by the social and economic conditions in which we live(1). This in demonstrated in the Health Rankings Model diagram at the top of this report. Some examples of social and economic factors of interest are education, employment, income, poverty and crime.

Graduation Rates

Historically, Mason County’s high school graduation rates have been lower than the state rates for both on-time and extended graduation (2). On-Time graduation rates in Mason County are improving over time (2).

Extended graduation rates include students who completed their high school diploma after their expected year of graduation (2). Extended graduation rates have also improved over the past seven years (2).

Educational Attainment

Mason County’s adult education attainment levels have been and continue to be lower than state rates. However, local rates have increased when compared to rates of the previous decade. Mason County has a higher percent of adults with less than a high school diploma and a lower percent of adults who have completed a college degree. Twenty percent of Washington State residents have a Bachelor degree or higher, while only 12% of Mason County residents has attained this same education level (3).

Unemployment Rate

Mason County’s unemployment rates have been consistently higher than the state’s rates over a number of years. Most recently in 2018, Mason County’s unemployment rate was 1.8% higher than the state’s rate (4). Mason County has experienced a slower recovery since the economic downturn of 2008. Despite the slow recovery, unemployment rates continue to fall in Mason County, with a 5.6% improvement in rates occurring since peak unemployment rates in 2010.

Poverty and Income Inequality

Poverty rate is defined as “living at or beyond the Federal Poverty Guidelines.” In 2018, the poverty threshold for a family of four with two children under the age of 18 was any family making at or below $25,465 a year (5). In Mason County, 16% of residents met these criteria and were living below the federal poverty level (6). That same year, 1 in 4 Mason County children, under the age of 18, lived in poverty (6). Over time the total poverty rate has decreased but by a minimal amount. The poverty rates for children have remained consistent, with a quarter of children in Mason County living in poverty (6).

The incidence of children in poverty is not evenly spread across the county, as indicated by Free/ Reduced Meal Program data (2). For example, 84% of students who attend Hood Canal School district receive free or reduced meals, compared to 24% of Mary M. Knight students (2).

Income inequality can also be an indicator of health outcomes. Income Inequality is defined as the ratio of household income at the 80th percentile to that at the 20th percentile. A higher inequality ratio indicates greater division between the top and the bottom ends of the income spectrum. Between 2013-2017, Mason County’s income inequality ratio was 4.3 which was consistent with Washington state’s ratio of 4.6 (7). Since 2013, the income inequality ratio has been increasing in Mason County along with Washington State’s ratio.

Household Structure

Single parenthood presents unique challenges in regard to social interaction. Both parents and children living in single parent households experience poorer health outcomes. In 2017, the divorce rate in Mason County was 3.5 per 1,000 persons (8). Divorce rates in Mason County have decreased from 257 recorded in 2015, compared to 184 divorces in 2017. The majority of families in Mason County with children under the age of 18 are headed by couples. However, 41% of families are single parent households (9).

Social and Emotional Support

Research shows that individuals with limited social and emotional support experience poorer health outcomes. The majority of Mason County youth report having consistent social and emotional support. 3 out of 4 youth reported that they could ask their parents for help with a personal problem (10). Over half of those same youth also reported having an adult in their lives they could turn to if they felt depressed (10). 

Crime Rates

The safety of the community in which we live and work can also be an indicator of health outcomes (1). In Mason County, the arrest rates for youth ages (10-17) are lower than the state’s rates for all types of crime (8). The total arrests for youth in Mason have decreased significantly over the past decade. In 2005, there were 381 recorded arrests for youth ages 10-17, compared to a mere 7 arrests in 2018 (8). For adults, Mason County arrest rates are lower than the state’s rate for property crime and drug law violations, and similar to the state for violent crime (8). Arrest rates for adults over time have remained relatively the same (8).

Youth is defined as 10-17 years of age. There were no reported arrests for youth in 2017. 

Unintentional Injury Deaths

The final indicator used to access social and economic health is injury death rates (1). Between 2014 and 2018, deaths due to unintentional injury or accidents were the third leading cause of death for Mason County residents, occurring at an age-adjusted rate of 49.0 per 100,000 (or 191 deaths) (11). This rate is higher than the state’s rate for that same time period of 42.1 per 100,000 (11). The top 3 causes of unintentional injury death in Mason County in the last five years (between 2014-2018) were poisoning, falls, and motor vehicle-traffic, in that order (11). Death rates due to unintentional injury have remained consistent over the past two decades, although the specific causes have changed over time. For example, the leading cause of accidental injury death between 2004 and 2018 was motor vehicle-traffic accidents (11). Today, deaths resulting from motor vehicle traffic injuries has fallen below poisoning and falls. 

Health Behaviors

The Health Rankings Model estimates approximately 30% of our health is influenced by an individual’s health behaviors (1). This in demonstrated in the Health Rankings Model diagram on page 1 of this report. Some examples of health behaviors of interest are substance use, physical fitness and safe sex practices.

Cigarette Smoking

The smoking rates of both adults and youth in Mason County have historically been higher than the state’s rates. Between 2014 and 2018, 21% of Mason County residents were current smokers compared to 14% of Washington state residents (12). Since 2012, smoking rates among adults in Mason County have remained around 1 in 5 residents. However, youth smoking rates have been decreasing since 2008. For example, 22% of 10th graders were current cigarette smokers in 2008, compared to only 8% in 2018 (10). Current smoking was defined as having smoked in the past 30 days (10).

‘Vaping’ or electronic- cigarette use has become more popular in recent years. Between 2014 and 2018, 23% of Mason County 10th graders reported using electronic cigarettes, compared to 17% of 10th graders in Washington State (10). The rate of 10th graders who report vaping has double since the last report between 2012 and 2016 when only 12% of 10th graders reported vaping. This increase reflects national trends for which the Surgeon General declared youth vaping at epidemic levels in December of 2018 (13).

Substance Use

Substance use and abuse is an individual health behavior that strongly influences health outcomes (1). Compared to the state, Mason County adults have lower usage rates of marijuana and similar heavy alcohol usage rates (12). Adult marijuana use rates have remained consistent since 2012, whereas heavy alcohol usage rates have decreased (12).

Mason County youth have higher binge drinking rates compared to the state at each grade level (10). Binge drinking is defined as having five or more drinks in a row in the past 2 weeks (10). Binge drinking rates among youth have decreased over time (10). In 2006, 28% of 12th graders reported binge drinking compared to only 16% in 2016 (10). Between 2014 and 2018, 1 in 3 12th graders in Mason County reported using marijuana in the past 30 days (10). Regular marijuana usage rates have increased since 20120 among both youth and adults in Mason County (10).

Deaths as a result of accidental poisoning from drugs or alcohol have remained relatively the same over the past decade (11). Between 2014 and 2018, the rate of deaths due to accidental poisoning in Mason County was 20 per 100,000 deaths, compared to 16.5 per 100,000 for Washington State (11).

Drug Overdose Deaths

Drug-specific overdose deaths have been increasing in Mason County for a number of years. Prior to 2010, death rates due to any drug overdose were as low as 8.2 per 100,000 population (14). In 2016, the rate of any drug overdose deaths in Mason County was higher than the state’s rate (14). That same year, Mason County Community Services-Public Health Division began their work in reducing drug overdose deaths. In 2017, the age-adjusted death rate due to any overdose decreased by 22% compared to the previous year (14).The age-adjusted death rate due to opioid overdose dropped even further from 13.7 per 100,000 to 4.8 per 100,000, a 65% decrease (14). In 2018, the age-adjusted death rate due to any overdose decreased again to a rate of 13.5 per 100,000, this time dropping below the state's rate of 15.4 per 100,000 (14). Also in 2018, the age-adjusted death rate for opioid overdose increased from the previous year, yet still remained below the state's rate. 


Although Mason County and Washington State report similar rates for adult diabetes (10% and 8%), a larger portion of the Mason County adult population is diagnosed as obese. Between 2014 and 2018, the obesity rate for Mason County adults was 10% higher than the state’s rate (12). Adult obesity rate in Mason County is increasing overtime. Between 2012-2014, 32% of adults in Mason County self-reported an obese BMI (Body Mass Index). Between 2016-2018, this percentage increased to 42% of Mason County residents (12). 

Mason County’s youth also experience higher rates of obesity when compared to the state. For example, 17% of Mason County 10th grade students are obese, compared to a state average of 12% (10). Youth obesity rates appear to be increasing over time in Mason County. In 2014, 13% of 12th graders self reported an obese BMI. This percentage increase to 19% in 2018 (10).  8th grade students also demonstrated a 7% increase in that same time frame (10). 

Physical Activity

Nearly a quarter of Mason County adults do not participate in leisure time physical activity (12). Leisure time physical activity is defined as “physical activity or exercises such as running, calisthenics, golf, gardening or walking for exercise” (12). In 2018, 75% of 10th graders in Mason County did not meet the recommendations for 60 minutes of physical activity 7 days a week, compared to the state’s 78% (11). 

Sexually Transmitted Infections

Sexually transmitted infection indicators are typically based upon reported Chlamydia cases, as Chlamydia is the most commonly reported sexually transmitted infection (1). In 2018, the rate of Chlamydia infection was 371.6 per 100,000 in Mason County, which was less than the state rate of 467.9 per 100,000 (15). Despite the overall rate being lower than the state’s, Chlamydia infection rates are increasing in Mason County. In the past decade, since 2008, Chlamydia infection rates have increased by 68% (15).

The teen birth rate in Mason County has historically been higher than the state’s (16). Between 2014 and 2018 there were 30 births per 1,000 female population ages 15-19, compared to 16 births per 1,000 for Washington State (16). The teen birth rate in Mason County varies by demographic.

Clinical Care

Clinical Care factors account for 20% of a community’s health status as demonstrated in the Health Rankings Model diagram on page 1 of this report  (1). Clinical care considers both 1) access to care and 2) quality of care issues.

Health Insurance Status

The quality of health care in a community is dependent on an individual’s ability to access both health insurance coverage and health care providers (1). Since 2013, the number of individuals who are insured has been increasing (17). In 2017, 91% of Mason County residents under 65 years old were insured compared to 93% of Washington state residents (17). In 2017, 96.6% of children under the age of 19 in Mason County were also insured. That same year, 97.4% of children under the age of 19 were insured in Washington State (17).

Access to Care

Accessing health care providers can be a challenge in Mason County due to barriers like geographical distances and provider shortages. In 2016, the ratio of Mason County’s population to primary care physicians was 4,440:1 (18); meaning there is only one primary care provider per every 4,070 residents in Mason County. In comparison, the ratio for Washington State was 1,220:1 (18). As a result, many residents are forced to leave the county to access primary care, or utilize urgent cares and emergency departments. In 2017, the population to dentist ratio was 2,550:1, which was two times higher (worse) than the state’s ratio of 1,240:1 (18). Finally, the ratio of residents to mental health care providers was also two times higher (worse) than the states ratio. In 2018, Mason County’s ratio was 650:1, compared to the states ratio of 310:1 (19).

Physical Environment

Physical Environment factors account for 10% of a community’s health status as demonstrated in the Health Rankings Model diagram at the top of this report (1). Some examples of physical environment factors of interest include housing stock, housing cost, and water and air quality.

Housing Stock

According to the American Community Survey, between 2013 and 2017 there were 33,190 housing units located in Mason County (20). Of that total, 23,034 units are currently occupied with 77% of those units being owner-occupied and 23% of units being rentals (20).

Housing Cost

A measure used to identify housing problems is housing cost burden (21). Housing cost burden is the ratio of housing cost (including utilities) to household income (21). The U.S. Department of Housing and Urban Development (HUD) considers households that pay more than 30 percent of their income for rent or housing costs (including utilities) as housing cost burdened (21). Nearly one-third (31%) of Mason County residents have a housing cost burden greater than 30 percent of their income (22). Of those residents that are housing cost burdened, 36% of households are renters and 64% are owner households (22). The percentage of residents in Mason County that are housing cost burdened is similar to the percentage of residents in the state of Washington (32%), but higher than the neighboring Grays Harbor county (29%) (22).

Water Quality

Mason County residents receive drinking water from three different types of public water systems: Group A, Group B, and private wells (23). Group A systems are the largest type of system and are regulated by the State Department of Health Office of Drinking Water (23). Group B systems are smaller systems and are regulated by Mason County Community Services-Public Health Division (23). Homeowners with private wells are responsible for monitoring their own drinking water systems for quality.

Open shellfish harvesting areas are an indicator of good water quality (24). Washington State monitors marine water quality to assure safe shellfish for the consumer (24). In addition to shellfish harvesting, stringent water quality requirements exist to assure the public’s health is protected. At the beginning of 2018, 350 acres in Mason County were restored to recreational harvestable shellfish acreage (25). This increase in harvestable shellfish acres indicates the correction of pollution sources (24).

Air Quality

The relationships between air pollution and poor health outcomes have been well documented (26). Unsafe levels of air pollution can lead to decreased lung function, chronic bronchitis, asthma and other adverse pulmonary effects. In Mason County, the main source of particulate matter is wood burning fire emissions. Forest fires are also a source of particulate matter. One way to evaluate the quality of the air is to measure particulate matter less than 2.5 micrograms in diameter. Particulate matter days are a measure of the annual number of days that air quality was unhealthy for sensitive populations due to fine particulate matter of 20.4 µm^3 or above (26). Higher values seen in 2017 are largely due to wildfire events (26).


(1) County Health Rankings and Roadmaps: Mason County

(2) Office of Superintendent of Public Instruction, State of Washington

(3) Educational Attainment. 2012-2016 American Community Survey 5-Year Estimates

(4) Unemployment Rates by County. Bureau of Labor Statistics

(5) U.S. Census Bureau, Poverty thresholds by Size of Family and Number of Children

(6) Poverty Status in the Past 12 Months. 2013-2017 American Community Survey 5-Year Estimates

(7) GINI Index of Income Inequality. 2013-2017 American Community Survey 5-Year Estimates

(8) Risk and Protection Profile for Substance Abuse Prevention in Mason County, July 2019

(9) Children Characteristics. 2013-2017 American Community Survey 5-Year Estimates

(10) Washington State Healthy Youth Survey. 2014-2018

(11) Community Health Assessment Tool – CHAT. Mortality-External Cause, 2014-2018 and 2004-2008. 

(12) Community Health Assessment Tool – CHAT. Behavioral Risk Factor Surveillance System (BRFSS), 2014-2018

(13) Surgeon General Warns Youth Vaping Is Now An Epidemic

(14) Community Health Assessment Tool – CHAT. Washington State Residents Drug Overdose Quarterly Report, 2017

(15) Community Health Assessment Tool – CHAT. Sexually Transmitted Diseases, 2008-2016

(16) Washington State Department of Health, Center for Health Statistics Birth Certificate Data, 1990–2018, Community Health Assessment Tool (CHAT), October 2019

(17) U.S. Census Bureau's Small Area Health Insurance Estimates—SAHIE. 2012-2016

(18) U.S. Department of Health and Human Services, Health Resources and Services Administration Data Warehouse, 2016 and 2017

(19)  National Plan and Provider Enumeration System (NPPES), National Provider Identification Registry, 2018

(20) Selected Housing Characteristics. 2012-2016 American Community Survey 5-Year Estimates

(21) Affordable Housing, U.S. Department of Housing and Urban Development,

(22) Comprehensive Affordability Strategy—CHAS. U.S. Department of Housing and Urban Development. 2012-2016

(23) Mason County 2036 Comprehensive Plan, Chapter 7: Utilities Element

(24) 2018 Washington State Health Assessment, Washington State Department of Health

(25) 2018 Shellfish Safety Information, Washington State Department of Health

(26) Olympic Regional Clean Air Agency.