Saint Joseph hospitals in Lexington, London and Mount Sterling seek applications for grants to improve well-being, health equity

By Melissa Patrick

Kentucky Health News

The CHI Saint Joseph Health hospitals in Kentucky are accepting applications for local nonprofit organizations to apply for grants aimed at supporting services to improve well-being and health equity in their service areas. 

The grants are part of the Community Health Improvement Grants program, which was created in 2019 when Catholic Health Initiatives and Dignity Health came together to create the national health system CommonSpirit Health.

Grants through Saint Joseph Hospital and Saint Joseph East in Lexington, and Saint Joseph London, can be as small as $20,000 and as large as $100,000. Grant opportunities are also available at Saint Joseph Mount Sterling to serve that area, ranging from $10,000 to $19,500.  Click here for the link to the application website. 

"Grant applications must include collaborating partner organizations helping to deliver services and not be solely about one agency’s work,” Michael Bilton, CommonSpirit Health's senior director for community health and benefit, said in a news release. 

The application period is open through Aug. 16. Grants are available to nonprofit organizations that address substance-use disorders, mental health, and issues involving weight, physical activity and nutrition. All projects must be planned for calendar year 2025. 

The priorities were identified in the hospitals' most recent community health needs assessment, which is conducted every three years. 

“We are deeply committed to the well-being of our community," Christy Spitser, interim market president of CHI Saint Joseph Health, said in the release. "Providing grants to local nonprofits is a vital part of our mission to give back and make a tangible difference in the lives of those we serve.” 

Interested organizations can learn more about the grant program, including eligibility criteria, how to apply, and a local contact for questions, by visiting https://www.commonspirit.org/communitygrants.

Health officials call for more coronavirus testing, expect new antibody test will be key to getting people back to work

By Melissa Patrick
Kentucky Health News

Health experts say more coronavirus testing -- both for the virus itself and for antibodies that show whether a person has been previously infected -- is needed before the nation and the states consider relaxing social-distancing rules and "reopening the economy," as President Trump says he wants to do.

Photo by Aaron Lavinsky, StarTribune, via Getty Images

"How we are able to move forward very much is dependent on having access to the right information, and clearly testing is essential for all of this," Dr. Jennifer Nuzzo said during a Friday media conference held by SciLine, a science-information service for journalists.

"All of the game plans for the next phase really come up against a hard limit -- which is not being able right now to expand testing, given limitations in supplies and other things like that," Nuzzo said. "We very much need to be able to do that in order to move forward."

Nuzzo is a senior scholar at the Johns Hopkins Center for Health Security and an associate professor of environmental health and epidemiology at the Johns Hopkins Bloomberg School of Public Health.

She cautioned that moving from the current social-distancing strategy to slow the spread of the virus would surely  increase covid-19 cases.

"In order to make decisions about when and how to lift social-distancing restrictions, we need to have better surveillance both for the disease and also for the impact on the health system," she said. "And right now we have very little surveillance on the health system and quite imperfect surveillance for the disease."

Nuzzo, like Centers for Disease Control and Prevention Director Robert Redfield, said the next phase of dealing with the pandemic in the U.S. must include more testing as well as a move to what she called "case-based measures," a labor-intensive, tried-and-true public health measure that identifies individuals who have the virus, places them in isolation, locates all of their contacts and then monitors those contacts as well. This practice is also called contact tracing.

"These case-based measures are going to be essential for the United States in its next phase, because if we release our social-distancing measures, we will have to have a plan to deal with the rising cases," she said. "Otherwise, it will just escalate again, potentially to the point where we were before we implemented these population-based measures."

Nuzzo called for a national testing strategy, which she said would allow for a better understanding of what is happening across the nation, would better inform any plans going forward, and would eliminate some of the current bottleneck around supplies.

More than 30 different covid-19 tests are available, but states are still struggling to get enough of them, said Dr. Jana Broadhurst, director of the Nebraska Biocontainment Unit Clinical Laboratory and assistant professor of microbiology at the University of Nebraska.

"Despite this daily increase in the availability of diagnostic tools, that's not translating into a similar rate of increase in our ability to actually deploy that testing and to get test results to physicians and public-health authorities as well as we need to do," she said.

Gov. Andy Beshear spoke to the need for more testing at his covid-19 briefing Friday: "We are truly testing the very sickest right now," and are so short of test kits that people who have been mildly symptomatic and wanted to be tested have been asked to "ride it out without a test."

Not only are states still having to decide who to test based on resources available; there is still a need to ensure that the large platform of available tests are accurate and reliable, Broadhurst said, noting that the rate of false-positives is reported to be around 30 percent, and voicing concerns about the quality of specimens collected in drive-through locations or home-based testing.

"It's just absolutely critical that there's a way to ensure the quality of the specimen that is collected," with the understanding that drive-through or home-based specimens may not be comparable to a specimen collected in a clinical setting, she said.

Another type of test, for antibodies to the coronavirus, may play a more important role in determining who will be allowed to go back to work because it is the only way the U.S. has to determine the virus's infection rate.

"If their antibody test is positive, one can formulate strategies about whether or not they would be at risk or vulnerable to getting re-infected," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN Friday morning.

Broadhurst the antibody tests will initially be available only to front-line health workers, but the Food and Drug Administration approved the first such test last week, and "Within a period of a week or so, we're going to have a rather large number of tests that are available," Fauci said.

Eran Bendavid and Jay Bhattacharya, professors of medicine at Stanford University, also point to the importance of antibody tests as a way to determine the true infection rate in the U.S. and as a way to get people back to work. 

"Given the enormous consequences of decisions around covid-19 response, getting clear data to guide decisions now is critical," they write in an op-ed for the Wall Street Journal.

Bendavid and Bhattacharva say current estimates about covid-19 death rates may be too high because the "true fatality rate is the portion of those infected who die, not the deaths from identified positive cases." They say that using this as the measure for death rates would result in a much smaller rate than the 2 to 4 percent estimated by the World Health Organization and others.

In other words, they say that if the number of actual infections is much larger than the number of cases identified, then the true fatality rate is much lower as well.

And if this is true, they write that this could mean measures focusing on older populations and hospitals would continue to be necessary,  but "a universal quarantine may not be worth the cost it imposes on the economy, community and individual mental and physical health."

Health officials also worry that as covid-19 testing increases, so too will the number of false negative results. "If you have likely exposures and symptoms suggest covid-19 infection, you probably have it, even if your test is negative," Dr. Harlan Krumholz, a professor of medicine at Yale University, writes in The New York Times.

And as other health officials have pointed out, while a positive result is fairly reliable, a negative result can only confirm that that person does not have covid-19 on the day of the test, since the incubation period for the virus is up to 14 days.

Ads touting McConnell's record on surprise billing, Medicare for All could be a surprise of their own, since they confuse the issues

This ad promoting Sen. Mitch McConnell conflates the issues of surprise billing and Medicare for All.

Analysis by Al Cross
Kentucky Health News

A conservative group has started television and radio commercials in Kentucky and other states thanking Senate Majority Leader Mitch McConnell and others in Congress for blocking legislation that would offer consumers some protection from surprise medical bills.

While that may not sound politically advantageous to the senator's re-election campaign, the ads conflate and confuse the surprise-billing issue with the much more prominent "Medicare for All" proposal, which is favored by the most liberal Democratic presidential candidates.

The TV ad says, "Some politicians are too scared to stand up to the special interests. But not Mitch McConnell. He fights for us, like on health care and surprise medical billing. Special-interest groups have tried to use the issue to implement a government-run Medicare for All scheme, putting our hospitals and care at risk. But Mitch said NO, because he knows how devastating that would be, for us and our children. So, thank you, Mitch McConnell, for putting patients first."

The Taxpayers Protection Alliance said that in December, McConnell "and legislative allies halted attempts by members of Congress such as Sen. Lamar Alexander (R-Tenn.) and Rep. Frank Pallone (D-N.J.) to have the government impose rate-setting in cases of surprise medical billing. Surprise bills occur when patients receive unwanted and unexpected healthcare bills in the mail days or even weeks after a hospital room visit."

Yes, but the surprise-billing issue has little if anything to do with "Medicare for All," one possible exception being that proponents of the latter cite the former as one problem it would solve. TPA says the two are related this way: "Surprise medical billing is only an issue because of rampant government intervention in the medical sector due to Obamacare and Medicare’s disastrous rural price controls. This is a problem that was specifically caused by misguided government intervention. In fact, three-quarters of Obamacare networks are now considered ‘narrow’ with few choices for patients, leading to many patients receiving ‘surprise bills.’"

TPA says its campaign in Kentucky, Kansas, Texas, and New York is intended to thank McConnell "and like-minded lawmakers for standing up for patients and opposing the federal government dictating health-care prices across the country."

The proposed legislation "doesn’t set actually set rates for out-of-network procedures, but instead sets benchmarks for how much out-of-network providers can collect if a surprise bill shows up," health journalist Trudy Lieberman notes. "But in a TV ad that lasts a few seconds, how would the viewer be able to make that distinction?"

This isn't the first time that a group with undisclosed sources of money has tried to mischaracterize the issue of surprise billing. Last summer, a "dark money" group called Doctor Patient Unity ran an ad campaign in Kentucky and other states saying that Alexander's bill would hurt patients and help insurance companies. The campaign targeted McConnell, Sen. Rand Paul and six other senators.

New House health committee chair says she asked for the job because 'health care is too important to leave to chance'

Rep. Kim Moser in her Capitol Annex office (Photo by Al Cross)

By Melissa Patrick

Kentucky Health News

The new chair of the state House Health and Family Services Committee has been a legislator for less than two years and two months, but says she's uniquely qualified for the position because of her background in health care and her willingness to speak out about important issues. 

Rep. Kim Moser, a Republican from Taylor Mill, told Kentucky Health News that she asked to be considered for the chair's position after briefly toying with the idea of running for one of the five slots in the House Republican leadership, but realized that "surprisingly few" House members have a health background.

"I said, you know what, health care is too important to leave it to chance, so I really felt strongly about doing this," she said in an interview in her corner office in the Capitol Annex. "I'm really very happy right here. I think this is where I need to be." 

Moser is a registered nurse with a specialty in neonatal intensive care. She also served as the director for the Northern Kentucky Office of Drug Control Policy between 2014 and 2018, and remains on its board. 

Moser describes herself as a "fiscal conservative" and "very pro-life" and says it's no surprise that she ended up in politics since she grew up in a political home. Her father, Dr. Floyd Poore, is a longtime family practice physician who sought the Democratic nomination for governor in 1991 after serving as state transportation secretary and gubernatorial campaign fund-raiser.

Moser said her father remains a registered Democrat, and grinned when she said she is working on getting him to change that. "I tell him all the time that he's really a Republican because I grew up in that house and that's how conservative he really is," she said. 

Moser said her involvement in health advocacy and policy also influenced her decision to run for office and her desire to lead the health committee. She provided some legislative education for the Kentucky Medical Association as a volunteer, and had worked for the KMA Alliance and the American Medical Association Alliance, of which she is the immediate past president. 

"That, coupled with the Office of Drug Control Policy, I was working on addiction and medical legislative issues on a local, state and national level," she said. "And I just saw how valuable it was, first of all, to have influence in all of those spaces and understand how one affects the other."

Moser replaced 30-year representative Tom Kerr in 2016. She said when Kerr asked her if she was ready to run for office after he decided to not seek re-election, the stars must have been aligned because her youngest of five sons was a senior in high school and the time was right. This is Moser's second term from House District 64, which covers parts of Campbell and Kenton counties. 

"I love it," she said. "I love working with constituents. I love helping solve problems, and maybe that's just the nurse and mom in me, but it feels like a good fit right now. I grew up in it, and when I got here, I kind of felt right at home." 

Moser, 56, said she doesn't rule out running for a higher position, but isn't actively pursuing it. "This wasn't the plan and that's not my plan, but you never know what opportunities come your way," she said. "And again, if I feel like I can offer something, that is why I would do that." 

As a legislator, Moser said, it's important to look at the big picture and to not get bogged down in the details, which she said can lead to political polarization.

For example, she said it's important to make sure programs exist to support foster care and addiction treatment, but it's even more important to implement policies that address the underlying causes: "I like to take a broader, 30,000-foot view of things."

When people take a short view of a problem, she said, they "get stuck in their party's talking points and don't always look at what is best for the child, the family, the state and the return on investment, if you will, on implementing programs that really get to the underlying causes."

Moser noted that there are often "recurrent themes" that act as the underlying causes for many of the issues that plague Kentucky, such as adverse childhood experiences. She said it's important to look at these recurrent themes and address them through legislation. 

According to America's Health Rankings, Kentucky is in the top 10 states for adverse childhood experiences, with 27 percent of its children having experienced two or more stressful or traumatic events on a list of 10 -- such as physical abuse or substance misuse in the home -- that are proven to have a lasting impact on their health and well-being.  

Moser said she subscribes to the Republican belief that cutting taxes would improve economic opportunities for low-income Kentuckians, and the notion that "a rising tide lifts all boats." 

"The economic stability of our state has a lot to do with our workforce and all the issues that we know cause problems for individuals. Certainly we know that if folks don't have a job, then they can't provide for their families and this increases stress," she said. "So I absolutely subscribe to that." 

Moser said that as the chair of the House's health committee, she plans to work on finding ways to address the underlying issues that contribute to so many of the chronic diseases in the state -- like addiction, obesity and tobacco use. 

She has already gotten a statewide tobacco-free school bill out of her committee, but it has run into some opposition in the full House. Moser is the prime sponsor of the measure, House Bill 11.

She also said she will work on figuring out ways to improve access to care for mental health, which she said is currently under-treated. "Mental health issues affect addiction, poverty, school safety," she said. "The list is pretty endless."

Analysts think Medicaid work requirements pose little political risk

Bevin and President Trump (AP photo)

"Kentucky is one of the poorest states in America, and its residents are among the sickest. Yet the governor's decision to force Medicaid recipients to meet a work requirement — something that could take health coverage away from 100,000 people — is unlikely to carry any political repercussions for the GOP in this deeply red state." Tony Pugh reports for McClatchy Newspapers' Washington bureau.

Pugh notes that 2017 Kaiser Family Foundation poll found that 70 percent of Americans support work requirements for Medicaid recipients, and that Republican Gov. Matt Bevin is betting Kentucky feels the same way.

Kaiser Family Foundation graphic.
Click on it to enlarge. Click here for more information.  

Read more here: http://www.mcclatchydc.com/news/politics-government/article194990909.html#storylink=cpy

In Kentucky and other states with many low-income residents, people who work but often struggle to pay for health care tend to resent those who get government-subsidized health care, according to Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News. "If you can say, 'All we’re doing is requiring people to be more active participants in their health care and require some work-related activities,' I think the general population looks at that and says, 'What’s the matter with that?'" Cross told Pugh.

"Supporters say the Medicaid work policy will cut government dependency, weed out people who don’t really need the assistance and build work ethic among low-income enrollees," Pugh reports. "Critics say the requirement will be expensive to administer, provide an unnecessary barrier to coverage and penalize people who can’t work due to undiagnosed medical problems." Kentucky's new policy estimates nearly 100,000 fewer Kentuckians will have health coverage in five years, than if the policy were not implemented.

Eight other states with Republican governors (Arkansas, Arizona, Indiana, Kansas, Maine, New Hampshire, Utah and Wisconsin) and one state with a Democratic governor (North Carolina) have asked the Trump administration for the green light to enact similar requirements. Several of those states could be battlegrounds in statewide and congressional elections in November. But the Medicaid work requirements aren't likely to be a problem for most Kentucky Republicans, since there are no statewide races this year.

The traditionally lower turnout among low-income voters who would be affected by the measure could also help protect Republicans, Cross said. And it's worth noting that the Kentucky counties with the highest Medicaid rates backed Bevin in 2014, mostly because of social issues such as religion, abortion and anti-Obama sentiment.

But the political dynamics at play in Kentucky may not apply in other states. "It may depend on rival Democrats making a linkage between Medicaid and overall concerns about health care and insurance," Pugh writes. Democrats are likely to emphasize health coverage in elections this year, since 3.2 million Americans lost health coverage in 2017 and it's an issue that most people care about. A poll by Hart Research Associates last week showed that voters cared about health care more than the economy, taxes, immigration, or terrorism in the 2018 congressional elections.

Here are some expert tips for making and keeping New Year's resolutions that will stick, and help improve your health

Dreamstime.com

By Melissa Patrick
Kentucky Health News

It's time again to make those New Year's resolutions. A recent national poll found that some of the most popular resolutions have to do wiht health: losing weight, exercising more, eating healthier and kicking the smoking habit.

These are all admirable goals, and some that many Kentuckians-- who lead the nation in poor health, obesity and smoking -- could take to heart, the problem seems to be sticking to them.

According to Statistic Brain, a survey-based research institute, 41 percent of Americans make a New Year's resolution, but fewer than 10 percent of them are successful, and over 40 percent of those who make a resolution will give up before the end of January, The Wall Street Journal reports.

A national poll conducted by the Marist College Institute for Public Opinion offers a bit more hope, reporting that 44 percent who make a resolution will keep it, and that 68 percent of those who made a resolution in 2017 said they kept at least a portion of the promise.

So you might ask, why even bother?

Research conducted by Dr. John Norcross, a psychology professor at the University of Scranton, found that people are 10 times more likely to make a change by declaring a New Year's resolution compared to "non-resolvers." It also found that 44 percent of people who make a resolution are successful six months into the new year, ABC News reports.

The American Psychological Association offers several, common-sense suggestions to get started.

First, the psychologists say, start small and change only one behavior at a time. For example, if your overarching goal is to eat healthier, commit to eating one serving of fresh fruits or vegetables with each meal instead of seeing your diet as a form of punishment.

They also encourage community, noting that finding a support group increases your odds of success. And don't beat yourself up, they say, missteps are normal. Finally, they suggest seeking professional help from a psychologist or other professional if you need help changing unhealthy behaviors or addressing emotional issues.

“Setting small, attainable goals throughout the year, instead of a singular, overwhelming goal on January 1 can help you reach whatever it is you strive for,” psychologist Lynn Bufka told the association. “Remember, it is not the extent of the change that matters, but rather the act of recognizing that lifestyle change is important and working toward it, one step at a time.”

The New York Times sums up these ideas nicely, saying it's time for us to "resolve to set better resolutions." This author suggests we need to make sure we are resolving to change something we want to change, and not what society is telling us to change, adding that our resolutions should be clearly defined and realistic.

ABC adds that it's important to dig deep and make sure you know why you are making the resolution. For example, we all know that we need to eat better and exercise more, but the why of doing this could be different for each of us. For example, for some it could be to reduce their cholesterol levels or to get off their Type 2 diabetes medicine, but for others it may simply be to live long enough to know their grandchildren.

A separate New York Times article recommends using the SMART method when making New Year's resolutions -- an acronym that was coined in the journal Management Review in 1981 as a guideline for making goals that are Specific, Measurable, Achievable, Relevant and Timely.

If you need help picking a resolution, Newsweek offers 15 simple resolutions that are linked to research supporting why they would be meaningful; many of them are related to improving your health. The first suggestion is to eat more fish, linking to another article full of research showing why that's a good idea. One example: Eating more fish helps children sleep better, improve their IQs and avoid heart disease. Some of the magazine's easy, health-related resolutions include preparing a meal at least once a week, eating a salad once a week, and spending more time outside.

USA Today, in an article originally published in Exact Sciences, also offers five easy resolutions to make and keep, with supporting evidence on how they will improve your health. They include flossing daily, scheduling a physical examination, eating vegetables instead of drinking them, eating more slowly and chewing your food longer, and going to bed 15 minutes earlier.

USDA nixes further reduction of salt in school lunches

The U.S. Department of Agriculture announced Nov. 29 that it's halting an Obama-era plan to gradually reduce the amount of salt in school lunches each year. But the new plan would keep current sodium level targets unchanged through 2019. "Those targets are currently not more than 1,230 milligrams per meal for elementary, 1,360 mg for middle and 1,420 mg for high schools," Maria Danilova reports for The Associated Press.

The targets cover only meals served to students at breakfast and lunch, not a la carte items sold during meal times or vending machines and other sources of non-meal food sales. Public schools nationwide require that all such non-meal foods meet the nutritional requirements of the USDA's Smart Snacks Standard, first implemented in 2014. Those standards require that snacks be lower in sodium.

Margo Wootan of the Center for Science in the Public Interest said current sodium levels are too high, and the high-school sodium target is two-thirds of a child's daily recommended intake. "This is locking in dangerously high levels of salt in school meals," she told Danilova. The federal Centers for Disease Control and Prevention backs up this claim, saying that about 90 percent of school-age U.S. children eat too much sodium daily, and that 1 in 6 children have raised blood pressure (which can be lowered partly with a healthy diet that includes less sodium).

In Kentucky, 33.5 percent of children age 10-17 are overweight or obese, compared to 31.2 percent nationwide. A diet high in sodium is strongly associated with obesity.

Agriculture Secretary Sonny Perdue has criticized the sodium restrictions, saying that children won't eat the healthier meals and that food gets thrown away.

The USDA's Food and Nutrition Service is also keeping in place a program that allows school districts to opt out of a requirement to supply whole grains in lunches, if the schools feel they can't procure enough whole-grain products.

Roundtable discusses how poor health is an obstacle to economic development in Appalachia, and what to do about it

By Melissa Patrick
Kentucky Health News

JOHNSON CITY, Tenn. -- Appalachia faces many hurdles when it comes to economic development and creating a healthy workforce, including education barriers, addiction issues, stigma and overall poor health.

Appalachian Regional Commission roundtable on new health
data and economic development in Appalachia. (ARC photo)

Those were the conclusions of a 13-member panel convened to discuss the findings of two new Appalachian Regional Commission reports that found Appalachian health continues to fall behind the rest of the nation, and how that affects economic development.

"Without a healthy workforce, the economic prospects in the region are greatly diminished," declared Julie Marshall, an ARC economist and a principal investigator for the "Health Disparities in Appalachia" report.

Marshall said the study found Appalachians feel unhealthy 12 more days a year than the average American if you account for physical and mental health, which results in more sick days, lower work productivity and more injuries, and "That is a significant hurdle to developing a healthy workforce."

The second report, "Diseases of Despair," looked at deaths from overdose, suicide and alcohol-related liver diseases in Appalachian and found them to be 37 percent higher than the rest of the nation: Overdose deaths were 65 percent higher, suicide deaths were 20 percent higher, and alcoholic liver-disease deaths were 8 percent higher.

Michael Meit, lead author of the study, reminded the panel that it's important to look beyond poverty as the only reason for these high rates, pointing out that some Appalachian states, like Mississippi and Georgia, have high poverty levels, but lower death rates for these measures.

The report also notes that most people who die from an overdose in Appalachia are between the ages of 25 and 54, which are prime working years.

One surprise in the report, based on 2015 data, was that overdose deaths were higher in metropolitan counties than rural counties. The other report, using data through 2014, found overdoses were higher in rural Appalachia.

Meit, who is also the senior fellow for the NORC Walsh Center for Rural Health Analysis, said the difference may indicate a new trend.

Addiction is an economic issue

Meeting in Johnson City, Tenn., the panel said addiction -- to opioids, alcohol, methamphetamine and cocaine -- is a major workforce issue in the region.

Dan Eldridge, the mayor of surrounding Washington County, said he had recently talked to a company looking to bring more than 600 jobs to his area, and spent most of the time talking about the region's workforce. And when he asked why, they told him that among other things, one of their selection criteria was access to a drug-free workforce and "this region of the country does not have a good reputation."

Eldridge said he thought one contributor to the problem is that high-school students who aren't college-bound don't have any plans for the future, and their drug use seems to increase after they graduate.

"We have got to really help get our kids focused on a plan for success and career orientation . . . to make them ready for the workforce," Eldridge said. "I think in doing that we are going to be able to avoid some of these issues that they slip into."

Virginia Health Secretary William Hazel said a cultural change is needed in the workforce to provide help for people with addictions, noting that it is no longer plausible to simply "weed out the drug users."

Mark Birdwhistell, vice president for Administration and External Affairs at the University of Kentucky, agreed and said it's time to "eradicate the stigma of addiction."

"Addiction is a clinical condition that needs to be addressed just like diabetes, asthma and any other medical condition," Birdwhistell said. "And once you get to that point, it's a lot easier to address many of the issues that we are talking about ."

Randy Wykoff, dean of the East Tennessee State University College of Public Health, said it's time to bring people together from different sectors -- health-care providers, the criminal-justice system, advocacy groups and people with substance-use disorders --  to "rethink this whole thing." He said it's time to quit putting people in jails who need rehabilitation and treatment.  

Successes

The panel stressed the importance of also sharing the success stories from the region. "These problems don't define the region," Meit said.

Eldridge said his county has a program that teaches employees how to recognize personal or work-related problems and encourages employers to implement employee-assistance programs to address them.

Tennessee now offers all high-school graduates tuition-free attendance to a Tennessee community or technical college, noted Ted Townsend, deputy commissioner and chief operating officer of the Tennessee Department of Economic and Community Development.

Wykoff reminded the panel that statistics are changeable, noting that Tennessee's high-school graduation rate had moved from 49th in 2005 to a top 10 slot this year.

Mike Caudill, CEO of the Mountain Comprehensive Health Corp., a federally qualified health center in Letcher County, pointed to its "Farmacy" program as one of their many successes.

The grant-funded program gives qualifying individuals a "prescription" for fresh fruits and vegetables at their local farmers' market. Caudill noted that one of their participants lowered his A1C, a test for blood sugar, from 14 to 6.2 in just eight months. A normal A1C is between 4 and 5.6.

What next?

"There is no plan without technology that fixes the problem,"  said Jared Arnett, executive director of Shaping Our Appalachian Region, a bipartisan effort to revitalize and diversify Eastern Kentucky's economy.

Arnett explained how technology opens doors for new economic opportunities, expands entrepreneurship, provides access to health-care specialists through telemedicine, and provides more opportunities for education and workforce training.

Other ideas to improve the workforce included creating multi-sector partnerships, involving community members in decision making, taking advantage of the region's high rate of social associations, including health considerations in all government policies, and better coordinating local educational systems with the region's workforce needs.

"For me, this discussion and the data that we are looking at is the story of human capital and where do we want to take human capital in this region," said Jen Giovanutti, the regional community development manager for the Federal Reserve Bank of Richmond.

Arnett added: "In the midst of all this bad news, somebody has to speak life into what is possible." 

Study on strip mining and health suspended, but all sides were heard at meetings already scheduled in Hazard and Lexington

Historical map shows mountaintop-removal sites in red, other
strip mines in yellow. (For a larger version, click on the image.)

By Melissa Patrick
Kentucky Health News

A study of possible health risks of living near big strip mines in Central Appalachia held what may have been its final public meetings in Kentucky last week, following suspension of the study by the Trump administration.

On Aug. 18, the Office of Surface Mining Reclamation and Enforcement told the National Academies of Sciences, Engineering and Medicine to stop all work on the study, citing a budget review of the Interior Department, OSMRE's parent agency.

"The National Academies believes this is an important study and we stand ready to resume it as soon as the Department of the Interior review is completed," the academies said in a statement, but the spokeswoman for the agency said they didn't know when that might be.

The academies created an 11-member committee to review the available research on the health effects of mountaintop removal and other forms of surface coal mining, and identify gaps in the research for study.

A number of studies have shown that surface mining is associated with higher rates of cancer, heart disease, birth defects and other health conditions in Central Appalachia, but have not established a connection, and other studies have been inconclusive or not even found correlation.

Hazard and Lexington meetings

The committee's first Kentucky meeting, Aug. 21 in Hazard, included coal-mine visits and a public meeting. The second was Aug. 22 in Lexington, where the panel heard from Kentucky environmental officials, geologists and others.

Several who spoke at Hazard said they hoped the Trump administration would restart the study and also expressed concerns that "mountaintop mining hurts air and water quality, impairs human health and destroys mountains and streams," Bill Estep of the Lexington Herald-Leader reports.

"Science isn’t going to hurt us. What we don’t know very well could," said Dee Davis of Whitesburg, president of the Center for Rural Strategies.

Coal-industry representatives said "Coal companies do a good job of reclaiming land and monitoring water quality," Estep reports. Tyler White, president of the Kentucky Coal Association, said his organization supports the decision to halt the study and the tax dollars appropriated for it would have been better spent combating health problems or drug abuse in the coalfield.

Glynis Bourd of Ohio Valley Resource reports that the effects of surface mining on health have been a concern of people in Central Appalachia for a long time. Her story includes a detailed video timeline demonstrating them.

At the Lexington meeting, Larry C. Taylor, an environmental scientist for the state Department for Environmental Protection, told the panel that a state study found there was no correlation between two metals, arsenic and chromium, in drinking water and cancer incidence and deaths in Eastern Kentucky. The metals are released by mountaintop removal and other large-scale surface mining.

Richard Wahrer of the state Department of Natural Resources said state regulators perform extensive evaluations on the impact of mining on watersheds. "Remember, water can't leave the mining site unless it is in compliance with established standards," he said. "We have not had material damage occurring outside the cumulative impact area."

Viney Aneja, a professor at North Carolina State University, reported on his study that measured the environmental exposure of residents in southwest Virginia to coal dust generated by trucks hauling coal from a nearby surface coal mine.

The study found that coarse dust particles, called PM10, often exceeded the national standards in locations both near and about one mile away from the surface mine, and on some days were three times higher than the national standards. PM10 particulates, which can be as small as 2.5 micrometers across, can easily be inhaled and pose a risk of lung damage.

Charles Snavely, secretary of the Kentucky Cabinet for Energy and the Environment and a former coal executive, said he had never heard anyone in his Eastern Kentucky community attribute a health problem to coal mining.

"I don't see how you could tell it because the problems that we have in the coalfields of Kentucky are obesity, smoking, lack of exercise, poor medical care and drug abuse," he said. "I'm sorry, I tried to stay to data . . . but I and a bunch of people who work there, grew up there, lived there our entire adult lives and I never heard that complaint once." He is a native of Prestonsburg.

Others weigh in

Luke Popovich, a spokesman for the National Mining Association, told The New York Times that the decision to halt the study may have been justified: “The National Institute of Environmental and Health Sciences concluded in July that after examining available studies, it didn’t see evidence justifying a health hazard, noting that no conclusive evidence connected mountaintop mining with health effects and that studies often failed to account for extraneous health and lifestyle effects.”

Actually, the institute said it could not reach any conclusion because the existing research had a "strong potential for bias." It called for more research and concluded: "Without such work, uncertainty will remain regarding the impact of these practices on the health of the people who breathe the air and drink the water affected by MTR mining."

The American Public Health Association said in a statement that the study's suspension shows the Trump administration's "disregard for science and evidence when it comes to the environment and safeguarding health."

U.S. Rep. John Yarmuth, D-Louisville, who has introduced legislation to block new surface-mining permits until the health risks have been determined, said in a statement: “The fact that mountaintop-removal permits have been approved when there has never been a federal study on the health effects of mountaintop-removal mining is shameful enough. To now prevent this study from being completed would be reprehensible."

Interactive map gives estimated premiums under latest Senate health-insurance bill, by age, income and county

The fate of health-insurance legislation in the Senate remains very much up in the air, but the Kaiser Family Foundation has updated its interactive, county-level map showing how the latest version of the Better Care Reconciliation Act would affect premiums for silver-level Obamacare plans, the type most commonly purchased with tax-credit subsidies. The figures are the estimated premium in 2020 after tax credits. Pop-up tables for each county also show premiums for cheaper bronze-level plans, the amounts of tax credits (or savings from putting pre-tax income into health-savings accounts), and the change from current law. Here's a screenshot of the map for a 40-year-old Kentuckian with a yearly income of $40,000:

The map can be adjusted for age (27, 40 and 60) and income (mostly in in $10,000 increments). The version above is for 40-year-olds with income of $40,000 a year. Here's one for 60-year-olds making $60,000, showing that premiums for them would go up in every county:

To show how the individual county estimates are displayed, here's a screenshot of estimates for a 40-year-old with $40,000 annual income in Grayson County (click on it for a larger version):

Rich-poor divide grows in oral health; Ky. ranks 2nd in seniors with no natural teeth; what's your county's toothless rate?

The rich-poor divide is causing many impoverished rural residents to forgo oral health care, or resort to having teeth pulled rather than pay for costly fixes, Mary Jordan and Kevin Sullivan report for The Washington Post. The rate of Americans who have lost all their natural teeth is higher in rural areas in every age group and 20 percent of all Americans over 65 do not have a single real tooth remaining. (CDC graphic: National Health Survey 2010-12 results of of people who have lost all their natural teeth)

Toothless rates among those 65 and older are especially high in the South. According to Kaiser Family Foundation data from 2014, 33.6 percent of West Virginia residents 65 and older had no natural teeth. Kentucky was second, 23.9 percent, followed by Mississippi and Oklahoma (22.5), Tennessee (22.4), Alabama (22.2), Arkansas (22) and Louisiana (20.5). (CDC graphic: Where people 65 and older have lost all their teeth)

More than 50 million Americans "live in areas officially designated by the federal government as Dental Health Professional Shortage Areas," reports the Post. "A great many of them are working poor. In these rural areas, even the water can work against people." Many people rely on well water that is not fluoridated, which helps reduce tooth decay. The Centers for Disease Control and Prevention says 25 percent of Americans are not connected to a fluoridated water system. Another problem in rural areas is a shortage of dentists.

For the percentage of adults in your county who are missing six or more teeth, go to KentuckyHealthFacts.org, click on your county and ask for its health outcomes.

While rich people can afford the luxuries of the best oral health care, poor people often resort to standing in line at free clinics, reports the Post. "High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth." The problem is that emergency rooms are not typically equipped to fix dental problems. That means they prescribe painkillers, which can lead to addiction, which destroys teeth, and dry mouth, which leads to more cavities.

Free journalism workshop will be held June 9 in Cincinnati on covering health care and health in rural America

The Association of Health Care Journalists is hosting a free workshop on covering rural health on June 9 in Cincinnati. The keynote speaker will be Julie Willems Van Dijk, director of County Health Rankings and Roadmaps, an annual measure of vital health factors revealing a snapshot of how health is influenced by where people live, learn, work and play. The registration deadline is May 26.

Five workshops will cover a variety of areas, including "Finding rural health stories: What reporters need to know," featuring Trudy Lieberman, contributing editor of Columbia Journalism Review and Laura Ungar, investigative and enterprise reporter for The Courier-Journal and USA Today. The workshop will moderated by Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News.

Another workshop, "Challenges of keeping a rural health workforce," will include Timothy L. Putnam, president and chief executive officer of Margaret Mary Health and Brent Wright, associate dean for rural health innovation at the University of Louisville School of Medicine. The workshop will be moderated by Melissa Patrick, a journalist for Kentucky Health News, which is published by the Institute for Rural Journalism and Community Issues.

Other workshops on the schedule are: "How the battle over health reform is impacting rural residents;" "The geographic divide: Reporting on disparities;" and "Covering the opioid epidemic beyond cities." To register for the event click here.

Community health workers aren't medically trained, but they help rural people manage their health care and their health

By Melissa Patrick
Kentucky Health News

As health advocates at the April 24 Kentucky Voices for Health annual meeting discussed how to reduce health disparities and assure health equity in the state, a model of integrated care that includes community health workers resonated as a possible solution.

MCHD Community Health Worker helping a patient

"I really believe in the community health worker model," said Keisha Cornett, health education coordinator for the Montgomery County Health Department in Mount Sterling. She added later, "Everything that we've talked about, about health equity, community health workers can play a very important role in. The goal is to empower individuals to take an active role in their health care, their health and also in their environment."

CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy and deliver education on prevention and disease self-management.

Cornett noted that patients will often tell their CHW things they would never tell their doctor, such as not having adequate transportation to get to the pharmacy or not having enough money to buy their medications. CHWs work to understand what their clients need on an individual level and then meet them where they are, she said.

The federal Bureau of Labor Statistics says Kentucky had 710 CHWs in May 2016 with an annual average wage of $38,290.

Cornett said some providers have voiced concerns about CHWs providing health education. But she said it's important to allow CHWs to work at the top of their skill set, adding, "We are just encouragers" who "never go out of the scope of what we can do."

Montgomery County's CHW program, called "The Bridge" ("El Puente" for Latino clients) is funded by a federal Health Resources & Services Administration grant and focuses on chronic disease self-management and education. It largely serves clients whose incomes are less than 150 percent of the federal poverty level.

Cornett explained that CHWs connect people to services that help improve their health, like the Kentucky Diabetes Prevention and Control Program, which teaches diabetes self-management, or the Kentucky CARE Collaborative, a heart-disease and stroke-prevention program with a focus on high blood pressure.

Cornett pointed to an ongoing survey that shows clients have reduced emergency room visits; are more likely to have a medical home; have better medication adherence and have shown a drop in their A1C levels, a test for blood sugar.

She said the local diabetes self-management education class recently increased from four participants to 12, and 11 of the participants were from the CHW program. The CHWs have also created a diabetes support group, which they will lead for a month before turning it over to the members.

CHWs recently formed the Community Health Worker Association, which is working with the CHW Workgroup of the state Department for Public Health to standardize training across the state. Cornett said they are getting close to having the certification and curriculum approved.

"CHWs are an evidence-based model to address the health care concerns that we have . . . and really [gets] people involved in their own health care," she said.

Senate Health and Welfare Chair Julie Raque Adams, a Republican moderate from Louisville, had a banner session

Sen. Julie Raque Adams

By Melissa Patrick
Kentucky Health News

The term "public servant" comes to mind when state Sen. Julie Raque Adams starts talking about being a legislator, especially when she mentions the Senate Health and Welfare Committee, which she chairs.

"I love it," Adams said. "I love every minute of it and I feel very blessed to do this job."

Adams, a Louisville Republican, has chaired the Senate's health committee for three years and calls it "the best committee in the whole legislature."

She added, "It is the committee where you can really touch individuals as well as groups, and that is very important to me. I'm a big believer that if I'm going to take time away from my family to do a job like this, I want to feel as if I'm touching someone, or helping someone or changing someone's situation."

Adams had a banner legislative session. She got a smoking-related bill passed, as well as two pieces of legislation that had been introduced for years, one after it had been vetoed by Gov. Matt Bevin.

"I really felt like I brought a lot of really significant issues to the table and I feel very proud that I was able to get a lot of them passed," she said.

Smoking, mental health and DUIs

Passing any kind of smoke-free legislation in Kentucky has proven to be a monumental task, especially since Bevin has said smoking bans should be local issues.  

Despite polling that says 71 percent of Kentucky adults support a statewide smoking ban and 85 percent support tobacco-free schools, for the first time in six years a smoking ban wasn't even introduced, and a Senate bill to make all Kentucky schools tobacco-free died in the House. 

But Adams, who is often a co-sponsor of anti-tobacco legislation, filed a bill this session aimed at decreasing the state's high smoking rates by requiring all Kentucky health plans, including Medicaid, to provide barrier-free access to all federally approved smoking-cessation treatments. It passed.

"The smoking-cessation bill was tricky only in the sense that most people believed that I was bringing another smoke-free ban because the word smoking was in there," Adams said. The bill leaves the responsibility with smokers, while assuring that they have the tools they need to help them quit, she said. 

Another victory for Adams was the General Assembly's override of Bevin's veto of "Tim's Law," legislation she sponsored that lets judges order mentally ill adults who meet strict criteria into an "assisted outpatient treatment" program, and confine them if they don't comply. This was the fifth year the measure had been introduced.

The legislation is called "Tim's Law" for Tim Morton, a Lexington schizophrenic whose mother had him hospitalized involuntarily 37 times to get him the treatment he needed. He died in 2014. 

Another long-introduced measure that finally passed was House Bill 222, which eliminates "shock probation" for those who kill someone while driving drunk. Adams, who carried the bill in the Senate for Rep. Robert Benvenuti, R-Lexington, said she became involved with the bill soon after she was elected to the House, after learning about a girl who was killed in Seneca Park by a drunken driver who only served two months before being granted shock probation. 

A moderate, and now less of a horse trader

Adams, always the optimist, said most legislators are there to do the "right thing."

"Even though politicians get a really bad rap, particularly nowadays in this toxic environment, I think that most of the people here, along with me, are really here because we are trying to do the right thing. And so I hope that Frankfort does not turn into Washington, D.C., because we are making progress and I think we are helping people."

Asked if  her comments would be different if Democrats were in control, Adams said she has always believed, and still hopes, that lawmakers are all there to serve Kentucky and should be able to work together. She recalled serving two terms under Democratic control in the House before becoming a senator.

"When I was in the House under Speaker Stumbo, I still got some things done and I think the reason is because I was not a bomb thrower," she said. "I was respectful. I worked with them under their structure that they had established. . . . You have to pick and choose your battles."

Adams said it's been easier to get things done in the Senate health committee since Republicans took control of the House because she can prioritize and collaborate on issues with Rep. Addia Wuchner, R-Florence, chair of the House's health committee.

Adams called the change a "breath of fresh air," saying they no longer had to be so secretive or always be dealing in a "horse trade" to get things done. "And so, it's a very positive energy now that I feel in our synergies, in our chairmanships," she said.

Senate Democrats, long in the minority, like Adams. "She treats everybody fairly and I have not found her to use the weight as her chairman to cut people off," said Sen. Julian Carroll of Frankfort, a former governor who is on the health committee. "She does her best to make certain that everybody has an opportunity to be heard. I am extremely complementary of her,"

Sen. Danny Carroll, R-Paducah, also on the committee, added persistence to that list of strengths. He said her persistence with the shock-probation bill and her willingness to have open discussion with him about it over the years helped him to finally vote in favor of it.

"She has a very good ability to convince and to make adjustments where they need to be adjusted and to compromise where that needs to be done," Carroll said.

Julian Carroll vounteered, "I consider her, by the way, to be one of the more independent members of her caucus in that she seems to be her own boss without question. She doesn't always agree with leadership and sometimes she votes against leadership."

Adams was the only Republican senator to join all Senate Democrats in voting against HB 281, which would have stripped the power from the attorney general (now a Democrat) to file civil lawsuits or handle appeals on behalf of the state, and instead award those powers to the governor (now a Republican).

"I think there is a time sometimes to toe the party line," she said, "and there are times where my constituency expects me to be an independent voice, and so I try to meet all of those expectations." She said she absolutely is a Republican, and is pro-life.

Adams is less conservative on some issues than most Republican senators, and was the only GOP co-sponsor of a bill to add sexual orientation and gender identity as protected classes under the state civil-rights law.

The civics teacher

"I love first of all being a voice for those who are voiceless because if you look at so many of the issues we deal with, they are not that interesting to a lot of people and they are difficult and they are sad and they are hard, and I almost think it takes a mom to be that person who steps up for some of those other moms," Adams said.

"And one of the biggest eye-openers for me is the lack of knowledge of how the political process works. . . . I love to take people and I say, 'Here's how it works, and let me hold your hand and let me take you through this process and then maybe we'll see if we can get something done.' I never make any promises, but I always tell them, 'I'll listen and I'll help you and I will be your advocate and we'll navigate this together."

Adams said she has surprised some constituents with how far she will go, having good ideas put into bill form for review. "I'll e-mail it back to them and they will say, ' Oh my gosh, you mean my idea is actually in bill form?' . . . I think the best ideas come from the people that you represent."

And they can come from anywhere. "My husband sometimes won't let me go to the grocery store because he says Kroger is my campaign headquarters," Adams said. "Every line, they are like 'Hey, I've been meaning to call you about this.'"

Looking ahead

Looking ahead to the 2018 legislative session, Adams said topics on the horizon include medical marijuana, creating real access to cannabidiol oil in Kentucky, finding more ways to address addiction and recovery, and gun violence.

She said some are surprised when she talks about gun violence as a public-health issue, a view not commonly held by many Republicans.

"I truly think that the violence that we are experiencing in our state, and particularly  in Louisville, rises to the level of a public-health issue," she said. asked if she was talking about gun-control measures, she said, "I think we need to have that conversation."

Eastern Kentucky has some of the nation's highest cancer mortality rates, study finds

Eastern Kentucky has some of the highest cancer rates in the U.S., says a study by researchers at the Institute for Health Metrics and Evaluation at the University of Washington published in the Journal of the American Medical Association. While cancer mortality rates declined 20.1 percent from 1980-2014, death rates in poor counties with high rates of obesity and smoking, such as Eastern Kentucky, rose by about 50 percent. (UW map: Mortality rate for cancer and other neoplasms for both sexes, by county, in 2014)

Researchers used data from the National Center for Health Statistics, the Census Bureau and the Human Mortality Database from 1980 to 2014 for 29 cancers. During that time, there were 19.5 million cancer deaths in the U.S.  From 1980 to 2014, the cancer mortality rate declined from 240.2 to 192 per 100,000.

"In counties with the highest 2014 cancer death rates, six of the top 10 were in Eastern Kentucky," Lindsey Tanner reports for The Associated Press. "Six of the 10 lowest rates were in the Colorado Rockies. For lung cancer deaths, four of the five counties with the highest 2014 rates were in Eastern Kentucky, with rates up to 80 percent higher than in 1980." (Map: Percent change in mortality rates for cancer and other neoplasms, 1980-2014)

"Three of the five counties with the lowest 2014 rates were in the Colorado Rockies, where rates dropped by up to 60 percent," Tanner writes. "Death rates for breast and colorectal cancers increased in Madison County, Mississippi, and in 2014 were at least five times higher there than in Summit County, Colorado, where the rates fell."

Researchers found that "for many cancers, there were distinct clusters of counties with especially high mortality. Clusters of breast cancer were present in the Southern belt and along the Mississippi River, while liver cancer was high along the Texas-Mexico border, and clusters of kidney cancer were observed in North and South Dakota and counties in West Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska and Illinois."

Rural veterans less likely than urban counterparts to receive mental health care, says study

Rural veterans are less likely than their urban counterparts to receive treatment for mental health conditions, says a study by the federal Center for Behavioral Health Statistics and Quality and the Substance Abuse and Mental Health Services Administration, published in The Journal of Rural Health. About 5.3 million veterans—24 percent of all veterans—live in rural areas, according to Office of Rural Health of the Veterans Health Administration.

The survey, which used data from SAMSHA's 2012-2014 National Survey on Drug Use and Health, found that veterans in rural areas were 36 percent less likely than urban veterans to receive any mental health treatment, 33 percent less likely to receive outpatient treatment and 44 percent less likely to be prescribed medications. (Table: Percent of respondents answering yes to each question)

Researchers analyzed the past 12 months for five factors: If patients stayed overnight in a hospital; received outpatient mental health treatment; received psychotropic medication; received any mental health treatment; and whether in the past 12 months they perceived an unmet need for mental health treatment/counseling that was not received. For the last variable respondents were asked, “During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn’t get it?”

Overall, 29 percent of rural respondents said they received any mental health treatment in the past 12 months, compared to 45 percent of urban ones. At the same time, 25 percent of rural respondents said they were prescribed medication, compared to 45 percent of urban veterans and 20 percent of rural veterans received outpatient treatment, compared to 33 percent of rural veterans.

Annual health forum looked at connections between health and the economy

The relationship between health and the economy in creating healthy communities was the focus of the 14th annual Howard L. Bost Memorial Health Policy Forum in Lexington Sept. 19. The theme of the Foundation for a Healthy Kentucky conference was "Health as an Economic Driver."

Through a series of TED-style talks, breakout sessions and a keynote address, the forum explored the relationship between health and the economy, offering insights on how anchor institutions can contribute to local economies; the high cost of health care and the lack of price transparency for consumers; and how racial inequities affect the cost of health care.

Health systems as employer and purchaser

Health systems can work as economic drivers in communities through buying local, hiring local and helping employees to live local.

Robert Eckardt

That's what three anchor institutions in Cleveland, Ohio, have done with the help of The Cleveland Foundation, Robert Eckardt, executive vice president of the foundation, said during his TED-style talk. The institutions are Case Western Reserve University and its School of Medicine, University Hospitals of Cleveland and the Cleveland Clinic.

The neighborhoods around the highly profitable anchor institutions are among the poorest in the state, Eckardt noted. His foundation asked the institutions to become stronger partners with the communites through a three part strategy: "Buy local, hire local and live local." The institutions have changed their hiring protocols to hire locally, adding a six-month training program to make it possible, and have agreed to work with three worker owned co-operatives.

Eckardt said foundations can be a "safe space" to help institutions think about their role in the community, noting that many of them have never even considered this an option or a responsibility. "I encourage you to think about how anchor institutions can change their perspective from an internal one to an external one," he said. 

Health care costs

High-deductible, consumer-driven health plans are designed to encourage patients to become more active consumers of their health care by seeking out best price and value, but often this information isn't readily available, said AJcScheitler, manager of stakeholder relations at the UCLA Center for Health Policy Research.

AJ Scheitler

Scheitler said an analysis of health-care costs in Los Angeles found the cost of a circumcision varied between $175 at a reputable clinic that does 20 to 30 circumcisions a day and $3,000 at a local hospital.

She said the cost of care in the U.S. is much higher than in other countries, citing an article by David Lazarus of the Los Angeles Times that told the story of a woman's experience getting a four-shot treatment for rabies in four different facilities that costs less than $20 overseas, and ran more than $5,000 in the U.S.

She mentioned a Reuters analysis of drug prices that found Americans pay seven and a half times more for their insulin than people in Great Britain, and a study published in the Journal of the American Medical Association that found the average cost of insulin in the U.S. more than tripled between 2002 and 2013, jumping to $736.09 from $231.48.

"We have no idea what we are paying for," she said, and though there is beginning to be some price transparency, it is not enough to be effective yet. 

Social justice, health and the economy

Adewale Troutman

Dr. Adewale Troutman, who identifies himself as a social justice and human rights activist, pointed out during his TED-style talk that poor communities with no employment or educational opportunities have poor health outcomes.

"It has been proven quite clearly that the most important number in your (health) profile is not your blood pressure, not your blood sugar or any of that," he said. "The most important number is your zip code. Where you live is the most important factor in your health outcomes."

Among other things, Troutman is the former president of the American Public Health Association with ties to Kentucky as a former associate professor in the University of Louisville School of Public Health and Information Sciences and former director of the Metro Louisville Department of Public Health and Wellness.

Troutman also noted how health inequities increase the cost of care, citing a study by Thomas A. LaVeist of John Hopkins University that examined the direct and indirect costs of providing health care to a sicker and more disadvantaged population.

The report says, "More than 30 percent of direct medical costs faced by African Americans, Hispanics and Asian Americans were excess costs due to health inequities, more than $230 billion over a four year period. And when you add the indirect costs of these inequities,the tab comes to almost $1.3 trillion."

"When you look at the issue of economics and health, it is quite clear that the relationship is very, very strong," he said.

Gail Christopher

Dr. Gail Christopher, a national expert in holistic health and diversity, also emphasized the importance of improving racial inequities as a way to improve health outcomes and to create savings in health care.

"The lions share of the cost savings that this country would experience if we were to achieve racial equity . . . are health care cost," she said in her keynote speech.

Christopher, vice president for program strategy at the W.K. Kellogg Foundation, said that the unifying factor that connects racial inequity to poor health outcomes is exposure to adversity and to stress.

"People who have access to education, people who have access to income, people who are not subjected to discrimination and adversity have better health outcomes," she said. "And when they have better health outcomes, they have fewer interactions with the health care system and therefore they spend less."

The forum is held in memory of Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental-health services in Kentucky and created the vision for the foundation.
Co-sponsoring partners with the Foundation for a Healthy Kentucky were Kentucky Educational Television, Health Enterprises Network, Kentuckiana Health Collaborative, Kentucky Center for Economic Policy, Kentucky Chamber of Commerce, Kentucky Hospital Association and the Federal Reserve Bank of Cleveland.