Another General Assembly has adjourned without tackling the addiction that kills the most Kentuckians — tobacco.
We are reminded of this by the 2016 County Health Rankings released last month; the places where smoking rates are highest have the worst health outcomes. We’re reminded also by The Washington Post’s exploration of why death rates are rising among rural women.
A complex web of stressors, opioid addiction (thanks again, Purdue Pharma) and suicide help account for why death rates among rural white women are outpacing those of men and urban women. One of the killers is smoking; lung cancer kills more women than breast cancer.
Kentucky’s worst health outcomes are concentrated in the rural counties and smalls towns of the south and east, part of what has always been one of this nation’s poorest regions and now hammered by what seems almost certain to be the mountains’ last coal bust. The factors that drive health outcomes — behaviors such as smoking, access to clinical care, socioeconomic conditions and physical environment — are stacked in favor of sickness and early death in the sickest counties.
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Sorting out cause and effect is complicated. But one thing is obvious in this tragedy of suffering and lost human potential: Sick people can’t build a new economy. Shaping Our Appalachian Region and other economic transition efforts must make improving health a top priority.
Income inequality is writ large on the geography of health. So is the equalizing power of sex education and access to birth control.
Some Kentuckians live where just one primary care physician serves every 14,060 people; more fortunate Kentuckians enjoy access to 1 primary care physician for every 780 people. The ratio for the state overall is 1,500 to 1, which is better than the U.S. median of 1,990 to 1. The gap is even wider for mental health providers.
Depending on where you grow up in Kentucky, the rate of births to 1,000 females, ages 15-19, ranges from a low of 14 to a high of 86. The statewide rate is 47 compared to a national rate of 40 births per 1,000 teen girls. There’s an equally stark disparity in rates of sexually transmitted disease, depending on where you live in Kentucky.
Across the state, innovative efforts are underway to address health inequities. But the challenges are huge. The Medicaid expansion — both in terms of caring for more people and covering more services, including mental health and addiction treatment — creates huge opportunities for more innovation and better outcomes.
Communities must also look for ways to heal themselves. The County Health Rankings, compiled nationally by researchers at the University of Wisconsin-Madison and published by the Robert Wood Johnson Foundation, provide detailed data for each county and guidance for how to turn local concern into action.
One of the cheapest, most effective ways to do that (since the legislature won’t) would be to join the places across Kentucky that have enacted local smoke-free laws.