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Kentucky Among Nation's Sickest States
LOUISVILLE, Ky. - Kentucky ranks among the unhealthiest states — a plight that's largely self-inflicted due to smoking, eating fatty foods and not exercising enough, The Courier-Journal reported in a special section published Sunday.
Chronic poor health threatens lives and hits all Kentuckians in the pocketbook through taxes and insurance premiums, according to the Louisville newspaper's special report.
On almost every health measure, Kentuckians fare poorly — second worst nationally for cancer deaths, fifth worst for cardiovascular deaths and seventh worst for obesity, according to the paper, which published a special eight-page section on the state's poor health.
Kentuckians die at a rate of 18 percent above the national average, the newspaper reported. Its report said residents of all income levels are disabled and killed by cardiovascular disease, cancer and diabetes — chronic illnesses that are linked to smoking, poor eating habits and sedentary lifestyles.
"We don't have to worry about foreign aggressors," said Dr. Baretta Casey, a Hazard physician and University of Kentucky professor. "We are killing ourselves off."
Poverty is at the center of the problem, factoring into nutrition, health habits and medical care that people receive. Minorities in Kentucky's cities, who are disproportionately poor, die from diseases at rates comparable to those in some of the hardest-hit rural areas. And Kentucky has 43 of the nation's 340 persistently poor rural counties.
In Knott County, two brothers and a father share a small house and serious health woes.
James White, 42, weighs 340 pounds and has high blood pressure, but still eats mostly fatty foods, such as fried chicken and pork chops. His older brother Eddie, 46, had a six-way heart bypass last year. He is unemployed and uninsured and so can afford little medical care. He owes thousands of dollars in medical bills.
Their father, Fred "Justin" White, 70, has heart disease, chronic kidney failure and Parkinson's disease. He can't stand for more than 10 minutes at a time, gets around using a cane he carved and needs help with tasks as simple as dressing.
At the White House Clinic in McKee, also in eastern Kentucky, Dr. Sandra Dionisio remembers a patient with cancer so advanced she had a foul-smelling, open wound in her breast.
"I see a lot of illnesses similar to a third-world country," said Dionisio, an internist trained in the Philippines.
The General Assembly took steps this year to deal with the state's health woes, raising the cigarette tax from 3 cents a pack to 30 cents and passing legislation to improve nutrition and physical fitness in schools.
Dr. James Holsinger Jr., secretary of the state Cabinet for Health and Family Services, said he and Gov. Ernie Fletcher, also a physician, view health as a top priority.
"We've got some big mountains to climb," Holsinger said.
Each of the state's major chronic diseases costs the Medicaid program hundreds of millions of taxpayer dollars. In the fiscal year ending June 2003, Medicaid spent $611 million for diabetes, $422 million for cancer, $372 million for coronary artery disease and $728 million for chronic obstructive pulmonary disease. The state and federal program provides health insurance for the poor, disabled and those in nursing homes.
Health-related costs are a concern for Mike Hamrick, a 45-year-old pastor in Lawrenceburg and a father of two teenagers, even though his family is generally healthy. Health insurance takes a large chunk of his salary.
If the state's population were healthier, experts said, government would be able to spend more money on other priorities.
"Any dollar you spend on Medicaid, you don't have to spend on K-12 education, for example, said Jeanne Boeh, chairwoman of the economics department at Augsburg College in Minneapolis.
But the chronic diseases plaguing Kentuckians are linked to behaviors that are woven into the state's culture, making them difficult to change.
Smoking is a prime example. Kentucky, the nation's top producer of burley tobacco, also has the highest percentage of adult smokers. Almost one out of three Kentucky adults light up despite evidence that smoking contributes to heart disease, strokes and lung cancer.
Lung cancer kills Kentuckians at the nation's highest rate.
Carolyn Sue Cheek of Clay County started smoking at age 7. The 51-year-old once quit for more than a year, but started up again under the stress of watching her mother, a former smoker, die of lung cancer.
Cheek, who smokes two or three packs a day, labors to breathe with asthma and emphysema. She tells her grandchildren: "Don't ever take up the smoking habit. You know how Mom-mom struggles with her lungs."
Poor eating and exercise habits also are common.
Many Kentucky meals include fried and fatty foods, part of the traditional Southern diet.
Compounding the problem, research shows that two-thirds of Kentuckians in 2003 didn't meet national recommendations to get at least 30 minutes of moderate physical activity five days a week or 20 minutes of vigorous exercise three times a week.
More than a quarter of all state residents are obese, putting them at risk for heart attack, stroke, Type II diabetes and colorectal cancer.
Unless far more effort and political will is focused on curing the problem, health advocates said, a bad situation will only worsen as obese children, young smokers and baby boomers grow older.
However, experts and advocates said Kentucky's problems are not insurmountable. If the state solves its health crisis, it can show the way for the rest of the nation, which now has a lower life expectancy than such industrialized countries as Canada, Japan and Germany.
"Our state does not have to be the worst health state in the nation," said Casey, the Hazard doctor. "Don't ever take up the smoking habit."
The newspaper plans two more special reports this year on the health of Kentuckians. As part of its series, it also scheduled a free health fair July 26 in conjunction with a television station and a number of health groups.
Information from: The Courier-Journal, <a href='http://www.courier-journal.com' target='_blank'>http://www.courier-journal.com</a>
