Community Context

Located directly south of Seattle in Pierce County, Tacoma is a port city characterized by its environmental beauty and racial diversity. Military and advanced manufacturing jobs are the largest sources of middle-skills employment, and healthcare has grown as a local employer over the past decade as the city has transitioned away from heavy industry. Many Tacoma residents commute to Seattle for work, which has resulted in recent population growth and concerns about affordable housing shortages. Tacoma is a Democratic stronghold while larger Pierce County is considered more conservative, which has presented some conflicting priorities among levels of government. However, in 2020, Pierce County Council flipped Democratic for the first time in 17 years.

Homelessness and a lack of affordable housing have been long-standing issues in Tacoma. Health issues of concern have evolved over the past five years as the community began focusing less on obesity and tobacco use to address more upstream causes of poor health and well-being. The area currently of most concern to stakeholders in Tacoma is access to behavioral health services, followed by affordable housing and homelessness, opioid use, and transportation. Legacy environmental contamination threatens some of Tacoma’s most prized environmental assets and the former site of the Asarco smelter was one of the country’s first Superfund sites. Across all these areas, there are concerns with health disparities and inequities based on race and income.

 

Tacoma’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, capacity has been grounded in the efforts of the public health and healthcare sectors, local government, education, and community-based stakeholders.

Efforts in Tacoma focused on equity, youth development, and healthcare coordination have grown over the past five years, and new activities have been initiated targeting homelessness, workforce development, and community diversity. With regard to the health narrative in Tacoma, a long-standing focus on the social determinants of health has only deepened over the past five years, with additional stakeholders seeing the connection between factors like housing, education, and physical and mental health. With regard to health equity, Tacoma’s approach has evolved over the past five years, from established structures dedicated to equity to implementing policies explicitly intended to have equity impacts and establishing anti-racist commitments and actions.

Lessons Learned: Where is Tacoma Five Years Later?

Tacoma’s journey to promote health, well-being, and equity is one that illustrates the deepening of prior commitments, and the role of shared values in making those changes. Commitments to health and equity that were in place for several years prior to 2017 laid the groundwork—such as through strategic frameworks, staff capacity, data, and informal collaborative networks—for the community to transition from conversation to action around equity and systems change; from healthcare access to the SDOH; and from service provision to representative decision-making, a process that’s still ongoing. Other communities can learn from Tacoma’s approaches to make these changes, as well as the challenges they encountered, to inform their own journeys. And as COVID-19 recovery continues, with historic funding flowing to local communities, future research could consider the ways in which momentum around health, equity, and well-being influences community health narratives and decisions moving forward.

 

Tacoma has leveraged facilitators like strong leadership and capacity for health and equity to make progress on health and well-being outcomes. Yet, remaining data and governance barriers have stymied progress, many of which are expected to continue to persist.

Facilitators:

  • History of prioritizing health equity

  • Legacy of environmental activism

  • Public health leaders in new sectors

  • Strong use of data

  • State-level Medicaid demonstration focused on prevention

Barriers:

  • Navigating diverse stakeholder perspectives

  • Misalignment between city and county

  • Independent health department results in inefficiencies

  • Lack of comprehensive understanding of systems

  • Data integration challenges

  • Lack of authority to address homelessness