Health officials and advocates list Kentucky's top 5 health issues, including one newly identified: adverse childhood experiences

About 125 people worked on the state health assessment at the
Kentucky History Center in Frankfort on Wednesday, March 22.

By Melissa Patrick
Kentucky Health News

A group of about 125 people spent March 22 with officials from the Kentucky Department of Public Health to prioritize the top health issues in the state, and after a long, deliberate process decided they were substance abuse, obesity, tobacco, health-care access and adverse childhood experiences.

"Adverse childhood events" such as abuse and household dysfunctions, like having a household member in jail or coming from a divorced family, can have lasting effects on health and well-being.

ACEs affect 59 percent of Kentuckians, according to the 2015 Kentucky Behavioral Risk Factor Survey, the first one to include questions about 11 such events. The results showed that Kentucky has a higher-than-average percentage of people with six or more ACEs.

"There are things that happen to us early that make a huge difference as we get older," Dr. Connie White, senior deputy commissioner of the state health department, told the gathering of about 125 people, about half of them from outside the agency.

As for the other big issues, "Eating less, good exercise and not smoking would solve so many of our problems," said Deputy Secretary Tim Feeley of the Cabinet for Health and Family Services. He said the solution to Kentucky's health problems rested in early health education and personal responsibility.

"There isn't a pill that will fix everything," he said. "We need to make people more responsible, more in tune with their own health and we need to do that through education; we need to do that through access to good health care that encourages them to do it that way."

Various health officials reviewed data on the state's health, reminding the room full of health-minded participants that Kentucky has the nation's highest smoking rate (26 percent of adults) and the highest rate of new hepatitis C infections; has seen its opioid overdose deaths triple between 2006 and 2015; is largely sedentary; and has some of the nation's highest rates of cancer, diabetes, heart disease and obesity.

One of the few bright spots in the overview was the drop in the share of Kentuckians without health insurance, from 18 percent to 7 percent since the implementation of the Patient Protection and Affordable Care Act. This was largely because Kentucky expanded Medicaid under federal health reform to those who earn up to 138 percent of the federal poverty level.

Throughout the meeting, participants expressed concerns about Republican plan to repeal and replace the Patient Protection and Affordable Care Act, which among other things would phase out the Medicaid expansion, drop the requirement to cover 10 essential health benefits and turn Medicaid into a block grant program and give the states control of it.

Allison Adams, director of the Buffalo Trace District Health Department and president of the Kentucky Health Department Association, gave an overview of Public Health 3.0. This national initiative calls for local health-department leaders to become the "chief health strategists" in their communities, focusing on prevention and social determinants of health. This new approach to public health relies on health departments working with community partners to address the health needs of their community.

Participants wrapped up the day-long meeting by forming work groups centered around each of the five identified priorities. The groups were charged to find out what is already being done in the state around these issues, and to then decide the best holistic plan to "move the needle forward."