“Whole Health” a Priority for King County

In the years since the M7.2 Seattle Fault earthquake, King County has made significant progress in rebuilding the health of its community as a whole. The county suffered a large amount of disconnect and pain following the disaster, but has since taken action to tackle those challenges and has seen major improvements in the last 10 years.

This story is a work of fiction, including all names and quotes, written by WWU DRR students for public education purposes. Site design by Dr. Scott Miles.

King County officials have worked directly with community members through public forums, surveys, local entertainment events, and community centers that offer recovery health services. Though the county has faced several obstacles that have inhibited progress, the officials and community members have managed to work with the resources they possess to produce a county that has focused on whole community health and is now considered one of the US’s happiest places to live.

After the earthquake King County suffered a setback in overall community health. The residents faced mental and physical health challenges directly resulting from the earthquake. Many peoples’ physical health problems were caused by the earthquake directly or resulted from poor conditions following the event.

Some common immediate injuries were minor lacerations or contusions caused by falling building contents. More serious conditions that resulted from diminished housing conditions were hypothermia, starvation, and wound infections. Some of these secondary injuries that went untreated resulted in deaths. Lack of healthcare or access to a nearby health facility was often what lead to these deaths. The populations that were most susceptible were low-income and minority populations.

The residents of King County also faced post-disaster mental health issues. Many residents admitted to the fear of sudden aftershocks. This fear disrupted their peace of mind and ability to work. There were spikes in depression and feelings of loneliness across the county. All kinds of issues could have contributed to these feelings.

Many residents lost their homes or jobs and thus were uprooted from their way of living. Instability of housing was a major contributor to post-disaster depression and anxiety. With the loss of housing, many residents ended up moving away and leaving behind their friends, neighbors, or loved ones. This left the remaining population lacking key social ties. These mental and physical health deficits had an effect on the greater community of King County.

Many buildings that had served as community health centers suffered earthquake damage and therefore were unable to meet the pressing needs of individuals. Citizens were struggling to meet their basic needs financially and so little money was spent on socializing in public places. This diminished community social strength and pride. Physical needs took precedence and so less pressing emotional strains lingered years after the earthquake. The County as a whole was suffering. King County officials, community members, and organizations recognized this and took immediate action. Out of this action the community has drastically increased their community health capacity.

King County has taken advantage of the depth of community activism to increase its health. Public input is received during meetings where citizens are able to voice their concerns and needs. They can share with officials what is needed locally, but also share about action that they have taken to meet the needs of their neighbors and strengthen community bonds. The picture below from a meeting in Enumclaw shows the interactive participation that goes on in these meetings.

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Interactive participation at a community meeting in King County.

Seth Kinzel, a County official working with the Community Transformation Grant Small Communities Program says that this community participation is invaluable.

“Before the earthquake Seattle had such a strong community voice and so it’s great to see that that voice remained after the disaster and is being used to benefit the whole health of the community.”

Kinzel says that the community would not be as well off now if it weren’t for the work of individuals as well as the Community Transformation Grant Small Communities Program, a federally funded $3.6 million grant made available through the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention. The funds aimed towards providing citizens better access to health resources.

Three health centers were constructed within three years of the earthquake, as well as four other community centers that offer counseling services. These facilities have proved to enrich individual lives over the years by offering services closer to home and providing a space where communities can meet and discuss the common difficulties they are facing.

Despite these successes, the grant program had difficulties reaching certain communities. Minority groups were especially difficult to involve because of social barriers. Kinzel says that in order to reach these communities, him and his team had to connect with one individual member inside the community and then work with that member on the most effective method of getting these populations involved in health services. Working with existing bilingual organizations also proved to be effective in reaching these diverse populations.

Los Angeles County, California has a similar disaster resilience project that implements aspects of FEMA’s ‘Whole Community’ approach by developing a comprehensive resilience curriculum for community leaders and health workers to implement. The curriculum aids the identification of community coalition and program linkages. It promotes preparedness, expands volunteer networks, community level emergency planning partnerships and much more. The players involved in this project are health educators, public nurses, and much of the LA county dept of public health.

The National Council for Behavioral Health has also created a curriculum that aids those who have chronic mental disabilities. This curriculum, entitled “Whole Health Action Management” gives instruction on how to create and manage support groups for those who need them. This curriculum is being used by several facilities in King County and has been recommended for other communities recovering from disasters.

Community input in King County was also achieved through well being surveys given by the County biannually. The King County Board of Health administers this well being survey twice a year to residents in an effort to monitor overall health of the community. The survey, entitled “The King County Well Being Survey”, examines 25 different impacts that might affect the day-to-day functioning of residents.

Some of these impacts are positive, for example, “pride in ability to cope under difficult circumstances”. On the other hand, some are negative, for example, “lack of opportunities to engage with others in my community through arts, cultural, sports or other leisure pursuits”. The County has been very pleased with the participation in the survey over the years and sees great value in the whole process.

Initially, the survey was thought to be in violation of HIPAA rules and faced opposition. But the administrators of the survey were able to avoid these rules by administering the survey out of health offices and had the participants sign a release waiver so that the data could be used.

Marissa Gonzales works for KCOEM, the King County Office of Emergency Management and has been with the project since the beginning.

“We were rushed to complete the study after the earthquake occurred, but knew that in order to recover effectively we needed to have the right data to assess the health of our communities. We administered the survey through different venues and spent time hanging out at places where people were in order to widen our responses.”

Gonzales says that the most common places where they were able to receive responses were Westlake Center and Northgate Mall.

“Parents didn’t have many places to take their kids and so shopping malls became the hub for communication. We found that constructing health centers in communities addressed this issue of loitering and allowed members to take pride in their local facilities.”

Gonzales reports, “Year to year you can see the decrease in negative issues and increase in positive issues in these surveys. It’s incredible.” The KCOEM’s goal was to decrease overall negative issues by 30% in six years and 70% in ten. She says they have exceeded both and are extremely happy with the overall health of King County.

“We couldn’t be more pleased. We have seen individual members make marked improvements as well as the community as a whole over the years. It makes my job even more meaningful knowing that I am helping improve my community, and getting paid to do it.”

The KCOEM also manages a recovery website that provides resources for residents. The site gives information about where to find low and no cost services, special events in different communities, and general information about how to deal with emotional stress caused by the earthquake.

The KCOEM launched a campaign directly after the earthquake to bring to light the common stresses that residents may be experiencing. The campaign brings together members of smaller communities to recover together and provide support for each other. The campaign also hosts events that inform the public about the different issues that the survey discusses. Community members are encouraged to share their struggles as well as encouragements in small groups during these events.

Mark Williams, a Kent resident, says he connected with a neighbor of his at one of these local events.

“They divided us into small groups based upon which neighborhood we lived in. Then we were supposed to share what issues of the survey were on our mind. I sat next to a woman who lived three doors down and I related to the struggles that she was sharing. We both were getting sick of all the construction noise. It seemed like such a petty discomfort, but it was nice knowing that someone else thought about it too.”

The KCOEM also hosts other events that attempt to draw out individuals from their homes and give them places to connect with other members of their communities. These events have included outdoor films, performances of local bands, picnics, festivals, art shows, and many others. Williams says that he has attended these events with his family, and even met a city official at one of these events too.

The places that the events are held at are locations of former houses. After the earthquake the government bought land with red-tagged houses. Many of the owners of these houses had already chosen to relocate or earned enough from the purchase price that they moved to another neighborhood. The houses were demolished and the land was used as venues for these events. One of these venues is located in Williams’ neighborhood and is pictured below.

Formerly damaged land now being used as a venue for community events.

Formerly damaged land now being used as a venue for community events.

“It’s kind of bittersweet to be congregating on an old neighbor’s land. But we just have to move on. It’s great to be able to take my family to something free that they’ll enjoy, right around the corner     from our house. My son even met another kid that happened to live down the street at a carnival a couple years ago and now they are good friends. I can really see how those events have brought my neighborhood together.”

The King County Housing and Community Development Program, located within the Department of Community and Health Services has made progress through the last ten years to incorporate “whole community” practices into urban planning. They have worked directly with the King County Department of Permitting and Environmental Review in order that these practices would be included in the County’s comprehensive plan.

The successful recovery of King County has even been nationally recognized in a television episode of 60 Minutes that aired on CBS just a few months ago.

The episode states that, “The County was transformed from a place of heartbreak and despair to a whole community of hope and support. Communities around the country ought to take notice of the care and effort given to strengthening community health in King County after the Seattle Fault Earthquake.” This attention recently resulted in King County being voted one of the top 10 best places to live in the United States.