Health Factors

Health Factors
     There are numerous factors that can influence a person’s and a community’s overall health. The distance to and the number of grocery stores, the quality of the air, and the number of fast-food restaurants are just a few of those factors. The County Health Rankings focuses on four main factors: Health Behaviors, Clinical Care, Social and Economic Factors, and Physical Environment

Health Behaviors

     Health Behaviors are practices, such as diet and exercise, which can improve or damage the health of individuals. The County Health Rankings estimates that 30% of our overall health is impacted by our behaviors and choices we make. Health Behaviors are determined by the options available to us, where we work, live, and learn (1).

Comparison of Key Indicators, table


     Historically, the smoking rates of both adults and youth in Mason County have been higher than those of the state (1). 
Adult Cigarette Smoking, line graph

     Youth smoking and vape use is significantly higher in Mason County than the state. Due to a small sample size, the data in 6th and 12th grade has been suppressed (4).



     Obesity is considered a national epidemic and increases the risk for several chronic health conditions, including heart disease, type 2 diabetes, hypertension, and stroke. A body mass index (BMI) of over 25 is considered overweight, and over 30 is considered obese.

Adult Obesity, line graph

     From 2016 to 2019, the adult obesity rate in Mason County was higher than neighboring counties, Grays Harbor and Lewis, as well as the state. In 2019, the rate dropped below the rate of Grays Harbor (5).
     The obesity or overweight rates for students in 8th and 10th grade are also higher than those of the state. 27% of 8th graders are obese and 15% are overweight, while 26% of 10th graders are obese and 12% are overweight. The data collected for 12th grade was suppressed due to less than 40% participation (4). 

Youth Obesity, bar chart

Physical Activity

     Physical activity is anything that gets your body moving and increases your heart rate. Physical activity can help with your mental health, pain management, and lowers your risk of high blood pressure. For adults, it is recommended to get 150 minutes of moderate-intensity aerobic physical activity each week. This can include walking, running, playing tennis, or even mowing the lawn. The percentage of adults not meeting the leisure time physical activity recommendations has varied over time. In 2019, the percentage spiked to 38%, compared to 15% in 2018 and 24% in 2020 (6).

     For children and adolescents, it is recommended that they get 60 minutes of moderate to vigorous physical activity each day. This should include aerobic activity, muscle strengthening, and bone strengthening exercises. In 2021, 81% of 8th graders and 82% of 10th graders did not meet these recommendations. Both of these numbers reflect the numbers around the state (4).
Leisure Activity, 2 charts, adult and youth
Food Insecurity

     The County Health Rankings measures a county’s Food Environment Index based on the estimated percentage of the population that is low income and does not live close to a grocery store. For rural areas, this means living more than 10 miles from a grocery store. It also measures the estimated percentage of the population that did not have access to a reliable food source. The Food Environment Index is ranked from 0 to 10, with 0 being the worst and 10 being the best. In 2020, Mason County was ranked at 7.6, compared to the state’s ranking of 8.4. The percentage of the population that lacks adequate access to a reliable source of food has remained relatively consistent throughout the county, while steadily decreasing throughout the state (1).
Food Insecurity Rates, line graph, Mason County and Statewide

     The schools in Mason County have seen a steady increase in the participation rates for free or reduced-price meals. The rates in the county have consistently been higher than those of the state (8).

Participation Rate Free School Meal
Substance Use

     Substance use and abuse is harmful to the health and wellbeing of individuals as well as their loved ones. Over the past few years, heavy alcohol consumption and binge drinking have been on a steady decline. Binge drinking is defined by having five or more drinks in a row and heavy alcohol consumption is defined by having two or more drinks in a day for men or, one or more drinks for women. Contrary to this, marijuana use has increased over the past few years (5).

     Youth alcohol consumption has decreased consistently over the past 10 years. For youth marijuana usage, both 8th and 10th graders had an increase in usage from 2016 to 2018. However, since 2018, marijuana usage has decreased, across both grade levels (4).

Substance use line chartYouth Alcohol Drinking, line graphYouth Marijuana Use, Past 30 days, line graph

Drug Overdose Deaths

     The drug overdose death rate has varied over the past decade but has skyrocketed since 2018. In 2016, Mason County Public Health and Human Services implemented new programs to help reduce drug overdose deaths in the county. In the following years, the death rate steadily decreased.

     With the introduction of fentanyl to our community, as well as the negative impact on mental health from COVID-19, the overdose death rate has dramatically increased.


Sexually Transmitted Infections

     Sexually transmitted infection (STI) indicators are usually based on the reported Chlamydia cases. Chlamydia is the most common STI in the United States. The infection rate in Mason County has continuously been lower than the state’s and has been decreasing since 2019. It is important to note that the burden of disease may be higher than what is reported as not all STIs are diagnosed (7). 

     In 2021, the Shelton WIC clinic closed. This created a new gap in services to thousands of families who regularly accessed the clinic for nutrition, breastfeeding support, and many other resources. This past year, Mason County was chosen for a new WIC grant and will be able to open a new clinic in the next few months.

     Becoming pregnant during teenage years significantly increases the likelihood of future risky sexual behavior, STI, and other negative health outcomes. Pregnant teens are more likely than older women to receive late or no prenatal care, and experience an increased risk of complications in pregnancy, preterm delivery, low birthweight, and severe neonatal conditions.

Teen Births, bar chart
     Historically in Mason County the teen birth rate has been higher than the state’s rate. Between 2014 and 2020, there were 30 births per 1,000 females aged 15-19 in the county compared to 15 births per 1,000 for Washington state. The teen birth rate in the county varies by race demographic. For example, the teen birth rate among Hispanic females ages 15-19 is 79 births per 1,000, compared to 21 births per 1,000 White females (1).

Clinical Care

     Clinical Care is anything that relates to the direct medical treatment of patients. Approximately 20% of a community’s health status is determined by clinical care factors. Low quality or limited care can lead to delayed diagnosis and treatment, lower quality of life, and shorter lives. Access to care and the quality of care can vary because of race, income, or location. Key indicators that are examined when looking at clinical care are the percentage of uninsured individuals, and the ratios of the population to providers for mental, medical, and dental services (1).

Clinical Care Comparison of Key Indicators

Health Insurance Status

     Receiving quality care is dependent on one’s ability to not only find a provider, but also by having insurance. From 2013 to 2017, there was a sharp decline in the county’s uninsured rates, meaning more people under the age of 65 had health insurance. Since then, there has been a slight increase in the uninsured rate, but it has evened out in the past few years. Historically, the uninsured rate in Mason County has been higher than the state’s rate. In 2020, 13% of adults (under age 65) and 4% of children (under age 19) were uninsured (1).
Uninsured, line chart

Access to HealthcareHealthcare Provider Ratios


    In Mason County, access to healthcare can be a challenge to residents due to the rural geography, and a shortage of resources and providers. In 2022, the ratio of patients to primary care physicians was 3,590:1. This means there is only one provider per 3,590 people. In comparison, the state’s ratio is 1,180:1. The ratio for the population to dentists is 2,730:1 and for mental health is 560:1. Both of these ratios are more than double those of the state, which are 1,230:1 and 270:1, respectively. As a result of these high ratios, residents of Mason County are obligated to travel to other counties for care (1).

Childhood Immunizations

     Childhood immunization rates have taken a sharp decline over the past few years. The COVID-19 pandemic has caused people to be hesitant to vaccinate their children.

Childhood ImmunizationsSocial_Indicators

Social and Economic Factors

     Approximately 40% of our health is influenced by the social and economic conditions we live  in. This includes education, employment, income, poverty, and crime (1).


Graduation Rates

     Education is an important indicator for health. Those who have a higher education are less likely to smoke, more likely to exercise, and have better physical health overall. People who graduate high school are employed more often and tend to earn more money than those who do not. On-time graduation rates in the county have been increasing since 2015 and have only recently matched those of the state. High school completion rates in Mason, Grays Harbor, and Lewis counties are all very similar. They are all slightly lower than the rates of the state (1). 

High School Graduation
3c1dfe1ac11911e8baab0242ac110005_modifiedEducational Attainment

     Mason County has a lower percentage of adults with less than a high school diploma and a higher percentage of high school or GED equivalent, some college, and associates degree than the state. 39% of Washington state adults have a bachelor's degree or higher, compared to approximately 24% of Mason County adults. The educational attainment levels are comparable to, or better than those of neighboring counties (9).

Educational Attainment


     Unemployment rates in Mason County have historically been higher than the state’s rate. There is a sharp increase in unemployment from 2020-2021. This is due to the COVID-19 pandemic that caused numerous people to lose their jobs. In 2022, the unemployment rate fell as the world started to open up again and people resumed working (10). 

Poverty and Income Inequality

     The poverty rate is the ratio of people whose income falls below the poverty line. In 2021, the poverty threshold for a family of four, with two children under the age of 18, was $29,678. Meaning any family making $29,678 or less is considered to be in poverty (11).

     In Mason County, 13.8% of the population met these criteria. Mason County’s poverty rate has historically been higher than the state’s. While the rate is below neighboring counties Lewis and Grays Harbor, Mason County’s rate has been increasing over the past few years (12).

     Poverty at any age contributes to an increased risk of chronic health conditions, however children in poverty can experience long term effects on their education, health, and future income (12).

Household Structure

     Adults and children in single-parent households are more at risk for adverse health outcomes, such as mental illness, substance use disorder, and other unhealthy behaviors. In 2021, 17% of children in Mason County lived in a single-parent household (1).


     In 2019, the divorce rate in Mason County was 3.6 per 1,000 people. 194 divorces were recorded (14).  The majority of families (68%) in the county with children under the age of 18 are headed by couples (13).

Family & Social Support

     Those who have greater social support, interpersonal trust, and less isolation are happier and healthier than those who are socially isolated. Social support comes from one’s relationship with their family, friends, and community. Socially isolated individuals have an increased risk for poor health outcomes, such as high levels of stress and anxiety, cardiovascular disease, overeating, smoking, and many other unhealthy behaviors.

     In 2021, 59% of 8th graders and 55% of 10th graders reported having adults in their lives that they can turn to when feeling anxious or depressed (4).


Community Safety

     The safety of our community can be another indicator of health outcomes. Living in an unsafe neighborhood is linked to chronic stress, anxiety, and depression. It is also linked to higher rates of preterm birth and lower birth weight.

     In Mason County, the arrest rates for adults are lower than the state’s, for property crime and drug law violations. Arrest rates are very similar to the state for violent crime (14).

     For adolescents in Mason County, the arrest rate for adolescents has been steadily decreasing over the past decade and has consistently been lower than that of the state (14).

Unintentional Injury Deaths

     The final factor for accessing social and economic health is injury death rates. Injuries happen when the physical environment is unsafe or when one is engaging in unsafe behaviors. Community conditions can impact the safety of an area differently for different age groups, genders, socioeconomic classes, and neighborhoods. Unintentional injuries or accidents are one of the top three leading causes of death in Mason County. From 2017-2021, the age-adjusted rate for unintentional injury death is 78.8 per 100,000 or 232 deaths. Mason County’s rate, as well as the rates of neighboring counties Lewis and Grays Harbor, are higher than the state’s rate. Three causes of unintentional injury death in Mason County are poisoning, falls, and motor vehicle accidents (3).

Physical Environment

     The remaining 10% of a community’s health status is determined by the Physical Environment. The air quality, water quality, the housing we live in, and the transportation systems are just a few examples of the physical environment (1). 

Housing and Homelessness

     Stable and affordable housing are necessary to provide a safe environment for families to live, grow, and learn. Having a home that is safe and free from any physical hazards greatly reduces the risk for injuries, infections, and poor childhood development. Housing is often the largest expense for a family, and a housing cost burden forces people to choose between essential utilities, food, transportation, or medical care. In 2021, there were 33,219 housing units in Mason County, with 25,085 units occupied. Of those occupied units, 78.4% were owner-occupied, and 21.6% were renter-occupied.

     One measure used to identify housing problems is the housing cost burden. Households that pay more than 30% of their income on rent or housing costs are considered as housing cost burdened. Almost 30% of Mason County residents have a housing cost burden. Mason County has a lower housing cost burden compared to the state, and neighboring counties.

     The US Department of Housing and Urban Development (HUD) and Washington State require an annual statewide count of people experiencing homelessness, known as the Point in Time (PIT) Count. The PIT count includes both sheltered and unsheltered persons. Sheltered refers to all people living in a temporary housing program while unsheltered refers to people living in places that are not meant for human habitation. The 2022 PIT Count included both sheltered and unsheltered in the total (15).

     Increasing Rent has been the main driver of homelessness in Washington. Fair Market Rent is a statistic calculated by HUD to determine payments for various housing assistance programs. From 2022 to 2023, rent in Mason County increased for all types of units by at least $80 dollars (16).

Water Quality 

     Water contaminated with chemicals, pesticides, or other contaminants leads to illnesses, infections, and increased risks of cancer (1).  Mason County residents get their drinking water from three different types of public water systems: Group A, Group B, and private wells. Group A systems are the largest type of system and are regulated by the State Department of Health Office of Drinking Water. Group B systems are smaller systems and are regulated by Mason County Public Health. Homeowners with private wells are responsible for monitoring their own drinking water systems for quality (17). In 2021, there was at least one drinking water violation in the county (1).

Air Quality


     Air pollutants such as fine particulate matter, ozone, sulfur oxides, carbon monoxide, and greenhouse gases can be harmful to our health and to the health of the environment. These harmful particles can be directly emitted from sources such as forest fires, or they can form when gases emitted from power plants, and automobiles react in the air. In Mason County, the main source of particulate matter is wood burning fires, including forest fires (1).

Asthma in Mason County has fluctuated over the past few years. Rates of asthma in the county are very similar to the rates of the state. This suggests that there are no environmental conditions contributing to adverse health outcomes in the county (5).


(1) County Health Rankings & Roadmaps. University of Wisconsin Population Health Institute.

(2) United States Census Bureau, QuickFacts: Mason County. 

(3)Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990-2019, Community Health Assessment Tool (CHAT), April 2023.

(4) Washington State Department of Health. (2021). Healthy Youth Survey.

(5) Behavioral Risk Factor Surveillance System (BRFSS) 2012-2021. Washington State Department of Health, Center for Health Statistics, Community Health Assessment Tool (CHAT), December 2021.

(6) Centers for Disease Control and Prevention. (2022, March 17). Physical activity basics. Centers for Disease Control and Prevention.  

(7) Washington State Department of Health. (1 June 2021). Sexually Transmitted Infection Cases and Rates by County.

(8) Washington Office of Superintendent of Public Instruction Data Portal. (2015-2023). School Meals Participation Report.

(9) U.S. Census Bureau. (2021). Educational Attainment for the Population 25 Years and Over, 2017-2021 American Community Survey 5-Year Estimates.

(10) U.S. Bureau of Labor Statistics, U.S. Department of Labor (2023). Local Area Unemployment Statistics Map.

(11) U.S. Census Bureau (2021). Poverty Thresholds by Size of Family and Number of Children.

(12) U.S. Census Bureau. (2021). Poverty Status in the Past 12 Months, 2017-2021 American Community Survey 5-Year Estimates.

(13) U.S. Census Bureau. (2021). Children Characteristics, 2017-2021 American Community Survey 5-Year Estimates.

(14) Washington State Department of Social & Health Services, Research and Data Analysis Division. (2021). Risk and Protection Profile for Substance Abuse Prevention in Mason County.

(15) Washington State Department of Commerce. (2017-2022). Annual Point in Time Count.

(16) FY 2023 Fair Market Rent Documentation System. FY 2023 Fair Market Rent Documentation System - Calculation for Mason County, WA,  

(17) Water System Data for Download. Washington State Department of Health,