Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

county government county health boards county health departments health departments hepatitis c heroin HIV legislation local government needle exchanges public health

Gusty 16:40 Add Comment

The Kenton County Fiscal Court unanimously approved a mobile needle exchange program March 29, which moves the City of Covington's needle exchange program one step closer to fruition, Terry DeMio reports for the Cincinnati Enquirer.

The Fiscal Court's approval was one of several conditions required by the City of Covington to allow its exchange to move forward. Covington's plan also requires two other counties in the Northern Kentucky Health District to adopt exchanges (only Grant County has); limits access to only resident's of the district's four counties; and would move the exchange to St. Elizabeth Healthcare hospital.

In addition, it requires a one-for-one needle exchange and a mandate that all participants must be tested for hepatitis C, hepatitis B, HIV, and, where applicable, pregnancy. This condition is likely not legal and is being investigated by the Northern Kentucky's Health Board's legal counsel, DeMio reports.

Kenton County's plan differs from Covington's in that it mandates only the offering of these tests, DeMio reports.

Both plans will require the Kenton County Board of Health's approval.

Needle-exchange programs were authorized by the state anti-heroin law passed in 2015, and require both local approval and funding. They are meant to slow the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. Northern Kentucky has been hit the hardest in the state by heroin and its hepatitis C rates have been reported at 19 times the national rate.

The needle exchange would be funded by $250,000 from the R.C. Durr Foundation, and the health department would use its staff and already available testing to further pay for the exchange, DeMio reports.

The Fiscal Court also approved exploring the idea of building a community-wide addiction treatment center on the county jail grounds; putting $25,000 toward a heroin helpline; and approved a resolution to encourage the Northern Kentucky Board of Health to create a high-quality prevention and education program for the community.

The Northern Kentucky Area Development District has already put out proposals for the heroin helpline, DeMio notes. And County Judge-Executive Kris Knochelmann told him that Boone and Campbell counties were willing to consider putting $25,000 each toward it, and that St. Elizabeth had promised $75,000 toward its operation.

The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and in the counties of Pendleton, Carter, Elliott, Franklin, Grant and Jessamine.

Princess Health and Louisville opens first needle exchange in state; officials predict rural counties will be slow to follow.Princessiccia

Princess Health and Louisville opens first needle exchange in state; officials predict rural counties will be slow to follow.Princessiccia

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Gusty 11:34 Add Comment

Photo by Scott Utterback, The Courier-Journal

Louisville Metro Public Health & Wellness opened its mobile needle-exchange program Wednesday, June 10, making Louisville the first place in Kentucky to implement such a program.

Lexington and Northern Kentucky are expected to follow soon, but officials say that establishing needle exchanges in much of Kentucky will be "more politically complex," Mike Wynn reports for The Courier-Journal.

"We're going to see some parts of our state where this is available and others where it is not," Scott Lockard, president of the Kentucky Health Departments Association, told Wynn. "Rural areas are opting for a slow and deliberate approach, heavy on education and dialogue," he said, and some communities won't even consider a exchange because of "seemingly endless hoops to jump through."

Bullitt County, south of Louisville, is a prime example. There, officials told Wynn that they plan to do a needs assessment and host a community forum with input from law enforcement and mental health experts.

"It's a work in progress," Public Health Director Andrea Renfrow told Wynn. "We are not able to go as quickly as Louisville Metro."

One critic, Magistrate Joe Laswell, told Wynn that he had talked to many voters who are against the exchanges and want to know why police wouldn't arrest addicts when they show up to swap out dirty needles. "I believe in charging and incarcerating," he said, apparently unaware that the addicts would need to have drugs in their possession to be charged.

Lockard, who heads the Clark County Health Department, told Wynn that he won't ask his board to take a vote until August and that he can't predict the political outcome when it goes to city and county officials.

In three other Bluegrass counties, Scott, Harrison and Nicholas, the board of the Wedco District Health Department wants to start a needle exchange, reports The Cynthiana Democrat, but can't proceed in any of the counties without approval of the fiscal court.

So, despite the two-year debate that just ended in Frankfort over the law, it's not really over.

Democratic state Rep. John Tilley of Hopkinsville, the legislature's biggest proponent for needle exchanges, told Wynn that giving city councils and fiscal courts final authority over the programs was necessary to sooth critics and pass a comprehensive heroin bill this year.

Opponents of the law say the exchanges promote drug use, while proponents cite evidence that doesn't support those claims, but instead "help prevent the spread of deadly and expensive diseases and pull addicts into treatment programs while keeping dirty needles out of parks and off the streets," Wynn writes.

A Lexington Herald-Leader editorial wrote about needle exchanges: "Congressional critics rely on a gut feeling that providing needles endorses drug use, but 20 years of research argues otherwise." Listing that where there are syringe exchange programs:

• Participants are five times more likely to get treatment.
• HIV and hepatitis C declines among drug users.
• Participants can get referrals to substance abuse treatment, disease prevention education, vaccinations, condoms, counseling and testing for communicable diseases.
• Costs are more than recaptured. A 2011 European study found that $1 spent on needle-exchange programs yielded $27 in health-care cost savings, prompting an international report to call needle exchanges "one of the most cost-effective public health interventions ever funded."

The federal Centers for Disease Control and Prevention recently reported that new cases of hepatitis C more than tripled in Kentucky, Tennessee, Virginia and West Virginia between 2006 and 2012, mainly from the use of dirty needles. Officials fear an outbreak of HIV and AIDS will follow.

Princess Health and Princess Health andTobacco heritage blocks smoking bans in rural Kentucky.Princessiccia

Princess Health and Princess Health andTobacco heritage blocks smoking bans in rural Kentucky.Princessiccia

cigarettes county health departments local government smoking smoking ban smoking bans smoking ordinances tobacco

Gusty 07:24 Add Comment

"A mural showing a tobacco harvest has been on display high in
the second-floor rotunda of the Bourbon County Courthouse for
than 100 years," Mary Meehan writes. (Herald-Leader photo) 

Bourbon County's strong tobacco heritage is the main obstacle for proponents of a local smoking ban, and similar feelings exist in many Kentucky counties, Mary Meehan reports for the Lexington Herald-Leader in the second of a series of stories about tobacco use in Kentucky.

"At an April political forum at Bourbon County High School, cigarette butts lined the walkway to the auditorium, although the campus is designated smoke-free," Meehan writes. "Onstage, candidates for city council and magistrate were asked whether they would support a smoking ban. Some said they had fathers or sisters who were longtime smokers who had cancer, most said they didn't smoke, and a few said they weren't sure smoking was really a health risk. Of 18 candidates, only one said he would support a smoking ban. He didn't win in last week's primary election."

The forum was organized by Students Making a Change in Our Communities, a youth group advocating a smoking ban. They have helped rejuvenate efforts begun three years ago by the Coalition for a Smoke-Free Bourbon County and Cyndi Steele, health coordinator for the Bourbon County Health Department.

"Twelve of Kentucky's 120 counties and 26 cities have enacted some type of smoke-free ordinance," Meehan notes. "In Kentucky, 34 percent of the population is protected by smoke-free laws. Almost all Kentucky cities with bans are county seats, leaving most of rural Kentucky without smoking regulations. Efforts to enact a statewide ordinance have failed in the legislature.

"Across the country, about half the population lives in places with smoke-free rules, said Cynthia Hallett, executive director of the nonprofit Americans for Nonsmokers' Rights. She said the science on the dangers of smoking and exposure to secondhand smoke was clear, as were the benefits of smoke-free laws. Kids who grow up where smoking is banned in public places are less likely to smoke, she said. People tend to quit when towns go smoke-free." (Read more)

Read more here: http://www.kentucky.com/2014/05/25/3259432/bourbon-countys-tobacco-heritage.html?sp=/99/322/&ihp=1#storylink=cpy

Read more here:

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

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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 Knox County converting ambulance tax, taking 3/8 of health tax and asking library for same in order to save hospital.Princessiccia

Princess Health and Knox County converting ambulance tax, taking 3/8 of health tax and asking library for same in order to save hospital.Princessiccia

county health departments critical access hospitals health departments hospitals rural health taxes

Gusty 13:55 Add Comment

The Knox County Fiscal Court and the Knox County Board of Health reached a deal Monday to aid its debt-laden county hospital's recovery from bankruptcy by diverting, at least temporarily, 37.5 percent of local health tax revenue to the hospital, asking the local library to do likewise and converting an ambulance tax into a hospital tax.

The proposed agreement is "revenue neutral" and would not create any additional tax for Knox County residents while allowing the Knox County Hospital in Barbourville to stay open, writes Jeff Noble of The Times-Tribune in Corbin.

To save the hospital, the hospital board needs a tax of about 8 cents per $100 worth of property, County Judge-Executive J.M. Hall said. The deal would convert a 5-cent ambulance tax to a hospital tax, and the county health board has agreed to shift 1.5 cents of its 4-cent tax to the hospital. The library board is considering similar action, which would make up the total 8 cents, Hall told Noble.

Health Department Director Susan Liford said the two-year deal with the health board will begin in January 2014 and will be re-evaluated at the end of that period. The health department will be diverting $300,000 to $400,000 a year to the hospital, Noble reports.

"The board felt like we needed to help the hospital, and they were very adamant they did not want to put the health department in jeopardy and have no one here lose their jobs," Liford told Noble. "I think it�s the moral thing to do. And we need our hospital."

The hospital has a debt estimated at $23 million, though the Knox County Fiscal Court purchased it out of bankruptcy by in 2004 for just $7.2 million, according to documents analyzed by the Barbourville Mountain Advocate, Knox County's weekly newspaper. Last July, the fiscal court took over hospital operations of the hospital, borrowing $6 million to fund them, after the former owners filed Chapter 11 bankruptcy. (Mountain Advocate graphic; click on it for larger version)

Princess Health and Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems.Princessiccia

Princess Health and Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems.Princessiccia

county health departments health departments local government public health taxes

Gusty 11:06 Add Comment

Some county health departments are trying, and others may try, to increase property-tax rates to make up for Medicaid shortfalls, program cuts and the rising costs of employee benefits so they can continue providing essential public health services for their communities.

Anderson County Health Department Director Tim Wright has proposed a 33 percent rate increase from 3 cents per $100 of assessed property value to 4 cents per $100. The increase would add an estimated $150,000, which Wright says he would use to end employee furloughs and make up for $200,000 that has not been paid by the Kentucky Spirit managed-care company, reports Editor Ben Carlson of The Anderson News.

Many departments have already cut positions and implemented furloughs to compensate for Medicaid shortfalls, state program cuts and employee benefit costs, said Scott Lockard, past president of the Kentucky Public Health Association and director of the Clark County Health Department. Most departments have done everything possible to increase efficiency of the departments' resources, he said.

A recent tax increase in Boyle County will make property owners pay a little more to help fund the county health department. The fiscal court recently voted to raise the county's health tax from 2.4 cents per $100 to 2.5 cents.

As funding streams have changed, departments need additional revenue sources, said Brent Blevins, director of the Boyle County Health Department. Blevins said without the rate increase, the already short-staffed department would have to cut services.

Declining property values during the recession have decreased tax revenue, said Marcia Hodge, director of the Garrard County Health Department. It proposed a tax rate increase from 4 cents to 4.25 cents in September that was estimated to bring in about $21,000, but the fiscal court did not approve it, she said.

Another problem that health departments face, Hodge said, is that they are required to participate in the state's insurance and retirement system. Over the 12 years she has been at the department, retirement contributions have increased from 4 percent to 25 percent, while costs of fringe benefits have more than doubled while salaries have only increased 10 percent, she said.

The Floyd County Health Department increased its tax rate last September for the first time in 20 years, primarily because of increased costs of employee benefits and department funding cuts, said Thursa Sloan, director of the department.

Sloan said she anticipates a big change in the services that health departments provide over the next 10 years.  Primary care will take a much more preventive approach, she said, and health departments will have to pull back in such services and go back to the basics.

Princess Health and Health departments in N. Ky. and Franklin County are among the first 11 in the nation to be accredited, a milestone in public health .Princessiccia

Princess Health and Health departments in N. Ky. and Franklin County are among the first 11 in the nation to be accredited, a milestone in public health .Princessiccia

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Gusty 16:06 Add Comment

Three Kentucky departments are among the first 11 in the nation to receive accreditation from the national Public Health Accreditation Board, which announced the achievements Thursday.

The Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties received five-year accreditation.

"I am proud of the departments achieving this public health milestone of national accreditation," said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health. "Before now, there has not been a national system for health departments to demonstrate accountability and quality to their community."

Scutchfield said accreditation means a department is providing a "high quality of public health service, leadership and accountability to its constituents," and is a clear indication of the departments' "passion and dedication to improving and protecting the health" of the community.

The board, funded by the federal Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, has received 128 total applications for accreditation: 112 from local health departments, 15 from state departments; and one tribal department.

In addition to the three Kentucky departments that have received accreditation, other Kentucky departments have applied and are awaiting site visits. Those are the Lexington-Fayette County, Barren River District, Madison County and Christian County health departments, said Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services.

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year. (Click here to learn more about accreditation)