Kentucky Institute of Medicine™

The Health of Kentucky A County Assessment:

The Health of Kentucky A County Assessment report is available for download here.

Executive Summary

In general, Kentucky is a healthy place to live and work. Few diseases are endemic to the state and most of Kentucky's workplaces are relatively safe. Many of the health problems in the state are due to poor lifestyle choices, which lead to otherwise preventable diseases and premature deaths. Modifiable behavioral risk factors—tobacco use, poor diet and physical inactivity—have been identified as the leading causes of mortality in the United States as a whole, as well as in Kentucky. While some diseases are due to risk factors that cannot be mitigated, such as age, sex, race, and genetics, most risk factors for chronic disease can be prevented or modified to improve health.

Given the diverse nature of Kentucky in terms of topography, socioeconomic factors, and education, the health status of Kentucky counties varies greatly when compared to state and national rates. In order to address the problems that undermine health, citizens, providers, and policymakers need to initiate change in the communities where they live, work, and participate in the healthcare system. However, local communities often lack the information and knowledge they need to take action. Data accessible to groups trying to improve their community's health status and access to healthcare are usually taken from national or state studies and are not designed to give information specific to local problems. Statewide and regional studies aggregate data that often conceal the disparities that exist among counties, masking the true situation found at the local level. For example, the percentage of Kentucky adults who smoke is 29% but the rate varies by county from a high of 36% to a low of 20%. In order to effectively plan interventions sensitive to health barriers and disparities, county-level data on all health and health-related issues are necessary.

The findings of The Health of Kentucky were organized around a set of risk factors and disease outcomes which, taken as a whole, would approximate a composite picture of the health of Kentucky's counties. They were grouped into the following categories: behavioral/social factors, demographics, health access, and health outcomes. In addition, rates were provided for four types of cancer. In examining measures of behavioral and social factors, the report found smoking to be Kentucky's greatest challenge. Cancer, cardiovascular disease, and respiratory illness are among the more well-known consequences of tobacco use. More than half of the individuals who smoke will die of a smoking-related illness and more than 23% of all deaths in Kentucky are attributable to smoking, a modifiable health risk factor. Only five of Kentucky's 120 counties have smoking rates below the national average.

Another major challenge is the combination of obesity and lack of physical activity. These risk factors are related to the increased incidence of cardiovascular disease, diabetes, stroke, and other health disorders. Only 10 of Kentucky's counties are above the national average for physical activity and 78 are above the national average for obesity. Other measures of behavioral and social factors that were considered include oral health, motor vehicle deaths, violent crime offenses, drug arrests, and occupational fatalities. For all of these measures, except violent crime offenses, Kentucky is worse than the national average.

Of the demographic measures selected for study, high school graduation rates and per capita income are the greatest challenges for Kentucky. Better educated individuals are more likely to have access to preventive healthcare and to engage in behaviors that benefit their health. Only nine of Kentucky's counties have high school graduation rates above the national average. In 2005, Kentucky ranked 48th among the 50 states in the percentage of people age 25 and older who have a high school diploma or its equivalent and 47th in the percent who have a bachelor's degree. Poverty is one of the most challenging issues in Kentucky. Economic status has a profound impact on health and well-being. Only five Kentucky counties have per capita incomes above the national average. The size of Kentucky's older population will figure prominently in the health status of the state's population, as the incidence of chronic disease and disability increases with age. Seventy-nine of Kentucky's counties have a percentage of elderly population above the national average.

In examining measures of health access, the greatest challenge in Kentucky is the primary care physician-to-population ratio. Having a regular primary care physician is strongly associated with a positive health status. Rural areas have major difficulty in attracting and retaining primary care physicians. Almost half of Kentucky's population lives in the state's 85 rural counties. Only seven Kentucky counties have primary care physician-to-population ratios above the national average. Kentucky does well in regards to adequacy of prenatal care and immunization rates. Kentucky's percentage of pregnant women receiving adequate prenatal care is above the national average and about half of the counties are above the national rate. Eighty percent of Kentucky's children are immunized and over half of the counties are above the national rate.

In looking at health outcomes, Kentucky is at or below the national average for low birth weight babies and infant mortality. For infectious diseases (HIV, hepatitis, and tuberculosis), the state is also well below the national average. For diabetes, Kentucky is above the national average and only sixteen counties are below the national average. Kentucky's rate of adults with limited activities in previous month is above the national average and reflects the state's high disability rate. Cardiovascular disease is the leading cause of death in Kentucky. There are 113 counties with rates above the national average. Kentucky's cancer death rate is above the national average with 112 counties having rates above the national average. Kentucky's mortality rate for all counties exceeds the national rate. Premature death rate is a good indicator of overall health status and a high rate reflects a decrease in work productivity and economic development. The premature death rate is above the national average in 88 counties.

The study looked at four specific cancer death rates. For lung/bronchus cancer, the state's death rate is far higher than the nation's. All of Kentucky's counties have a rate above the national average. Kentucky also has a colorectal cancer death rate that is higher than the national average. Only five of Kentucky's counties have a rate below the national average. Kentucky has a breast cancer death rate above the national rate. Only forty-eight of Kentucky's counties have a rate below the national average. Kentucky has a prostate cancer death rate above the national average. Only thirty-one of Kentucky's 120 counties have a rate below the national average.

This report from the Kentucky Institute of Medicine provides objective data and resource information about risk factors and disease outcomes. This information is meant to assist officials and concerned citizens at the county level in assessing the health of their community and making decisions that will improve health. A county profile and ranking was developed for each of Kentucky's counties to focus attention on these critical factors at the state and county level.

Each county profile contains 25 items which have equal weight in a ranking of 1 (best) to 120 (worst) as a measure of the county's health status relative to the other counties. The most and least healthy counties in Kentucky, according to the county profiles, are presented in Tables I and II. A complete ranking of the counties is presented in the County Profiles section of the report (page 29).

Table I:
Most Healthy Counties
 Table II:
Least Healthy Counties
County NameRankCounty NameRank

A key premise of this study is that individuals can avoid many serious illnesses and premature deaths by engaging in more healthful behaviors, such as not smoking, having a healthy diet, engaging in regular physical activity, using seatbelts and child safety restraints when driving, and using safety equipment at work and when using tools at home. The poor health that results from poor individual lifestyle choices is a significant liability to Kentucky's capacity to realize economic development and prosperity. The unnecessary costs incurred by unhealthy individuals are borne by their community as economic losses. Advancing the health status of Kentuckians will improve productivity and the economic viability of the state. Kentucky cannot realize economic gains nor improve quality of life without a healthy populace.

The Health of Kentucky describes a process to help counties improve their health status and provides examples of communities which have undertaken health improvement activities. Guidance is provided for conducting local studies and surveys. The report also provides suggested community interventions, sample programs, and resources related to each of the measures included in the individual county profiles.

Task Force Members

Emery A. Wilson, MD (Co-Chair)
Office of Health Research & Development
University of Kentucky College of Medicine
Lexington, Fayette County

Raymond D. Wells, MD (Co-Chair)
Assistant Professor
Department of Family and Community Medicine
University of Kentucky College of Medicine
Inez, Martin County

David Bolt
Lewis Co. Primary Care System
Fleming Co. Family Health Center
Flemingsburg, Fleming County

James H. Booth
Booth Energy
Lovely, Martin County

Forrest Calico MD, MPH
Stanford, Lincoln County

Richard Clover, MD
School of Public Health and Information Sciences
University of Louisville
Louisville, Jefferson County

Mark Dignan, PhD, MPH
Prevention Research Center
University of Kentucky Department of Internal Medicine
Lexington, Fayette County

Larry S. Fields, MD, FAAFP
American Academy of Family Physician
Flatwoods, Greenup County

Nancy Galvagni, JD
Kentucky Hospital Association
Louisville, Jefferson County

Tony Goetz
Nicholasville, Jessamine County

Lori Stewart Gonzalez, PhD
University of Kentucky College of Heath Sciences
Lexington, Fayette County

James W. Holsinger, Jr., MD, PhD
University of Kentucky College of Public Health
Lexington, Fayette County

Paris Hopkins, MSW
Frankfort, Franklin County

H. Fred Howard, DMD
Harlan, Harlan County

Lonnie Lawson
The Center for Rural Development
Somerset, Pulaski County

Ancil Lewis
Big Sandy Health Care
Prestonsburg, Floyd County

Sylvia L. Lovely
Kentucky League of Cities
Lexington, Fayette County

Loretta Maldaner
Purchase Area Health Education Center
Murray, Calloway County

Carlos Marin
Northeast Area Health Education Center
Morehead, Rowan County

Michael K. Murphy DO, FACOFP
Clinical Sciences
Pikeville College of Osteopathic Medicine
Pikeville, Pike County

Bertie Kaye Salyer
Magoffin County Health Department
Saylersville, Magoffin County

Sheila A. Schuster, PhD
Licensed Clinical Psychologist
Mental Health & Health Care Advocacy
Louisville, Jefferson County

Joseph E. Smith
Kentucky Primary Care Association
Frankfort, Franklin County

Martha Helen Smith
Lexington, Fayette County

A. D. Sprague, MD
Henderson, Henderson County

Vicki Yonts
Delta Project Specialist
Greenville, Muhlenberg County

Ann Vail, PhD
School of Human Environmental Sciences
Human Environmental Science
Lexington, Fayette County

Advisory Staff

Linda M. Asher
Kentucky Institute of Medicine
Lexington, Fayette County

David Gross
University of Kentucky Center for Excellence in Rural Health
Hazard, Perry County

Kevin Kainulainen
Office of Rural Health Policy
Lexington, Fayette County

Michael E. Samuels, DrPH
Endowed Chair/Distinguished Scholar in Rural Health Policy
Professor of Family and Community Medicine
University of Kentucky College of Medicine
Lexington, Fayette County

Elmer T. Whitler, MA, MPA
Research, Technology and Workforce Planning
University of Kentucky Center for Excellence in Rural Health
Lexington, Fayette County

Foundation Representative:
Susan G. Zepeda
Foundation for a Healthy Kentucky
Louisville, Jefferson County