When 91探花 President Ana Mari Cauce launched the Population Health Initiative in 2016, she spoke in soaring, ambitious terms. 鈥淲e have an unprecedented opportunity to help people live longer, healthier, more productive lives 鈥� here and around the world,鈥� she said. 91探花researchers have leapt at that opportunity, forging connections across the university, working side by side with community partners and breaking down traditional barriers to improving public health. 听

In just eight years, the Initiative has funded 227 innovative, interdisciplinary projects. Many are focused right here in Western Washington, where projects have helped in South Seattle, identified soil contaminants in community gardens in the Duwamish Valley, and improved how community leaders along the Okanogan River . Other projects have reached across the globe, targeting health disparities in Somalia, Peru, Brazil and more.听听

鈥淚n this relatively short period of time, we鈥檝e demonstrated the power that accrues when faculty and staff across the various areas of our campuses are working together and also exposing students to the cutting-edge work of tackling grand challenges,鈥� Cauce said in her most recent .听

And they’re just getting started. Many PHI-funded projects are still in their earliest stages, leveraging initial funding to show proof-of-concept for their ideas and setting the stage for future work. Fourteen projects so far have received much larger grants to empower researchers and community partners to expand successful projects and scale up for greater impact.听

With the Initiative now a third of the way into its 25-year vision, 91探花News checked in with three projects that recently received funding to scale their efforts.听

Spotting potential memory health issues in rural Washington

Diagnosing memory health issues in the best of circumstances is extraordinarily difficult. Patients typically make multiple visits to their doctor and take a many of which can produce flawed results 鈥� people who take the same test more than once, for example, will often score higher, potentially masking memory loss. 听

It鈥檚 even harder in rural America, which has a Patients seeking memory care might have to make a long, expensive trip to a major city, which leads many people to wait until a problem becomes apparent. By then, it鈥檚 often too late 鈥� modern treatments can slow the progress of memory loss, but there鈥檚 no way to regain what鈥檚 been lost.听

鈥淪o, how do you catch it early?鈥� said , a 91探花associate professor of psychology. 鈥淲e give people an app to have them check for themselves.鈥澨�听

Stocco and , director of the 91探花Alzheimer鈥檚 Disease Research Center, together with Hedderik van Rijn of the University of Groningen in the Netherlands, led the development of an online program that can measure a person鈥檚 memory and predict their risk of memory disorders. Like a flash-card app that helps students cram for a test, the program shows pictures and asks the user to recall what they saw a few minutes earlier. The app records how quickly and accurately the user responds to each question and makes the next one a little easier or more difficult.听听

Researchers have long understood that a person鈥檚 ability to recall a specific memory tends to fade over time. This is called the 鈥�.鈥� In听 Stocco and van Rijn found that they could measure individual differences in the slopes of such curves.听 The app works by comparing a person鈥檚 responses to an internal model of forgetting and adjusting the slope of the model until it matches the responses. The resulting slope can be used to estimate the likelihood that their memory is fading faster than normal.听听

By taking the test regularly, a person can track their memory鈥檚 decline over time. But preliminary tests, Stocco said, have shown that even a single use can spot a potential problem.听

鈥淛ust by looking at a single lesson, based on the result, there鈥檚 almost a perfect correspondence between the speed of forgetting and your probability of being diagnosed by a doctor,鈥� Stocco said. 鈥淚t can be as accurate as the best clinical tests but, instead of taking two or three hours, this can be done in eight minutes, and you don鈥檛 need a doctor.鈥�听

A Tier 3 grant from the Population Health Initiative and a collaboration with the will allow the researchers to share the app with up to 500 people in rural and counties. Participants can take the test on their own time, and the results will be shared with researchers. If a potential problem emerges, the researchers plan to invite participants to Seattle for an in-person evaluation.听听

鈥淚t鈥檚 a solution that seems to solve these problems of early access and diagnostic bottlenecks,鈥� Stocco said. 鈥淚f this works, there鈥檚 no problem giving it to everybody in the state. We鈥檙e really interested in expanding and adding people from underrepresented populations and underrepresented areas, and the grant will allow us to do that.鈥�听

Nancy Spurgeon of the Central Washington Area Health Education Center is also a collaborator on the project to test the prototype app, which is not yet available to the public.听

Revamping the Point-In-Time Count to better understand King County鈥檚 unhoused population听

For years, volunteers fanned across King County on a cold night each January, flashlights and clipboards in hand, searching for people sleeping outside. They鈥檇 also gather the shelter head counts for that night. Officially called the , this effort attempted to tally the number of people who lacked stable housing. This endeavor was replicated in cities across the country, and the results were combined to create a national count that influences how the federal government allocates funding.听

There鈥檚 just one problem 鈥� the count is Volunteers can鈥檛 possibly find everybody. It captures only a single moment in time, and collects only limited data on people鈥檚 circumstances or personal needs. A person sleeping in their car might need different services than a person who sleeps in a tent, and the count didn鈥檛 fully capture that distinction.听

So, a team of 91探花researchers designed a better way to count. Their method, detailed in a published Sept. 4 in in the American Journal of Epidemiology, taps into people鈥檚 social networks to generate a more representative sample, which the researchers then ran through a series of calculations to estimate the total unhoused population.听听听

Called 鈥渞espondent-driven sampling,鈥� the method stations volunteers in common 鈥渉ubs,鈥� like libraries or community centers, and offers cash gift cards for in-person interviews and peer referrals. Volunteers collect detailed information on people鈥檚 circumstances and needs, giving each person three tickets to share with their unhoused peers. When those peers come in for an interview and show the ticket, the person who referred them receives another small reward. The new person gets a gift card and another three tickets.听

鈥淭his method gives people a more active voice in being counted. It鈥檚 a more humane way to count people, and it鈥檚 also voluntary,鈥� said , a 91探花associate professor of sociology and co-lead on the project. 鈥淭he regular PIT (Point-In-Time) count just counted people. Now we can collect all sorts of information from people on their circumstances and their needs. Should policymakers want to, they could leverage that data to change service offerings.鈥�听

The researchers received a Tier 2 grant to develop the system. They launched it in partnership with King County in 2022 and 2024, and were recently awarded a Tier 3 grant to test out the feasibility of running it quarterly.听听

鈥淩unning the count quarterly allows us to estimate how many people move in and out of homelessness and whether there are seasonal changes, which are rarely measured,鈥� Almquist said. 鈥淎lso, people鈥檚 needs change depending on the time of year, and this method will help us better understand those rhythms.鈥澨�听

Other cities and counties have expressed interest, the researchers said. The team has also begun to expand the effort, aiming to improve data across the broad spectrum of housing and homelessness services.听听

鈥淎 very important byproduct of this work across schools and departments at 91探花is that we can create an ecosystem of people and projects,鈥� said , a 91探花professor emeritus of health systems and population health and co-lead on the project. 鈥淲e鈥檝e spun off projects on sleep assessments, relationships with organizations that collect data on homelessness, and we鈥檙e mapping the sweeps of encampments in relationship to where people choose to be located. We have a whole network of homelessness-related research now.听

鈥淭hese PHI grants gave us the fuel to ignite these projects.鈥�听

Other collaborators are of the 91探花Department of Health Systems and Population Health and of the VA Health Services Research and Development; of the 91探花Departments of Sociology and Statistics; of the Center for Studies in Demography & Ecology and the eScience Institute; and Owen Kajfasz, Janelle Rothfolk and Cathea Carey of the King County Regional Homelessness Authority.听

Engaging community to mitigate flood risk in the Duwamish Valley听

More than a century ago, Seattle leaders set out to control and redirect the Duwamish River. They dredged the riverbed and dug out its twists and turns. Wetlands were filled in, the valley was paved over and a system of hydrology was severed. What had been a wild, winding river valley with regular flooding became an angular straightaway built for industry. But when 91探花postdoctoral scholar looks out at the Duwamish, she sees the river fighting back.听听

鈥淭he water was always there,鈥� Jeranko said, 鈥渁nd now it鈥檚 fighting to come back up.鈥澨�听

The river returned with devastating effect in December 2022, when a king tide and heavy rainfall , submerging homes and shuttering local businesses. The underserved neighborhood faces a significant risk of future floods.听

To mitigate that risk, the City of Seattle has updated the neighborhood鈥檚 stormwater drainage system and launched a new flood-warning system. But the , a nonprofit focused on river pollution and environmental health, saw an opportunity for something greater. The DRCC asked a team of 91探花researchers to help develop flood adaptation plans that are community-based, culturally responsive and that enrich the local environment.听听

鈥淚n the community, people don鈥檛 think there鈥檚 been enough engagement. There鈥檚 all this talk about flood mitigation, but all they see are sandbags,鈥� Jeranko said. 鈥淪o DRCC was like, 鈥楲ook, we really need the people who live in the flood zone to understand the solutions.鈥� Because we have this long-lasting relationship with them, they see us as someone who鈥檚 able to provide a list of solutions, not favor one over the others, and do it in an informative way.鈥�听

Boosted by a Tier 3 grant from the PHI, Jeranko and a team representing five 91探花departments, the Burke Museum and the DRCC are engaging with the community. This fall, the team will present the neighborhood with an expansive list of flood mitigation options and encourage city leaders to consider people鈥檚 preferences. Early work shows the community would favor nature-based solutions, Jeranko said. Floodable parks, for example, would provide ecological, recreational and public health benefits to the entire community, while storing flood water during storms.听听

鈥淚t has been wonderful to collaborate with the 91探花team on this to make sure we are centering community voices in every single step of the planning for climate resilience,鈥� said Paulina L贸pez, executive director of the DRCC. 鈥淐ommunity leadership and representation is indispensable to bring climate justice to the Duwamish Valley.鈥�听

Jeranko hopes their community-based model will be replicated by communities across the country facing similar risks from climate change and sea level rise.听

鈥淓ven though 91探花and a lot of other universities really support and invest in community-engaged work, a lot of times it鈥檚 fundamentally hard to make that research happen,鈥� Jeranko said. 鈥淏ut the Population Health Initiative grant was about supporting all those things.鈥�听

Other collaborators on the project are , and of the Department of Environmental & Occupational Health Sciences; of the Department of Landscape Architecture; of the Department of Civil & Environmental Engineering, of the School of Environmental and Forest Sciences; of the Quaternary Research Center and the Burke Museum; and L贸pez and Robin Schwartz of the DRCC.听

For more information on any of the projects mentioned, or to learn more about the 91探花Population Health Initiative, visit the Initiative’s website or contact Alden Woods at acwoods@uw.edu.听听

Cummings, community engagement manager for the at the UW, seeks to remedy that with her book “,” published in July by 91探花Press.

“The city of Seattle grew from the rich resources of the river’s tide flats, from the monumental feats of its early industrial barons, and from the persistence of generations of Native and immigrant residents,” Cummings writes. “But this growth came at a high cost.”

Cummings knows the topic well, having founded the Duwamish River Cleanup Coalition and served also as director of Sustainable Seattle. 91探花Notebook caught up with Cummings for a few questions about the book and the future of the Duwamish.

Why did you write this book about the Duwamish, and what is its audience?

BJ Cummings: I have always been drawn to rivers, and to the struggle for human rights. I wrote my one other book () 30 years ago, about native, environmental, religious and scientists’ resistance to building a complex of 80 dams on the tributaries of the Amazon River.

Several years after that, it became clear to me that I needed to figure out where my own home was and focus my attention there, so I could be a part of trying to solve problems, not intervening or just reporting on those who were engaged in those struggles.

Though I grew up in New York City, my family has been in the Puget Sound region since the 1800s, and I had bonded with this place as a child. So I landed in Seattle. I began working on the Duwamish River 鈥� Seattle’s hometown river 鈥� in 1994 and I’ve never looked back. This river, and its incredible people, stole my heart.

This book is a reflection not just on the river’s history, but on Seattle’s history, because they are joined at the hip. The Duwamish River and its people are largely invisible in the written histories of this city. But without knowing the history of the Duwamish, Seattle doesn’t know its own history, or its character. So the book’s audience is everyone who wants to understand who we, as Seattleites, are, and what the story of our city is, warts and all.

You write that despite advocating for the Duwamish for 25 years, you felt you “hardly knew the river at all.” What was the research like for this book? How long did it take and what were your main sources?

BJC: Doing the research for this book 鈥� learning the hidden stories of the river and its native and immigrant communities 鈥� was honestly the most fun and fascinating work I’ve done in my life. I went down so many rabbit holes, chasing so many personal and family stories, most of which never made it into this book. There’s just too much history to tell it all in a format anyone would read, but its enough to keep me busy for the rest of my life, even if I had the luxury of doing nothing else.

This is, at its core, the story of a place 鈥� ecologically, culturally, politically, etc. Learning all about it requires probing family stories, doing genealogical research, finding the long-lost newspaper stories of the early 1900s, and challenging the historical status quo.

Most of all, this book could not have been written without the many, many people I interviewed who shared their own personal and family histories. Without them, and their willingness and enthusiasm for rewriting history to include their own stories, this book would not exist.

You write that restoring the Duwamish presents an opportunity to “act in accordance with our values.” An eye-catching restoration that fails to protect river-dependent communities “will speak volumes about the classism and racism that underpin it.” Based on your study, what might be a path forward? 听

BJC: I think we need to begin with acknowledging not just what we’ve taken from this river, but who has been disenfranchised by those decisions. A cleanup of the Duwamish River must support both Seattle’s economic and social sustainability, and provide sufficient access, use and even reparations to those whose lives and livelihoods were taken from them so that those communities 鈥� both native and immigrant 鈥� can thrive again.

If we can agree on basic principles that center on equity and justice, then we can craft a cleanup and restoration of the river that strives to, and will ultimately, achieve those goals. If we don’t, then this river and its communities will continue to decline, the Superfund cleanup notwithstanding.

“As this book goes to print, government, industry and community representatives working to clean up the Duwamish River are struggling to find common ground,” you write. What will it take to find what you describe as “a new model of collaboration”?听

BJC: Respect. A commitment to equity. A willingness to listen and relate to people whose needs are different from your own. The upheaval happening in this country today both scares me and gives me hope. As in making decisions about the future path of this country, the decisions about this cleanup are being made by people.

There is no predetermined outcome, and nothing is impossible. The future state of Seattle’s river is wholly a question of our values, and our commitment to see them reflected in how we treat the river and its people.

Speaking of this worldwide upheaval, with the world’s attention now on confronting longstanding injustices and inequity, how do issues of the Duwamish River, its people and restoration relate to this larger movement? 听

BJC: Standing Rock, BLM, other struggles of disenfranchised people saying “no more” to the powers that be. That’s the story of the Duwamish 鈥� the river, the Tribe, and the river valley’s diverse immigrant communities. The United States is a colonial nation built on stolen land and labor.

The story of the Duwamish is no different, except in that we have the opportunity and the power 鈥� within the microcosm of the Seattle/King County region 鈥� to make this an environmental and economic justice success story and a model for other struggles against injustice. We can only control what is within our sphere of influence, but those successes then spread and replicate themselves elsewhere. We benefit from the victories being achieved in these other movements, and, if we are lucky and determined, vice-versa.

For more information, contact Cummings at bjcumngs@uw.edu.