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.

Beshear, writing in The New York Times, defends Obamacare

Ever since he decided to expand Medicaid with money from the federal health-reform law, Democratic Gov. Steve Beshear has been telling opponents of Obamacare to "Get over it." Now, as Republicans have made the law the sticking point in talks to keep the government open and cover the national debt, Beshear has taken that argument to a national audience.

"Get over it, and get out of the way, so I can help my people. Here in Kentucky, we cannot afford to waste another day or another life," Beshear concluded in an op-ed piece in The New York Times on Friday. While not naming Sens. Mitch McConnell and Rand Paul, he took some swings at them.

"Sunday morning news programs identify Kentucky as the red state with two high-profile Republican senators who claim their rhetoric represents an electorate that gave President Obama only about a third of its presidential vote in 2012," Beshear wrote. "So why then is Kentucky — more quickly than almost any other state — moving to implement the Affordable Care Act?"

The real answer is that Beshear is a Democrat and Kentucky law allowed him to expand Medicaid and create a state-based health-insurance marketplace without approval of the legislature, which is divided between the parties. But the governor answered his question another way: "Because there’s a huge disconnect between the rank partisanship of national politics and the outlook of governors whose job it is to help beleaguered families, strengthen work forces, attract companies and create a balanced budget."

Beshear noted that several Republican governors have expanded Medicaid and/or created insurance exchanges, saying they "see the Affordable Care Act not as a referendum on President Obama but as a tool for historic change. That is especially true in Kentucky, a state where residents’ collective health has long been horrendous."

Beshear said health insurance will now be available to the 640,000 uninsured Kentuckians. "Lack of health coverage puts their health and financial security at risk. They roll the dice and pray they don’t get sick. They choose between food and medicine. They ignore checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a condition turns out to be nothing. And they live knowing that bankruptcy is just one bad diagnosis away. Furthermore, their children go long periods without checkups that focus on immunizations, preventive care and vision and hearing tests. If they have diabetes, asthma or infected gums, their conditions remain untreated and unchecked. For Kentucky as a whole, the negative impact is similar but larger — jacked-up costs, decreased worker productivity, lower quality of life, depressed school attendance and a poor image. . . . Frankly, we can’t implement the Affordable Care Act fast enough." (Read more) 

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.

Survey suggests Great Recession has harmed the health of Kentuckians

A recent poll shows continuation of a trend threatening Kentucky's overall health: as the number of Kentuckians living in poverty goes up, the percentage of adults who report their health as excellent or very good goes down.

Just over four in 10 Kentucky adults in the latest Kentucky Health Issues Poll described their health as excellent or good. In 2008, almost half used those descriptions.

People with higher incomes have consistently reported better health since the poll began tracking the health status of Kentucky adults 2008. Since research has shown a strong link between higher income and better health, the Great Recession and the resulting increases in unemployment, underemployment and poverty appear to be harming the overall health of Kentucky’s population.

In the accompanying graph, showing responses by income categories, FPL stands for federal poverty level, which in 2011 was a yearly household income of $22,350. Among the categories, 58 percent in the highest category said their health is excellent or good, but only 25 percent of those living in poverty used those descriptions.

Although the health status for each income category has remained fairly constant, the poll reflects federal data that show more people living in poverty. More than 33 percent in the latest poll were earning less than the federal poverty level; in 2008, that was only 19 percent. The polls, which used self-reporting of income and survey methods that differ from federal methods, showed much higher poverty rates than federal data.

“We know there is a direct relationship between income and good health, and these data reflect that,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, a sponsor of the poll. “While changes in our health-care delivery system may provide more health-care opportunities for low-income Kentuckians, these results show how vital a strong economy, and jobs that pay well, are to our population’s health.”

The poll, co-sponsored by the Health Foundation of Greater Cincinnati, was taken Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points.

Kentuckians think their children's generation will be less healthy and worse off economically than current working-age generation

Forty percent of Kentucky adults think their children's generation will be less healthy than the current generation of working-age Kentuckians, and 61 percent think the newer generation will be worse off economically, according to a statewide poll conducted last fall.

The Kentucky Health Issues Poll also found that 54 percent think their parents' generation was better off economically, and 42 percent thought that generation was healthier than the current generation of Kentuckians.

“It is a cornerstone of the American Dream that, if we work hard, we will get ahead and be better off than our parents were,” said Dr. Susan Zepeda, President and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “Our polling suggests that optimism for a better future may be slipping away.”

Zepeda added, “Policymakers in Kentucky and Washington are grappling with economic and health policy issues that have long term impacts. Our polling clearly indicates the concern Kentuckians have, on the need to do better for our kids.”

For details of the poll, go to the foundation's website, www.healthy-ky.org.

The poll was conducted for the foundation and the Health Foundation of Greater Cincinnati from Sept 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by landline and cell telephones. The margin of error for each figure is plus or minus 2.5 percentage points.

KET program will focus on children's health this Sunday

A discussion about the problems Kentucky families and children face on a daily basis will be at the heart of this week's "One to One" with Bill Goodman on KET.

Dr. Terry Brooks, executive director of Kentucky Youth Advocates, will be speaking about the 2012 legislative session. The program airs Sunday at 1 p.m. EST and Tuesday at 7:30 p.m. EST.

KYA has been busy as of late, holding KIDS COUNT conversations in different parts of the state. A recent conversation in Hardin County painted a picture of the health status in the area as well as pointed out which public policies are in place to improve children's health. The conversation turned to topics like childhood obesity, oral health, health insurance, physical activity and birth-related indicators and outcomes like smoking during pregnancy and low-weight births.

The conversations are held in different counties about four times a year. Last week, there was another KIDS COUNT conversation in Jefferson County.

"We try to cover topics across the child's lifespan," said Amy Swann, KIDS COUNT coordinator. "We're touching on infants, touching on issues when they're still in utero, we're touching on school-age stuff, touching on teens."

HBO's 'Weight of the Nation' examines the obesity epidemic

A compelling four-part documentary delving into the obesity epidemic sweeping the country is being aired on HBO and can be watched free by clicking here. A reporter wanting to write a series of stories on the issue would find "weight of the Nation" a good reference.

The program is divided into four parts. The first segment, "Consequences," looks at the scope of the epidemic and the ramifications of being overweight or obese. "Choices" looks at the science behind how to lose weight, how to maintain weight loss and prevent weight gain. The third part, "Children in Crisis," looks at how the problem is affecting American children, exploring the decline of physical activity, school lunch, the demise of school recess and how marketing of unhealthy food targets children. The final segment, "Challenges," looks at the major forces driving obesity, including agriculture, economics, evolutionary biology, food marketing, racial and socioeconomic disparities, physical inactivity, American food culture, and the influence of the food and beverage industries.

The documentary is on a detailed website that answers questions that range from "What is obesity?" to "How do I know if I'm overweight or obese?"

The project is a presentation of HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention and the National Institutes of Health, with support from the Michael and Susan Dell Foundation and health insurer Kaiser Permanente.

Kentucky is 43rd among the states in health rankings report

Kentucky is near the bottom of the list in a ranking that determines which states are the healthiest. It came in 43rd, up from 44th last year.

Kentucky's low ranking is attributed to its unusually high numbers of people who smoke, are obese, die of cancer and are hospitalized for preventable reasons, according to America's Health Rankings, funded by the United Health Foundation.

"As it has for the last decade, Mississippi was ranked 50th on this year's list, which was topped by Vermont at No. 1," Louisville's Business First reports.

"Kentucky's rank of 43rd is a reminder that, while are making progress, as Kentuckians we still have much to do to keep ill health from holding us down," said Susan Zepeda, president/CEO of the Foundation for a Healthy Kentucky. "The good news is there are many concerned civic leaders working to reduce rates of smoking and obesity in the state and keep young people from starting to smoke."

Highlights of the report show:

• While smoking has decreased from 30.5 percent to 24.8 percent of Kentucky adults in the past 10 years, 822,000 still smoke. Recently, Kentucky ranked 36th in the nation for its smoking cessation efforts.

• Almost 1.1 million Kentuckians are obese, 353,000 more than 10 years ago.

• Diabetes decreased from 11.5 percent to 10 percent of the populations in the past year, but there are still 322,000 adults in Kentucky with diabetes.

• In the past five years, the percentage of people without health insurance increased from 13 percent to 15.4 percent.

• In the past 10 years, the percentage of children living in poverty increased from 15.2 percent to 24.7 percent.

As for the entire country, overall health has not improved this year over 2010. "Between 1990 and 2000, the overall health of the nation ... improved by an average of 1.6 percent each year. After 2000, however, the upward trend slowed to 0.5 percent annually," until this year, Health.com reports.

"Physical activity, nutrition, and tobacco: If we could get people focused on those three, we could take a huge bite out of the chronic-disease epidemic," said Georges Benjamin, the executive director of American Public Health Association. "This is not an infinite list of things that people have to address."

America's Health Rankings has been assessing health data for the past 22 years, making it the longest-running health assessment report in the country. For its methodology, researchers look at four groups of health determinants: behaviors, such as smoking and obesity rates; community and environment, such as children living in poverty, violent crime and infectious disease; public and health policies, such as lack of health insurance and public health funding; and clinic care, such as prenatal care, the number of primary care physician and preventable hospitalization rates.

Each of these four determinants are intimately connected with one other, researchers contend. "For example, an initiative that addresses tobacco cessation requires not only efforts on the part of the individual but also support from the community in the form of public and health policies that promote non-smoking and the availability of effective counseling and care at clinics," the report reads.

Data sources include the Centers for Disease Control and Prevention; American Medical Association; Federal Bureau of Investigation; U.S. Census Bureau; and National Center for Health Statistics.