Annual policy forum will focus on role of education in health

Individual and public health are influenced by many things, including the educational characteristics of people and their communities. Education will be the focus of the Foundation for a Healthy Kentucky’s 2022 Howard L. Bost Memorial Health Policy Forum, to be held virtually from 9:30 a.m. to 4:30 p.m. Oct. 17.

The forum will look at the connection between educational opportunities and health outcomes of Kentuckians, as one of the social determinants of health. Presenters and panelists will consider education as a cornerstone of Kentucky’s health outcomes. It is offred free of charge. Register here.

“Education is more than what happens between the four walls of a school building,” said Ben Chandler, president and CEO of the foundation. “Educational factors that influence health outcomes include everything from life skills — mental health, emotional literacy, financial literacy, and nutritional literacy — to local community programs, such as out-of-school care and workforce training, to equity issues. It’s important we consider all the factors of health to find ways to make a positive impact.”

Looking beyond the K-12 education system, panelists and presenters will discuss programs that can enhance education and provide more equitable access, while leading to better health outcomes for individuals and communities. Attendees will learn about replicable community-oriented collaborations and coordination between sectors that have led to improved health overall.

The 2022 Kentucky Teacher of the Year, Willie Carver, will give the keynote address. Sessions will include:

• Making the Case for Funding, in Education and Beyond: Considering education as a social determinant of health, panelists will discuss school funding, social safety net programs’ impact on education, and real examples from urban and rural schools.
• Literacy for Life (Critical Lessons for Positive Health): They’re lessons most don’t receive in school but can mean the difference between addressing and overcoming life’s challenges or becoming overwhelmed. Panelists will discuss mental health and emotional literacy, financial literacy and navigating systems, and how nutrition education impacts hunger long-term.
• Linked but Addressable; Helping Families Overcome Obstacles: A look at how family income plays a critical role in the academic outcomes of students, and therefore, the lifelong health of individuals.
• Breaking Down Barriers; Real Examples of Kentucky Communities Making Positive Change: Learn how local communities are lifting up families. Panelists will share about connecting families with early childhood intervention services; public schools and public health collaborating on mental health services; and, how a community is working to chart paths for non-traditional career building.

The forum is designed to raise awareness of the health issues impacting Kentuckians and highlights model strategies and policy opportunities to improve Kentucky’s health. The foundation created it to honor Dr. Howard L. Bost, a notable health economist and a founding member of the foundation’s board of directors. It welcomes a range of audiences, inside and outside the health industry – including health care advocates, providers and educators, business professionals, civic leaders, policy makers and more.

Updates on the forum are at Healthy-KY.org/bost-forum-2022.

 

Research suggests local journalists quote local experts, not Fauci et al., when discussing pandemic health guidelines

Journalists want to keeping readers informed about the coronavirus pandemic, but widespread skepticism of government-endorsed public-health measures makes it difficult, as some rural editor-publishers can attest.

Soon-to-be-published research suggests a solid approach to making public-health information seem more trustworthy to readers: Quote local sources such as doctors or health department administrators instead of "elite" sources such as Dr. Anthony Fauci, Austin Fitzgerald reports for the University of Missouri's Donald W. Reynolds Journalism Institute. So advise Associate Professors Monique Luisi and Ben Warner, who analyzed the results of a nationwide survey of more than 3,000 adults about their attitudes concerning coronavirus vaccines, politics, and trust in public-health recommendations.

The findings "were striking," Fitzgerald reports: "While demographic factors — such as age and race — and partisanship explained some variance in views about vaccination and public health recommendations, anti-elitism accounted for more than a third of this variance. Though partisanship has been seen as an important factor in the divide between the vaccinated and unvaccinated, this finding indicates the story is more nuanced, especially given that the media — one of the primary purveyors of public health information — is itself considered 'elite' by many who hold anti-elitist values."

So, local newsrooms are likely best served by quoting local sources and citing local impact. "When people hear about the burden the virus is creating in their community or learn about what their local health department is doing, they are more receptive," Luisi told Fitzgerald. "And a more receptive audience could mean more lives saved."

Health Literacy Month reflects why Kentucky Health News exists; attention must be paid to health issues, including drug abuse

By Al Cross
Editor and Publisher, Kentucky Health News

Kentucky Heath News is in the business of health literacy: helping Kentuckians understand how to maintain and improve their health, and understanding the health-care system. But somehow we failed to notice that October is Health Literacy Month. Maybe we've been too busy with our work. But that prompts me to write a bit about KHN, why it exists, and what we hope you get from it.

The idea was conceived at a Kentucky Chamber of Commerce meeting about nine years ago. I sat down at a table with Robert Slaton, a health-care consultant and former state health commissioner, and Susan Zepeda, then the president and CEO of the Foundation for a Healthy Kentucky. Robert said, "Al, you ought to ask Susan for some money."

The obvious follow-up question was "What for?" and I had the answer. For five years, I had been publishing The Rural Blog, a daily digest of events, trends, issues and journalism from and about rural America, as director of the Institute for Rural Journalism and Community Issues at the University of Kentucky. The institute's mission is to help rural journalists define the public agenda in their communities, through strong reporting and commentary, especially on broad issues that have local impact but few if any good, local sources.

From the time Al Smith and others conceived it, one of the institute's main issues has been health, because it is a chronic problem in rural areas, and especially in Kentucky, where people's overall health status is one of the worst in the nation. So, when Robert made his suggestion, I already had the answer to the "For what?" question: a service that would help Kentucky news media help their audiences live healthier lives and understand the health-care system.

The foundation got us started, and has been increasingly supportive of our work, allowing us to have a reporter, former nurse Melissa Patrick, who works 25 hours a week doing original stories and excerpting others. Many in news outlets have also supported our work by publishing it, but we wish more did so. Our stories appear with some regularity in many newspapers, but not in most, despite our weekly emails to every paper in the state (and to the Kentucky Association of Broadcasters).

This is understandable to those of us who have worked at small-town radio stations or have been editors of rural newspapers, which exist to provide local news and information. Most Kentucky Health News stories aren't local, but they do touch on issues that matter to local audiences. Some newspapers pick up on such stories and use them as the basis for their own stories or editorials.

Many times, though, certain information about local health doesn't reflect well on the community that the newspaper serves, so it's not reported. In community journalism, there is often a reluctance to make an effort to report such news; there may be plenty of bad news already, and the role of community cheerleader is a long-established one in rural journalism.

That used to show up in Kentucky papers' treatment of the annual County Health Rankings, which rank every county in every state on its health outcomes and the factors that affect those outcomes. For the first few years that the rankings were issued, the better your county's ranking, the more likely you were to read about in your local Kentucky newspaper. And the worse your county's ranking, the less likely you were to read about it. The papers were declining to print bad news.

But that has changed. A couple of years ago, we found that there was no longer any correlation between a county's ranking and its publication in the local newspaper. A poor ranking was just as likely to be published as a good one. This is just one example, and the trend varies from year to year, but we'd like to think that our work has made many rural journalists in Kentucky realize that health is an important local issue that needs attention.

Now we hope they realize something else needs attention: the epidemic of substance abuse that is plaguing Kentucky, and the means of fighting it, as individuals and communities. This is primarily a health issue, but in rural news media is usually presented as a criminal-justice issue. The lack of coverage of it as a health issue is an obstacle to solving the problem, according to research by Oak Ridge Associated Universities.

To reduce that obstacle, ORAU and the institute will hold Covering Substance Abuse and Recovery: A Workshop for Journalists, in Ashland, Ky., on Nov. 15. Journalists from weekly and daily papers will join health experts and public officials to explore the subject, and we hope for a good turnout that will make some headway in rural communities. Space is limited; the registration fee until Nov. 1 is $50; it will be $60 through Nov 8, when registration will close. Get details and register here.

This probably isn't your cup of tea; it's a difficult subject, but attention must be paid. That's one of the best-known lines from the play Death of a Salesman: "He's not the finest character that ever lived. But he's a human being, and a terrible thing is happening to him. So attention must be paid. He's not to be allowed to fall into his grave like an old dog. Attention, attention must finally be paid to such a person." Let's pay attention to these people and their problem, and help solve it.

Register by Nov. 6 for Covering Health: a News Workshop, free of charge to all journalists, in Madisonville Friday, Nov. 10

On Friday, Nov. 10 in Madisonville, the Institute for Rural Journalism and Community Issues and the Foundation for a Healthy Kentucky will present the latest in their series of workshops to help local journalists cover health care and health in Kentucky.

The presenters will include Al Cross, director of the institute and editor-publisher of Kentucky Health News; KHN reporter Melissa Patrick, a former nurse; Dr. Ellen Hahn of the University of Kentucky College of Nursing, who directs the Bridging Research Efforts and Advocacy Toward Health Environments (BREATHE) program; and Wayne Meriwether, CEO of Twin Lakes Regional Medical Center in Leitchfield, a leader of the Population Health Committee in Grayson County.

"Covering Health: A News Workshop" will run from 9:30 a.m. to 4 p.m. at the Ballard Convention Center, near the KY 70 interchange with Interstate 69 (formerly the Pennyrile Parkway). Lunch will be served, and the event will be free of charge, thanks to support from the foundation.

"We hope many reporters and editors who cover Western Kentucky will spend a few hours with us to learn how their reporting can help their readers, listeners and viewers live healthier lives and better understand the health-policy debates going on in Frankfort and Washington," Cross said. "We also invite their suggestions for the program."

The program will include:

• Information about the major health issues facing Kentucky, with special attention to Western Kentucky and the counties represented by the attendees
• An explanation of the Medicaid program and the changes that the administration of Gov. Matt Bevin wants to make (and which may be federally approved by Nov. 10)
• An explanation of health insurance under the Patient Protection and Affordable Care Act ("Obamacare") and the issues in play in Congress and the Trump administration
• How to gather and use health data on your county to do stories that help your readers, viewers and listeners realize the depth of the health issues facing your community
• How drug abuse has become less of a law-enforcement issue and more of a health issue, and the issue of syringe exchanges to prevent outbreaks of HIV and hepatitis C
• The impact of tobacco on Kentucky's health and the issues around local and state laws to limit smoking
• How a local health coalition in Grayson County won passage of smoke-free ordinances
• How to cover local health issues, including your health department, health board and hospital

While the workshop is free, registration is required, and the deadline is Friday, Nov. 3has been extended to Monday, Nov. 6. To download a registration form, click here. For a report on last year's workshop, in Eastern Kentucky, click here.

October is health literacy month, and the revived Health Literacy Kentucky wants you to know it's a topic that affects everyone

By Melissa Patrick
Ketnucky Health News

Most states do not have have an organization dedicated to health literacy, but Kentucky does, and it's spending 2017 re-branding itself and letting Kentuckians know what it offers.

Health Literacy Kentucky is a statewide coalition of volunteers who work toward improving the state's health outcomes through improved health literacy.

"Health literacy affects everyone and is critical in helping us make choices for the best health that we can -- for ourselves and for our family and friends," Charles Jackson, The Humana Foundation's consultant for the initiative, said in an interview with Kentucky Health News.

Jackson, who is also the head of the HLK steering committee, noted that the American Medical Association says "Health literacy is a stronger predictor of health than age, income and employment status, education or race."

HLK's website says the impact of low health literacy is well-documented. It says people with poor health literacy have overall poorer health, higher rates of emergency-department use, lower use of preventive services and increased difficulty managing their chronic conditions. It adds that poor health literacy cost the nation up to $238 billion every year.

HLK was founded in 2009 and has focused most of its past efforts and resources hosting an annual health literacy conference that largely targeted health care providers. But this year, Jackson said it's working to re-brand itself and increasing public awareness -- and it also has a new partner.

In June, HLK signed a memorandum of understanding with the Center for Health Service Research at the University of Kentucky, which will now house the organization and offer it administrative and operational support. Center Director Mark Williams, who has done research on health literacy since 1990, said they expect this partnership to be a "powerful" one.

"Health literacy encompasses far more than just literacy. It represents an individual’s ability to obtain and use health information to make decisions," Williams said. "Through this partnership with Health Literacy Kentucky, the UK Center for Health Services Research can support efforts to work with patients, their family caregivers and community providers to address health literacy education and research."

Jackson noted that one of their first efforts as partners will be to conduct a heath-literacy needs assessment of health professionals to help inform future HLK strategies.

Another new initiative for the organization is its first Kentucky Health Literacy Award, of which it will soon call for nominations. The award will be presented at the Dec. 5 Kentuckiana Health Collaborative forum in Louisville, which will focus on health literacy. The results of the needs assessment survey will also be announced at this forum.

Elizabeth Edghill, who is also on HLK's steering committee, says the need for health literacy is "profound" for everyone.

"We need to recognize that it's not about education, it's not about income or language barriers," she said. "Those are all huge contributors and of course they can make one at higher risk for low health literacy, but I really think we have to use what we call a universal precaution approach. We need to assume that anyone can be having a low health literacy moment at any encounter and treat them respectfully and with good communication."

Edghill is a registered nurse who is the manager of refugee and immigrant services for Family Health Centers in Louisville. Along with a co-worker, she has initiated several health-literacy programs, including one for all of the center's patients; one that involves a patient advisory group that helps create better health related materials, and another that focuses on health-insurance literacy.

Asked how individuals could immediately improve their health literacy, Edghill said: "One of the most important ways to improve your health literacy is to find a way to record the information."

Edghill told a story illustrating how three people can hear the same health information from a health-care provider and leave with three different interpretations. She offered several suggestions on how to record information, including asking the provider if you can record the conversation; taking notes during the visit; taking someone with you to listen and take notes; or to make sure you understand the after-visit summary that is often provided before you leave the office.

Edghill has been named the 2017 Medi Star Dickinson Wright Nurse of the Year, an award  she will receive Oct. 24 in Louisville.

Jackson said health departments and libraries are great resources to improve health literacy. "Those are the kind of resources we want people to feel comfortable using," he said.

He also noted some free online resources, which he said are important for areas with poor access to health care. They include "Learning About Diabetes;" "The Depression and Bipolar Support Alliance;" and another for children who are overweight or obese called "Weigh2Rock."

Also, the HLK website offers resources for individuals and communities, a "tools for teaching" page, a free online course with continuing-education credits, and training for health-care providers.

Williams noted that the UK Center for Health Services Research was awarded a $4.5 million grant in July to identify and address the social determinants of health in 27 Appalachian counties and parts of Louisville Metro. He said that after determining the most vulnerable patients in these areas, the researchers will then  identify their unmet social needs that contribute to poor health, like unstable housing or a lack of transportation, and then connect them with  community resources to meet these unmet needs.

"This is related to health literacy," he said, "because these patients on their own don't have the health literacy skills to be able to find these resources which could help them personally, and that results in improved, overall health."

Foundation for a Healthy Kentucky lists its 2015 grants

The Foundation for a Healthy Kentucky invested more than $1.6 million in 2015 with community-based organizations, health-care providers, universities and health advocacy groups across the state, with a focus on polling and policy initiatives, according to a news release.

"Foundation funding supports innovative approaches to reducing health risks and promoting health equity and health care access for Kentuckians throughout the Commonwealth," Susan Zepeda, CEO of the foundation, said in a news release.

"Promoting Responsive Health Policy," one of the foundation's 2012-17 initiatives, includes a multi-year study of the Patient Protection and Affordable Care Act's impact in the state, including its impact on Kentucky's children; a three-year study of the state's transition to Medicaid managed care; the Kentucky Health Issues Poll; and support for Kentucky Voices for Health, Kentucky Equal Justice Center, Kentucky Youth Advocates, the Center for Smoke-Free Policy at the University of Kentucky, and the Kentucky Population Health Institute.

Another initiative, "Investing in Kentucky's Future," supports seven communities in developing and implementing strategies to reduce chronic disease risks in children to help them grow up to be healthier than their parents.

Six of the seven communities in this initiative received money in 2015 to implement their strategies, including: Kentucky River Community Care - Breathitt County ($115,800), Clinton County School District ($158,361), Fitness for Life Around Grant County ($182,033), Louisville Metro Department of Public Health & Wellness ($161,850), United Way of Paducah-McCracken County ($150,000) and Partnership for a Healthy McLean County ($87,065).

The foundation's grants to improve health literacy and communication includes support for Kentucky Educational Television; the Institute for Rural Journalism and Community Issues at the University of Kentucky, mainly for Kentucky Health News; the Next Louisville: Community Health project at WFPL-FM public radio; and the foundation's local health data website: www.kentuckyhealthfacts.org.

Several groups, including the Kentucky Public Health Association, Community Catalyst, The Healing Place, and Health Watch USA received conference support grants to help host health policy and equity conferences, seminars, and symposiums.

The foundation was created in 2001 from the charitable assets of Anthem Inc., recovered in a lawsuit by then-Attorney General Ben Chandler after the company converted from a mutual insurance firm to a stock company. Under a settlement, the $45 million was invested and only the earnings from it may be spent.

Louisville hospitals get grant to help people get health coverage; Jan. 31 is last day to get insurance or face a federal tax penalty

Jewish Hospital & St. Mary's Foundation, part of KentuckyOne Health, has received a $108,000 grant to help uninsured people understand their health insurance options and get coverage for 2016, with a focus on reaching those with cultural or language barriers.

“Research shows that individuals with health coverage are three times more likely to receive preventive care and screenings,” Alice Bridges, vice president of healthy communities for KentuckyOne, said in a news release. “Helping individuals enroll in health coverage plans is a critical tool in our efforts to create a healthier Kentucky.”

The Robert Wood Johnson Foundation grant will allow the hospital to train additional "Kynectors," advisers who help people unfamiliar with health insurance buy it through the Kynect insurance exchange, and expand its outreach through mobile enrollment sites. KentuckyOne has also partnered with Family Health Centers of Louisville and the Kentuckiana Regional Planning & Development Agency to increase its outreach.

The grant is meant to "enroll hard-to-reach populations to include the homeless, justice-involved individuals, and immigrants/refugees; improve take-up rates for individuals eligible for qualified health plans; support Medicaid enrollees in maintaining coverage which is often lost due to low comprehension of how to use and keep benefits; and addressing gaps in accessing data maintained at the State level to ensure accurate measurement of outcomes," says the release.

Kentuckians have until Jan. 31 to sign up for subsidized insurance through Kynect, the state's online insurance marketplace, or face a penalty of $695 per adult and $347 for each child (up to $2,085 per family), or 2.5 percent of annual household income, whichever is higher. Enrollment in the Medicaid program, for people with incomes up to 138 percent of the federal poverty level, is year-round.

National study and Paducah Sun story illustrate value of local Kynectors, who would be far away if exchange is abolished

Gwyn Artz, left, of Lexington talked with Miriam Fordham about
signing up for health insurance through Kynect during the opening
of a storefront in Lexington's Fayette Mall. (Herald-Leader photo)

Read more here: http://www.kentucky.com/opinion/op-ed/article44546313.html#storylink=cpy

Critics of Republican Gov. Matt Bevin's plan to dismantle Kynect, the state's health insurance exchange, often cite the loss of most locally responsive "Kynectors" as a reason for him to reconsider. Now a study published in Health Affairs supports this argument, finding that programs with such local, in-person "assisters," as the study calls them, are the most successful at signing people up for coverage.

Kynectors are exchange employees in every county who help those unfamiliar with health insurance navigate the system. In 2014, they held more than 3,000 events for enrollment and education, and are credited with helping more than 500,000 Kentuckians sign up for health insurance.

Bevin said during his campaign and re-iterated at his inaugural speech Dec. 8 that he would dismantle Kynect and shift to the federal exchange, calling the state exchange "redundant."

If Kentucky does that, customers will still have access to assisters, but they will be located in a customer service center "hundreds of miles away," outgoing Gov. Steve Beshear said in a plea for Bevin to keep Kynect. Funding for exchange assisters would decrease by 75 percent.

The Health Affairs study found that consumers who received in-person assistance were more than twice as likely to successfully enroll compared to those who tried to enroll online without any assistance, and those who received local assistance were the most successful.

“Assister programs play a vital role in supporting consumers particularly when assisters maintain ongoing relationships with consumers,” lead researcher Rachel Grob told the Center for Patient Partnerships at the University of Wisconsin-Madison.

“Our synthesis of the evidence from the first two years of open enrollment also highlights that assister programs are successful when assisters come from, and are situated from within, communities that they serve; when local programs are well coordinated; and when post enrollment issues can be addressed," she said.

In brief, according to Grob, “evidence from the field suggests that enrolling cannot be separated from educating and engaging—and that assisters are positioned to do this work.”

Lindsay Nelson, state coordinator for outreach and enrollment with Kentucky Primary Care Association, told the Lexington Herald-Leader that this has also held true in Kentucky.

She told the Herald-Leader the system wouldn't have worked if it had hired people from outside Eastern Kentucky to work in the region that is the greatest beneficiary of the expanded Medicaid program.

"People in the counties with the higher rates of signups say personal connections have helped spur friends and neighbors to sign up," the Herald-Leader reported.

The Health Affairs study also found that in addition to clients needing an average of two to four hours of help, and more than half of them coming back for a second session, assisters were heavily involved in the post-enrollment work because many consumers did not understand their coverage provisions.

Bill Wagner, executive director of the Family Health Centers of Louisville, shared a similar story at the Friedell Committee for Health's annual meeting in October.

He said Kynectors often "end up becoming case managers" for their patients even after they have chosen their insurance, helping them find providers who accept Medicaid, helping them with their health literacy and helping them understand how to maintain eligibility.

"Having the boots on the ground from the Kynectors, having the close working relationship with the Kentucky Health Benefit Exchange [Kynect's official name], I think has really helped us provide more ongoing care and coordinated case management around insurance, so I worry about that if that were to change," Wagner said.

Genevieve Postlethwait of The Paducah Sun wrote recently about the role of Kynectors, including keeping their clients informed about regulatory changes, particularly the one that only allows 30 days to change their address when they move or they will loose Medicaid eligibility; the importance of not missing appointments; and understanding the penalties involved if they don't have insurance.

"It's not necessarily the case anymore that there aren't enough primary care providers,but the problem is that people who are newly insured don't have the knowledge of how to access providers, how to set up appointments. Or if they hit bumps along the road, they don't know how to manage an insurance company," Monique Zuber, executive director of the United Way of Paducah-McCracken County, told the Sun "It's hard enough for those of us who have been insured for a long time."

Jackie Eubanks, Kynector program manager with Mayfield-based West Kentucky Allied Services, concurred. "With the expanded Medicaid, there's this huge group of people who are covered now, but they don't know what to do," she told the Sun. Later adding that people need time to change "their paradigm and get into a new way of thinking. It doesn't happen overnight."  (The Paducah Sun is behind a paywall.)

6th annual Kentucky Health Literacy Summit in Louisville Oct. 7

The 6th Annual Kentucky Health Literacy Summit, "Health Literacy in the Age of the Affordable Care Act," will be held Wednesday, Oct. 7 at the Founder's Union Building on the University of Louisville, Shelby Campus in eastern Jefferson County.

The Summit is hosted by Health Literacy Kentucky and will showcase national health literacy and plain language experts.

Speakers will include: Wilma Alvarado-Little, principal and founder of Alvarado-Little Consulting LLC, which advocates for linguistically and culturally appropriate health services; Craig Blakely, dean of the UofL School of Public Health and Information Sciences; Elizabeth Edghill, refugee health educator and coordinator for Family Health Centers Inc.; Carlos Marin, assistant dean, Community and Cultural Engagement at the University of Kentucky's College of Medicine; Glen Mays, director of the National Coordinating Center for Public Health Services and System Research at UK; Kristen Munro-Leighton, health educator at Family Health Centers; and former journalist Kim Parson, a strategic consultant at Humana Inc.

The summit is targeted toward physicians, physician assistants, pharmacists, psychologists, social workers, health education specialists, dentists, dental hygienists, and extension agents. Continuing education credits are available. Registration fees are $95 or $25 for students. For more information and to register click here: http://www.cecentral.com/live/9828.

New health chair of Appalachian Ky. economic group says he's a conductor, not a director; deflects query on mining's health effects

By Melissa Patrick
Kentucky Health News

Dr. William Hacker, a former state health commissioner, is the new chair of the Community Health Advisory Council for Shaping Our Appalachian Region, a non-profit organization created last year by Democratic Gov. Steve Beshear and Republican U.S. Rep. Harold "Hal" Rogers of the 5th District to improve Appalachian Kentucky's economy.

Dr. William Hacker

So, what does that mean for Hacker? And for a region with some of the worst health in the nation, so bad that it is a drag on the economy?

Hacker said in an interview with Kentucky Health News that he was still learning about his responsibilities, but felt that one of the most important skills he brings to this role is his ability to network.

"What I'm assuming my primary role will be is not so much (to be) the director as it is being the orchestra conductor," he said.

He added later, "If I can use my platform to bring people together so that they can share resources, share energy, share knowledge, share success stories. ... Even if we don't have any new dollars to spend, we may be able to have better outcomes if we know what works and make that translational across communities. ... As the old African saying goes: If you want to go fast, go alone. If you want to go far, go together."

Hacker, a native of Clay County, practiced as a pediatrician in Corbin for 18 years, spent six years with Appalachian Regional Healthcare and was the medical director for a health insurance plan.

"I have a lifelong interest in Kentucky in general, and Eastern Kentucky in particular," he said. "My roots are in Eastern Kentucky."

He began his career in public health in 2001 when he joined the state health department's Maternal and Child Health division. After 9/11/01, he established the state's first public-health disaster preparedness program. In 2004, Republican Gov. Ernie Fletcher named him commissioner, a position he kept under Beshear until he retired in 2011. Hacker holds a clinical professorship at the University of Kentucky Department of Pediatrics and is an associate professor at UK's College of Public Health.

As an active volunteer, he said that many of his current activities "deal with core issues that help address prosperity in terms of education, of economic development and of health."

With SOAR, Hacker succeeds Dr. Nikki Stone of Hazard, who left the position after the final report of her Health Working Group, which initially set two priorities: coordinated health program in schools and a study of the health effects of large-scale surface mining, which research has suggested could be significant.

When the recommendations of the health group and working groups addressing other issues were published last fall, the mining-study recommendation wasn’t included in the list, which was limited to shorter-term recommendations, but it was mentioned in the health group’s report. Some other working groups continued to meet over the winter, but the health group did not.

A representative from the federal Centers for Disease Control and Prevention, after spending three months at the SOAR Pikeville office evaluating the recommendations, announced at the May 11 "Strategy Summit" that SOAR's health focus should be on substance abuse, obesity and diabetes, with no mention of the top two recommendations made by the people in the region.

Asked if he agreed with the CDC recommendations, Hacker said, "Clearly those are three issues that need to be addressed," but he added, "I don't want to be a disease-focused program, I want to be a community-focused program that leverages all assets and resources available to deal with the social determinants of health, while also addressing those three issues."

The CDC defines social determinants of health as "the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness."

Hacker said, "The core issue of poor health, really, is not so much health, as education and economic opportunity. The tripod of prosperity is good education, good economic opportunity and good health. If you have these three components, then you can build within your community, you can recruit industry and you have an educated workforce that is healthy."

"So it is the chicken and egg thing: How do you get economic opportunity to prosper in a place that has poor health outcomes? Which comes first, and how do we do that?," he mused, while commending Rogers and Beshear on their efforts to maximize federal, state and local resources to address these core problems within Appalachia.

Hacker said that one such resource is the CDC's commitment to provide a person for one year to help bridge SOAR activities with federal resources, programs and activities. Lt. Cmdr. Jenna Meyer has already been assigned to this role and is working from SOAR's Pikeville headquarters. Meyer said she was unable to comment.

Hacker remains optimistic. "I have never seen the leadership being provided that is comparable to what Congressman Rogers and Gov. Beshear have brought to bear on the SOAR activity," he said. "I am very hopeful that SOAR will be perceived 20 years from now as a turning point in improving the prosperity of Eastern Kentucky."

Hacker said one of the Advisory Council's greatest challenges is the responsibility of "distilling down" an actionable program to improve the long-term prosperity of the region from a list of so many valid, scientifically based issues that need to be addressed.

Asked if determining the health effects of large-scale surface mining would be one of his priorities, Hacker didn't answer directly: "Any contamination of the environment is unhealthy and should be avoided when possible, whether we are talking about heavy metals or whether we are talking about second-hand cigarette smoke.

"Within the million people who live in the SOAR area, coal mining is a very important part of some communities, but not for others. So, I will certainly listen and receive input from all concerns of the communities."

He said later of SOAR, "We need to tackle issues that have the broadest reach and the greatest impact."

As for the recommendation for a coordinated children's health program, Hacker said he recognized its importance, but noted that improving health was more complex than simply changing behaviors, and emphasized the importance of getting families out of poverty as a means of improving children's health.

He also noted that "grass-roots engagement is critical to any long-term success," reflecting on a saying of Dr. Gil Friedell, founding chair of UK's Markey Cancer Center, " If the problem is in the community, then solution is in the community."

The Advisory Council decided at its first meeting Aug. 10 that each of the 11 SOAR issue groups should focus on how they could contribute to bringing more jobs to Kentucky's 54 Appalachian counties. It was also established that each of the issue groups would hold an annual roundtable to ensure community involvement.

Adair paper's health section is latest to appear in edition sent to all postal patrons; most stories are from Kentucky Health News

Kentucky newspapers appear to be publishing more special sections on health, supported by advertising from health-care providers. They often putting the sections into sample-copy editions that are mailed to all postal patrons in the paper's home county, or rely heavily on stories from Kentucky Health News, or both.

The latest example of that is the section published last month by the Adair County Community Voice, in which most of the stories came from KHN. "They are always timely and pertinent," Editor-Publisher Sharon Burton told us in an email. "A great resource for community papers with limited resources to cover all the news."

Burton said she always puts the health section in her "total market coverage" edition. The Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News, advises papers to do that, not only because advertising is easier to sell, but because the people who most need health information are unlikely to be subscribers. Most weekly newspaper sales in Kentucky are by single copy, not subscription.

"The community has been extremely supportive of our health sections," Burton wrote. "We provide one every time we publish a TMC product and believe it’s a well-read section. Statistics show Kentucky does not rank well when it comes to health, and our community is striving to get more active and focus our efforts on becoming healthier. This issue featured a local Refit class that has a huge following. Our local WATCH group sponsors a monthly community walk. Sadly, our city earmarked funds for parks and recreation at the end of last year but reversed that just recently. Those are all issues we cover throughout the year." And she adds that the health-related advertisers "are partners in our effort to make Adair County healthier."

The section is not on the Voice website, but is posted on the Institute site as a 35 mb PDF, downloadable by clicking here.

Almost one-third of teens have changed their health habits after looking up information on the Internet, study suggests

A decade-long study by researchers at Northwestern University about how teenagers use the Internet for health information found that almost one-third of adolescents report changing health habits after looking for information online, Lena H. Sun writes for the Washington Post.

The study also found that almost 25 percent of teens check the Internet to find information about health conditions their family and friends have. "While most teens rely on digital resources to learn more about puberty, drugs, sex and depression, among other issues, a surprising 88 percent said they did not feel comfortable sharing their health concerns with friends on Facebook or on other social networking sites," Sun writes.

"I mainly find it kind of moving because it really illustrates that a lot of teens are grappling with very real, very important health challenges and that the Internet is empowering them with the information they need to take better care of themselves," said Vicky Rideout, a co-author of the study.

Although the study found that parents are still the leading source of health information—55 percent of teens reported learning "a lot" of health information from parents—and health classes in school, doctors and nurses came in second and third, the Internet is the fourth-largest source of health information. "Eighty-four percent of teens said they turned to the Internet for health information," Sun reports.

Teens are still asking their parents health questions, and only 13 percent of those surveyed said they consult the Internet because they couldn't talk to their parents. "The Internet is not replacing parents, teachers and doctors; it is supplementing them," the researchers wrote.

Participants in the study were 1,156 American teenagers between 13 and 18 years old. "We need to make sure there is good information for teens online," Rideout said. Teenagers need to learn digital literacy skills and acquire the ability to tell the difference between advertising and content. (Read more)

Mount Sterling follows lead of another KentuckyOne Health hospital, in Bardstown, to host monthly 'Walk With a Doc'

Saint Joseph Mount Sterling is the second KentuckyOne Health hospital to host monthly "Walk With a Doc" events as part of a nationwide program that promotes walking as a great way to improve your health, while at the same time offering a place to get to know your local physicians in an informal setting as you walk together. The program also offers a complimentary health screenings at the event, says a news release from KentuckyOne Health.

Flaget Memorial Hospital in Bardstown, also part of KentuckyOne Health, began its "Walk With a Doc" program in March.

"According to America Walks, brisk walking has been shown to reduce body fat, lower blood pressure, increase high-density lipoprotein and even reduce risks of bone fracture. Not only that, it is also associated with lower mortality rates from cardiovascular disease and cancer," says the release.

The Mount Sterling walks begin at 9 a.m. on Saturday, April 25 at Easy Walker Park, located at 1395 Osborne Rd. For more information call 859-497-5556.

Bardstown hospital sponsors monthly 'Walk With a Doc'

Here's an interesting idea to promote physical activity and maybe even health literacy: take a walk with your doctor.

Flaget Memorial Hospital in Bardstown hosts monthly "Walk With a Doc" events as part of a nationwide program. Participants can also receive complementary health screenings at the event, says a news release from KentuckyOne Health, which owns Flaget.

"According to America Walks, brisk walking has been shown to reduce body fat, lower blood pressure, increase high-density lipoprotein, and even reduce risks of bone fracture," the release says. "Not only that, it is also associated with lower mortality rates from cardiovascular disease and cancer."

The walks begin at 10 a.m. on the second Saturday of each month, so the next one is March 14. The walks begin at the Court Square in the middle of Bardstown. For more information, call 502-350-5040.

Almost as many Kentuckians support health reform as oppose it, but half say they don't know how it may affect them

By Al Cross and Melissa Patrick
Kentucky Health News

The federal health-reform law is gaining support from Kentuckians, to the point that they are almost evenly divided about it.

Those are among the results of the latest Kentucky Health Issues Poll, conducted for the Foundation for a Healthy Kentucky among a random sample of almost 1,600 Kentucky adults Oct. 8 through Nov. 6, the final month of an election season in which the law was an issue.

After two years in which opinion of the law was clearly unfavorable, the poll found that 39 percent view it favorably while 41 percent view it unfavorably. That is well within the poll's error margin of plus or minus 2.5 percentage points, which applies to both numbers.

The findings are similar to a national survey taken at about the same time. The October 2014 Kaiser Health Tracking Poll found that 36 percent of U.S. adults had favorable views of the law; 43 percent were unfavorable, and 20 percent did not know or offered no opinion.

In the Kentucky poll, about as many people reported a negative impact from the law (21 percent) as a positive impact (18 percent). The positive-impact number rose form 7 percent in the 2013 poll, which was taken just after enrollment for expanded Medicaid and subsidized health insurance had opened.

Notably, 51 percent of those polled said they didn't have enough information to know how the law would affect them personally. That was down from 57 percent a year earlier.

Most of those who reported not having enough information, 64 percent, had not graduated from high school. Almost half of Kentuckians (47 percent) said they understood how the law would impact them personally. Sixty-six percent said the law had no effect on them.

“KHIP data trends show overall support for the ACA has risen since 2013 as more Kentuckians have gotten information about the law," Susan Zepeda, President and CEO of the Foundation for a Healthy Kentucky, said in a press release. "More work is needed to educate people about the law’s provisions and potential impacts on families.”

The poll was also conducted for Interact for Health, formerly the Health Foundation of Greater Cincinnati, by the Institute for Policy Research at the University of Cincinnati. It used landline and cell phones.

Opinions of the Patient Protection and Affordable Care Act, often called Obamacare, are still driven partly by politics. The survey found that 58 percent of Democrats had favorable views of the law and 64 of Republicans had unfavorable views. Among independents, 42 percent had unfavorable views and 31 percent were favorable.

Prescriptions for better health care and health: empowering patients, increasing health education and collaboration

By Melissa Patrick
University of Kentucky School of Journalism and Telecommunications

The importance of empowering patients, increasing health education and collaboration were a few of the topics discussed at the Health Watch USA 2013 Conference in Lexington Nov. 1.

"Patients must be empowered with knowledge" was the primary message of Dr. Joycelyn Elders, professor emeritus of pediatric endocrinology at the University of Arkansas School of Medical Science and former surgeon general under President Clinton.

“You can’t keep ignorant people healthy,” Elders said. “We must educate our patients or we will continue to have major problems.”

Elders called for doctors to fight for comprehensive health education, everyone must be involved – the schools, the Internet, social media – and said that as a country we need to embrace comprehensive health education instead of being afraid that all discussions will lead to sex.

Patients have a responsibility to ask questions about their health care, Elders said, and if people are better educated in health care they will have a better idea of what to ask.

Karen Meyers, who works with catastrophic-injury victims and health-care providers, shared the story about her elderly mother who was critically injured during a fall; the doctor said she was terminal. Meyer persuaded the physicians to try to save her critically injured mother eight years ago, and that spurred her passion for the importance of patient and family-centered care. She attributes her mom’s recovery to doctors who listened to her and excellent nursing care.

 “Patient and family centered care,” Meyers said, “is based in dignity, respect, information sharing, participation and collaboration. We must teach doctors collaboration and that the patient and family are part of the team. We are not a threat. We are not ignorant. We should not be dismissed.”

Meyers went on to say that “The home care agency of the future is the patient, the family and the support systems. We have to have a support system that works and we have to include them.”

Elders also talked about collaboration between physicians. She said they need to provide integrated, comprehensive and transparent care because when a patient is seen on the same day by a team of specialist, they receive better care and experience better outcomes.

Martha Deed, a retired psychologist and a member of the Consumers Union Safe Patient Project's patient safety advocates network, was a seasoned patient advocate for her daughter, Millie Niss. who had Behcet's disease, a chronic disorder of the blood vessels.  Millie was hospitalized with a severe case of swine flu in 2009, coding within one hour of arrival at the hospital, and died less than a month later.

While in the hospital, Deed and Niss documented everything.  They voiced their concerns, followed the proper channels of communication, documented faulty medical equipment, found inaccuracies in nursing and doctor reports and requested test.  Despite this high level of advocacy, Millie died.

Millie's autopsy revealed a missed diagnosis that might have saved her if it had been discovered and treated, Deed said. She has since applied her research skill to investigate both the specific medical as well as hospital culture/system causes of her daughter's death. Her goal is to prevent future premature deaths in the hospital. "Patients and families very much need to be listened to," Deed said.

Elders offered advice on how to be an empowered, health literate patient:
• Take a trusted person with you when you go to the doctor
• Ask questions, write them down before you go to the doctor
• Bring all of your medications with you to each doctor visit
• Ask the doctor to write down suggested actions and medications
• Let your doctor know if you have vision and/or hearing problems
• Ask your doctor about the results of your test and what they mean

“Our health care system is presently physician centered, but patients need to be involved,” Elders said. “The largest health care work force that we are going to have is our own patients. We need to push for education.”

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

Molly Burchett is new chief writer for Kentucky Health News

Kentucky Health News welcomes a new reporter, writer and blogger: Molly Burchett, a master's student in health communication at the University of Kentucky.

Burchett graduated from Transylvania University in 2009 where she studied business and communication.  She was president of the Student Government Association and a yearbook editor.  Her jobs before UK included development director for a Lexington medical practice. She started her master's program in August 2012 and is focused on raising awareness about community health issues in ways that can encourage positive changes in health behavior.

She is from Prestonsburg, where her father and mother are the lead physician and manager of Prestonsburg Primary Care. She is a graduate of Prestonsburg High School. At KHN she follows Tara Kaprowy and Amy Wilson, who have both returned to freelance journalism.

Kentucky Health News is funded by the Foundation for a Healthy Kentucky but is independently reported and edited by UK's Institute for Rural Journalism and Community Issues.

HBO's 'Weight of the Nation' examines the obesity epidemic

A compelling four-part documentary delving into the obesity epidemic sweeping the country is being aired on HBO and can be watched free by clicking here. A reporter wanting to write a series of stories on the issue would find "weight of the Nation" a good reference.

The program is divided into four parts. The first segment, "Consequences," looks at the scope of the epidemic and the ramifications of being overweight or obese. "Choices" looks at the science behind how to lose weight, how to maintain weight loss and prevent weight gain. The third part, "Children in Crisis," looks at how the problem is affecting American children, exploring the decline of physical activity, school lunch, the demise of school recess and how marketing of unhealthy food targets children. The final segment, "Challenges," looks at the major forces driving obesity, including agriculture, economics, evolutionary biology, food marketing, racial and socioeconomic disparities, physical inactivity, American food culture, and the influence of the food and beverage industries.

The documentary is on a detailed website that answers questions that range from "What is obesity?" to "How do I know if I'm overweight or obese?"

The project is a presentation of HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention and the National Institutes of Health, with support from the Michael and Susan Dell Foundation and health insurer Kaiser Permanente.

Study finds doctors often overestimate how well they communicate in English as a second langauge

A study appearing in Health Services Research shows physicians who speak English as a second language, an increasing phenomenon in the U.S. and parts of Kentucky, often overrate how well they are communicating with patients.

The finding is the result of a language scale adopted by the Palo Alto Medical Foundation, which rates language proficiency in five levels: poor, fair, good, very good and excellent.

After the new scale was introduced in 2009, out of four of physicians who participated changed their rating. Of the 258 participants, 31 who had considered themselves "fluent" downgraded to "good" or "fair." Just 11 percent deemed their proficiency "excellent." "Seventeen percent used 'very good' and 38 percent said they were 'fair,'" reports Glenda Fauntleroy of research-reporting service Newswise. "Being 'fair' was defined as 'can get the gist of most everyday conversations but has difficulty communicating about health care concepts.'"

"This is a very tricky area as this demonstrates how many providers overestimate their proficiency in another language," said Joseph Betancourt, director of the Disparities Solutions Center at Massachusetts General Hospital in Boston. "This can lead to miscommunication and even medical errors." (Read more)

Nine breast cancer programs get total of $360,000 from Komen

Nine programs in Central and Eastern Kentucky will share $360,000 for breast cancer screening, treatment, education and patient navigation.

The grants go to breast cancer-specific projects of the Lexington-Fayette County Health Department; the Kentucky Pink Connection; Central Baptist Hospital; St. Joseph Breast Center; King's Daughters Medical Center; Mountain Comprehensive Health Corp.; Our Lady of Bellefonte Hospital; Dayspring Family Health Center; and North Central Area Health Education Center. Programs chosen were determined to have the greatest impact on underserved women in a 58-county service area, the Lexington Herald-Leader reports.

The grants were awarded by the Lexington affiliate of Susan G. Komen for the Cure. Another $100,000 raised in Kentucky went to the Susan G. Komen for the Cure National Grants Program to fund research. (Read more)