Seven counties in Southern Kentucky stand out as 'Bright Spots' in study, pointing the way to healthier communities

By Melissa Patrick
Kentucky Health News

Nine counties in Appalachian Kentucky have been recognized as "bright spots" when it comes to health, and seven of them adjoin in Southern Kentucky: Green, Adair, Russell, Wayne, McCreary, Pulaski and Lincoln. The other two counties were Lewis and Morgan.

"The Bright Spots project offers hope and a path forward to a healthier Appalachian Kentucky," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "Congratulations to the hardworking leaders in the nine Kentucky counties that have formed strong, cross-sector coalitions to address pressing health issues in their communities."

The study, which looked for Appalachian counties that had better than expected health outcomes given their resources, analyzed 19 health indicators in each of the 420 Appalachian counties and identified 42 as Bright Spots.

The goal of the research was to to identify successful activities, programs and policies that other struggling communities could replicate. A report is scheduled to be released later this year to identify them. The study was sponsored by the foundation, the Appalachian Regional Commission and the Robert Wood Johnson Foundation.

All the adjoining Bright Spots counties except Lincoln are served by the Lake Cumberland District Health Department. Its health education director, Tracy Aaron, told Kentucky Health News that improving the district's health has been a group effort, and each county has a health coalition made up of numerous organizations, agencies and individuals that meets monthly to choose what health issues they want to address and to then create plans to work on them.

"Our communities are rural and have limited resources, so we all work together to identify and leverage resources," she said in an e-mail. "Many times we may facilitate the discussion around health and improving the health of the community, but we are very fortunate to have dedicated organizations and individuals [working with us] as we continue to improve the health of people that live in Lake Cumberland."

McCreary and Wayne counties were part of a 10-county case study that took a deeper dive into what they were doing to improve the heath of their citizens, despite their many challenges. Both of these counties were named "Healthy Kentucky Policy Champions" by the foundation, citing the stuidies.

"What's happening in Wayne and McCreary counties is changing our understanding of what is possible for health in these and other Appalachian counties," Chandler said in the release announcing the awards. "They show us that there's always somewhere to start when working to improve health, and that dedicated individuals volunteering and working together with a few focused community leaders can change health outcomes for the better."

The report says Wayne County was one of three in the 10 case studies that stood out "for both the range of outcomes that were better than expected and the extent to which the outcomes exceeded expectations." The county performed better than expected on 16 of the 19 measured health outcomes, falling short in the areas of obesity, physically bad days and opioid prescriptions.

Cover page of report section on Wayne County

The Wayne County Health Department, part of the district health department, and the local office of the Cooperative Extension Service play "critical roles in improving community health," the report said.

It noted the department's program to increase access to healthy, local foods; its diabetes education work; and its strong HANDS (Health Access Nurturing Development Services) program, a voluntary home-visitation program for new and expectant parents, which the researchers say could be partly responsible for lower-than-expected rates of infant mortality and low birth weight.

"Wayne County’s strong community partnerships and social connections, integration of health services, and focus on healthy foods, are likely contributing to the better-than-expected health outcomes," the report says.

The county performed 36 percent better than expected for poisoning deaths, including drug overdoses; 34 percent better than expected for stroke deaths, 30 percent better than expected for heart disease hospitalization; 26 percent better than expected for the percentage of Medicare patients with depression; and 25 percent better than expected for years of potential life lost.

For example, the study found that 35.2 people per 100,000 in Wayne County actually died from a stroke, but when using a statistical model that factored in barriers to good health, the predicted stroke-death rate was 53.7 per 100,000. (The county's population is about 21,000.)

Cover page of report section on McCreary County

McCreary County, which has about 18,000 people, performed better than expected on 14 of the 19 measured health outcomes. It fell short in mentally bad days, suicide, diabetes, physically bad days and opioid prescriptions.

The report says the county has strong local volunteer organizations and emergency medical services, and a library that connects residents to health and social services.

Researchers found that the county performed 40 percent better than expected for injury deaths, 37 percent better than expected for stroke deaths; 34 percent better than expected for poisoning deaths; 19 percent better than expected for percentage of Medicare enrollees with depression; and 15 percent better than expected for years of potential life lost.

The report adds that local practices contributing to the overall health in McCreary County include intra-county cooperation and resource sharing, sustainable, community-focused nonprofit organizations, a strong integration of health services and systems, a shared value for health in the community and community engagement and dedicated local leaders.

Among other things, the report notes a strong health education program run by the district health department, which gives school-age children information on reproductive health, tobacco-use cessation and risky-behavior prevention. It also provides a health consultant for children and supports preventive initiatives like farmers' markets and smoke-free restaurants.

Among the other four Lake Cumberland counties named Bright Spots:

• Adair was 41 percent better than expected for poisoning and overdose deaths; 36 percent better than expected for unintentional injury deaths; and 26 percent better than expected for deaths from chronic obstructive pulmonary disease.
• Green scored 34 percent better than expected for poisoning and overdose deaths, and 31 percent better than expected for both years of potential life lost and opioid prescriptions as a percentage of Part D Medicare claims.
• Russell was 36 percent better than expected for heart-disease hospitalizations; 33 percent better than expected for opioid prescriptions as a percentage of Part D Medicare claims; and 18 percent better than expected for diabetes.
• Pulaski scored 39 percent better than expected for poisoning and overdose deaths; 26 percent better than expected for unintentional injury deaths; and 20 percent better than expected for stroke deaths.

The researchers report that while the counties in the case studies offered individual approaches to address their local health challenges, there were common themes, including: community leaders engagement, cross-sector collaborations, resource sharing, a commitment from local health care providers, active faith communities and grassroots initiatives to combat substance abuse.

In addition to a community of people with a shared value for health, the report says the Bright Spot communities also benefited from "anchor institutions," like schools, businesses, churches and hospitals that worked together to improve the health of their communities.

"The Bright Spots research is a roadmap for struggling Appalachian communities, showing how building strong coalitions and focusing resources in particular on reducing teen births and smoking, increasing physical activity and treating and preventing substance abuse can have an outsized impact on improving local health," Chandler said. "It also is a call to action for policy makers, funders and advocates to support laws and programs that are proven effective in addressing these issues."

The 10 case studies are at https://www.healthy-ky.org/res/images/resources/BrightSpotsCaseStudiesJuly2018.pdf. Data for all 420 Appalachian counties are at https://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=144. The data can be mapped at https://healthinappalachia.org/.

This is the second report in the "Creating a Culture of Health in Appalachia: Disparities and Bright Spots" research initiative. The first report focused on health disparities in the region.