Despite some improvements, Kentucky continues to rank near the bottom of all states for senior health

By Melissa Patrick
Kentucky Health News

Kentucky ranks 48th for seniors' health in the most recent America's Health Rankings Report -- a potential source of great concern, since the senior population in Kentucky, and the rest of the nation, is only growing larger. Only Mississippi and Louisiana ranked worse than Kentucky.

The U.S. Census Bureau estimates that one in five Americans will be over the age of 65 by 2030, and by 2035, seniors will outnumber children younger than 18.

The report looked at 34 measures of senior health that included factors that influence health, which were broken into four categories: behaviors, community and environment, policy and clinical care, and health outcomes. Kentucky also ranked 48th in both of these broad categories.

It also highlighted two supplemental measures, senior suicide and risk for social isolation, which has been linked to increased mortality, poor health status and greater use of health-care resources.

The report found Kentucky seniors are at a high risk for social isolation, scoring in the bottom 10 states for four of the six indicators used to measure this risk, including seniors who are divorced, separated, or widowed; poverty; disability, and difficulty living independently. This indicator was also broken down by county. (See map.)

Since the 2014 report was published, the national suicide rate among seniors increased by 12 percent, to 16.6 deaths per 100,000 adults 65 and older, but it remained the same in Kentucky at 20 deaths per 100,000.

Kentucky senior health strengths and improvements

Despite their low health ranking, Kentucky's seniors have shown many improvements on the health front and have some solid strengths.

For example, the report found that only 4.5 percent of Kentucky seniors are heavy drinkers and only 6.9 percent who require a low amount of care are in nursing homes, ranking the state seventh and eighth, respectively.

Kentucky also ranked high for the percentage of seniors with prescription-drug coverage, 87 percent; those with a dedicated health-care provider, 95.2 percent; and diabetes management, 81.6 percent.

And while many Kentucky senior-health measures ranked near the bottom, they showed some improvement. For example, senior dental visits, which ranked 44th in the nation, rose to 58.6 percent from 57 percent in 2017; the number of home-health workers per 1,000 adults 75 and older (45th) increased to 62.6 per 1,000, from 56.5; the percentage of adults having teeth extracted (47th) decreased to 22 percent from 23.9 percent; and the number of nursing home beds with four- and five-star ratings (45th) increased to 35.6 percent from 29.5 percent in 2017.

Challenges persist

Smoking plagues every age group in Kentucky, with Kentucky seniors ranking 49th for for this measure, at 12.4 percent -- though the researchers say it's never too late to quit.

"Cessation, even in senior smokers, can have profound benefits on current health and long-term outcomes," the report says. "For example, the risk of dying of lung cancer drops by half 10 years after cessation."

Kentucky also ranks near the bottom for its low number of "able-bodied" seniors, 57.7 percent, compared to the national average of 64.8 percent; and its high number of preventable hospitalizations, 76.6 per 1,000 Medicare enrollees.

And though Kentucky's flu vaccination rate is higher than many states, the number of Kentuckians who got vaccinated this year dropped 12 percentage points, from 67.3 percent to 59.4 percent.

This is important because "around 71 to 85 percent of flu-related deaths occur in individuals aged 65 and older, and half of flu-related hospitalizations were among older adults in 2015-16," says the report.

Kentucky also ranks low, 44th, for the number of seniors who were enrolled in hospice during the last six months of life after a diagnosis that held a high probability of death: only 43.4 percent. In the state with the highest health ranking, Utah, nearly 66 percent who met this criteria enrolled in hospice.

Food insecurity is also an issue for Kentucky seniors, with 18 percent saying they had faced the threat of being hungry in the past 12 months.

Kentucky ranked 49th for home-delivered meals to seniors, delivering only 3.8 meals per 100, compared to the national average of 9.1 per 100. Utah, ranked first for senior health, delivered 19.1 meals per 100; New Hampshire, ranked second, delivered 33.7 meals per 100.

The report also shows Kentucky ranks 39th for the share of seniors (49.1 percent) who participate in the Supplemental Nutrition Assistance Program, formerly called food stamps; only 42 percent of eligible seniors participate in the program.

"The purpose of the report is to promote data-driven discussions among individuals, community leaders, the media, policy makers and public health officials that can drive positive change and improve the health of seniors," says the report.

UK and Norton hospitals rank high in resistant bloodstream infections; UK cites complex cases, recent improvements

Lexington Herald-Leader table by Chris Ware, adapted by Kentucky Health News, lists safety ratings and rankings of selected Kentucky hospitals by various rating groups, and number of methicillin-resistant staphlyococcus aureus bloodstream infections in fiscal 2017.

"Kentucky's two biggest hospital systems had some of the country's highest instances of an often deadly bacterial bloodstream infection known as MRSA" in the fiscal year that ended June 30, 2017, Linda Blackford reports for the Lexington Herald-Leader.

The Albert B. Chandler Hospital at the University of Kentucky and Louisville's Norton Healthcare each had 40 bloodstream infections of methicillin-resistant staphylococcus aureus, according to the Centers for Medicare and Medicaid Services. Of the 3,800 hospitals reporting, Norton and UK ranked sixth and seventh, respectively.

"UK's MRSA number was deemed 'no different from the national benchmark,' which considers a hospital's size and mission, according to a report by the CDC that compares hospitals," Blackford reports. "Still, UK's number was higher than many comparable teaching hospitals, such as the University of Cincinnati hospital, which had 27, or the University of North Carolina, with 33. . . . Norton and the bottom six hospitals were deemed 'worse than the national benchmark'."

Officials from both hospitals told Blackford that they follow precautions recommended by the federal Centers for Disease Control and Prevention, and that using the raw number of cases can be misleading because it doesn't take into account how many patients are admitted each year and how long they stay.

"At UK HealthCare, we take quality and safety very seriously and have implemented multiple processes to help reduce the number of infections to keep patients safe," spokeswoman Kristi Willett told Blackford. "Our large patient volumes and high level of patient complexity make us unique in the state of Kentucky as those things are known risk factors that can increase the risk of infection." MRSA is resistant to most antibiotics, and is most dangerous as a bloodstream infection.

UK handles many of the state's most complex medical cases, which require longer stays, making them more vulnerable to infection, said Derek Forster, UK's medical director for infection prevention and control. He said that since 2016, when it added precautions for patients in intensive care, the hospital's "standardized infection ratio" is down 55 percent, and MRSA infections in its ICUs have been reduced by half.

Norton's chief medical officer, Steven T. Hester, "said Norton noticed an increase in MRSA cases in 2016, and convened a system-level task force to deal with the issue," Blackford reports, quoting him: "Unfortunately, Kentucky is a state with a high incidence of opioid and intravenous drug abuse. We had concerns that our increase in MRSA could be related to the increased incidence and risk with substance dependent patients, specifically intravenous drug users."

Blackford reports, "Among other hospitals in Kentucky, the University of Louisville Hospital had 17 MRSA cases, Pikeville Medical Center had 12 and Hazard ARH had 10 cases. Hazard's number was deemed to be 'worse than the national benchmark.' Most of Kentucky's small, regional hospitals had fewer than five cases."

"Hospitals can and must do better," retired Somerset physician Kevin Kavanagh, board chair of Health Watch USA, writes in an op-ed for the Herald-Leader, in which he takes a close look at hospital ratings, especially on safety issues.

Pikeville Medical Center, citing bad decisions by prior management, continues to reduce staff, this time by laying off 100

Pikeville Medical Center, Eastern Kentucky's largest hospital, is cutting its workforce to correct what CEO Donovan Blackburn called "poor business decisions" by his predecessor, Walter May.

"The news comes a week after the credit rating agency Moody's lowered the hospital's credit rating two notches, citing increased labor costs and limited cash flow," notes Will Wright of the Lexington Herald-Leader.

May, who led the hospital's growth over the past 20 years, was fired in January. Since then, the hospital has cut 250 employees by attrition, but now is laying off 100, Blackburn said. Another 30 recently "left through a normal exit including quitting or being fired," WKYT-TV of Hazard reports.

Blackburn said the hospital hired 600 people for a clinic it built in 2015, pushing its workforce above 3,000, but didn't need 480 of them. "In 2016 we had the best year we ever had at the end of the 2016 year, but in 2017 we had the worst year we ever had," he told the station. The clinic was named for May's wife, hospital attorney Pamela May, who died in May 2017. That was the same month that the hospital hired Blackburn, who had been Pikeville's city manager.

Latest Commonwealth Fund health scorecard finds Kentucky in the bottom fifth of states again, but improving on 15 measures

By Melissa Patrick
Kentucky Health News

Kentucky's ranking among the states rose from 46th to 42nd in the latest Commonwealth Fund Scorecard on State Health System Performance, partly because it had fewer adults who lack health insurance or went without health care because of cost.

The scorecard evaluates states on more than 40 indicators in five areas: care access and affordability; prevention and treatment; avoidable hospital use and hospital cost; health outcomes; and health equity.

Since 2016, Kentucky improved on 15 indicators and worsened on five. Only eight states improved on more health indicators than Kentucky.

The report notes that states that expanded Medicaid to people who earn up to 138 of the federal poverty level, which Kentucky did in 2014, saw greater improvements, on average, than states that did not.

The Commonwealth Fund has issued a state scorecard since 2013, but it says this year's version uses different indicators and methods so it's not directly comparable to previous ones. That said, Kentucky has been in the bottom fifth of states in each of the reports.

Kentucky's top rankings were in access, affordability, prevention and treatment (30th). It remained near the bottom for avoidable hospital use and cost (47th), health outcomes (48th) and health equity (41st). The latter ranking largely reflects wide disparities between rich and poor Kentuckians.

Click here for an interactive map.

The report also estimated what would happen if the state improved to the level of the best-performing state, which this year was Hawaii.

It said, among a long list of other improvements, that if this were to happen: 77,109 more Kentucky adults would be insured, 167,087 fewer Kentucky adults would go without needed health care because of cost and the state would have nearly 535,000 fewer smokers, which causes many of the health problems that plague our state.

Among the state's top indicators, the report found Kentucky ranked fifth for its low percentage of home-health patients who did not get better at walking or moving around; fifth for the low percentage of children without health insurance; and sixth for the low number of diabetic adults with employer-sponsored insurance who did not get an annual blood test for hemoglobin A1C, an indicator of diabetes.

At the bottom of the rankings, Kentucky ranked 51st for its high percentage of hospital admissions for ambulatory care-sensitive conditions among very poor adults who are eligible for both Medicare and Medicaid; 48th for its large percentage of adults who smoke, 50th for the large share of adults who report fair or poor health, and 49th for the high percentage of adults who have lost six or more teeth.

The state's most improved indicators included the percentage of uninsured adults, which moved from 21 percent in the 2013 baseline performance to 7 percent; adults who went without care because of cost, improving from 19 percent to 12 percent; and home-health patients who did not get better at walking or moving around, which improved from 36 percent to 25 percent.

The indicators that worsened the most in Kentucky were hospital 30-day mortality, which increased from 13.3 percent in 2013 to 14.4 percent; adults with any mental illness reporting unmet needs, increasing from 19 percent to 23 percent; and deaths from suicide, alcohol and drug use per 100,000 people, up from 48.9 to 61.7, known as "deaths of despair." The national rate for such deaths was 43.2 per 100,000.

Cabinet for Health and Family Services announces appointments to 5 key leadership positions; 2 top jobs were filled in mid-May

Several key leadership positions were filled at the Cabinet for Health and Family Services June 1, and take affect immediately, according to a state news release.

Dr. Jeffrey Howard, who has been acting state health commissioner since Dr. Hiram Polk left last fall, was appointed commissioner.

Howard attended Union College, University of Louisville School of Medicine and the Harvard T.H. Chan School of Public Health. He is a native of Eastern Kentucky and lives in Louisville.

Jill Hunter has been appointed acting commissioner for the Department for Medicaid Services. Hunter has worked for state government for more than 16 years, most recently as a deputy commissioner within the department where she focused on the redesign of the home and community-based service waiver program.

Hunter replaces Steve Miller who is retiring effective June 15. Miller has held this position for the past two and a half years.

Shannon Gadd was named commissioner for the Department for Aging and Independent Living. Gadd had been senior director of programs at ElderServe in Louisville.

Anne-Tyler Morgan has been named senior adviser to Cabinet Secretary Adam Meier for administrative hearings. Morgan, an attorney, served as a deputy commissioner in Medicaid.

LaToya Payne, who has held various leadership roles in the cabinet since 2007, was named the director of the administrative hearings branch.

“CHFS, and the commonwealth, are fortunate to have so many qualified individuals stepping into key leadership roles at this important time,” said Meier in the release. “I also want to thank Steve Miller for his dedicated service as Medicaid director. His steady leadership will certainly be missed but we wish him the best in his well-deserved retirement.”

Meier was appointed secretary of the cabinet May 17, when Kristi Putnam was named deputy secretary.

Federal judge sets trial date for state's ban on most common type of second-trimester abortion; meanwhile, law remains suspended

A federal judge has ruled that a new law banning a common abortion procedure called dilation and evacuation, or D&E, after roughly 11 weeks will not be enforced in Kentucky until after a trial is held in November.

The order from Chief Judge Joseph H. McKinley set the trial for Nov. 13 after vacating the preliminary injunction hearing that had been scheduled June 5.

The new law banning the procedure, except in cases of medical emergencies, was House Bill 454, sponsored by Rep. Addia Wuchner, R-Florence. It passed the state Senate 31-5, and the House 75-13. The law went into effect immediately after Gov. Matt Bevin signed it on April 10.

McKinley delayed the enforcement of the law through a joint consent order April 12 after the American Civil Liberties Union filed a lawsuit arguing that the law is unconstitutional. A federal court struck down a ban on the procedure in Texas, and similar bans have been temporarily blocked in other states while they await litigation.

A D&E abortion, which is the most common kind of second-trimester abortion, involves dilating the cervix and removing the fetus using suction and surgical tools. If the law is upheld, abortion providers found in violation would be guilty of a felony that carries a prison sentence. Women undergoing the procedure would not be prosecuted.

Foundation for a Healthy Ky. will help state keep people covered as Medicaid changes; summit discusses new work requirements

Ben Chandler, president and CEO of the foundation,

with Gov. Matt Bevin (Associated Press photo by Adam Beam)

By Melissa Patrick

Kentucky Health News

LOUISVILLE, Ky. -- The Foundation for a Healthy Kentucky is partnering with the administration of Gov. Matt Bevin to help low-income Kentuckians keep their health coverage under the new Medicaid plan that starts taking effect July 1.

"We have a singular objective in the endeavor announced today, and that is to keep Kentuckians covered," Ben Chandler, president and CEO of the foundation, said at a May 30 press conference to announce the partnership.

Chandler told the nearly 200 people in attendance that "an independent, non-profit, non-partisan foundation" is "uniquely situated" to help Kentuckians on Medicaid meet the new requirements.

"The foundation's passion for this is our passion for this," Bevin said. "It is not a partisan issue." He is a Republican; Chandler is a Democrat who was in Congress in 2004-12, state attorney general in 1996-2003 and a 2003 nominee for governor.

Bevin's new Medicaid plan, called Kentucky HEALTH (for Helping to Engage and Achieve Long Term Health) includes, among other things, requirements for work, education or training; monthly reporting; lock-out periods for failure to comply; and premiums and co-payments based on income.

The changes will largely impact "able-bodied" Kentuckians who have gained Medicaid coverage through the expansion of the program to people with incomes up to 138 percent of the federal poverty level, which is less than $16,394 for an individual.

Medicaid covers almost one in three Kentuckians, almost half a million of them on the expansion. A county-by-county spreadsheet of enrollment in Medicaid, as of January 2018, can be downloaded from http://www.uky.edu/comminfostudies/irjci/MedicaidbycountyJan2018.xlsx.

Chandler said that through this partnership, the foundation will help Kentuckians keep their health coverage by helping them to better understand the new requirements; helping communities offer ample community engagement requirements; helping people find ways to pay their premiums, promoting preventive health initiatives, focusing on helping those with substance use disorders, and providing health and financial literacy education, as required by the program.

In addition, he said they will facilitate a "statewide feedback program," as the implementation rolls out " to identify best practices and lessons learned, and to resolve program inefficiencies."

Bonnie Hackbarth, spokeswoman for the foundation, said in a telephone interview that while they haven't specifically talked to other health advocacy groups in the state to enlist their help in this endeavor, like the Friedell Committee or Kentucky Voices for Health, she said they would likely reach out to them as they look to engage.

Veronica Judy Cecil, who had served as a deputy commissioner in the state Department for Medicaid Services under Bevin and Democratic predecessor Steve Beshear, has been hired to oversee this partnership. Cecil ran Chandler's congressional office.

Critics of Kentucky HEALTH say it is too complicated and creates barriers to health care.

The Center for Budget and Policy Priorities recently released a report saying that the plan's new rules, which were approved by the federal government through what is called a demonstration waiver, will likely cause many people to lose coverage.

"Current waiver proposals and recently approved waivers will cause large numbers of eligible people to lose coverage and will increase administrative costs," the report concludes. "Those who lose coverage will have less access to care, less financial security and worse health outcomes."

The Bevin administration estimates that 95,000 fewer Kentuckians will be on the Medicaid rolls with the changes than without them, partly because of non-compliance. The state has budgeted $186 million for fiscal year 2018 and $187 million for 2019 to implement the waiver, and has requested that the federal government pay for 90 percent of these costs, according to the budget center's report.

Chandler said the foundation was well aware that many stakeholders had "deep concerns" about beneficiaries losing their coverage, and added, "So do we."

Bevin has said that the state can't afford to have nearly one-third of its population on Medicaid, but when asked if his goal to decrease the Medicaid rolls was in conflict with the foundation's goal of keeping people on them, he said that kicking people off the program was never his goal.

“My goal is to get a healthier outcome for the people of Kentucky. I’ve never made any mention with respect to the size and scope of Medicaid," he said. "What I do believe is if you have a healthier population, you won’t need as many people.”

Chandler later added, "Not at any time have any of these folks here suggested to us that they are trying to throw people off Medicaid."

Attendees at the Partnership Summit (Photo by Melissa Patrick)

The second part of the morning was devoted to the Kentucky HEALTH Partnership Summit, which brought together state, business, health and education leaders to discuss the details of the community engagement requirements -- which require "able-bodied" Kentuckians on Medicaid to work, volunteer or attend school or job training at least 80 hours a month, and document their hours monthly, to keep their Medicaid coverage.

Bevin talked about the benefits of the engagement requirement, likening it to the pride in ownership a child has when they buy their own bicycle instead of having it given to them: "If you don't have engagement in your own health outcomes, you're not as likely to get the health outcomes you desire."

Most of the new requirements will kick in July 1, but the new work or community-engagement rules requirements will be phased in slowly, starting in Northern Kentucky. Campbell County's requirements begin on July 1, followed by Boone County on Aug. 1 and Kenton County on Sept. 1.

After that, large groups of counties will be rolled into the program each month until the last scheduled counties are added Dec. 1. Eight counties in Eastern Kentucky are exempt until December 2019 because they are already part of a pilot project that helps find jobs for people in the Supplemental Nutrition Assistance Program, formerly called food stamps.

Hugh Haydon, chair of the Kentucky Workforce Innovation Board, told the summit that from an economic perspective, his group fully supports the community engagement requirements. And he implicitly disputed some critics by saying that there are plenty of jobs to be found.

Calling it a huge "disconnect," Haydon said 200,000 more Kentuckians need to go to work for Kentucky to meet the national average for workforce participation and that there are "hundreds of thousands of jobs available. "

"We also know that for this program to succeed, employers have to be fully engaged," he said. Later adding, "We are ready to do this."

Tim Robinson, founder and CEO of Addiction Recovery Care, who said he was also in long-term recovery, spoke passionately about the importance of the new work requirements for recovering addicts.

He said that while his 14 treatment centers have always maintained a holistic approach to recovery, including clinical, medical and spiritual care, they added vocational rehabilitation and job training to their continuum of care two years ago and "the results have been amazing."

He said 46 of his patients have graduated from his company's Peer Support Specialist Academy, which was launched in 2016, and that 40 of them are sober and working full time. "Which tells me that job training is just as important as drug addiction treatment," he said to applause.

"Incredible things happen when you give someone whose trashed their life a path from crisis to career," Robinson said. "You give them hope for the future, the power of purpose, the dignity that comes from work, raising their self-esteem and an opportunity to pay their recovery forward."

At the end of the meeting attendees broke into groups, based on their local workforce development area, and discussed their concerns about implementation of the new plan.

Some of the concerns included the need for more communication about the changes; the importance of individuals learning how to self-report their monthly engagement requirements, and to manage their Kentucky HEALTH accounts, because there are no added resources to help them do this; concerns about transportation barriers, prompting a suggestion for a Kentucky HEALTH Uber service; and the need to create a "ramp" instead of a "cliff" for the many who will only work up to a certain number of hours for fear they will earn too much money and then lose their health coverage.

Smaller Kentucky HEALTH summits modeled after this bigger one are expected to be held across the state. Click here for Kentucky HEALTH resources page.

Grant for coolers from Southeast U.S. dairy group helps food banks in Lexington and Winchester provide milk to the needy

Agriculture Commissioner Ryan Quarles announced the gift.

Clients of the God's Pantry Food Bank in Lexington and Winchester have greater access to fresh milk thanks to a $30,000 grant from The Dairy Alliance, formerly the Southeast United Dairy Industry Association.

God’s Pantry used the grant to put a total of seven milk coolers in its four food pantries in Fayette and Clark counties. The grant was part of the group's Milk 2 My Plate initiative to get Kentucky milk into Kentucky homes, and was announced by state Agriculture Commissioner Ryan Quarles as part of his Hunger Initiative.

“As a bonus, our hard-working dairy farm families will get a new market for their products. This is one small step that hopefully will lead to more such initiatives to help Kentucky’s dairy farmers. We are extremely grateful to The Dairy Alliance for its support,” Quarles said in a news release.

Winchester Farms Dairy delivered milk to God’s Pantry as part of the May 29 announcement. The pilot project is providing 60 gallons of milk a week to the food bank; God’s Pantry CEO Michael Halligan is hoping to increase the volume.

“Hungry families, particularly those with young children, often lack calcium-rich milk in their diet. This pilot project will help us establish a consistent, sustainable flow of milk to those in need,” Halligan said. “In the first few weeks, we’ve witnessed so much joy and excitement through a cold glass of milk.”

Map the Meal Gap 2017, an annual study by Feeding America, found that one in six Kentuckians – including one in five children – were food insecure in 2015, meaning that consistent access to adequate food is limited by a lack of money and other resources at times during the year, the news release said.

New services tax includes memberships in fitness centers and Weight Watchers, though Kentucky ranks seventh in obesity

Will memberships in fitness programs at YMCAs, like this one in
Lexington, be taxed? The state isn't sure. (Lane Report photo)

"Kentucky, which has the seventh highest rate of obesity in the U.S., will begin to tax fitness center and Weight Watchers memberships on July 1," Chris Otts of WDRB notes in a report on the expansion of the state's 6 percent sales tax to several services.

"But is the YMCA – a nonprofit organization – required to collect the tax, or only for-profit gyms such as Planet Fitness?" Otts asked Richard Dobson, executive director of the Office of Sales and Excise Taxes at the state Department of Revenue. Dobson replied, “We are working on that [question] and we will be giving further clarification.”

The taxes were levied as part of a deal between House Republicans, who wanted to protect education funding and make fewer changes to teacher pensions, and Senate Republicans, whose apparent priority was tax cuts, such as lowering the state income tax to 5 percent from the current range of 5.8 to 6 percent for income above $8,000.

"Republican Gov. Matt Bevin vetoed the bill, saying he wanted a more 'comprehensive' overhaul of the state’s tax code, but lawmakers voted to override the veto on April 14, putting the changes into law," Otts notes. "Last week Kentucky officials launched a website to better explain the tax changes. They have also set up a phone line – 502-564-5700 – to take recorded questions." Questions can be emailed to taxanswers@ky.gov.

In close vote, Louisville sets content rules for children's menus, citing child obesity; critics say law invades parental responsibility

A food-service business in Louisville will be allowed to offer a children's menu only if it includes certain types of healthy items, under an ordinance passed by 13 Democrats on the Metro Council over "vocal bipartisan objections" from 11 other members, Phillip M. Bailey reports for the Courier Journal. "The proposal touched a nerve with many residents and council members who said such choices should be left up to parents."

Supporters said the ordinance is needed to fight an epidemic of child obesity and is the first in the United States to set food and drink standards for children's menus. The American Heart Association, which spearheaded the proposal, said about 12 cities, mostly in California, have adopted similar rules, Bailey reports. Mayor Greg Fischer said he plans to sign the measure into law.

The ordinance will require food service businesses "to provide a non-fried fruit or vegetables, a whole grain product or a lean protein or one 2-ounce serving of nuts, seeds, dry beans, peas or one egg," Bailey reports. "The restaurant must make available either a water, sparkling water, flavored water with no added natural or artificial sweeteners or milk product." Violation carries a fine of up to $100.

"Many of the council members who voted against the idea said they support the goals but that it shouldn't be the city's job to tell people how to eat," Bailey writes.

"Here we go again, this is a government overreach. We continue to tell parents what they need to do with their children," said Councilwoman Mary Woolridge, D-3rd District, one of three Democrats who joined eight Republicans in voting against it.

"Several Democrats who voted for the measure also expressed doubts that it would achieve its goals," Bailey reports. Councilwoman Vicki Aubrey Welch, Blackwell's co-sponsor, said it would address the local childhood obesity epidemic.

"Nearly 25 percent of Louisville sixth-graders and 18 percent of kindergartners are obese, according to the Louisville health department," Bailey writes. "Health advocates point out that one out of three children in the United States eat fast food and thus have a higher caloric intake that can result in a poor diet, obesity and diabetes."

Summer's here, which means it's time to protect our skin from the sun and keep a regular watch for skin cancer

Chart from Great Plains Center for Agricultural Health; click on it
to view a larger version; to download a full-size version, click here.

Friday, June 1 is the start of meteorological summer, which is a great reminder to make sure you have enough sunscreen on hand and to remember to check your body for skin cancer.

The American Cancer Society says the top cause of skin cancer is exposure to ultraviolet, or UV, rays from the sun or other sources like tanning beds.

To protect yourself from the sun, the ACS recommends wearing clothing and a wide-brim hat to protect as much skin as possible; using a broad-spectrum sunscreen with a SPF of 30 or higher, and to reapply every two hours, as well as after swimming or sweating; staying in the shade if possible; and avoiding tanning beds and sunlamps.

But it's also important to be careful when using sunscreens on children.

Brenda Goodman of WebMD reports on a 14-month-old child who is recovering from a "painful, blistering rash that spread over her cheeks and nose, right where her mom had spread a palmful of Banana Boat Kids Free spray sunscreen."

The U.S. Food and Drug Administration is investigating the case, and told WebMD that it is aware of three other Canadian children who had reactions to the same product.

Dr. Alok Vij, a dermatologist at the Cleveland Clinic, told WebMD that he thought the reaction was something called a photoallergy, which happens when the sunlight combines with a chemical to cause a chemical reaction.

His advice to parents includes: Keep kids out of the sun during the brightest parts of the day, 11 a.m. to 4 p.m.; use sun-protective clothing; use mineral-based sunscreens, like those with zinc or titanium; and avoid spray sunscreens. 

The American Academy of Dermatology reports that one in five Americans will develop skin cancer in their lifetime.

 The doctors at University of Louisville Physicians – Surgical Oncology, in a U of L news release, recommends regular skin self-exams after a shower or bath.They note that it's important to learn where your birthmarks, moles and blemishes are located, and to take note of how they usually look and feel. Family members can examine areas that are hard for an individual to see.

"Using a full-length mirror and a hand-held mirror, check for anything new such as a mole that looks abnormal, a change in size, shape, color or texture of a mole or a sore that doesn’t heal," the doctors advice. "Check yourself from head to toe, including all areas and crevices of the skin."

They also offer these "ABCDE" tips to help you remember what to watch for:

• Asymmetry – The shape of one half does not match the other.
• Border – The edges are often jagged, uneven, distorted or atypical in outline; the pigment may spread into the surrounding skin.
• Color – The color is uneven. Shades of black, brown and tan may be present. Areas of white, gray, red, pink or blue also may be seen.
• Diameter – There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (1/4 inch or 5 mm).
• Evolution – Anything that changes over time. It is important to call a dermatologist if you find one of these suspicious characteristics.

And just because you have dark skin doesn't mean you shouldn't check yourself. A 2016 American Academy of Dermatology study, “Racial Disparities in Melanoma Survival,” found that while melanoma incidence is higher in whites, death rates are relatively higher among people of color.

 “Far too often, black, Hispanic, and Asian patients with melanoma cancer tell us they believed that melanoma was only a danger for sun-seeking whites,” says the study report. “But anyone – regardless of skin color – may develop melanoma, in both sun-exposed and sun-protected sites. Not noticing or ignoring a new or changing mole in a sun-protected site can be fatal.”

Children are at risk of death from being left in hot cars; health officials say don't do it in any circumstances, offer prevention tips

Image from Huffington Post

Every summer, children die from heat stroke because they are unintentionally left in a hot car, with the majority of these deaths occurring in children age 3 and under The latest reported victim was a 1-year-old girl in Nashville who was accidentally left inside a hot car May 23.

According to the safety organization Kids and Cars, 37 children a year die in hot cars. These include instances of children being forgotten, accidentally locking themselves in a car or trunk, or in a small number of cases, intentionally left in a car.

“Infants and small children are not able to regulate their body temperature in the same way that adults do,” Dr. Heather Felton, medical director of the University of Louisville Pediatrics - Sam Swope Kosair Charities Centre, said in a U of L news release. “Sweating won’t cool down an infant or young child in the same way that it does an adult, and children may not be able to extract themselves from a car seat or remove clothing to help their bodies adjust.”

A new study out of Arizona State University and the University of California San Diego School of Medicine, published in the science journal Temperature, found that it takes about an hour for a child left in a hot car to suffer heatstroke, an average of 80 minutes in a sunny car to kill a child, and a little under two hours for a 2-year-old's body to reach a core temperature of greater than 104 degrees Fahrenheit, a degree from which a body cannot cool down," Dr. Sima Patel reports for ABC News. Patel notes that in reality, different children reach hyperthermia at different times, based on the climate, child's size, clothing, ethnicity and age.

"I don’t think our study can address the overall ‘risk’ of heatstroke because that depends on human behavior and actions more than anything," Jennifer Vanos, lead study author told ABC.  "All cars heat up to lethal temperatures across every state, and although it’s the level of heat that in the end causes the death, it’s the act of forgetfulness that is the trigger. Deaths have occurred in not-so-hot states as well. And even though parking in the shade decrease the heart rate of the child’s core temperature, the risk of death is likely the same as if parking in the sun."

Felton offers these American Academy of Pediatrics-endorsed tips for parents when traveling in a car with infants or young children:

• The inside of a car can reach dangerous temperatures quickly, even when the outside temperature is not hot. Never leave a child alone in a car, even if you expect to come back soon.
• Always check the back seat to make sure all children are out of the car when you arrive at your destination. 
• Avoid distractions while driving, especially cell phone use.
• Be especially aware of kids in the car when there is a change from the routine such as someone else is driving them in the morning, or you take a different route to work or child care. 
• Have your childcare provider call if your child has not arrived within 10 minutes of the expected arrival time.
• Place your cell phone, bag or purse, or shoes in the back seat, so you are reminded to check the back seat when you arrive at your destination.
•  Lock your car when it is parked so children cannot get in without supervision.
• Drink plenty of water and have your children drink plenty of water when temperatures soar.
• Plan for extra rest time – heat and a change from the normal routine leaves kids and parents feeling tired.