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 finds only counties in Appalachia, mostly in Kentucky, had increasing rates of death among both sexes as century turned

By Molly Burchett
Kentucky Health News

More than 40 percent of counties saw increases in female death rates as the 21st Century began, while the death rate for men rose in just 3 percent of counties, a study shows. Only Appalachian counties, mostly in Kentucky, had worsening rates for both sexes. (Click on a map for a larger version.)

Change In Male Mortality Rates From 1992–96 To 2002–06

Change In Female Mortality Rates From 1992–96 To 2002–06

On the Health Affairs maps above, blue counties showed substantial improvement, while those in aqua showed minimal improvement and worsening counties are in red.

The study identifies some shared characteristics among the 1,334 counties where more women are dying prematurely, but the main factors weren't medical or behavioral, according to David Kindig and Erika Cheng, authors of the study report.

Although counties with high rates of smoking and obesity had increased mortality rates, the report found socioeconomic factors in the Appalachian states of Kentucky and West Virginia, such as the percentage of a county’s population with a college education and the rate of children living in poverty, had more to do with increased mortality rates.

In Kentucky, Owsley County has been ranked last on health-related measures by the Population Health Institute. Areas like this in Appalachia suffered rising death rates in both sexes because college education is a rarity, child poverty is normal, recreational facilities are scarce, restaurants are mostly fast-food outlets, and adults lack social support, reports Geoffrey Cowley of msnbc.

The chart below shows how Kentucky compares to the national average in premature death and that Owsley County suffers from tremendously high rates.

County Health Rankings by University of Wisconsin's Population Health
Institute and the Robert Wood Johnson Foundation (countyhealthrankings.org)

These findings provide supporting evidence for the ever-increasing need for significant health improvement efforts in Appalachia. According to the report, efforts must extend beyond a focus on health care delivery and include stronger policies affecting health behaviors and the social and environmental determinants of health,with corresponding investments in those areas. (Read more)

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.

Kentucky's well-being ranks next to last, just above West Virginia

Kentucky ranks next to last in the annual Gallup-Healthways Well-Being index, just ahead of West Virginia. The Bluegrass State ranked last in the index's Healthy Behaviors category, which measures the percentage of residents who smoke, exercise frequently and eat healthy daily.

The chart on the left shows Kentucky's score in each of the six categories. The state's rankings haven't changed much since last year, with the exception of the Work Environment index, which fell from 8th to 31st.  The colored chart on the right shows the state's overall and category rankings for 2011 and 2012 (1 is the highest rank and 50 is the lowest). Click here for the detailed report on Kentucky.


Left: Kentucky Well-Being Indexes     Right: Well-Being rankings of Kentucky among the states

West Virginia, with an index score of 61.3, had the lowest well-being for the fourth year in a row. The report shows West Virginians were the least likely to be thriving and also had the nation's worst emotional health. They had the lowest score in the Physical Health category, which reflects having the highest percentage of obese residents in the nation.

There were few changes from 2011 to 2012 among states with the highest and lowest well-being scores. Hawaii residents had the highest well-being for the fourth straight year, followed by Colorado, Minnesota, Utah, and Vermont.

The report shows a consistent regional pattern in well-being over the past five years. Western and Midwestern states earned seven of the 10 highest overall scores, while New England states held the other three spots. Southern states had the six lowest scores, and Southern states had eight of the 10 lowest well-being scores.

Lack of statewide smoking ban represents one part of Kentucky's struggle to deal with tobacco use and the health issues it creates

By Molly Burchett

Kentucky Health News

As the bill for a statewide smoking ban lies on its deathbed in the General Assembly, new federal data show Kentucky still has the highest percentage of smokers (29 percent) of any state, leads the nation in the share of smoking high school students (24 percent) and spends only a minuscule portion of their tobacco revenues to fight tobacco use. Those figures come from the federal Centers for Disease Control and Prevention's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.)

The lack of a statewide smoking ban, which nevertheless has become popular among Kentuckians, represents only a small part of the struggle to address Kentuckians' tobacco use and resulting health problems. Kentucky's program to discourage tobacco use has been severely underfunded for years, contributing to the state's lack of or slow progress in reducing its smoking and tobacco use rates and subsequent health problems, said Dr. Ellen Hahn, director of the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

State tobacco revenue (left bar) and spending (right bar)

The CDC says Kentucky should spend $57.2 million a year to have an effective, comprehensive tobacco-prevention program, but the state allocates only $2.1 million a year to such programs -- 3.7 percent of the recommended amount.

By another measure, the amount is only 0.6 percent of the estimated $381 million the state gets from tobacco taxes and the 1998 national settlement with cigarette manufacturers, according to a tobacco settlement report.



Meanwhile, Kentucky's health-care costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use or cigar and pipe smoking.

Despite the known health risks that tobacco use poses, smoking in Kentucky remains a part of everyday life in most places. But that is increasingly less so around the country, so there is an increasing gap between heavy-smoking and low-smoking states; smoking in Kentucky is about twice as prevalent as in Utah and California, reports Steven Reinberg of HealthDay. Click here for an interactive map of states' tobacco prevention efforts.

There are proven, multi-pronged strategies to curb smoking. They include combinations of higher tobacco taxes, smoke-free laws, media campaigns, and restricted access to tobacco products. However, Kentucky continues to lag behind other states due to "stagnant policies" and a lack of funding, said Hahn.

Many other factors contribute to Kentucky's lack of tobacco-prevention progress. By failing to substantially reduce adult smoking, the state misses opportunities to encourage younger adults and children not to smoke, Hahn said. Kentucky needs to employ strategies that communicate the success and affordability of tobacco cessation programs, she said; people often lack the encouragement to quit smoking because they don't know how or they don't believe it is possible.

The latest tobacco report is a timely reminder that tobacco use remains a huge public health problem for Kentucky and there are proven strategies that, if implemented, could help Kentuckians live a healthier, tobacco-free life.

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.

Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.

Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

Kentucky's obesity rate and ranking are better than last year, but the figures may not be truly comparable

The percentage of Kentucky adults who are obese is smaller than its was, but the state is still 10th in the country, according to a new, influential analysis by Trust for America's Health and the Robert Wood Johnson Foundation. The report found 30.4 percent of Kentucky adults are obese, an improvement from last year's 31.5 percent and the state's sixth-place ranking. The numbers do not include the percentage of adults that are merely overweight.

The statistics are based on data collected through telephone surveys by the Centers for Disease Control and Prevention. The surveys this year included people who only have cell phones, not land lines. Such people tend to be younger, so officials warned about putting too much stock in comparing this year's ranking from last year, reports Barb Berggoetz for the Indianapolis Star.

Mississippi has the highest obesity rate in the country at 34.9 percent, followed by Louisiana (33.4) and West Virginia (32.4). Twenty-six of the 30 states with the highest rates are in the Midwest and South.

"Obesity has contributed to a stunning rise in chronic disease rates and health care costs. It is one of the biggest health crises the country has ever faced," said Jeffrey Levi, executive director of Trust for America's Health. "The good news is that we have a growing body of evidence and approaches that we know can help reduce obesity, improve nutrition and increase physical activity based on making healthier choices easier for Americans. The bad news is we're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in terms of health and savings."

In 2006, obesity-related medical costs were $147 billion or the equivalent of 10 percent of total medical spending, a 2011 study in Health Affairs found. Most of it is spent on treating diseases related to obesity, like diabetes.

The ranking is the first part of the 2012 "F as in Fat" report, which analyzes state obesity rates and efforts to address the problem. It will be released in full in September. For the first time, the report will include forecasts about obesity rates in 2030 in each state. It will also look at the potential impact of a 5-percent reduction in body mass indices. (Read more)

Children's health and education improves in Kentucky, but one in four kids lives in poverty, report shows

New data show one in four Kentucky children live in poverty, a sharp increase since 2005, but the state is improving when it comes to children's health and education. These were the latest findings in the influential Kids Count report by the Annie E. Casey Foundation, as assessment of children's overall well-being in the country.

Compared to national averages, fewer Kentucky children go without health insurance (6 percent compared to the nation's 8 percent) and there are fewer teens who abuse alcohol or drugs (6 percent in Kentucky; 7 percent nationwide).

Though it remains higher than the national average, Kentucky's rate of child and teen deaths decreased considerably from 2005 to 2009 (41 per 100,000 to 32 per 100,000). And the number of babies who are born underweight dropped slightly in Kentucky from 2005 to 2009 (9.1 percent to 8.9 percent), though the number remains higher than the country as a whole (8.2 percent).

These were some of the 16 factors, shown below, that the report used to assess overall child well-being. The factors fell into four main groups: economic well-being, family and community, education and health. Kentucky ranked a somewhat dismal 35th among the 50 states in overall well-being of children. But in education, it was 28th, and in health, 25th.

The report shows the share of Kentucky children living in poverty grew by 18 percent from 2005 to 2010, meaning they lived at or below the federal poverty line. In 2010, that meant "an annual income of less than $22,113 for a family of two adults and two children," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

The Courier-Journal's Jessie Halladay points out that more children have access to health insurance in part because of a statewide push to get more children enrolled in the federally funded Kentucky Children's Health Program, known more commonly as KCHIP. Now, about 65,000 children are enrolled. "We are clearly making a difference in easing the difficulty these tough economic conditions put on our families," said Gov. Steve Beshear, who launched the effort.

But much work remains to be done, points out Terry Brooks, executive director of Kentucky Youth Advocates. He referred to the fact that while more fourth-graders are proficient in reading than they were in 2005, a whopping 65 percent of them were still not considered reading proficient in 2010. "At one level you want to celebrate us doing well compared to other states, but you can't celebrate too much," Brooks told Halladay. (Read more)

Louisville comes in third to last in fitness and health ranking of 50 largest cities

Rowing under California's Bay Bridge (Photo by City Kayak)

In a fitness ranking of the country's 50 largest cities, Louisville ranked an abysmal 48th, sitting just above Detroit and Oklahoma City.

These were some of the results of the American College of Sports Medicine's 2012 Fitness Index. Cities were assessed on preventive health behaviors; levels of chronic disease; health care access; and community resources and policies that support physical activity such as bike lanes and parks.

Minneapolis-St. Paul was ranked first for the second year in a row, scoring 77.2 out of a possible 100 points. Louisville got just 32.1 points, but it did climb up one ranking slot over 2011's assessment.

The index is gaining notoriety and "might well become the scorecard for cities looking to attract health-conscious companies and people to settle in for a spell," reports Melissa Healy for the Los Angeles Times. "It draws on parks and recreation data from the Trust for Public Land, on nutrition and health behavior collected by the Centers for Disease Control and Prevention, and on federally tallied school report cards to learn about school policies that promote fitness." (Read more)

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.

Kentucky continues to lead nation in cancer death rate

Though cancer deaths rates are falling nationwide, Kentucky continues to rank worst in the country for its number of cancer deaths, The Courier-Journal's Laura Ungar has determined. (C-J graphic shows rates for the nation, Kentucky and Indiana, the southern part of which the Louisville newspaper serves.)

Ungar's analysis stems from Thursday's release of the Annual Report to the Nation on the Status of Cancer, which concluded cancer death rates declined about 1.6 percent each year between 2003 and 2007 nationwide. Kentucky's death rate declined an average of 0.7 percent each of those years.

The state had a cancer death rate of 213.7 per 100,000 residents in 2007, which translates to about 9,700 Kentuckians dying each year from cancer. In 2007, Kentucky had a lung cancer death rate 50 percent higher than the national average, ranking it highest in the nation. It also ranked eighth highest in brain and other nervous-system cancers and higher than average for colorectal, prostate and breast cancer death rates.

Lung cancer is the most deadly cancer in the country, though researchers found, for the first time, a decrease in the number of women who die from lung cancer nationwide. The decline comes "more than a decade after deaths began dropping in men," Ungar reports.

Doctors are hoping to make more strides in battling the disease in the years to come. Thomas Tucker, director of the Kentucky Cancer Registry, told Ungar that smoking bans, higher cigarette taxes and anti-smoking messages should help drive down lung cancer rates. There has also been progress in the percentage of Kentuckians who are getting colonoscopies, a screening for colon cancer. Though more Kentuckians died of colorectal cancer than any other state in 2007, the rate has declined since. (Read more)

County health rankings in Kentucky show few changes, but ranks are less important than the trove of data they reflect

By Tara Kaprowy
Kentucky Health News

The health evaluation tool that calls itself "the annual check-up of over 3,000 counties in the nation" was released today, showing little change from last year in how Kentucky counties compare when it comes to factors like obesity, smoking rates and mortality. But the data provide plenty of fresh angles for stories about the health status of individual counties and regions.

The County Health Rankings for Kentucky, which are compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation, ranked Appalachian counties at the bottom and Central Kentucky counties in the Lexington and Louisville markets at the top. The far western portion of the state ranked lower as well.

The rankings fall into two categories: health outcomes and health factors. Health outcomes, left, include factors such as premature death rates, low birthweight and how many days of the past 30 that someone said they felt bad physically or mentally. Boone, Oldham and Calloway counties ranked first, second and third in health outcomes category, and Wolfe, Martin and Owsley were at the bottom.

In health factors, right, Woodford, Boone and Fayette counties were first, second and third, and Jackson, Clay and McCreary at the bottom of the list. Health factors include the percentage of adults who smoke, are obese or drink excessively; and assess a county's health care landscape: the number of primary-care providers and what percentage of adults are uninsured, for example. Social and economic factors in this ranking include unemployment rates, high-school graduation rates, percentage of children in poverty, pollution rates, access to healthy food and the number of recreational facilities. (The last item replaced the number of liquor stores. "Some of the data were not available for the availability of alcohol and it was difficult to interpret," said Dr. Patrick Remington, project director and associate dean for public health at the University of Wisconsin. The change could have affected the rankings, because Kentucky has many "dry" counties and liquor stores often cluster in "wet" counties adjacent to dry ones.)

Interestingly, the rankings between the two categories vary considerably. Fayette County, for example, ranked third in the health factors list but 10th in the health outcomes assessment. McCracken County was listed eleventh in the health factors list but 45th in health outcomes.

Though Appalachian counties in Kentucky, West Virginia and Tennessee generally ranked very low, there was one very bright spot: Morgan County, which ranked 23rd in health outcomes despite being surrounded by counties that were down in the 100s. It also ranked high last year.

While the rankings didn't change drastically from last year, there was some deviation downward in the Southern Kentucky, including Adair, Clinton, Cumberland and Wayne counties. But Shawn Crabtree, executive director of the Lake Cumberland District Health Department, didn't see much reason for concern. "Naturally, the rank of counties are going to go up and down each time," he said. "I don't know that the communities are any sicker or that anyone is doing anything any different."

Crabtree said it is important to remember the assessment is ranking one county against another, not making a comment on if counties are getting healthier or not. "That's not to say our area isn't an unhealthy area; it is," he said. "That doesn't mean we don't need to improve; we do."

Also, statistical data from counties with small populations can greatly affect rankings. "That number is a little bit volatile," Remington said of certain disease numbers. "It's not a survey, it's the actual experience of what happened." He added, "When you present a statistic for an entire community, you realize it's an average. This is like a screening test. It tells people in a community where the problem areas are, but it really doesn't make the diagnosis."

 

Researchers assembled the snapshot county portraits with information from several sources, including the Behavioral Risk Factor Surveillance System, a random telephone survey by the Centers for Disease Control and Prevention. They also used data from the National Center for Education Statistics, the National Center for Health Statistics and the Census Bureau's American Community Survey and Small Area Income and Poverty Estimates. For a complete list of sources, click here.

Given the number of sources used and the conclusions drawn, researchers hope the data will spur community interest and, ultimately change. In a conference call with reporters, Mayor Joe Reardon of Kansas City, Kan., said, "It was a call to action for me personally and a wake-up call for our community."

Annual county health rankings will be released Wednesday

The national County Health Rankings for 2011 will be released Wednesday, March 30. The rankings give a snapshot view of every county in the nation by examining factors such as rates of obesity, smoking, uninsured adults and various diseases.

The Robert Wood Johnson Foundation will host a live teleconference that day to brief news media about the data. Speakers will include James Marks, senior vice president and director of the Health Group at the RWJF; project director Patrick Remington, associate dean for public health at the University of Wisconsin; and Joe Reardon, mayor of Kansas City, Kan.

The conference will be held from 10 to 11 a.m. EDT. For free registration, click here. To view the County Health Rankings for 2010, click here. The rankings are used to produce a county-by-county Health Outcomes Map for each state. Here is Kentucky's for last year; for an interactive version, which enables county-by-county information, click anywhere on the map.