(LOUISVILLE, Ky - July 24, 2018) Nine Appalachian Kentucky counties have been labeled "bright spots" in health because they scored much better than expected across an array of health measures given the economic, resource and other challenges they face. The Kentucky counties comprise a third of the 27 rural bright spot Appalachian counties identified by research released today by the Foundation for a Healthy Kentucky, the Appalachian Regional Commission and the Robert Wood Johnson Foundation.
Another 15 metropolitan counties also were labeled as bright spots in the project, for a total of 42 Appalachian counties that significantly exceeded researchers' predictions on 19 health outcome measures. The outcomes include mortality rates, mental health issues, child health, chronic disease and substance abuse.
"The Bright Spots project offers hope and a path forward to a healthier Appalachian Kentucky," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky (FHKy). "It details strategies and interventions that are working to improve health across a broad array of measures in counties that face significant economic and resource challenges. Congratulations to the hardworking leaders in the nine Kentucky counties that have formed strong, cross-sector coalitions to address pressing health issues in their communities."

Identifying Bright Spots in Appalachian Health: A Statistical Analysis examines the region's 420 counties in terms of 29 different "health driver" measures, and then predicts how those counties would fare in the 19 health outcomes measures. The drivers include environmental factors, health behaviors, health care systems, certain screening measures and social determinants measures. The nine Kentucky counties that exceeded predictions are: Pulaski, Green, Russell, Lincoln, Adair, Lewis, Wayne, McCreary and Morgan.
A second report, Exploring Bright Spots in Appalachian Health: Case Studies offers a deep dive into 10 representative bright spots counties, including Wayne and McCreary Counties in Kentucky.
While each bright spot county developed its own approaches to local health challenges, researchers identified several cross-cutting themes, including cross-sector collaboration, community leader engagement in health initiatives, and resource sharing. Active faith communities also made a difference, as did local health care providers who are committed to improving the health of the entire community. Another key takeaway from the research, according to Chandler, is that programs to reduce teen births, cut smoking rates, increase physical activity and prevent and treat substance abuse have the greatest impact on improving overall community health.
"The case studies report indicates that both Wayne and McCreary Counties are characterized by committed local leaders who are willing to partner and share resources, often across sectors, to improve the lives of their neighbors," said Mark Carter, chair of FHKy's board of directors and also CEO of Passport Health Plan. "They are not the healthiest counties in Kentucky or even in the eastern part of the state, but they are an example of the progress that even the most resource-strapped and health-challenged communities can make when they build strong local coalitions of engaged leaders to focus on public health."

In Wayne County, researchers gave credit to the health department, the cooperative extension service, Mountain Moms, the Wayne County Health Coalition, the Hope Center, Wayne County Hospital, and Adanta for 16 better-than-expected outcomes, including:

- Poisoning mortality - The expected rate of poisoning deaths (including drug overdoses) was 32.3/100,000 persons, but the actual rate was 20.7/100,000, 36 percent better than expected.
- Stroke deaths - Expected rate 53.7/100,000; actual, 35.2/100,000, 34 percent better.

- Heart disease hospitalizations for Medicare beneficiaries - Expected 67.6/1,000; actual 47.5/1,000, 30 percent better.

Wayne County also achieved higher scores than predicted for low-birthweight babies, heart disease and cancer mortality, diabetes, suicides, and mentally unhealthy days.

The growing farmer's market, diabetes education classes, school health programs, and food and clothing programs were highlighted in the case study report. Engaged community leadership and cross-sector collaboration are themes that stand out in the county, according to the report.
Strengths identified in McCreary County include a particularly strong public library leader who offers a variety of programs that contribute to better health, the Christian Care Center's food pantry, Adanta, and the Lord's Gym, a nonprofit community center. The county outperformed predictions by 40 percent for injury mortality, 36.5 percent for stroke mortality, and 18.5 percent for depression among Medicare beneficiaries. In addition, low-birthweight babies, and cancer and heart disease deaths were better than predicted.

The absence of a hospital or major health center in McCreary forces the county to pool resources and cooperate with neighboring Wayne County; for example, a regional transportation program, Rural Transit Enterprises Coordinated, is a group of volunteers that provides transport services for residents to medical and other appointments. The local EMS also provides transportation, as well as education programs in schools. The Lake Cumberland District Health Department is credited for spearheading the local farmer's market, smoke-free restaurants, and other preventive health initiatives.

"The Bright Spots research is a roadmap for struggling Appalachian communities, showing how building strong coalitions and focusing resources in particular on reducing teen births and smoking, increasing physical activity and treating and preventing substance abuse can have an outsized impact on improving local health," Chandler said. "It also is a call to action for policy makers, funders and advocates to support laws and programs that are proven effective in addressing these issues."
Copies of the reports are available here. A third component of the project announced today is an interactive website, HealthinAppalachia.org, that explores extensive county-level health data for the entire Appalachian region. This research follows a report released in August 2017, Health Disparities in Appalachia, that documents the dramatic disparities in health outcomes and other health-related factors in the Appalachian region.

About the Foundation for a Healthy Kentucky
Funded by an endowment, the mission of the nonpartisan Foundation for a Healthy Kentucky is to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity. Since the Foundation opened its doors in 2001, it has invested more than $27 million in health policy research, advocacy, and demonstration project grants across the Commonwealth. Follow the Foundation on Twitter, Facebook and YouTube, and visit our website at www.healthy-ky.org.

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