Oldham Near Top in Ky. County Health Rankings

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THE COURIER-JOURNAL | LAURA UNGAR | MARCH 25, 2015

Oldham County has one of the state’s wealthiest populations, plus easy access to doctors, hospitals, well-stocked grocery stores, parks and gyms.

But counties in the heart of Kentucky’s Appalachian region are beset by poverty, high rates of smoking rooted in the culture, and limited access to nutritious food, safe places to exercise and medical care.

Health officials say these are some of the reasons Oldham fared among the best and Appalachian counties among the worst in the Robert Wood Johnson Foundation County Health Rankings for 2015, which were released Wednesday.

The rankings, a collaboration between the foundation and the University of Wisconsin Population Health Institute, measure the health of nearly every county in the nation — looking at health factors and health outcomes — and are designed to help counties understand the reasons behind the health status and lifespan of residents.

Wayne Rawlins, an internist who is national medical director for the insurer Aetna, pointed to research showing that personal behaviors such as smoking, eating too much fast food or not exercising — “things we do to ourselves” — represent 40 percent of the causes of premature death.

Where people live, whether they’re employed and how much money they make all contribute to health behaviors, since wealthier areas generally offer more opportunities for exercising, eating right and getting good medical care. They’re also usually less stressful places to live, with lower crime rates and better housing.

“Wealth equals health,” Rawlins said.

That’s evident in the health outcomes rankings, which combine data on premature death from the National Center for Health Statistics and survey results on quality of life from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. It’s also clear in the health factors rankings, which measure things like tobacco use, diet and exercise, clinical care, income, education and the physical environment.

Among Kentucky’s 120 counties, Jefferson County ranks 38th for health factors and 34th for health outcomes in the 2015 rankings, while Oldham ranks first for health factors and second for health outcomes.

In Eastern Kentucky, several counties ranked among the worst on both measures. Owsley, for example, ranked last for health outcomes and 110th for health factors. Perry, a more developed county with a hospital, doctors, a college and other amenities, still ranked 116th for health outcomes and 107th for health factors.

Renee Neace, health education director for the Kentucky River District Health Department, which includes Perry, Owsley and five other counties, attributes the area’s health to problems with access — to health care, nutritious food and places to exercise.

“There’s a lack of opportunity for physical activity,” with fewer parks and other recreational areas than urban centers like Louisville, Neace said. “Here, you’re really restricted. I relate it to our landscape. We just don’t have flat land. We have mountains.”

Even in sprawling Perry, there are only two main groceries — a Wal-Mart and a Food City — and good produce can be difficult to come by for many residents. And getting to doctors and the hospital can be a challenge since it takes an hour to get from one end of the county to the other on narrow, winding mountain roads.

Plus, more than a third of adults smoke, which Neace attributes partly to growing up amid tobacco farms.

Oldham, meanwhile, fares better on all of these counts — and on socioeconomic measures such as income, poverty and educational attainment, said Dori Livy, nurse program manager for the Oldham County Health Department.

For instance, according to kentuckyhealthfacts.org, 91 percent of Oldham County residents 25 and older are high school graduates, compared with 82 percent statewide. Only 56 percent of Owsley residents that age, and 70 percent of Perry residents, have graduated high school.

Livy also pointed out that Oldham is close to Louisville, giving residents relatively easy access to primary care physicians, specialists and several hospitals. “A lot of that is where we’re located,” she said.

Dave Langdon, spokesman for the Louisville Metro Department of Public Health and Wellness, also pointed to the quality of clinical care in the city as a major strength contributing to Jefferson County’s ranking in the top third of counties.

“We have very good physician- and dentist-to-patient ratios,” he said. “We also expect that the rates of people who have no health insurance in Jefferson County will continue to go down as more and more people gain health coverage under the Affordable Care Act. More than 81,000 people have gotten coverage in the past 18 months alone.”

Officials in Jefferson, Oldham and the Kentucky River District said they are working to improve the health of their populations through education, outreach and programs such as smoking cessation. In Louisville, for example, the housing authority has designated all 228 public housing units in the new Sheppard Square development smoke-free and is phasing in smoke-free units at its other complexes throughout the city.

The researchers behind the Robert Wood Johnson rankings say they hope their work inspires even more action.

“In the six years since the County Health Rankings began, we’ve seen them serve as a rallying point for change,” said Bridget Catlin, co-director of the project. “Communities are using the rankings to inform their priorities as they work to build a culture of health.”

Reporter Laura Ungar, who also covers public health for USA Today, can be reached at (502)582-7190 or on Twitter @laura_ungar.

LOCAL COUNTY RANKINGS

Here are how local rankings among the states’ 120 counties in health outcomes and health factors. Health outcomes combine data on premature death from the National Center for Health Statistics and survey results on quality of life from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Health factors measure things like tobacco use, diet and exercise, clinical care, income, education and the physical environment.

OUTCOMES FACTORS
Oldham 2 1
Shelby 3 17
Spencer 11 7
Meade 19 54
Nelson 21 44
Bullitt 27 21
Jefferson 34 38

Source: Robert Wood Johnson Foundation

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