State

Where you live in Kentucky might cut eight years off your life

A baby born today to parents in Wolfe County can expect to live eight years less than a baby born in Fayette County.

The reason is that while Campton and Lexington are just an hour apart, they differ significantly in ways that have an impact on health and how long people live, such as education levels, poverty level, opportunities to be physically active and access to health care, according to a researcher who mapped life expectancy in the state.

The research showed variations in life expectancy from county to county across Kentucky. Places where people can expect to live the fewest years are clustered in Eastern Kentucky, however.

Many places in the region were relatively poor even before the economy was battered by a sharp decline in coal jobs the last four years, and the prevalence of health problems such as heart disease, cancer and diabetes has long been among the worst in the nation.

All the counties where data showed the lowest life expectancy are in Eastern Kentucky. The life expectancy at birth in Perry, Breathitt and Wolfe counties is 70 years, with Floyd, Harlan and Owsley at 71.

Many of the counties where residents have the longest life expectancy are in the triangle between Lexington, Louisville and Northern Kentucky, where pluses such as jobs, health care, recreational opportunities and even nutritious food are more widely available.

All the counties where data showed the lowest life expectancy are in Eastern Kentucky.

“It’s a pretty stark regional difference,” said Derek Chapman, a professor at Virginia Commonwealth University.

Chapman, associate director of research at VCU’s Center on Society and Health, used data on historic trends to map life expectancy for every Kentucky county as part of a project supported by the Robert Wood Johnson Foundation.

The map will be released Monday at the Shaping Our Appalachian Region, or SOAR, summit in Pikeville.

SOAR was established to help boost the economy of Appalachian Kentucky, but its mission also includes improving the quality of life. That includes a focus on improving health.

One goal of mapping life expectancy in the state is to raise awareness of how a variety of factors affect health, especially social and economic factors.

Health differences between communities rarely happen because of a single cause, VCU and the foundation said in a news release.

Rather, research shows that “a complex web of factors influence health — opportunities for education and jobs, safe and affordable housing, availability of nutritious food and places for physical activity, clean air, and access to health care, child care, and social services,” according to the release.

Similar research shows variations in life expectancy are not unique to Kentucky, and are even larger within some large cities.

There was a gap of 20 years between two areas within Philadelphia, for example, and 16 years in Las Vegas.

The spread in Kentucky was from a high of 79 years in Oldham County, one of the state’s wealthiest, to 70 years in three counties.

The leading causes of death, such as heart disease, cancers and strokes, are generally the same in places at both the low and high ends of life expectancy, but take root earlier in places that face challenges correlated with health problems, such as lower education levels and higher poverty rates, Chapman said.

According to U.S. Census figures, the poverty rate in Fayette County in 2014 was estimated at 19.8 percent, compared to 36.2 percent in Wolfe County; 89.2 percent of people age 25 and older in Fayette had a high-school degree or higher, compared to 64 percent in Wolfe.

And between 2010 and 2014, the median household income in Oldham County was $84,447, compared to $26,094 in Breathitt County and $21,198 in Wolfe, according to Census statistics.

“So many of our health issues are tied to socioeconomic status,” said Jared Arnett, executive director of SOAR.

Between 2010 and 2014, the median household income in Oldham County was $84,447, compared to $26,094 in Breathitt County and $21,198 in Wolfe, according to Census statistics.

Some factors that influence health have broad impact, such as air quality, while others are based on individual factors such as smoking or lack of physical activity.

In Wolfe County, 30 percent of adults smoke, compared to 23 percent in Fayette County, and the rate of obesity — a risk factor for diabetes, heart disease and other health problems — is higher in Wolfe County, according to a separate report from the Robert Wood Johnson Foundation called County Health Rankings & Roadmaps.

However, factors in a community can affect or limit individual choices, Chapman said.

That can include a lack of sidewalks so people can get out and walk or a shortage of places to buy healthy food.

“We know that not all neighborhoods are created equal,” Chapman said.

In Fayette County, for instance, 97 percent of people have access to exercise opportunities while only 37 percent do in Wolfe County, according to the foundation rankings.

Chapman said one key point behind the life expectancy rankings is that improving health requires a range of strategies.

People need to make good choices, such as not smoking and staying active, and communities need the right amenities and approaches to promote better health.

“You can’t just address one thing,” Chapman said.

There are a number of approaches underway in the state to improve health in places that face challenges.

Those cited by VCU and the Robert Wood Johnson Foundation include efforts by the state Department for Public Health to reduce smoking, develop places for people to walk and promote farmers’ markets to make healthy food more widely available, including to people using public assistance.

Another example is the University of Kentucky’s Center of Excellence in Rural Health, based in Hazard, which has been recognized nationally for the Kentucky Homeplace program that has community health workers educate poor people on disease prevention and helps them get medical and other services.

Among other things, the program has improved diabetes management and screening for colorectal cancer.

Homeplace has served more than 150,000 people since it was founded more than 20 years ago, said Frances J. Feltner, director of the center.

The center also educates community leaders and health care providers.

“There’s positive things that are going on,” Feltner said.

Feltner said there are still shortages of providers in some places in Appalachian Kentucky, however, and that health outcomes in the region would benefit from having more workers to do community outreach and help people navigate the health care system.

A SOAR committee made several recommendations in 2014 for improving health, including hiring more community health workers, banning smoking in public places, promoting healthy living and coordinating school health programs.

The suggestions included exploring research suggesting a link between mountaintop mining and health problems.

The life expectancy study did not examine particular causes of death, but it would be appropriate to consider environmental factors as part of the discussion, Chapman said.

There’s a lot of correlations in the universe but that doesn’t mean they’re connected.

Bill Bissett, president of the Kentucky Coal Association, who argues studies do not directly prove that surface mining causes health problems

Each community may have its own set of circumstances that contribute to how long people live, he said.

“Some areas have high infant mortality rates, some have high HIV/AIDS mortality, some have high rates of cancer,” Chapman said. “If there are increased rates of cancer in parts of Kentucky, then any environmental factors causing this increase can and likely do contribute to lower life expectancy.”

The potential link between mining and health has been a controversial issue in Appalachia.

Studies that controlled for factors such as smoking and obesity have shown that mountaintop mining in Central Appalachia is associated with health problems such as higher rates of cancer, heart disease and birth defects, said Michael S. Hendryx, a professor at Indiana University who was formerly at West Virginia University.

Hendryx has taken part in more than 15 studies of potential links between mining and public health. He was not involved in a separate study published this year that found lung and bronchus cancer deaths went up in Boone County, W. Va., after the advent of large scale mountaintop mining.

Dust kicked up by surface mining, which contains substances such as rare earth metals, is a likely source of health impacts, Hendryx said in an interview.

Research “strongly indicates that mountaintop removal coal mining is destructive of local environments and impairs human health,” Hendryx said.

The coal industry has been critical of Hendryx.

The method used in several studies — having people self-report health problems — is questionable, and Hendryx is an “anti-coal ideologue” allied with activist groups such as the Sierra Club, said Bill Bissett, president of the Kentucky Coal Association.

The studies do not directly prove that surface mining causes health problems, Bissett said.

“There’s a lot of correlations in the universe but that doesn’t mean they’re connected,” he said.

Hendryx said he thinks mountaintop mining should be banned, but only reached that position “because of the evidence of its harm.”

The industry funded a study by Yale University researcher Jonathan Borak and others, published in February 2012, with findings indicating that “coal mining is not per se the cause of increased mortality in rural Appalachia.”

“On the contrary, our results underscore the substantial economic and cultural disadvantages that adversely impact the health of many area residents,” the study said.

Hendryx and Borak have differed with each other’s findings.

Hawaii is America's healthiest state, North Carolina improved the most, and Louisiana is ranked dead last in the 2015 America's Health Rankings Report from The United Health Foundation. (Natalie Fertig / McClatchy)

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