Perry County was recently ranked as nearly the last county in the state for health outcomes, something local officials say they’re attempting to reverse.

The Kentucky Center for Economic Policy recently released a report outlining health issues across the state and detailed how state tax and budget cuts choices impact communities’ health.

According to the report, in 2018, Kentucky was ranked 45th in the nation for overall health outcomes. In the 2019 report, many Appalachian counties were among the lowest-ranked counties in  Kentucky for health outcomes and health score factors.

Perry County was ranked 94 out of 120 for composite health factors and 119 out of 120, second to last, for composite health outcomes.

The need for better healthcare accessibility has become clear after the Remote Area Medical Free Clinic made its second annual visit to Hazard. About 400 people visited the clinic in Hazard in 2018, and 516 patients received care from the clinic this year, amounting to almost $223,000 worth of care, according to Kaylen Mallard, chief development officer for Remote Area Medical.

Mallard also said the clinic is invited to come and provide their services to underserved areas like Hazard, saying there can be a lack of accessible and affordable dental, vision and medical services in rural areas.

A number of factors leading to poor health

The report’s author, Dr. Ashley Spalding, a senior policy analyst, said there are a number of factors contributing to poor health in Kentucky.

“We rank really low on a lot of rankings about health, we have a lot of challenges,” said Spalding. “In Kentucky, most of us are really familiar with the struggle that Kentuckians face in our state and overall in terms of health.”

Spalding said health is often influenced by other factors not directly relatable to healthcare.

“Eighty percent of health outcomes are actually not healthcare-related, they relate to other factors that we refer to as ‘social determinants of health,’ the conditions in which people are born, grow, live, work, things like socioeconomic status, education, neighborhood location and physical environment,” said Spalding. “We looked at the barriers to health that particular groups of people different parts of the state have and some Kentuckians face more barriers than others things like water quality issues and access to healthy foods.”

The report outlined how different health factors influenced health outcomes in Kentucky communities.

In the bottom-ranked counties for health outcomes, six had drinking water violations. Five of these counties had a higher percentage of residents in severe housing (overcrowding, high housing costs or lack of kitchen or plumbing) than the state as a whole.

In the state of Kentucky, 14 percent of people have severe housing problems.

Eight of the lowest-ranked Kentucky counties also scored lower than the state’s overall score for access to healthy foods. Four counties had lower access to exercise opportunities than the state as a whole. The child poverty rate in the lowest ranked counties ranged from 33 percent to 49 percent, as opposed to the top counties’ rates which ranged from 5 percent to 21 percent. All 10 of the lowest ranked counties had a lower share of residents with at least some college than the state as a whole.

Many of the lowest-ranking counties are in the Kentucky River District which includes Knott, Lee, Letcher, Leslie, Owsley, Perry and Wolfe counties.

Poverty, smoking, lack of resources lead to issues

Anthony Scott Lockard, public health director for the Kentucky River District Health Department said officials use the health factors and outcomes ranking as a planning tool.

“We look at those health factors and those health outcomes data and it’s very beneficial to us an a planning tool and seeing what some of our biggest challenges are identified there with that information,” said Lockard. “It’s not surprising that we scored very low on many of the factors there related to positive health outcomes.”

Lockard said some issues on the local level that contribute to low health outcomes include poverty, smoking and lack of resources.

“We have a huge issue with smoking and smoking-related illnesses in this region,” he said. “Then there’s obesity and diabetes and other illnesses related to lack of physical activity. When you look at our health outcome data, we’re seeing lots of challenges there that’s indicative of the culture and the lifestyle and poverty plays a huge role in that.”

Lockard said poverty is intrinsically linked to health and the data shows that.

“In the Kentucky River District, 42 percent of the people qualified for Medicaid, you have that huge portion of your population that is in poverty which is the biggest indicator of health status,” said Lockard. “The number one county in Kentucky is Oldham County. They also have the highest per capita in family income. That’s not an accident, because health status and factors dramatically improve in a positive correlation with income and socioeconomic status.” Lockard said that things like smoking, suicide and the drug use epidemic are also negatively impacting the region.

“The health ranking data shows that the life expectancy is actually going down in Owsley County,” he said. “They saw a 3 percent decrease in life expectancy and that has a lot to do with a couple of factors. We’re in the middle of the biggest opioid and substance abuse epidemic that we’ve ever seen. We now have more people die from overdoses than we do automobile accidents.”

Lockard said that the region’s suicide rate is also rising, as is the youth smoking rate.

“We’re now seeing in our most recent data that involves children that as much as one in four of our youth are vaping now in some of our schools,” said Lockard. “So that’s a huge concern, we saw great declines with this for many years with combustable cigarettes but now vaping is going up the opposite way.”

Lockard also said the basic needs of many of the residents in low ranked counties aren’t being met, such as access to clean drinking water and a sanitary sewer system.

“There’s basic things that should be easy,” he said. “We should all have sidewalks. We should all have safe areas to walk and exercise. We should all have spaces to ride bicycles. Our children should have safe places to play. Some people laugh and say that parks and bike lanes aren’t a good use of money but we have to have more ability for people to get physical activity.

“Unfortunately this is just not a reality for many of our residents in this area,” he continued. “They do not have spaces where can safely avail themselves to physical exercise.”

Officials say local leaders working, but support needed

Spalding said that to work on overcoming the barriers faced in the region, lawmakers need to focus on improving these factors and recognizing the reasons Kentucky has these barriers. “When you see an are of the state with so many economic challenges those translate into health challenges,” said Spalding. “This part of the state that we’re looking at in terms of low health outcomes, they’re also the part of the state where they don’t have enough jobs, there are a lot of challenges in the eastern part of the state that are related to the long reliance on a single industry.”

Spalding said the coal industry’s issues play a role in health problems.

“Research shows that the economy plays a big role,” she said. “There’s higher poverty rates in that part of the state and of course with the history that the economy was focused on the coal industry and the decline of coal and the impact that has had.”

Spalding also said that the coal industry has negatively impacted the health of miners and those in the area.

“With the coal industry, there are some negative environmental and health effects through water but also through other areas.” The report and Dr. Spalding stress the importance of looking at the bigger picture when it comes to making decisions about health. “Too often all of that context, all of these structural economic regions aren’t talked about when they talk about poor health in this part of the state.”

“A lot of our local elected leaders recognize the importance of promoting physical activity and health in our local budgets,” said Lockard, “but there are a lot of challenges.”

Lockard said that the county governments are doing what they can to address these issues but are limited.

“We have the desire amongst our local leaders, they’re working to obtain grant funding and do different things to promote physical activity in our communities, but there’s many basic needs that are not being met for our residents and local communities, so it’s hard to try and direct resources at these other things.”

Lockard said that despite the challenges and barriers there are efforts to overcome them within Eastern Kentucky communities.

“All seven county judges in the Kentucky River District are on the board of health,” he said. “They’re a very supportive group of individuals. We’re seeing some positive things here in Letcher County and Perry County. We have local elected leaders now who recognize the importance of this and are really working to try and improve and if we improve those health factors we will see improved health outcomes on down the road.”

Some of the changes for the region include expanding smoking ordinances.

 According to the report, in order to make real improvements to health outcomes in the state 966,042 more Kentucky adults would need to attain postsecondary education, more than 39,047 Kentucky children would need to attend preschool, nearly 115,000 more Kentuckians would need to have good-quality housing, and nearly 439,000 more Kentuckians would need to be food secure.

“Right now, we are headed in the wrong direction with mounting budget cuts over the past decades,” said Spalding. “Unfortunately, so many of our counties are struggling financially, in part because of state budget cuts.”

Spalding said focusing on providing things like clean water, education and housing would be beneficial to Kentuckians’ health.

“What we found is that investments in things like clean water, safe and efficient transportation systems and good schools that these things are building blocks in healthy and prosperous communities,” she said. “So we examined what our state is doing in terms of these investments and we found that, as a state, we’re not making the investments we need in order to move the state forward on health.”

Lockard said the region needs more support from state and federal sources to improve health outcomes.

He said many of the highest-ranked counties in health outcomes were able to fund efforts with local money.

“Madison County, Clark County, Fayette County, central Kentucky, they have a huge amount of these resources to be able to do these things, they’ve got the funding to do it locally,” said Lockard. “With our property tax value we can just not raise the money locally, we do not have the property taxes and our residents can not afford to pay them to raise enough money locally as we need to address the local health challenges. We have the biggest health challenges and the least ability to raise that money.”

An opportune time

Spalding said that the budget year of 2020 could be an opportune time for Kentucky lawmakers to focus on the health of Kentuckians.

“If we really want to be a healthy state, if we really want to have access for health with everyone in the state then we need to make other critical investments, said Spalding. “There are a lot of choices lawmakers can make in 2020 to reprioritize Kentuckians’ health and to help to advance the health of Kentuckians across the state, we recommend raising more revenue and basing our tax system on the ability to pay and if we do that we can make these critical investments.”

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