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.

Floyd County woman is Kentucky's smoke-free advocate of year

For her work spreading the word about second-hand smoke and founding the coalition that ultimately helped Prestonsburg pass a smoke-free ordinance in 2009, Floyd County's Jean V. Rosenberg was named 2012 advocate of the year at the annual Smoke-Free Policy Conference hosted by the University of Kentucky's Kentucky Center for Smoke-Free Policy. She stands with center Director Dr. Ellen Hahn, left, and Dr. Melissa Walton-Shirley, right, the Glasgow cardiologist who won in 2011.

Rosenberg started her work in 2005 when she began working for the Floyd County Health Department as a program specialist to increase awareness about the dangers of second-hand smoke, reports Ann Blackford reports in a university press release. During that time, she founded the Breathe Easy Floyd County Coalition, which educated people about second-hand smoke and supported local smoke-free initiatives.

On Nov. 1, 2009, the City of Prestonsburg implemented a 100 percent smoke-free ordinance in all workplaces and enclosed public places, with Rosenberg at the helm to propel the effort forward. (Read more)

Mayor will propose smoking ban in Hopkinsville, largest Kentucky city without one

The largest Kentucky city that has not banned smoking in public places may change that.

Hopkinsville Mayor Dan Kemp's proposal "fundamentally resembles Lexington's ban," reports Nick Tabor for the Kentucky New Era. The law would apply to bars and restaurants but not private clubs; retail tobacco stores and tobacco warehouses; and rented rooms in hotels, hospitals and nursing homes. "The best thing would be to have no exemptions," Kemp said, adding that he recognizes the need for compromise. 

An online survey by the Christian County Health Department two years ago indicated strong support for a ban. A recent, scientific survey of 500 Kentuckians shows 59 percent support a statewide ban, the American Cancer Society found. Kemp said he has "received a mostly positive response from local businesses," Tabor reports.

As for a smoking ban imposing on a person's right to light up, Kemp said, "I just think it's such an overriding health concern that that trumps the individual rights argument." Kemp hopes the council will vote on the proposal June 5. If they ratify it, the ban could take effect July 1. (Read more)

In 11-1 vote, Somerset passes comprehensive smoking ban

Lighting up in Somerset, once a big tobacco town, will no longer be allowed in all enclosed public places. The city council voted 11-1 Monday evening to pass a smoking-ban ordinance, reports Heather Tomlinson of the Commonwealth Journal. (C-J photo)

The ordinance includes restaurants, bingo halls, gaming facilities, nursing homes and any place of employment. "It's a public health safety issue," said councilor Jerry Girdler, who lost his well-known brother Eddie two weeks ago to throat and lung cancer. "The facts back up that smoking is harmful to the people around them."

The meeting attracted a crowd of more than 50, many of whom voiced their opinions. Business owner Teresa Singleton said, "I am really shocked at the fact that the City of Somerset is considering taking away the rights of businesses to make those decisions on whether we want our place of business to be smoking or non-smoking. For you to take that on your own, I think that's a major step in the wrong direction."

Local podiatrist Pamela Jensen-Stanley disagreed. "I believe the ban is necessary," she said. "I think it's time that Somerset moves up and gets with the program." (Read more)

Recession has hit health departments hard: 23,000 jobs (15%) lost, core funding cut

Funding and job cuts as a result of the economic recession have weakened the impact public health departments have on their communities, says a series of articles published in the Journal of Public Health Management and Practice.

"Continued cuts to public health services will have an unsatisfactory impact on the health of individuals and the community," said Dr. Lloyd F. Novick, the journal's editor-in-chief. "There is a heightened vulnerability at the present time for adverse health outcomes. Above all, the realization of the vital need to maintain resources for our public health delivery system is imperative."

In 2009, 23,000 jobs in public health departments were eliminated, 15 percent of the total. By 2010, more than half the agencies had a cut in core funding. As they scramble to make do with their new bottom lines, more cuts are expected. "The current, alarming trend of diminishing resources, reduced workforce and impaired capacity to maintain public health programs pose major hurdles for local agencies, with consequences that will be felt well into the future," said Dr. Rachel Willard of the University of California.

To view an article on the impact of the 2008-2010 economic recession on local health departments, one on a local health department that is providing only essential services, and one on enhancing public health value in an era of declining resources, click here.

In front-page editorial, rural weekly in Adair County demands that board members of county-owned hospital resign

In our experience, most weekly newspapers don't have editorial pages, much less editorials, so when one puts an editorial on the front page and also runs an editorial about the decision, and the work is well-written and well-argued, it's worth noting.

The Adair County Community Voice in Columbia, Ky., noted county government's bailout of the "collapsing" county-owned hospital; elected officials' request that they have "a say in any final decision to sell the hospital" and that "the hospital administration will try just as hard to keep the hospital independent as they will to sell it;" and some appointed board members' dislike of the requests.

"It seems like little to ask of someone who is $13 million in debt and asking you for $1.7 million," the editorial said, noting that one member said the board had been "a rubber stamp" for agents who secured the bonded debt. That admission "saves us the trouble of trying to prove that board members acted irresponsibly in overseeing the hospital’s business," the editorial said. "Now the question has to be, 'Why are they still on the board?'" It said the board not only "ran the hospital into the ground" but is "in control of a document that will show if any criminal activity took place," a forensic audit that gives board members "a personal stake in any damaging evidence that may come out."

In her explanatory editorial, Editor-Publisher Sharon Burton said she put the editorial out front because "We believe this is a critical time for our community, and we believe bad decisions will continue if the board is left as it is. We believe it’s our job to bring the issue to the forefront, and there is no better place to do that than on the front page of the Community Voice." The explanatory editorial also included useful background and perspective, including: "At small newspapers we don’t have the luxury of separating the people who cover the news from the people who write opinion pieces. Instead, we work hard to provide fair and unbiased coverage of local news. Then, we look at how that news impacts the people in our community and take a stand as needed on our editorial page."

Burton told us in an email that the editorial generated responses by phone, emails, Facebook messages "and of course being stopped at church and the grocery store," all of them positive except a letter from the daughter of a board member, which is running this week. The Community Voice doesn't put editorials or most news online, but PDFs of the pages with the editorials are available on the Institute for Rural Journalism and Community Issues website. The front page, with color, is 3.5 MB; the inside page is 682 KB.

Hopkinsville newspaper endorses smoking ban

The Kentucky New Era newspaper in Hopkinsville said in a recent editorial that if the state legislature doesn't enact a smoking ban, the city should.

The General Assembly "should not squander the opportunity or delay action on a law that could protect everyone against the health risks associated with exposure to secondhand smoke," the editorial said. "Legislators should not disregard the overwhelming scientific evidence of the effects of secondhand smoke. . . . Opponents of a smoking ban argue that they want to protect the rights of smokers. We believe those rights to not extend to smoking in places where non-smokers work, shop and eat." (Read more)

Johnson County focus of C-J series on docs, prescription abuse

The second day of The Courier-Journal's investigation into prescription drug abuse and the role of doctors looks at Johnson County, ranked 11th in the state for drug overdose deaths despite its small population of 24,000. It ranks second in such deaths per capita, right behind adjoining Floyd County, as shown on this C-J map of death rates by county. (Click on map for larger version.)

In Paintsville, Johnson's county seat, three doctors have been convicted in the past 10 years of prescribing narcotics illegally. The epidemic prompted the county Fiscal Court to try to pass an ordinance that would have outlawed clinics that were "dealing largely in cash; drawing significant numbers of patients from other counties; generating at least half of their revenue from prescribing narcotics; dispensing disproportionate amount of prescriptions, compared with other medical services; and not being affiliated with a nearby hospital," R.G. Dunlop reports. Attorney General Jack Conway's office ruled the county did not have the authority to pass such a ban.

Dunlop relays the stories of the Paintsville doctors with shocking prescribing practices and also speaks to the mayor, who called the problem "an epidemic." "What we end up doing is arresting all these 'victims' ... and the doctors who create the problem continue to practice." The C-J site also includes this video of Dunlop and photographer Scott Utterback's encounter with Aaron Cantrell, a co-owner of a clinic that is pictured today and will be the focus of more coverage tomorrow. (Read more)

Corbin City Commission enacts smoking ban

The Corbin City Commission passed an ordinance this week to ban smoking in all enclosed public areas and enclosed public buildings. The ordinance will also require smokers to remain at least 25 feet from building entrances. Areas subject to the ban include bingo parlors, restaurants except for outdoor seating, and motels and hotels, "which may not offer more than 20 percent of rooms as smoking," Dean Manning of The News Journal reported. "Once the ordinance is advertised, it will become law," Becky Kilian of The Times-Tribune reports.

McCracken County to consider banning new kind of synthetic pot

In response to several teenagers overdosing on it, officials in McCracken County are considering banning chemicals that are being sold as synthetic marijuana.

"Death is a realistic side effect when using this stuff," said Jamey Locke, emergency director for Mercy Regional Hospital.

Between July 10 and Aug. 21, 17 people — 13 of them teenagers — were taken to hospitals by ambulance after having smoked synthetic marijuana. "In almost every case they ended up in ICU," McCracken County Sheriff Jon Hayden said.

An ordinance will be introduced Nov. 14 at a Fiscal Court meeting. It would outlaw the sale or possession of the new synthetic marijuana. Although Kentucky has previously banned certain types of synthetic marijuana, "It appears manufacturers have changed the chemical composition to meet that requirement," The Associated Press reports. (Read more)

Bullitt County health board will appeal judge's ruling against smoking ban, with financial help from Clark County

The Bullitt County Board of Health will appeal a local judge's ruling that it lacks the authority to impose a smoking ban, and it will get some help from the board in Clark County, one of four where bans have been enacted by health boards instead of county fiscal courts.

The $5,000 will come not from tax dollars, but from "money received from the University of Kentucky for consulting services provided by Health Department Director Scott Lockard," Rachel Parsons of The Winchester Sun reports. UK "contracted with the Clark County Health Department so Lockard could work with the university and other local public health directors on smoke-free issues."

If the Bullitt County ruling is upheld, the decision could invalidate regulations enacted by health departments in Clark, Madison, Woodford and Hopkins counties. At the Court of Appeals, “If they uphold the lower court’s ruling, then we will have an injunction against our ruling until it goes to the Supreme Court, so we will suspend the enforcement of it until we get a final determination,” Lockard said. “We fully anticipate that the ruling will be in favor of the boards of health, because this is just a very narrow interpretation.” (Read more)

Lexington council turns to wellness center to cut insurance costs

Following a national trend to improve employee health so companies can cut health-insurance costs, the Lexington-Fayette Urban County Council agreed Tuesday to set up a wellness center for city employees.

The center will "be voluntary and free for employees, retirees and dependents covered by the city's health insurance plan," reports Beverly Fortune of the Lexington Herald-Leader. Acute and primary care, chronic-disease management and preventive screenings will be among the services provided at the center, the location of which has not yet been chosen. It is estimated to cost $1.3 million.

Chattanooga opened a similar center in 2006. Its health insurance costs were increasing about 20 percent annually, with health benefits costing the city $16 million that year. Today, the city is saving about $5 million a year, said Madeline Green, director of risk management and incentives for the city. (Read more)

Bullitt judge strikes down health board's smoking ban; could lead to decision with statewide impact, if appealed

A Bullitt County judge has extinguished a countywide smoking ban that was supposed to go into effect Monday, saying the county health board overstepped its authority. The ruling could lead to a decision with statewide impact, determining whether county health boards have such power; a judge in another county approved a ban there and the ruling was not appealed.

Circuit Judge Rodney Burress called the ban void and unlawful, Charlie White of The Courier-Journal reports. "This court does not believe that type of 'Big Brother' conduct was anticipated by the Kentucky state legislature in its grant of power and authority to boards of health," Burress wrote.

"It's a win for business and a win for choice in Bullitt County," said Harlen Compton, one of the founders of Bullitt County Choice, a group of area business owners and residents.

The ban would have prohibited smoking in bars, restaurants and all public places. But even before the Bullitt County Board of Health passed the ban, the county's eight cities and its Fiscal Court sued the board, White reports.

Swannie Jett, the county's health director, said health officials were "very disappointed" and will decide in the coming weeks if they will appeal the decision.

Burress wrote that Bullitt County residents "are entitled to be governed by their elected representatives and should not be subjected to additional laws enacted by an administrative agency without an express grant of authority."

The health board passed the ban under Kentucky Revised Statute 212.230, which says health boards "shall" adopt, implement and enforce regulations necessary to protect public health. Opponents said such a far-reaching regulation as a smoking ban can only be legally passed by city councils or fiscal courts, White reports.

However, the Bullitt County board is not the first in Kentucky to enact such a ban. Health boards in Woodford, Hopkins, Madison and Clark counties have done likewise. The move in Hopkins County did result in a legal battle, but the judge sided with the health department. (Read more)

Judge to decide if health board's smoking ban will stand in Bullitt County, as one did in Hopkins County

Whether the Bullitt County Board of Health had the authority to pass a countywide smoking ban is in the hands of Bullitt Circuit Judge Rodney Burress, who heard from the board and representatives of the Fiscal Court objecting to the move Thursday.

In March, the Board of Health passed a ban that would prohibit smoking in bars, restaurants and all public places, including some that are outside. It was supposed to go into effect in September.

But attorneys representing the Bullitt Fiscal Court said the health board has "overstepped its authority by enacting a policy that should have been handed down by a legislative body, such as a city council or Fiscal Court," The Courier-Journal's Charlie White reports.

Margaret Miller, who is helping to represent the board of health, cited the Kentucky statute, which gives boards of health the authority to adopt, implement and enforce regulations to protect people's health.

The Bullitt County Board of Health is not the first in Kentucky to enact such a ban. Health boards in Woodford, Hopkins, Madison and Clark counties did likewise. The move in Hopkins County did result in a legal battle, but the judge sided with the health department and the ruling was not appealed. (Read more)