Overview of Idaho
Idaho is a large western state with impressive mountain ranges, large areas of high desert and massive expanses of forested terrain. Idaho contains the second largest wilderness area in the lower 48 states, the Frank Church – River of No Return Wilderness, which covers almost 2.4 million acres. Geography and distance impact both the demographic characteristics and social determinants of health within Idaho. Idaho is ranked 40th of the 50 United States for total population and 14th for geographic size. The 2019 estimated population for Idaho was 1,787,065 and, because of its large size and relatively small population, Idaho remains one of the most rural states in the nation. With approximately 21.6 people per square mile, Idaho ranks 44th of the 50 states in population density. The national average population density is 92.2 people per square mile, a four-fold greater density than Idaho. Thirty-five of Idaho’s 44 counties are rural, with 19 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 (92.9%); Black (1.4%); American Indian/Alaska Native (2.8%); Asian (2.4%); and Native Hawaiian and Other Pacific Islanders (0.4%). Data indicate that 3.3 percent of Idahoans identify as being of two or more races. Persons of Hispanic or Latino origin comprised 13.0 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. The social determinants of health vary at every stage of life and include factors such as age, personal behaviors, socioeconomic status, educational attainment, employment status, the physical environment and access to healthcare.
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.” The social, economic and environmental factors and their influence on health can vary greatly depending on the neighborhood one grows up in and their 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 U.S. Census 2016 Current Population Survey, 12.8 percent of Idahoans were living below the poverty level and the median household income in Idaho was $50,985. Idaho’s per capita income in 2016 was $25,471.5 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 most recent national data (2013 to 2017 five-year average) indicate that the percentage of Idahoans over the age of 25 who have graduated from high school is higher than the national average (90.2 percent and 87.3 percent respectively). A quarter (26.8 percent) of Idahoans over the age of 25 hold a bachelor’s degree or higher, compared with the national average of 30.9 percent.
Data on Idaho’s social determinants of health show 36.1 percent of children enrolled in public schools were eligible for free or reduced-price lunch; 30.8 percent of residents do not own their housing units; and, 27.6 percent of homeowners’ monthly housing costs were 30 percent of household income or greater.
According to the 2017 County Health Rankings, Idaho’s most rural counties experience higher rates of obesity and diabetes, higher rates of food insecurity and limited access to healthy foods. These counties also have more limited access to quality healthcare services and suffer from higher rates of premature death.
According to the Idaho Vital Records Annual Report 2017, Idaho’s Hispanic, Black and Tribal populations experience higher rates of teen pregnancy. The Hispanic population also experiences higher rates of obesity, and Hispanic youth ages 9-12 represent a high percentage of cigarette smokers.
Idaho’s percentage of adolescent suicide attempts exceeds the U.S. median at 9.7 percent, compared to 7.4 percent. Of those, the Idaho Hispanic population’s adolescent suicide attempts are 12.9 percent.
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 have 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 2019, 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. Idaho had 64.5 primary care physicians per 100,000 population in 2018. In 2019, the Idaho Hospital Association membership directory reported 50 hospitals (including facilities in Oregon, Washington, and Wyoming). Twenty-seven of these hospitals are critical access hospitals, located in Idaho, and own a combined 55 clinics. These clinics include primary care and specialty services and may be co-located with the hospital or operate as remote clinics.10
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. The impact of ICOM on the health professional shortages in Idaho remains to be seen.
In SFY 2019, approximately 280,000 Idahoans were enrolled in Medicaid. Medicaid enrollment 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. Overall, Medicaid’s enrollment declined four percent from SFY 2018.
Medicaid serves individuals from birth to end of life, provided they meet eligibility criteria. In SFY 2019, 33 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 456,849 participants). However, some of the smallest counties have the greatest density of residents receiving Medicaid benefits, with Lewis County at 31 percent, followed by Owyhee County at 24 percent and Cassia, Gooding and Jerome Counties at 23 percent.11
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.