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United Healthcare Medical Director Discusses Kentucky's Health Rankings

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Kentucky was recently ranked as the 47th healthiest state in the U.S.

The state’s low marks were attributed to a high prevalence of smoking, a high percentage of childhood poverty and a high rate of preventable hospitalizations, the report by the United Health Foundation said.

Kentucky's ranking fell from the year before—the state ranked 45th last year, according to United Health Foundation, a non-profit focused on the health workforce and the wellbeing of communities.

Dr. Guy Shrake, market medical director for the insurance company United Healthcare of Kentucky, spoke to WFPL News about the state's rankings. Here's what he had to say:


Kentucky came in as the 47th healthiest state in the country. Last year, the commonwealth came in at 45th. Why the decline?

In general some other states were able to bring themselves up a little bit more. There isn't one particular thing that got worse that had Kentucky drop.

The United Health Foundation listed Kentucky as having the second highest smoking rate in the country. Why can't Kentuckians seem to kick the habit? 

There are so many variables in the use of tobacco. A lot of it is that aha moment. Does a patient get to that ready to change moment in their life where they're willing to tackle that  and stop smoking?

There are some folks who would talk about Kentucky as a tobacco growing state and whether that influences tobacco usage overall. That could be. But there are other things that Kentucky has done on the policy level in terms of smoking in public places. I think from the doctors and health insurance side there are certain pieces of support that comes into that, such as doctors counseling patients to stop smoking.

Does the organization have any recommendations for lowering the smoking rate?

There are certainly lots of options on the table. We want to support our physicians in our networks to make sure they counsel patients to stop smoking at every visit they make not just at their annual check-up.

At the community level there are certainly opportunities for educational campaigns. There could also be policy changes around smoking and different environments. The e-cigarettes are a potential area for legislation as well.

In general, every place can take a look at what incentives they have for stopping smoking. At the employer level there are many businesses that are now smoke-free and some employers have taken the path of putting in different levels of premiums for smokers and non-smokers.

Almost 32 percent of children in Kentucky live in poverty. What are the effects of economic hardships on children?

In general, when children are in poverty, there is less access to medical care and there may be less access to good nutrition. There may even be issues with getting adequate sleep and these things impact children across the board in all  levels of wellness—physical, mental and social.

To the extent that people recognize the amount of children in poverty, it is good to work on as many programs as possible to give those kids a leg up. As we all know there is no quick and easy answer to poverty. Health care reform ... has at least shore up that one piece of that puzzle which is getting them adequate access to health care services when they're sick as well as when they're healthy in terms of vaccinations and anticipatory guidance or counseling on child development.

The state also has a high rate of preventable hospitalizations. What are Kentuckians going to the hospital for?

This is a pattern that we've found across the country. Old habits die hard. We've spent a lot of effort in this country over the last 30 years developing access to medical services at the doctor's office and at the hospital level. What has happened along the way  is there has been a tendency to think that [going to the hospital] was the best and first place to receive care.

Preventable hospitalizations is really a look at what kind of illnesses are chronic in nature; that if they could get all of the attention they needed in an office or at home that they would not need to be in the hospital as often. The classic few examples might be diabetes, congestive heart failure, chronic obstructive pulmonary disease and asthma.

The obesity rate in Kentucky is the fifth highest in the nation, which is reflected by the state's ranking for physical inactivity. What can Kentuckians do to get active?

Physical inactivity is not just a Kentucky problem, that is clearly one that is an issues across the country.  If you have a job that is sedentary, where you're sitting most of the time; if you have chronic illnesses that prevent you from being as active you'd want to be or should be, both of those can really change the dynamic on the physical inactivity and therefore obesity in the community.

If you could stand for five minutes at work instead of sitting for the entire time. If you could take the stairs occasionally, if you're able to do so. If you could park farther away and walk a little farther to the building you're going to.

Any little thing can be the first step on the road to change. At the community level it becomes a matter of  opportunity. At a fundamental level you could talk about, "How are our communities? the violent crime statistics? Is it safe for people to just get out and just walk in their neighborhood?" How about sidewalks and parks and other places to take advantage of those abilities.

 Kentucky had a few positive rankings, too. There were low rankings for binge drinking and violence. Also, many children in the state have been immunized.

The important thing on those types of statistics is that there is more to health than just access to doctors. What are the behaviors that we all engage in that might influence our health? These are things that are actually worked on at the community level and are working pretty well.

What sorts of things need to be done to ensure healthy outcomes for Kentuckians?

We each need to start asking ourselves in that open and honest way, "What are we doing to improve our health?" We have to remember that health is  physical, mental and social. We have to look at those behaviors we all engage in whether it's the smoking or binge drinking or physical inactivity that contributes so significantly to the obesity problem.

Our community leaders and our individuals in each community can take a look at these statistics and say we're not happy with our 47 ranking, so we're going to try the following and see what works.