People live far shorter lives in some Kentucky counties. See how your county ranks.

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Eula Hall transformed health care in rural Kentucky by building the first -- and only -- medical clinic for low-income families. More than 40 years later, Hall, now 90, says the fight for community-based health care is as important as ever.
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Eula Hall transformed health care in rural Kentucky by building the first -- and only -- medical clinic for low-income families. More than 40 years later, Hall, now 90, says the fight for community-based health care is as important as ever.

People in some poor, rural Kentucky counties can expect to die an average of nine years sooner than people in the county with the highest income level, according to rankings released Tuesday.

The ranking shows that Kentucky counties with relatively high levels of poverty and other risk factors, such as smoking and obesity, continue to trail the rest of the state and the nation in measures of health.

Owsley County had the lowest average life expectancy in the state between 2015 and 2017, at 67.8 years, the report said.

That was a decline of more than two years from the average life expectancy in the county in 2014, which was highlighted in a 2017 study.

It was also nearly 12 years less than in far more affluent Oldham County, which had the highest life expectancy in Kentucky at 79.6 years, according to the study.

Average life expectancy in Perry, Powell, Whitley, Breathitt and Floyd counties trailed Oldham County’s by nine years or more, and some others were nearly that far behind.

The average life expectancy in Fayette County was 78.1 years.

Owsley County Judge-Executive Cale Turner said he believes cancer and drug overdoses are key factors in the county’s rate of premature deaths, which the study calculated as the highest in Kentucky.

Turner said a few months ago, the fiscal court started including discussions of Casey’s Law in its meetings. That is a state law under which family members can ask a judge to order an addict into treatment.

Turner said the goal of the discussions was to educate residents who might want to use the law.

Drugs have gotten more powerful and deadly, he said.

“They’re gonna die if something don’t change,” Turner, a Democrat, said of many drug abusers.

County health rankings
Eastern Kentucky showed up as relatively less healthy in a March 19, 2019 report that compared health outcomes among counties. This map divides the state into four groups; the darker the color, the less healthy the county overall. Robert Wood Johnson Foundation / University of Wisconsin Population Institute

The report released Tuesday was from the Robert Wood Johnson Foundation and the University of Wisconsin Population Institute.

The partnership releases an annual ranking of health outcomes for nearly every county in the country, assessing the rate of premature death — defined as years of potential life lost before age 75 — and markers such as the number of days that people report feeling mentally or physically unhealthy.

The cumulative figure for years of life lost in Owsley County was 21,923 per 100,000 population, compared to a national figure of 6,900 and 9,700 for Kentucky, according to the report.

The groups also analyze and rank counties on more than 30 factors that influence health, including poverty, tobacco use, alcohol and drug use, obesity, physical inactivity, the number of primary-care physicians in a county, the violent crime rate, and air and water quality.

Kentucky compared well to the nation on some measures, including a lower violent-crime rate, more people under age 65 with health insurance, and a better high school graduation rate.

However, the state had higher rates of adult smoking, obesity, teen births and the number of days people reported fair health at best.

The groups said one take-away is that where people live has an impact on how long and well they live.

Places with less access to good jobs, opportunities to be active, grocery stores that sell fresh food and ample decent housing, for instance, don’t fare as well as others.

Poverty affects health, the report said, limiting opportunities for good housing, safe neighborhoods and healthy food.

The healthiest Kentucky counties in the rankings released Tuesday were Oldham, Boone, Shelby, Spencer and Calloway.

The least healthy counties were clustered in Eastern and Southeastern Kentucky, an area hit hard by a sharp loss in coal jobs since 2011. They were Owsley, Perry, Breathitt, Bell, McCreary, Leslie, Floyd, Wolfe, Harlan and Whitley.

The median household income in Oldham County, the healthiest, was $97,960 in 2017, compared to just $25,344 in Owsley County, the least healthy, according to the report.

In Owsley County, 89 percent of school students qualified for free and reduced-rice lunches, compared to just 21 percent in Oldham County.

The report underscores that many factors beyond health care have an impact on health, said Dr. Jeff Howard, commissioner of the Kentucky Department for Public Health.

The counties at the bottom of the ranking don’t score well on those factors, such as smoking, diet and exercise.

“Eastern Kentucky suffers worse in these health drivers than any other area in the state,” Howard said.

Howard said he has directed a change at health departments to focus on the foundations of public health, including conducting a community health assessment.

Housing was a particular focus in the 2019 rankings released Tuesday.

The report said there is growing evidence that the lack of safe, secure, affordable housing plays a role in health problems.

High housing costs makes it harder for families to afford other things that contribute to good health, including healthy food or a car to get to school or work, the report said.

“Our homes are inextricably tied to our health,” Dr. Richard Besser, president of the Robert Wood Johnson Foundation, said in a news release. “It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing.”

In Kentucky, 47 percent of children living in poverty were in a household that spends more than half its income on housing costs, the report found.

The report said 12 percent of households in the state spend more than half their income on housing, but that level varied by race. Black residents facing high housing costs totaled 20 percent, compared to 11 percent for white residents.

Turner, the Owsley County judge-executive, said the county has made a particular effort to improve housing through a local non-profit called Partnership Housing.

The agency receives state and federal funding to build affordable housing. In the last six years, it has built 37 energy-efficient, single-family homes and paid for renovations on 225 homes, and is building three duplexes, said Cassie Hudson, the director.

The program has helped families cut their electricity bills, a key driver of housing costs in older, poorly-insulated homes.

The quality of housing in the county is improving, Turner said, but “we have a long way to go.”