Princess Health and Kentucky's life expectancy, a basic measure of health status, is 76; it fluctuates as many as 9 years from county to county. Princessiccia

Princess Health and Kentucky's life expectancy, a basic measure of health status, is 76; it fluctuates as many as 9 years from county to county. Princessiccia

county health health care life expectancy

Gusty 12:19 Add Comment

By Danielle Ray

Kentucky Health News

A life lived in Kentucky is expected to vary up to nine years in length depending on the county in which it's spent.

Life expectancy is perhaps the most basic measure of a community's overall health. Health researchers say life expectancy is driven by a complex web of factors that influence health: opportunities for education and jobs, safe and affordable housing, availability of nutritious food and places for physical activity, and access to health care, child care and social services.

The state average is 76 years. Twenty-four of 120 Kentucky counties exceed that figure, mostly in the counties near Louisville, Lexington, Frankfort, Bardstown, Elizabethtown, Owensboro and Bowling Green, with a few exceptions. Oldham County has the state's highest life expectancy, 79 years. Nine counties (Fayette, Jessamine, Scott, Garrard, Shelby, Bullitt, Meade, Boone, and Calloway) share a life expectancy of 78.

Differences become more apparent moving east along the Bert T. Combs Mountain Parkway and down its KY 15 extension. In general, the starkest comparisons in the state exist between the metropolitan areas of Louisville and Lexington versus southeastern Kentucky counties. Only one Eastern Kentucky county, Morgan, has a life expectancy equal to the state�s. Others range from 70 (Perry, Breathitt and Wolfe counties) to 75, mostly found in counties in northeastern Kentucky.

Eastern Kentucky counties are not the only ones with below-average numbers. Other counties ouitside that region with life expectancies of 74 or below are Fulton, Webster, Muhlenberg, Gallatin, Carroll, Casey, Monroe, Metcalfe, Cumberland and Clinton.

The numbers are on a Kentucky life expectancy map released Monday by researchers at the Virginia Commonwealth University Center on Society and Health and the Robert Wood Johnson Foundation. It shows that chances to lead a long and healthy life can vary dramatically by county.

�Health differences between communities are rarely due to a single cause,� the researchers said in a press release. �The health differences shown in these maps aren�t unique to one area. We see them in big cities, small towns, and rural areas across America,� said Derek Chapman, the VCU center�s associate director for research.

The map is the latest effort by the Robert Wood Johnson Foundation to raise public awareness of the many factors that shape health, particularly social and economic factors.

Another is the County Health Rankings, done annually by the University of Wisconsin Population Health Institute. The rankings don�t provide a comprehensive explanation for life expectancy, but they provide helpful correlations.

For example, Harlan County, with a life expectancy five years below the average, ranks 117^thin overall health outcomes and last in health factors. The county has rates of smoking, obesity and teen births that are higher than statewide. It also has less access to exercise opportunities. The rankings show that the county's unemployment rate is nearly 14 percent, more than double the state's. In addition, 43 percent of Harlan County children live in poverty, compared to the statewide figure, 26 percent.

The complete rankings are available at the County Health Rankings web site.

The state Department for Public Health says it and partners have several efforts underway to tackle the many factors that shape health:

�          Promotion of farmers� markets and their acceptance of federal food assistance benefits such as SNAP, WIC and Senior Farmers� Market Nutrition Program Vouchers, incentive programs to help with affordability and community outreach.

�          Promotion of walking and walkability by providing communities with targeted training and technical assistance to develop pedestrian plans.

�          Protecting youth from tobacco exposure through the �100 percent Tobacco Free Schools� program, which provides guidance to districts that wish to reduce tobacco use by students and staff.

Experts say local efforts are needed, too. �We must build a society where everyone, no matter where they live, the color of their skin, their financial or family situation, has the opportunity to lead a productive, healthy life,� said RWJF President and CEO Risa Lavizzo-Mourey.  �There�s no one-size-fits-all solution. Each community must chart its own course, and every person has a role to play in achieving better health in their homes, their communities, their schools and their workplaces.�

Princess Health and Annual County Health Rankings for Kentucky show many shifts in the middle echelons, not much at the top and bottom. Princessiccia

Princess Health and Annual County Health Rankings for Kentucky show many shifts in the middle echelons, not much at the top and bottom. Princessiccia

county health health rankings rankings

Gusty 20:15 Add Comment

By Melissa Patrick
Kentucky Health News

The sixth annual County Health Rankings report shows little change in Kentucky's top and bottom rankings, but there were a few surprises, with several counties showing up in the top 10 for the first time.

Marshall County was one, ranking 10th in both health outcomes and health factors, the rankings' two main measures. This is an improvement from last year's 26th in outcomes and 19th in factors. Bullitt County also moved into the top 10 for the first time this year, ranking sixth for outcomes, up from 27th.

Health outcomes include length and quality of life. Health factors contribute to outcomes and include four categories: health-related behaviors, clinical care, social and economic factors, and the county's physical environment. The rankings for each county are relative to other counties in the same state.

"Communities use the rankings to help identify issues and opportunities for local health improvement, as well as to garner support for initiatives among government agencies, healthcare providers, community organizations, business leaders, policy makers, and the public," says the report.

The County Health Rankings are a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

2016 Health Outcomes - Kentucky

The report is a general categorization of a county's health status. The rankings are arranged in quartiles, or four numerical classes, to de-emphasize the small statistical differences among closely ranked counties. Kentucky has 120 counties, in quartiles of 30.

The bottom quartile comprises almost entirely Appalachian counties, the only exception being Fulton, in the Mississippi Delta at the state's western tip.

Oldham and Boone counties continued to be the top two for health outcomes in the state, as they have been since the rankings began. Spencer County, ranked third, spent the last two years ranked 11th. Shelby and Scott counties are ranked fourth and fifth in outcomes. All are suburban, formerly rural, counties in the state's three major metropolitan areas.

The bottom 10 counties in health outcomes are all rural. They saw little change from last year, with Harlan (117) and Wolfe (119) being the only new additions. The bottom five counties in outcomes are Floyd, Harlan, Perry, Wolfe and Owsley (which has been ranked last for health outcomes every year, except 2013, when it ranked 102nd).

Counties that saw the greatest improvements in health outcomes were Livingston (LG on map), moving up from 70th to 35th; Trimble (TI), moving up from 56th to 27th; and Crittenden (CD), moving up from 64th to 38th. All these counties moved into a higher quartile with these ranking changes.

Morgan County, which for years had health outcomes far better than its health factors, saw the greatest decline in the outcome rankings, moving from 48th to 76th. It was followed by Russell, which fell from 61st to 88th; and Bracken, which dropped from 46th to 72nd. Russell County remained in the same quartile as last year, but the other two counties shifted to a lower one.

2016 Health Factors - Kentucky

The top five counties for health factors have all been in the top 10 before. They include Oldham, Boone, Spencer, Woodford and Campbell counties; Campbell had dropped last year to 12th.

The bottom five counties for health factors are Magoffin, Wolfe, McCreary, Breathitt and Bell, all in the Eastern Kentucky Coalfield.

Counties that saw the greatest improvement in health factors were Clark, moving from 53rd to 29th; Gallatin, going from 89th to 67th; and Crittenden, rising from 86th to 64th. Only Clark, just east of Lexington, moved into a higher quartile.

Counties that saw the greatest declines in health factors were Taylor , dropping from 30th to 58th; Butler, falling from 66th to 94th; and Union, dropping from 46th to 73rd. Each of these counties dropped into a lower quartile. Butler, Fulton and Carroll were the only non-Appalachian counties in the bottom quartile.

The report identifies "meaningful gaps" that exist between the best and worst Kentucky counties and suggests that policymakers look at these gaps as they search for ways to improve the counties' health, including: adult smoking, adult obesity, uninsured rates, preventable hospital stays, education levels, unemployment, children in poverty and income inequality.

The report says, "Every year, over 2,800 deaths in Kentucky could be avoided if all residents in the state had a fair chance to be healthy."

Princess Health and Newspapers' data analysis finds that Kentucky's seniors on Medicare are among the sickest in U.S.; local data available.Princessiccia

Princess Health and Newspapers' data analysis finds that Kentucky's seniors on Medicare are among the sickest in U.S.; local data available.Princessiccia

Appalachia chronic disease county health data elderly Medicare seniors

Gusty 18:20 Add Comment

Red counties are over 21%. For map with data, click here.

The top 10 Kentucky counties with the highest percentage of seniors on Medicare who have six or more chronic conditions are also in the nation's top 50 for sick seniors, according to government data analyzed by USA Today and The Courier-Journal. Nine of the top 10 counties are in Appalachia.

"That's not surprising," Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health, told The C-J's Laura Ungar. "And when you're having breathing problems, high blood pressure problems and other problems, to me it seems like you're waging a daily battle against the chronic diseases. It's hard to fight the battle ... and as you get older, it's harder."

The top 10 Kentucky counties ranked by percentage of the 65-and-older Medicare population with six or more chronic conditions are Clay, 27.1 percent; Breathitt, 26.3 percent; Johnson, 26.2 percent; Knott, 25.1 percent; Perry, 24.6 percent; Letcher, 24.2 percent; Bell, 24 percent; Floyd, 23.8 percent; Wolfe, 23.7 percent; and Taylor, 23.6 percent. Taylor County (Campbellsville) is not in Appalachia but borders three non-coal Appalachian counties.

Beve Cotton (C-J photo by Mark Mahan)

Beve Cotton, 81 and with a long list of chronic diseases, is one of those seniors. He lives in Manchester, the seat of Clay County, which ranks 12th among more than 3,100 counties nationally for the percentage of seniors on Medicare with six or more chronic conditions, Ungar reports.

"I'm a mess," said Cotton, who gets around in a power chair and wears a full set of dentures after losing all his teeth. "I'm not able to do things. I'm an accomplished cook, but I can't do that anymore ... I can't drive. My legs don't cooperate. ... It's very hard."

Ungar reports that Clay County, population 21,147, has many of the factors that combine to cause poor health.: "Nearly 38 percent of residents live below the poverty level, compared with a state average of 19 percent, according to the Census Bureau. Median household income is about $22,000 a year, about half the state average.Access to health care, especially specialists, is limited, and there are few well-stocked grocery stores or safe places to exercise. Smoking and obesity rates are sky-high."

Carmen Webb, who directs the senior center in Manchester, told Ungar that many seniors struggle with being able to afford staples, let alone healthy food and also the high cost of transportation, making it difficult to get to doctors appointments to manage their illnesses.

Cotton, who grew up in Manchester, told Ungar that he depends on others for rides, frequently to doctors' appointments, including many at the Veterans Affairs Medical Center in Lexington, about 100 miles away. Webb noted that public transportation in the area costs $1.50 per mile.

Feltner added that many seniors in the area don't know how to prevent chronic disease, some have fatalistic attitudes and because many of them are on multiple medications, they face the dangers of drug interactions and side effects, Ungar reports.

Experts say that such high levels of illness hurts communities, "hastening a downward economic spiral locally and requiring huge portions of Medicare budgets," Ungar writes. It also overtaxes the medical communities in rural counties even thinner.

"These patients need to be seen frequently by doctors, and they need much longer visits. ... These folks need intense care," Dr. Michael Karpf, executive vice president for health affairs at UK, told Ungar. "Given the shortage of primary care in Appalachia, this kind of patient just exacerbates that shortage."

"The real issue is prevention � weight control, exercise, food habits," Karpf said. "But it's hard. Fast food is cheaper than wholesome, healthy food, and (the way people eat) is partly cultural. Those things are hard to change. It's a generational process."

Princess Health andProposals sought for research of Appalachian 'bright spots' where health is better than socioeconomic factors would indicate.Princessiccia

Princess Health andProposals sought for research of Appalachian 'bright spots' where health is better than socioeconomic factors would indicate.Princessiccia

Appalachia county health Foundation for a Healthy Kentucky health health rankings health status overall health status research

Gusty 15:58 Add Comment

A three-year research project to determine factors that can support a culture of health in Appalachia and whether that knowledge can be translated into actions that address the region's health disparities has released its Request for Proposal to invite proposals from qualified research teams and consultants who would like to work on this project.

The project,�Creating a Culture of Health in Appalachia: Disparities and Bright Spots,� is sponsored by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthy Kentucky and will run through the end of 2017.

The research for this project will identify Appalachian �bright spots,� where health outcomes are better than would be expected based on unemployment and poverty rates and other community factors, and try to figure out why. Researchesr will also try to determine why health outcomes in some communities are not as good as would be expected.

The request for proposals offers detailed guidelines for submissions, which are due June 8. Applicants are encouraged to register for a webinar, detailed on the RFP, to be held May 7 at 10 a.m. EDT. Click here for more information.

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Appalachia county health economy health status poverty research

Gusty 06:59 Add Comment

Though some people equate Appalachian areas with poverty, David Krol seeks to "shine a light" on a different picture�one that reflects "how health can flourish across Appalachia," despite data that confirms economic hardship, Krol writes for the Robert Wood Johnson Foundation.

While Krol was reviewing the Appalachian Regional Commission's county-based economic data, which compares economic indicators like poverty and unemployment rates with national averages and then ranks each county, it occurred to him to overlay this county index with the annual County Health Rankings.

For the most part, Krol said he found what he expected, "that the most economically distressed counties in Appalachia would also be in the lowest quartiles of health outcomes and factors for their state." But some counties that were economically distressed ranked in the top quarter of their state in health factors and outcomes.

"What was it about Wirt County, West Virginia; Pickett County, Tennessee; and Oktibbeha County, Mississippi, that helped them overcome significant economic challenges towards better health outcomes when similarly distressed counties in the same state did not?" he wrote.

The need to know why these "unexpected outliers" occurred has prompted Krol, with the help of the ARC and the Foundation for a Healthy Kentucky, to study how these counties have accomplished this and to look at whether this could be re-created in similar communities.

"This approach is rooted in the belief that communities have the best solutions to the problems they face�as opposed to solutions driven by outside experts," he wrote.

It�s an opportunity to �go beyond the data.. to community conversations about what�s important,� Susan Zepeda, CEO of the foundation, told Krol.

Krol wrote, "Quantitative data can get only get us so far�it�s up to us to ask those critical questions of �Why? How? What can be done? It�s up to us to turn data into action."

Princess Health and Princess Health and'Stars are aligned' for making Ky. healthier, and let's start with schools, health commissioner tells County Health Rankings event.Princessiccia

Princess Health and Princess Health and'Stars are aligned' for making Ky. healthier, and let's start with schools, health commissioner tells County Health Rankings event.Princessiccia

county health county health departments farmers' markets health rankings health reform nutrition public health smoking state government tobacco tobacco prevention

Gusty 15:42 Add Comment

Kentucky is poised to make itself healthier, and one key push needs to be making schools smoke-free, the two top officials in charge of the effort told a gathering of state and local health leaders and activists in Frankfort on Wednesday.

Mayfield

"We know our health statistics are bad, but the stars are aligned for Kentucky, and the time to get healthy is now," Dr. Stephanie Mayfield, the state commissioner of public health, said at a gathering held to highlight "Signs of Progress" in conjunction with the national release of the fifth annual County Health Rankings.

"We're seeing changes that we haven't seen in a generation or multiple generations," Mayfield said, such as the expansion of Medicaid under federal health reform; the enrollment of almost 400,000 Kentuckians in the program or private coverage through the state insurance exchange, Kynect; and a coordinated effort by state agencies to make specific improvements in Kentucky's health statistics.

"I can't stop smiling about this," Mayfield said of the effort, called Kyhealthnow. "This is public health at its best," using accountable strategies to reach measurable goals. "These are strategies we need to implement across our state," she said, "but we need to do it in a  way that's not condemning to people and helps them make healthy choices."

Mayfield is co-chair of the effort, headed by Lt. Gov. Jerry Abramson under appointment from Gov. Steve Beshear. Both of them said it must include a stringer effort to ban smoking on school grounds.

Abramson (cn|2 image)

"Only 33 of our 173 school districts have tobacco-free policies," Abramson said with a touch of incredulity, repeating the line for impact. "We have areas where the government has stepped up [with a smoking ban] and the school districts haven't; we have areas where the school districts have stepped up and the governments haven't; and unfortunately, we have lots of areas throughout the commonwealth of Kentucky where neither has occurred"

Mayfield said, "It is disgraceful that all of our schools are not smoke-free. . . . We need to target our children," because the tobacco companies are.

In a national County Health Rankings video, Grant County School Supt. Sally Skinner said, "We have for some time realized the connection between healthy students and strong academic results." Grant County was recognized nationally for focusing on its health ranking as a motive for improvement, and for raising it from 89th to 60th out of 120 counties.

The program also featured videos of three other counties (Floyd, Franklin and Todd) that have used the rankings and associated data to motivate their efforts. The counties are representative of many others "that are doing something" to improve community health, said Dr. Connie White, clinical director for the state Department of Public Health.

Floyd County was recognized for its work against diabetes; Franklin County was noted for its creation of smoke-free environments; and Todd County was recognized for starting a farmers' market to make more fresh produce available.

"There are so many exciting efforts under way in Kentucky," said Katie Wehr of the Robert Wood Johnson Foundation, which funds the County Health Rankings and Roadmaps. She praised the three health departments that have won national accreditation: Franklin County, Three Rivers and Northern Kentucky. "You are demonstrating to the rest of the nation what's possible."

The foundation held similar events in Rockingham County, North Carolina, and Amherst, N.Y., a Buffalo suburb, to mark the fifth anniversary of the rankings and the importance of the roadmaps, which give communities guidance on campaigns to improve community health.

"The rankings are the starting point for the conversation," said Kitty Jerome, director of the Roadmaps to Health Action Center at the University of Wisconsin. "The number is not as important as the people in this room."

Abramson said it's unfortunate that so many Kentucky counties are chronically at or near the bottom of the rankings. "Many areas simply aren't getting the message," he said, "and anything we can do to spread that message and beat that drum is very important. . . . "We've got to do something in a coordinated, collaborative way to bring about an enhanced environment of health for our citizens."

"We are all on the same page," said Jane Chiles, chair of the Friedell Committee for Health System Transformation, which co-sponsored the event and is working with other groups on a statewide, county-by-county campaign to improve the state's health. "It is a winning collaboration going forward that will result in a healthier Kentucky."

Former University of Kentucky president Lee Todd, who emceed the event, said the state needs to declare war on what he calls "Kentucky's uglies" to get citizens and communities motivated to improve their health. He acknowledged that the term "war" is "a little tough-sounding, but I think it's time we get mad enough about some of the statistics. . . . If we had one one-hundredth the interest in moving our health rankings as we do our basketball rankings, we would be a top-ten state."

Princess Health and Princess Health andSmoking persists or even increases in poor, rural, working-class counties; New York Times cites Clay County as an example.Princessiccia

Princess Health and Princess Health andSmoking persists or even increases in poor, rural, working-class counties; New York Times cites Clay County as an example.Princessiccia

cancer cigarettes county health education health rankings lung cancer poverty rural health rural-urban disparities smoking smoking cessation tobacco tobacco prevention

Gusty 10:55 Add Comment

Clay County has a dubious distinction. It has the highest rate of smoking for any U.S. county with a population under 15,000. Researchers at the University of Washington pointed that out, and The New York Times focused on it in reporting the larger finding: Some poor, rural and working-class counties have increasingly high rates of smoking, while the smoking rates in wealthy counties continue to decline.

Ed Smith Jr.
(NYT photo by Tim Harris)

In Clay County, the smoking rate was 36.7 percent in 2012. �It�s just what we do here,� Ed Smith Jr., 51, told the Times, which reports, "Several of his friends have died of lung cancer, and he has tried to quit, but so far has not succeeded." (Institute for Health and Metrics map shows adult smoking rates by county; Clay and Knox counties are the red area in southeastern Kentucky. The interactive map shows how rates have changed since 1996, overall and among men and women. To view it, click here.)

The smoking rate among adults has decreased 27 percent since 1997, but only 15 percent among poor people, and haven't changed at all for adult smokers living in deep poverty in the South and Midwest, the study found. "The findings are particularly stark for women," Sabrina Tavernise and Robert Gebeloff write. "About half of all high-income counties showed significant declines in the smoking rate for women, but only 4 percent of poor counties did." Education also plays a role. "Americans with a high-school education or less make up 40 percent of the population, but they account for 55 percent of the nation�s 42 million smokers."

Clay County is one of the nation's poorest, and only 7 percent of its people have a college degree. The county seat, Manchester, passed an indoor smoking ban in 2012, and Manchester Memorial Hospital "runs a smoking-cessation program that offers free nicotine patches and gum in an effort to reach low-income smokers," the Times reports. �Smoking cessation is our biggest uphill battle,� Jeremy Hacker, the hospital�s community outreach coordinator, told the newspaper. Smoking is no longer a normal activity in urban places, he said, but in Clay, �It�s not viewed as a problem.� (Read more)

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

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

county health health outcomes health rankings

Gusty 12:35 Add Comment

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.

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

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

Appalachia county health education health rankings poverty rural health women women's health

Gusty 14:39 Add Comment

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.

Princess Health and How to take local action to improve health at the local level is outlined at Frankfort conference.Princessiccia

Princess Health and How to take local action to improve health at the local level is outlined at Frankfort conference.Princessiccia

county health county health boards county health departments health departments health rankings local government

Gusty 14:51 Add Comment

By Tara Kaprowy
Kentucky Health News

A recipe for how to improve health at the local level in Kentucky was the capstone of a day-long seminar in Frankfort Monday, with experts stressing that partnerships are key and funding will remain tight.

Communities must mobilize, prioritize, "effectivize" their actions, publicize and evaluate, measure and report performance, Trudi Matthews, director of policy and public relations at HealthBridge, summed up at the end of the Kentucky Health Quality Collaborative Conference.

The gathering was hosted by Kentucky Voices for Health in partnership with the Friedell Committee for Health System Transformation. "No single actor or set of stakeholders can solve what's wrong," Matthews said. "We really need to think across silos. We really have to collaborate."

When it comes to funding, governments "have made it very clear they will not increase the number of dollars that will be put into health care," said keynote speaker Dr. Robert Graham, national program director for Aligning Forces for Quality. "We're in a perfect storm," agreed Sue Thomas-Cox, branch manager for chronic disease prevention at the Kentucky Department for Public Health. "Federal, state and local governments don't have enough money . . . so we must work together."

Luckily, health care happens at the local level, Graham said, with hospitals and clinics unique to communities, health insurance agents locally based and consumers grounded in their communities. While there is "no particular model for how to get (change) started," Graham said, the first step is getting all stakeholders � purchasers, insurance agents, providers, consumers, faith-based organizations � around the same table. "You've got to make sure there is a balance of interests," he said. 

Also key are local boards of health and health departments, whose members and staff are charged with safeguarding the health of the people of a county, under state law, and have the advantage of being "relatively untainted by the illness-for-dollars disease," pointed out Dr. Forrest Calico, a rural health consultant and longtime worker in the field.

Health departments must ensure they don't spread themselves too thin, said Dr. Steve Davis, acting commissioner for the Department for Public Health. "One of the biggest reasons why we have not moved the health needle in Kentucky is we need to be an inch wide and a mile deep," he said. Communities need to "come up with five or six things and let's hammer, hammer, hammer it," he said. Of those priorities, Davis pointed out the importance of tackling chronic disease: "That's what's killing our brethren and eating our financial lunch." For adults, he would like to see an increase in breast, cervical, colon and lung cancer screening, as well an increase in immunization rates especially for flu and pneumonia.

For children, Davis has six priorities: reduce preterm and low-birthrate babies; improve injury-prevention programs; decrease tobacco use; reduce obesity; increase immunization rates; and improve oral health.

To get more accomplished, health departments need to team up with local organizations to avoid duplication of services, which Davis said accounts for $300 billion in unnecessary spending nationwide. He added the goal is to make "1 plus 1 equal 3," with health departments needing to adopt a "do or assure" philosophy.

But there are challenges in health departments, with some local health board members failing to "roll up their sleeves," Davis said. "You can go in with nothing in your head and leave with nothing in your head," agreed Henry Bertram, chair of the Pendleton County and Three Rivers District Board of Health.

A survey of health departments showed just 46 percent of local boards of health have a vision for the next three years to improve the health status of their community and just 44 percent say they are tracking compliance for the 10 essential services they are charged with providing. And the real numbers might be worse, because the survey was voluntary.

While about half of the state's health departments are committed to working toward achieving national accreditation, only three departments � Franklin, Northern Kentucky and Three Rivers District � have actually applied for it. 

Also crucial for communities is using data to identify priorities, take action and measure performance, whether using county-specific numbers at www.kentuckyhealthfacts.org or using national data.

"We don't want to get stuck in analysis paralysis," but communities can use the data as "a story you can use as leverage," said Jan O'Neill, community engagement specialist for County Health Rankings & Roadmaps. The County Health Rankings evaluate the morbidity and mortality rates for nearly every county in the country and rank them within a state.  The rankings can act as a motivator for counties interested in effecting health changes, but "We have to be aware of their limitations" given their margins of error, especially for small counties, pointed out Al Cross, director of the Institute for Rural Journalism and Community Issues. 

O'Neill spoke of San Bernadino County in California, which used its low ranking to spur change. The county focused on its built environment, pressing hard for Walk or Wheel to School programs, community gardens and a kids community health center. O'Neill pointed out the changes are about more than infrastructure. "It's the relationships," she said. "It's the human capital ... It's many not all doing it all, but bringing what you do best. That's what mobilizing looks like."

Jodi Mitchell, executive director for Kentucky Voices for Health, said she is "starting to see a tide of change" already in Kentucky. What's important is to keep momentum building and, equally vital, ensure people are willing to participate. "If you're not at the table," she said, "you're on the menu."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Neat app shows how education, income affect a county's health.Princessiccia

Princess Health and Neat app shows how education, income affect a county's health.Princessiccia

county health diabetes education health rankings income

Gusty 13:18 Add Comment

Based on the premise that much of what influences health happens outside the doctor's office, the 2012 County Health Calculator uses education and income to illustrate how these factors can affect one's health any county. 

The app estimates how many cases of diabetes would be prevented, how many lives would be saved and how many diabetes costs would be eliminated if income or education levels improved by specific amounts in a specific area. For example, the Pulaski County page shows, "If 5 percent more people attended some college and 4 percent more had an income higher than twice the federal poverty level, we could expect to save 17 lives, prevent 175 cases of diabetes, and eliminate $12 million in diabetes costs every year."

The application also shows which counties have the highest and lowest education levels (best: Fayette County, worst: Clay County) and income levels (best: Oldham County, worst: McCreary County).

The interactive app was developed by the Robert Wood Johnson Foundation and Virginia Commonwealth University's Center on Human Needs and renders "ballpark estimates" of avertable deaths, diabetes and diabetes cost. Researchers obtained education and income data from the U.S Census Bureau and county death rates and estimates of the prevalence of diabetes from the U.S. Department of Health and Human Services. Estimates of diabetes prevalence were based on self-reports by people who responded to the Behavioral Risk Factor Surveillance System. Data on medical spending on diabetes derived from The Dartmouth Atlas of Health Care. (Read more)