1105 CSF-2 HEALTH

1105.1 One of Washington, DC’s most important resources is the health of its residents. While many of the District’s residents and neighborhoods enjoy exceptional health, significant health disparities persist along dimensions of income, geography, race, gender, and age in the District.

1105.2 DC Health promotes health, wellness, and equity across the District and protects the safety of residents, visitors, and those doing business in the nation’s capital. The responsibilities of DC Health include identifying health risks; educating the public; preventing and controlling diseases, injuries, and exposure to environmental hazards; coordinating emergency response planning for public health emergencies; promoting effective community collaborations; and optimizing equitable access to community resources.

1105.2a Text box: Social and Structural Determinants of Health

The World Health Organization defines social and structural determinants of health (SSDH) as the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. The District has adopted this understanding of the larger factors that shape health and that influence the systems and conditions for health and outcomes, including health equity in the District.

1105.3 The DC Health Equity Report (HER) 2018 lays out a comprehensive baseline dataset of key drivers of health. Non-clinical determinants of health influence 80 percent of health outcomes, with the remaining 20 percent determined by clinical care (HER 2018). The nine drivers—education, employment, income, housing, transportation, food environment, medical care, outdoor environment, and community safety—were mapped thematically by statistical neighborhood (n=51) and overlaid with life expectancy estimates. There was a strong correlation between differences in life expectancy and differences in key driver outcomes by statistical neighborhood, underscoring the need for shared collective impact goals and practices across sectors and applied health in all policy approaches.

1105.4 While the 2006 Comprehensive Plan focused on advancing equitable access to health care services to address disparities in health outcomes, the District’s approach has evolved to better recognize and incorporate the role and effect of social and structural determinants on health. Thus, the Comprehensive Plan now seeks to improve population health by providing health-informed policy guidance for the future of Washington, DC’s built and natural environments. While policies contained in this section focus on the traditional health care infrastructure and clinical care service delivery system, transportation, housing, economic

development, and other important social/structural determinants are addressed in other Comprehensive Plan Elements.

1105.5 This section of the Community Services and Facilities Element focuses on the adequacy, maintenance, and expansion of health care facilities as important contributors to the health of District residents, as well as the provision and improvement of human service facilities such as senior wellness centers. Recognizing that education and learning are lifelong endeavors and reflecting the District's evolving approach to early childhood care and development, the child care section was moved from this element to the Educational Facilities Element and retitled to "Child Development."

1105.5a Text box: Health

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (Source: World Health Organization.)

1105.6 Planning for accessible and equitable health care facilities is complicated by a broad set of factors, including the changing nature of the nation's health care delivery system and the District's limited jurisdiction over private service providers. The Comprehensive Plan can inform and guide public and private investments in support of Washington, DC's commitment to provide an adequate distribution of facilities and services that support the health of District residents, promote health equity across the District, and increase the District's emergency preparedness. This includes measures to advance health through the design of Washington, DC and conservation of the environment.

1105.7 HER 2018 shows that there are differential opportunities for health across the District by income, geography, and race. The most racially and economically segregated neighborhoods are also at the extremes of life expectancy estimates, with majority Black (and low-income) populations experiencing the lowest life expectancies and majority White (and high-income) populations experiencing the highest life expectancies. Overall life expectancy at birth for Washington, DC residents increased from an average of 78 years in 2013 to 79 years in 2015, closing the gap with the U.S. estimate of 78.8 in the same year. All District wards experienced an improved life expectancy from 2010 to 2015, with the largest gain seen in Ward 6 and the smallest gain seen in Ward 7 (see Figure 11.1). However, when evaluating smaller geographic areas, the gap between the highest and the lowest life expectancy estimates increases to more than 21 years. Again, the social and structural determinants of health influenced by geography, race, and income level are major intersecting components that drive the differences in estimated life expectancy and other population health outcomes across Washington, DC.

1105.8 The 2020 public health emergency is anticipated to have broad impacts that can exacerbate existing inequities in the District, including disparate health effects. While the data in this chapter precede the 2020 health emergency, the policies

contained in the Health and Health Equity section below address equity in a manner that supports the District’s response to and recovery from the 2020 health emergency in the near-term, and that provides guidance for shocks and stressors that may occur in the long-term. Additionally, social and structural determinants of health such as income, employment, housing and transportation, are also addressed in other elements of the Comprehensive Plan.

1105.9 Figure 11.1. Life Expectancy in 2010 and 2015 at Birth by Ward in the District of Columbia

Sources: Data for the 2010 life expectancy estimates are drawn from DC Health’s 201 Community Health Needs Assessment. Data for 2015 are drawn from DC Health’ Draft/Unpublished HER.

Note: The 2010 and 2015 life expectancy estimates were calculated as the average of the current and preceding four years. Five-year averages are more reliable predictors of life expectancy estimates than single-year data points since the latter identify a trend over multiple years.

1105.10 Figure 11.2. Leading Causes of Death in the District of Columbia, 2015

Age-Adjusted Rate Per 100,000 Population
District Rank	Cause of Death	Age-Adjusted

1	Heart Disease	186.4
2	Malignant Neoplasms (Cancer)	166.5
3	Accidents (includes falls and overdoses)	39.4
4	Cerebrovascular Disease (Stroke)	37.9
5	Diabetes	25.6
6	Chronic Lower Respiratory Disease	23.1
7	Alzheimer's Disease	19.2
8	Homicide/Assault	17.5
9	Influenza and Pneumonia	16.2
10	Septicemia	13.4
District of Columbia Department of Health, Center for Policy, Planning, and Evaluation, Data Management and Analysis Division

(Source: Behavioral Risk Factor Surveillance System, 2015 Annual Report, DC Health)

1105.11 Compared to national trends, data from 2015 in Figure 11.3 indicates that Washington, DC has higher rates of heart disease mortality and homicide compared to the U.S. and a higher prevalence of stroke. However, a larger percentage of District residents report routine health care checkups compared to the U.S. average. Additionally, while HIV/AIDS incidence and mortality have decreased over the last decade, the rates are still at an epidemic level in the District, with a prevalence of 1.9 percent as of 2017.

1105.12 Notable trends displayed in the District's 2015 Behavioral Risk Factor Surveillance System (BRFSS) annual health report show a slight improvement among residents who receive preventive care and who take steps to prevent future illness. However, data trends from 2015 demonstrate a steady decline among Washington, DC residents who are overweight or obese. The variation in obesity rates is linked to access to healthy foods and to parks and recreation facilities.

1105.13 Figure 11.3. Top 10 Leading Causes of Death in the District of Columbia and the United States, Age-Adjusted Rates per 100,000 population, 2015 DC Health

District of Columbia	Rate per 100,000	United States	Rate per 100,000
1. Heart Disease	186.4	1. Heart Disease	168.5
2. Cancer	166.5	2. Cancer	158.5
3. Accidents	39.4	3. Chronic Lower Respiratory Disease	41.6
4. Cerebrovascular Disease (Stroke)	37.9	4. Accidents	43.2
5. Diabetes	25.6	5. Cerebrovascular Disease (Stroke)	37.6
6. Chronic Lower Respiratory Disease	23.1	6. Alzheimer's Disease	29.4
7. Alzheimer's Disease	19.2	7. Diabetes	21.3
8. Homicide/Assault	17.5	8. Influenza and Pneumonia	15.2
9. Influenza and Pneumonia	16.2	9. Kidney Disease	13.4
10. Septicemia	13.4	10. Suicide	13.3

(Sources: Center for Policy, Planning, and Evaluation; DC Health; Xu, Jiaquan et al; Mortality in the United States, 2015; Centers for Disease Control and Prevention.)

1105.14 Washington, DC has experienced improvements in perinatal health outcomes, such as a decline in infant mortality rate from 11.8 deaths per 1,000 births in 2009 to 7.1 in 2016. However, while the overall infant mortality rate has declined, significant disparities persist based on race and geography (Figure 11.4). In 2015, non-Hispanic Black mothers were five times more likely to experience infant mortality than non-Hispanic White mothers, and Hispanic mothers were 1.6 times more likely to experience infant mortality than non-Hispanic or White mothers in the District.

1105.15 Figure 11.4. Infant Mortality Rate per 1,000 Live Births, District of Columbia, 2010-2016

(DC Health, Perinatal Health Report, 2018)

1105.16 Figure 11.5: Newly Diagnosed HIV Cases, Deaths, and HIV Cases Living in the District by Year, 2011-2015

*Information concerning death in 2013-2015 is limited to the District of Columbia vital records only. The number of deaths documented 2013-2015 may increase as information from other sources (i.e. NDI and SMMF) become available.

(Source: HIV/AIDS, Hepatitis, STD, and TB Administration, Annual Epidemiology & Surveillance Report: Surveillance Data through December 2015, DC Health, 2017.)

1105.17 Figure 11.6: Proportion of HIV Cases Living in Washington, DC by Race/Ethnicity, Gender Identity, and Mode of Transmission, District of Columbia,

2015 (n = 13,391)

(Source: HIV/AIDS, Hepatitis, STD, and TB Administration, Annual Epidemiology & Surveillance Report: Surveillance Data through December 2015, DC Health, 2017.)

1105.18

As shown in Figure 11.5, approximately 1.9 percent of Washington, DC residents live with HIV (considered an epidemic level). While there were still newly diagnosed cases of HIV in 2017, this number declined significantly, by 31 percent from 2013 and by 73 percent from 2007. However, concerns remain as the populations with the highest rates of HIV are Black men and Black women. When examining residents living with HIV, 27 percent were Black men who have sex

with other men and/or use injection drugs, 16 percent were heterosexual Black women, and 14 percent were White men who have sex with other men and/or use injection drugs in 2017.

SOURCE: District of Columbia Comprehensive Plan Act of 1984, effective April 10, 1984 (D.C. Law 5-76; 31 DCR 1049 (March 9, 1984)); as amended by District of Columbia Comprehensive Plan Act of 1984 Land Use Element Amendment Act of 1984, effective March 16, 1985 (D.C. Law 5-187; 32 DCR 873 (February 15, 1985)); as amended by District of Columbia Comprehensive Plan Amendments Act of 1989, effective May 23, 1990 (D.C. Law 8-129; 37 DCR 55 (January 5, 1990)); as amended by District of Columbia Comprehensive Plan Amendments Act of 1989 NCPC-Recommended Amendments, and Closing of Public Alleys in Square 669, S.O. 88-452, Act of 1990, effective May 23, 1990 (D.C. Law 8-132; 37 DCR 2213 (April 6, 1990)); as amended by District Government Land Use Temporary Amendment Act of 1994, effective October 1, 1994 (D.C. Law 10-190; 41 DCR 5360 (August 12, 1994)); as amended by Comprehensive Plan Amendments Act of 1994, effective October 6, 1994 (D.C. Law 10-193; 41 DCR 5536 (August 19, 1994)); as amended by District of Columbia Comprehensive Plan Act of 1984 Land Use Amendment Act of 1994, effective March 21, 1995 (D.C. Law 10-235; 42 DCR 30 (January 6, 1995)); as amended by Technical Amendments Act of 1996, effective April 18, 1996 (D.C. Law 11-110; 43 DCR 530 (February 9, 1996)); as amended by Second Technical Amendments Act of 1996, effective April 9, 1997 (D.C. Law 11-255; 44 DCR 1271 (March 7, 1997)); as amended by Comprehensive Plan Amendment Act of 1998, effective April 27, 1999 (D.C. Law 12-275; 46 DCR 1441 (February 19, 1999)); as amended by Technical Amendments Act of 1999, effective April 12, 2000 (D.C. Law 13-91; 47 DCR 520 (January 28, 2000)); as amended by Comprehensive Plan Amendment Act of 2006, effective March 8, 2007 (D.C. Law 16-300; 54 DCR 924 (February 2, 2007)); as amended by Technical Amendments Act of 2008, effective March 25, 2009 (D.C. Law 17-353; 56 DCR 1117 (February 6, 2009)); as amended by Comprehensive Plan Amendment Act of 2010, effective April 8, 2011 (D.C. Law 18-361; 58 DCR 908 (February 4, 2011)); as amended by Comprehensive Plan Amendment Act of 2021, effective August 21, 2021 (D.C. Law 24-20; 68 DCR 006918 (July 16, 2021)).