Kentucky is one of only 2 states where adult obesity rose last year; now we're fifth in the nation; state diabetes rate highest ever

By Melissa Patrick
Kentucky Health News

We're fat, and getting fatter. And that's making us sicker.

More than one-third of Kentucky adults are obese, placing the state fifth in the country in obesity, a big jump from 12th the year before. Kentucky was one of only two states where obesity rates increased from 2014 to 2015, according to the latest State of Obesity report.

Graphics are from the State of Obesity report

Kentucky's adult obesity rate increased to 34.6 percent in 2015, up from 31.6 percent in 2014. In 1990, only 12.7 percent of Kentucky adults were obese. Get the adult obesity rate in your county at KentuckyHealthFacts.org.

“Obesity remains one of the most significant epidemics our country has faced, contributing to millions of preventable illnesses and billions of dollars in avoidable health care costs,” Richard Hamburg, interim president and CEO for Trust for America's Health, said in a news release.


"Obesity continued to put millions of Americans at increased risk for a range of chronic diseases, such as diabetes and heart disease, and costs the country between $147 billion and $210 billion each year," says the release.

The report, "The State of Obesity: Better Policies for a Healthier America," is conducted by Trust for America's Health and the Robert Wood Johnson Foundation and is based on data from the federal Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, a continuous national poll.

Most obese Kentuckians fall between the ages of 26 and 64, with 36.8 percent of those aged 26-44 obese and 40.5 percent of those aged 45 to 64 obese, says the report.

The report found that black Kentucky adults were the most likely to be obese, at almost 43 percent, followed by whites (32.9 percent) and Latinos (24.3 percent). There was little difference between men and women.

The report also measured obesity-related health issues, such as diabetes and high blood pressure.

Kentucky's reported diabetes rate is at its highest ever, 13.4 percent, which places it fourth in the nation. This is up from 12.5 percent in 2014 and 10.6 percent in 2013. The report projects that almost 600,000 Kentuckians will have diabetes in 2030.

"Diabetes is the seventh leading cause of death in the United States, accounting for around $245 billion in medical costs and lost productivity each year," says the report.

The state's high-blood-pressure rate, at 39 percent, is about the same as the year before. The state ranks sixth in this measure. The report projects that 1,175,750 Kentuckians will have high blood pressure in 2030.

"Approximately 30 percent of hypertension cases may be attributable to obesity, and the figure may be as high as 60 percent in men under age 45," the report says. "People who are overweight are more likely to have high blood pressure, high levels of blood fats and high LDL (bad cholesterol), which are all risk factors for heart disease and stroke."

The report also updated high-school obesity rates and found that Kentucky's 18.5 percent was about the same as the last time such data were gathered in 2013. But because some other states' rates went up, Kentucky no longer ranks first in the nation. We're third.

The report notes that Kentucky adults fall into the top 10 states for the highest rates of physical inactivity (32.5 percent); states with the highest rates of obese 10- to 17-year olds (19.7 percent); and states with the highest rates of obesity among 2- to 4-year-olds (15.5 percent).

Kansas and Kentucky were the only two states to see obesity increases in 2015. Most remained steady, and four states saw a drop: Minnesota, Montana, New York and Ohio.

Nine of the 11 most obese states are in the South, and 22 of the top 25 are in the South and Midwest. Louisiana has the highest obesity rate, 36.2 percent.

More than half the states have obesity rates at or above 30 percent, with four above 35 percent. Obesity rates are above 20 percent in every state; in 1991, no state had a rate above 20 percent.

The authors outline a set of policy recommendations to combat obesity, including: investment in obesity prevention; focusing on early-childhood and school-based policies and programs that support healthier meals, physical activity and less screen time; prioritizing active transportation planning and access to healthy foods in communities; and covering a full range of obesity prevention, treatment and management services under all public and private health plans.

“These new data suggest that we are making some progress but there’s more yet to do. Across the country, we need to fully adopt the high-impact strategies recommended by numerous experts," Hamburg said. "Improving nutrition and increasing activity in early childhood, making healthy choices easier in people’s daily lives and targeting the startling inequities are all key approaches we need to ramp up."

CDC doesn't deliver on reported promise to probe health effects of surface coal mining, but other federal agencies are tackling it

When Shaping Our Appalachian Region was formed to help improve and diversify the economy of Appalachian Kentucky, one of the 10 working groups on issues was about health, which is not good in the region.

As the working group held 16 meetings around the region, it heard repeated concerns about the health impacts of surface coal mining, which has evolved from small contour-strip mines around hillsides to huge mines that take the tops off of mountains.

At every meeting, someone brought up the West Virginia University research that showed a correlation between poor health and surface mining, such as increased rates of cancer and birth defects, according to Dr. Nikki Stone, a University of Kentucky dentist in Hazard.

Dr. Nikki Stone (Photo by Mimi Pickering, Appalshop)

“It was something that people were afraid to talk about, but it came up over and over, and it ended up at the top of our list,” along with a coordinated health program in schools, Stone told Benny Becker of West Virginia Public Broadcasting. "In its final report, the working group advised that SOAR should ask a federal agency for help studying the issue," Becker notes.

But when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. At the health session of SOAR's "Strategy Summit" in May 2015, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the federal Centers for Disease Control and Prevention, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it. But when questioned about it, she said that she had heard about it.

Davis told Becker that CDC Director Thomas Frieden told the working group when it presented its recommendations that if they made a request the CDC would investigate. "Davis said that as far as he knows, that was the last time anybody from the CDC acknowledged the request. The CDC recently confirmed that the agency is not engaged in any such research," Becker reports. "It’s not clear where exactly things got stalled, but SOAR Executive Director Jared Arnett said there’s a reason why the group tends to steer clear of environmental issues."

“It’s about uniting, and a lot of things that may not be a part of SOAR that people want to be a part of SOAR are very divisive,” Arnett told Becker. He said earlier that the group would focus its health efforts on substance abuse, obesity and diabetes.

Davis told Becker, “If we want our talent to be part of what turns our region around, then it’s not really going to help us to sweep big questions about cancer and birth defects under the rug. . . . It’s about building an economy in a place,” Davis said, “and part of that is making sure that our communities are places people want to live.”

But while CDC hasn't acted, two other federal agencies have. At the request of the state of West Virginia, the federal Office of Surface Mining Reclamation and Enforcement gave the National Academy of Sciences $1 million to examine existing research, primarily done by Indiana University's Michael Hendryx when he was at West Virginia University. "Another study, from the National Institute of Environmental Health Sciences, was announced last year, and has already produced a draft," Becker reports. "NIEHS Director Linda Birnbaum recently visited eastern Kentucky and said she expects that study will be released within the year."

New health chief says drug crisis takes up most of his time; wants to guide kids to make better choices about tobacco, drugs, alcohol

Dr. Hiram Polk

By Melissa Patrick
Kentucky Health News

One of new Public Health Commissioner Hiram Polk's top priorities is to create an early-childhood education program to help Kentucky's children become healthy, drug-free adults. But when it comes to smoking bans, not so much.

"I have been on this job for eight to 10 weeks, and I've spent more effort on the drug thing than I have on anything else," he said. "The big-picture issue is to take a long-term look at tobacco, drug and alcohol use and find a way through education to make kids more likely to be immune to that when they grow up."

Health Secretary Vickie Yates Brown Glisson appointed Polk, 80, of Louisville, after searching for months for a doctor who would take the job. State law requires the commissioner to be a medical doctor.

Polk said he first declined the position, but changed his mind, then told Glisson he would stay only through the 2017 legislative session. However, he said he has since hired a driver, and that this "crucial" decision could very well influence his decision to stay longer.

"What has turned out is that this is a wonderful job," he said.

His stance on some issues

Polk said that one of the first things he would like to accomplish as health commissioner is to create an education program to teach young children how to live healthy, drug-free lives, and then find a way to set up and fund a foundation to research the outcomes of the program in 10 to 20 years.

"If there is a secret to drug, tobacco and alcohol addiction, it is through very early childhood education. I believe that," he said.

When asked if he would be willing to promote a statewide smoking ban, which Gov. Matt Bevin opposes, he said he probably wouldn't.

"I would be willing," he said, "but it doesn't have anything like the emotional appeal of some of these other things, like the drug addiction does."

Also, "I have an idea about drug addiction, but I don't have an idea of how to do better with tobacco," Polk said. "If somebody walked in here with a good idea, I'd listen and probably try to implement it, but I just don't see that happening."

Smoke-free advocates would likely say they have already offered up a "good idea" to decrease the smoking rate in the state, improve the health of the state's citizens and save the state an enormous amount of money: a statewide ban on smoking in workplaces.

To this suggestion, Polk reflected on the difficulties in enforcing such a ban, noting that while government property and buildings are now smoke-free in the state, smokers still stand outside.

"I'm not saying it's not important," he said. "I think it's important. It's vitally important, but there are an awful lot of smart people who have taken a run at that and have failed and I might not try it."

Kentucky's smoking rate is 26 percent, second highest in the nation. The national rate is 18 percent. A recent study said that if the state could cut its rate to the national one, it would save an estimated $1.7 billion on health care the following year. Smoking bans and smoke-free policies have been proven to decrease the smoking rate and to protect workers from secondhand smoke. The latest Kentucky Health Issues Poll found that 66 percent of Kentucky adults favor a statewide smoking ban.

When asked if his department would support local health departments in efforts to get local governments to pass smoking bans, he shifted the conversation and said his first priority for local health departments is to re-establish a positive working relationship with them. He said he has recommended the hiring of a new deputy commissioner to work solely on this effort.

"I want to make those local health departments feel like they are connected to us, that we are their friends and they can call on us anytime, any place for help," he said.

As for mandating the human papilloma virus vaccination, which has been proven to prevent cervical cancer and genital warts, Polk said he supports Gov. Matt Bevin's stance on minimizing mandates.

"I would try to find every way you can to softly encourage the uniform use of that vaccine," he said. "But I wouldn't start requiring something."

Polk noted that he was very much aware of the state's rural health issues, having started the first rural surgical education program in America in 1972. But he also said he was surprised by the number of disparities that still exist in Eastern Kentucky.

"I'm surprised by how really under-served and deprived some of the things in Appalachia still are," he said. "I thought all of these Appalachian programs by now would have had some success, but they are still behind the curve on virtually everything . . . poverty, lack of education, misconduct. It is terrible. There are some problems that aren't going to be easily solved."

A new line of work

Polk praised the abilities and the passion of those who work in the Cabinet for Health and Family Services several times during the interview, suggesting they made his job easier.

"I am absolutely amazed at the quality of people who work in the trenches.They are the most altruistic, unselfish people I have ever seen," he said. Later adding, "The quality of the people and their commitment to the organization, their belief in what they are doing is fairly amazing."

Polk is an internationally renowned surgeon, but has little background in public health. He described himself as having "always been pretty busy."

He is a graduate of Harvard Medical School and was chairman and professor of surgery at the University of Louisville from 1971 to 2005, where he trained more than 330 surgical residents and started one of the world's first hand-transplant programs. He remains a professor emeritus and the surgery department is named for him.

Polk is widely published. He served as editor-in-chief of the American Journal of Surgery for 16 years and was chair of the accrediting body for Surgery in America for seven. He has served as Kentucky chair of the American Cancer Society and serves as a director of the Biomedical Research Foundation, which funds research on veterans' health. He is a director of the Thoroughbred Owners and Breeders Association and a steward of The Jockey Club.

Attorney general, stiffed again by UK's refusal to let it examine heart-clinic records, says university violated Open Records Act

Attorney General Andy Beshear has ruled that the University of Kentucky violated the state Open Records Act by not giving the Lexington Herald-Leader records about a Hazard heart clinic that proved to be a financial debacle.

"The Herald-Leader asked UK for a copy of a presentation made May 2 to the UK Board of Trustees by lawyer David Douglass regarding the Appalachian Heart Center in Hazard," the newspaper's John Cheves reports. "The newspaper also asked for records showing money paid to Douglass’ law firm and for copies of audits of the cardiology practice, which separated from UK after questions were raised about its billing."

UK gave the paper on a few documents, "citing five separate legal exemptions under the records law, including executive privilege, attorney-client privilege and the confidentiality required by the federal Health Insurance Portability and Accountability Act," Cheves writes. The paper appealed to Beshear's office, which asked to examine the records in camera, or confidentially, but the university refused, as it has in a string of cases.

“Given that UK refused to provide any of the disputed records for in camera review, we can only find that UK failed to meet its burden to establish any of its claims of exemptions,” Assistant Attorney General James wrote in his decision, signed by Beshear and issued Wednesday. “We are not prepared to accept, without independent confirmation, that all of the responsive documents are shielded from public inspection.”

James dismissed all the exemptions cited by UK. "Regarding the patient confidentiality required by HIPAA, James said, UK can redact identifying information about patients from documents that contain them, but it cannot use that law to justify withholding all records related to a medical facility," Cheves reports.

Attorney general's opinions in open-records matters are decisions that have the force of law unless overturned by a court. UK seems likely to do so in this case; it has more than one such lawsuit pending.

10 Ky. health departments nationally accredited, 30 in pipeline

By Melissa Patrick
Kentucky Health News

Ten Kentucky health departments are now nationally accredited, with about 30 more in the pipeline, placing Kentucky third in the country for the number of health departments to have earned this status.

The Public Health Accreditation Board accredited Louisville Metro Public Health and Wellness on Aug. 17, making it the 10th in the state.

What does it means for a health department to be accredited? "It means that it is one of the finest health departments in the nation, and that it can assure its citizens that it has the capacity to meet any of the public health problems that that community might address," said PHAB Chair Dr. Douglas Scutchfield, the Peter Bosomworth Professor of Health Services Research and Policy at the University of Kentucky.

Kentucky has led the way in getting its health departments accredited. In 2013, Franklin County Health Department in Frankfort, Three Rivers District Health Department in Owenton and the Northern Kentucky Independent District Health Department were among the first 11 health departments in the nation to be accredited.

Since then, the Barren River District Health Department in Bowling Green, Bullitt County Health Department in Shepherdsville, Christian County Health Department in Hopkinsville, Green River District Health Department in Owensboro, Madison County Health Department in Richmond and the Lexington-Fayette County Health Department have been added.

Health departments are accredited for five years, and must re-apply for accreditation.

New state Health Commissioner Hiram Polk, who served seven years as the chair of the accrediting body for Surgery of America, emphasized the importance of accreditation, saying he plans to make sure the state Department for Public Health is accredited during his tenure, and encouraged all of Kentucky's local health departments to do the same.

"The accreditation process is hugely valuable," he said in an interview. "The process makes you better."

Scott Lockard, director of the Clark County Health Department, which plans to apply for its accreditation in January, agreed.

"We have already benefited from the process of preparing for accreditation," he said, because the process has created a "culture of quality improvement" in his organization. He said that because of the application process, which requires a community health assessment, his department now looks at programs based on what the community needs and the expected outcomes, instead of simply whether the funding is available to provide a service.

"Accreditation assures the public that there is a base level of professionalism that they can expect," Lockard said. "[And] feel confident that the health department in their community is serving them with high quality programs."

Scutchfield said engaging community partners in the community health assessment and community health improvement plan, which are both early accreditation requirements, often re-establishes relationships in the community that have been lost.

"Frequently people are unaware of the capacity and the activities of their local health department," he said. By engaging them in the process, it allows the health department to collaborate with others, like local hospitals, non-profits, fire-departments and schools, to help them with their missions, he said.

Scutchfield also noted that becoming accredited improves a health departments performance, governance and management systems, promotes quality improvements, helps departments better identify strengths and weaknesses, and helps boards and departments better provide their required 10 essential public health services. It also assures that certain plans and programs are in place to respond to both emergent and non-emergent situations.

"It provides credibility and accountability to the community. The community knows and can believe that its health department has met the rigorous standards of now some 150 health departments, out of the 2,600 in the United States," he said. "This is an important thing for health departments to do."

State health officials warn of looming 'public health crisis from dangerous drugs,' including heroin laced with potent Fentanyl

Kentucky health officials are warning that a "public health crisis involving dangerous drugs" looms over the state, and could hit this weekend, the Department for Public Health said in a press release.

“There is a public health crisis brewing – much like a tornado forming – with a new supply of heroin and other drugs coming into this area,” said Dr. Hiram Polk, the state health commissioner. “This is a serious public health threat tied to a number of overdoses, hospitalizations and deaths across the county and needs public attention now.”

Polk said officials expect a rise in recreational drug use on the Labor Day weekend, so they felt a warning was needed. “Recent law-enforcement reports cite a new supply of heroin laced with the drug Fentanyl coming into the state – especially Louisville,” Polk said. “These drugs are much more toxic and can cause respiratory failure and death. Over the coming days, DPH is asking hospitals and facilities to prepare for increases in drug overdoses so that individuals can be properly treated, deaths prevented and we are better informed about the prevalence and nature of these occurrences.”

The state is asking hospitals to expand emergency-room and intensive-care staff, have pharmacies stock up on Naloxone, the “antidote” to heroin and other drug overdoses. to assist patients who may need long term drug treatment.

“It can take as much as three times the amount of Naloxone to reverse a given overdose with these mixed drugs as it would normally,” Polk said.

Assistance is available by calling the health department at 1-888-9REPORT (973-7678) or the Kentucky Emergency Management System at (502) 607-1638 or 800-255-2587. “Many of these services are available 24 hours a day,” Polk said.

Report shows race and ethnicity matter when it comes to health

When it comes to health, your race and ethnicity matter, says a recent Foundation for a Healthy Kentucky report.

A study of federal and state polling data found that multiracial and black Kentuckians tend to report higher rates of smoking, obesity, asthma and poor mental health than their white counterparts, and that black and Hispanic Kentuckians are less likely to have health insurance than white Kentuckians.

"This report helps us see how race and ethnicity make a difference in how healthy you are, just as previous Foundation reports have shown that where you live and your education and income levels affect your health status," Susan Zepeda, outgoing president and CEO of the foundation, said in a news release.

Findings from the report, Health Disparities in the Commonwealth, A Report on Race and Ethnicity and Health in Kentucky, are based on federal and state Behavioral Risk Factor Surveillance System polling from 2011 through 2013. It is the third in a series of reports exploring health disparities in the state, with the first focusing on geographic disparities and the second on socioeconomic disparities.

The report looked at access to health care and preventive services, a variety of social and behavioral health indicators and health outcomes of Kentucky adults of different racial and ethnic groups.

Access to health care and preventive services

The report said there are "significant associations" between racial and ethnicity and access to care in Kentucky.

Lines atop bars indicate confidence intervals, or possible range
of percentages. The percentage given is the most likely one.

It found that white Kentuckians were less likely to forego medical care due to cost and Hispanics were most likely. Although, overall Kentucky adults forego medical care due to cost at a higher rate than the rest of the nation.

"Nearly 1 in 5 Kentucky adults (19.1 percent) reported that there was a time in the prior year when they needed to see a doctor but could not because of the cost," says the report. "Access to care was considerably more limited for Hispanic adults in Kentucky, with nearly 1 in 3 adults (28.9 percent) unable to afford needed medical care."

It also found that white Kentuckians were more likely to have a personal doctor than other races and ethnicities; and that black (25.6 percent) and Hispanic Kentuckians (34.1 percent) were less likely to have health insurance than white Kentuckians (16.7 percent).

Black Kentuckians reported they were less likely to have an annual flu shot (34.3 percent) than white Kentuckians (40.1 percent), whereas white Kentuckians were "significantly less likely" to have been tested for HIV than other racial or ethnic groups in Kentucky, 28.8 percent.

"The Centers for Disease Control and Prevention recommends that HIV screening be provided to everyone, as part of their routine health care, unless they decline to be tested," says the report.

Social and Behavioral Health

As for risky behaviors, except for binge drinking, Kentucky adults were more likely to smoke, be physically inactive, have limitations due to other health conditions and be overweight or obese than the rest of the nation. And these risky behaviors were higher in some racial and ethnic groups than others.

For instance, multiracial Kentuckians reported the highest rate of smoking in the state, 41.3 percent, between 2011-2013. The state's smoking rate, 27.9 percent, was significantly higher than the nation's rate of 19 percent. This group was also most likely to have activity limitations due to health conditions.

"Smoking increases the risk of cancer, heart disease,stroke and other chronic conditions, exacerbates asthma, and reduces overall health status," says the report.

The report also noted that while 66.9 percent of Kentucky adults were overweight or obese, black Kentuckians were "significantly more likely" to be overweight or obese (72.9 percent) than whites (66.8 percent), Hispanics (62.8 percent) and others (51.1 percent). The national average was 63.5 percent.

"Obesity is both a chronic disease and a risk factor for other diseases,including heart disease, stroke, type 2 diabetes and certain cancers," says the report.

On a positive note, Hispanics in the state reported getting more physical activity than other Kentucky adults or the average American.

Health outcomes

Overall, Kentucky adults reported poorer health status than the national average (23.2 percent and 18.1 respectively). Although Hispanic Kentuckians reported fair or poor health at a similar rate as other Americans.

Multiracial (24.4 percent) and other race (22.6 percent) adults in Kentucky were more likely to report poor mental health than white (15 percent) or black Kentuckians (14.8 percent).

Multiracial Kentuckians also reported slightly more asthma diagnosis (27.2 percent) compared to white (14.7 percent) and black (17.1 percent) Kentuckians.

Hispanic and other race Kentuckians were slightly less likely to report having diabetes.

The report says the foundation "believes that health disparities can be eliminated, and that they must be eliminated," and that this report helps to understand and monitor where they exist.

Zepeda said, "Understanding these disparities is an important step in enacting the policy changes and programs that can reduce and ultimately eliminate them."

Giving employees money to spend on local produce could improve their health, lower insurance costs, pilot program shows

Photo: Charles Bertram, Lexington Herald-Leader

A pilot program that gave Lexington-area employees money to spend on fresh, local produce boosted their health and local agriculture, Janet Patton reports for the Lexington Herald-Leader.

Tim Woods, a University of Kentucky agriculture marketing professor, introduced the idea to the UK Health and Wellness program last year, backing it up with data from research he did in 2015 that found people who eat local, fresh produce are healthier.

“We were thinking if we want to really make a solid case to our employers at the University of Kentucky, Baptist Health, [Lexington-Fayette] Urban County Government, all these other entities in the Lexington area, we have to be able to have some really solid research-based, carefully measured metrics to be able to state our case," Woods told Patton.

The research, published in the International Journal of Agricultural Sustainability, wanted to know if people were given a voucher to participate in a community supported agriculture program, would they do so? And if they did participate, did it make any difference in their health?

CSAs provide participants with a weekly allotment of seasonally available produce, eggs and meat and typically have an upfront cost of $600 to $750, Patton reports.

The study found that the 95 people who participated reported a long list of positive lifestyle changes, such as eating out less often, increasing their daily consumption of fruits and vegetables, and a decrease in prescription costs and doctor visits.

"Most importantly, their monthly expenditure at the pharmacy dropped from an average of $33.84 to $17.23, almost a 50 percent decrease," Patton writes. Also, the average number of doctor visits during the six-month program dropped to two from almost seven and a half.

Woods told Patton, "Improvements in these various health measures actually get better over multiple seasons. You see some movement after the first year, but after folks come back over the second year they are increasing fruit and vegetable consumption more. And the biggest advances are taking place amongst folks starting at the poorest places of health. That’s a really strong selling point to these self-insured organizations.”

UK Health and Wellness decided to create its own voucher pilot that included 200 CSA shares after Woods shared his research findings with them. Soon after, Appalachian Regional Healthcare in Hazard joined in and offered 50 shares to its employees. And then Hospice of the Bluegrass offered 30 shares to its employees, Patton reports.

“We are a self-insured plan so the cost of keeping someone off medication is certainly paying for the cost of her food box," Liz Fowler, president and CEO of Hospice of the Bluegrass, told Patton.

Sandy Canon, president of Bluegrass Harvest, which administers the program, told Patton that they hope to expand to about 1,500 shares next year and that she is targeting the 108 self-insured employers in Kentucky first.

Hospice of the Bluegrass has committed to doing the program again next year. UK Health and Wellness said it likely will, but any expansion would depend on the budget.

“I think it’s been a really positive experience for everyone involved,” UK Health and Wellness Manager Jody Ensman told Patton.

Fowler told Patton that the program also has intangible benefits, such as employees swapping vegetables and recipes.

And it's good for farmers Patton reports: "This year’s program resulted in about $100,000 in new sales for local farms, Canon said."

Ann Bell Stone of Elmwood Stock Farm told Patton that the study data should persuade employers that “When people eat better and have good nutrition, life is better on many levels."

A similar program in Madison, Wis., the FairShare CSA Coalition, offers insurance-funded vouchers to help people participate in CSAs. This program has grown from 96 vouchers in 2005 to about 9,000 to 10,000 vouchers, supporting more than 50 local farms and growing by $6 million annually, Woods told Patton.

New guidelines recommend no more than 6 teaspoons of sugar a day and one sugared drink a week for children and teens

By Melissa Patrick
Kentucky Health News

Children and teens should consume no more than six teaspoons of added sugars a day and drink no more than one 8-ounce sugar-sweetened beverage per week, according to new advice from the American Heart Association.

"The typical American child consumes about triple the recommended amount of added sugars,” Dr. Miriam Vos, lead author, nutrition scientist and associate professor of pediatrics at Emory University School of Medicine in Atlanta, said in a news release. "[And] are currently drinking their age in sugary drink servings each and every week."

The average American child takes in about 80 grams of added sugar daily — half from food and half from beverages, according to the AHA's analysis of the most recent data from the National Health and Nutrition Examination Survey.

The 2015 KentuckyYouth Risk Behavior Survey found that almost one-third of Kentucky's high school students drank a sugared soda one or more times per day during the seven days before the survey; 23 percent had sugared soda two or more times a day; and 13 percent three or more times a day. Nearly 36 percent of Kentucky's children are either overweight or obese, acccording to the Alliance for a Healthier Generation.

The AHA statement, based on a comprehensive review of scientific research on the effects of added sugar on children's health, is published in its journal Circulation.

The statement also says children younger than 2 should have NO added sugar. They have lower calorie needs than older children, so there is little room for foods and drinks with added sugars that don't provide "good nutrition," AHA says.

Why is the heart association interested in this problem? Children who eat diets high in added sugar have increased risk factors for heart disease, including obesity, high blood pressure, diabetes, fatty liver disease and unhealthy cholesterol levels, says the report.

Added sugars are any sugars or syrups that are added to foods during processing or preparation. The sugars in fruits, vegetables and other whole foods are natural sugars. One teaspoon of sugar equals 4 grams of added sugar.

The best way to avoid added sugars is to "serve mostly foods that are high in nutrition, such as fruits, vegetables, whole grains, low-fat dairy products, lean meat, poultry and fish, and to limit foods with little nutritional value," Vos says.

"A plain whole grain bagel with cream cheese can have no added sugar, while a frosted doughnut has 23 grams of added sugar," she told Jacqueline Howard of CNN. "A bowl of cereal can range from 1 gram to 12 or more grams, depending on the brand. One soda typically has 33 grams. A healthy breakfast of a low added-sugar, whole-grain cereal with a piece of fruit and a glass of low-fat milk would have about 1 gram of added sugar [but] varies by the cereal."

Starting in July 2018, food manufacturers will be required to list the amount of added sugars on nutrition labels.

The latest national U.S. Food and Drug Administration guidelines recommend limiting added-sugar intake to less than 10 percent of your daily calories. For someone older than 3, that means eating no more than 12.5 teaspoons, or 50 grams, of added sugar a day and 25 grams for children 1 through 3 years. The AHA guidelines cuts this amount in half for children.

That amount is "closely aligned with the new recommendations," Vos told CNN. "The AHA statement provides a fixed amount, 25 grams, that is less than 10 percent of calories for most children and is easier for parents to understand."

“I hope our recommendations help parents feel more confident limiting sugar. This statement helps answer the question how much is OK so parents can choose the right combination of foods and drinks so their children are healthier,” Voss told AHA News. “If parents know how much they are looking for, it will help the food industry satisfy that goal.”

State Supreme Court rejects Lexington abortion clinic's bid to remain open while it challenges Court of Appeals ruling closing it

The only abortion clinic in the eastern half of Kentucky will remain closed while it appeals the state's closure of it to the state Supreme Court.

The court denied a request from EMW Women's Clinic to repoen. It closed in June, "when the Court of Appeals overturned a Fayette Circuit Court ruling that allowed it to stay open after a legal challenge by Gov. Matt Bevin. The Court of Appeals’ ruling meant Bevin’s request to temporarily close the clinic until it received a license from the Cabinet for Health and Family Services was granted," Linda Blackford reports for the Lexington Herald-Leader.

Bevin issued a statement: “We are pleased that the Kentucky Supreme Court has upheld the Court of Appeals’ decision recognizing that an unlicensed abortion clinic is prohibited from performing abortions. The laws of Kentucky matter and must be followed, even when individuals, corporations or lower court judges think otherwise.”

EMW attorney Scott White said in a statement: “At the end of the day, we are disappointed, but in no way disheartened. The fight for the EMW Clinic to be re-opened and the rights of Kentucky women will continue. We are optimistic that when we have the full trial later this year before Judge [Ernesto] Scorsone that we will win.”

Bevin submits formal Medicaid proposal to federal government, largely unchanged from his draft; negotiations come next

By Melissa Patrick and Al Cross
Kentucky Health News

Gov. Matt Bevin's administration formally submitted its revised Medicaid plan to Health and Human Services Secretary Sylvia Burwell Aug. 24, leaving largely unchanged provisions that Burwell has said will not be approved. But Bevin says he will negotiate.

At stake is coverage for about 430,000 people who are covered by the 2014 expansion of Medicaid under federal health reform by Democratic Gov. Steve Beshear, to households earning up to 138 percent of the federal poverty threshold.

The Republican governor's plan mainly targets able-bodied adults who qualify for Medicaid under the expansion. The plan is designed to encourage participants to have what Bevin calls "skin in the game" though premiums and a higher level of involvement in their health care.

The plan would require able-bodied adults who aren't primary caregivers to work, eventually 20 hours a week. Burwell has said that would violate "longstanding principles" of the program and would not be approved.

The submitted plan differed from the draft in that the "community engagement" to earn additional benefits could include personal caretaking, getting preventive medical care for children, and studying for and passing the high-school equivalency exam, with the state paying the testing costs.

But it made no change in the proposal to charge monthly premiums of $1 to $15, depending on income, except that people deemed "medically frail" would not have to pay and premiums would be assessed on households, not individuals.

Health and Human Services Secretary Sylvia Burwell

Burwell has indicated that she would not approve premiums for people below the poverty level, saying "States may not impose premiums or cost sharing that prevent low-income individuals from accessing coverage and care."

The submission to Burwell did not, as many health advocates had hoped, leave dental and vision care and over-the-counter drugs in regular Medicaid coverage. It would still make them available by performing certain tasks, though the changes would be delayed by three months to allow Medicaid members to earn credits for them.

The plan is called Kentucky HEALTH, standing for Helping to Engage and Achieve Long-Term Health. It seeks a waiver from federal rules, under a section of law allowing demonstration programs.

"The submission of this waiver is the result of many months of extensive research, planning and time spent traveling the state listening to Kentuckians,” Bevin said in a news release. “Kentucky HEALTH will allow us to continue to provide expanded Medicaid coverage, but unlike the current Medicaid expansion under Obamacare, it will do so in a fiscally responsible manner that ensures better health outcomes for recipients.”

The proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," by reducing enrollment in the program, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs.

Gov. Matt Bevin (Lexington Herald-Leader photo)

Bevin says the state cannot afford to have 1.32 million people, nearly 30 percent of the Kentucky's estimated population, on Medicaid. About 430,000 are covered through the expansion, for which the federal government is paying the full cost through this year. Next year the state will be responsible for 5 percent, rising in annual steps to the federal health-reform law's limit of 10 percent in 2020. The state pays about 30 percent of the cost of traditional Medicaid participants.

Other changes to the draft that Bevin proposed in June included coverage of allergy testing and private-duty nursing.

The original proposal, submitted in June, was largely opposed by health advocates at three public hearings, with complaints that the program was too complicated and created barriers to care.

U.S. Rep. John Yarmuth, D-Louisville, issued a statement saying Bevin "has submitted a Medicaid waiver proposal that the federal government legally cannot approve. Once they deny it, he will terminate our Medicaid expansion and attempt to blame President Obama when Kentucky families lose their coverage."

But Washington, D.C., lawyer Dennis Smith, a former Medicaid official who has advised Bevin, said Wednesday no law keeps Burwell from accepting the plan. “There is certainly flexibility there for those provisions to be approved,” Smith told John Cheves of the Lexington Herald-Leader. “Part of the very purpose of Medicaid is to help people become independent.”

Several advocacy groups have posted statements about the final proposal, saying there are areas of it to applaud, but still some concerns.

Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, applauded the cap for household premiums and the expanded rules around caregiving, among other things. But she also had a long list of concerns, including dental and vision benefits, elimination of retroactive coverage, removal of coverage for emergency transportation and lock-out periods for nonpayment of premiums. The lock-outs could be waived if members get current on their payments and take a financial- or health-literacy course.

Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said he was glad that former foster children up to age 26 will be excluded from the waiver, and that getting preventive care for children can earn rewards. But he voiced "major concerns" that the plan would "negatively impact many parents and, as a result, impact their children as well." He cited concerns about co-payments and premiums that he said many can't afford, and that vision and dental services "are considered an earned benefit rather than services covered in a standard benefit package."

The state news release clarified some misconceptions that were apparent during the public comment period. For example, full-time students or individuals working more than 20 hours per week would be considered to meet the community-engagement requirements; smoking cessation benefits would not be changed; and disabled individuals receiving waivers or Supplemental Security Income would not be affected.

The release reiterates that the plan would not affect children, pregnant women, the medically frail and adults who were eligible for Medicaid before the expansion.

Bevin, a Republican, said in June when he announced the proposal that if federal officials don't approve this proposal, he would end the expansion. The submitted waiver says it "represents the terms under which the Commonwealth will continue Medicaid expansion."

The governor told reporters Wednesday, "If there are not structural changes made, there will not be the ability to have expanded Medicaid in Kentucky. That's just the reality of it. So the ball is in HHS's court."

Asked the next day at the State Fair if he was willing to negotiate with Burwell, Bevin said, "Absolutely, that's where we are in the process."

Beshear issued a statement saying, "By submitting this waiver proposal, which threatens to move Kentucky’s nation-leading progress in health backwards, Gov. Bevin is putting his own political ideology ahead of the health and well being of hundreds of thousands of Kentuckians."

The Centers for Medicare and Medicaid Services has 15 days from the date of submission to acknowledge that the waiver has been submitted correctly. A 30-day comment period will follow.

Burwell has indicated that the process could easily continue until after the November election, in which Republicans hope to take control of the state House and the White House. She told Beshear in a July 21 letter, "We are prepared to continue our dialogue with the state for as long as it takes to find a solution that continues Medicaid coverage for the people of Kentucky. As you know, Medicaid waivers in other states have often taken between six to 12 months to negotiate."

For the state Cabinet for Health and Family Services page on the topic, click here.

Bevin joins lawsuit that targets federal transgender rule, saying it will force health-care providers to provide 'controversial services'

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin has joined a lawsuit that challenges a federal rule guaranteeing transgender people equal treatment by insurers and medical providers.

"Not only does the rule require taxpayers to fund all treatments designed to transition to a different sex, it also forces health-care workers, including physicians, to provide controversial services," says a state news release. "Under the new rule, a physician who believes that certain treatments are not in a patient's best medical interests may be in violation of federal law."

"The Obama administration continues its attacks on the constitutional rights and religious freedoms of Kentuckians," Bevin said in the release. "It is both appalling and illegal for the federal government to force Kentucky taxpayers to foot the bill for sex-change operations."

Mara Keisling, executive director of the National Center for Transgender Equality, told Pete Williams of NBC News that the rule is intended to prevent discrimination against transgender people in getting access to all kinds of health care.

"The ACA rule does not mandate what kind of care doctors can and cannot give. It bans discrimination. It's there to make sure that transgender people can get the treatment we need without facing harassment — or worse," she said. "It simply requires that medical decisions be made based on medicine, not prejudice."

The rule falls under the nondiscrimination provisions of the Patient Protection and Affordable Care Act that offers protections against discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs or activities. The new rule expanded the definition of gender identity to mean a person's "internal sense of gender which may be male, female, neither, or a combination of male and female." The rule went into effect July 18.

The rule extends to any health program or activity that receives funding from the U.S. Department of Health and Human Services, including health insurers on the state and federal exchanges.

The lawsuit was filed Tuesday in Fort Worth by Texas, Kansas, Kentucky, Nebraska, Wisconsin, joined by the Christian Medical and Dental Association and the Franciscan Alliance. It is filed against HHS and its secretary, Sylvia Burwell.

"This is the second lawsuit Bevin has joined over transgender issues. In May, he joined 12 other states in a challenge of federal guidelines to accommodate transgender students in schools," Daniel Desrochers notes for the Lexington Herald-Leader.

"Kentucky taxpayer dollars will not fund this lawsuit," says the release, but it doesn't say who will.