Research Accomplishment Reports 2007

Commonhealth Commonwealth

D. Murray
HEEL

 

Project Description

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.

The Kentucky Institute of Health’s report, The Health of Kentucky, which profiles the health status of each county, gives a complete picture of the poor health status of Kentucky. More than half of Kentuckians 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 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. All of these factors combined with the high costs of treating chronic disease.

The Cooperative Extension Service through the Health Education through Extension Leadership program collaborated with the College of Public Health, the Foundation for a Healthy Kentucky and Kentucky Educational Television, and the Kentucky League of Cities to convene groups of citizens across the Commonwealth to talk with each other about their ideas and feelings regarding health care in Kentucky. The HEEL Associate Director and the Family and Consumer Science Program Leader served on a team of trainers for community teams of agents and partners conducting the community forums. The HEEL Associate Director served on a project advisor. According to the Foundation for a Healthy Kentucky, Extension was pivotal to the success of this mammoth project.

The goals of this project were to provide health forum conveners and facilitators (county extension agents and community partners) in sixty Kentucky counties with the training and materials they needed to begin a community dialogue about the health system, to engage citizens in defining the underlying values and principles of a health system, to track the values identified through these discussion forums and draw from them guiding principles for health policy change, to encourage ongoing community engagement for local and state action in creating a health system that works for all Kentuckians, to have a high-performing health system that works for all Kentuckians, to collect and synthesize the experiences of a diverse cross-section of Kentuckians to present to the Governor and the Kentucky legislature as well as to plant the seed for further citizen engagement on the issue.

Impact

Groups convened and led by Extension Agents, Associates, and community partners, gathered all across the Commonwealth – 90 meetings in 60 communities to discuss this important topic in Commonwealth Commonhealth forums in the winter of 2007.  More than 2,000 Kentuckians participated in the process. Throughout 2007, people across Kentucky gathered in church basements, firehouses, libraries, and other public venues to openly discuss their experiences with health care and envision a health system that works for all. During the fall of 2007, more than 300 community and agency partners were convened in Louisville, Kentucky by the Foundation for a Healthy Kentucky to hear about the impacts of the forums. Dr. Ron Davis, President of American Medical Association presented spoke about advocating for health. During the lunch portion of the event Kentucky Educational Television Host, Bill Goodman had a conversation with then Governor Ernie Fletcher about Kentucky's health and the themes that emerged from local conversations.

Emergent themes from the forums, centered on access to care, navigating care, quality of care, affordable patient centered and respectful care, and support for healthy living. The forums, according to the Foundation for a Healthy Kentucky, have become a springboard for action in the state. KET produced a documentary, Every Heartbeat Has a Voice, chronicling the comments of Kentuckians in seven communities that hosted public forums about health care.

In Maysville, Kentucky, a river rural town, forums documented exactly how a community hosts forums like these and viewers heard firsthand about the challenges and the successes. In Smoketown, a predominantly African-American community in the heart of Louisville, health-care practitioners and patients at the free Harambee Clinic talked about issues they face—long waits for specialists, high co-payments, and prohibitively high prescription costs. In Eastern Kentucky, in Clay County, citizens discussed ongoing problems with isolation and transportation. In Harlan County in East Kentucky, two determined women grappling with the stigma of mental illness, talked about barriers in the mountainous region of the state. In Murray, a Western Kentucky college town, the hardships that small-business employers face when trying to provide health coverage for employees were discussed. In Berea, a central Kentucky college town, community advocates working for the creation of walkways and bikeways to support healthy lifestyles in addressed the built environment necessary for supporting physical activity.

As a result of the forums, the Foundation for a Healthy Kentucky has made available grant dollars through the Local Data for Local Action Initiative to foster community action for improved health.

At the direction of local legislators, the Health Education through Extension Leadership (HEEL) Associate Director, worked with an East Kentucky Leadership group to develop a health platform for the least healthy region of the state (based on data and the outcomes of these forums) and presented the platform to the newly elected Governor, Steve Beshear.