Legislature passes bill aimed at preventing doctors' burnout by saying they don't have to report seeking mental-health treatment

Photo from Getty Images via Kentucky Lantern

By Sarah Ladd
Kentucky Lantern

A bill aimed at preventing burnout among physicians has cleared both chambers of the General Assembly. Senate Bill 12 unanimously cleared the Senate in late February and the House on Monday.

The legislation would protect Kentucky doctors who seek mental-health help from wellness programs by stating they do not need to report their participation in such a program and can't be dismissed for not reporting it. It does not mean that physicians don’t need to report conditions that have the potential to hinder their judgment, the Lantern previously reported.

Doctors who testified in committee in favor of the bill said burnout among doctors can lead to lower patient satisfaction, low morale, high turnover, increased rates of substance abuse and even suicide.

The bill's primary sponsor, Sen. Donald Douglas, R-Nicholasville, is a physician. He has testified that being able to access private help for stress “without fear of retaliation” is “imperative” for Kentucky’s doctors.

Rep. Killian Timoney, R-Nicholasville, in presentoing the bill to the House, sid it would “have a significant impact for Kentucky physicians.”

“Like many professions over the last few years,” Timoney said, “physicians have seen significant increases in work-related stress both due to the Covid-19 pandemic and the overall demanding nature of their work.”

He said SB 12 will help address this by encouraging doctors to get mental health help when they need it — and promising them confidentiality when they do so.

There was no discussion before a unanimous and bipartisan House vote. The bill now heads to Gov. Andy Beshear’s desk for a signature or veto.

Kentuckians' sense of well-being, as measured by analysis of Gallup polls from 2008 to 2017, was second lowest in U.S.

By Al Cross
Kentucky Health News

Kentuckians' sense of well-being from 2008 to 2017 was the worst of any U.S. state except West Virginia, according to a research paper that uses polling data to compare life satisfaction, enjoyment, smiling and being well-rested along with the negative affects of pain, sadness, anger and worry. 

The research also looks at 163 other nations, and ranks them along with U.S. states. In those rankings, Kentucky is 89th, just below Russia and Uruguay and just above South Korea and Belgium. West Virginia is 101st, just below Sri Lanka and just above Mauritania.

The research is being done by economics professor David G. Blanchflower of Dartmouth College in New Hampshire and the University of Glasgow in Scotland, and social-science professor Alex Bryson of University College London. It is published as a working paper by the National Bureau of Economic Research, a nonprofit organization that says it is "committed to undertaking and disseminating unbiased economic research among public policymakers, business professionals, and the academic community."

The researchers write that their four positive measures aren't just the flip side of the negative measures: "It seems they are, at least to some extent, measuring different things. . . . The implication is that we might need more than life satisfaction alone to obtain a robust assessment of state rankings on well-being."

The four negative questions in the Gallup Inc. polls asked respondents if they had experienced physical pain, sadness, worry or anger "during a lot of the day yesterday." The four positive questions were:

• Please imagine a ladder with steps numbered from zero at the bottom to 10 at the top. Suppose we say that the top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. If the top step is 10 and the bottom step is zero, on which step of the ladder do you feel you personally stand at the present time?
• Did you experience the following feelings during a lot of the day yesterday? How about enjoyment?
• Did you smile or laugh a lot yesterday?
• Now, please think about yesterday, from the morning until the end of the day. Think about where you were, what you were doing, who you were with, and how you felt. Did you feel well-rested yesterday?

Kentucky's highest rank among the states and nations, 62nd, was for enjoyment the previous day. It ranked 71st in the ladder of life, 88th in smiling or laughing, and 138th in being well-rested.

Among the negative questions, with stronger responses resuilting in a lower ranking, Kentucky did best with anger, ranking 80th. It was 103rd in pain, 113th in sadness and 118th in worry.

The top state in the rankings was Hawaii, followed by Minnesota, North Dakota, South Dakota, Iowa, Nebraska, Kansas, Alaska and Wisconsin. The bottom 10, starting with No. 41, were Rhode Island, Nevada, Oklahoma, New Jersey, Ohio, Tennessee, Arkansas, New York, Kentucky and West Virginia.

Former Kentuckian recovering from serious health challenges offers hope and advice for others in similar situations

Written as "an open letter to friends and colleagues," this essay offers hope and insight for people and families facing serious health challenges.

By Wes Irvin

Over the last seven years, I have been on a medical journey that has unfortunately taken me away from many folks who I still miss working with on a daily basis in Washington, D.C.

I’m sure many of you have wondered if I just fell off the face of the earth. Well, I have fallen along the way many times, and this journey has been a rollercoaster in every sense of the word, but I remain thankful to still be here every day.

Wes Irvin

Here’s my story: In September 2012, my life took an unexpected turn. Since then, I have undergone 60 surgeries and survived abdominal flesh-eating bacteria, five septic episodes, and multiple pulmonary embolisms. I also lost my spleen and gallbladder. I’ve been treated (and my life saved, more than once) in hospitals in Baltimore, Cleveland, Houston, and Rochester. I could go on, but you get the picture. It’s an understatement to say that there is no playbook for what my family and I have undergone. Thankfully, my underlying health was strong and it’s a big part of my story of survival.

I write not to seek sympathy, but to share some reflections born from this journey of compounded trauma, emotional healing and wellness, patience, perseverance, faith, and forgiveness—and also to thank some of the people closest to me who have been so supportive.

1. Yes, it is the journey, not the destination. As Robert Hastings writes in The Station, life really is about the journey. If you look out over the horizon, and try to figure out everything in your life, you’ll simply outrun yourself and miss living the gift of today. We exhaust ourselves by overreaching for the future—becoming less and less aware of what’s directly in front of us.

2. Today is the real deal. We all get excited about opening a Christmas present, a wedding present, or a birthday present. Right? There is so much anticipation and enthusiasm around a new gift. I have learned after losing hundreds of days since 2012—and from coming in and out of the woods—that I needed to open my “daily present” a bit more mindfully. I’ve realized that yesterday is in the rear-view mirror, tomorrow is uncertain, but today is for real: it’s a gift; it’s here. We should open today with excitement, surprise, and thanksgiving. Grab on and enjoy! As Eleanor Roosevelt wisely said, Tomorrow is a mystery. Today is a gift. That is why it is called the present.

3. Find the pony in the pile. It sounds crass, but I’ll say it anyway: Find the pony in whatever pile of crap you unexpectedly wander into—and work tirelessly to find it. When horrible things happen to us, believe it or not, there is good we can find. I encourage you to hone in on that. If you can approach adversity with this mindset—and it isn’t easy—then you can ride that pony to the finish line. What I’m saying is find the positive, that morsel of goodness inside what may seem the deepest, darkest place in the issue you are facing.

4. Love is not just for “loved ones.” It is so important not only to love yourself, and your family, but to love people from all walks of life, every day, because I assure you that one day it may take all walks of life to save yours. Since day one of my ordeal, I have reminded the very kind folks who cleaned my rooms from the ICU to the ER in every hospital where I’ve stayed, how critical their jobs are. They, too, are busy with the work of saving lives. I hope you will look around for individuals working to ensure we can open the gift of today and tomorrow—folks working tirelessly to keep us safe, get us where we’re going, to ensure we get food. The list is endless. . . .

5. Forget politics—we’re all people. The America in 2012 when I fell sick is not the America I recognize today, in terms of the rhetoric. As politicized and divided as the country is today, I have seen up close the incredible professionalism, courage and skill of medical teams whose only concern is the care of their patients. My caregivers have been from all walks and stations of life and from countries around the world. I have been blessed that they call America their home. It’s because of the microsurgeon from Turkey, the nurse from India, and so many others who treated and helped me, that I am here. All of them worked and continue to work to find ways to put Humpty Dumpty back together. And I remain grateful to all of them.

6. Giving thanks, with gratitude. Finally, I want to thank the people who have accompanied me on this journey: First, my wife Tricia and our children, Ashby, Jack, and Mary Rose. Trish has navigated the unimaginable with grace and forgiveness—and our children have done so as well. I also want to add that Trish did all this while serving our community in multiple roles over the years. They have all been a blessing and extremely understanding during rough times and managed to pick themselves up—and often me as well—every day while moving forward.

I also want to thank my former bosses who helped me along the way. They have either sat by my bedside or helped to keep my focus balanced and strong. And speaking of bedsides, Secretary Norman Mineta was also an inspiration to me as I watched him, too, bravely navigate a serious illness while managing his leadership duties from a hospital bed. So thank you: Secretary Mineta, Ernie Fletcher, Frank Wolf, Jay Timmons and the National Association of Manufacturers, Jim Simpson, Mike DeWine, Bill Schubert, and Dave Camp. You were there for me, and it has meant the world.

I have been enveloped by a spiritual guiding light and have felt all the prayers and positive thoughts over the years from so many of you reading this. My heartfelt thanks to you all. As I like to say, “Thankful is simply every day.” The S.S. Irvin remains afloat, and we are working hard to mindfully navigate it every single day. Our family, knowing we are all survivors from this journey, has so much to celebrate and to continue to be thankful for.

Wes Irvin is a former Lexington resident who was congressional, campaign and gubernatorial press secretary for Ernie Fletcher. He lives in Annapolis, Md., and says he is an evolving survivor who advocates for the disabled and focuses his volunteer time on emotional wellness issues, due to a multi-year health journey.

Albany doctor's weight-loss clinic sees big results with old-fashioned methods: eat better food, less of it, and exercise

Dr. Carol Peddicord holds a model representing

five pounds of body fat. (Clinton County News photo)

A doctor and a pharmacist in rural Albany are seeing big results in the fight against obesity after opening a weight-loss clinic. Since The Doctor's Health and Weight Loss Clinic opened in January, its 433 patients have lost a collective 4,079 pounds, and most have maintained their weight loss, Brett Gibson of the Clinton County News reports.

Dr. Carol Peddicord and pharmacist Arica Collins of Dyer Drug Co. came up with the idea for the clinic after seeing how many patients came in looking for a quick fix to lose weight. But the best way to do that is to live a healthier lifestyle, not through a pill or a crash diet, the News reports.

The emphasis is on healthier, Peddicord told the News: "We don’t want people to be skinner, we want them to be healthy and live longer." Obesity is a significantly bigger problem in rural areas than in suburban and urban areas, according to the Centers for Disease Control and Prevention. Among adults, 34.2% of rural residents are obese, compared with 28.7% in metropolitan counties. Kentucky has the fifth highest adult obesity rate in the nation, at 36.6%, and the third highest rate for youth 10 to 17, at 20.8%,

Though the duo first conceived of the clinic because they were worried about children's health, most of their patients are women between 35 and 58. There are a few high schoolers, though, and they're starting to see more men coming in. That's good, Peddicord told the News, because men typically have heart disease earlier in life.

Albany, in Clinton County (Wikipedia)

The clinic, which takes insurance, offers individually tailored wellness plans for patients, depending on whether they have high blood pressure, diabetes, and/or heart disease. They offer diet plans and will soon have plans for meal replacements such as shakes, the News reports.

Though Peddicord was glad to note that the clinic's patients had lost 680 pounds last month, she told the News that pounds aren't the only thing that matter. Patients have seen other "non-scale victories" such as being able to stop taking insulin for diabetes. "People are losing weight, feeling better and are able to exercise," she said.

Kentucky libraries have become key partners in helping rural residents learn about health, nutrition and healthy lifestyles

An information board in the Pulaski County Public Library has
much material about health. (Photo by Sarah Baird for Stateline)

Libraries in rural Kentucky are becoming a key partner in helping small-town residents learn about health and nutrition and maintain a healthier lifestyle, Sarah Baird reports for Stateline, a national publication of the Pew Charitable Trusts.

Libraries offer everything from free healthy-cooking and Zumba classes to seminars on how to prevent diabetes or administer Narcan, the overdose-reversal drug. In Somerset, the Pulaski County Public Library offers a nutrition class with a registered dietitian and will soon offer chair yoga. In the nearby London, the Laurel County Public Library works with a local hospital to offer learning lunches, "an event that pairs a free box lunch with an hour-long lesson on a relevant health topic, from migraines to sepsis. The lunches, launched in 2014, see attendance as high as 40 people. Topics planned for 2020 run from urology to shingles," Baird reports.

Having such offerings in rural areas can make a difference, where residents are more likely to suffer from chronic conditions and drug addiction rates are high, but there are fewer medical resources. "In Eastern Kentucky, the number of primary-care physicians is 26 percent lower than the national average and 21% lower than the rest of the state, according to a 2017 report from the Appalachian Regional Commission and the Foundation for a Healthy Kentucky," Baird reports. "Specialty physicians are even harder to find, with 59% fewer specialists in the region than in the nation."

Libraries can also serve as a source of information for seniors or caregivers, an important function in rural areas since thet tend to have a higher proportion of seniors, many with age-related ailments. "According to the Cornell University 2013 Disability Status Report, a third of older Kentuckians (ages 65 to 74) have some form of disability, with rural areas being particularly affected by a lack of access to proper doctors, therapies and treatment options," Baird reports.

Rural residents may feel more comfortable coming to the library, than, say a gym, for a yoga class, especially if that person is self-conscious. "Especially in small towns, public libraries serve as a neutral ground, allowing patrons to seek out information or attend classes that they might feel uncomfortable pursuing in a more traditional setting," Baird reports.

However, libraries sometimes lack the funds to implement public health efforts, and often lack the staff to write grants that could net them more funding, Baird reports.

Adult obesity in Ky. reaches all-time high of 36.6%, fifth in U.S.; doctor says insurance needs to start covering obesity prevention

By Melissa Patrick
Kentucky Health News

Kentucky adults just keep getting larger, reaching an all-time high for the number of obese adults in the state, ranking it fifth in the nation.

"As a society, as a whole, we're not quite convinced yet what a major problem this is," said Dr. Barbara Fleming-Phillips, an internist who helps run the weight management clinic at UK Healthcare's Barnstable Brown Diabetes Center.

Kentucky's adult obesity rate in 2018 was 36.6 percent, according to an annual report by Trust for America's Health and the Robert Wood Johnson Foundation. That's an increase of 6.7% , and 2.3 percentage points, from last year's rate of 34.3%, eighth highest in the nation.

The report says Mississippi and West Virginia have the highest rates of adult obesity, at 39.5%, and Colorado the lowest at 23%.

That said, all the state rates could actually be higher, says the report, since their numbers are based on the Behavioral Risk Factor Surveillance System, a continuous national poll; people self-report, and tend to over-report their height and under-report their weight. Obesity is calculated through body mass index, essentially a ratio of height to weight.

Supporting that theory, the national adult obesity rate is 39.6%, which comes from actual body measurements from the National Health and Nutrition Examination Survey.

The report for Kentucky shows that 68.5% adults in the state are either obese or overweight.

"Clearly things are going in the wrong direction in Kentucky just as they are in the rest of the country," said Fleming-Phillips. "And it's really a systemic, overall-society problem; it's not just a matter of counseling individual people on weight loss, which we do with my job, but it's a matter of looking at the entire system."

Strategies to combat obesity

Fleming-Phillips said it will take a "multi-pronged approach" to tackle excessive weight in Kentucky and the nation. She said that from her clinical experience, the most important contributor to weight loss is the diet, but added that exercise is definitely a component.

Nutritional education is needed in childhood, but adults also need nutrition education that teaches them to choose "real foods" over convenient, processed foods, Fleming-Phillips said.

As for exercise, she said because we are such a sedentary society with sedentary jobs, exercise must become a habit early on in a person's life; otherwise they will have to decide it is important.

Kentuckians don't exercise much. The report says Kentucky ranks No. 1 in the share of adults who say they are physically inactive: 32.3%.

The state also recognizes the need to focus its obesity efforts on children. That's because a child who is overweight when they start kindergarten is three times as likely to become obese by middle school compared to their peers, Christina Dettman, spokeswoman for the Cabinet for Health and Family Services, said in an e-mail.

For example, she said the State Physical Activity and Nutrition Program works to increase breastfeeding in birthing facilities, since studies show children who have been breast-fed are less likely to be obese. The program also works to implement healthy-food guidelines in work and community settings; to integrate nutrition and physical-activity standards into early-care and education systems; and to improve sidewalks, paths and bicycle routes throughout the state.

Dettman added that Kentucky has received a federal grant that can be used for evidence-based strategies at the local level to improve nutrition and physical activity. It will be allocated to 11 community health departments in Eastern and Western Kentucky. They include health departments in the Purchase District, Pennyrile District, Kentucky River District, the Cumberland Valley District, and Muhlenberg, Todd, Calloway, Christian, Pike, Floyd and Whitley counties. According to the Centers for Disease Control and Prevention, the grant is for $856,326.

The report notes that obesity levels are closely tied to social and economic conditions, finding that those with lower incomes are at higher risk of being obese as are people of color.

The obesity rate for blacks in Kentucky is 39.3%; for Latinos it is 30.9%; for whites it is 35.2%. About the same number of men and women are obese.

Baby boomers have the highest obesity rate at 43.8%, followed by those between the ages of 25 and 44 at 40%, seniors at 30.8% and those between 18 and 24 at 18.5%.

The report includes 31 recommendations for policy actions that are largely designed to improve access to nutritious foods, provide safe places for physical activity and to minimize the harmful marketing and advertising tactics that currently exist.

A few examples of its recommendations include the expansion of the Special Supplemental Nutrition Program for Women, Infants and Children to age 6 for children and for two years after birth for mothers, fully funding the WIC Breastfeeding Peer Counseling Program and taxing sugary drinks.

The push to expand WIC services is supported by an obesity decline seen in 31 states among 2- to 4- year-olds enrolled in the program between 2010 and 2014. Kentucky, with a decline of 18.2% to 13.3% respectively, was one of those states.

That said, Kentucky's older children haven't fared so well, with those between the ages of 10 and 17 having the third highest obesity rate in the nation, at 19.3%. And just like the state's adults, obesity rates among Kentucky's high school students continues to creep up and at 20.2% this group also ranks third in the nation for this measure.

Charts from report show figures from earlier years about childhood obesity in Kentucky, by age group

The latest Kentucky Health Issues Poll that asked about childhood obesity found that 56% of Kentucky adults saw childhood obesity as a serious problem for the state; another 35% said it was a problem, but not serious; and 6% saw it as no problem at all.

Obesity treatment and insurance

The American Medical Association recognized obesity as a disease in 2013, with hopes that the designation would change the way the medical community treats obesity, including how insurance companies would pay for the treatment.

But that has not happened, Fleming-Phillips said. Dedication to nutritional education and obesity prevention is still not a priority "anywhere in the medical system," she said.

"It's kind of baffling that obesity has been declared a disease -- and obviously there is a giant problem with obesity -- but insurance companies are not paying for obesity education and prevention or even treatment of the disease, medical treatment of the disease of obesity," she said.

The report also addresses coverage for obesity prevention, saying that while the law requires most insurance plans to cover preventive services, "there is great variability of actual implementation or uptake of these recommendations across insurers."

Chart from report shows the diabetes rate in Kentucky is up.

Being overweight or obese greatly increases the risk of developing other chronic diseases, like type 2 diabetes, high blood pressure, heart disease, stroke, and many types of cancer -- all conditions that plague Kentucky. Obesity is estimated to increase national healthcare spending by $149 billion annually, says the release.

About 14% of Kentucky's adults reported having diabetes, ranking the state seventh highest for this measure, and 39% of them reported having high blood pressure,which put the state at No. 5, the same rank it has for adult obesity.

Foundation says its 6-year, 7-county effort to help communities tackle health issues can be a model for the rest of the state

Foundation for a Healthy Kentucky map of recently finished "Investing in Kentucky's Future" program

If more Kentucky communities tackled their health issues as communities, the overall health of the state could be improved. That's one lesson of a six-year program that the Foundation for a Healthy Kentucky recently completed in seven counties.

The "Investing in Kentucky's Future" initiative focused on children. It "improved student eating habits, increased youth physical activity, trained teachers to support students experiencing trauma, and increased youth resilience," the foundation said in a report on the program, which reached nearly 13,000 students in 28 participating schools.

It said the initiative "strengthened cross-sector coalitions" in the seven counties and "led to the adoption of 38 local ordinances and policies to help sustain the improvements and promote health equity long-term." Looking ahead, it "has prompted the foundation to expand its work in obesity prevention and childhood trauma interventions."

For example, in May, the foundation announced a $200,000 grant in Russell and surrounding counties to address childhood trauma in a rural setting, building on lessons from a Jefferson County program that was part of the initiative.

The overall goal of the $2.4 million initiative was to reduce school-aged children's risk of developing chronic diseases later in life. The communities contributed $1.7 million in matching funds, as well as countless volunteer hours by local citizens.

"Health is something that people don't typically recognize as a community undertaking, and this initiative aimed to transform that thinking and set in motion a series of changes that will lead to healthier, more productive adults throughout each participating Kentucky county," foundation president and CEO Ben Chandler said. "We're sharing what's been learned so other Kentucky communities can replicate these achievements."

An event of the Clinton County Healthy Hometown Coalition

Six of the participating communities (Breathitt, Clinton, Grant, McLean, McCracken and Perry counties) chose childhood obesity prevention as their issue. Jefferson County focused on adverse childhood experiences (ACEs) and building resilience in children who have faced trauma.

Both issues are complex, and influenced by a variety of factors, so they require involvement by various sectors of the community, working in a coalition, the foundation said. With its report, the foundation released videos on obesity prevention and ACEs to help other Kentucky communities.

"Participants told us that identifying a local champion and engaging the school system were critical to success in each of the counties," Chandler said. "But by far the most decisive factor was ensuring that the local health coalition includes multiple members from a broad range of community organizations: schools, hospitals, elected officials, youth groups, and businesses. It takes more time to get everyone aligned but the resulting collaboration makes all the difference in creating long-term change to improve health."

The grant "gave us an opportunity to do something big and to really make an impact and we've done that," Marsha Bach, a member of the Grant County coalition, Fitness for Life Around Grant County (FFLAG) and a health promotion manager with the Northern Kentucky Health Department, says in the obesity video.

Each grant included a one-year planning phase in which the foundation provided training and technical assistance for development of a business plan. This made the program more accessible to small communities with fewer resources, said Amalia Mendoza, senior program officer at the foundation, who developed and oversaw the program.

Among the successes the foundation listed were:

• New policies expand physical education in middle school, require future streets to be usable by walkers and cyclers, allow school fitness equipment to be used by the community after school, and make healthier foods available in schools and park concession stands.
• New facilities include parks, fitness equipment, sidewalks and walking paths, playgrounds, filtered drinking water fountains, community trails and standing desks in schools.
• Many communities leveraged the Foundation grant to secure additional funding. For example, the Purchase Area Health Connections-Paducah Chapter secured another $400,000 Rotary Club grant to build a playground at the health park developed with foundation funding, and then another $500,000 donation to build a second phase of the park; sidewalks to school in Grant County will be part of trail system funded by a follow-up grant from another foundation.
• More than 90 percent of students had increased physical activity and improved nutrition, from such measures as classroom movement activities and standing desks; events such as fun runs, walking and biking programs, and the Annual Nutrition Fair created by the Partnership for a Healthy McLean County; a "Fitness Buddies" program of the Clinton County Healthy Hometown Coalition, in which high-school students helped third and fourth graders with intense physical activity; elimination of deep fryers in school cafeterias; installation of filtered drinking water fountains; and work with farmers to get more fresh produce to students.
• All six coalitions began or expanded student food programs over the weekends or the summers. Most students reported that school was the only place they got fruits and vegetables. Offering fresh produce at snack time "appears to be a successful strategy" to increase consumption, the report found.

Ky. ranked 34th for overall well-being of children in Kids Count report; advocates say key to improvement is to address poverty

By Melissa Patrick
Kentucky Health News

As long as more than one every four Kentucky children live in poverty, the state will struggle to improve the overall well-being of its children, says a Kentucky Youth Advocates release about the 2017 Kids Count Data Book, released Tuesday by the Annie E. Casey Foundation.

The book ranks Kentucky 34th in the overall well-being of its children, where it has hovered since 2012 when the current criteria for the measure were adopted.

“We know that economic well-being drives every other aspect of this report," KYA Executive Director Terry Brooks said. "Unless and until we get serious about changing the trajectory of poverty for kids, we will not see substantial change. While we must battle a tradition of poverty in this state, we don’t have to shrug our shoulders.”

Kentucky ranks 39th for economic well-being, down one slot from last year. Contributors for this category included 34 percent of the state's children living in homes where neither parent has secure employment; 26 percent living in households with a high housing-cost burden; and 9 percent of its teens between the ages of 16 and 19 not working or attending school.

The report did offer several bright spots, including continued improvement of Kentucky's education ranking, up to 24th from 27th last year, and fewer Kentucky teens getting pregnant.

The report offers a state-by-state assessment that measures 16 indicators to determine the overall well-being of children. The latest data are for 2015, and is compared with data from the last six or so years earlier. The report focuses on four major domains: economic security, education, health and family and community security.

Health continues to be Kentucky's highest ranking, though the state dropped four spots since last year's report, from 16th to 22nd. The state saw an increase in the number of child and teen deaths, to 31 per 100,000, up from 28 per 100,000 in 2014.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said decreasing the state's smoking rate could decrease the number of babies born with low birth weight, which is known to increase a child's risk of short- and long- term health complications as well as being associated with impaired cognitive development. Almost 9 percent of Kentucky babies are born with low-birthweights.

“Smoking during pregnancy accounts for as many as 30 percent of low-birthweight babies,” Chandler said in the release. “The foundation is committed to ensuring healthier infants by working with advocates and local communities to promote smoke-free ordinances, ensuring that expectant mothers have easy access to effective tobacco treatment, and raising the state tax on cigarettes. Each of these strategies will reduce Kentucky’s high smoking rate. We must get serious about protecting our children from the harmful effects of tobacco.”

In education rankings, Kentucky is sixth in the nation for high-school graduation, with only 12 percent of its students not graduating on time. The bad news is that 60 percent of the state's three- and four-year-olds are not enrolled in preschool; 60 percent of its fourth graders aren't proficient in reading; and 72 percent of its eighth graders aren't proficient in math -- and these numbers haven't changed much since 2009.

Brooks optimistically looks to recent legislative changes as possible ways to improve these poor education outcomes.

"A stronger focus on career and technical education, the new potential for innovative public charter schools, differentiated career ladders for teachers, and the newly created school accountability system from Senate Bill 1, championed by Senator Mike Wilson, are all hopeful indicators that the best days for Kentucky schoolhouses are on the horizon,” Brooks said.

Kentucky dropped one spot in the "family and community" domain to 38th, a category that shows 36 percent of the state's children live in single-parent families; 11 percent live in families where the household head lacks a high school degree; and 16 percent live in high-poverty areas -- all measures that stayed about the same as last year.

However, the one measure in this category that continues to improve is the state's teen birth rate, which dropped to 32 teen births per 1,000 in 2015, from 35 per 1,000 in 2014, a 9 percent drop. And compared 2010, it's dropped by 30 percent. It remains well above the national average, 22 per 1,000.

The Kentucky Youth Advocates release calls for "common-ground solutions" to improve the well-being of Kentucky's children including: reauthorization of the Children's Health Insurance Program; implementing proven strategies to decrease smoking rates, including smoke-free laws and increased tobacco taxes; family-focused tax reforms; and investing in child welfare programs that keep families together.

“Without fundamental improvement in lifting kids out of poverty, we face a losing battle on improving education outcomes, safety, and our children’s health. Solutions abound and we are calling on the governor and the General Assembly to build a budget for children in 2018,” Brooks said.

Click on a chart to view a larger version of it.

Southern Kentucky weekly starts a column from a recovering addict in the same week it publishes another health testimonial

Clinton County (Wikipedia map)

From 2012 to 2015, the last year for which figures are available, 25 people died of drug overdoses in Clinton County, a community of 10,000 people on the Tennessee border south of Lake Cumberland. This spring, a local doctor was indicted on charges of illegally prescribing painkillers to six people, three of whom died in 2014. The county is among the 54 in Kentucky, out of 220 in the U.S., considered most at risk from an outbreak of HIV or hepatitis C from intravenous drug use. Clearly, Clinton County has a drug problem.

Last week, on an inside page of the weekly Clinton County News, a new column appeared, with a standing headline, "An Addict's Corner," with the subhead "the Journey of an Addict." It was written by local resident Phillip Lee, who told how he became addicted to crystal methamphetamine, lost his wife, cars and homes, lost contact with his children and grandson, and put him behind bars again and again for 17 years. "I'll get down to specific details in later articles," he wrote. "I'll tell you all I remember going through." Lee credits his religious faith for his recovery.

Alan Gibson, editor and publisher of the paper, said in an email that Lee "came to me a few weeks ago with a hand-written article in his hands. He was proposing the column in an effort to help others who might be facing addiction problems, as well as families who were dealing with problems with other loved ones. He wanted to submit the column on a weekly basis under a pen name, or either anonymously. I told him he should be able to own up to his writings and be proud of his message to others as well as his accomplishments. He pondered about 10 seconds and signed the column and left it with me." He has submitted two more. "I also offered to put his photo in the header like we do some of the other regular headers, but he opted out of that," Gibson wrote. "If it helps just one person, I'm glad to offer up the space." To read Lee's first column, click here.

In the same edition of the paper, recent high-school graduate Thomas Holsapple wrote a column for the Twin Lakes Wellness Center, describing how his family had turned its health around after the death of his grandmother, who was overweight and had been a smoker, and how he took the next step by exercising regularly at the center in Albany. "Even after the first night I could feel the energy it gave me and how it entirely lifted my spirits. . . . Keeping myself in shape and eating healthy has changes my life, and the lives of my friends and family." For his column, headlined "Health and Fitness: My Story," click here.

The Clinton County News is a hotbed of testimonials about health, which can be an effective motivator for others to get healthier. The Clinton County Healthy Hometown Coalition, funded by the Foundation for a Healthy Kentucky, has had a regular column that often featured articles by local residents saying how they made themselves healthier. One of those was from Julie Holsapple, the mother of Thomas Holsapple.

County Health Rankings show troubling trend of more premature deaths, contrasting trends among some counties

By Danielle Ray
Kentucky Health News

The premature death rate is getting worse in 44 of Kentucky's 120 counties and improving in 12 counties, according to a health rankings report released Wednesday.

The figure is calculated using data from 1997 through 2014 and is part of the annual County Health Rankings & Roadmaps, released by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.

Experts say the premature death rate is fueled by drug overdoses, which accounted for nearly 1,250 deaths in 2015, according to the Overdose Fatality Report by the Kentucky Office of Drug Control Policy.

The rate of premature death is the years of potential life lost before age 75. Every death occurring before age 75 contributes to the total number of years of potential life lost. The state average is 8,900 years, which is 1,200 years worse than the national average.

Van Ingram, executive director of the Office of Drug Control Policy, told Bill Estep of the Lexington Herald-Leader that preliminary for 2016 are about the same as the 2015 numbers, but “It’s hard to celebrate leveling off.”

Beyond the drug issue, the latest County Health Rankings have much more to say. They give each county two scores: one for health outcomes, which include premature death and low birth weight, and one for health factors, such as access to physicians and areas to exercise, children living in poverty, violent crime, long commutes and other environmental dimensions.

The highest ranked counties in health outcomes are Oldham, Boone and Spencer, respectively. Traditionally, counties with the highest rankings tend to surround cities, where there is better access to medical care and exercise opportunities, like parks, and incomes are relatively high. The lowest ranking counties tend to be poor and in rural Appalachia, and this year is no exception: Owsley, Wolfe and Breathitt.

"The rankings show that people living in Eastern and rural Kentucky counties tend to have much poorer health than those in urban Kentucky counties," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "The rankings also make it clear that good health is influenced by many factors beyond medical care, including whether we can find and afford healthy foods, whether we can exercise safely in our neighborhoods, whether we have health insurance and if that insurance covers preventive care, and how safe our water is to drink and our air is to breathe."

The report has been released annually since 2011. Since then, some counties have seen big improvements, while others have seen their situations worsen.

Hickman County is one of the success stories. It ranks 23rd, up by 53 spots since the initial report in 2011. Multi-year trends are important, because rankings can vary from year to year, especially in small counties like Hickman; it ranked 73rd in outcomes last year. The county's health-factors ranking has also improved, to 37th from 58th in 2011, with an increase in employment and a decrease in preventable hospital stays.

Carter County has also shown great improvement over the years. It ranked 91st for the first three years of the report, and 90th in 2014, but rose to 82nd in 2015 and 68th in 2016. This year, it ranks 57th, showing improvements in both length and quality of life.

The latest move put Carter County into the second quartile of Kentucky counties. The rankings divide the counties into four groups because the differences among closely ranked counties can be very small, within the error margins for surveys that form part of the basis for the rankings.

Some counties, such as Menifee, have seen improvements in health outcomes despite lagging ion health factors. The county's outcomes ranking bottomed out in 2013, when it placed 111th. It improved to 92nd in 2015 and 79th in 2016, and this year, zoomed to 36th. Somehow it is overcoming bad health factors, in which it ranks 97th. It has a high unemployment rate and a high percentage of children living in poverty.

Similarly, Cumberland County has steadily improved its numbers since 2014, when it reached a low outcomes rank of 107th. It improved to 102nd the following year and 97th in 2016. This year, it ranks 83rd in outcomes. Like Menifee, it still ranks lower (91st) in health factors, with too few dentists and a high number of preventable hospital stays.

Morgan County once had much higher outcome rankings than its neighbors, despite bad heath factors, and now those factors appear to be catching up with it. Morgan's outcomes ranking slipped to 91st from 76th last year and 23rd in 2011. The county's scores for both length and quality of life have steadily declined. The county also has a high unemployment rate and a high percentage of children in poverty.

For every county that moves up in the rankings, another has to take its place. Rockcastle County ranks 100th in outcomes and has experienced a steady decline since 2011, when it ranked 64th, partly due to high marks for quality of life. Since then, the county's rate of premature death has increased and its quality of life scores have decreased. It suffers from a shortage of dentists and mental-health providers, with just one for every 8,500 people, drastically lower than either state or national figures.

View an interactive map of your county's ranking, with details for each measurement, here.

Kids Count report finds Ky. remains in the bottom 1/3 of states for children's well-being; is this a predictor of the state's future?

By Melissa Patrick
Kentucky Health News

If Kentucky's future lies in the well-being of its children, there's reason to worry, because a recent report shows that Kentucky consistently remains in the bottom one-third of states for this measure.

The 2016 Kids Count report ranks Kentucky 35th in the overall well-being of its children, down from 34th last year. The state showed a significant improvement in its health ranking and a further drop in its teen birth rate, but otherwise didn't show much change from last year's report by the Annie E. Casey Foundation and Kentucky Youth Advocates.

"The real issue is not a drop or increase of one position, but rather that Kentucky continues to be in the bottom one-third of all states," KYA Executive Director Terry Brooks said in a news release. "Are we really content with the idea that two-thirds of America's children are better off than Kentucky kids?"

The annual report offers a state-by-state assessment that measures 16 indicators to determine the overall well-being of children. The latest data are for 2014, and is compared with data from the last six or so years earlier. The report focuses on four major domains: economic security, education, health and family and community security.

Kentucky continues to rank highest in health, climbing to 16th from 24th in 2015, 28th in 2014 and 31st in 2013. Contributors included a continued drop in the number of children without health insurance (4 percent); a 15 percent decrease in child and teen mortality, fewer teens abusing alcohol or drugs (4 percent) and improvements in the percentage of low-birthweight babies (8.8 percent).

The state's greatest drop among the rankings was in economic security, going down to 37th from 32nd last year. Education (27th) saw a slight improvement from the past two years and the family and community (38th) rankings remained similar to the past three years.

The release notes that the state now ranks 10th for the percentage of children with health insurance.

"We are seeing better outcomes for kids in Kentucky, and expanded health coverage and access to quality care play a vital role in making that happen," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in the release. "Research shows that when parents have health coverage, their children are more likely to also be signed up for health insurance."

Another bright spot in the report is that the state's teen birth rate continues to drop. It declined 34 percent from 2008 to 2014. While Kentucky still has one of the nation's highest teen birth rates, it dropped to 35 births per 1,000 girls aged 15-19 in 2014, down from 39 per 1,000 in 2013 and 53 per 1,000 in 2008. The national average is 24 per 1,000, an all-time low.

Kentucky consistently ranks lowest in the "family and community" domain, with 35 percent of its children living in single-parent families; 12 percent living in families where the household head lacks a high school degree; and 16 percent living in high-poverty areas, which are neighborhoods where more than 30 percent of residents live in poverty.

"Kentucky will thrive when policies that support the whole family, caregiver and child, are implemented," Adrienne Bush, executive director of Hazard Perry County Community Ministries, said in the release.

And though the state's education ranking improved to 27th from 30th, not much has changed in these indicators since the foundation started doing this report. The bottom line is that more than half of fourth graders (60 percent) still can't read at a national proficiency level and that the majority of eighth graders (72 percent) still aren't proficient in math. (In 2007, these indicators were 67 percent and 73 percent respectively.)

"Student performance should alarm parents and business leaders and jolt Kentucky leaders into making fundamental education reform a policy priority to ensure college and career readiness," Brooks said.

In addition, more than half the state's three-and four-year-olds (58 percent) don't attend pre-school and 17 percent of its high school students don't graduate on time.

Perhaps the direst message from the report is about the state's economic well-being. One in four Kentucky children live in poverty (26 percent), a rate that has remained higher than it was pre-recession when it was 23 percent, says the release. Nationally, the child poverty rate is 22 percent.

"Growing up in poverty is one of the greatest threats to healthy child development," says the report. "Poverty can impede cognitive development and a child's ability to learn."

The report also says 35 percent of Kentucky's children live in homes with parents who don't have secure employment, which places the state in the bottom 10 states for this indicator. It also found that 28 percent live in households with a high housing-cost burden.

The release suggested "bipartisan solutions" to improve the well-being of Kentucky's children, including expanding oral health coverage; supporting school-based health centers; education reform that includes public charter schools, expanded child care assistance and family-focused tax reforms.

Ashland hospital expands into wellness and prevention programs

By Judi Kanne
Kentucky Health News

Hospitals’ basic business is taking care of the sick and injured, not keeping people from getting sick. But more and more of them are getting into wellness and prevention, not only to help their communities but to make money.

King's Daughters Heart and Vascular Center

One of those is King’s Daughters Medical Center in Ashland, which has developed an innovative strategy for building relationships with local employers to help their employees live healthier lives.

King’s Daughters began by focusing on self-insured employers, who can get the most direct benefit from reduced health-care expenses. It used one-to-one employer outreach activities such as a farm-to-table employer lunch, to which more than 126 local employers were invited.

The first question for employers, said Matt Ebaugh, vice president and chief strategy officer at King’s Daughters, is “Do you understand what is driving the cost for your employees?” because “Self-funded employers do not always have the analytics or tools needed to understand where those costs come from.”

King’s Daughters used Strategic Health Services of Alpharetta, Ga., to create a portal for health risk assessment, biometric screening results, claims analytics and personal health profiles of employees.

While the program is aimed at wellness, it also finds new cases for the hospital. “We knew if we did a smart thing for local employers, demonstrated value, and coupled it with good customer service, then when employees needed a higher level of care, they would come to us,” Ebaugh said.

By means of screenings for diabetes, cholesterol, and body mass index, employees become patients.

Diabetes screening can be critical. About 86 million American adults are pre-diabetic, but nine out of 10 people who are don’t know it, according to the federal Centers for Disease Control and Prevention. That can be detected with health-risk assessment lifestyle questionnaires.

Beyond individual screenings, hospitals can examine the emerging risks in a population using claims data. That can also help them show employers what’s driving up their costs. Claims also indicate which employees are most likely to use hospital and pharmacy services.

“We need to find innovative ways to motivate individuals to change old and dangerous patterns,” Ebaugh said, because simple lifestyle changes can dramatically cut the risk for developing diabetes.

But getting healthy may require offering financial and other incentives to get people to participate in wellness programs. The Ashland hospital plans to try gamification, incorporating into the workday a set of programmed games and activities that remind sedentary employees to get up, stretch, and move around.

The idea is to make health and fitness fun, a social experience and accessible to as many members as possible. Gamification programs include computer notifications or other reminders that stimulate sedentary disruption and track activity. In some cases, motivation includes team competition in which employees win points by stopping to stretch.

Ebaugh said such programs have been shown to work and are critical in some cases, because a pre-diabetic employee may not be motivated enough to change eating and exercise patterns. “Knowing is not enough,” he said. “We anticipate the energy and participation with gamification will increase as a result of more engaging activities.”

The hospital first started a wellness program for its own employees, and plans to add gamification to it, Ebaugh said: “It’s important our model work well to show our employers the success we are having with our internal employees.”

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

Report says hospitals could fund improvements in Ky.'s health

A focus on population health, prevention and wellness is how Kentucky will become a healthier state, and one source for funding these efforts is hospitals, because most nonprofit hospitals are required to invest back into their communities, according to a recent report from the Friedell Committee for Health System Transformation.

“Right now, in Kentucky, most of the money that is spent in health is for healthcare and services,” Dr. Richard Heine, executive director of the Friedell Committee and author of the report, said in a news release. “Very little money is available to address population health and wellness, which would lead to healthier people.”

The report, "Hospital Community Benefits and the Health of Kentucky," says that while many Kentucky nonprofit hospitals are already partnering with local health departments to create a community health needs assessment and addressing community needs, there is room for more collaboration between community leaders and their local hospitals to find ways to use these funds toward improving their communities health.

Figure 1 has 2009 national data. Figure 2 has 2011-12 Kentucky data. (Friedell Committee graphic)

Almost 10 percent of the annual $9 billion operating budgets of Kentucky's non-profit hospitals, or $877 million, goes toward community benefits.

More than 80 percent of that is used to cover bad debts or care that wasn't reimbursed. Only 5 percent goes to "community health improvement services and community benefit operations," according to the report.

The report ponders that there might be more dollars available for community needs and improvement of population health because the expansion of Medicaid has reduced the amount of uncompensated care.

"With some portion of the more than $877 million in community benefit funds available, Kentucky nonprofit hospitals are in a position to stimulate significant changes in the reach and efficacy of preventive health programs, health policy, and with collaboration and cooperation of the people they serve, much progress can be expected," the report says.

“This partnership can be powerful and important in creating positive change,” Heine said in the release. “These funds present a possible means to finance community health initiatives, which typically do not have a designated funding source.”

90 percent on state's Kentucky Employee Health Plan are enrolled in its wellness program

If a focus on wellness and prevention is the key to living a longer life, then Kentucky public employees are well on their way with 90 percent of them now participating in the HumanaVitality™ wellness program, which is offered through their Kentucky Employee Health Plan, compared to only 10 percent just three years ago, according to a state news release.

Through this wellness program nearly 158,000 members completed an annual health assessment or biometric screening this year; more than 132,000 members are enrolled in a health plan tied to wellness; and the number of plan members using a pedometer or other fitness-tracking device has increased from around 6,000 to nearly 17,000.

The wellness plan offers and encourages preventive screenings and this year it became the first in the country to offer the national Diabetes Prevention Program to nearly 85,000 members who are considered at-risk of developing the disease, with nearly 300 KEHP members taking them up on it. Plan membership totals around 160,000 plan holders and 266,000 covered lives.

“The program has been a lifesaver,” Connie Armstrong, a Clinton County schools employee, said in the release. “The program is the main reason that I have lost close to 40 pounds – and best of all, my blood sugar has dropped from high risk to normal.”

Ten major diagnostic conditions, including diabetes, heart failure, COPD, obesity, and chronic back and neck pain account for almost 80 percent of all claim costs, says the release.

“Reducing the high rates of chronic conditions has been a major focus for the health plan,” Employee Insurance Commissioner Joe Cowles said in the release. “Now we are seeing a substantial increase in cancer screenings and prevention program participation.”

Pulaski County hits the mark with a community program to get kids up and moving; a great model for other communities to follow

Communities wondering what they could start that is fun, and will also improve the health of local families, might consider hosting something like "The Longest Day of Play," which Pulaski County has done for the last five years.

The Longest Day of Play at SomerSplash Waterpark
(Photo by Katie Pratt, UK Agricultural Communications)

The Longest Day of Play is a day, typically around the longest day of the year, on which SomerSplash Waterpark invites families from across the region for a day of physical activity and healthy living, Katie Pratt reports for the University of Kentucky. For those under 18, the event includes free admission, a healthy lunch, a book to read for the summer and sunscreen.

“A lot of times the people who are here today wouldn’t otherwise get to come, so it’s an opportunity for us to give back to the community,” Stephen Sims, manager of the waterpark, told Pratt. “It’s a way to get kids out and let them be active and not just simply stay at the house all summer long.”

The event is hosted by Pulaski County schools, UK's Cooperative Extension Service, the Lake Cumberland Health District Department, Eastern Kentucky Personal Responsibility in a Desirable Environment (PRIDE), and the city of Somerset.

“We have a Working on Wellness group in the community, and we wanted an event to give children nutrition, physical activity and to help our new waterpark grow," Edith Lovett, Pulaski County family and consumer sciences extension agent, told Pratt.

While Pulaski County has an awesome venue for the event, most communities have something special to offer -- parks, swimming pools, bike trails, school running tracks -- that could bring families together for a day of physical activity, fun and nutritious food.

Clark County schools engage students as taste-testers in search for newly required, healthy foods the kids will eat

New federal nutrition standards "are not universally popular with students" in Clark County — some throw away recently required fresh fruits and vegetables — but "participation in school lunch programs has not been greatly affected," Whitney Leggett reports for The Winchester Sun after reading School Nutrition Director Becky Lowery's annual Wellness Report Card.

“This is a way for us to just sort of look at where we are and evaluate what we can do better,” Lowery told Leggett. The report highlights the requirements of the 2010 Healthy Hunger-Free Kids Act, such as a switch to whole-grain products, restrictions on fat and salt, and age-based calorie limits.

The greatest resistance has been to fruits, vegetables and whole-grain bread and pasta, Lowert told Leggett. Despite the complaints, participation in the school lunch and breakfast programs has only decreased by 1 percent since the 2013-14 school year, Leggett reports, along with a localized illustration.

To improve student satisfaction, Lowery implemented a student panel to taste possible new menu items. “It is much more difficult and more expensive to find good quality products that students will accept,” she told Leggett. “We’re just always trying to find good products that will still meet regulations.”

As part of the Farm to School initiative, Clark County strives to use more Kentucky Proud products, such as corn grown in Clark County, green beans from Louisville, and Western Kentucky blueberries, Lowery told Leggett. “As I hear about more things available to us that we can use, I will look into them,” she said. “We try to use as much as we can.”

Millions of children on Medicaid are missing free check-ups; Kentucky is a little below the national average

Millions of low-income children across the country aren't getting free preventive exams and screenings guaranteed by Medicaid, and some experts say federal and state health officials aren't doing enough to fix the problem, according to a federal watchdog report.

The report from the Department of Health and Human Services’ Office of Inspector General says that while the Obama administration has boosted rates of participation for children getting regular wellness exams, dental checkups and vision and hearing tests, it needs to do more.

The report says that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but most states are still falling short of the department’s 80 percent goal. Only Iowa and California met that participation rate goal last year.

In Kentucky, 57 percent of the 381,231 children covered by Medicaid who should have received at least one annual screening exam did so. Most states require at least one annual exam, and more frequent exams for infants. The reports shows that Kentucky's rate is better than 20 other states and equal to the rates in North Carolina, Rhode Island and Florida.

Some experts say state officials bear most of the responsibility for the low rates because they run Medicaid, the state-federal program for the poor, reports Phil Galewitz of Kaiser Health News. The OIG reports says the federal administration should be doing more to encourage states to address the problem.

"Child health advocates cite several factors for the low completion rates, including a shortage of doctors treating Medicaid patients, states’ low pay for providers and parents’ lack of awareness about the importance of the visits," writes Galewitz.

Congress introduced the Medicaid benefit, known as the Early and Periodic Screening, Diagnosis and Treatment program in 1967. In Kentucky, the EPSDT benefit includes screenings and special services, according to the Cabinet for Health and Human Services. Preventive care, such as routine physicals or well-child check ups, is provided under the screenings program.

Last year, 514,298 children were eligible for Kentucky’s EPSDT, says the the cabinet's annual participation report. Based on that number and eligibility periods, about 507,000 screenings were expected, but only 391,079 were, for a ratio of 83%. Additionally, the report says 236,830 children received dental services of any kind, with 208,783 receiving preventive services.

Some states require Medicaid health plans to educate members about the EPSDT benefit and what it covers. Others have implemented incentive plans that offer gift certificates for screenings. According to the National Academy for State Health Policy, Kentucky requires Medicaid managed-care organizations to provide an EPSDT coordinator to coordinate case-management services and continuity of care. Click here for more information about EPSDT screenings in Kentucky.

Kentucky ranks 49th in well-being survey, and Eastern Kentucky's congressional district ranks last in the nation

Kentucky ranked 49th in the nation in a survey that measures perception of well-being, ranking higher than West Virginia and lower than Mississippi, and its 5th Congressional District ranked dead last in the nation.

"The survey assessed people's emotional and physical health; behavior that affects health, such as smoking or exercising; job satisfaction and access to basic needs, including food and housing; and their outlook on life," Bill Estep reports for the Lexington Herald-Leader. The Gallup Organization and Healthways, a Tennessee-based company that provides services to improve well-being, administered the survey.

Kentucky has ranked 49th each year except for 2008, the year the index began, when it ranked 48th. Factors contributing to this result include high poverty, top smoking rates, many uninsured people, high depression rates, drug abuse, obesity and other health issues. "Our health status is dismal in Kentucky," state Health Commissioner Stephanie Mayfield told Estep.

Louise Howell, a consultant for Kentucky River Community Care, said Eastern Kentucky has "profound health disparities." Harlan County lost 13,054 years of individual lives due to premature death, according to the survey. In Breathitt County, only 25.1 percent of people have access to satisfactory exercise opportunities. In Martin County, 37.4 people smoked.

Shaping Our Appalachian Region, a program Gov. Steve Beshear and 5th District Rep. Hal Rogers began last year, is forming strategic plans to improve the region's economy through expansion and diversification. This summer the public meeting will take place to brainstorm ideas and promote involvement. "I think this is the toughest most difficult region we've worked in, ever," said Charles W. Fluharty, who heads the Rural Policy Research Institute and is interim executive director of SOAR. However, he said the region will benefit from people's awareness that the coal-depend region has to try to a new strategy, Estep writes.

Dee Davis, president of the Center for Rural Strategies in Whitesburg, told Estep: "People realize if we've got any chance at all we've got to seize the reins; we've got to diversify the economy." (Read more)