Healthy Living Environment Indicators: Spokane

Introduction to Healthy Environments

When it comes to healthy living, we tend to think of things like gym memberships and eating vegetables. However, our social conditions, including the neighborhoods we live in, can also have a substantial impact on the public's health. Social Determinants of Health are defined as “Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Healthy People 2020, the health promotion and disease prevention initiative of the United States government, focuses on Five Key Social Determinants:

• Economic Stability
• Education
• Social and Community Context
• Health and Health Care
• Neighborhood and Built Environment

Local Focus: Spokane

These determinants have the most significant impact when we view them through the lens of a particular city. In 2015, approximately 18% of Spokane’s population was in poverty, compared to a statewide 12%. Within Spokane, there are serious inequalities among neighborhoods, with unemployment ranging from 10% to 28%, and 17% to 36% of adults living in poverty.
In 2016, there were 70 primary care practitioners (a physician, physician assistant, or nurse practitioner visited for general health concerns and annual checkups) per 100,000 people in eastern Washington, compared to 84.4 primary care practitioners per 100,000 people on the west side of the state.

Local Disparities

According to the Centers for Disease Control and Prevention, more than 32% of Spokane residents are obese compared to 22% in Seattle. Some Spokane neighborhoods have obesity rates as low as 21%, while others have rates of more than 40%.

Two aspects of heathy living are physical activity and diet; however, an estimated 20% of the adult population does not engage in any recreational physical activity. Significant variances in physical activity exist in the city, with rates ranging from 13% to 30%. Like many other major cities in the U.S., Spokane is a car-dependent community. Census data shows that 88% of commutes in the region are by vehicle while only 4% of trips are done by walking or other active options.

These patterns of obesity and low physical activity in Spokane align with a built environment that does not facilitate active living. Figures published by the City of Spokane show sidewalks missing on 38% of the suitable 981 miles of roads, with many existing sidewalks in poor condition. Additionally, there are

only 42 miles of lanes and paths dedicated for bicycles (3.1% of the suitable road network). Many neighborhoods with limited active travel incentives also have limited green space, including parks and trees. Neighborhoods with access to green space encourage walking and cycling, as well as informal social interaction, building neighborhood community.

Some parts of the city tend to have less-healthy food environments as well, either because residents have limited access to healthy food retailers or there is a high density of fast food or convenience stores present. In fact, some Spokane neighborhoods have access to 25 or more fast food outlets within a mile.