The Healthy Columbia Willamette Collaborative has identified discrimination, racism and trauma as the main drivers of health concerns for people in Clark County and the Portland metropolitan area, according to the recently released 2019 Community Health Needs Assessment.
The Collaborative is made up of four Public Health departments — Clark County, Multnomah County, Washington County, Ore. and Clackamas County, Ore. — as well as 15 hospitals and one coordinated care organization from those four counties.
According to a Clark County Public Health news release, seven other core issues explored in the assessment were: chronic conditions, sexually transmitted infections, behavioral health, community representation, culturally responsive care, access to health care, transportation and resources and isolation.
The Collaborative and its partners hosted four town halls and 18 community listening sessions across the region, with more than 200 participants.
“One of the important things about this report is hearing from the community, and learning what they see as important health issues,” said David Hudson, the healthy communities program manager with Clark County Public Health.
Clark County Public Health will use findings from the assessment to help it apply for grants and focus its preventative work. The assessment identifies core health issues and offers potential solutions to address the problems.
Compared with the other three counties, Clark County had the lowest median income ($15,171) among Latinos, and among those reporting two or more races ($15,935). It also had the highest percentage of residents who commute to work by driving alone (78.9 percent), while also holding the lowest percent of residents who commute to work by using public transportation (2.3 percent), carpooling (9 percent) or walking (1.9 percent).
Hudson said employers offering incentives for carpooling or public transit, or offering covered bike racks can help promote healthier commutes.
Clark County also had the lowest rate of social associations, meaning county residents are more isolated from their community. Hudson said people are more likely to exercise if they have a friend of family member who will do it with them. He said it’s especially important for older populations to have someone to go out and get active with so they can stay socially connected to their community.
“We know that impacts people’s emotional, mental and physical health,” he said.
The county had the highest percentage of population with a routine checkup in the previous year (68.6 percent), and the lowest percentage of eighth graders who were food insecure (8.6 percent). The county also had the lowest percentage of eighth graders who smoked cigarettes (1.3 percent). Hudson said the low cigarette usage was a testament to the work of Prevent Coalition and local schools, but also mentioned Clark County second-highest percentage who used e-cigarettes or vaping products.
“We can always do more,” Hudson said.
The report identified more “culturally and linguistically competent behavioral health services” were a need, according to town hall sessions.
“There aren’t a lot of therapists who look like us,” said a listening session participant.
The trend of racism and discrimination factored heavily into the findings on chronic conditions, where people of color suffered much higher rates of mortality from chronic conditions when compared to white people.
Diabetes and liver disease most impacted black, Pacific Islander, Latino and Native American people; hypertension held the same standing for black and Pacific Islander people. Heart disease mortality was most severe for black, Native American, Pacific Islander and white people.
The assessment concluded that racism and discrimination harmed trust between people of color and medical providers and impacted health disparities negatively.
“Many communities — LGBTQ+, rural, people living with disabilities, people living with mental health concerns, immigrants, refugees and people of color — face greater challenges in accessing resources, health care, and attaining overall well-being, due to discrimination and racism,” the report reads.
Town hall participants expressed that microaggressions, gentrification, racial profiling by police and hate crimes or riots from groups such as the Proud Boys made everyday life more stressful and impacted their overall health.
As one town hall participant phrased it: “There is a lack of acknowledgement that racism is a chronic health issue.”