HAZARD — Possible links between health problems and mountaintop mining in Eastern Kentucky emerged as a key concern of people attending sessions aimed at coming up with ideas to improve the economy and quality of life in the region, according to the dentist who chaired the sessions.
Dr. Nikki Stone, who practices in Hazard, said her committee will likely recommend further study.
"There's something there that we need to explore further," Stone said Tuesday.
Stone heads a committee on health issues that is part of the Shaping Our Appalachian Region (SOAR) initiative that Republican U.S. Rep. Hal Rogers and Gov. Steve Beshear, a Democrat, started last year to look for ways to boost the region in the wake of steep job losses in the coal industry.
The health committee and panels on agriculture, tourism and other issues have been holding "listening sessions" this summer to solicit ideas, and will boil those down into recommended strategies later this year.
Stone, speaking at a SOAR session in Hazard on Tuesday, listed the 10 main themes that people discussed at 15 meetings of the health committee.
They included the need for more physical and health education in schools; transportation to get people to health facilities; more substance-abuse treatment; and laws to ban smoking in public places.
But the possible link between mountaintop mining and health tied for first with calls for coordinated school health programs, Stone said.
A growing number of studies have concluded there is a correlation between surface mining on Appalachia's steep slopes — which involves blasting apart the earth and can release metals and other contaminants into the water — and health problems in the region, including cancer and birth defects.
High smoking rates, obesity, poor eating habits, poverty and other factors contribute to Eastern Kentucky having some of the highest rates of heart disease and cancer in the country, but some studies have shown the disparities persist even when those factors are taken into account.
Coal operators have begun to finance their own research about the problem, including a study presented last year that confirmed mortality rates were "statistically significantly higher" in counties with mining than in counties without mining, as were rates for cancer and other diseases. But the researchers said they could not control for "personal risk factors" that had nothing to do with mining, so more study is needed before blame can be assigned.
Stone said people are talking more about the possible links between mining and health because they've heard about the studies and wonder if mining pollution could help explain problems, including "inexplicable" birth defects.
The call at the listening sessions was for more information on issues such as how surface mining affects water and air quality, the health impact of that, and whether public water systems are testing for the right substances, Stone said.
The head of the federal Centers for Disease Control and Prevention, Dr. Thomas Frieden, is taking part in SOAR sessions this week at Rogers' invitation, and was at the Hazard meeting.
Asked whether he would support having the CDC study the public health effects of mountaintop mining in Central Appalachia, Frieden said the agency "only goes where it's invited."
"If invited in, we could certainly look at it," he said.
Frieden added that it is often challenging to get enough health information to make definitive conclusions.
Asked if he would support finding out more about the link between mining and health problems, Rogers said "we need to know if there's anything to it, certainly."
Stone said she was surprised that mining was one of the top issues broached at the health sessions.
She said many people in the region have long been reluctant to talk about the possible link between mining and health problems because the coal industry was the backbone of the economy. Even now, they brought it up gingerly in the health committee meetings, Stone said.
The decline in coal has created an opening to address the concerns, Stone said
On another front, Frieden and others who spoke to about 250 people gathered for the SOAR health session at Hazard Community and Technical College didn't pull any punches on one key health challenge in Kentucky: the high smoking rate.
"It is the No. 1 cause of preventable death in this country," Frieden said.
Frieden discussed how higher tobacco taxes, laws barring smoking in public places and blunt advertising drove down smoking rates when he was the health commissioner in New York City.
The rate of young people smoking dropped by more than half, he said.
Frieden said 8,000 Kentuckians die each year from tobacco-related diseases, which plays a role in average life expectancy in the state being five to six years behind the national average.
Dr. Mark Evers, head of the Markey Cancer Center at the University of Kentucky, said the state has more people covered by smoke-free laws than many Southern states. Still, there is room for improvement in a state that leads the nation in overall cancer mortality, he said.
"My hope is that Kentucky is 100 percent smoke-free" within a few years, Evers said.
Many Kentucky cities and counties have local smoke-free laws, but calls for a statewide rule have failed in the legislature.
There have been successes in the fight against chronic health problems in Eastern Kentucky. Outreach programs by UK and partners, for instance, have increased screening for several types of cancer. The state went from 49th to 20th in the screening rate for colorectal cancer through one program, Evers said.
But statistics released at the meeting show that a big challenge remains.
For example, the death rate from lung cancer in Eastern Kentucky is worse than in Kentucky as a whole, which exceeds the national rate by 67 percent.
Frieden said Kentucky's ranking on heart disease has gotten worse compared to the rest of the country, going from 30 percent above the U.S. rate in 1999 to 54 percent in 2011.
Rogers said improving health will be integral to the region's progress.
"We cannot shape the future of this region without focusing on ways to improve the quality of life that we have," he said.
Dr. Stephanie Mayfield, the state health commissioner, said Kentucky's health insurance exchange under the federal Affordable Care Act has helped boost access to health care, with signups approaching 500,000.
People at the meeting said Eastern Kentucky and the rest of the state can become healthier, though it will take time and work.
"We can change our outcomes," said UK President Eli Capilouto. "Kentucky does not have to indulge these scourges."
Officials announced funding for two programs aimed at improving health in Eastern Kentucky.
In one, the CDC and the Appalachian Regional Commission are giving UK $1.5 million for a program in which "navigators" will guide cancer patients to the right services and promote increased screening.
Officials also announced funding from the National Institutes of Health for UK to train local leaders who make decisions related to health care.