Overview of Idaho
Idaho is a large western state with impressive mountain ranges, large areas of high desert and massive expanses of forested terrain. Geography and distance impact both the demographic characteristics and social determinants of health within Idaho.
Idaho is ranked 38th of the 50 United States for total population and 14th for geographic size. The 2020 census population for Idaho was 1,839,106 and, because of its large size and relatively small population, Idaho remains one of the most rural states in the nation. With approximately 22.3 people per square mile, Idaho ranks 44th of the 50 states in population density. The national average population density is 93.8 people per square mile, a four-fold greater density than Idaho. Thirty-five of Idaho’s 44 counties are rural, with 16 of these considered frontier, which means those counties have fewer than six people per square mile.
The racial groups that comprised Idaho’s population in 2019 were: White (93%); Black (0.9%); American Indian/Alaska Native (1.7%); Asian (1.6%); and Native Hawaiian and Other Pacific Islanders (0.24%). Data indicate that 2.6 percent of Idahoans identify as being of two or more races. Persons of Hispanic or Latino origin comprised 12.8 percent of Idaho’s total population. Idaho is home to six federally recognized tribes: Coeur d’Alene Tribe, Kootenai Tribe of Idaho, Nez Perce Tribe, Shoshone-Bannock Tribes of the Fort Hall Reservation, the Northwestern Band of the Shoshone Nation and the Shoshone-Paiute Tribes of the Duck Valley Reservation. Idaho also has two refugee centers located in southwest Idaho (Ada County) and south-central Idaho (Twin Falls County).
Social Determinants and other Demographics
The conditions in which people are born, live, learn, work and play have a substantial impact on health outcomes. These conditions, known as the social determinants of health, are important to consider when thinking about improving the health of a population.
While the ideology that “your zip code is a greater predictor of health than your genetic code” is widely used by public and community health professionals, a deeper look indicates that “your neighborhood is a greater predictor of your health.” Social, economic, and environmental factors and their influence on health can vary greatly depending on where one lives, as each neighborhood has differing levels of access to affordable housing, good jobs, healthy food, education and healthcare. In Idaho, mapping life expectancy by census tract shows a difference of as much as 20 years of life between the highest and lowest tracts.
According to the 2019 American Community 5-Year Survey (ACS), the median household income was $55,785 in Idaho compared to $62,843 nationally. Similarly, per capita income was less in Idaho at $27,970, compared to $34,103 nationally. All racial and ethnic groups measured in the ACS had lower household and per capita incomes in Idaho than their counterparts nationally.
Despite lower incomes, Idaho’s poverty level of 13.1% aligns with the national average of 13.4%.8 This alignment with national trends largely holds true across sex, age, education level, and racial and ethnic groups. However, increased poverty of 18.7% is felt by young adults between the ages of 18 and 34, compared to 16.3% for this age group nationally. Within Idaho, greater levels of poverty are experienced by certain demographic groups and within certain areas. For instance, 20.7% of Idaho’s Hispanic or Latino population lives at or below the poverty level in comparison to 11.5% of the white population who do not identify as Hispanic or Latino. Poverty measured at the county level ranges from 30.9% in Madison County to 4.5% in Teton County.
Idaho is an important agricultural state, producing nearly one-third of the potatoes grown in the United States. Wheat, sugar beets and alfalfa hay are also major crops. Other industries contributing to Idaho’s economy include information technology, mining, lumber, tourism, and manufacturing. The economic impact of COVID-19 on Idaho’s economy and people is still being realized.
A greater percentage of Idahoans over the age of 25 have graduated from high school (90.8%) than the national average of 88.0%. Yet, the rate for those who go on to higher levels of education are lower in Idaho across almost all demographic groups. Nationally, 32.1% of the population over the age of 25 hold a bachelor’s degree or higher, while only 27.6% do in Idaho. Educational attainment disparities are also seen among various racial and ethnic groups. For Idaho’s Hispanic and Latino population, the high school graduation rate is 64.6% while this group has a graduation rate of 68.7% nationally. Also, 9.9% of Idaho’s Hispanic and Latino population holds a bachelor’s degree or higher compared to 16.4% across the U.S. Within Idaho’s rural and frontier counties a smaller percentage of adults over the age of 25 have gone on to receive at least some post-secondary education than those living in urban counties, 54.5% compared to 66.76%.
Higher educational attainment or vocational certification has been tied to better health outcomes. College graduates are often able to secure better paying jobs with fewer safety hazards and income from these jobs can be used on higher quality housing as well as other health enhancing resources.
Food Security, Diabetes, and Obesity
Data from Feeding America demonstrate that 10% of Idaho’s population faced food insecurities in 2019. Among children enrolled in Idaho public schools during the 2020-2021 school year, 36.1% were eligible for free or reduced-price lunch. Idaho’s most rural counties tend to experience higher rates of food insecurity and limited access to healthy foods. These counties also tend to have higher rates of obesity and diabetes.
When looking at population groups in Idaho, those who are Hispanic, Latino, American Indian and Alaskan Native experience the highest rates of obesity. Obesity rates also vary by location and county. At the higher end, Owyhee County has an obesity rate of 40% while the rate is 14.6% for people living in Blaine County. Adults with obesity are at increased risk for many diseases and health conditions including type 2 diabetes, stroke, and heart disease. 2017 Estimates of Diabetes rates by county range from 16% in Owyhee County to 5% in Teton County.
Purchase prices for homes in the state have increased 91.79% over the past 5 years. Statewide, the cost of renting a 2-bedroom apartment has reportedly increased 57.97% from May 2020 to May 2021. This rapid increase in the cost of housing without a significant increase in income has resulted in many households struggling to meet living expenses. Many studies have shown that housing instability contributes to poor health and, as a result, increased healthcare costs.
People who rent housing comprise 28.4% of Idaho’s population, and of those, 45.7% are cost burdened, meaning they pay 30% or more of household income toward their rent8. For homeowners, 23.6% are cost burdened. According to the 2015-2019 American Community Survey 11% of Idaho households were severely cost burdened, meaning they reported spending 50% or more of their household income on housing. Severe housing cost burden differs greatly across the state from 4% in Power County to 24% in Madison County.
The US Department of Housing and Urban Development (HUD) estimates that Fair Market Rent for a two-bedroom apartment in Idaho is $903. To afford this level of rent without paying more than 30% of income on housing, a household must earn $3,010 monthly or $17.36 per hour for a 40-hour work week. However, the average wage for those who rent their housing in Idaho is $13.62. People who make the minimum wage would need to work 96 hours per week to afford a two-bedroom rental home. Based on the estimates, certain areas of the state require much higher wages to afford a two-bedroom apartment, $19.27 per hour in Boise and $20.48 per hour in Blaine County. As these estimates are based on 2019 data, housing cost burdens are even greater today.
Idaho’s suicide rate of 20.3 per 100,000 population greatly exceeds the national rate of 13.93. In looking more closely at 2019 county level data, rates vary greatly across the state, ranging from 0 per 100,000 in Butte, Camas, Clark, Lewis, Lincoln, and Teton Counties to 51.1 per 100,000 in Boise County.17 Suicide is the 8th leading cause of death in Idaho and for those aged 10-44 it is the 2nd leading cause of death. Idaho’s percentage of adolescent suicide attempts exceeds the U.S. median at 9.6%, compared to 8.9%. A higher percentage of Idaho’s adolescent females have attempted suicide, 12% compared to 6.9% for adolescent males. Idaho’s Hispanic population’s adolescent suicide attempts are 13.1% compared to 8% for non-Hispanic white students.
Public Health Districts in Idaho
To facilitate the availability of public health services, the state aggregated contiguous counties into seven local public health districts. The boundaries that separate each of the seven areas include geographic barriers, transportation routes and population centers. Access to healthcare and other services continued to be barriers to improving health outcomes for Idaho residents; however, Idaho's seven local public health districts represent the primary outlets for public health services. Each district responds to local needs to provide services that may vary from district-to-district, ranging from community health nursing and home health nursing to environmental health, dental hygiene and nutrition. Many services that the districts provide are through contracts with the division.
Health Professional Shortage
In 2021, 100 percent of Idaho was a federally-designated mental health professional shortage area, 95 percent of Idaho was a federally-designated shortage area in primary care and 94 percent of Idaho was designated a dental health professional shortage area. In 2021, the Idaho Hospital Association membership directory reported 51 hospital members (including facilities in Oregon, Washington, and Wyoming). Twenty-seven of these hospitals are critical access hospitals, located in Idaho. These small, rural hospitals also own primary and specialty care clinics and may be co-located with the hospital or operate as remote clinics.
In 2018, the first college of osteopathic medicine began operating in Idaho for the purpose of training and developing physicians. The Idaho College of Osteopathic Medicine (ICOM) received pre-accreditation status while it continues working towards establishing full accreditation status from the Commission on Osteopathic College Accreditation. ICOM's mission is to train competent and caring physicians prepared to serve persons in Idaho, Montana, North and South Dakota, Wyoming, and beyond with an emphasis on the rural, underserved areas within this five-state region.
In SFY 2020, approximately 340,000 Idahoans were enrolled in Medicaid, a 21 percent increase from SYF 2019 average enrollment. The growth in SFY 2020 is due to the Medicaid expansion program. In November 2018, voters passed a ballot proposition to expand Medicaid in Idaho. The goal of Medicaid expansion is to provide Medicaid coverage to individuals with incomes up to 138 percent of the Federal Poverty Level. The state implemented Medicaid expansion January 1, 2020. Medicaid enrollment typically fluctuates depending on the state’s economy: When the economy is strong, more people are working and have access to healthcare coverage through their employers; however, when the economy is not performing well, more Idahoans seek healthcare assistance through Medicaid.
Medicaid serves individuals from birth to end of life, provided they meet eligibility criteria. In SFY 2020, 35 percent of Medicaid Trustee and Benefits expenditures went to children from birth to 18 years of age. Medicaid enrollment varies by county, with the highest number of participants living in counties that include some of Idaho’s largest cities (e.g., Ada County has 70,189 participants). However, some of the smallest counties have the greatest density of residents receiving Medicaid benefits, with Lewis County at 40 percent, followed by Power County at 28 percent, Shoshone at 27 percent and Cassia, Gooding and Owyhee Counties at 26 percent.