A Better Future is Just a Matter of Will and Resources

Kentucky ranks 50^th in the country for cancer deaths.  Our cancer death rate is about 19% above the national average.  That means that, for every four people that die of cancer nationally, five will die in Kentucky.  Kentucky is 49^th in the number of adults who smoke.  Everyone knows the link between cancer and smoking.  We are 44^th in deaths due to heart and vascular diseases, about 15% above the national average.  We are also 44^th in obesity. 35% of our adult population is obese.  Obesity is closely correlated to cardiovascular disease, as is smoking.  We are 46^th in lack of physical activity.  Lack of exercise is closely correlated to obesity.

I could go on about Kentucky’s awful health statistics, but nobody likes statistics.  Let’s just say that the overall health of Kentuckians is not good, and it causes us to die about 6 years earlier than people in Japan.   And before you start thinking there is something inherently different in living in Japan versus living in the US, Canadians also live about 4 ½ years longer than we do, and there isn’t much difference between the a Canadian and an American, except Canadians talk funny.

I’ve started writing this post a dozen times.  I write half a page or maybe even a whole page, and then I stop, read through it and then start over, because it’s not coming out right.  Either I’m not saying what I want to say or the tone is all wrong.  You see, if we are going to do this—if we are going to work together to improve the health and well-being of our communities—I have to get you to believe in the mission.  I have to convince you that we have problems.  I have to convince you that there are solutions to those problems.  I have to get you to believe that we can make the kind of changes that need to be made—that real change is possible, right here in this little piece of rural Kentucky, starting right now.  I have to get across that making those changes is worth it.  We have to believe we can be better than we are.  The problem is that I’m kind of stuck on how to do that without quoting a bunch of statistics and being boring, so you quit reading, or without sounding like a scold, so you get mad and defensive.  I think I’ll try a new tack and see how that works.

About two years ago, we started something new called the ARCH Community Health Coalition.  The ARCH Coalition is a coalition of organizations from in and around Hopkins County that play some role in community health.  I’ve mentioned before that only about 20% of the factors that influence a person’s health are actually related to doctors, hospitals, germs and all those sorts of things that one usually associates with health.  You know, I just now thought of this, but when I was writing that list out, it dawned on me that doctors, hospitals and germs may be things that come to mind when we think of “health”, but what we are actually thinking about isn’t health—it’s sickness.  Germs make you sick and you go to a hospital so a doctor can treat your illness.  I think that, perhaps, says a very great deal about how we think about health.  “Healthcare” to us isn’t about being or staying healthy—it’s about being able to get treatment when health fails.  How we view healthcare and being healthy is an important topic and I think we’ll discuss that some more next time.

The ARCH coalition was formed (and is still being formed as we add new members) to be able to address, not just the 20% of health that is tied to our normal healthcare system, but also the other 80% of factors that impact health and wellness.  Our members include traditional healthcare organizations, but we also have educational organizations, housing, nutrition, literacy, child development, behavioral health, transportation, fitness, peri-natal services, shelters, job training centers, social services, government, and more.

We’ve done a number of community events.  We’ve had three health fairs and multiple health screening events.  At our health screenings, we test blood pressure, fat and cholesterol levels in the blood, body fat and all the other things that are typically measured at health screenings.  However, at our health fairs we also have had things like the library doing story time for kids.  We do education about cancer and cancer screenings.  We have nutrition displays about healthy eating options.  We do lots of things beyond just “typical health stuff”. Our ultimate goal is to not only improve the health of our people and our communities, but to build on that improved community wellness to create a more economically prosperous future. 

Big public events are only part of what we are planning on doing in the near future.  We are also looking for opportunities to reach out to people who live out in more rural areas and might have difficulty in seeking health care when they need it.  Finding people in places like that is a challenge, so we plan to work with churches to provide services for their congregations and their neighbors.

Building up the coalition, doing health screenings and reaching out to the underserved is only Phase One of the overall plan.  In Phase One we are trying to build up the capacity of the coalition.  We are beginning to engage with the public and raise awareness of issues with our health and our plans to do better.  We are spreading the message that improved health isn’t just about health—it’a about prosperity and a better future for everyone.   An example of what we’re doing in Phase One is the Community Health Needs Assessment we completed in 2018. This assessment is a good example of what our coalition can do working together.  Many non-profit healthcare organizations are required to conduct periodic assessments of health issues in their service areas, along with how they are helping to address them, in order to maintain their non-profit status.  Rather than each of our organizations conducting their own, isolated health assessments, our coalition members banded together to conduct one large survey that dug more deeply into the needs of the community.  We asked for your input, because it is imperative that we understand what the people in the community think are the most important issues to them.  What is most important to a senior citizen in Hanson is probably not what is most important to a single mother living in White Plains.  When we finish compiling and analyzing the data we have gathered, we will use the results as a blueprint that tells us where to start and how to best use our coalition to help facilitate change.  Thank you to everyone who filled out our survey.  Your thoughts are important to us and will help guide us as we move forward.

Phase Two of the plan for our coalition goes much further than that.  If you recall the story about the girl with the asthma attacks from the article I wrote before, I tried to paint a picture of a girl who had recurrent asthma attacks.  But the ultimate cause of those attacks wasn’t mold, or leaky pipes, but that her mother had developed an addiction to pain killers following a car wreck, and it was that addiction that was the root cause of her asthma attacks.  If we can help her mom through treatment, then she can get some job training and hold down a decent job that pays enough for her to pay a plumber to fix the pipes.  Now, obviously, helping a family through that process is neither a simple nor a short-term task.  This family would need lots of support, lots of assistance, lots of compassion, and lots of encouragement to navigate the extremely difficult path from where they start to a return to a productive, happy life where our girl has an opportunity to become whatever she wants. 

In Phase Two, our coalition will be combining our resources and experience to identify families, like our girl’s, that we can work together to help raise up.  Certainly, the pipes have to be fixed and the mold cleaned up, but until we fix the root cause of this family’s troubles, the pipes will just start leaking again, the mold will come back and the girl will be back in the emergency room.  This is where much of our social energy and resources has been spent in the past.  Medicaid pays for the emergency room visit, and if nobody fixes the pipes and cleans up the mold, Medicaid will pay for treating her asthma attacks over and over again, because the asthma attack is only a consequence of the real problem.  If some agency pays to clean up the mold, it will only come back if the pipes aren’t fixed.  If another agency pays a plumber to fix the pipes, it is a pretty good bet that the pipes, or some other pipe will start leaking again, and if the family can’t afford a plumber, the mold comes back and we’re back to the ER.  This is what I mean when I say that our efforts have been mostly aimed at consequences and symptoms in the past, not at root causes.  Until we look at the entire situation and manage it, we are just pushing the next problem down the road a little bit.  However, if all those agencies and organizations work together in a coordinated effort to find out what is underlying the chain of issues, then it all gets fixed.  This is the work of our coalition.  A family that would have been mired in misery and poverty for generations is helped up.  Instead of our girl dropping out of school and going to work to try to help support herself, she stays in school and becomes, maybe, a nurse.  That’s quite a turnaround for this family.  We can do this.  We can do it for this family, and when we’re done, we do it for the next.  As our capacity grows, we can help more families.  Our community grows stronger and more productive, with time, attracting more opportunity.

This isn’t the work of a year or even a decade. I won’t see it done in my lifetime.  It will take a long time, because the need is vast and the issues complex.  But just think of what the outcome will be!  Kids born in the next generation will live longer, healthier lives.  Those kids will have every opportunity to reach whatever their potential is.  Our communities will be more prosperous, with opportunities for more of our kids to stay home or come back home after college to build lives.  We could have all that.  It is possible.  We just have to decide to do it, and then do what needs to be done. The really amazing thing is that we really don’t need anything much to make it happen that isn’t already here.