The latest checkup on the health of Kentucky's counties found people in central Kentucky are among the healthiest in the state.
Fayette county -- along with five other central Kentucky counties -- ranked
among the ten healthiest. That's according to the Kentucky institute of medicine.
But the diagnosis for eastern Kentucky was much different. Nine of the ten "least" healthy counties are concentrated there. To come up with the rankings researchers looked at everything from lifestyles to availability of heath insurance to tobacco use.
LEXINGTON, Ky. (Sept. 17, 2005) – A new report ranking the health of each Kentucky county shows Oldham, Boone, Jessamine, Anderson, Woodford, Fayette, Spencer, Davis, Calloway and Clark to be the most healthy counties in the state. The least healthy counties are Owsley, Powell, Hart, Knott, Lee, McCreary, Perry, Harlan, Clay and Wolfe.
The report, "The Health of Kentucky: a County Assessment," was produced by a Kentucky Institute of Medicine™ (KIOM) [http://news.uky.edu/news/] task force. This research was funded by a grant from the Foundation for a Healthy Kentucky [http://news.uky.edu/news/]. The foundation's mission is to address the unmet health care needs of Kentucky.
According to the report, in general, Kentucky is a healthy place to live and work. Few diseases are endemic to the state and most of Kentucky’s workplaces are relatively safe. Many of the health problems in the state are because of poor lifestyle choices, which lead to otherwise preventable diseases and premature deaths. Modifiable behavioral risk factors—tobacco use, poor diet and physical inactivity—have been identified as the leading causes of mortality in the United States, as well as in Kentucky. While some diseases are attributable to risk factors that cannot be mitigated, such as age, sex, race, and genetics, most risk factors for chronic disease can be prevented or modified to improve health.
This report from the Kentucky Institute of Medicine™ provides objective data and resource information about risk factors and disease outcomes. The information is meant to assist officials and concerned citizens at the county level in assessing the health of their community and making decisions that will improve health. A county profile and ranking was developed for each of Kentucky’s counties to focus attention on these critical factors at the state and county level.
Each county profile contains 25 items which have equal weight in a ranking of 1 (best) to 120 (worst) as a measure of the county’s health status relative to the other counties. A complete ranking of the counties is presented in the county profiles section of the report (PDF file [http://news.uky.edu/news/healthyky2007a.pdf]).
The task force that compiled information for the report included 33 members. The task force co-chairs were Dr. Emery A. Wilson, director, Office of Health Research and Development, University of Kentucky College of Medicine, and Dr. Raymond D. Wells, assistant professor, Department of Family and Community Medicine, UK College of Medicine, and an Inez, Ky. physician.
"Like politics, all health care is local," said Wilson. "If we really want to improve the health of Kentuckians, we must start at the local or county level. This report is the first atttempt to provide health data and information for each county so that the people of every community can begin to address health behaviors and outcomes at the local level."
A key premise of this study is that individuals can avoid many serious illnesses and premature deaths by engaging in more healthful behaviors, such as not smoking, having a healthy diet, engaging in regular physical activity, using seatbelts and child safety restraints when driving, and using safety equipment at work and when using tools at home. The poor health that results from poor individual lifestyle choices is a significant liability to Kentucky’s capacity to realize economic development and prosperity. The unnecessary costs incurred by unhealthy individuals are borne by their community as economic losses. Advancing the health status of Kentuckians will improve productivity and the economic viability of the state. Kentucky cannot realize economic gains nor improve quality of life without a healthy populace.
“It was our intent to do a HRA (health risk assessment) of each of the 120 counties in Kentucky," said Wells. "With this information each county may identify its own individual health strengths and weaknesses. Hopefully it might be of assistance to those entities and provide a focus to both identify and rectify their problem conditions.”
Given the diverse nature of Kentucky in terms of topography, socioeconomic factors, and education, the health status varies greatly among Kentucky counties. In order to address the problems that undermine health, citizens, providers, and policymakers need to initiate change in the communities where they live, work, and participate in the healthcare system. However, local communities often lack the information and knowledge they need to take action. Data accessible to groups trying to improve their community’s health status and access to healthcare are usually taken from national or state studies and are not designed to give information specific to local problems. Statewide and regional studies aggregate data that often conceal the disparities that exist among counties, masking the true situation at the local level. For example, the percentage of Kentucky adults who smoke is 29 percent, but the rate varies by county from a high of 36 percent to a low of 20 percent. In order to plan effectively interventions sensitive to health barriers and disparities, county-level data on all health and health-related issues is necessary.
The Health of Kentucky report describes a process to help counties improve health status and provides examples of communities which have undertaken health improvement activities. Guidance is provided for conducting local studies and surveys. The report also provides suggested community interventions, sample programs, and resources related to each of the measures included in the individual county profiles.
“Our research team developed health measures and linked them to disease outcomes for all 120 Kentucky counties," said Michael Samuels, Endowed Chair/Distinguished Scholar in Rural Health Policy and professor, Department of Family and Community Medicine, UK College of Medicine. "Local people will know how many lives they lost and why. They will be given the information to show how they can plan interventions to improve the health of their communities. This is step one in an academic/community effort to improve the health of all Kentuckians.”
The findings of The Health of Kentucky report were organized around a set of risk factors and disease outcomes which, taken as a whole, would approximate a composite picture of the health of Kentucky’s counties. They were grouped into the following categories: behavioral/social factors, demographics, health access, and health outcomes. In addition, rates were provided for four types of cancer. In examining measures of behavioral and social factors, the report found smoking to be Kentucky’s greatest challenge. Cancer, cardiovascular disease, and respiratory illness are among the more well-known consequences of tobacco use. More than half of the individuals who smoke will die of a smoking-related illness and more than 23 percent of all deaths in Kentucky are attributable to smoking, a modifiable health risk factor. Only five of Kentucky’s 120 counties have smoking rates below the national average.
Another major challenge is the combination of obesity and lack of physical activity. These risk factors are related to the increased incidence of cardiovascular disease, diabetes, stroke, and other health disorders. Only 10 of Kentucky’s counties are above the national average for physical activity and 78 are above the national average for obesity. Other measures of behavioral and social factors that were considered include oral health, motor vehicle deaths, violent crime offenses, drug arrests, and occupational fatalities. For all of these measures, except violent crime offenses, Kentucky is worse than the national average.
This has been a monumental project for the KIOM, but it is type of project that was envisioned for the KIOM to undertake," said Linda M. Asher, executive director, Kentucky Institute of Medicine. "Hopefully it will have the impact that is expected. It will be important to continue to monitor the results of community efforts to improve the health of Kentuckians."
Of the demographic measures selected for study, high school graduation rates and per capita income are the greatest challenges for Kentucky. Better educated individuals are more likely to have access to preventive healthcare and to engage in behaviors that benefit their health. Only nine of Kentucky’s counties have high school graduation rates above the national average. In 2005 Kentucky ranked 48th among the 50 states in the percentage of people age 25 and older who have a high school diploma or its equivalent and 47th in the percent who have a bachelor’s degree. Poverty is one of the most challenging issues in Kentucky. Economic status has a profound impact on health and well-being. Only five Kentucky counties have per capita incomes above the national average. The size of Kentucky’s older population will figure prominently in the health status of the state’s population, as the incidence of chronic disease and disability increases with age. Seventy-nine of Kentucky’s counties have a percentage of elderly population above the national average.
In examining measures of health access, the greatest challenge in Kentucky is the primary care physician-to-population ratio. Having a regular primary care physician is strongly associated with a positive health status. Rural areas have major difficulty in attracting and retaining primary care physicians. Almost half of Kentucky’s population lives in the state’s 85 rural counties. Only seven Kentucky counties have primary care physician-to-population ratios above the national average; however Kentucky does well in regards to adequacy of prenatal care and immunization rates. Kentucky’s percentage of pregnant women receiving adequate prenatal care is above the national average and about half of the counties are above the national rate. Eighty percent of Kentucky’s children are immunized and over half of the counties are above the national rate.
"In looking at health outcomes, prenatal care in Kentucky has improved significantly such that the infant mortality and number of low birth weight babies are now below the national average," said Wilson. "Also, the prevalence for infectious diseases is lower than the national average because Kentucky has low rates of serious infections such as HIV and hepatitis. On the other hand, diabetes tends to be more prevalent in Kentucky, and the high number of Kentuckians with limited activity during the past month, an indication of the state’s high disability rate, is above the national average."
Cardiovascular disease is the leading cause of death in Kentucky. There are 113 counties with rates above the national average for cardiovascular disease. Kentucky’s cancer death rate is above the national average with 112 counties having rates above the national average. Kentucky’s mortality rate for all counties exceeds the national rate. Premature death rate is a good indicator of overall health status and a high rate reflects a decrease in work productivity and economic development. The premature death rate is above the national average in 88 counties.
The study looked at four specific cancer death rates. For lung/bronchus cancer, the state’s death rate is far higher than the nation’s. All of Kentucky’s counties have a rate above the national average. Kentucky also has a colorectal cancer death rate that is higher than the national average. Only five of Kentucky’s counties have a rate below the national average. Kentucky has a breast cancer death rate above the national rate. Only 48 of Kentucky’s counties have a rate below the national average. Kentucky has a prostate cancer death rate above the national average. Only 32 of Kentucky’s 120 counties have a rate below the national average.
The Kentucky Institute of Medicine™ was established in March 2005 with the mission to improve the health of Kentuckians by providing objective, evidence-based advice concerning health and health care to policy makers, professionals, leaders of society, and the public.
The institute is accomplishing this mission by conducting research and developing a consensus among its members about issues relating to health and health care. The institute responds to requests from outside sources for analysis and advice when aid is needed in forming a basis for health policy decisions.
The Kentucky Institute of Medicine™ was organized by Wilson, who recognized the success of the National Institute of Medicine and saw the need for an institute in Kentucky. The structure and organization of the Kentucky institute is based on the North Carolina Institute of Medicine, which was established in 1983. Wilson said when the
Institute was established that Kentucky needs a ‘think tank’ of
individuals who can serve in an unbiased, advisory role about the health care
concerns of the people – health care access, the uninsured, Medicaid
funding, medical liability and other issues. The members are knowledgeable
and experienced about these issues.
"What the Pritchard Committee is for education, the Kentucky Institute of Medicine™ is for health care… a group that provides data driven recommendations to improve the health of Kentuckians,” said Wilson.