The Health Of Kentucky

above the national rate. Eighty percent of Kentucky’s children are immunized and over half of the counties are abovethe national rate.ficials and concerned citizens at the county level in assessingthe health of their community and making decisions that willimprove health. A county profile and ranking was developedfor each of Kentucky’s counties to focus attention on thesecritical factors at the state and county level.In looking at health outcomes, Kentucky is at or below the national average for low birthweight babies and infant mortality. For infectious diseases (HIV, hepatitis, and tuberculosis),the state is also well below the national average. For diabetes, Kentucky is above the national average and only sixteencounties are below the national average. Kentucky’s rate ofadults with limited activities in previous month is above thenational average and reflects the state’s high disability rate.Cardiovascular disease is the leading cause of death in Kentucky. There are 113 counties with rates above the nationalaverage. Kentucky’s cancer death rate is above the nationalaverage with 112 counties having rates above the nationalaverage. Kentucky’s mortalityrate for all counties exceedsTable I:the national rate. PrematureMost Healthydeath rate is a good indicator ofCountiesoverall health status and a high CountyRankrate reflects a decrease in work1productivity and economic Oldhamdevelopment. The premature2Boonedeath rate is above the nationalaverage in 88 counties.3JessamineEach county profile contains 25 items which have equalweight in a ranking of 1 (best) to 120 (worst) as a measure ofthe county’s health status relative to the other counties. Themost and least healthy counties in Kentucky, according to thecounty profiles, are presented in Tables I and II. A completeranking of the counties is presented in the County Profilessection of the report (page 25).A key premise of this study is that individuals can avoidmany serious illnesses and premature deaths by engagingin more healthful behaviors,suchas not smoking, having aTable II:healthydiet, engaging in regLeast Healthyularphysicalactivity, usingCountiesseatbeltsandchildsafety reCountyRankstraints when driving, and us111Owsleying safety equipment at workand when using tools at home.112PowellThe poor health that resultsfrom poor individual lifestyle113Hartchoices is a significant liabil114Knottity to Kentucky’s capacity torealize economic develop115Leement and prosperity. The116McCrearyunnecessary costs incurredby unhealthy individuals are117Perryborne by their community as118Harlaneconomic losses. Advancingthe health status of Kentuck119Clayians will improve productivity and the economic viability120Wolfeof the state. Kentucky cannotrealize economic gains norimprove quality of life without a healthy populace.4The study looked at four spe- Andersoncific cancer death rates. For Woodford5lung/bronchus cancer, the6state’s death rate is far higher Fayettethan the nation’s. All of Ken- Spencer7tucky’s counties have a rate8above the national average. DaviessKentucky also has a colorectal9Callowaycancer death rate that is higherthan the national average. Only Clark10five of Kentucky’s countieshave a rate below the nationalaverage. Kentucky has a breast cancer death rate above thenational rate. Only forty-eight of Kentucky’s counties havea rate below the national average. Kentucky has a prostatecancer death rate above the national average. Only thirty-oneof Kentucky’s 120 counties have a rate below the nationalaverage.The Health of Kentucky describes a process to help countiesimprove their health status and provides examples of communities which have undertaken health improvement activities. Guidance is provided for conducting local studies andsurveys. The report also provides suggested community interventions, sample programs, and resources related to eachof the measures included in the individual county profiles.This report from the Kentucky Institute of Medicine providesobjective data and resource information about risk factorsand disease outcomes. This information is meant to assist of-The Health of Kentucky8Kentucky Institute of Medicine

INTRODUCTIONhe Commonwealth of Kentucky is a diverse state interms of landscape, industry, rural/urban distributionof population, socioeconomic factors, level of education, and health. These measures of diversity emphasizethe importance that living environments play in health assessment. Life, and therefore health, is likely to have manymeanings, each derived from the distinct and complex set ofcircumstances that define any given community. To Kentuckians, community identification is often equated with countyof residence.riod to establish patterns or trends, rather than a single pointin time, which may or may not be representative of actualcircumstances. Based on the data gathered for the measurespresented for each county, counties were ranked from 1 to120 to illustrate their health status relative to other counties.Finally, for the purposes of comparison, select state maps thatare color coded by quartile to illustrate gradations of countylevel health status and a ranking table are provided. In total,these comparative data provide a comprehensive profile ofhealth in Kentucky.Given the diverse nature of Kentucky and the importanceplaced on locality, efforts to address the problems that undermine health must begin with the citizens, providers, andpolicymakers in the communities where they live, work, andparticipate in our healthcare system. However, local communities often lack the information and knowledge neededto take action. Data accessible to groups trying to improvetheir community’s health status and access to healthcare areusually from national or state studies and are not designed togive information specific to local problems. State-level dataaggregates our 120 counties or uses a sample so small thatconclusions are only valid for the state as a whole or for largeregions. While helpful, these data can conceal the disparitiesthat exist among counties, masking the true situation foundat the local level. For example, the percentage of adults whosmoke in Kentucky is estimated at 29%; however, the ratevaries by county from a high of 36% to a low of 20%. As thisexample shows, efforts and scarce resources need to be concentrated on geographic areas where health challenges drivedown overall statistics and adversely affect the health rates ofthe entire Commonwealth. To effectively plan interventionsspecific to health barriers and disparities, county-level dataon all health and health-related issues are necessary.Local communities and the state can use the data and information offered in The Health of Kentucky to identify and address critical health issues and to lend urgency, direction, andpurpose to planning and actions designed to confront thoseissues of the highest priority. This will allow the development of statewide policy that is sufficiently flexible to targethigh-need counties or groups of counties. The report providescitizens at the county level with the needed information,knowledge, and methodologies to make better health-relateddecisions, tailor policies to meet their particular needs, andengage elected officials in an informed debate over healthpolicy.TOne process communities can use to achieve health improvement is Community-Initiated Decision Making (CIDM).CIDM assists communities in their efforts to focus on specific health problems and develop action plans to reduce oreliminate them. In the CIDM process community participantsgather, analyze, and interpret data, reflect community priorities and values, develop and enhance working relationshipswithin the community, explore alternatives, prioritize needs,and develop and implement action plans for health improvement. This report provides information on how to implementa CIDM process as well as examples of how other communities have successfully addressed a particular health problem.In light of this, the Kentucky Institute of Medicine has produced The Health of Kentucky, a report offering a profile ofhealth at the county level. The variables presented are classified broadly as behavioral and social factors, demographics, health access, and health outcomes. Within these classifications, data are provided for 25 different measures foreach county, which are compared to state and national benchmarks. The report also provides county rates for the four cancers which have the highest mortality rates in Kentucky toinform the efforts of community leaders in mitigating knowncauses of poor health outcomes and to advance critical preventive screening where necessary. Selections of data wereguided by the availability of data over a sufficient time peKentucky Institute of MedicineThe state has many health and health-related problems as indicated by comparisons to national rates. Kentucky is ranked49th for the percentage of persons who smoke, 45th in the percentage of adults who are obese, 49th in poor mental healthdays in the past month, 48th in poor physical health, 46th incardiovascular deaths, 50th in cancer deaths, 42nd in premature deaths, and 50th in total mortality. All of these factorsare interrelated. The state’s unfavorable rankings for premature death and total mortality are largely a result of equallyunfavorable rates of chronic diseases. Chronic diseases, inturn, are often the result of health-damaging behaviors, par9The Health of Kentucky

ticularly tobacco use, physical inactivity, and poor nutrition.Therefore, chronic diseases, which account for 70% of Kentucky’s total mortality and are among the most prevalent andcostly of all health problems, are highly preventable throughimprovements in personal behaviors and regular primaryhealthcare. Many of the health crises that confront Kentuckyare derived from individual actions and behaviors that occurat the local level and, therefore, the local level is where actions to address these crises must begin.It is important to note that education and health go handin hand. Improvement in one improves the other, and goodstanding in both is needed to improve the quality of life ofall Kentuckians. Healthy children are better learners, whichis important considering the widespread personal and societal benefits associated with education. Educated people aremore likely to understand the risks involved with poor healthand are more likely to make better lifestyle choices. Thesechoices will help prevent chronic diseases that lead to economic loss as well as early and preventable deaths in Kentucky. So, while improvements in health are needed to improve education, improvements in education also are neededto improve health. Education includes both formal educationand increased health literacy. Residents accomplished in bothrespects can work to reduce health risk at the local level and,with the proper information, also engage state-level decisionThe Health of Kentuckymakers in informed discussions about community healthcareneeds that are not entirely within their control, such as accessto healthcare and employment.Poor health is a significant liability that significantly undermines Kentucky’s drive for economic prosperity. To improveKentucky’s health, it is important not to discount the significance of what people do, or do not do, as they go about thebusiness of daily living. The costs incurred by unhealthy individuals are borne by their community, as citizens shoulderunnecessary economic losses. For example, the direct and indirect costs related to diabetes in Kentucky were 2.9 billionin 2002. Considering that an estimated 40% of the population between the ages of 40 and 70 are currently overweightor obese and are considered to be in a pre-diabetic phase,these costs are likely to increase if corrective and preventive measures are not taken. Improving personal health behaviors and advancing the health status of Kentuckians willalso improve productivity and the economic competitivenessof the state. Industry has become increasingly reluctant tolocate in communities with known or perceived health problems which generally are viewed as increasing the cost ofdoing business because of increased health insurance costsand worker absenteeism. To put it briefly, Kentucky cannotrealize economic gains nor improve quality of life without ahealthy populace.10Kentucky Institute of Medicine

METHODSTwenty-five measures were used to form a profile ofhealth risks and outcomes for each of Kentucky’s 120counties. These measures were selected based on areview of health literature and deliberations by KIOM taskforce members.the values. These ranks were combined for a total score foreach county. Finally, county scores were ranked from 1-120or healthiest to least healthy based on measures used in thestudy. Measures for lung cancer, breast cancer, prostate cancer, and colorectal cancer were included to supplement theinformation provided by the county profiles. However, therates for these four leading causes of cancer deaths were notincluded in county scores or overall rankings. The reason forthis is because the impact of death from the four types ofcancer on county scores and rankings were captured in theprofile measure, Total Mortality.The chosen measures are the most useful for identifying theimpact of personal behaviors, social conditions, demographic characteristics, and access to healthcare on the health andwell-being of county residents. Profile measures permit comparison of one’s county with rates of other counties, the state,and nation. The comparisons can be useful for determiningwhat the level of health status is within a county for a particular measure and where improvements should be sought.To obtain the strengths, challenges, and outliers for eachcounty, a scale from 1-120 was applied to the rankings foreach profile measure. Favorable values that were within 35%of the median were classified as strengths. Unfavorable valueswere classified as challenges, and unfavorable values 90% orhigher compared to the median were classified as negativeoutliers. As the report shows, all counties are characterizedby strengths, challenges, and outliers.A key premise of this study is that individuals can avoid manyserious illnesses and premature deaths by engaging in morehealthful behaviors, such as not smoking, having a healthydiet, engaging in regular physical activity, using seatbeltsand child safety restraints when driving, and using safetyequipment at work and when using tools at home. This reportincludes measures that indicate the damages to health thatoccur by not p

The Health of Kentucky 2 Kentucky Institute of Medicine Kentucky Institute of Medicine Lexington, KY 859-323-5567 www.kyiom.org 2007 The Health of Kentucky: A County Assessment was funded in part by a grant from the Foundation for a Healthy Kentucky. The Foundation's mission is to address the unmet healthcare needs of Kentucky.