Overview of the State

The District of Columbia is the urban center of the Washington Metropolitan Statistical Area. This geographic area is bordered by the county of Arlington and the city of Alexandria in Virginia; Prince George’s and Mongomery counties in Maryland; and the Potomac River. At only 68 square miles, it ranks as the 23rd most populated city in the United States. The District has a population of approximately 680,000 residents and is divided into over 200 ZIP codes, four (4) quadrants (northeast, northwest, southeast, and southwest), and eight (8) principal Wards, which are subdivisions created for the purposes of voting and political representation.

Age and Gender

DC’s population skews toward a younger age group, with a median age of 34.8 years[1]. Children under the age of 18 comprise about 18% of the population; seniors (65 years and over) comprise about 12%. Females comprise about 53.34% of the population, while males comprise about 46.66% of the population[2]. The average household size in DC is 2.07 persons[3].

Race and Ethnicity

 

The majority of DC’s residents identify as non-White with 41.87% identifying as Black/African American (both Hispanic and non-Hispanic). Approximately 80,000, or 11%, of individuals identify as Hispanic/Latino with one or more races.[4]  The Northwest quadrant of the District includes Wards 1, 2, and 3, has a disproportionately higher White population, at approximately 50.99%, 59.50%, and 68.13%, respectively, and Wards 1 and 4 have a substantial number of Hispanic residents, 19.02%% and 22.31%, respectively compared to 11.69% of the District population. Ward 6, located in the heart of Washington DC, is 51.85% White. Approximately 88% of the residents in Wards 7 and 8 (the Southeast quadrant) are African American; they experience higher poverty rates, earn lower incomes, and experience higher rates of unemployment than residents of the District’s other six Wards.

 

2024 DC Demographics By Ward[5]

Ward	Total         Population	% Child Population (less than 18)	% Child            Population (0-9)	% Population by Race and Ethnicity
				Non-Hispanic Black	Non-   Hispanic White	Hispanic/   Latinx	Non-Hispanic Asian/PI
1	83,773	12.12	7.65	21.15	50.99	19.02	6.32
2	82,156	8.80	5.43	14.93	59.50	12.41	10.51
3	76,884	15.72	8.52	9.13	68.13	10.78	7.91
4	82,875	21.23	12.43	44.90	27.40	22.31	2.80
5	90,211	17.66	10.89	49.26	32.20	11.28	3.92
6	108,473	13.16	8.50	31.07	51.85	8.35	5.07
7	74,720	24.36	13.74	88.67	3.95	4.58	0.48
8	73,442	26.37	14.98	88.06	5.45	3.43	0.47

 

Socioeconomic Indicators

Education: Over 90% of residents are high school graduates or higher, with more than half (62.01%) holding at least a bachelor’s degree. Although the District’s median household income is $98,916, 11.86% of the population lives below the poverty line. The average household income for Whites is $159,692, yet the average for Blacks is $74,714 and $69,454 for American Indian/Alaskan Natives.  16.63% of residents speak another language than English at home, with Spanish being spoken in about 9% of all households.[6]

 

School enrollment data for public schools in the District of Columbia during the 2023-24 school year indicate 99,132 students attend all DCPS K-12 schools.[7] Regarding educational attainment, 92.51%% of residents are high school graduates or higher: 15.29% of residents had earned a high school diploma, 12.06% had completed some college, 25.42% had earned a bachelor’s degree, and 36.59% had earned a graduate or professional degree.[8]

 

Income and Unemployment: A review of economic well-being indicators shows that from January 2015 to September 2023:

• The unemployment rate in DC decreased from 7.4% to 5.0%
• The unemployment rate in Ward 7 decreased from 12.9% to 8.9% and the unemployment rate in Ward 8 decreased from 16.1% to 10.7%
• The total number of unemployed DC residents decreased by 8,800
• The total number of jobs in DC increased by 31,900[9]

 

Although the unemployment rate has decreased across the District, disparities continue to exist among resident location. The table below[10] shows a breakdown of the unemployment rate by Ward.

 

 

 

Homelessness: In 2023, the District of Columbia was listed among the top 25 U.S. cities with large homeless populations. The estimated rate of homelessness is 7.3 per 1,000. In 2023, 704 children were in families experiencing homelessness.[11]

 

Housing: Housing plays a critical role in a person’s health status. Homelessness is closely connected to declines in physical and mental health. Over the last decade, DC has seen rapidly rising housing costs, leading to a significant loss of affordable housing. The median value of owner-occupied housing unit price of a single-family home was $157,200 in 2000. In May 2023, DC home prices were up 2.8% compared to 2022, selling for a median price of $668,000. As of 2024, the owner-occupied housing unit median value is $761,465[12]. On average, homes in Washington, DC sell after 39 days on the market.

 

Rent increased from 2023 to 2022 in some parts of D.C. and nearby communities. As of May 2024, the average rent in Washington, DC is $2,252 a month. For a studio apartment, the average rent is $1,798 a month. For a 1-bedroom apartment, the average rent is $2,252 a month. For a 2-bedroom apartment, the average rent is $3,033 a month. For a 3-bedroom apartment, the average rent is $3,774 a month[13].

 

Health Insurance

In 2021, DC had one of the lowest uninsured rates in the nation, with only 3.7% uninsured residents. Of those insured, approximately 34.5% of residents receive public coverage, while 71.9% are privately insured. In 2021, about 40.4% of all District children under the age of 19 were covered by publicly funded healthcare coverage according to the US Census Bureau. Of the entire child population, 96.3% are insured. The District has historically had higher rates of insured residents, in large part due to publicly financed insurance.

 

Health Care System

There is a diverse and geographically well-distributed network of primary care practice sites that provide a comprehensive array of high-quality, well-integrated, and coordinated services to residents of DC, including obstetrical care. From 2006 through 2015, the District invested more than 70 million dollars to construct or renovate 14 community health centers in areas of the city with disparate healthcare access and health outcomes. In 2020, DC had approximately 245.7 active primary care physicians per 100,000 residents.18 Though DC has one of the strongest and most comprehensive primary care safety net systems in the nation, not all DC residents are fully engaged in appropriate primary care. Large portions of DC’s population are not engaged in needed primary care services, struggle to access care when and where needed, and face disparities in health-related outcomes despite the availability of health resources. For example, from June 2015 to May 2016, only 56% of Medicaid and DC Alliance enrollees had a primary care visit within the last 12-month period.19

 

The District is home to seven hospitals and hospital systems. All seven of DC’s acute care hospitals provide inpatient services, emergency services, comprehensive outpatient medical specialty, and surgical services, with inpatient care being the core service provided. Based on current licensure data, DC has a total of approximately 3,380 staffed beds.20 Four hospitals (Children’s National Medical Center, George Washington University Hospital, Medstar Washington Hospital Center, and Howard University Hospital) are verified Level I trauma centers. The District also has several neonatal intensive care units (NICUs). Children’s National Medical Center and MedStar Georgetown University Hospital are Level IV NICUs, offering the highest level of care for premature and ill children. Level III NICUs are available at George Washington University Hospital, Howard University Hospital, and MedStar Washington Hospital Center; Sibley Hospital has a Level II NICU. Emergency Department (ED) visits saw a significant decrease from 2019 to 2020 due to COVID-19. Unlike in 2021, 2022 data shows a slight 0.6% increase in ED visits compared to the previous year with a total volume of 376,116 ED visits. Notably, 2022 volumes remained below the 2019 pre-COVID-19 levels.21

 

Of the seven hospitals, five are birthing facilities. These facilities are concentrated in the Northwest and Northeast quadrants of the District, which leaves many residents to reside in areas with few hospital options. On February 17, 2022, Mayor Muriel Bowser, and Universal Health Services (UHS) along with George Washington University and Children’s National Hospital broke ground on the Cedar Hill Regional Medical Center. This $375 million project located in the Southeast Quadrant of DC (Ward 8) includes a 136-bed full-service hospital, ambulatory pavilion for physician offices, clinics, and community space, a 500-car garage, and a helipad for emergency transports. Key services include newborn delivery with a NICU, academic medicine, pediatric care, women’s health services, and more.

 

Disease Burden

The District of Columbia’s 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey found that residents living in Wards 7 and 8 were more likely to report having fair or poor health, high blood pressure, and pre-diabetes. About one-third of District adults were reportedly overweight, and an additional 24.3% reported being obese. Of those categorized as obese, 39.6% were African American compared to 11.5% who were White. In 2020, 12.0% of adults were smokers, with the majority of those residents living in Wards 7 and 8. While the smoking prevalence in the District continues to decline, the use of Hookah has severely increased. In 2019, 17.1% of the District’s residents reported they tried smoking Hookah, and by 2020 this number had increased to 35.4%.

 

Lastly, 14.5% of District residents reported 14 or more days during which their mental health was not good, with most of the residents who reported poor mental health ranging from 18 to 24 years old (21.8%). In 2021, the 10 leading causes of death in the District of Columbia, in ranked order, were heart disease, cancer, accidents (unintentional injuries), COVID-19, stroke, assault (homicide), diabetes mellitus, chronic lower respiratory diseases, septicemia, and hypertension. These conditions accounted for 75.81% of deaths among DC residents. However, most deaths (50.96%) were attributable to just the top three leading causes. The District of Columbia has seen a positive trend in life expectancy at birth. Over the past several years, the District’s life expectancy has improved at a faster rate than the national average. Currently, the average life expectancy is 78 years, an increase from 77.4 years in 2009. Disparities in life expectancy are evident in DC, with those living in impoverished communities having a lower life expectancy than more affluent residents. Life expectancy estimates for District of Columbia neighborhoods vary by 22.1 years.  

 

Governance

The Home Rule Act of 1973 established the Council of the District of Columbia, the legislative branch of local government. This Act allowed for an elected mayor and Council and limited federal control of DC. The Act was the result of the ongoing push by District residents for control of their own local affairs; however, it maintains Congressional oversight with provisions that allow Congress to 1) review all legislation passed by the Council before it can become law and 2) retain authority over the District's budget. The existing local government is the most expanded form of self-government since the establishment of the District as the seat of the federal government. In 1790, when the District was established on land ceded by Maryland and Virginia to the federal government, only about 3,000 citizens lived in the area —far less than the 50,000 required to be a state.    

  

The mayor of the District of Columbia is the head of the executive branch of DC’s government. The mayor has the duty to enforce city laws, and the power to either approve or veto bills passed by the Council. In addition, the mayor oversees all city services, public property, police and fire protection, and most public agencies. There are more than 20 District agencies (or departments) divided into five clusters (Planning and Economic Development, Health and Human Services, Education, Economic Opportunity and Public Safety and Justice). Each cluster is led by a Deputy Mayor who reports to the City Administrator. Sworn in on January 2, 2015, Muriel Bowser currently serves as Washington, DC’s seventh elected Mayor.   

  

The Council of the District of Columbia is the legislative branch of local government. The Council is composed of a chairman elected at large and twelve Members —four of whom are elected at large, and one from each of the District's eight Wards. A Member is elected to serve a four-year term. The Council’s central role as a legislative body is to make laws. However, its responsibilities also include oversight of multiple agencies, commissions, boards and other instruments of District government. Working with the Mayor and the executive branch, the Council also plays a critical role in maintaining a balanced budget and the fiscal health of the District of Columbia government.   

 

DC Health operates as the District of Columbia’s state and local health department. DC Health works in conjunction with The Department of Health Care Finance (DHCF), the District’s state Medicaid agency to ensure all residents in the District of Columbia have the supports and services they need to be actively engaged in their health and to thrive. In addition to the Medicaid program, DHCF also administers insurance programs for immigrant children, the State Child Health Insurance Program (S-CHIP or CHIP) and Medical Charities, a locally funded program. DHCF works to improve health outcomes by providing access to comprehensive, cost-effective and quality healthcare services for residents of the District of Columbia.

  

The District of Columbia has historically enacted relatively progressive legislation to support the health and wellbeing of women, children and families residing in the District. Several recent examples are listed below:    

 

The Healthy Schools Act (2010) was designed to improve the health and wellness of students attending D.C. public schools by enhancing standards for breakfast/lunch access, school nutrition, farm-to-school food policies, physical activity and education, and health education. 

 

The Healthy Students Amendment Act (2017) strengthens nutrition requirements for school meals; increases the reimbursement for school breakfast; expands breakfast after the bell and alternate serving models to increase breakfast participation; requires DCPS to conduct a baseline study and progress reports to align purchasing with the Good Food Purchasing Program’s core values; requires the Office of Planning to submit a report to the Mayor and Council regarding best practices for developing a central kitchen; and requires that DCPS and public charter school students participate in specified amounts of age-appropriate physical education per week.

 

The Food, Environment, and Economic Development in the District of Columbia (FEED DC) Act (2010) offers incentives to attract full-service grocery stores into low-income “food deserts” and provides funding for a Healthy Food Retail Program, which helps small grocers and markets sell fresh produce and other healthy foods.   

 

The Youth Bullying Prevention Act (2012) requires the establishment of a bullying prevention task force and the implementation of bullying prevention policies at District agencies and educational institutions.      

 

The Healthy Tots (HTA) Act (2014) is designed to incentivize early care and education facilities to adopt higher nutritional standards and funds sub-grants for physical activity and nutrition programs.   

 

The Prohibition Against Selling Tobacco Products to Individuals Under 21 Amendment Act (2015) amends District law to prohibit the sale of cigarettes to those under 21 years of age. 

 

The DC Universal Paid Leave Amendment Act (2016) establishes a paid family leave program administered through the District of Columbia. The Act provides eight weeks of leave for caring for a newborn or newly adopted child, six weeks for tending to a sick relative, and two weeks for taking care of personal medical needs for any worker employed by a private business in the District.

 

Beginning January 1, 2023, for the first time, as part of the total 8 maximum weeks of paid leave currently available, employees will be eligible to receive up to 2 weeks of paid medical leave to care for their serious health condition. Employees will also be eligible to receive leave for more than one qualifying event per year, within the 8 maximum total paid weeks.

 

The District of Columbia Living Wage Act (2006) allows for an increase in DC’s living wage to $17.00 per hour by July 2023. This act also allows for the gradual increase in minimum wage offered to tipped employees, starting at 8.00 per hour in July 2023 supplemented by tip credit. The passing of Initiative 82 in 2022 allows for this tip credit to be phased out entirely in 2027.

 

The D.C. Maternal Mortality Review Committee Establishment Act (2018) establishes a Maternal Mortality Review Committee to examine the causes associated with maternal mortalities of District residents and to help create a strategic framework for improving the maternal health outcomes of racial and ethnic minorities in the District.    

 

The Defending Access to Women’s Health Care Services Amendment Act (2018) allows pharmacists to prescribe and dispense self-administered contraceptives and requires insurers to cover certain health care services without cost-sharing, including breast cancer screening and counseling, screening for HIV, and counseling for sexually transmitted infections.   

 

The Protecting Pregnant Workers Fairness Act of 2014 (PPWFA) requires District of Columbia employers to provide reasonable workplace accommodations for employees whose ability to perform job duties is limited because of pregnancy, childbirth, breastfeeding, or a related medical condition. Individuals who believe they were denied reasonable accommodation or treated unfairly in violation of PPWFA may file a complaint with the DC Office of Human Rights (OHR). If a violation is found, employers may be required to provide monetary or other relief to the employee.

 

The Preterm Birth Reduction Initiative (2022) was written based on lessons learned from the Preterm Birth Reduction Pilot Program (2019). In 2022, DC Health launched the Preterm Birth Reduction Initiative, in which four District birthing facilities (Community of Hope, MedStar Washington Hospital Center, Howard University, and Unity Healthcare) were selected as grantees. DC Health works with these prenatal care providers to implement quality improvement initiatives to reduce preterm birth. This includes a focus on screening tools and/or procedures to help identify women at risk for preterm birth; management of associated risk factors for those at risk for preterm birth; and improving linkages to care, including prenatal care, labor and delivery options, social services, and community programs.  

 

The Better Access for Babies to Integrated Equitable Services Act of 2018 (BABIES) eliminated stand-alone screening programs and consolidated all newborn screenings (metabolic, hearing, and CCHD) to provide a comprehensive program that establishes quality measures and ensures accountability, regardless of whether the baby is born in a hospital, maternity center, or at home. This bill was not enacted by the DC Council. However, the Community Health Omnibus Amendment Act of 2018, which includes the comprehensive newborn screening provisions of the BABIES Act of 2018 was signed by the Mayor on January 30, 2019, and became DC Law 22-290, effective April 11, 2019.  

 

The Better Access for Babies to Integrated Equitable Services Act of 2020 (DC Law 23-118), which became effective June 24, 2020, amends the Community Health Omnibus Amendment Act of 2018 to:  

  

1. Require individual and group health benefit plans to cover required newborn screenings.   

  

2. Authorize civil fines and penalties for the failure of hospitals and birthing facilities to comply with newborn screening, privacy, reporting, and discharge requirements.  

  

3. Establish a report card that assesses the performance of hospitals and birthing facilities in meeting newborn screening, inpatient services, and discharge requirements.  

  

4. Establish a Perinatal and Infant Health Advisory Committee to provide recommendations to the Mayor and the DC Health Director regarding improving perinatal health and assuring access to quality perinatal health services.   

  

The Certified Professional Midwife Act of 2020 (DC Law 23-97) amends the Health Occupations Revisions Act of 1985 to provide for the certification and regulation of certified professional midwives and certified nurse midwives. It also specifies requirements for maternity centers, provides reimbursement for services provided by certified professional midwives, establishes an Advisory Committee on Certified Professional Midwives to develop guidelines for licensing professional nurse midwives, and regulates the profession of certified professional midwifery. Finally, the legislation includes certified professional midwives in the District of Columbia Health Professional Recruitment Program. This bill became law effective June 17, 2020.  

 

The Postpartum Coverage Expansion Amendment Act of 2020 (Bill 23-326) amends the Telehealth Reimbursement Act of 2013 to extend inpatient and outpatient benefits to at least a year after childbirth. The mayor is required to seek a Medicaid waiver to enable all health policies covered through the District’s Medicaid program to cover inpatient and outpatient maternity and newborn care for at least a year after childbirth. This legislation went into effect on October 20, 2020. Effective October 1, 2022, the Department of Health Care Finance (DHCF) will provide reimbursement for doula services and enroll doulas as providers in health programs (Medicaid, Alliance, and the Immigrant Children’s Program).

 

The Perinatal Health Worker Training Access Act of 2019 (Bill 23-341) requires DC Health to provide grants to implement a perinatal health worker-training program to train residents in Wards 5, 7, and 8, to provide culturally congruent nonclinical care to women during their perinatal period. A hearing was held on this legislation on December 18, 2019.   

 

The Baby Friendly Hospital Initiative Act of 2018 (Bill 22-808) required all general acute care hospitals and special hospitals that have a perinatal unit to adopt the “Ten Steps to Successful Breastfeeding” as created by Baby-Friendly USA, an alternative process adopted by a health care service plan that includes evidence-based policies, practices, and targeted outcomes, or the Model Hospital Policy. This legislation expired at the end of Council Session 22, and thus did not become law.  

 

 

 

The Community Health Omnibus Act of 2018, Amendment to Chapter 21 (Neonatal Screening Services) of Title 22 (Health), Subtitle B (Public Health and Medicine) of the District of Columbia Municipal Regulations (DCMR) 2023 amends 22-B DCMR § 2101.1 to add Spinal Muscular Atrophy (SMA) to the panel of newborn dried blood spot screening tests that hospitals and birthing centers must make available to parents of newborns. SMA is a genetic disorder that is manifested by weakness and wasting of the muscles that are used for movement. The muscle weakness usually worsens with age and can be lethal by age two if left untreated.

 

The addition of SMA follows the recommendations of the DC Committee on Metabolic Disorders and the Health Resources and Services Administration’s (HRSA’s) Advisory Committees on Heritable Disorders in Newborns and Children and is based on the best available clinical guidelines. SMA is an important addition to the District’s newborn screening panel because of the severe impacts of undiagnosed SMA on newborns and their families, the availability of an accurate screening test for this condition, and the fact that treatment of SMA can prevent the death of the child and is only effective if implemented early.

The Elimination of Discrimination Against Women Amendment Act of 2022. This act amends the District of Columbia Commission for Women Act of 1978 to require that all District government agencies conduct gender analyses every 2 years, and that the Commission for Women develops a citywide action plan to eliminate discrimination against women and to require the Commission for Women to provide training on gender equity and human rights to District government employees.

D.C. Law 24-168. Medically Necessary Foods Coverage Act of 2022. This act requires health insurers in the District to provide coverage for medically necessary foods to treat diseases including Inflammatory bowel disease, Eosinophilic disorders, inherited metabolic disorders, and other related conditions. It became law on September 21, 2022. Medically necessary foods can include a low protein modified food product, a modified fat preparation product, or a nutritional formula tailored for the client.

 

DC Law 25-49 Expanding Access to Fertility Treatment Amendment Act of 2023. Amended the Women’s Health and Cancer Treatment Rights Federal Law Conformity Act of 2000 to require individual or group health benefits plans to provide coverage for the diagnosis and treatment of infertility and standard fertility preservation services.

DC Law 25-142 Home Visiting Services Reimbursement Act of 2023. Amends Title 1 of the Birth- To-Three for All DC Act of 2018 to extend health insurance coverage for eligible home visiting services through Medicaid, the DC Healthcare Alliance, and the Immigrant Children’s Program.

 

[1] Age Data for City: District of Columbia. (2024). DC Health Matters. https://www.dchealthmatters.org/demographicdata?id=130951&sectionId=942#sectionPiece_209

 

[2] Sex Data for City: District of Columbia. (2024). DC Health Matters. https://www.dchealthmatters.org/?module=demographicdata&controller=index&action=index&id=130951&sectionId=943

 

[3] Households/Income Data for City: District of Columbia. (2024). DC Health Matters. https://www.dchealthmatters.org/demographicdata?id=130951&sectionId=936#sectionPiece_65

 

[4] Race Data for City: District of Columbia. (2024). DC Health Matters. https://www.dchealthmatters.org/demographicdata?id=130951&sectionId=940

 

[5] Population Data for Ward: Ward 7. (2024). DC Health Matters. https://www.dchealthmatters.org/?module=demographicdata&controller=index&action=index&id=131494&sectionId=935

 

[6] Demographic Data for City: District of Columbia. (2024). DC Health Matters. https://www.dchealthmatters.org/demographicdata?id=130951&sectionId=938

[7] Audit and Verification of Student Enrollment for the 2023-24 School Year (2024). District of Columbia Office of the State Superintendent of Education. https://osse.dc.gov/page/data-and-reports-0

[8] Demographic Data for City: District of Columbia. (2024). DC Health Matters. https://www.dchealthmatters.org/demographicdata?id=130951&sectionId=938

[9] D.C. Labor Market Indicators: January 2015 – September 2023 (2023). DC Department of Employment Services. https://does.dc.gov/page/dc-monthly-labor-market-indicators

[10] Unemployment Data for DC Wards (2023). DC Department of Employment Services. https://does.dc.gov/page/labor-statistics

[11] Homelessness in Metropolitan Washington: Results and Analysis from the Annual Point-in-Time (PIT) Count of Persons Experiencing Homelessness (2024). Metropolitan Washington Council of Governments. https://www.mwcog.org/homelessnessreport/

 

Homelessness in Metropolitan Washington: Results and Analysis from the Annual Point-in-Time (PIT) Count of Persons Experiencing Homelessness (2023). Metropolitan Washington Council of Governments. https://www.mwcog.org/homelessnessreport/

[12] Demographic Data for City: District of Columbia. (2024). DC Health Matters. https://www.dchealthmatters.org/demographicdata?id=130951&sectionId=937

[13] Monthly Income Limits and Fair Market Rent (2022). https://dhs.dc.gov/page/monthly-income-limits-fair-market-rent

 

Rent Market Trends in Washington, DC (2024). https://www.apartments.com/rent-market-trends/washington-dc/