Ky. Voices: Health care access one step to heal Ky.

I applaud our commonwealth's leadership in making health care more financially accessible to all of Kentucky's residents. The data show that access to medical care is associated with health status.

This is particularly important when you consider that the new health care marketplace will assure access to clinical preventive services, like disease screening, without deductibles or co-pays.

It also provides for ready access to primary care, to keep illness from becoming more serious and decreasing the number of preventable hospitalizations in Kentucky, another alarming health statistic where Kentucky leads the nation.

But this is only one of the things that Kentucky needs to do to make us a healthier state.

Financial access is important, but there are other access issues, such as geographical access to medical care services, access to culturally appropriate services for our growing Latino population, and the lack of adequate health personnel to manage these newly insured patients.

But even these access problems and their solution won't solve our health problems.

Estimates from experts suggest that only 10 percent of our premature mortality is related to lack of access to health services. They point out that 50 percent is related to lifestyles — tobacco, diets, sedentary lifestyles and drug and alcohol abuse problems — that, in turn, result in motor vehicle accidents and homicide. Another 20 percfent is related to environmental factors, and 20 percent to biological factors.

So the 90 percent that remains if we have successfully dealt with lack of health insurance continues to loom as a deterrent to Kentucky's becoming a more healthy state.

But there is a problem behind that problem. Why do people use tobacco, alcohol and drugs, have sedentary life styles and poor diet habits?

If we can deal with the problem behind the problem, then perhaps we have a real chance to really improve Kentucky's health. The answer is fairly simple, but difficult to deal with.

Public-health professionals describe smoking, obesity and drug use as proximal problems, they are the determinants of disease that are closest to the cause of illness.

There are distil determinants, those that underlie and are responsible for our poor health habits, the proximal determinants, and many of our environmental factors that determine disease rates.

What are those distil determinants? They are poverty, inequality — both of income and class, education or lack of it, joblessness or underemployment.

Do these sound familiar? They should. If you take a map of our state and overlay mortality rates, they coincide with both distil and proximal determinants of health. They will form the same pattern, with the worst rates of each falling on the far southeast corner of the state, the mountains of Eastern Kentucky, my birthplace.

So, will the access to medical care that the Medicaid expansion and the creation of the health exchange fix our health problems?

They will help, no doubt, but they are not the cure. The cure lies at a deeper level of attention that needs to be directed at the underlying problems of poor health: education, poverty, discrimination, jobs, and the development of the dignity of each of our citizens.

A colleague, Steve Woolf has done research that suggest that expenditures on the education of our citizens is much more important than additional medical care technology and expense in improving our mortality rates.

He has, online, a simple device that shows the impact of education on the health of the community, www.countyhealthcalculator.org.

Try it and you will see what I mean.

I am not suggesting we stop or delay the improvement of access to medical care for those who are doing without, merely pointing out that is not the whole solution.

How to provide education, jobs, good housing, income, equity and environmental justice remain on our agenda after we cover the 95 percent of the population that will receive insurance coverage with the new Affordable Care Act.

What I am suggesting is that we figure out how to solve the underlying problems of poor health and address those health factors that beg for our attention.

Until we do, we have only started the effort to make Kentucky the nation's healthiest state.