New health ranking of counties places Oldham at top for second straight year; some counties had big jumps and drops

By Molly Burchett
Kentucky Health News

A new report of the national county health rankings shows several Kentucky counties have improved in the last two years while others have gotten significantly worse.

For the second year in a row, Oldham County ranked best in health outcomes, and Floyd County ranked worst this year, but the statistical differences among closely ranked counties are so small that they are subject to error margins. The rankings recognize that by placing the counties into quartiles, or fourths, of the state's 120 counties.

Ranks in quartiles: white, 1st-30th; gray, 31st to 60th; light green, 61st to 90th; dark green, 91st to 120th.

The results were released Wednesday in the fourth annual County Health Rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and are available at www.countryhealthrankings.org. Detailed, county-by-county health data are available at KentuckyHealthFacts.org.

Morgan County jumped two quartiles over the past year, improving its rank by 40 notches, from 69th to 29th. Another strongly positive change from last year was Mercer's County's improvement from 61st to 40th.

On the other hand, other county rankings worsened: McLean went down two quartiles and 36 steps, from 57th to 93rd. Bourbon went from 42nd to 68th, Gallatin went from 71st to 94th and Hickman County 31st to 61st.

These Eastern Kentucky counties have been listed in the bottom quartile (91st to 120th) for the past three years: Lawrence, Johnson, Martin Powell, Wolfe, Magoffin, Floyd, Pike, Breathitt, Knott, Jackson, Owsley, Perry, Letcher, Clay, Leslie, Knox, Bell and Whitley.

The rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make Kentucky communities healthier places to live: health behaviors, such as diet, exercise and alcohol use; clinical care, including access to care and quality of care; social and economic factors, such as education, employment and income; and the environmental quality of the physical environment.

Other factors considered in the rankings include the rate of people dying before age 75, high-school graduation rates, unemployment, access to healthy foods, air and water quality, income, and rates of smoking, obesity and teenage pregnancy.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Study suggesting that coal is a cause of health problems in E. Ky. is disputed by industry and politicians, defended by researcher

By Molly Burchett
Kentucky Health News

A heated debate centers on new research showing that residents in Floyd County, where coal is stripped from the tops of mountains and ridges, report more health problems than those in two nearby communities without such mines, Elliott and Rowan.

The study, published in the online Journal of Rural Health, is the latest by Dr. Michael Hendryx of West Virginia University to suggest that residents of mining areas have poorer health conditions and experience more serious illness. It is available to readers of Kentucky Health News by clicking here.

Unlike some of his West Virginia research, Hendryx does not say there is a correlation between mining and poorer health outcomes in Eastern Kentucky. He does suggest the possibility of a connection by showing residents' self-reported health problems like asthma, chronic obstructive pulmonary disorder and hypertension are more common in mining areas. And in an interview, he said he believes there is a connection.

Stonecrest Golf Course at Prestonsburg in Floyd County,
built on a reclaimed mountaintop-removal coal mine.

The study and its critics highlight the challenges and pitfalls of discussing and reporting such research. The study's underlying motives and methodology are contested. The president of the Kentucky Coal Association, Bill Bissett, said Hendryx has reached a conclusion and is seeking evidence to support it.

"Bissett's accusation is completely false," Hendryx replied. "On the contrary, he is obviously the one with the biased perspective and has a strong financial motivation to try to discredit this work."

Bissett questions the study's use of self-reported health measures that did not consider medical history. Self-reporting is susceptible to bias, which can be reduced by using other sources of data/. This study only included data collected from interviews conducted by volunteers, which may have introduced more bias, Bissett said.

Hendryx replied, "We used undergraduate students from Christian colleges who were trained to be fair and objective in the survey procedures, and to use the same procedures in both the mining and non-mining communities." He said Peter Illyn, who runs the Christian organization Restoring Eden, approached him to do the survey because Illyn "wanted to give the students this experience, and he wanted to replicate the survey that we had done the previous year in West Virginia, this time in Kentucky."

The volunteers interviewed 544 participants lived in Floyd County and 351 in Rowan and Elliot counties, where coal is not mined. It used standard statistical devices to control for factors that might influence health status: age, sex, education, marital status, work as a coal miner, weight and tobacco habits. However, there was no consideration of health behaviors such as drug and alcohol use, wellness measures, exercise or other healthy lifestyle habits that could have positive influences.

"The survey had to be brief with the time and resources we had," said Hendryx. "We did measure overweight and obesity, which is a reflection of diet and exercise. We measured tobacco use. We did not measure alcohol use in this survey but in other studies we have found that heavy alcohol use is not common and is not an explanation for the findings."

Kentucky House Speaker Greg Stumbo, who is from Floyd County, said he disagreed with the use of Rowan County, home of Morehead State University, as a control group due to the higher rates of education attainment and per capita income, reported Ronnie Ellis of Community Newspaper Holdings Inc.

Stumbo told Ellis, “Everybody in the world knows that you can take a population that is less well educated and that has a lower per capita income and you’ll see their health habits are (worse) and hence their rates of diseases are attributable to those two things.” Rowan has a much better health status than surrounding counties, according to the latest national County Health Rankings.

Hendryx defended his research controls and the process of relying on self-reported medical histories. He said the health problems may be caused by tiny particles of dust from coal mining, which have been linked to health problems, can penetrate the lungs to cause health impacts, reported James Bruggers of The Courier-Journal. Hendryx said there are also concerns about polluted water and soil.

The study's data only hint at a connection between surface coal mining and poor health. Hendryx said he can’t prove that mountaintop removal is causing people to get sick, but he believes it is. What is needed, he told Bruggers, is a more thorough and expensive “gold standard” study of air and water quality near residences, and samples of blood, hair and toenails that can reveal exposure to pollutants.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Infections, other safety issues plague hospitals, maybe more so when nursing is cut; here's a good series on it

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

HBO's 'Weight of the Nation' examines the obesity epidemic

A compelling four-part documentary delving into the obesity epidemic sweeping the country is being aired on HBO and can be watched free by clicking here. A reporter wanting to write a series of stories on the issue would find "weight of the Nation" a good reference.

The program is divided into four parts. The first segment, "Consequences," looks at the scope of the epidemic and the ramifications of being overweight or obese. "Choices" looks at the science behind how to lose weight, how to maintain weight loss and prevent weight gain. The third part, "Children in Crisis," looks at how the problem is affecting American children, exploring the decline of physical activity, school lunch, the demise of school recess and how marketing of unhealthy food targets children. The final segment, "Challenges," looks at the major forces driving obesity, including agriculture, economics, evolutionary biology, food marketing, racial and socioeconomic disparities, physical inactivity, American food culture, and the influence of the food and beverage industries.

The documentary is on a detailed website that answers questions that range from "What is obesity?" to "How do I know if I'm overweight or obese?"

The project is a presentation of HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention and the National Institutes of Health, with support from the Michael and Susan Dell Foundation and health insurer Kaiser Permanente.

More county-specific health data are available, painting detailed pictures of your local area's health

Five years' worth of county-specific data are now available for many types of health indicators on the Kentucky Health Facts website. The site features data on demographics, social and behavioral indicators, health outcomes, access to care, and maternal and child health, much of which can be useful to journalists all over Kentucky.

The Health Outcomes category, for example, looks at a county's premature-death rate, motor-vehicle deaths, prevalence of asthma, diabetes prevalence and cancer deaths. The Maternal and Child Health category looks at adequacy of prenatal care, infant mortality rates, teen birth rates and prevalence of youth who smoke cigarettes. It compares that data to the rest of the state and nation.

The data paint a detailed picture of what is happening in a specific area. One interesting nugget in the newly updated data on asthma show that in Warren County (Bowling Green), the percentage of adults with the respiratory condition has nearly doubled from 10 percent in 2003-05 to 19 percent in 2007-09. Here is the county asthma map:

The data come from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, which is the world's largest ongoing telephone health survey. It has tracked health conditions and risk behaviors in the United States on an annual basis since 1984.

The data can be viewed by going to www.kentuckyhealthfacts.org or by clicking here. Kentucky Health Facts is a service of the Foundation for a Healthy Kentucky.