How to take local action to improve health at the local level is outlined at Frankfort conference

By Tara Kaprowy
Kentucky Health News

A recipe for how to improve health at the local level in Kentucky was the capstone of a day-long seminar in Frankfort Monday, with experts stressing that partnerships are key and funding will remain tight.

Communities must mobilize, prioritize, "effectivize" their actions, publicize and evaluate, measure and report performance, Trudi Matthews, director of policy and public relations at HealthBridge, summed up at the end of the Kentucky Health Quality Collaborative Conference.

The gathering was hosted by Kentucky Voices for Health in partnership with the Friedell Committee for Health System Transformation. "No single actor or set of stakeholders can solve what's wrong," Matthews said. "We really need to think across silos. We really have to collaborate."

When it comes to funding, governments "have made it very clear they will not increase the number of dollars that will be put into health care," said keynote speaker Dr. Robert Graham, national program director for Aligning Forces for Quality. "We're in a perfect storm," agreed Sue Thomas-Cox, branch manager for chronic disease prevention at the Kentucky Department for Public Health. "Federal, state and local governments don't have enough money . . . so we must work together."

Luckily, health care happens at the local level, Graham said, with hospitals and clinics unique to communities, health insurance agents locally based and consumers grounded in their communities. While there is "no particular model for how to get (change) started," Graham said, the first step is getting all stakeholders — purchasers, insurance agents, providers, consumers, faith-based organizations — around the same table. "You've got to make sure there is a balance of interests," he said. 

Also key are local boards of health and health departments, whose members and staff are charged with safeguarding the health of the people of a county, under state law, and have the advantage of being "relatively untainted by the illness-for-dollars disease," pointed out Dr. Forrest Calico, a rural health consultant and longtime worker in the field.

Health departments must ensure they don't spread themselves too thin, said Dr. Steve Davis, acting commissioner for the Department for Public Health. "One of the biggest reasons why we have not moved the health needle in Kentucky is we need to be an inch wide and a mile deep," he said. Communities need to "come up with five or six things and let's hammer, hammer, hammer it," he said. Of those priorities, Davis pointed out the importance of tackling chronic disease: "That's what's killing our brethren and eating our financial lunch." For adults, he would like to see an increase in breast, cervical, colon and lung cancer screening, as well an increase in immunization rates especially for flu and pneumonia.

For children, Davis has six priorities: reduce preterm and low-birthrate babies; improve injury-prevention programs; decrease tobacco use; reduce obesity; increase immunization rates; and improve oral health.

To get more accomplished, health departments need to team up with local organizations to avoid duplication of services, which Davis said accounts for $300 billion in unnecessary spending nationwide. He added the goal is to make "1 plus 1 equal 3," with health departments needing to adopt a "do or assure" philosophy.

But there are challenges in health departments, with some local health board members failing to "roll up their sleeves," Davis said. "You can go in with nothing in your head and leave with nothing in your head," agreed Henry Bertram, chair of the Pendleton County and Three Rivers District Board of Health.

A survey of health departments showed just 46 percent of local boards of health have a vision for the next three years to improve the health status of their community and just 44 percent say they are tracking compliance for the 10 essential services they are charged with providing. And the real numbers might be worse, because the survey was voluntary.

While about half of the state's health departments are committed to working toward achieving national accreditation, only three departments — Franklin, Northern Kentucky and Three Rivers District — have actually applied for it. 

Also crucial for communities is using data to identify priorities, take action and measure performance, whether using county-specific numbers at www.kentuckyhealthfacts.org or using national data.

"We don't want to get stuck in analysis paralysis," but communities can use the data as "a story you can use as leverage," said Jan O'Neill, community engagement specialist for County Health Rankings & Roadmaps. The County Health Rankings evaluate the morbidity and mortality rates for nearly every county in the country and rank them within a state.  The rankings can act as a motivator for counties interested in effecting health changes, but "We have to be aware of their limitations" given their margins of error, especially for small counties, pointed out Al Cross, director of the Institute for Rural Journalism and Community Issues. 

O'Neill spoke of San Bernadino County in California, which used its low ranking to spur change. The county focused on its built environment, pressing hard for Walk or Wheel to School programs, community gardens and a kids community health center. O'Neill pointed out the changes are about more than infrastructure. "It's the relationships," she said. "It's the human capital ... It's many not all doing it all, but bringing what you do best. That's what mobilizing looks like."

Jodi Mitchell, executive director for Kentucky Voices for Health, said she is "starting to see a tide of change" already in Kentucky. What's important is to keep momentum building and, equally vital, ensure people are willing to participate. "If you're not at the table," she said, "you're on the menu."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Neat app shows how education, income affect a county's health

Based on the premise that much of what influences health happens outside the doctor's office, the 2012 County Health Calculator uses education and income to illustrate how these factors can affect one's health any county. 

The app estimates how many cases of diabetes would be prevented, how many lives would be saved and how many diabetes costs would be eliminated if income or education levels improved by specific amounts in a specific area. For example, the Pulaski County page shows, "If 5 percent more people attended some college and 4 percent more had an income higher than twice the federal poverty level, we could expect to save 17 lives, prevent 175 cases of diabetes, and eliminate $12 million in diabetes costs every year."

The application also shows which counties have the highest and lowest education levels (best: Fayette County, worst: Clay County) and income levels (best: Oldham County, worst: McCreary County).

The interactive app was developed by the Robert Wood Johnson Foundation and Virginia Commonwealth University's Center on Human Needs and renders "ballpark estimates" of avertable deaths, diabetes and diabetes cost. Researchers obtained education and income data from the U.S Census Bureau and county death rates and estimates of the prevalence of diabetes from the U.S. Department of Health and Human Services. Estimates of diabetes prevalence were based on self-reports by people who responded to the Behavioral Risk Factor Surveillance System. Data on medical spending on diabetes derived from The Dartmouth Atlas of Health Care. (Read more)

Kentucky ranked sixth in nation for obesity, fourth in high blood pressure, second for diabetes

A new report shows 29.5 percent of Kentuckians are obese, sixth highest in the nation. The state ranked second in the nation for the highest percentage of diabetes, with 13.7 percent of Kentucky residents diagnosed with the disease, and fourth in high blood pressure, at 36.3 percent.

According to the Gallup-Healthways Well-Being Index, West Virginia had the highest rates of obesity (35.3 percent),  diabetes (15.7 ) and high blood pressure (38.9) in the country. Colorado had the lowest, with 18.5, 6.8 and 22.6, respectively. Colorado "is the only state where fewer than 20 percent of adults are obese," reports Elizabeth Mendes for Gallup. West Virginia's obesity rate is the highest for any state since the study began in 2008.

The survey asked respondents if they had been diagnosed with diabetes or hypertension. to measure obesity, "participants were asked to report their height and weight, allowing Gallup to calculate their body mass index," reports The Huffington Post. A person with a BMI of 30 or higher is considered obese. (Read more)

Website helps journalists, community planners, other Kentuckians in search of county-specific health data

A treasure trove of health data about every county in Kentucky is available to journalists and community planners looking to draw a statistical picture of their area. That was the message of a webinar hosted by the Foundation for a Healthy Kentucky Wednesday.

"We really hope the information we have on kentuckyhealthfacts.org will start a conversation," said Sarah Walsh of the foundation's "Local Data for Local Action" Initiative.

The website features a map of the state that is broken down by county. By clicking on a county, a plethora of information pops up, including information on a county's:

• demographics, such as graduation rates and per capita personal income;

• social and behavioral indicators, such as lack of physical activity and prevalence of smoking and obesity;

• health outcomes, such as infectious disease rates, motor vehicle deaths and premature death rates;

• access to care, such as flu vaccination rates, and number of available health care providers and physicians;

• maternal and child health, such as infant mortality, teen birth rates and low birthweight rates;
• senior health, such as the percentage of the senior population in a community.

The data can be compared to the rest of the state, the rest of the country or other counties, and users can create tables, bar graphs, line graphs or maps suitable for publication. "There's a lot of information here," Walsh said. (Graph created online shows obesity declining in Laurel and Pulaski counties after three years of increase, but still rising in Knox County and holding steadier in Rockcastle County. Up to six counties can be placed in one such graphic.)

The site is especially valuable to journalists, said Al Cross, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky. "These are the hard facts that local news media need to report as they hold up a mirror to their communities and help them address community problems," Cross said. "In most Kentucky counties, one or more facets of health are a community problem. They need more attention." Kentucky Health News is a service of the institute, funded by the foundation.

Much of the data come from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance Survey, a nationwide, random telephone poll that is conducted each year. Because there may not be enough survey responses from residents in some counties, much of the data on the site have been developed by looking at three or four counties that are near each other and demographically similar, which Walsh said makes the data more "stable and robust." Statisticians have reconfigured the data so that they are all based on a population of 100,000 people, enough to have confidence in the percentages.

While encouraging community planners to use the site, Walsh said the Kentucky Cancer Registry website is "one of the best in the nation" and has cancer-specific data that may not be available on kentuckyhealthfacts.org. She also pointed listeners to the Kids Count website, an Annie E. Casey Foundation-funded project that has statewide data specific to children.

What surfers won't find, however, are Kentucky numbers on the childhood obesity or childhood diabetes. "Different school districts and communities are collecting data but in different ways and at different ages," she said, adding those disparities make comparison analysis difficult. A bill to make schools collect and report body-mass-index data failed in the last session of the General Assembly.

The goal of Wednesday's webinar was to disseminate information so community planners can identify and address health needs in their area. "At the foundation we take a lot of inspiration from the words of Arthur Ashe, 'Start where you are. Use what you have. Do what you can'," Walsh said. "We believe communities can do a lot to change their health status." The webinar was part of the foundation's "Health for a Change: Ignite — Unite — Act" initiative and was the first in an ongoing series. The next session, July 27, will focus on how to plan a community health needs assessment. For more information about the series, click here.

Kentucky 6th in obesity; state rate rises for 2nd consecutive year

"It's official: Kentucky is a mecca for blubber," The Courier-Journal's Darla Carter reports. The state has the sixth highest rate of obese adults, is one of just six states whose obesity rate has risen for the second year in a row, and is one of a dozen states with above 30 percent. The findings are in the 2011 "F as in Fat" report released by the Trust for America's Health and the Robert Wood Johnson Foundation.

Kentucky's obesity rate is 31.5 percent. Mississippi had the highest rate with 34.4 percent and Colorado was lowest with 19.8 percent. The problem is biggest in the South, which has nine of the 10 fattest states; Michigan also ranks. Fifteen years ago, no state had an obesity rate of more than 15 percent, the report notes. "Today, the state with the lowest obesity rate would have had the highest rate in 1995," said Jeff Levi, executive director of the Trust for America's Health. "There was a clear tipping point in our national weight gain over the last 20 years, and we can't afford to ignore the impact obesity has on our health and corresponding health care spending."

The problem is largest for racial and ethnic minority adults — the obesity rate for blacks in Kentucky is over 43 percent — and for those with less education and lower incomes. Almost 33 percent of adults who didn't graduate from high school are obese, compared to 21.5 percent of people who have college or technical college degrees. More than 33 percent of adults who earn less than $15,000 per year were obese, compared to nearly 1 in 4 adults who earn at least $50,000 each year.

The obesity epidemic is having an effect on people's health. Since 1995, diabetes rates have doubled in eight states, including Kentucky. In 1995, Kentucky had a diabetes rate of 4.2 percent. Now it is 10.5 percent. The hypertension rate 15 years ago was 22.2 percent. Now it is 31.6 percent. (Read more)

The rates only reflect adults who are defined as obese, not overweight. Taking both figures into account means 67.1 percent of Kentucky adults are either obese or overweight. For county-by-county data, from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and Kentucky Health Facts, click here.