Ky., high in childhood obesity, fights it with better school meals, increased activity requirements and maybe help from Big Bird

By Melissa Patrick
Kentucky Health News

Kentucky children are some of the nation's fattest.

In 2011, the last year for which data are complete, Kentucky ranked sixth in the U.S. in the percentage of obese 2-to 4-year-olds from low-income families (15.5%), eighth for percentage of obese 10-17 year-olds (19.7%), and third in percentage of obese students in high school (16.5%), according to a project of the Trust for America's Health and the Robert Wood Johnson Foundation. (Read more

Kentucky has several programs in place to fight childhood obesity, such as improving food choices in schools with farm-to-school mini-grants and improved school nutritional guidelines. Efforts are also being made to increase the standard expectations of physical activity, according to the federal 

Centers for Disease Control and Prevention website.  

Laws that require Kentucky school districts to develop local wellness policies for grades K-5 that includes moderate to vigorous physical activity each day and encourages healthy choices among students are a step in the right direction toward decreasing childhood obesity. This legislation also requires assessment tools to measure each child's level of physical activity on an annual level, according to the National Association of State Boards of Education website. There is also a push to increase the activity requirements in child care facilities, according to the CDC website.

The frequency at which children eat fast food, and its nutritional value, are also challenges in decreasing childhood obesity. Kids and teens consume up to 300 calories more per trip to a fast-food or full service restaurant compared to days they eat at home, Ryan Jaslow reports for CBS News. (Read more)

Although fast-food restaurants have made some improvements with healthier sides and beverage choices in most children's meals, "there is room for improvement," researchers say in the "Fast Food Facts 2013" report, issued by Yale University's Rudd Center for Food Policy & Obesity.

The report examines how 18 major restaurant chains market their foods and beverages to children and teens, and analyzes the nutritional quality of the chains' food. Significant findings included: Less than 1 percent of all children's meal combinations at such restaurants met recommended nutrition standards; McDonald's spent 2.7 times as much to advertise its products as all fruit, vegetable, bottled water and milk advertisers combined; the total amount spent on all advertising by fast-food restaurants in 2012 was $4.6 billion; preschoolers viewed 2.8 fast-food ads per day in 2012; children 6 to 11 saw 3.2 such ads per day; and teens viewed 4.8. The researchers also found that fast-food restaurants continued to target black and Hispanic youth, populations at high risk for obesity and related diseases.

Researchers called for fast-food restaurants to stop marketing unhealthy foods to children and teens, saying "Research shows that exposure to food marketing messages increases children’s obesity risk." (Read more

On the marketing front, "Sesame Street" characters have joined the Produce Marketing Association to help market fresh fruits and vegetables to children, according to a press release from the Robert Wood Johnson Foundation.

"Marketing healthy products with the same skill and vigor typically used for less healthy options could make a major difference in shaping children's food preferences," Dr. Risa Lavizzo-Mourey, the foundation's president and CEO. "I have a vision of children pestering their parents for pears and begging for broccoli."

Obama says health policies that don't comply with reforms can be renewed for another year; state will let insurance firms decide

People with insurance policies that don't measure up to the federal health-reform law will be able to renew them for another year, President Obama announced today in an effort to quell outrage about policy cancellations that made hash of his promise "If you like your plan, you can keep it."

An estimated 280,000 Kentuckians have policies that are being canceled because they do not comply with the law's coverage requirements. Obama said insurance companies will be required to tell such policyholders "what protections these renewed plans don't include" and that they have alternatives that may be better and cheaper, with the help of federal tax subsidies.

The president also said state insurance commissioners will still have the power to decide what plans can and can't be sold in their states. "Kentucky will comply with the president’s request to allow Kentucky’s insurers the option of determining whether to extend existing health insurance policies to current policyholders for one more year," Gov. Steve Beshear said in a written statement. "This will be a business decision for each insurer to make, as many of them have invested a great deal of time and money into preparing for the transition to new standards under the Affordable Care Act."

At a White House press conference, Obama was asked why he kept repeating that people could keep their plan when his own administration had said in the Federal Register that people in the individual and small-group markets, about 6 percent of Kentucky's policyholders, would lose policies.

"There's no doubt that the way I put that forward unequivocally ended up not being accurate," he said. "It was not because of my intention not to deliver on that commitment. . . . We put a grandfather clause into the law but it was insufficient." The law said people could keep policies they had in place when it was passed, but that protection disappeared if an insurance company changed the policy, which seems to have happened in most cases.

Obama said he thought that most people whose policies were canceled "could find better policies at lower costs or the same costs in the marketplaces" run by the federal government and individual states like Kentucky, and the rest would be covered by the grandfather clause. "There's a good chance they'll be able to buy better insurance at lower costs," he said.

Asked if his broken promise creates a breach in public trust and confidence in government, Obama said, "There is no doubt that people are frustrated" and think that in Washington, "'not enough is being done that helps me with my life.' They expect me to do something about it. . . . It's legitimate for them to expect me to have to win back some credibility on this health-care law in particular and on a whole range of these issues in general."

U.S. Sen. Mitch McConnell issued this statement: “President Obama’s announcement doesn’t even come close to fixing the problems that so many Americans are facing right now as a result of cancelled health care plans and skyrocketing premiums. But, it does represent the clearest acknowledgment yet that his oft-repeated pledge ‘if you like your plan, you can keep it’ was false all along. What makes this admission even worse is the fact that it was prompted not by the heartbreaking stories of millions of Americans, but by the private pleadings of a handful of endangered Democrats. Americans are becoming increasingly aware of the fact Obamacare is broken beyond repair. The only ‘fix’ is full repeal followed by step-by-step, patient-centered reforms that drive down costs and that Americans actually want.”

Obama said at the press conference that the law will work and he is not backing away from it: "We’re going to do everything we can to help the Americans who have received these cancellation notices. But I also want everybody to remember there are still 40 million Americans who don’t have health insurance at all. I’m not going to walk away from 40 million people who have the chance to get health insurance for the first time. And I’m not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years."

Tacitly acknowledging that it makes some people pay more, he said society and governments often make decisions carrying initial costs that are outweighed by long-term benefits, such as requiring motor vehicles to have seat belts. Speaking of the law's ineffective grandfather clause, he said “It's almost like we said to folks, 'You gotta buy a new care even though you can't afford it right now.'”

Many questions at the press conference dealt with the faulty federal website, which Kentuckians to not use. Obama said, "These are two fumbles . . . on a big game, but the game's not over."

"This solution combines a clever public-relations stunt, a stalling tactic, an act of retribution, the genuine possibility of transition assistance for some, and a large political and substantive gamble," Brian Beutler writes for Salon. "It bears the hallmarks of desperation and frustration and determination, but it just might work."

Pike County officials urge newly eligible residents to sign up for health insurance before Dec. 15

A call to action.

That's what Pike County officials are calling their efforts to encourage citizens to sign up for health care insurance, as called for by the Patient Protection and Affordable Care Act, reports Russ Cassady of the Appalachian News-Express in Pikeville.

The act and the state's expansion of Medicaid under the law have made an estimated 9,915 people in the state's easternmost and geographically largest county eligible to receive health insurance, county Social Services Commissioner Carol Napier said at a Fiscal Court meeting last week.

“Of that number, 5,127 are now eligible for Medicaid,” she said, adding that 3,984 others are eligible to get subsidies for private health insurance.

The call to action also reminds people to apply before Dec. 15 to assure that their coverage will begin Jan. 1, Cassady reports. “There’s still yet those individuals that are under the impression that they don’t qualify,” Napier said.

Judge-Executive Wayne T. Rutherford, at the same meeting, reminded Pike County residents who apply through the state insurance exchange that they will not have to go through the national system, Cassady reports.

Kentucky's online health insurance exchange, Kynect, hailed by some as the best Obamacare website, is available to all Kentucky residents to explore their options, find out if they qualify for subsidies, and sign up for health insurance.

Cassady's story gives a list of local Kynect assistance sgencies, where people can call to ask questions or request help:
 • Pike County Health Department, (606) 437-5500
 • Mountain Comprehensive Care Center, (606) 432-3143
 • Big Sandy Area Development District, (606) 886-2374
 • Appalachian Research and Defense Fund of Kentucky, (606) 886-3876
Citizens of Pike County can also call the county Social Services office at (606) 432-6246 with questions about their eligibility for health insurance under the Patient Protection and Affordable Care Act. (Read more; subscription may be required)

Health care's culture doesn't encourage doctors to report medical errors of colleagues; article says patients should come first

By Melissa Patrick
Kentucky Health News

Doctors are often aware of their colleagues' medical errors, but fail to report them because of a culture that does not support or encourage such actions, Marshall Allen writes for ProPublica, a non-profit, non-partisan journalism organization.

Medical errors are estimated to kill 400,000 people in U.S. hospitals each year according to an online article by John T. James in the Journal of Patient Safety, causing some to say that medical errors are one of the nation's leading causes of death, Allen reports.

According to a report from the U.S. Department of Health and Human Services, most health-care providers employ a philosophy of "deny and defend" when confronted with issues related to medical errors. Providers fear full disclosure will lead to more lawsuits, higher jury awards, higher insurance premiums, and the loss of reputation or coverage for the provider, the opposite is true, the HHS report says. It says honest and open communication helps to lessen malpractice costs.

The Department of Veterans Affairs Medical Center in Lexington has led the way in the move toward health-provider transparency. It has worked under a philosophy of full transparency and disclosure since 1987, requiring prompt reporting and investigation of medical errors and near misses, full investigation, full disclosure of investigation results to the patients and families who have been injured because of accidents and medical negligence, and expressions of apology and  fair remedy, including compensation for injuries, according to the HHS report.

Several years ago, Allen contacted a Las Vegas surgeon to follow up on hospital data that showed peers of this surgeon that had high rates of surgical injuries. Allen reported that before he could reveal the list of peers to the surgeon and request his services in the investigation, the surgeon shared stories of the many surgeries he and his partners did to "clean up" the mistakes of "the worst surgeons in town" and said "he did not need a database to tell him which surgeons made the most mistakes."

An article in the New England Journal of Medicine, “Talking With Patients About Other Clinicians’ Errors,” says that although there is a common belief that there is an ethical duty to inform patients who have been harmed by medical errors, physicians often do not.

The existing guidelines emphasize ethical duties related to self reporting when physicians make  errors, says the report, but offers little guidance about what to do when they discover someone else's mistake.

In a survey separate from the New England Journal of Medicine report, but led by the same main author, more than half of doctors said that in the previous year they had identified at least one error by a colleague.  Gallagher told Allen that the survey did not ask what the doctors did about it.

For the New England Journal report, Dr. Thomas Gallagher, an internist and professor at the University of Washington, led a team of 15 experts who identified possible reasons doctors stay silent about errors by their peers. One reason is the system of referrals on which doctors depend, Allen reports; if a physician "becomes known as a tattler" he or she will lose referrals, and thus suffer financially.

The report lists other reasons for not reporting colleagues' medical errors, such as lack of time to investigate, a culture that promotes loyalty and solidarity, concerns about harming one's institution or becoming involved in a medical malpractice case,  concerns about causing a colleague to face legal issues,risk of acquiring an unfavorable reputation with colleagues and issues related to cultural differences, gender, race and seniority.

The bottom line, Gallagher told Allen, is that "physicians are not learning from their errors and patients are not getting the information they need to receive proper treatment or compensation when the outcome is harmful."

Dr. Brant Mittler, a cardiologist who works as a medical malpractice attorney in Texas, told Allen that in almost four decades in medicine he often saw errors and stayed quiet because "there would have been hostility" if he had reported them. “There’s not a culture where people care about feedback,” Mittler said. “You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you."

Gallagher told Allen, "The result of this culture is too much leniency toward mistakes."

The New England Journal article said that despite the challenges of disclosure, the patient comes first, and doctors should "explore, not ignore" a colleague's error, Allen notes.

Once an error is suspected, the report suggests, the doctor recognizing the error should find the facts, starting with a direct conversation with the physician who made the error so together they can decide how to inform the patient. The article also suggests that hospitals and other health-care institutions lead by supporting transparency.

Dr. David Mayer, vice president of quality and safety at Medstar Health, which runs 10 hospitals in Maryland and Washington, D.C., told Allen that "reporting of medical errors (and near misses) is a top priority at the organization so everyone can learn from mistakes, saying that each month there are about 1,400 reported safety events."

The safety events are analyzed for trends, Mayer told Allen.  If a patient is harmed, an investigation is conducted and the information is disclosed to the patient and family, an apology can be made and compensation can be offered.

Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, which provides guidance for how state boards regulate doctors, told Allen that doctors and other providers should be more assertive about reporting errors. "Failing to tell a patient about another doctor's mistake undermines the doctor-patient relationship," Chaudhry told Allen. "It makes patients wonder if they can trust their own physicians and the profession of medicine."

Bill Clinton says Obama should keep promise on insurance, but knows that won't work, Washington Post writer says

Former president Bill Clinton's recent statement that President Obama should change the health-reform law to keep his promise that people who liked their health-insurance plans could keep them or ironic because "He's the reason Obama made the disastrous promise in the first place," Ezra Klein writes for The Washington Post.

"Veterans of the effort to pass Clinton's health-care plan believed that their core mistake was producing a plan that upended the insurance arrangements of almost every American," Klein reports. "In the aftermath of Clinton's failure, health-care reformers swung far to the other side. Rather than building a plan in which almost everyone lost their insurance, they began trying to build plans in which almost no one lost their insurance — and selling them under the promise that literally no one would."

But that promise "went too far," Klein writes, because "saying 'everyone who likes their health insurance can keep it' is very different from saying '95 percent of people who like their health insurance can keep it'." However, Clinton "knows that it's functionally impossible to reform the health-care market if you upend nothing." (Read more)

Draft plan for a statewide campaign for better health gets endorsement, much talk at Friedell Committee annual meeting

By Al Cross
Kentucky Health News

A statewide committee of volunteers is on target with its plan for a campaign to make Kentucky a healthier state, an expert in state and local health told the committee Monday.

“You guys are absolutely on the right track,” Julie Willems Van Dijk of the University of Wisconsin told the Friedell Committee for Health System Transformation at its annual meeting in Lexington.

The committee is developing a campaign that would involve many partners around the state, including health-care providers, education and business leaders, state and local health officials, and other groups and individuals interested in improving Kentucky’s poor health. The draft campaign’s working motto is “healthier, wealthier and wiser,” reflecting how education, health and economic development are related.

“Your three-legged stool of health, industry and education fits solidly within the model we’re talking about,” said Van Dijk, deputy director of the County Health Rankings and Roadmaps Program funded by the Robert Wood Johnson Foundation.

Dr. Lee T. Todd Jr.

Kentucky’s health rankings – we’re first in smoking, cancer deaths and preventable hospitalizations – prompted Dr. Lee T. Todd Jr. to dub such statistics “the Kentucky uglies” when he was president of the University of Kentucky. Now part of the group developing the campaign, he told the committee in a keynote speech Sunday night, “Those are things we need to remember and repeat.”

Noting the low life expectancy in many Kentucky counties, and the wide range of life expectancy among Louisville neighborhoods, Todd asked, “Why can’t people get excited about that, or disappointed, or just mad about it?”

Kentucky ranks 44^th among the states in health, and “The bottom line is, it hurts us economically,” Audrey Haynes, secretary of the state Cabinet for Health and Family Services, told the committee Monday.

Todd noted how San Antonio reduced its obesity rate after losing a prospective employer that cited how fat the city’s sixth-graders were. He said local communities should “get mad about something and decide you’re going to change something. . . . We have just got to stop tolerating ill health.”

As examples, he cited Grant County’s successful effort to improve its health ranking, the Hopkins County oral-health program that reduced premature births, and Clark County’s effort – now funded by a small extra tax – to varnish students’ teeth to prevent cavities.

“Why can’t we get this stuff to roll across this state and make a big difference?” Todd asked. He suggested that one reason has been a shortage of leadership and courage, as demonstrated by the political dominance of traditional industries with health implications, such as coal and tobacco.

Todd said the committee needs to find “a market driver” like the state Supreme Court ruling that forced education reform in 1990 or the Russians’ launch of the first man-made satellite in 1957, which prompted national reform of science and math education.

He said the federal health-reform law could provide that spark, because it will bring many people into the health-care system and provide free preventive services. He suggested a targeted effort, such as getting the newly enrolled to check their A1C hemoglobin (a rough measure of blood sugar and an indicator of diabetes), and predicted the tests would show many of them “are diabetic but didn’t know about it.”

While the statewide campaign can focus on certain things, Todd said, it “can’t be viewed as outsiders” giving direction to local communities. He said the effort must be led by people in local communities, focusing on their local health problems. Willems said the committee could set strategic priorities from which communities could select.

As the committee met Monday, Todd and Committee Chair Jane Chiles of Lexington said the campaign needs grant money and a staff. “This subject is too important for us to nickel-and-dime it,” he said.

As Chiles adjourned the meeting, she said of the proposal, “This is a winning concept, a winning strategy.”

For a PDF copy of the committee’s draft proposal, click here.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. Al Cross is director of the Institute and a member of the Friedell Committee.

FactCheck.org finds little support for Sen. Rand Paul's claim that Medicaid expansion will 'bankrupt' Kentucky hospitals

U.S. Sen. Rand Paul said on ABC's "This Week" Sunday, Nov. 3 that the federal health-reform law may "bankrupt" rural Kentucky hospitals "by overwhelming them with Medicaid patients." However, health-care leaders in the state "say its hospitals stand to benefit, since the expansion would provide insurance to those who otherwise wouldn’t be able to pay their hospital bills," reports FactCheck.org, a nonpartisan service of the Annenberg Public Policy Center at the University of Pennsylvania.

Sen. Rand Paul (ABC News)

Paul made his remarks when host George Stephanopoulos asked him if the successful launch of the state's insurance exchange showed that Obamacare can be successful. "Well, nearly 90 percent of them are signing up for Medicaid, free health insurance from the government," Paul replied. "My concern is not that we shouldn’t help people. I do want to help these people to get insurance. But there is going to be a cost. And in my state, we have a lot of rural hospitals that teeter in the balance. My fear is that these hospitals may be bankrupt by overwhelming them with Medicaid patients."

At the time Paul spoke, the latest figures were that 85.7 percent of Kentucky enrollees were in Medicaid. A week later, the figure had declined to 82 percent of a total of 40,572. Exchange Director Carrie Banahan said Nov. 10 that she expects the Medicaid percentage to be about 70 percent by Dec. 31. She noted that Medicaid qualification is faster than enrolling in a private health plan because the income qualification is automatic, and 16,425 people have been determined eligible for subsidies for private plans through the exchange.

Gov. Steve Beshear announced in May that the state would expand Medicaid to people with incomes up to 138 percent of the federal poverty level; the previous threshold was 69 percent.

Eugene Kiely of FactCheck notes that the Robert Wood Johnson Foundation and Urban Institute said in March 2013 that hospitals should expect more revenue from Medicaid expansion; that the month before, Kentucky Hospital Association President Michael Rust said likewise; and so did Foundation for a Healthy Kentucky President Susan Zepeda several months earlier.

"That’s not to say there are no concerns in Kentucky about expanding Medicaid," Kiely writes. The state does not have enough medical providers to serve its population, even without the 300,000 residents who are newly eligible for Medicaid. In an email to Kiely, Zepeda said the foundation "remains very concerned about the capacity of the state's health-care system, particularly in rural areas, to cost effectively care for a much larger number of patients."

Zepeda also noted the problems that hospitals have had being paid by insurance companies that are now managing Medicaid for the states, but the foundation "still believes the state’s residents and hospitals will benefit from the expansion," Kiely reports.

Paul's staff did not respond to inquiries from FactCheck. For its analysis, click here.

Some schools let kids with live head lice stay; policy change has some Kentucky parents scratching their heads

By Molly Burchett
Kentucky Health News

School districts across the country are adopting policies that say students diagnosed with live head lice or nits (louse eggs) can remain in school and parents don't need to be alerted when their child comes in contact with lice. Others schools say they will keep strict lice policies and will continue to alert parents about lice infestations. What's the policy at your child's school?

The American Pediatric Association, the Harvard School of Public Health and the National Association of School Nurses recommend that schools discontinue "no-nits" policies, taking the position that students should not be excluded from school due to suspected head lice or due to nits only. The Kentucky Department of Education and the Kentucky School Board Association also support this recommendation.

The organizations say "no-nit" policies that require a child to be free of nits before they can return to schools should be discontinued because nits are very unlikely to hatch and become crawling lice, nits are cemented to hair shafts and are unlikely to be transferred to another person, and the burden of absenteeism to the students and communities isn't doesn't outweigh the risks of head lice.

This policy shift is designed to help keep children from missing class and to shield children with lice from embarrassment, but these more lenient policies are bugging some parents, reports Jennifer Kerr of The Associated Press.

One school in Paducah says its strict policy about alerting parents if their child gets lice won't change anytime soon, reports Mychaela Brunen of WPSD-TV.

Vicki Brantner has been a school nurse at McNabb Elementary School in Paducah for six years and says the school's strict lice policy is here to stay. "When we have somebody that has head lice, we have a step-by-step procedure that we give to them to take home, it's not only washing the hair, but you have to clean your environment," Brantner told Brunen.

"We have a no-nit policy which means not only can they be here if they have the actual bug, but all the eggs removed also," said Brantner. She said parents with elementary school-aged kids should check their child's hair for lice once a week.

Marcey Davis, a mother of five, said she appreciates getting notices about lice infestations from McNabb Elementary. "It keeps me informed as a parent, as to what's going on in their classrooms and the school," she told Buren. "Parents need to stay on top of in order to keep a lice-free school, at the risk of embarrassing my child, I would rather know about it."

The head louse is a parasitic insect that can be found on the head, eyebrows, and eyelashes of people, and the CDC estimates that 6 million to 12 million infestations occur each year between schoolchildren between the ages of 3 and 11. It is much more common for schoolchildren to get lice because schools bring large numbers of children together where they are in close contact with each other, reports Mike Potter of the University of Kentucky College of Agriculture.

Here are some tips from the CDC that can be used to prevent and control the spread of lice:

• Avoid head-to-head (hair-to-hair) contact during play and other activities at home, school, and elsewhere (sports activities, playground, slumber parties, camp). 
• Do not share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or barrettes.
• Do not share combs, brushes, or towels. Disinfest combs and brushes used by an infested person by soaking them in hot water (at least 130°F) for 5–10 minutes. 
• Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.

National Rural Health Day to be held Nov. 21, including webinars on current topics

The third annual National Rural Health Day, which brings awareness to rural health issues and current efforts in addressing these issues, will be observed with events nationwide and special presentations in Sterling Heights, Mich., Nov. 21.

The National Organization of State Offices of Rural Health and all 50 state offices of rural health said in a news release that health concerns of the 60 million rural Americans include: a lack of health care providers; accessibility issues, particularly transportation and technology; and affordability, as the result of higher out-of-pocket costs and other factors.

"Meanwhile, rural hospitals and health systems face declining reimbursement rates and disproportionate funding levels that make it challenging to meet the physical, social and economic needs of their communities," organizers say.

The observance also focuses attention on state rural-health offices, which foster relationships, disseminate information and provide technical assistance that improves access to quality health care for rural citizens, according to the news release.

National Rural Health Day events include several free webinars. Topics, times, and speakers are:

• AgriSafe: Protecting the People Who Feed America (Noon EST) – Natalie Roy, executive director and Carolyn Sheridan, clinical director, AgriSafe Network (Registration: https://www3.gotomeeting.com/register/491563334)
• Rural 101: The Basics of Rural Health (1 p.m. EST) – Kristine Sande, program director, Rural Assistance Center (Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=660990830) 
• Population Based Health and Health Promotion in Rural (2 p.m. EST) – Lynda Bergsma, program director, Arizona Center of Rural Health; Caroline Ford, former director, Nevada State Office of Rural Health (Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666479151)
• The Affordable Care Act in Rural America (3 p.m. EST) – Tom Morris, associate administrator; Deepti Loharikar, public health analyst, and Aaron Fischbach, public health analyst, federal Office of Rural Health Policy (Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666426441)
• Resources for Recruitment, Networking, and Telehealth (4 p.m. EST) – Mike Shimmens, executive director, National Rural Recruitment and Retention Network; Rebecca Davis, executive director, National Cooperative of Health Networks Association; Kathy Hsu Wibberly, director, Mid-Atlantic Telehealth Resource Center (Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=664434416)

The rural health offices' national organization will have a National Rural Health Day press conference and celebration at the National Press Club in Washington at 10 a.m. EST Nov. 21. To learn more about the observance, visit http://celebratepowerofrural.org. Contacts: Bill Hessert at 814-360-1964, billh@nosorh.org; Teryl Eisinger at 586-850-5257, teryle@nosorh.org.

Kentucky, in Diabetes Belt, needs to do more to keep percentage of residents with costly disease from rising, advocates say

By Dr. Gilbert Friedell and Isaac Joyner

World Diabetes Day is Nov. 14, and we urgently need to address this plague right here at home. Diabetes is a major public health problem — an epidemic — in the United States. One out of 10 people over the age of 20 now has diabetes, primarily Type 2 or “adult onset” diabetes, and the disease is rapidly increasing. This increase has been particularly striking in the several Southeastern states comprising what the federal Centers for Disease Control and Prevention calls the “Diabetes Belt.”

PERCENTAGE
OF ADULTS

In Kentucky, one of eight people now has the disease — a frightening fact. Even more frightening: one-fourth of those with diabetes do not know they have the disease! If this epidemic is not interrupted, by 2050 about one out of three people in this country will have diabetes. For minorities, that figure will be closer to one out of two.

Diabetes itself poses a significant health problem, but the real burden of the disease is its complications. The high blood-sugar levels characteristic of diabetes, plus the effects of high blood pressure and elevated cholesterol levels, damage both small and large blood vessels. Over time, those with diabetes frequently go blind, have a toe or foot amputated, lose kidney function and frequently die of a stroke or heart attack. These complications are BAD: blindness, amputations and dialysis.

The cost of diabetes is staggering. In 2025 its annual direct and indirect cost to the country is projected to exceed $500 billion. Here’s what we need to do about this epidemic.

First, we need to focus on primary prevention of the disease, and that means stressing proper nutrition and regular exercise. Early childhood is the time to begin good dietary habits, and the conscious selection of food for school snacks and lunches provides an excellent opportunity for establishing these habits.

With young people and adults, a structured program of weight loss and exercise can prevent the onset of diabetes among about half of the overweight population that has elevated but not diabetic levels of blood glucose.

At the community level, we need active engagement by local health departments and officials interacting with the population. We recommend the creation of broad-based Community Diabetes Control and Prevention Councils, with health providers, business leaders and teachers, along with diabetes patients and their advocates.

At the state level, we need mandatory screening of all adults, and mandatory reporting of all new cases of diabetes to a state diabetes registry. Strong support from the federal government must be provided for these efforts, and for local health departments.

Diabetes prevention will require a significant change in the behavior of patients, health providers, communities and government. This will not be easy, but the current fragmented way in which we deal with diabetes is not working. It is long past time for greater public recognition of the grave threat that the diabetes epidemic poses — and for a rational, coordinated response to it.

Gilbert Friedell and Isaac Joyner, of Lexington, are co-authors of The Great Diabetes Epidemic: A Manifesto for Action.

Friedell Committee will consider what it will take for Kentucky to become a healthier state at meeting Sunday and Monday

What will it take for Kentucky to become a healthier state? That will be the question at the fall meeting of the Friedell Committee for Health System Transformation, at the Marriott Griffin Gate in Lexington Sunday, Nov. 10 and Monday, Nov. 11. Participants will examine how the committee can work with communities and individuals to create a Kentucky that is “healthier, wealthier, and wiser,” a possible motto for a campaign the committee is considering.

“We have learned that building a healthier Kentucky will depend largely on what we do beyond the health-care system,” said Richard Heine, executive director of the committee. ”Efforts to promote good health must take place in the environment where people live, work, and play. For Kentuckians to be healthier, we must address the factors behind the problem of poor health, such as lack of education, poverty, poor nutrition, lack of employment, violence, transportation, and housing.”

Topics at the meeting include the state Health Benefit Exchange, managed-care Medicaid, the state’s financial situation, successful local policy changes, and the prevention and control of Kentucky’s major health challenge: diabetes.

Lee Todd, former president of the University of Kentucky, will be the keynote speaker Sunday evening and will introduce components of the committee’s campaign for a healthier Kentucky, now being formulated. Monday’s morning sessions will focus on public health, with discussions of county health rankings, public health partnerships with communities, and opportunities for progress in the health of Kentucky. Afternoon sessions will look at education partnerships and Kentucky’s workforce.

This meeting is funded in part by a grant from the Foundation for a Healthy Kentucky. For a copy f the full agenda, click here. For more on the committee, click here.

Obamacare's employer mandate poses challenges for schools

While Kentucky public-school employees get their health insurance through the state’s self-funded program and don't have to worry too much about how federal health reform may affect them, their employers do, Madelynn Coldiron points out in the November issue of the Kentucky School Board Advocate.

“School districts probably thought that they were not involved in the ACA or it was not a hot-button issue for them, but it really is,” Shannon Stiglitz, a lobbyist for the Kentucky School Boards Association, which publishes the Advocate, told Coldiron. “They do have roles and responsibilities under the Affordable Care Act and they need to be aware of them or costly penalties could be incurred.”

The law will require employers with 50 or more employees working 30 hours or more a week or 130 hours a month to cover them or pay a fine starting Jan. 1, 2015.  Almost all Kentucky school districts have at least that many employees, said Susan Barkley, assistant director of the state Department of Education's Division of District Support, which created an ACA implementation guide for school districts.

The law means that districts may have to make some employment changes, or changes to employment policies. What’s very complicated for schools is documenting actual time worked for people in positions like substitute teachers, paraprofessional coaches and part-time employees, Barkley told Coldiron. And, Stiglitz said, districts must be careful because if a school district worker who is eligible for coverage instead purchases a health plan from the state’s marketplace, the district faces a big fine.

To control costs, local boards can amend policies to limit the number of hours or days that “variable hour employees” like substitute teachers or coaches may work, Bass said. Or, substitutes who turn down assignments after they've worked enough hours to qualify for health insurance may be terminated. News reports across the country have detailed school systems' plans to cut some substitute teachers and college adjunct professors as a result of the health law's mandates.

"School districts are facing vexing financial and operational questions about how they will comply with the Affordable Care Act, which some administrators say is forcing them to choose between absorbing the hefty costs of health coverage for currently uninsured employees or cutting back on those workers' hours," reports Sean Cavanagh of Education Week.

Next week the federal House Committee on Education and the Workforce will hold a hearing to learn more about how the health law is affecting schools. Meanwhile, districts are waiting for additional Internal Revenue Service guidelines regarding substitute teachers and short-term employees.

For more information about the health law's impact on Kentucky's school districts, click here to view the education department’s ACA guide.