Kansas City Community Health Assessment

The Kansas City, Missouri Health Department is proud to present the latest Community Health Assessment (CHA) report. With this report, we aim to build a deeper understanding of our community's health needs, strengths, and areas for improvement. We especially focus on those conditions that are unevenly affecting our most vulnerable residents.

To complete the CHA, we conducted surveys of community residents and reviewed hospitalization and death data. Our team examined several factors that tell us about the health of Kansas City, Missouri residents, including the numbers of people who are living with certain conditions, common health behaviors, and the extent to which people can access healthcare. These are some of the factors that affect the wellbeing of our residents. The CHA report allows us to prioritize the use of our resources and ensure that we build effective strategies for long-term health improvement. In this CHA report, we focus on data collected between 2019 and 2023.

With this report, our goal is to both inform and inspire action. We invite all residents and stakeholders to read this CHA and reflect upon the underlying causes of unequal health potential. We also ask that you join us in a united effort to improve health outcomes. Together, we can build a healthier Kansas City for all who call it home.

In order to understand the current health of Kansas City, it is important to demonstrate how we got here in the first place. Many intentional structural inequities from decades ago ( Redlining , school segregation, racially restrictive housing covenants, etc.) have had long lasting and visible effects on the health of our city residents, primarily impacting our African American and Hispanic populations. The time-lapse map below begins in 1939, where a combination of federal policy from the Home Owner's Loan Corporation (HOLC) and racially restrictive covenants (a practice pioneered by Kansas City native J.C. Nichols) limited the roughly 40,000 African American residents to home ownership just a few neighborhoods. Restrictions were also placed upon immigrants of other descent, like those of Jewish heritage, but the bulk of the restriction and the largest group of residents were African American.

Realtors went so far as to pay cash incentives to white residents in order to expedite the segregation of the city. Shortly after these restrictions took effect, disinvestment in the areas where African American and other minority populations were concentrated began. Reduction in the maintenance of public spaces like fountains and parks started in the 1930s and 40s. This began the entrenchment of the "Troost divide" between white and African American residents. As you can see in the final year of data, this remains a primary dividing line through present day. Tracts east of Troost are up to 91% African American residents, while many tracts north of the Missouri river and west of Troost have are estimated to have 94% white residents.

Building on the historical context of structural inequities in Kansas City, it becomes evident how these past actions have shaped the present health landscape of our community. The legacy of redlining, segregation, and discriminatory practices not only influenced the physical makeup of our city but also its health outcomes. These historical injustices have laid the groundwork for the social determinants of health that we see today.

Social determinants of health are all about where and how people live, learn, work, and play, and how these factors affect their health. Things like having a good job, a nice place to live, going to a good school, and being part of a supportive community can make people healthier. On the other hand, if people don't have these good things in their life, they might not be as healthy. When we look at health in a community, it's really important to think about these social determinants because they help us understand why some people are healthier than others and what we can do to help everyone be as healthy as possible.

As we delve deeper into the current state of health in Kansas City, it is crucial to examine these social determinants—factors like access to quality healthcare, education, safe neighborhoods, and economic opportunities—that continue to influence the well-being of our residents. Understanding these determinants will allow us to address the root causes of health disparities and work towards a more equitable health future for all Kansas Citians.

There are a wide variety of social determinants which may affect the health of our residents, and not all areas are affected the same by each of these determinants.

To see all the data above and more social, use the interactive tool below or visit it at the  Social Determinants of Health Explorer . When possible, comparison city data has been provided in order to understand where Kansas City ranks relative to other metro areas. You can also use the selection tools to highlight a particular part of the city, or even your ZIP Code or Council District, to explore the determinants of health most meaningful to you.

Social determinants drive differences in residents ability to engage in a healthy life, impacting things like life expectancy. Life expectancy is a way to predict the average number of years a person is expected to live, taking into account their current age, the year they were born, and other demographic factors, such as the area they live in. It serves as a general measure to understand the health and longevity of different groups of people.

The Office of Population Health Science conducted  an analysis  which aimed to explain some of the most important behaviors and risk factors explaining why life expectancy varies so highly across census tracts in Kansas City. Of the health variables that were available for the whole city, the analysis revealed that the following behaviors and risk factors were most responsible for decreases in life expectancy for residents:

As you can see, the top behavior or risk factor identified by the analysis was poor sleep. When we asked our community partners and residents to rank the drivers of lower life expectancy, neither group identified poor sleep as a primary driver of lower life expectancy - both groups ranked poor sleep last of the 10 potential drivers. This is important, as it indicates that many residents are unaware of the high impact poor sleep can have on their overall health.

While it is important to understand both how a person might improve on these behaviors, it is very important to know what the neighborhood level influences on these behaviors might be. Because the analysis used census tract estimates of behaviors and risk factors, it is really demonstrating that there are structural inequities driving health inequity. For example, if one person sleeps poorly (less than 7 hours per night on average), that might be attributable to lifestyle choices. But if a majority of a neighborhood is not able to engage in quality sleep, that demonstrates clear structural factors at play - in other words, the analysis has determined poor sleep to be a neighborhood level issue, requiring neighborhood level interventions.

We asked the community for input on how to address some of these factors. Many people said stress was a big reason they couldn't sleep well, with about 32.7% mentioning it. Other issues like noise and not feeling safe at night were also problems for about 14.5% of people. Last, about 12.2% said that feeling physical pain made it hard for them to sleep. This shows us that trouble sleeping can come from many things, like feeling stressed, problems in the environment, and not feeling well.

Working so many hours [at] more than one job...taking [kids] to school, feeding [and] washing [them], way too much to do

The community made several suggestions to help with sleep problems. Programs that help people manage stress might really help, especially since a lot of people talked about stress. Making places quieter and safer could also make it easier for people to sleep better. Finally, learning about good sleep habits could help everyone, especially if pain is making it hard to sleep. If we make sure these programs fit what different people and places need, they could work even better at helping people sleep well and feel good. As a result of this feedback, the Kansas City Health Department has developed a program which aims to address these issues at the neighborhood level. To learn more, see our page on  Kansas City Health Prosperity Zones .

Life expectancy is a highly useful metric in showing overall health outcomes within a community. When we talk about life expectancy for different "census tracts," we're looking at this estimate for small areas, almost like specific neighborhoods, within a larger place. A census tract helps us break down big areas into smaller ones to get a better picture of people's health in each spot. This difference in outcomes is particularly stark in Kansas City, which has a difference in 31 years between the census tracts with the shortest and longest life expectancy.

Kansas City...has a difference in 31 years between the census tracts with the shortest and longest life expectancy

This detailed look can show us which areas have lower life expectancy, hinting at possible health challenges there. It's a way to pinpoint where people might not have as much access to healthcare, where living conditions might be tough, or where there might be other factors that could affect their health. Understanding life expectancy by census tract helps in planning better health services and making improvements where they're most needed.

However, it is important to remember that life expectancy is meant to describe what a population's health has been, not predict it in the future. Life expectancy is not a life sentence, and the Health Department is committed to increasing health outcomes for all Kansas Citians.

In addition to overall life expectancy, KCHD looks at causes of death to identify key risks to our population.

Older adults are a key population when considering health needs in Kansas City. Per the Center for Disease Control and Prevention:

Aging increases the risk of chronic diseases such as dementia, heart disease, type 2 diabetes, arthritis, and cancer. These are the nation’s leading drivers of illness, disability, death, and health care costs.

These needs, combined with a projected increase in population size, make understanding and addressing issues facing older Kansas Citians a priority. See below for more details

Many organisms live in and on our bodies, they are normally harmless and may even be helpful in some cases. When there are too many or too few, some organisms can cause disease that make a person feel sick. Another type of disease is known as "Communicable Disease" and these are diseases that can be passed from one person to another, from an animal to person, or through food and water that a person eats and drinks. The Kansas City Health Department has a  list of illnesses  that they keep track of so they can provide interventions to help people get better or provide education to help people stay healthy by avoiding getting sick in the first place.

For persons who are reported with a Sexually Transmitted Infection (STI), the Kansas City Health Department has the ability to provide exams and testing for patients and their contacts. Below is a summary of the confirmed cases reported in Kansas City.

One type of STI that can be passed from a pregnant mother to her baby is called congenital syphilis. Many persons who can become pregnant don't realize that they need to be tested for syphilis because they don't feel sick. Syphilis can take a long time to show symptoms so it's important to get tested when a person finds out they are pregnant since syphilis can cause major health problems to both the mother and baby.

Hepatitis A

Alongside the COVID-19 pandemic, Kansas City experienced two other outbreaks. The first, beginning in 2021 was Hepatitis A (HAV). HAV is a contagious liver infection, and spreads primarily through direct contact with an infected person or by consuming contaminated food or water. The outbreak saw a significant increase in cases, with 111 reported: 66 in 2021 and 45 in 2022, a stark rise from the 5 total cases in the three years preceding 2021. The majority of these cases were male (62%), white (77%), and non-Hispanic (92%), predominantly affecting older adults aged 35 to 64 years, accounting for 78% of the cases.

Particularly at risk for HAV infection are international travelers, men who have sex with men, drug users, individuals with occupational exposure risks, and those experiencing homelessness. Of the reported cases, 45% involved substance use, with 29% engaging in non-intravenous drug use and 21% in intravenous drug use. Additionally, 35% of cases were among individuals experiencing homelessness, highlighting the vulnerability of these groups to HAV.

To contain the outbreak, the local health authorities distributed Hepatitis A information and condoms to social service agencies and administered vaccinations at a local homeless resource center and trailer park, both linked to reported cases. However, intervention efforts faced challenges as many cases lacked identifiable connections, and only 69% of individuals could be located for interviews. From these efforts, eight contacts identified through interviews received the Hepatitis A vaccine, underscoring the importance of targeted intervention and the need for effective public health strategies to manage and contain such outbreaks.

MPOX

As part of a national epidemic, Kansas City experienced a rapid increase in mpox (formerly monkeypox) from June 2022 to June 2023. Mpox, related to the smallpox virus, presents with similar but typically less severe symptoms, including a distinctive rash, fever, chills, swollen lymph nodes, muscle aches, headaches, and sometimes respiratory symptoms. The rash can appear on various body parts such as the hands, feet, chest, face, mouth, or genitals. Transmission mainly occurs through close, personal, often skin-to-skin contact, which can include sexual contact, hugging, kissing, or even prolonged face-to-face interactions..

During the outbreak, the Kansas City Health Department (KCHD) was proactive in its response, identifying 56 cases, with 88% of these reported in the latter half of 2022. The KCHD's efforts included thorough disease investigation, partner identification, patient examinations, testing, and the provision of vaccinations and antiviral treatments to those affected. Vaccination has been identified as the most effective way to prevent mpox, underscoring the importance of community health measures in controlling such outbreaks.

Chronic diseases are conditions such as heart disease, cancer, and diabetes that last for an extended period of time. They are the leading causes of death in the United States, and often require ongoing medical attention and limit daily life.

Many chronic diseases are caused by a short list of risk behaviors including poor sleep, smoking, poor nutrition, physical inactivity, and excessive alcohol use. As  highlighted earlier , these risk factors affect people unequally due to a range of social conditions. Because of this, rates of chronic diseases vary across our population.

Unacceptable levels of racial inequity exist for both maternal and infant mortality in Kansas City. For example, infant mortality rates for African American babies were over twice as high as White babies in 2022 (10.2 vs 4.7 per 1,000 births).

Infant mortality rates for African American babies were over twice as high as White residents in 2022

Similarly, Kansas City has high levels of inequity in maternal morbidity. Maternal morbidity refers to health problems that women experience during pregnancy, childbirth, or after delivery. These health issues can vary in severity, ranging from mild conditions that require minimal medical attention to severe complications that can have long-lasting effects on a woman's health. In Kansas City, African American mothers experience morbidity at a rate more than twice that of white mothers (29 vs 14 per 1,000 births).

Below, you can find a variety of data on health outcomes during and after pregnancies. Click on the various tabs below to see different outcomes.

Based on these graphs and aggregated data, the racial disparity in maternal mortality is most pronounced in rates of death from 43 days to 1 year after birth. Further, this disparity is most prominent when looking a non-obstetric causes of death, where the difference is 126 per 100,000 for Black/African American mothers, compared to 57 per 100,000 for White mothers.

Mental health and physical health are two sides of the same coin, and directly affect each other continuously. If someone is in a state of poor mental health, they may be more prone to engage in behaviors that serve to protect them from expending energy.

For example, individuals experiencing depression or anxiety may gravitate towards higher calorie foods as a way of protecting themselves from future energy needs. This may lead to a higher likelihood of obesity and cardiovascular disease, which then may increase symptoms of depression or anxiety.

Drug overdose deaths have risen fivefold over the past two decades across the nation. In 2021 alone, over 106,677 deaths occurred, resulting in a rate of over 32 people dying of an overdose for every 100,000 people in the United States.

Prior to 2018, synthetic opioids (primarily fentanyl) were a relatively minor issue for residents, comprising less than 10% of all overdose deaths. However, between 2019 and 2020, there was a 211% increase in fentanyl deaths.

Between 2019 and 2020, Kansas City residents saw a 211% increase in fentanyl deaths

2020 showed the highest increase across the board with increases in all overdoses, opioids, and synthetic opioids. Opioids are made from naturally occurring substances (morphine and codeine) and can be lab-created, called synthetic opioids, (fentanyl and heroin) but both types can prescribed by doctors to reduce pain. In 2022, both opioids and synthetic opioids again started to rise significantly while all overdoses started to decline.

Note that the below table includes overdoses from accidental, intentional, and unknown intent, and includes all causes of death. Numbers may vary from reports that only include unintentional overdoses and overdoses of unknown intent, or from those that only consider primary causes of death.

The next few graphs provided show how often people went to emergency departments in Kansas City hospitals because of drug-related issues in 2022.

To understand what counts as a drug-related visit, experts used advice from big organizations like the United States Drug Enforcement Administration (DEA), the National Center for Health Statistics (NCHS), and others. They looked at specific codes from laboratory tests and billing to figure out if a visit was because of a drug overdose. They also checked the patients' own words in their files to see if they mentioned taking too much of a drug. As you look at the graphs, there will be explanations on the left side to help you understand what you're seeing. These notes will guide you through reading the graphs correctly.

The National Institute of Environmental Health Sciences notes that:

[Poor air quality] is a major threat to global health and prosperity. Air pollution, in all forms, is responsible for more than 6.5 million deaths each year globally, a number that has increased over the past two decades.

Kansas City faces air quality issues from a number of sources and its impacts can be seen in our residents health outcomes.

The Kansas City Health Department's Environmental Health Services unit responds to complaints about a variety of local air quality concerns through the City's 311 system. The city's urban core sees the bulk of complaints, particularly for open burning, odor, and asbestos. However, complaints related to dust from construction and factory emissions are more common further to the south.

A potential impact of air pollution for our residents can be seen in the percent of the population with respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease. The map below shows that asthma rates are most concentrated in similar regions as air quality complaints and registered emissions facilities, particularly in the eastern and southern parts of Kansas City. You can also use this tool to explore additional trends in health and air quality complaints.

Note that the above data shows resident input, which may not fully reflect actual conditions. To report an issue in your area, see  https://www.kcmo.gov/city-hall/311 .

Safe housing conditions are a crucial part of overall positive health outcomes. Kansas City supports this through its  Healthy Homes Rental Inspection Program , which provides regulations for minimum health and safety standards in rental housing.

All rental property owners are required to register their rental properties, and tenants may file inspection requests through the City's 311 system. Inspection requests generally come from neighborhoods with the most tenants and cover a wide variety of issues. The most common reported issues are related to water, heating and ventilation, pests, and mold, all of which can lead to negative health outcomes and worsen existing health issues.

Use the below tool to explore additional trends in rental complaints.

Note that the above data shows resident input, which may not fully reflect actual conditions. To report an issue in your area, see  https://www.kcmo.gov/city-hall/311 .

This map illustrates the locations of grocery and convenience stores throughout Kansas City, highlighting disparities in access to fresh and nutritious food. Notably, the region east of Troost Avenue is characterized by a significant scarcity of grocery stores, underscoring the challenges faced by residents in obtaining healthy food options. This area has historically encountered socioeconomic challenges, and the limited availability of grocery stores exacerbates these issues. While convenience stores are more uniformly distributed across the city, they often offer a restricted selection of healthy foods.

The map below aims to draw attention to the need for strategic initiatives to enhance food accessibility and promote health equity in underserved communities. It includes an overview of where food pantries are located. Click on each green dot to see information about the food pantry.

Lead poisoning hurts the brain and many other parts of the body. The effects of lead poisoning can make life a lot harder and some of these effects may never go away. Impacts include both mental health (including brain damage, memory loss, and behavioral problems) and physical health (including kidney damage, constipation, and anemia). 

Young kids are most vulnerable to lead poisoning, but most children don’t show symptoms of lead poisoning right away, unless they are severely lead poisoned. The Kansas City Health Department's Lead Poisoning Prevention program provides free lead testing to both children and adults. Areas with older housing that are more likely to use lead paint or have lead in the soil are also at greater risk of lead poisoning. It is particularly important for people who are pregnant and recent immigrants to receive lead testing.

To learn more about KCHD's Lead Poisoning Prevention and the services that it offers, see  https://www.kcmo.gov/city-hall/departments/health/lead-poisoning-2022 . 

Climate change is the single largest health threat facing humanity. The impacts of climate change that are seen to affect health are through increased air pollution, extreme weather events like hurricanes, tornadoes, and drought, disease, forced displacement, pressure on mental health, and increased hunger and poor nutrition in places where people cannot grow or find sufficient food.

Temperature data is monitored during the summer from May 1 to September 30 each year. By monitoring the highs and lows as well as the humidity and air quality, the Kansas City Health Department is able to provide community partners with helpful recommendations on ways to cool down and to provide guidance for decision-making in our partner community based organizations.

Based on data collected for each heat season over the past three summers, 2023 was the hottest season that Kansas City has experienced with nearly twice the amount of people reporting to the Emergency Department along with the single highest day of persons being seen at 115. Temperature wise, three peaks were seen during the summer in which 3 or more consecutive days of 100+ degree highs were seen; June 28-30, July 25-28, and August 19-25. Additionally. a total of six non-consecutive 100+ degree days were seen throughout the summer.

Concrete structures such as buildings, roads, and other infrastructure absorb and re-emit the sun’s heat more than natural landscapes such as forests and water bodies. These structures are known as impervious surfaces and are areas where water and other precipitation is not absorbed. Urban areas, where these structures are highly concentrated and greenery is limited, become “islands” of higher temperatures relative to outlying areas. These pockets of land that contain several concrete structures in a small area are referred to as “heat islands.” The effects of these heat islands have been proven to have a negative effect on human health. Heat islands are areas where daytime highs can be substantially degrees hotter than the surrounding areas and have difficulty cooling at night leading to the reduced nighttime cooling needed for restorative sleep.

The effort to complete this community health assessment was led by the Office of Population Health Science. Our office, established in March of 2022, serves to study the overall health of the City of Kansas City, utilizing any and all data available.

The team:

Alex Francisco, PhD - Chief Science Officer

Dylan Knaggs (CHArchitect) - Data Quality and Modernization Manager

Nicole Schlaefli, MPH, MBA – Injury Epidemiologist

Indigo Warren – Health Assessment Coordinator

Lesha Dennis – Epidemiology Specialist

Elizabeth Duggan – Evaluation Analyst

Aminju Nkeng, MPH – Population Health Scientist

We would like to extend a special thanks to the following KCHD employees and for their help in completing this assessment:

Lisa Mertz, Cindy Calendar, Stacie Duitsman, Amy Roberts, Devon Bandad, Teresa Cassell, Lia Thompson, Rashid Junaid, Robert Schepis

Special thanks to the following people and organizations for their time and input:

The Nia Project, Nicoya Helm LLC, Children’s Mercy Hospital, Kanas City Public Schools, Heart to Heart International, Erin Cardwell at the Mid-America Regional Council, Cecil Wattree, Councilmember Andrea Bough (6 ^th  District at Large), Mayor Pro Tem Ryana Parks-Shaw (5 ^th  District)

And a final thanks to the 90 residents of Kansas City who contributed their time, thoughts, and expertise to this Community Health Assessment

Check out our other publications at: