Breathitt, Lee, Jessamine and Nelson counties are certified as Recovery Ready Communities, totaling 14 in effort's 14 months

Kentucky Health News map

Gov. Andy Beshear presents Recovery Ready Community
certificate for Lee County to Scott Lockard and Jo Ann Fraley
of the Kentucky River District Health Department. (Photo by Al Cross) 

By Al Cross
Kentucky Health News

Four more Kentucky counties have been certified as Recovery Ready Communities, signaling that they have the services needed to help their residents recover from addiction. That brings the total to 14 out of 120; the program began 14 monhs ago. "We've got 106 to go," Gov. Andy Beshear said.

Breathitt, Jessamine, Lee and Nelson counties earned cetification by showing they are able to provide addiction treatment to their 123,000 residents, according to Beshear, who presented Lee County's certificate at a wide-ranging press conference Thursday.

Scott Lockard, public-health director for the seven-county Kentucky River Disrrict Health Department, accepted Lee County's certificate with Jo Ann Fraley, who runs the department's harm-reduction program, which includes a syringe exchange to prevent disease among intravenous drug users and steer them into treatment.

"The substance-use-disorder problem is the largest public-health issue that we are facing today in Eastern Kentucky and many parts of our commonwealth," Lockard said.

Noting another major topic of Beshear's press briefing, Lockard said, "These great economic-development announcements are fabulous, but each one of those factories need people to work in them. Second-chance employment is huge, and we have so many people who are being impacted by substance-use disorder, especially in our part of the state, in Eastern Kentucky."

Lee County's recovery program is based in The Hub, in the health department's annex. "Our motto at the Hub is 'We meet people where they are, but we do not leave them there,' because it's key that everyone who comes through our door is treated with respect and dignity."

Lockard said the program has gotten more 230 people into treatment, including three that morning. They were immediately transported to a treatment facility, Lockard said: "When they're ready, we need to get them in there right then."

When people leave residential treatment, The Hub offers them 11 support groups, links to second-chance employment and "a ministry that fills the soul," Lockard said. "You know, this emptiness left by drugs, we need to fill it with somethng else, and if we can get individuals back and show them that they have worth, that they have dignity, then we have the possibility to really help them to be gainful members of our society and fill some of these many jobs and just have a higher quality of life."

 

Lockard said substance use must be approached as a disease. "We cannot incarcerate our way out of this problem." He said The Hub includes a court diversion program for low-level drug offenders.

Immediately before the recovery discussion, Beshear and State Police Commissioner P.J. Burnett announced a statewide drug roundup of 206 suspects, mostly on trafficking charges. Burnett said another 50 suspects are still being sought.

To be certified as recovery-ready, a county must have peer-support services, mental-health treatment, addiction treatment, employment services and a stigma-free environment to encourage recovery. The program "encourages communities to provide transportation to and from employment services and job interviews, allowing Kentuckians to make positive changes in their lives while filling much-needed jobs and contributing to the commonwealth’s record-breaking economic growth," a news release from Beshear's office said. 

The release included statements from representatives of the other counties.

“This is a huge step in continuing to move Breathitt County forward in applying for grants that will improve the lives of every person in our county,” said Breathitt County Circuit Court Clerk James Elliot Turner II. “We need to provide every opportunity for each person in Breathitt County to fulfill their potential. This is a win for our people.”

Shauna O’Nan, Jessamine County Health Department harm reduction director, said “There is no set path of recovery, but after going through this certification process, we are confident, as a community, that we will be able to meet people where they are on that path.”

In Nelson County, "Collaboration and community involvement underlie Nelson County’s efforts to provide recovery resources to its citizens," the release said. Jessica Bickett, safe-communities specialist with the Lincoln Trail District Health Department, said “Nelson County has a strong network of community partners who are committed to supporting the recovery community.”

"These communities are stepping up to help fellow Kentuckians who are struggling with addiction," Beshear said. "We are grateful for, and we applaud, their good work."

To learn more about the program and to apply for certification as a Recovery Ready Community, click here.

Paths to treatment

If you or a loved one are struggling with addiction, connect to treatment by calling 833-8KY-HELP (833-859-4357). Information about treatment programs all across the commonwealth is available at FindHelpNowKy.org.

Information on how to obtain the life-saving drug naloxone, which is used to reverse an opioid overdose, can be found at that website as well as at FindNaloxoneNowKy.org and FindMentalHealthNowKy.org.

Visit the State Police website to find a post where those suffering from addiction can be paired with a local officer who will assist with locating an appropriate treatment program through KSP’s Angel Initiative.

To find recovery housing, go to FindRecoveryHousingNowKY.org.

Health department director says she has work to do, to educate Attorney General Coleman about syringe exchanges

Dr. Crystal Miller with state
Health Commissioner Stack

Kentucky Health News

The director of a district health department with a syringe exchange has voiced disappointment to her local newspaper over Attorney General Russell Coleman's opposition to the exchanges.

Dr. Crystal Miller, director of the Wedco Health District, which serves Scott, Harrison and Nicholas counties, told the Georgetown News-Graphic that syringe-exchange programs are misunderstood.

“It is unfortunate that our attorney general doesn’t support syringe service programs,” Miller told the newspaper. “We have work to do to educate him on grasping a full understanding of what this program entails.”

Noting Coleman's statements to Kentucky Health News, Miller said, “This program is designed around the very things he’s supportive of, prevention and treatment. We work closely with community partners to create a system that no matter where someone enters, we know how to link them to an agency that can assist. Substance abuse is a problem in our society that we will never enforce our way out of, and successful mitigation requires all hands-on deck. Syringe service programs are a framework for that in our community.”

The News-Graphic notes, "Approval for such a program, here, was difficult and strongly opposed by the Scott County Fiscal Court several times until a magistrate who once opposed such a program became aware of a situation involving someone he knew and reversed his opposition."

Miller said, “At surface level, syringe service programs can be misconceived. This program provides an entry point to many resources for people who use drugs and allows us to promote recovery. Through this program alone, we have referred people to treatment for drug use, linked them to care and resources within the community to help them make better, healthier choices.

"We have success stories of people recovering in every SSP program across Kentucky. However, one of the biggest successes within this program is the amount of hepatitis C and HIV that we have been able to detect and treat within our communities. Without this program, we would not have identified communicable diseases that are killing people and costing taxpayers large amount of money. Just within the Wedco District, through our SSP program, we have saved taxpayers $1.3 million in early identification/treatment of Hepatitis C. We are effective at prevention and treatment and the data proves it."

As for Coleman's concern that syringe exchanges promote drug use, Miller said, “I can assure you that not one participant has ever reached our doors and decided to start using drugs because we are providing clean syringes. We prevent the spread of disease, focus on reducing as many barriers as possible and being a resource to helping people make better decisions and recover, all while saving taxpayers money. I hope that we can work more closely with our AG to help him understand and support the impact that this program has in communities.”

More than half of Kentucky's counties have syringe exchanges.

Health officials in counties with high and low Covid-19 death rates point to vaccination rates, residents' underlying health status

Kentucky Health News map via Datawrapper, highlighting high-death-rate counties of Metcalfe, Monroe, Harlan, Perry, Lee and Robertson, and low-death-rate counties of Jefferson, Fayette, Scott and Woodford. For an earlier story with an interactive map with all counties' rates and data, click here.

By Melissa Patrick

Kentucky Health News

Health officials from Kentucky counties with some of the state's highest and lowest Covid-19 death rates both cited vaccination rates as a contributor, but the health official in the county with one of the highest death rates said the relatively low health status of the population must also be considered. 

A breakdown of Covid-19 deaths per 1,000 people in each county found that the highest county death rate is five times the lowest one. To explore that discrepancy, Kentucky Health News talked with a health official in a county with one of the highest rates, and one in a county with one of the lowest rates. 

In Woodford County, which had the fourth lowest rate, 2.09 Covid-related deaths per 1,000 residents, Public Health Director Cassie Prather said she attributed the low rate to its high Covid-19 vaccination rates, especially among residents 65 and older, who are among the most vulnerable.

"I would love to see a map overlay of the death rates and the vaccine rates," she said. Later adding, "I think the correlation is there." 

Woodford County has had one of the highest vaccination rates in the state throughout the pandemic. According to the Centers for Disease Control and Prevention Data Tracker, 78.3% of Woodford County's population has received at least one dose of the Covid-19 vaccine. Among residents 65 and older, 93.3% are fully vaccinated; 73.3% of those who are fully vaccinated have received one booster shot; and 54.6% of  those who have had the first booster have also received the second. 

Cassie Prather

Prather said getting people in Woodford County vaccinated has been a community effort that includes weekly clinics that are still running, community members volunteering to drive people to the clinics, a partnership with the emergency medical service to do home visits, and a mobile clinic that goes out twice a week to farms and people they normally wouldn't see at the health department. 

She added that city and county governments have worked diligently to keep their citizens informed, and that she and Judge-Executive James Kay still do weekly Covid-19 updates on the county government's Facebook page. "We knew how important communication would be . . . because we wanted people to be aware and to be able to make the best decisions for their family and friends," she said. 

Kay, who as judge-executive chairs the county health board, said his pandemic role has been to unite the community in an effort to fight the virus, while allowing the health department to lead the response. 

"We did a full county and community response," Kay said. "And we brought the cities and the county and the schools together to all be on the same page every day for nearly two years."

Expanding on the importance of giving the public direct, real-time information to combat misinformation, he said, "We created a level of trust. When we told them information; they knew it was true."  

Adjoining Scott County's Covid-19 death rate was just .007 per 1,000 higher than Woodford's. Crystal Miller, public health director of the regional health department that serves the county, told Mike Scogin of the Georgetown News-Graphic that the community's response to the pandemic was critical to keeping Covid-19 under control. 

“It was all hands on deck,” Miller told Scogin. “All our community partners bought in and everyone contributed. From elected leaders to businesses and industries, the hospital, schools and the newspaper, everyone wanted to do the right thing. A big portion was community support. The calls we received at the health department were, ‘How can we keep people safe?’”

Miller also said Scott County has one of the state's highest vaccination, which saved lives. The CDC says 65.2% of the county's population has received at least one dose of Covid-19 vaccine. 

“We did not get a lot of pushback," Miller said. "I know that was not the case in other communities, where people refused to even wear masks."

Metcalfe County, in south-central Kentucky, had the sixth highest Covid-19 death rate, 7.348 per 1,000 residents. It is served by the Barren River District Health Department, where Public Health Director Matt Jones said he thinks the rate stems from multiple factors.

Jones cited the county's poor health outcomes, gauged by life expectancy and measures of quality of life; and health factors, such as access to physicians, tobacco use, children living in poverty, and other environmental factors that contribute to or detract from the local population's health. 

"Those health outcomes, those health factors, they were already at play," he said. "And I think that is one of the leading reasons why we had higher mortality rates in Metcalfe County and the other six counties that you listed."

Counties with death rates higher than Metcalfe were Lee, 7.565; Perry, 7.803; Monroe, 8.075; Harlan, 8.574; and Robertson, the state's smallest county, 10.436 deaths per 1,000 residents.

Comparing just Metcalfe and Woodford counties' 2022 County Health Rankings, Metcalfe ranked 71st for health outcomes and 89th for health factors and Woodford County ranked eighth for health outcomes and third for health factors. 

Eight of the top 10 counties with the lowest Covid-19 death rates in Kentucky ranked in the top 11 counties for health outcomes, and included the top six counties for health factors.

"ZIP code matters," Jones said. 

Among the seven counties with the highest Covid-19 death rates, all ranked 69th or lower for health outcomes, and four ranked in the bottom 11. All seven ranked 64th or lower in health factors, with three in the bottom six. 

Jones also pointed to the discrepancies in health-care access between rural and urban counties as a possible reason for Metcalfe County's higher Covid-19 death rate.

He noted that Warren County, which has a population of nearly 133,000, and Metcalfe, with around 10,000, have very similar vaccination rates, 45.7% and 45.3%, respectively, with at least one dose, but Warren's death rate was less than half Metcalfe's, 3.02 deaths per 1,000 residents. 

Warren, with its fast-growing county seat of Bowling Green, has many more health resources than Metcalfe County, including two hospitals, while Metcalfe County has no hospital and a shortage medical providers, Jones noted.  

Asked about the county's lower vaccination rates, he said, "I think vaccinations did play a role, especially as it relates to moderate and severe cases. But I do think those health outcomes and the other indices played a major role in the overall outcomes of Covid." 

Among Metcalfe County seniors, 62.7% are fully vaccinated; 67.8% of those have received one booster shot; and 36% of that group have taken the second shot, according to the CDC.  

Jones said the eight counties in his health district have taken a multifaceted approach to the pandemic that has evolved as their needs have evolved. Beyond providing testing and Covid-19 vaccination clinics, the local departments participated in work groups with community leaders to keep them informed and used social media, local newspapers and radio stations to keep the public informed.

Financial troubles may make Letcher County Health Department vacate the multi-million-dollar building it opened 12 years ago

UPDATE, Oct. 13: The health department bought the former Dairy Queen for $280,000 and is renting parts of its building, the Mountain Eagle reports.

Letcher County Health Department (Mountain Eagle photo)

By Sam Adams
The Mountain Eagle

An unwillingness to raise tax rates, a declining tax base, reduction in federal and state funding, and Covid-19 closures and layoffs have created a perfect storm that has put the Letcher County Health Department in danger of losing the multi-million-dollar health center that opened just 12 years ago.

Discussions are underway for the department to purchase the old Dairy Queen building just across the river for storage of records, and possibly to move some services to the Letcher County Recreation Center, though officials would not talk about that possibility.

“At the last board meeting, what I can tell you, is the health department is exploring options because the amount of taxes the public health taxing district will take in is the lowest it has received in decades,” said Scott Lockard, director of public health for the Kentucky River District Health Department.

Lockard would not say what those options are, but he said the department has not defaulted on its loans. He said it was able to pay all its bills except its assessment to the district.

“We have no plans to move out of it at this time, but I don’t know what the future holds,” Lockard said. The department is “actively seeking renters” for space in the 32,000-square-foot building, he said.

Letcher County (Wikipedia map)

Minutes of the Letcher County Board of Health meetings, which occur only one time a year, show the district has been struggling since at least 2019, when Lockard informed the board it was facing a $183,000 deficit and recommended a tax increase. Judge/Executive Terry Adams, who sits on the board, suggested renting unused space instead of raising taxes. Adams made a motion during the same meeting to set the tax rate at 8 cents per $100 assessed value, the same as the prior year, and the board voted to accept that rate. The board has set the same rate each year since then, turning down a 9.2 cent per $100 tax rate in June of this year.

During that meeting, Lockard suggested the board cash in certificates of deposit to buy the old Dairy Queen building, and the board voted unanimously to authorize Dr. Ricky Collins, chairman of the board, and board member Dr. Debbie Williams to sign a purchase contract.

Collins, who was elected chairman during the meeting, said Tuesday that discussions on the property purchase are still underway. He said he had heard talk of a move to the recreation center also, but he has not been involved in anything about it and knew of nothing official. He referred questions to Judge Adams.

Adams said he could not comment on whether the department could move to the recreation center, which is just across the river from the Health Center. “There’s nothing affirmative about doing anything,” he said.

Kentucky's contact-tracing program lacks specific data sought by Beshear's critics; he says its main purpose is to prevent disease

Terrie Burgan traces contacts for the Lincoln Trail District
Health Department. (Photo by Pat McDonogh, Courier Journal)

When Gov. Andy Beshear shut down indoor dining in restaurants and bars to slow the increasing spread of the coronavirus, "criticism from Republican leaders in Frankfort was both swift and predictable," Joe Sonka of the Louisville Courier Journal notes in a story about the effort to trace past contacts of those with the virus. 

Republican legislative leaders reiterated their complaint about Beshear's lack of collaboration, but also said he had no contact-tracing data to show why the move was necessary. Some restaurant owners in Louisville have made similar complaints, Sonka reports, "saying there was no data in Kentucky to justify the prohibition in the first place." 

Beshear counters that "a litany of national research and public health experts to justify his latest orders restricting things such as indoor dining," Sonka reports. But the governor and his administration acknowledge that the program lacks the sort of detailed data the critics want to see. They point to a decentralized system of 61 local health departments as one reason.

Sonka reports in some detail that other states have been able to quickly gather and disseminate the kind of data that the Republican lawmakers and restaurant groups are looking for, like what types of locations individuals visited in the days before testing positive for the coronavirus, or where "cluster locations" are, where multiple people have tested positive after visiting. 

In Kentucky, the Louisville Metro Department for Public Health and Wellness has begun publishing this type of data, including "weekly contact tracing data detailing the types of places people reported visiting in the two days before testing positive or showing symptoms, in addition to the locations where they worked in person," Sonka reports. 

However, health officials at the Louisville agency told Sonka that it's been a laborious task because of the state's approved data management system.

"The state's system allows sortable data entry only in very broad categories of potential exposure locations, such as "events" or "other" to capture exposures besides household, work or school, said Karen Handmaker, who has run the agency's tracing program since May. Handmaker told Sonka that pulling together specific locations like bars, restaurants, churches, gyms and grocery stores "is manual. . . . It is a human endeavor as opposed to an automated."

Asked by Kentucky Health News at his Dec. 7 briefing if the challenges to get better contact tracing data is an indication that the state needs a more centralized system, Beshear didn't answer directly, but said, "I think the way that we share information, the way that we collect information, needs to be more uniform, and I think that they agree as well. It's a little harder in the original system that we had out there, but we're getting closer and closer to it."

Beshear was referring to a new tracking system into which all health departments put data on where exposure to the virus may have occurred. The system was funded by federal coronavirus money and can be used after the pandemic for other communicable-disease tracing. 

State Department for Public Health map; click to enlarge

Beshear has said more than once that the Barren River District Health Department's contact tracers identified outbreaks at 46 different restaurants, but department spokeswoman Ashli McCarty told Sonka that she could not provide specifics on that claim. 

 "We are collecting data on the number of cases that become clusters within establishments (staff), but are unable to collect data on any community spread cases that stem from these clusters," McCarty wrote in an email. "We are not providing data to the public on any specific establishments, but are tracking clusters within establishments on a case-by-case basis.” 

Beshear objected Monday to what he called the "narrative that's being pushed on contact tracers" and said the two primary purposes of tracing is to prevent the spread of the disease from the infected person and those they came into contact with after exposure. 

"What we're talking about is going backwards and getting data," Beshear said. "We're in the middle of a battle to stop this thing from spreading wider, and if that means we put more focus on stopping it from reaching and potentially killing more people than being able to say, in these 34 examples it came from X, then yes, we're doing what we have to do."

He added that he has received "calls for data in areas where every national expert tells us the same thing. So if we don't believe that it was spreading in these places, ask the White House for their data; I'm sure they could give you everything that they have been relying on." 

Beshear has cited research showing that indoor service at bars and restaurants worsens the spread of Covid-19, and that there is no reason to think what goes on in other states isn't happening in Kentucky.  Sonka notes, "A CDC study of 10 states found adults with positive test results were twice as likely to have dined in a restaurant than those testing negative, while a Stanford University simulation suggested fully opened restaurants would spread four times the numbers of additional infections as gyms."

Beshear has also cited the decrease in cases in Florida, Texas and Arizona during the second wave of the virus when those states put restrictions on restaurants, and the strong recommendations of the White House Coronavirus Task Force, which regularly calls on the state to limit bar and restaurant capacity. 

On Nov. 18, when Beshear banned in-person dining and in-person schooling, Senate President Robert Stivers said the lack of publicly available contact-tracing data to justify the restrictions was unacceptable.

Last week, Stivers said the state should "kill the contract" for the tracing program and put the remaining $40 million "back into a fund to help these businesses that are barely surviving." The program employs 1,600.

Beshear, in effect, rejected that idea Monday: "Come back to those who think that we don't need contact tracers. How alone would you feel if you got an email saying you had Covid and nobody ever called you, ever?" He said the call from a tracer "puts you in a system that says: Do you need food assistance? Do you have a doctor? Who do you call? Here are the symptoms you need to monitor?"

He added, "I know the attacks are intended to be on me, but . . . the local health departments feel those too."

Mark Carter

At the governor's Dec. 1 briefing, Mark Carter, who heads up the state's tracing program, said a significant update to the data management system for contact tracers could improve its publicly available data "in the next month or so." 

Because of the recent surge in cases, contact tracers throughout the state have been instructed to tell positive cases to reach out to their potential contacts themselves and give instructions on how to self-quarantine. 

Meanwhile, federal money for the program will dry up on Dec. 30 unless Congress appropriates more, and Beshear and Carter have made urgent pleas for it.

With 68 counties in red zone, another Top 3 day for new cases, and record hospitalizations, Beshear calls it a frightening time

State list; red-zone counties had 25 or more new cases per 100,000 people in the last seven days.

By Melissa Patrick
Kentucky Health News

With more than half of Kentucky's counties in the most dangerous zone for new coronavirus cases and the state having three of its top days for new cases this week, Gov. Andy Beshear called it a "frightening time."

"This is a type of outbreak where we can't deny our way out of it," Beshear said at his daily briefing. "We can't rationalize our way out of it. We can't try to find excuses for not following the guidance. It is that present."

The state reported the second-highest single day of new coronavirus cases on Thursday, 1,821, after reporting 1,864 on Wednesday, the record, and 1,786 on Tuesday, the third-highest. (The state announced 2,398 cases Oct. 7, but 1,472 of them were from a Fayette County backlog.)

The share of Kentuckians who have tested positive for the virus in past seven days is above 6 percent for the second day in a row, at 6.04%. Anything above 5% is a concern to public-health experts.

Hospitalizations for covid-19 in Kentucky set a new record, at 969, including 234 in intensive care and 120 of those on ventilators. 

Beshear said 68 Kentucky counties are in the "red zone," meaning they have at least 25 new cases per 100,000 people in that county. Click here for the list. 

Today marks the first day that these red-zone counties are not only asked to follow already-in-place guidelines for schools and nursing homes, but to also follow a set of nine red-zone reduction recommendations, which, among other things, call on businesses and government offices to allow people to work from home if possible and for individuals to cancel all gatherings of any size and to stay home as much as possible. 

"If you are in one of those 68 counties, and most Kentuckians are, we need you to reduce your contacts as much as possible. Really starting now, but certainly Monday through Sunday of next week," Beshear said. "Don't go out unless you have to, don't have gatherings, try to do curbside shopping." 

Again, Beshear said if Kentuckians would just follow the mandates and recommendations already in place, fewer counties will find themselves in the red zone. 

"We know that compliance is our biggest problem right now," he said, adding that if individuals and smaller communities will come together to take ownership of this problem, "We know if that happens, that'll increase compliance."

Beshear said much of Kentucky's infection is coming from other states. Thursday, more than 89,900 new cases were reported in the U.S., the highest number yet, and the total number of cases passed 9 million.

Beshear announced 19 new deaths from covid-19 on Thursday, bringing the state's death toll to 1,461. 

He again encouraged Kentuckians to follow the state's guidance, noting that by doing so they are saving lives.  

"Pease help us save lives. Every day you get up and put on a mask, you save lives. Every day you follow the guidance, you save lives. If you are a red county, when you follow what we need you to do in the recommendation, you are going to save lives," he said. 

State Department for Public Health graphic; for a larger version, click on it.

Halloween: Beshear offered a final pitch to get Kentuckians to follow the state's Halloween guidelines, with several pleas for anyone hosting Halloween parties to cancel them. 

"If families follow this guidance, we think that trick or treating can be safe," he said.. "If you don't, it is not."

The guidance calls on people to only provide individually wrapped candy that is placed on the porch, driveway or table instead of a communal bowl; to maintain social distancing, to wear a face mask, that is not a Halloween mask; to only trick or treat with your family, to sanitize hands often and to not travel to other neighborhoods, among other things. 

He added, "We cannot be having adult Halloween parties right now. . . . So if you're a facility that's out there and you're advertising for it right now, cancel it," later asking them to recognize that we've had three of our four highest days this week and to please not put their communities at risk. "It is dangerous for individuals to go to large gatherings right now," he said. 

Unemployment insurance update: Amy Cubbage, the governor's general counsel, said the state will now sort the claims by the date of the filing, instead of the day the claim is back-filed for to better serve those who have been waiting the longest. She added that the state has requested a federal waiver of the obligation to obtain repayment from those who were mistakenly paid benefits that they didn't qualify for after the federal government changed their eligibility guidance. She also announced several dates that the computer system would be shut down for upgrades. They are: Friday, Nov. 6, and Saturday, Nov. 7; Thursday, Nov. 26, through Saturday, Nov. 28; and briefly after business hours on Dec. 15.

Cubbage also warned Kentuckians to be on the lookout for email scammers using this fake account: PUA@unemployment.usdol.gov. She said scammers are trying to obtain personal information and shared tips to avoid the scam: Never respond to an email unless it is from a ky.gov domain and is clearly marked as coming from a Kentucky Office of Unemployment Insurance employee; you will never be asked to click on a link in an email from  the OUI; unless you initiate contact with U.S. DOL you should not receive any emails from them about your claim.

In other covid-19 news Thursday:

• Today's fatalities from covid-19 were a 68-year-old man from Adair County; a 75-year-old man from Calloway County; a 93-year-old man from Casey County; an 81-year-old man from Daviess County; a 65-year-old man from Fayette County; two women, 83 and 88, and two men, 88 and 90, from Jefferson County; a 73-year-old man from Jessamine County; a 72-year-old man from Lee County; a 61-year-old woman from McLean County; an 80-year-old woman from Meade County; a 71-year-old man from Muhlenberg County; a 68-year-old woman from Rowan County; a 58-year-old man from Russell County; a 68-year-old woman from Shelby County; an 87-year-old woman from Warren County; and an 89-year-old woman from Whitley County.
• Beshear said  227 of today's new cases are children and that in the last seven days, 1,322 of them have been children under 18. 
• In long-term care, Beshear announced there 71 more residents and 42 more staff have tested positive for the virus, with 993 active resident cases and 578 active staff cases.
• The K-12 dashboard shows another 89 students and 32 staff have tested positive for the virus, with a total of  3,136 students and 451 staff in quarantine this week.  
• The college and university report shows 212 new students have tested positive for the virus, with 503 testing positive in the past 14 days. 
• Counties with 10 or more new cases are: Jefferson, 331; Fayette, 127;  Hardin, 65;  Kenton, 52;  Warren, 47;  Christian, 44;  Nelson, 42;  Campbell, 41;  Barren, 40;  Clay, 38;  McCracken, 37;  Pike, 36;  Boone, 33;  Hopkins, 33;  Calloway and  Montgomery, 26 each; Madison, 25; Marion, 24;  Floyd and Whitley, 23 each;  Bullitt and Daviess, 22 each;  Bell, Lee and Marshall, 21 each;  Scott, 19; Caldwell, 18;  Henderson, Knox, Laurel and Oldham, 17 each; Garrard and Hart, 16 each; Boyd, Carter  and Jackson, 15 each;  Harlan and Monroe, 14 each; Logan, 13; Shelby, 12;  Anderson, Franklin, Graves, McLean, Perry and Taylor, 11 each; and Jessamine and Webster, 10 each.
• The Lake Cumberland District Health Department said it would no longer review plans for controlling the virus at public events because people who hold the events don't follow the plans. "Without fail, these groups share with us plans that align with the governor’s guidance. Almost equally without fail these events fail to unfold as planned, and consistent social distancing and masking does not take place," said the department, which serves 10 counties. "It will be the health department’s standing policy that we advise against any such social gathering. While we do not have the authority to prevent these types of events, we can no longer spend our time reviewing plans that consistently fail during execution. We will simply direct such 'event planners' to the state’s guidance."
• When coronavirus vaccines arrive, they will be free to all Medicare beneficiaries. Medicare will cover the entire cost of paying doctors to administer the vaccines, and doctors will bill traditional Medicare for all beneficiaries so private Medicare Advantage plans do not need to cover the cost, Medicare Administrator Seema Verma said Wednesday. Medicare "will also make antibodies and other covid-19 treatments free to seniors by paying hospitals extra for using newly approved or authorized covid-19 treatments and by paying outpatient providers for those products separately from bundled payments," Inside Health Policy reports.

Beshear's budget offers pension reprieve for health departments

Before the legislature froze health departments' pension contributions last year, the Department of Public Health made this map, which is based on 2019 data but still shows their relative financial health.

By Melissa Patrick
Kentucky Health News

As health departments across Kentucky face pension challenges that could force many of them to enforce big cuts in services or even close their doors, Gov. Andy Beshear's two-year budget proposal offers them a bit of a reprieve.

Beshear's proposal would give the departments about $16.5 million in each year of the budget as a way to freeze their employer contribution rate at 67.41% of payroll.

Their current rate is 49.47% of payroll, but this is set to jump to 83.43% on July 1, the day the next budget starts. The Democratic governor's proposal would have to be approved by the Republican-controlled legislature.

Scott Lockard, director of the Kentucky River District Health Department, said his agency, which serves Knott, Lee, Leslie, Owsley, Perry and Wolfe counties, will need this funding to stay open.

“I am very grateful,” Lockard said in an email. “This increase in funding is an acknowledgement of the importance of the critical services we provide. The options provided to KY River District under House Bill 1 of the special session are completely unaffordable for my agency. This increase in state support to cover pension cost increases is the only way will be able to continue to protect and promote the health of the residents of the KY River District.”

During a special session last summer, lawmakers gave health departments, regional universities and quasi-governmental agencies the choice of staying in the Kentucky Retirement System and paying the full obligations or leaving the system, either by paying a lump sum or buying their way out over time. Those that choose to leave would need to move employees to a 401(k)-type plan.

The departments say none of these choices are viable, and none have left KRS. The state Department for Public Health has said that without some relief from their obligations, dozens of health departments are at risk of closing.

To address their financial crisis, the departments want lawmakers to approve a major overhaul of the health-department system, including changes in how they are funded. HB 129, sponsored by Rep. Kim Moser, R-Taylor Mill, has passed the House Health and Family Services Committee. which she chairs, and is in the House Appropriations & Revenue Committee.

"I am appreciative of our governor recognizing the plight of local health departments and I look forward to working with our legislature thorugh the budget process," said Allison Adams, president of the Kentucky Health Department Association.

Health departments get another year before pension hikes kick in, but some are already raising taxes in anticipation

By Melissa Patrick
Kentucky Health News

While local health departments are more than grateful that legislation passed in the recent special legislative session gives them another year to manage their looming pension crisis, several counties have already asked for a tax increase as a way to help pay for it.

The Kentucky Department of Public Health said in an email last week that it had received 63 of this year's 113 county tax resolutions and so far 10 counties have asked for a higher rate. Of those, the department said board minutes show that Boone, Boyd, Campbell and Kenton discussed the increase in the Kentucky Retirement System cost prior to voting on the tax rate.

"However, the other six counties mentioned in their board minutes there was a discussion, but did not mention in the minutes details of the discussion," the email said. They are Leslie, Muhlenberg, Ohio, Union, Wayne and Webster counties.

The new law, written and signed by Gov. Matt Bevin, freezes the pension cost of health departments for another year, at 49 percent of payroll, avoiding an increase to 83 percent.

That gives them one more year to decide whether to stay in the state retirement system, with an increase in their pension contribution to 83% of payroll, or leave it -- and either pay a lump sum equal to their projected pension liabilities, or pay it off over the next 30 years in installments.

Allison Adams, director of the Buffalo Trace District Health Department, which includes Mason and Robertson counties, explained that the state has a cap of 10 cents per $100 property value for health taxing districts, and some counties have set this cap even lower through referenda.

Adams, who is also the president of the Kentucky Public Health Association, said it is a fallacy to believe that health departments can simply double their tax rate to pay for their pension obligations, as some legislators have suggested.

Using Robertson County as an example, she said the tax rate there is already set at 8 cents per $100 property value, which would allow it to request 2 more cents per $100 property value, which she said would bring in about $90,000.

But that's not enough to make any real difference, since the cost of one clerk and one nurse in that department, figuring 83% of payroll for their pension, is $175.207 -- an amount that does not include any other costs for required programs and services, Adams said.

"For those who have the tax base, it would help them," she said. "But for those who don't, it wouldn't help."

And for those counties that are levying the maximum tax rate and still don't have enough resources, even after whittling down their staff, to deliver only core and statutorily required services, Adams said, "The next thing to do is to cut services."

The Anderson County Health Department  increased its tax rate in June to help pay for the pension increase that was set to kick in on July 1, but has since been delayed until next year. But the county Board of Health rescinded a portion of the requested 75% increase, reducing it from 52.5 cents per $1,000 in assessed property value to 47.5 cents, which represents a 58% increase from the original rate of 30 cents per $1,000, Ben Carlson reported on June 19 for The Anderson News.

Public Health Director Tim Wright made the request to lower the rate at a specially called meeting after discovering he had made a mistake in his request, explaining that he was unaware that the spreadsheet he used to build his annual budget already included the increase for pension costs, so when he computed his figures the pension had been added in twice, Carlson reported.

The new rate will keep the department from tapping into its reserves to pay the looming pension costs. The new rate will generate about $230,000, and $140,000 of that will go into pension funding, according to documents provided by Wright, Carson reports. Wright said that this is the county's first rate increase in about 20 years.

J Smith, the public health director of Garrard County Health Department, told John Cheves at the Lexington Herald-Leader: “The only reason we came in under budget this year is because of all the cuts we made. But we can’t keep doing that, we’ve done all we can do there,” Smith said. “I told our Board of Health that if we want to keep the services we have left, we’re going to have to have a tax increase.

Chris Crum, public health director at Greenup Health Department, told Rachel Adkins of The Daily Independent in Ashland that because Greenup County raised its health tax last year, it was no longer at risk of closing because of the looming pension costs.

Another challenge is that some counties don't have a separate taxing district to finance their health departments, Melinda J. Overstreet reports for the Glasgow Daily Times.

Barren County Judge-Executive Micheal Hale told Overstreet that Barren is one of three counties in the eight-county Barren River District Health Department that does not have a separate taxing district for health, and without that the county is fiscally responsible for its funding. The county's health department is one that the state health department put on a list that were at risk of closing within 12 months if they didn't get a reprieve from the bigger pension obligation.

Hale told Overstreet that an overnight jump to an 83% contribution would require the county to contribute well over $1 million, which he said would be "catastrophic" for the county's budget. He added that after the final budget is decided, he would ask the committee to look into the possibility of a health taxing district.

Depending on local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties.

"Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard told Kentucky Health News in June.

Adams pointed out  that counties with high property values could raise their tax by 0.5 cents and generate more revenue than a county with low property values that double their rates.

Health departments and their employees making tough choices now that the General Assembly has passed Bevin's pension bill

Bevin at bill signing (Lexington Herald-Leader photo by Alex Slitz)

Kentucky's health departments and their employees face some difficult decisions in the wake of the pension legislation passed in the recent special session of the General Assembly.

The law written and signed by Gov. Matt Bevin freezes the pension costs of health departments for another year, at 49 percent of payroll, avoiding an increase to 83 percent, which would have forced layoffs and program cuts, and could have put some of them out of business.

But now the health departments must choose whether to stay in the Kentucky Retirement System "at full cost, leave the retirement system by paying a lump sum equal to future projected benefits payments, or buy their way out in installment payments over 30 years," writes David Zoeller of The Paducah Sun.

Marshall County (Wikipedia map)

Zoeller notes that the Marshall County Health Department "has already been making tough decisions," such as ending its school-nurse program and cutting its staff by almost 30 percent.

John Cheves of the Lexington Herald-Leader notes, "Public employers that quit KRS will be encouraged through financial incentives to freeze their employees’ pensions so they accrue no further benefits. Instead of a pension, employees will be transferred into a riskier defined-contribution retirement plan, such as a 401(k), with a balance that rises and falls with the stock market, and that retirees can outlive if their money runs dry. . . . Some could lose hundreds of thousands of dollars in anticipated retirement benefits if their pensions are frozen."

Cheves's object example is the Garrard County Health Department, which has seven employees, some of whom are less than 10 years from retirement. "Under the state pension formula, the final decade on the job is crucial to maximizing their monthly retirement checks," he notes, and gives a specific example:

"Cathy Stapleton, a nurse at the health department, is 55 with plans to retire at 62. She doesn’t want her pension to be frozen and replaced with a 401(k) account that would have seven years — not the usual 30 to 40 — to build wealth through compound interest. One ill-timed market crash could sink her." She told Cheves, "It means a lot when you come into a pension. It means you have a retirement where you can count on having that income every month." Getting a new 401(k) plan at age 55 "would be a lot different."

Garrard County (Wikipedia map)

Department Director J Smith told Cheves he will recommend to the Garrard County Board of Health that it stick with KRS and pay the 83 percent. "Telling middle-aged people who devoted their lives to public service that they’re suddenly going to risk financial insecurity in their senior years is not a viable choice, he said," Cheves reports, quoting him directly: “We’re not going to opt out. If we opt out, to me, we’re screwing our employees here. Some of my people have got just a few years left. We expect to get what we were promised. We were promised a pension.”

The department has already eliminated family-planning services, cut health education, "laid off its emergency-preparedness coordinator and a front-desk clerk, and officially eliminated a third position, Smith’s old job, which he still does in addition to being director," Cheves reports. "That means he splits his time between inspecting schools, businesses, septic tanks and the like for safety and cleanliness, and managing the department."

“I’ll admit, our response time is slower now because of it,” Smith told Cheves. “When people used to call in for a site evaluation, we usually could get out there the same day. Now it might take us a week. It’s just — I’m sorry, we don’t have the people we used to. . . . I told our Board of Health that if we want to keep the services we have left, we’re going to have to have a tax increase.”

Kentucky River District Health Department
service area: Wolfe, Lee, Owsley, Leslie,
Perry, Knott and Letcher counties (KRDHD map)

Using local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties. "Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard told Kentucky Health News in June.

Scores of reported cases of Rocky Mountain spotted fever in Lincoln Trail area; awaiting state health department confirmation

Kentucky Health News

Rocky Mountain spotted fever, the main tick-borne disease in Kentucky, has affected scores of people in the area served by the Elizabethtown-based Lincoln Trail District Health Department.

The six-county department "has investigated a total 79 cases of Rocky Mountain spotted fever for June in the district, which comprises Har­din, Meade, LaRue, Nel­son, Washington and Mar­ion counties," Mary Alford reports for The News-Enterprise in Elizabethtown.

In Grayson County, which is in the Lincoln Trail Area Development District but has a separate health department, 26 cases were reported from July 7 to 17. All the numbers are subject to confirmation by the Kentucky Department for Public Health. In a typical year, the entire state has 10 to 30 cases, Grayson Brown, director of the University of Kentucky Public Health Entomology Laboratory, told Kentucky Health News as the summer tick season began.

Dog ticks (middle) are the usual carriers of Rocky Mountain spotted fever.

"Reports of tick-borne illnesses that make it to the health department stem from people with a known tick bite who go to the doctor, exhibiting symptoms such as fever, rash, headaches, muscle aches and tiredness, and are tested for Rocky Mountain spotted fever, Lyme disease and other ailments,"Alford reports. The district health department has also found a few cases of tick-borne Lyme disease.

How can you protect yourself from these diseases, which can be debilitating and in rare cases fatal? Use insect repellents, shower soon after being outdoors, and check for ticks daily, especially in hard-to-see places, Rebecca Morris writes for The Record in Grayson County, citing material from the federal Centers for Disease Control and Prevention web page about ticks.

CDC recommends "a full body check upon return from potentially tick-infested areas," Alford writes. "Ticks most commonly attach around the ears, inside the belly button, behind the knees, between the legs, around the waist and especially in and around the hair. To remove a tick, people should use tweezers to grab the tick close to the skin and gently pull on the arachnid with steady pressure, and wash hands and the bite site with soap and water after the tick is removed. Also, apply an antiseptic to the bite."

Other tips, from UK's Brown:

• Check your pets.
• Keep grass and shrubs trimmed, and clear overgrown vegetation in your yard.
• Don't walk through uncut fields, brush and overgrown areas.
• Walk in the center of hiking trails.
• Wear light-colored clothes, which make it easier to spot ticks.
• Wear long pants tucked into boots or socks, and tuck your shirt into your pants.
• Place a band of duct tape, sticky side out, around your lower legs to trap ticks.
• Use tick repellent that has DEET or picaridin, or use permethrin-based clothing sprays.

Rocky Mountain spotted fever "can take three to 12 days to incubate," Morris notes. "Initial symptoms appear in one to four days, and include a high fever, severe headache, swelling around the eyes and on the backs of the hands, nausea and vomiting." The spotted rash usually appears two to five days after initial symptoms, but 10 percent of victims never develop a rash.

"After five days without medical treatment, patients can have altered mental states, lapse into a coma, develop respiratory problems or even have organ failure," Morris writes, citing the CDC. The disease "can lead to death if patients aren't treated early."

Health departments scramble to fight hepatitis A outbreak

Peyton Manning had hepatitis C but didn't know about hepatitis
A or the outbreak until it hit him. (Michael Clevenger, Courier Journal)

The nation's largest outbreak of hepatitis A has slacked off somewhat in Kentucky, but remains a threat and local health departments are dipping into their reserves and taking unusual steps to get people vaccinated for the liver disease, which has killed 44 Kentuckians during the outbreak.

The medical director of the Lake Cumberland District Health Department doesn't usually give vaccinations, but each of her counties only had one or two nurses to do that, so Dr. Christine Weyman started giving shots, too, Laura Ungar and Chris Kenning report for the Louisville Courier Journal.

"She has gone out to vaccinate drug users who largely were spreading the virus," they report. "She once went so far as to chase two men down a street to persuade them to get the shot. (They weren't interested.) She also went to the crowded Pulaski County Detention Center, realizing the 213-bed jail with more than 400 inmates could be an excellent incubator for the virus. Right outside the jailer's office door, her health department placed a refrigerator for the sole purpose of storing vaccines."

"In many ways," Ungar and Kenning wrote, the Somerset-based department "is a microcosm of rural Kentucky's continuing struggle with hepatitis A. What's happening there reflects how Kentucky's communities with limited resources are quietly battling the nation’s largest and deadliest outbreak — learning as they go and altering their strategies to meet the many challenges they face."

The state has averaged 76 hepatitis A cases per week this year, "sometimes reaching more than 90 a week, compared with 151 a week at its peak in early November," the CJ reports, but "Kathleen Winter, an epidemiologist at the University of Kentucky, said a recent downward curve in the outbreak doesn't necessarily mean it's waning."

"We still need robust intervention," Winter told the newspaper. "It's still too early to say whether it’s really winding down. We still have individuals getting sick, being hospitalized and dying."

The story's first example was Peyton Manning, 27, "who was sleeping behind a Walmart in Lexington and spending his days shooting meth and heroin. Late last year, he admitted himself to The Healing Place in Campbellsville. Then a virus hit him. He couldn’t sleep. He couldn't keep any food down." He went to the UK hospital and recovered at his mother's home.

Manning already had hepatitis C, but said he didn't know about hepatitis A or the outbreak. "didn’t even know it was a thing," he told the CJ. "I started to watch the news. It was like, damn, I didn’t know it was that bad."

Health departments are responding "with a mix of resources," the paper reports. "In addition to using state funding, local health departments can also order federally funded vaccine through the state or buy shots using money from $233 million in county health department reserves," which "vary greatly across counties and area development districts. They're in the negative numbers in some places and reach into the millions of dollars in others."

The Lake Cumberland agency had unrestricted reserves of about $5 million when the outbreak hit in 2017, but was "trying to avoid using this as much as possible to help with the pension crisis," said Ron Cimala, its administrative director. Many health departments have said they will have to close unless the legislature keeps giving them relief from the state's new requirement for funding their employees' pensions.

Ranges of health department reserves that could be used to pay Kentucky Employees Retirement System obligations. About half of the counties are in district departments; others are independent.

Williamstown is first city in Northern Kentucky to implement comprehensive workplace and public-place smoking ban

On Jan. 1, the Grant County seat of Williamstown became the first place in Northern Kentucky to implement a comprehensive ban with smoking ban. Kenton County has significant exemptions, meaning it does not have a comprehensive smoke-free policy.

The ordinance, which passed in September, bans smoking, including the use of electronic cigarettes, in all buildings and places of employment, as well as in public outdoor patios. The new law allows for an exception for private clubs, unless it is being used for a function where the general public is invited.

Parks in the city of Williamstown have been tobacco-free since July 2017.

The new law also requires smokers to be 25 feet away from all entrances and windows that open and ventilation systems.

The Northern Kentucky Health Department will be responsible for enforcing the law and investigating any complaints.

"We congratulate the Williamstown City Council in taking this important step to improve the health of the community,” department Health Director Lynne Saddler said in a news release.

Williamstown is the 33rd city in Kentucky to implement a comprehensive smoke-free law, according to the news release.

On Oct. 1, 35 percent of Kentuckians were covered by comprehensive smoking bans for indoor
workplaces and public places. Williamstown's took effect Jan. 1. (Kentucky Center for Smoke-Free Policy)

McCreary and Wayne counties win Health Policy Champion award from Foundation for a Healthy Ky. for being 'bright spots'

Foundation for a Healthy Kentucky CEO Ben Chandler announced the award as nominees listened.

By Al Cross
Kentucky Health News

Wayne and McCreary counties won the first overall Health Policy Champion award presented by the Foundation for a Healthy Kentucky, for being "bright spots" of progress on health issues in Appalachian Kentucky.

"We have a tie," Foundation President and CEO Ben Chandler said as he announced the award at the foundation's annual Howard L. Bost Memorial Health Policy Forum in Lexington on Monday.

The adjoining counties on the Tennessee border were two of eight nominees for the award, which spotlights "those folks who are advocating the policy changes that will make Kentucky healthier," Chandler said. The $5,000 award was divided equally between the McCreary County Health Coalition and the Wayne County Health Council.

"They show us there' s always somewhere to start when it comes to working to improve health," Chandler said.

The two counties were among nine in Kentucky and 42 in Appalachia that the Appalachian Regional Commission and the Robert Wood Johnson Foundation named "bright spots" because they had better than expected health outcomes given their resources and health indicators.

McCreary and Wayne were among 10 counties in a case study that took a deeper dive into what they were doing to improve the health of their citizens, despite their many challenges.

The Lake Cumberland district, with Wayne and
McCreary outlined. Taylor is not in Appalachia.

The other "bright spots" in Kentucky were Green, Adair, Russell, Wayne, McCreary, Pulaski and Lincoln counties, like McCreary and Wayne part of the Lake Cumberland District Health Department, and Lewis and Morgan counties.

The other Health Policy Champion award nominees were Dr. Van Breeding of Whitesburg, for fighting substance abuse; and Murray Mayor Jack Rose, Paducah cardiologist Pat Withrow, Paducah Mayor Brandi Harless, the Casey County Youth Coalition and, jointly, Lexington Mayor Jim Gray and Lexington Legends owner Andy Shea, all for efforts against tobacco use.

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.