The headliners in Gov. Steve Beshear's State of the Commonwealth speech this month were all worthwhile: casinos, pensions, tax reform.
They were also familiar. This was the governor's seventh such speech and the seventh round of gubernatorial attention to most of these issues.
But tucked into the 2014 speech was something different. It was this urgent observation that our state's "collective health stubbornly remains among the worst in the nation."
Lest anyone miss the point, he made it again: "Kentucky ranks among the worst, if not the worst, in almost every major health category, from smoking to cancer deaths, preventable hospitalizations, cardiovascular and cardiac heart disease and diabetes."
It was a blunt assessment of what former University of Kentucky President Lee Todd Jr. once labeled "the Kentucky uglies," a sobriquet he explained like this: "In my mind, the uglies are the things that have held us back for years, but that we didn't want to talk about. Things like being the leader in lung cancer, obesity, diabetes...."
It mattered. His university began to think of strategies to erase them. It is no accident that UK, in the heart of tobacco country, became a statewide leader in smoking abatement, guiding communities that wanted to pass smoking bans in the interest of public health.
It will matter as much — perhaps more — that Beshear has been frank with us about the health deficiencies that we know exist but pretend do not. Within a day of his speech, he announced a $1.7 million federal grant to go after the leading uglies — obesity, diabetes, stroke, heart disease and high blood pressure — to " support our goal of improving our dismal health statistics."
We were the 45th least-healthy state in the 2013 edition of America's Health Ranking, the bible of state health statistics. That same report lists Kentucky as first among the states for smoking, a deathly status that we can't shake even as we watch our friends and family suffer through the horrors of smoking's fatal consequences.
"Thank God for Mississippi" — that faint praise with which we so often soothe ourselves — soothes in only some categories of health. At 50th, Mississippi is worse overall. But when it comes to cancer rates, the Magnolia State (49th) can thank the deity for the Bluegrass State (50th). Worse yet are drug deaths. Mississippi is 18th to our 47th.
What to do about the uglies? The Friedell Committee for Health has been convening health professionals and laymen over the past year to ask that question. The solutions will require resources and time. We need a commitment in Frankfort. But we also need a community commitment.
Here's the good news: We have an existing infrastructure for state and community collaboration. We have a health department in each of our 120 counties. Their mission, guided by state statutes and they state Department for Public Health, has been transformed in recent years. They still combat communicable diseases, provide health screenings and services and protect us with restaurant and other inspections.
But the best of our health departments have also taken on the enormous task of keeping communities healthy by influencing the social, environmental and economic conditions affecting population health.
We need more of that.
Why bother? Isn't health an individual thing? If you want to smoke, smoke. If you want to supersize your soda, it's a free country. But here's the thing: Improved population health links directly to improved education and vice versa.
The same goes for economic vitality. If we want a prosperous, smarter Kentucky ready to compete with the world, we need a healthy Kentucky.
Here is how America's Health Rankings put that: "In Kentucky, 47.1 percent of adults aged 25 years and older with at least a high school education report their health is very good or excellent compared to only 17.9 percent with less than a high school education, resulting in a gap of 29.2 percent."
Healthy, wealthy and wise are inseparable. In his speech, Beshear gave this the attention it deserves. Robust applause followed his closing call to action: "We need to take bold, decisive action to build a healthier, more educated and better trained population. And together, I believe we can."
That, friends, deserves a second round of applause.
Jane Chiles is chair of the Friedell Committee for Health, a statewide citizens' group working to improve public health at the community level.