CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

Kentucky receives an F grade for its low funding of mental-health services; supply falls short of demand

Kentucky's supply of mental-health services is much lower than demand for those services, in terms of state funding, and the state spends only 45 percent of the national average in mental-health funding per person.

In 2010, Kentucky dedicated about $232 million to mental-health services, according to the Kaiser Family Foundation, which is $54 per person, compared with a U.S. average of $121 that year. That ranks Kentucky among the bottom 10 states without including individual mental health reimbursements for Medicaid, reports Chris Kenning of The Courier-Journal.

The state's Medicaid rates for mental-health services haven't been raised substantially in years, and only a fraction of mental-health facilities offer residential treatments, reports Kenning. He also reports the most recent “Grading the States” report of the National Alliance on Mental Illness gave Kentucky an F in 2009. The group considered measures such as the number of programs using evidence-based practices and the number of psychiatric beds.

Kentucky officials cite new efforts to improve care, such as partnering with the University of Kentucky at a new Eastern State Hospital that will open soon, and pursuing a change to allow Medicaid funding of community outpatient teams, reports Kenning. Kentucky also funds 14 regional community mental-health centers, which served 160,000 people last year, and there are 179 mental-health facilities, which include 40 offering residential care, reports Kenning.

Yet, these efforts fall short of providing mental health services for those Kentuckians in need.  In 2011, a surprisingly high 42 percent of Kentucky adult females and 31 percent of Kentucky males reported having poor mental health. Experts estimate that one in four people will suffer from some form of mental illness in a given year, which is nearly 1.1 million people in Kentucky, Kenning reports. 

It is critical for Kentucky officials to examine this issue in light of the Department of Health and Human Services rule that included mental-health benefits and treatment of substance-abuse disorders as part of the 10 "essential health benefits" insurance plans must provide when federal health reform takes full effect next year. HHS estimates it will expand mental-health and substance-abuse treatment benefits to 62 million Americans, and there is already a shortage of such services in Kentucky.

Recession has hit health departments hard: 23,000 jobs (15%) lost, core funding cut

Funding and job cuts as a result of the economic recession have weakened the impact public health departments have on their communities, says a series of articles published in the Journal of Public Health Management and Practice.

"Continued cuts to public health services will have an unsatisfactory impact on the health of individuals and the community," said Dr. Lloyd F. Novick, the journal's editor-in-chief. "There is a heightened vulnerability at the present time for adverse health outcomes. Above all, the realization of the vital need to maintain resources for our public health delivery system is imperative."

In 2009, 23,000 jobs in public health departments were eliminated, 15 percent of the total. By 2010, more than half the agencies had a cut in core funding. As they scramble to make do with their new bottom lines, more cuts are expected. "The current, alarming trend of diminishing resources, reduced workforce and impaired capacity to maintain public health programs pose major hurdles for local agencies, with consequences that will be felt well into the future," said Dr. Rachel Willard of the University of California.

To view an article on the impact of the 2008-2010 economic recession on local health departments, one on a local health department that is providing only essential services, and one on enhancing public health value in an era of declining resources, click here.

Some school districts say they can't afford new federal program to give free meals to all students

Many school districts are reportedly opting out of a new federal pilot program that provides free breakfast and lunch to all students attending schools where poverty rates are high. They say budget constraints, fear of losing other federal benefits, and the possiblity of having to raise taxes to maintain the program are keeping them from participating. Kentucky, Tennessee and Illinois were the three states chosen to implement the program first.

When the U. S. Department of Agriculture announced the Community Eligibility Program in March, officials called it a way to eliminate red tape for school districts and "make it easier for low-income students to receive meals in the National School Lunch and School Breakfast program." Districts would provide free meals to all students for four years, then claim reimbursement for them, as they do for students who already receive free or reduced meals, reports Heather Webb of the Salyersville Independent.

Webb reports that officials of the Magoffin County Schools officials said they are not participating because they want "see how the program works in the districts that do participate." The reimbursement rate outlined in the program is less than normal rates, and in the county, it would cause the current rate of 86 percent to drop to 47 percent.

Of Kentucky's 174 school districts, 102 are eligible for the program. However, only 18 of those eligible districts are participating, The Licking Valley Courier (which is not online) reported in its Aug. 11 edition. It said the Morgan County Schools declined to take part because they would have to pay 25 percent of the cost and feared they might have to raise taxes to cover that.

Bailey Richards of the Hazard Herald reported that schools who do not have more than 60 percent of their students receiving free or reduced lunch can still participate in the program, but the respective school boards will have to pay the difference to cover all students. Perry County Schools Food Service Coordinator Linda Campbell told Richards her district could not afford to pay that difference, which would amount to about $300,000 a year out of its general fund.

Hazard Independent Schools Supt. Sandra Johnson told the Herald that she feared her district would lose funding from other government programs, like Title I and Family Resource Centers, which depend on the exact number of students receiving free meals, if they could no longer keep track of those numbers.

State health commissioner retiring after seven years in the job, fighting for public health and expanding its role

By Tara Kaprowy
Kentucky Health News

After dealing with the aftermath of 9/11, an anthrax scare, H1N1 flu, the worst ice storm in Kentucky's history and a series of budget cuts, it's been a busy decade for Dr. William Hacker at the state health department. But after 10 years at the agency, seven as its boss, Hacker will retire at the end of the month.

He is getting great reviews for his work as commissioner, which has included expanding the role of public health beyond its traditional roles, including disaster response and prevention.

"Dr. Hacker has always provided quality leadership," said Scott Lockard, president of the Kentucky Public Health Association. "He has been a great advocate for public health. He has been well respected both in state and on the national level and he will be deeply missed."

"Dr. William Hacker has been an exemplary leader for public health and has led by example with his professional and genteel leadership style," said Linda Sims, director of the Lincoln Trail District Health Department and president of the Kentucky Health Department Association. "Dr. Hacker has been instrumental in helping local health departments during budgetary challenges with guidance and support. The development of new services and screenings for children have increased under his efforts that will make a difference for many years to come."

Hacker, a native of Manchester, joined the department in February 2001 to work in the maternal and child health division. He'd practiced as a pediatrician in Corbin for 18 years and subsequently spent six years with Appalachian Regional Health Care.

Just eight months after he came on board at the health department, his role expanded drastically. "On 9/11, we were asked how many burn beds we had available in Kentucky because they felt they would be flying burn victims to us," he said. "We had never had funding to establish the ability to actually track the beds available. Public health did not have a role to play in critical health care. But they called on public health that day."

Three weeks later, suspicious white powder started appearing in the mail, and public health offices nationwide were called again. Though anthrax spores were not found in Kentucky, envelopes containing white powder were, and they needed to be tested by public-health officials.

Dr. Rice Leach, then the commissioner, asked Hacker to establish the Public Health Preparedness Branch of the Division of Epidemiology and Health Planning, marking a major shift for the department. Traditionally, public health had not been involved in incident management, which occurs when first responders are sent in to handle a crisis. "We were the backup to deal with consequence management," Hacker said. "But when you're dealing with bioterrorism, public health needs to step in. There was a lot of learning that went on between law enforcement, emergency medical services and public health. That was a cultural shift. We were forced through the natural evolution of events to step up to the plate."

In 2004, following Leach's retirement, Republican Gov. Ernie Fletcher named Hacker commissioner. He established the Kentucky Outreach and Information Network, which expanded the department's ability to reach vulnerable populations like senior citizens and people with language, hearing or motor difficulties. Partnerships are still in place with other state agencies, Family Resource Youth Service Centers, literacy programs and faith-based organizations such as the Christian Appalachian Project. "We'd say, 'Here's the message we need to get out, whether we were talking about a hot weather advisory or how long is it safe to eat food out of your refrigerator if your electricity is out," he said.

In 2005, Hurricane Katrina struck New Orleans, prompting several thousand people to come to Kentucky. "We had to figure out how to take care of these people without any resources and many times without any family connections," Hacker said. Hurricanes Gustav and Ike followed, presenting similar challenges.

The next major disaster was the 2009 ice storm. The role of public health was to provide shelter, which Hacker called "a major challenge." But emergency stockpiles obtained by the Public Health Preparedness Branch proved useful. "We use cots, satellite radios and generators that were supposed to be used for an inflatable hospital," he said. "That provided power in Elizabethtown."

Emergency stockpiles were also tapped for items like face masks in 2009-10, when people started getting sick with H1N1. "We responded efficiently because of the training we had been planning for," Hacker said. In 2006, department officials prepared extensively for a bird flu "that is still smoldering," Hacker said, but has never reached the ability to spread quickly from person to person.

In the middle of all this, the state changed governors, but not health commissioners. Democratic Gov. Steve Beshear, who took office in December 2007, appointed a new secretary of the Cabinet for Health and Family Services, but showed confidence in Hacker by keeping him as commissioner of the cabinet's Department of Public Health. "I was prepared for Gov. Beshear to select someone else, but I was very pleased when he gave me the opportunity to continue to serve," Hacker said. Apart from Leach and Dr. Carlos Hernandez, Hacker has served one of the longest terms of any commissioner in the past 40 years.

Beshear told Kentucky Health News in July 2011, "Dr. Hacker’s commitment to public health and education is unassailable, and he provided great leadership and vision for our Department of Public Health. Dr. Hacker built teams, mentored, encouraged and connected organizations and people to achieve better outcomes for Kentuckians’ health. His success is largely driven by his belief in inclusion -- that bringing together many organizations can improve health in Kentucky. Kentucky will miss him."

Beshear's retention of Hacker greatly pleased Al Smith, who had just concluded 33 years as producer and founding host of "Comment on Kentucky" on KET. A former newspaper publisher in London and Western Kentucky, Smith helped Hacker campaign for a comprehensive hospital to serve Corbin and London. "He was ahead of his time, as usual, and we lost the political game," Smith recalled. "Fortunately, his great gifts have been appreciated by the state and other health providers who have kept him in leadership for many years. I hope there will be other opportunities for his influence and service at another time. . . . In or out of public service, Dr. Bill Hacker is a leader who always seeks the best for Kentucky."

Asked his biggest accomplishment, Hacker named two: leaving behind a capable team and establishing the Preparedness Branch, which he said is now deeply embedded. "I have a personal relationship with senior FBI agents that did not exist before," he said. "We have a very close partnership with emergency management officials. And we're close with the Department of Agriculture because of the correlation between animal diseases and human diseases. All those partnerships have positioned Kentucky's government entities to be more responsive."

That responsiveness, however, has a lot to do with funding, which Hacker said is his biggest worry, because public health tends to be invisible. "If you ask, most people think public health just takes care of poor people. We, in fact, take care of all forms of people. It's just we do our jobs well and so it's invisible to those folks unless they need a public health service."

Already, Hacker has dealt with several rounds of budget cuts and is worried that "political leaders and the public don't really understand the impact of what the future may look like" with a less well funded public health system. "It could mean slower response to diseases, slower response to disasters, less cervical cancer screening, less prenatal care. There's a whole host of services being provided but they cost money," he said.

Still, though it's not without concern for the future of the department, Hacker, 64, said it's time to head home. He will continue to live in Lexington. "My wife has some health problems and for 44 years she's made sacrifices to support my career. I think the time has come to reverse the equation," he said. "My decision to leave was a difficult one because I love the mission of public health. But it became clear to me that this was the right time to transition from employment to retirement. I will continue to support the mission of public health in any way I can contribute."

Dr. Steve Davis, longtime deputy commissioner of the department, will take over as interim commissioner Aug. 1. He called Hacker "a good doc and a good man. Simply put, we have been blessed to have him for many years."

Fla. governor agrees to implement prescription drug monitoring

"Florida Gov. Rick Scott reversed course Thursday and said he will allow a prescription drug monitoring program that Kentucky officials have demanded to help block the flow of illegal prescription drugs coming from the Sunshine State," the Lexington Herald-Leader reports.

The recently elected Republican said during a congressional hearing that private companies will fund the program for two years. Democratic Gov. Steve Beshear, who also testified at the hearing, said he was "very excited and pleased" at Scott's announcement.

"It was a rare moment of unity for the two governors," Halimah Abdullah writes for McClatchy Newspapers. "Their previous ideological differences on whether Florida should implement a prescription drug monitoring program to help stem the flow of drugs led to a tense standoff. Scott previously objected to such a program, citing privacy concerns, and turned down a $1 million donation from pharmaceutical giant Purdue Pharma, the maker of OxyContin, meant to help pay for a prescription database." (Read more)

Ky. officials ramp up criticism of plan to cancel Florida drug monitoring; U.S. drug czar says Fla. governor may lack facts

Kentucky officials continue to rail against Florida Gov. Rick Scott's proposal to cancel his state's prescription-drug monitoring program, a move they argue would keep the pipeline open for Kentucky dealers who head to the Sunshine State to get drugs.

"The callousness of this governor is absolutely incredible, with the number of people who are dying," said Frank Rapier, director of the Appalachia High Intensity Drug Trafficking Area program.

Democratic Gov. Steve Beshear and Republican U.S. Rep. Hal Rogers have written Scott expressing their displeasure. Kentucky "may have to take legal action," Lt. Gov. Dan Mongiardo, who lacks legal authority to do so for the state, told The Courier-Journal's Emily Hagedorn. "Rick Scott is trying to legalize prescription drugs on the street," Mongiardo said. "The last thing we need is an open spigot to illegal drugs."

Because Florida is one of few states without a drug-monitoring program, traffickers can to go from doctor to doctor, getting prescriptions for drugs at each stop. More people died from prescription drug abuse in Kentucky than traffic accidents, The C-J reported in a recent investigation. Scott has said the monitoring program is an invasion of privacy, is costly and may not be effective.

The issue was discussed in London Wednesday while R. Gil Kerlikowske, director of the White House Office National Drug Control Policy, made a stop there. Kerlikowske (right, C-J photo) is in Kentucky to investigate the prescription drug abuse in the state. "I am certainly giving (Scott) the benefit of the doubt that his decision comes from a lack of knowledge," he told Hagedorn. "So many people in his own state are dying, and others are dying, too." (Read more)

Yesterday, "Narcotics agents across South Florida descended on more than a dozen pain clinics," report Scott Hiaasen and David Ovalle of The Miami Herald. They call it "the most dramatic effort yet to curb the region’s booming business of illegal prescription narcotics." (Read more)

Kentucky politicians of both parties object to Florida governor's plan to stop pill-monitoring program before it starts

The new Florida governor's plan to scuttle a yet-to-start program to monitor painkiller prescriptions "has sparked an uproar in Appalachian states that say they are deluged with illegally bought pills from South Florida," Arian Campo-Flores reports for The Wall Street Journal. The strongest objections come from Kentucky.

"The tracking system would include a centralized database to help identify buyers who are accumulating large numbers of pills and the doctors who are overprescribing them. In his recently released budget proposal, however, [Gov. Rick] Scott [CFNews13 photo] recommended repealing the 2009 law directing the state to set up the system," the Journal reports. "Scott has raised concerns about the database's effectiveness and its possible intrusion on patient privacy. Pointing to a $3.6 billion budget deficit for the coming fiscal year, he also worries that the state would end up paying for a program that lawmakers designed to be funded by federal grants and private donations. Most drug-monitoring programs in other states rely on both federal and state funds."

Scott's move has prompted expressions of disappointment from some of his fellow Republicans in Florida and strong objections from politicians of both parties in Kentucky and West Virginia, hotbeds of for abuse painkillers such as oxycodone. "It seems Gov. Scott wants Florida to become the oxy-tourism capital of the world," Kentucky Lt. Gov. Daniel Mongiardo, a Democrat from Hazard, told the Journal. (Read more)

Republican 5th District U.S. Rep. Hal Rogers of Somerset, the new chairman of the House Appropriations Committee, sent Scott a sharp letter on Feb. 17 expressing alarm and dismay. "Now is not the time to back down from this life or death challenge," Rogers wrote, calling Scott's move "equal to firing firefighters while your house is ablaze; it neither makes sense nor addresses an urgent crisis. Governor, your state, more than any other, must take this crisis seriously. . . . Your state's participation is paramount to the success of our nation in fighting this problem, helping addicts get treatment and prosecuting pushers." (Lexington Herald-Leader photo by David Perry)

Rogers dismissed concerns about privacy, saying Florida's program, like those in other states, has strict regulations governing access to the data. Noting his new position, "I can certainly appreciate the fiscal pressures with which you are confronted in balancing a tight state budget. However, this is a matter which warrants sacrifices elsewhere." For a story from the Herald-Leader's Bill Estep, click here.

General revenues up, cigarette tax revenues down as tax is up

New numbers show revenues to Kentucky's General Fund, which pays for most state services besides roads, increased 5.4 percent since July 1, but money from the state's cigarette tax declined by 3.9 percent, perhaps in part because higher tobacco taxes have prompted some people to quit smoking.

Roger Alford of The Associated Press reports cigarette tax revenues dropped to $135 million, from $141 million in 2009. Gov. Steve Beshear acknowledged that cigarette tax revenue would decline when he pushed a 30-cent-per-pack increase in the tax two years ago. "Beshear said raising the cigarette tax would result in fewer smokers, which would translate into healthier Kentuckians and lower health care costs," Alford reports. (Read more)

Florida is slow to close valves on 'pill pipeline'

The "pill pipeline" from Florida to Central Appalachia and other regions has not been closed despite the passage of laws in Florida to tighten controls on prescription painkillers, Bill Estep reports for the Lexington Herald-Leader. (Herald-Leader photo: Pain clinic in Fort Lauderdale, Fla.)

"The prescription-monitoring system it mandated might not be in place for months, and there are concerns about continued funding for the program when it is up and running," Estep writes, noting that many Kentuckians leave the state to get painkillers because it is one of the few states with a prescription-monitoring system. "The program, a national model, allows doctors to see whether a patient has been doctor shopping, or going to multiple physicians to get prescriptions for drugs. Police also use the system to investigate whether legal drugs are being sold illegally."

Florida passed a law in April 2009 to set up a monitoring system, but setting it up "took many months," Estep reports. A contractor was chosen Dec. 21 but the losing bidder plans to appeal and Florida officials don't expect the system to be operating until June. And after a federal grant runs out, it may not have enough money to operate because of state budget problems. (Read more)

This item is also posted on The Rural Blog, a daily digest of events, trends, issues, ideas and journalism from and about rural America, published by the Institute for Rural Journalism and Community Issues, at http://irjci.blogspot.com.