Beshear says Medicaid plan will transform Ky. in a generation; acknowledges it was easier because he wouldn't face voters

In a generation, Kentucky will be a very different state because the federal health-reform law and expansion of Medicaid has made health insurance available to all residents of the state, Gov. Steve Beshear told Los Angeles Times political reporter Mark Z. Barabak for a story the paper published on Thanksgiving Day. And he acknowledged that his Medicaid decision was easier because he can't seek re-election.

"I knew if I was going to make a huge difference in the health status of Kentucky, it was going to take some kind of transformational tool to do that, and that's what the Affordable Care Act is for me," Beshear told Barabak. "I think we've started something here that a generation from now you'll see a very different Kentucky than what you see today."

Beshear "conceded, with a small smile, that it was easier knowing he would never face voters again," Barabak writes. "Embracing Obamacare is not without political risk. Undaunted by the early success in Kentucky, Republicans plan to make the controversial program a major issue in 2014, when the GOP will be vying to take control of the state House for the first time in close to a century."

Politics aside, "The need for care in this pretty but hard-pressed state is unarguable," Barabak writes. "Kentucky leads the nation in cancer deaths and preventable hospitalizations and suffers some of the highest rates of diabetes, cardiovascular illness and premature death." But he says "Kentuckians may feel understandably whiplashed" because the state's Republican U.S. senators firmly oppose "Obamacare." (Read more)

Draft plan for a statewide campaign for better health gets endorsement, much talk at Friedell Committee annual meeting

By Al Cross
Kentucky Health News

A statewide committee of volunteers is on target with its plan for a campaign to make Kentucky a healthier state, an expert in state and local health told the committee Monday.

“You guys are absolutely on the right track,” Julie Willems Van Dijk of the University of Wisconsin told the Friedell Committee for Health System Transformation at its annual meeting in Lexington.

The committee is developing a campaign that would involve many partners around the state, including health-care providers, education and business leaders, state and local health officials, and other groups and individuals interested in improving Kentucky’s poor health. The draft campaign’s working motto is “healthier, wealthier and wiser,” reflecting how education, health and economic development are related.

“Your three-legged stool of health, industry and education fits solidly within the model we’re talking about,” said Van Dijk, deputy director of the County Health Rankings and Roadmaps Program funded by the Robert Wood Johnson Foundation.

Dr. Lee T. Todd Jr.

Kentucky’s health rankings – we’re first in smoking, cancer deaths and preventable hospitalizations – prompted Dr. Lee T. Todd Jr. to dub such statistics “the Kentucky uglies” when he was president of the University of Kentucky. Now part of the group developing the campaign, he told the committee in a keynote speech Sunday night, “Those are things we need to remember and repeat.”

Noting the low life expectancy in many Kentucky counties, and the wide range of life expectancy among Louisville neighborhoods, Todd asked, “Why can’t people get excited about that, or disappointed, or just mad about it?”

Kentucky ranks 44^th among the states in health, and “The bottom line is, it hurts us economically,” Audrey Haynes, secretary of the state Cabinet for Health and Family Services, told the committee Monday.

Todd noted how San Antonio reduced its obesity rate after losing a prospective employer that cited how fat the city’s sixth-graders were. He said local communities should “get mad about something and decide you’re going to change something. . . . We have just got to stop tolerating ill health.”

As examples, he cited Grant County’s successful effort to improve its health ranking, the Hopkins County oral-health program that reduced premature births, and Clark County’s effort – now funded by a small extra tax – to varnish students’ teeth to prevent cavities.

“Why can’t we get this stuff to roll across this state and make a big difference?” Todd asked. He suggested that one reason has been a shortage of leadership and courage, as demonstrated by the political dominance of traditional industries with health implications, such as coal and tobacco.

Todd said the committee needs to find “a market driver” like the state Supreme Court ruling that forced education reform in 1990 or the Russians’ launch of the first man-made satellite in 1957, which prompted national reform of science and math education.

He said the federal health-reform law could provide that spark, because it will bring many people into the health-care system and provide free preventive services. He suggested a targeted effort, such as getting the newly enrolled to check their A1C hemoglobin (a rough measure of blood sugar and an indicator of diabetes), and predicted the tests would show many of them “are diabetic but didn’t know about it.”

While the statewide campaign can focus on certain things, Todd said, it “can’t be viewed as outsiders” giving direction to local communities. He said the effort must be led by people in local communities, focusing on their local health problems. Willems said the committee could set strategic priorities from which communities could select.

As the committee met Monday, Todd and Committee Chair Jane Chiles of Lexington said the campaign needs grant money and a staff. “This subject is too important for us to nickel-and-dime it,” he said.

As Chiles adjourned the meeting, she said of the proposal, “This is a winning concept, a winning strategy.”

For a PDF copy of the committee’s draft proposal, click here.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. Al Cross is director of the Institute and a member of the Friedell Committee.

Friedell Committee will consider what it will take for Kentucky to become a healthier state at meeting Sunday and Monday

What will it take for Kentucky to become a healthier state? That will be the question at the fall meeting of the Friedell Committee for Health System Transformation, at the Marriott Griffin Gate in Lexington Sunday, Nov. 10 and Monday, Nov. 11. Participants will examine how the committee can work with communities and individuals to create a Kentucky that is “healthier, wealthier, and wiser,” a possible motto for a campaign the committee is considering.

“We have learned that building a healthier Kentucky will depend largely on what we do beyond the health-care system,” said Richard Heine, executive director of the committee. ”Efforts to promote good health must take place in the environment where people live, work, and play. For Kentuckians to be healthier, we must address the factors behind the problem of poor health, such as lack of education, poverty, poor nutrition, lack of employment, violence, transportation, and housing.”

Topics at the meeting include the state Health Benefit Exchange, managed-care Medicaid, the state’s financial situation, successful local policy changes, and the prevention and control of Kentucky’s major health challenge: diabetes.

Lee Todd, former president of the University of Kentucky, will be the keynote speaker Sunday evening and will introduce components of the committee’s campaign for a healthier Kentucky, now being formulated. Monday’s morning sessions will focus on public health, with discussions of county health rankings, public health partnerships with communities, and opportunities for progress in the health of Kentucky. Afternoon sessions will look at education partnerships and Kentucky’s workforce.

This meeting is funded in part by a grant from the Foundation for a Healthy Kentucky. For a copy f the full agenda, click here. For more on the committee, click here.

Kentucky ranks high in prescription drug abuse, but also is a national leader in efforts to fight it, state-by-state analysis says

By Molly Burchett
Kentucky Health News

A new report finds many states do not have effective strategies in place to fight prescription drug abuse, but Kentucky scores high on most prevention measures, indicating that the state is working hard to combat the problem.

The Trust for America's Health report found that Kentucky, along with Massachusetts, New York and Washington, scored 9 out of 10 possible indicators of promising strategies to fight prescription drug abuse. Only two states, New Mexico and Vermont, scored 10 out of 10, while 28 states and Washington, D.C., scored 6 or less.

The only indicator Kentucky lacks is a Good Samaritan law, which would provide a degree of immunity from criminal charges or mitigation of sentencing for individuals who seek to help themselves or others experiencing an overdose, says the report. Such laws are in place in 17 states and D.C.

Prescription drug abuse has become a top national and state public health concern. Since 1999, rates have doubled in 29 states, tripled in 10 and quadrupled in four, including Kentucky. The state has the third highest drug-overdose death rate in the country, with 236 people per million people suffering overdose fatalities in 2010.

"Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response - starting with prevention and education all the way through to expanding and modernizing treatment," said Dr. Jeffrey Levi, executive director of Trust for America's Health, in a news release. "There are many promising signs that we can turn this around - but it requires urgent action."

To develop scores for the report, the organization worked with public-health, clinical, injury-prevention, law-enforcement and community organization experts to review a range of national recommendations and examine the 10 indicators. Kentucky received 9 out of 10 points because it:

• Has an active prescription drug monitoring program
• Requires utilization of monitoring program by prescribers
• Is participating in Medicaid expansion, which helps expand coverage of substance abuse services and treatment
• Has a "doctor shopping" law specifying that patients are prohibited from withholding information about prior prescriptions from their healthcare provider
• Requires or recommends prescriber education
• Has a rescue drug law to expand access to and use of naloxone, a prescription drug that can help counteract an overdose
• Has a law requiring health care providers to physically examine patients (or have a bona-fide physician-patient relationship) before prescribing a controlled substance
• Has a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance
• Has a pharmacy lock-in program under the state's Medicaid plan where individuals suspected of misusing controlled substances must use a single prescriber and pharmacy.

Although a cause-and-effect relationship cannot be determined, there are indications these efforts and strategies may be having a positive impact on reducing prescription drug abuse. A recent survey found fewer Kentucky teenagers said last year that they used prescription drugs without a doctor's direction, and this report indicates steps forward in the fight against abuse. There is still much more work to be done.

"We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis," said Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, in a news release. Click here for a full description of the indicators, state scores and the full report.

KET will show how annual county health rankings are stirring competition to improve health, community by community

The rankings are in quartiles, or fourths of the 120 counties

Kentuckians love the competition among their basketball and football teams. But what if that same spirit of competition was transferred to health? To help encourage such competition, and thus improve health county by county, the University of Wisconsin Population Health Institute produces county health rankings each year, in partnership with the Robert Wood Johnson Foundation.

The next edition of KET's "Health Three60," Tuesday at 9 p.m. ET, with Renee Shaw, looks at three communities that are taking those health statistics seriously and making positive changes. A health coalition drives change in Grant County, which moved from 89th to 60th in the rankings in three years. In Hardin County and some surrounding communities, a grassroots drive leads to a smoking ban. And new trails in Rockcastle County encourage healthy lifestyles, as well as economic development. The series is funded in part by the Foundation for a Healthy Kentucky. (Read more)

Just-released figures show uninsured by county, age, income

People in Logan, Magoffin, Casey, Todd, Menifee, Adair, Monroe, Edmonson and McCreary counties are more likely to lack health insurance than residents of other Kentucky counties, according to the data just released from the Bureau of the Census. And children are least likely to be insured in Todd, Monroe, Lyon, Edmonson, Webster, Hickman, Logan, Trigg, Woodford and Breckinridge counties.

Example of interactive mapping shows data for Logan County, highest in percentage of uninsured

According to the Census Bureau's Small Area Health Insurance Estimates , 22.3 percent of Logan County residents had no health insurance in 2011. Because of small sample sizes in the poll, the error margin for each county's figure is plus or minus 2 percentage points, approximately. The figures are for people under 65, who do not qualify for Medicare. Other counties with 20 percent or more uninsured, in descending order, are Magoffin, Casey, Todd, Menifee, Adair, Monroe, Edmonson, McCreary, Lewis, Metcalfe, Clinton, Breckinridge, Cumberland, Rowan, Gallatin, Butler, Robertson and Graves.

The maps are especially topical because enrollment in the state health-insurance exchange begins Oct. 1. An interactive tool allows users to map and rank counties by various factors. A little clicking reveals that Todd County, on the western border of Logan, probably has the highest percentage of children without health insurance, 10.3 percent, plus or minus 2.5 percentage points. To show county data, limit the geography to Kentucky and check the Show Counties box.

The data are from 2011, the latest year available. The figures can also be sliced by income levels: less than 138 percent of the federal poverty line, the new eligibility threshold for Medicaid in Kentucky and other states that have expanded it under the federal health-reform law; and less than 400 percent of the poverty line, the threshold for subsidies for insurance policies that the insurance exchange will offer.

Smokers, take note: Chinese meditation technique offers hope

In 2010, Kentucky had the second highest rate of adult smokers in the U.S., with 24.8 percent of the adult population -- or 1.1 million adults -- smoking, according to statistics from the Cabinet for Health and Family Services. Only West Virginia, at 26.8 percent, had a higher percentage of adult smokers.

So, what can Kentuckians do to cut the cigarette habit?  A Chinese meditation technique may contain the answer. And the kicker is, smokers don't even need to focus on quitting smoking to be successful.

A study by Texas Tech University and the University of Oregon "looked at the effect of the mindfulness meditation known as Integrative Body-Mind Training on the pathways in the brain related to addiction and self-control, discovered that by practicing the meditation exercise, smokers curtailed their habit by 60 percent. The control group that received a relaxation regimen instead showed no reduction in their smoking," reports Newswise, a research-reporting service.

Yi-Yuan Tang, a co-author and director of Texas Tech’s Neuroimaging Institute, told Newswise, “We found that participants who received IBMT training also experienced a significant decrease in their craving for cigarettes. Because mindfulness meditation promotes personal control and has been shown to positively affect attention and an openness to internal and external experiences, we believe that meditation may be helpful for coping with symptoms of addiction.”

The study group consisted of 27 young-adult smokers who averaged 10 cigarettes a day. Fifteen participants received the meditation training over a two-week period. "After two and four weeks, five of the responding smokers whose smoking had been significantly reduced after IBMT reported that they were continuing to maintain the improvement," Newswise reports.

Researchers wrote that "the apparent ability to enhance self-control and reduce stress could make the practice useful in reducing smoking and craving 'even in those who have no intention to quit smoking'" as well as treating individuals with other addictions," Newswise reports. "The meditation regime, they wrote, 'does not force participants to resist craving or quit smoking; instead it focuses on improving self-control capacity to handle craving and smoking behavior.'” (Read more)

U.S. News gives Kosair Children's Hospital a national ranking; 11 other Kentucky hospitals make 'high-performing' list

Each year, U.S. News and World Report publishes its "Best Hospitals" guide for people seeking a high level of specialty care. The only Kentucky hospital to be nationally ranked in the report for 2014 is Kosair Children's Hospital in Louisville. It received national rank in these areas of specialty care: heart, lung, neurology, cancer, orthopedics and urology.

While no Kentucky hospitals were nationally ranked in adult specialty categories, 11 Kentucky hospitals made the cut for meeting standards of strong performance within the state:
     1. St. Elizabeth Edgewood - 11 high-performing specialties
     2. Baptist Health Louisville - 10 high-performing specialties
     2. University of Kentucky Albert B. Chandler Hospital - 10
         high-performing specialities
     4. Baptist Health Lexington - 9 high-performing specialties
     5. Jewish Hospital in Louisville - 7 high-performing specialties
     6. Norton Hospital in Louisville  - 5 high-performing specialties
     7. University of Louisville Hospital - 2 high-performing specialties
     8. King’s Daughters Medical Center in Ashland - 1 high-performing specialty
     8. St. Elizabeth Florence - 1 high-performing specialty
     8. St. Elizabeth Fort Thomas- 1 high- performing specialty
     8. St. Joseph East- 1 high-performing specialty

To read more about specialty rankings for each hospital, click here for an article in The Lane Report or here for the U.S. News report.

Owsley men most likely in U.S. to be obese, Perry women most likely to die; Morgan women led nation in increasing exercise

Men in Owsley County are the fattest in the United States, and women in Perry County have the lowest life expectancy, 72, according to an NBC News report based on data assembled by the Seattle-based Institute for Health Metrics and Evaluation, which has developed a county-by-county, interactive map of obesity, physical activity, high blood pressure and life expectancy from 2001 to 2011.

In 2011, according to the map, 46.9 percent of men in Owsley County were obese. Women in the county were even fatter, at 53 percent, but that was well under the highest female-obesity county in the nation, Issaquena County, Mississippi, where 59.3 percent of women were obese.

Owsley was also the county where men were least likely to report that they get sufficient exercise, only 33.1 percent. But a nearby county, Morgan, was the one where weekly exercise increased the most in any U.S. county from 2001 to 2011 -- from 18.3 percent to 44 percent.

Several counties adjoining or near Owsley ranked almost as high in obesity, creating a cluster of high-fat counties in Central Appalachia. Here are the pertinent parts of the 2011 maps, with male obesity on the left and female on the right; for the interactive map, click here.

Female obesity rates by county, 2011

Male obesity rates by county, 2011

State health department asks Kentuckians to help improve the state's health by commenting on improvement plan by Aug. 1

Yes, Kentucky ranks first in smoking and cancer deaths, 10th in obesity and poorly in other health measurements, but Kentuckians can help improve the state's health status by giving their thoughts on how to do that.

The state Department for Public Health is seeking Kentucky residents' input for the state health improvement plan, which will help the DPH determine priorities for positive changes. Residents can fill out an online survey through Aug. 1; the survey can be accessed by clicking here.

"Now is the time to make a move in the right direction," said state Health Commissioner Dr. Stephanie Mayfield. "Too many Kentuckians are dying from issues that can be prevented. This will take public health, community partners, and the general public to weigh in on the best strategies to move in that direction. . . . The main objective of the state health improvement plan is to address these negative health indicators by developing a road map to transform Kentucky from a state that consistently reports poor health status to one that supports dynamic initiatives to help Kentuckians lead healthier lives."

Kids Count report shows where children in your county and school district rank, in a huge number of measures

Conditions have improved slightly for Kentucky children, especially in education and health, and the state's overall well-being ranking has gone up one spot, from 35th to 34th in the nation. But economic conditions for young Kentuckians have slipped since last year, says the Kids Count report released Monday by the Annie E. Casey Foundation.

The annual report measures how the country and its 50 states are doing according to four measures of child well-being – education, health, economic well-being, and family and community. How well Kentucky's children score in each domain paints a picture of Kentucky's future.

One of the many data sets available by county and school district

The report includes a wide range of data for every county and school district. The data include current and five-year rates of child poverty; median family income and median household income; infant mortality rate; child death rate; teen death rate; child abuse and neglect cases; foster care cases; births to mothers who are teenagers, who smoke, who are not high-school graduates, and who get early and regular prenatal care; pre-term births; low-weight births; newborns breastfed when they leave the hospital; early childhood obesity, number and percentage of child-support collections; asthma hospitalizations; recreational facilities; number and percentage of children receiving food stamps, Medicaid, child-care subsidies, Supplemental Security Income, and benefits from the Women, Infants and Children nutrition program; the number and percentage eligible for reduced-price meals at school; the number and percentage in publicly funded preschool; the hourly wage needed to pay fair-market rent and the percentage of renters unable to afford such rent; juvenile justice data; percentage of students ready for college and careers; and the six-year college graduation rate.

Statewide, the report shows that Kentucky has made gains in education, and the state ranks 28th on this measure. Since 2005, more children are attending preschool, more fourth-graders are proficient in reading and more eighth-graders are proficient in math, says the report.

Kentucky has also improved in many health measures. There are fewer low birth-weight babies, fewer children without health insurance and fewer teens who abuse alcohol or drugs. Medical coverage should only continue to improve as the state expands Medicaid coverage to households at 138 percent of the poverty line. However, youth advocates say gains in education and health may not be maintained if more children continue to live in poverty.

Unfortunately, Kentucky children continue to struggle economically, weighing in at 32nd in the nation. The report says 37 percent of Kentucky children have parents who lack stable employment, up from 33 percent last year, and 32 percent of children live in households that are burdened by housing costs, up from 27 percent.

The state's lowest ranking is 38th, on the family and community measure. Its constituents: More than 27 percent of children live below the poverty line, compared to the national average of 23 percent, and the number of children in single-parent families has increased from 31 percent in 2006 to 36 percent in 2011. On the bright side, teen births declined during that period.

With the hard work of child advocates, community agencies, educators and policymakers, the report shows progress has been made to improve children's well-being, but there is still much to be done. Click here for Kentucky's profile or here to go to the data center.

U.S. adult smoking rate dips to 18 percent; when state rates come out, will Kentucky still have the country's highest?

CDC chart; confidence interval (or error margin) means that
 95 percent of the time, the result for the entire U.S. population
would be within the range indicated at the tops of the bars.

The smoking rate for U.S. adults dropped to 18 percent last year, continuing a steady decline since 2009, when it was 20.6 percent, says an early release report of the 2012 National Health Interview Survey by the federal Centers for Disease Control and Prevention.

While state numbers will be released later, Kentucky's 2011 smoking rate was 29 percent, higher than any other state, says the CDC's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.) State leaders and other observers have cited the high rate as the largest single reason for the state's health problems.

A recent editorial in the Kentucky New Era of Hopkinsville, a tobacco town that recently enacted a smoking ban, says this about the state's smoking statistics: "Medical expenses related to smoking are $1.5 billion annually and smoking is the cause of approximately 7,800 deaths each year."

The editorial says the state's tobacco use hurts its economy and quality of life. In addition to health-care costs, smoking-caused productivity losses in Kentucky total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke or other tobacco use, and does not include the money spent to purchase cigarettes.

"At the very least, Kentucky’s political, health and business leaders should know the rates of smoking and what it costs the state in medical care and diminished earning potential," says the editorial.

Dr. Stephanie Mayfield, commissioner for Kentucky's Department of Public Health, recently told a legislative committee that a typical smoker in the state spent $2,237 last year on cigarettes, says the editorial. And, despite Kentucky’s continuous efforts to discourage youth smoking, about 6,100 minors begin smoking each year, reports The Associated Press.

Overall, the U.S. survey found smoking rates were lower among adults ages 65 and over (8.9 percent) than among those ages 45 to 64 (19.5 percent) and those ages 18 to 44 (20.3 percent). Additionally, the percentage of current smokers was higher for men (20.4 percent) than for women (15.8 percent). The report doesn't include smoking rates for children. Click here to read about all CDC early-release measures.

New report ranks Kentucky 45th in overall senior health

By Molly Burchett
Kentucky Health News

Everyone dreams about retirement being a happy, healthy time to finally settle down, take time for yourself, travel and count your blessings, but a recent reports suggests that if you want to retire right now in a healthy environment, don't stay in Kentucky.

Kentucky ranks 45th in overall health rankings for seniors and last in two measures: total health outcomes for seniors and preventable hospitalizations, says United Health Foundation's America’s Health Rankings Senior Report. Kentucky was next to last in cognition and education of seniors and  prevalence of dental visits, and likewise second worst in premature death rate for seniors.

The report shows Minnesota at the top of the list, with Vermont and New Hampshire following closely and Mississippi as the least healthy state for older adults.

This report aims to point out the health challenges affecting today’s seniors and encourage action that improves communities' overall health. In Kentucky, the reports shows community support is low, with total community expenditures at $358 per person aged 65 and older living in poverty, much lower than Minnesota's $542 per capita.

Not all of the report's findings about Kentucky were bad; the state is strong in three areas: underweight seniors, activity-limiting arthritis pain and low-care nursing home residents. And, on another positive note, Kentucky ranks 15th in the number of seniors receiving flu vaccines and 10th in pain management for seniors. Click here for details.

Determinants that were considered in the state's ranking include behaviors like smoking and dental visits; micro and macro community and environment measures like poverty and social support; policy measures like the state's geriatrician shortfall; and measures of clinical care like home health or hospital care and diabetes management.

The health of our state's seniors is critical, especially as baby boomers age. The number of Americans age 65 and older is expected to more than double by 2050, from 40.3 million to 88.5 million, according to the federal Centers for Disease Control and Prevention. About 13.5 percent of Kentuckians are 65 or older, which is higher than the national average.  Considering this, the report generates a provoking question. If our state's seniors are unhealthy, can Kentucky be healthy?

New health ranking of counties places Oldham at top for second straight year; some counties had big jumps and drops

By Molly Burchett
Kentucky Health News

A new report of the national county health rankings shows several Kentucky counties have improved in the last two years while others have gotten significantly worse.

For the second year in a row, Oldham County ranked best in health outcomes, and Floyd County ranked worst this year, but the statistical differences among closely ranked counties are so small that they are subject to error margins. The rankings recognize that by placing the counties into quartiles, or fourths, of the state's 120 counties.

Ranks in quartiles: white, 1st-30th; gray, 31st to 60th; light green, 61st to 90th; dark green, 91st to 120th.

The results were released Wednesday in the fourth annual County Health Rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and are available at www.countryhealthrankings.org. Detailed, county-by-county health data are available at KentuckyHealthFacts.org.

Morgan County jumped two quartiles over the past year, improving its rank by 40 notches, from 69th to 29th. Another strongly positive change from last year was Mercer's County's improvement from 61st to 40th.

On the other hand, other county rankings worsened: McLean went down two quartiles and 36 steps, from 57th to 93rd. Bourbon went from 42nd to 68th, Gallatin went from 71st to 94th and Hickman County 31st to 61st.

These Eastern Kentucky counties have been listed in the bottom quartile (91st to 120th) for the past three years: Lawrence, Johnson, Martin Powell, Wolfe, Magoffin, Floyd, Pike, Breathitt, Knott, Jackson, Owsley, Perry, Letcher, Clay, Leslie, Knox, Bell and Whitley.

The rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make Kentucky communities healthier places to live: health behaviors, such as diet, exercise and alcohol use; clinical care, including access to care and quality of care; social and economic factors, such as education, employment and income; and the environmental quality of the physical environment.

Other factors considered in the rankings include the rate of people dying before age 75, high-school graduation rates, unemployment, access to healthy foods, air and water quality, income, and rates of smoking, obesity and teenage pregnancy.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Study finds only counties in Appalachia, mostly in Kentucky, had increasing rates of death among both sexes as century turned

By Molly Burchett
Kentucky Health News

More than 40 percent of counties saw increases in female death rates as the 21st Century began, while the death rate for men rose in just 3 percent of counties, a study shows. Only Appalachian counties, mostly in Kentucky, had worsening rates for both sexes. (Click on a map for a larger version.)

Change In Male Mortality Rates From 1992–96 To 2002–06

Change In Female Mortality Rates From 1992–96 To 2002–06

On the Health Affairs maps above, blue counties showed substantial improvement, while those in aqua showed minimal improvement and worsening counties are in red.

The study identifies some shared characteristics among the 1,334 counties where more women are dying prematurely, but the main factors weren't medical or behavioral, according to David Kindig and Erika Cheng, authors of the study report.

Although counties with high rates of smoking and obesity had increased mortality rates, the report found socioeconomic factors in the Appalachian states of Kentucky and West Virginia, such as the percentage of a county’s population with a college education and the rate of children living in poverty, had more to do with increased mortality rates.

In Kentucky, Owsley County has been ranked last on health-related measures by the Population Health Institute. Areas like this in Appalachia suffered rising death rates in both sexes because college education is a rarity, child poverty is normal, recreational facilities are scarce, restaurants are mostly fast-food outlets, and adults lack social support, reports Geoffrey Cowley of msnbc.

The chart below shows how Kentucky compares to the national average in premature death and that Owsley County suffers from tremendously high rates.

County Health Rankings by University of Wisconsin's Population Health
Institute and the Robert Wood Johnson Foundation (countyhealthrankings.org)

These findings provide supporting evidence for the ever-increasing need for significant health improvement efforts in Appalachia. According to the report, efforts must extend beyond a focus on health care delivery and include stronger policies affecting health behaviors and the social and environmental determinants of health,with corresponding investments in those areas. (Read more)

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Kentucky's well-being ranks next to last, just above West Virginia

Kentucky ranks next to last in the annual Gallup-Healthways Well-Being index, just ahead of West Virginia. The Bluegrass State ranked last in the index's Healthy Behaviors category, which measures the percentage of residents who smoke, exercise frequently and eat healthy daily.

The chart on the left shows Kentucky's score in each of the six categories. The state's rankings haven't changed much since last year, with the exception of the Work Environment index, which fell from 8th to 31st.  The colored chart on the right shows the state's overall and category rankings for 2011 and 2012 (1 is the highest rank and 50 is the lowest). Click here for the detailed report on Kentucky.


Left: Kentucky Well-Being Indexes     Right: Well-Being rankings of Kentucky among the states

West Virginia, with an index score of 61.3, had the lowest well-being for the fourth year in a row. The report shows West Virginians were the least likely to be thriving and also had the nation's worst emotional health. They had the lowest score in the Physical Health category, which reflects having the highest percentage of obese residents in the nation.

There were few changes from 2011 to 2012 among states with the highest and lowest well-being scores. Hawaii residents had the highest well-being for the fourth straight year, followed by Colorado, Minnesota, Utah, and Vermont.

The report shows a consistent regional pattern in well-being over the past five years. Western and Midwestern states earned seven of the 10 highest overall scores, while New England states held the other three spots. Southern states had the six lowest scores, and Southern states had eight of the 10 lowest well-being scores.

Lack of statewide smoking ban represents one part of Kentucky's struggle to deal with tobacco use and the health issues it creates

By Molly Burchett

Kentucky Health News

As the bill for a statewide smoking ban lies on its deathbed in the General Assembly, new federal data show Kentucky still has the highest percentage of smokers (29 percent) of any state, leads the nation in the share of smoking high school students (24 percent) and spends only a minuscule portion of their tobacco revenues to fight tobacco use. Those figures come from the federal Centers for Disease Control and Prevention's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.)

The lack of a statewide smoking ban, which nevertheless has become popular among Kentuckians, represents only a small part of the struggle to address Kentuckians' tobacco use and resulting health problems. Kentucky's program to discourage tobacco use has been severely underfunded for years, contributing to the state's lack of or slow progress in reducing its smoking and tobacco use rates and subsequent health problems, said Dr. Ellen Hahn, director of the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

State tobacco revenue (left bar) and spending (right bar)

The CDC says Kentucky should spend $57.2 million a year to have an effective, comprehensive tobacco-prevention program, but the state allocates only $2.1 million a year to such programs -- 3.7 percent of the recommended amount.

By another measure, the amount is only 0.6 percent of the estimated $381 million the state gets from tobacco taxes and the 1998 national settlement with cigarette manufacturers, according to a tobacco settlement report.



Meanwhile, Kentucky's health-care costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use or cigar and pipe smoking.

Despite the known health risks that tobacco use poses, smoking in Kentucky remains a part of everyday life in most places. But that is increasingly less so around the country, so there is an increasing gap between heavy-smoking and low-smoking states; smoking in Kentucky is about twice as prevalent as in Utah and California, reports Steven Reinberg of HealthDay. Click here for an interactive map of states' tobacco prevention efforts.

There are proven, multi-pronged strategies to curb smoking. They include combinations of higher tobacco taxes, smoke-free laws, media campaigns, and restricted access to tobacco products. However, Kentucky continues to lag behind other states due to "stagnant policies" and a lack of funding, said Hahn.

Many other factors contribute to Kentucky's lack of tobacco-prevention progress. By failing to substantially reduce adult smoking, the state misses opportunities to encourage younger adults and children not to smoke, Hahn said. Kentucky needs to employ strategies that communicate the success and affordability of tobacco cessation programs, she said; people often lack the encouragement to quit smoking because they don't know how or they don't believe it is possible.

The latest tobacco report is a timely reminder that tobacco use remains a huge public health problem for Kentucky and there are proven strategies that, if implemented, could help Kentuckians live a healthier, tobacco-free life.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.

Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

Kentucky's obesity rate and ranking are better than last year, but the figures may not be truly comparable

The percentage of Kentucky adults who are obese is smaller than its was, but the state is still 10th in the country, according to a new, influential analysis by Trust for America's Health and the Robert Wood Johnson Foundation. The report found 30.4 percent of Kentucky adults are obese, an improvement from last year's 31.5 percent and the state's sixth-place ranking. The numbers do not include the percentage of adults that are merely overweight.

The statistics are based on data collected through telephone surveys by the Centers for Disease Control and Prevention. The surveys this year included people who only have cell phones, not land lines. Such people tend to be younger, so officials warned about putting too much stock in comparing this year's ranking from last year, reports Barb Berggoetz for the Indianapolis Star.

Mississippi has the highest obesity rate in the country at 34.9 percent, followed by Louisiana (33.4) and West Virginia (32.4). Twenty-six of the 30 states with the highest rates are in the Midwest and South.

"Obesity has contributed to a stunning rise in chronic disease rates and health care costs. It is one of the biggest health crises the country has ever faced," said Jeffrey Levi, executive director of Trust for America's Health. "The good news is that we have a growing body of evidence and approaches that we know can help reduce obesity, improve nutrition and increase physical activity based on making healthier choices easier for Americans. The bad news is we're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in terms of health and savings."

In 2006, obesity-related medical costs were $147 billion or the equivalent of 10 percent of total medical spending, a 2011 study in Health Affairs found. Most of it is spent on treating diseases related to obesity, like diabetes.

The ranking is the first part of the 2012 "F as in Fat" report, which analyzes state obesity rates and efforts to address the problem. It will be released in full in September. For the first time, the report will include forecasts about obesity rates in 2030 in each state. It will also look at the potential impact of a 5-percent reduction in body mass indices. (Read more)

Children's health and education improves in Kentucky, but one in four kids lives in poverty, report shows

New data show one in four Kentucky children live in poverty, a sharp increase since 2005, but the state is improving when it comes to children's health and education. These were the latest findings in the influential Kids Count report by the Annie E. Casey Foundation, as assessment of children's overall well-being in the country.

Compared to national averages, fewer Kentucky children go without health insurance (6 percent compared to the nation's 8 percent) and there are fewer teens who abuse alcohol or drugs (6 percent in Kentucky; 7 percent nationwide).

Though it remains higher than the national average, Kentucky's rate of child and teen deaths decreased considerably from 2005 to 2009 (41 per 100,000 to 32 per 100,000). And the number of babies who are born underweight dropped slightly in Kentucky from 2005 to 2009 (9.1 percent to 8.9 percent), though the number remains higher than the country as a whole (8.2 percent).

These were some of the 16 factors, shown below, that the report used to assess overall child well-being. The factors fell into four main groups: economic well-being, family and community, education and health. Kentucky ranked a somewhat dismal 35th among the 50 states in overall well-being of children. But in education, it was 28th, and in health, 25th.

The report shows the share of Kentucky children living in poverty grew by 18 percent from 2005 to 2010, meaning they lived at or below the federal poverty line. In 2010, that meant "an annual income of less than $22,113 for a family of two adults and two children," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

The Courier-Journal's Jessie Halladay points out that more children have access to health insurance in part because of a statewide push to get more children enrolled in the federally funded Kentucky Children's Health Program, known more commonly as KCHIP. Now, about 65,000 children are enrolled. "We are clearly making a difference in easing the difficulty these tough economic conditions put on our families," said Gov. Steve Beshear, who launched the effort.

But much work remains to be done, points out Terry Brooks, executive director of Kentucky Youth Advocates. He referred to the fact that while more fourth-graders are proficient in reading than they were in 2005, a whopping 65 percent of them were still not considered reading proficient in 2010. "At one level you want to celebrate us doing well compared to other states, but you can't celebrate too much," Brooks told Halladay. (Read more)