Health Equity Zones Background and History

Creation of the Health Equity Zones Initiative 

In recognition of deep and longstanding inequities across Washington state, lawmakers passed Senate Bill 5052 (only in English) in 2021 to create the Health Equity Zones Initiative.   


Community-Driven Leadership 

The Community Advisory Council is a statewide group made up of tribal community representatives, community representatives, and sector representatives from local health jurisdictions, Accountable Communities of Health, and the Governor’s Interagency Council on Health Disparities. This group has led decision-making on the development of the Health Equity Zones Initiative, including the nomination and selection process with guidance from the Community Workgroup – an open membership group made up of community members across the state. 


Zone Selection 2023 

In 2023, the first Health Equity Zones in Washington state were selected by the Community Advisory Council using a council-approved selection criteria and decision-making process. Data was used to support zone selection by applying an approach that values all forms of data, including stories or anecdotes from community members, cultural teachings, and data collected by community organizations and governmental agencies. 


More information about the 2023 nomination and selection process can be found below. 


Eligibility Criteria


  • Community must be geographically defined and connected. A zone should be small enough for focused solutions. 
  • Nominators must indicate whether their community is rural or urban. To support communities in making this determination, the Community Advisory Council and Community Workgroup created definitions of rural and urban. 
  • Nominators must live in Washington state and have a demonstrated connection to the community being nominated. Those who live in Washington state seasonally or as temporary/migratory farm workers are eligible. 


Selection Priorities

The zone selection process will prioritize communities most impacted by health inequities. This includes communities with significant populations that identify as black, indigenous, and people of color; immigrants, migrant farmworkers, refugees, and asylum seekers; low-income, unhoused, and under-resourced; living with disabilities and mental illness; elders or seniors; LGBTQIA+ and/or having limited access to healthcare. 

Rural and Urban Definitions

Rural Definition 

Urban Definition 

Rural is defined as remote areas on open land that are sparsely populated; small towns (places with fewer than 2,500 people); and larger towns with populations ranging from 2,500 to 49,999.​ Rural areas also have one or more of the following characteristics.   

Urban is defined as densely populated areas of 50,000 people or more with at least 1,000 people per square mile and the surrounding suburbs. Urban areas also have one or more of the following characteristics.   


Remoteness of location and geographic isolation; further proximity to quality resources; presence of open countryside and natural resources; varied access to public parks and recreational areas; household use of wells for drinking water; and/or prevalence of air and water pollution associated with agricultural and manufacturing industries.  

Residential crowding; increased risk of disease outbreaks associated with population density and environmental contamination; reduced tree canopy coverage and usable green spaces; varied access to public parks and recreational areas; prevalence of air and water pollution associated with urbanization; and/or depletion of natural resources.  

Public Access 

Limited availability of public transportation and reliance on personal vehicle; difficulty meeting basic needs such as food and housing due to limited availability of resources; lack of availability of support services for houseless individuals; long distance travel to access medical and behavioral health care services​; and/or impacts to service accessibility due to seasonal changes.   

Close proximity to public transit, international airports, railways, seaports; presence of large public education and healthcare institutions; service shortages associated with population density, and/or availability of healthy food options varies by neighborhood.  


Major industries are agricultural, forestry, and manufacturing; limited options for educational attainment and employment opportunities; and/or out-migration of highly skilled workers.  

History of redlining or residential displacement; high cost of living relative to income; competition for employment; and/or major employment industries are finance, science, and technology  


Limited access to reliable broadband; less ownership of computers and other electronic devices; and/or less reliance on electronic devices to receive information.  


Availability of advanced technologies in healthcare and communications; rapid means of communicating information; decentralized/fragmented communication systems; multiple streams of information sharing; and/or access to computers and high-quality broadband varies by neighborhood.   


Slow-paced way of life; strong relationships between people; willingness to help others in distress; and/or limited access to culturally and linguistically relevant resources.  


Fast-paced way of life; presence of cultural centers and culturally appropriate resources varies by neighborhood; diversity of people from different backgrounds and cultures; and/or neighborhoods with high proportions of immigrants, refugees, and asylum seekers.  

Scoring Rubric

Scoring Category 

Possible Points 

Community support  

  • Engaged the community in the decision to be nominated as a health equity zone  
  • Approach to engaging the community demonstrates intentional outreach to those most impacted by inequity (see zone selection priorities)  
  • Illustrates broad reaching support from community members, organizations, and/or institutions 

Centers community  

  • Describes the community being nominated, including key characteristics, strengths, and challenges  
  • Description of the community centers the experiences of those most impacted by inequity (see zone selection priorities)  
  • Demonstrates a strong understanding of the systemic contributors to the community’s inequities, such as historic and contemporary injustices, structural racism, and intersectionality*    
  • Highlights the experiences of community members by using stories, examples, and/or data  

Envisions collaboration 

  • Describes existing or new partnerships in the community, including coalitions, collaboratives, grassroots formations, and/or community councils and working groups  
  • Provides examples of how partnerships would be utilized if selected as a health equity zone 
  • Shows the ability to envision a Community Collaborative of community members and organizations working together to improve the health of their community  
  • Description of collaboration is not focused on the needs or goals of a single organization or institution 
  • Illustrates the community's innovativeness to address inequities 

Prioritizes equity 

  • Interest in community nomination is rooted in advancing health equity or the ability for all community members to thrive  
  • Identifies inequity(ies) in the proposed zone that impacted communities want to address 
  • Identifies intermediate and/or long-term benefits to being a health equity zone 
  • Demonstrates a visionary perspective to create systems change for future generations 

Total Points 


*Historic and contemporary injustices refers to wrong-doings committed in the past or present that continue to have a lasting impact.  

Structural racism refers to a system of policies, institutions, and practices that work together to create and reinforce racism.   

Intersectionality refers to the ways in which systems of inequality based on race, class, gender identity, disability and other forms of discrimination interact to create unique patterns of oppression. 


Point Scale  

  1. No Score = Criteria Not Met At All 

  1. Incomplete = Criteria Partially Met 

  1. Average = Criteria Met 

  1. Above Average = Criteria Exceeded