How to Begin


Alrighty, then. In my previous blog post, “Starting our Journey to a healthier, more prosperous future in western Kentucky“, I tried to introduce an idea about community health and creating a better future for our families, our communities and our region. In this post, I’ll start trying to explain how I think we can go about that.

Let me start off with a little story about myself. Please indulge me—I don’t want to tell the story because I’m particularly prone to sharing things about myself. Ask anyone who knows me, and they’ll tell you I’m pretty much the opposite of that. I want to tell this story because I think it explains where the idea I began to propose last week—that we came become an example of what rural America can be—came from and why I think we are ideally situated to achieve it. I told a piece of the story last time when I was relating my thoughts about growing up in Madisonville and thinking it really was the “Best Town on Earth”.

I said I didn’t really want to leave after high school but I had to in order to pursue my education and the kind of work I wanted to do. All very true. Although my path through higher education was neither smooth nor straight, I eventually ended up making it through graduate school and a post-doctoral fellowship. After I finished my training, I began working as a scientist doing biomedical research in St. Louis. Along about 2005, or so, I was home visiting my family when I happened to read a newspaper article about some new educational program at the Trover Foundation (which was, at that time, running the hospital and clinic). In all the time I’d lived away from Madisonville, I’d never really lost my affection for my hometown or my desire to live a small-town life, and it got me thinking—What Trover needed next was to start their own biomedical research facility! Naturally, I determined that I was just the guy to help them build it and set up the research program.   It was a win-win—Trover would get to add a research facility and I would get to come home and do my thing. I ended up pitching the idea to the Trover folks, but they decided that they didn’t want to spend millions of dollars on a research facility with little hope of ever getting their money back out of it. Go figure. Anyway, I thought that was the end of it. I went back to work in St. Louis and didn’t give it much further thought. Then one day in the summer of 2015, I got an email. The email basically asked me if I would be interested in the position of Vice-president of Education and Research at the hospital in Madisonville. My initial response was, “Thanks, but no.” At the time, I had a university job that I liked and at which I was pretty good. I liked going to work in the morning. I wasn’t making much money, but I was getting by and I felt good about my work.

I really am getting to a point. Just hang in there a bit longer.

They convinced me that I should at least come down and talk about it, which I did. And then I went back to St. Louis. Then I came back and we talked some more. And I went back to St. Louis. Then I came back a third time, and we talked some more. And I went back to St. Louis. As I said, I liked my job. I was doing some really fun, interesting and fulfilling work in STEM (Science, Technology, Engineering and Math) education and science literacy at the university and working with some of the underperforming public schools nearby. I also had some pretty strong personal ties to St. Louis by that time. I just really couldn’t justify stepping away from all that I had in St. Louis to become a “suit”, even if it was a chance to move back home. One night, after I had just about decided to turn the job down, I got a call from someone at the hospital who told me, “I really don’t know what else to tell you, but if you take this job, you’ll be in a position to make a difference in the health and wellbeing of these people”. Now, that was an argument I could get behind, and I came home to see if there was anything I could do to help us be the Best Town on Earth.

I had a great deal to learn (still do) about my new job, but one of the things I very quickly discovered was that the problems affecting community health in Madisonville are very similar to the problems affecting education in the public schools I had been working with in St. Louis. People have been trying to fix the poor performance of many inner-city schools for years by doing things like increasing funding and building new facilities with, for the most part, little improvement. The reason for that is that the issues that are most responsible for poor student performance in these schools don’t have much to do with the schools. The real reasons why the students don’t succeed are found in the streets and the neighborhoods and the homes they live in. A kid who doesn’t know where he’s going to be sleeping that night or when he is going to get to eat next, doesn’t really know school. He knows fear. It’s hard to look beyond deep, gnawing insecurity and constant need to learn how to multiple fractions. Just as the problems affecting those schools were mainly outside of the schools, the problems affecting community health in rural western Kentucky don’t, for the most part, have much to do with doctors and hospitals. Last week, I put that contribution at about 20% of the overall healthcare picture. That leaves 80% of what determines health lying somewhere else.

Let me tell you another story. There is a 10 year-old kid (not any particular kid) who comes into the Emergency Department about six or eight times a year with an acute asthma attack. It’s fairly easy to treat, and the ED fixes her up and she goes home. Everyone knows that she’ll be back in a month or two. What has been accomplished? The ED treated her attack, just as they had before and would again. Then she goes home to a house full of black mold. The house is full of black mold because the pipes under the kitchen sink leak. It’s the mold that is triggering her asthma attacks. This girl doesn’t need a doctor. She needs a plumber. But let’s look a little deeper. If my pipes leak, I call a plumber. Why didn’t her mother call a plumber to fix the pipes? She didn’t call the plumber because she can’t afford to. Why can’t she afford to? Because she doesn’t have a decent job. Why doesn’t she have a decent job? Because she has no education or training. Why doesn’t she get some training? Because she can’t get into a training program because she has a substance abuse issue. Why does she have a substance abuse issue? Maybe because she got addicted to prescription pain killers when she had a car wreck. So, what that little girl needs for her asthma isn’t a doctor. Ultimately, it’s not even a plumber. What she really needs is for her mother to get treatment for her substance problem. When she gets clean, she can get some job training, get a job that pays enough to pay the plumber, if she needs one, and all the sudden, our girl doesn’t end up in the ED, gasping for breath, any more.

So, what is my point, you may ask? My point is this: we will never be able to significantly improve our really poor level of community health and get to where we want to be if we continue to just treat symptoms and consequences. If we want to move the needle, we have to find the root causes for poor health and fix those. For those of you who read my previous column, here is where I tell you how I think we can do it.

First, we have to decide, as citizens of our region, that this is something we need to do. This is not the kind of change that can be imposed from above. It can’t be legislated or mandated. This kind of change has to be chosen. Do we want better lives for ourselves, our children and our neighbors, or don’t we? If we do want that, are we willing to do what needs to be done to make it happen? If the answer to those two questions is “yes”, then we can begin. No one expects you to just blindly commit to anything, and I hope to make a case for change over the course of the next few columns. If I make my case, then we can agree to start moving toward real change and a happier, healthier, more prosperous future for everyone.

I mentioned in my previous post that we had already taken a first, small step toward a better future. The step to which I was referring was that we have begun to build a coalition of community organizations who play a role in the health and well-being of our communities. Our coalition currently consists of healthcare providers and organizations involved in educational, housing, transportation, government, child development, nutrition, literacy, behavioral health and more. We are still expanding to bring in an even broader spectrum of organizations from all over our region. All of these organizations already are doing wonderful work and playing key roles in our communities, but what we are working toward is being able to work together to not just help people deal with their problems that lie within each of our various areas of expertise, but instead to treat the whole person. For instance, instead of just treating the little girl’s asthma, we want to be able to treat her asthma and also to treat all the issues that caused it. Until we can work at that level, where we address the underlying root causes of poor health, we are still just treating the symptoms, not the disease.

I mentioned last time that we were really lucky to have such a large and sophisticated healthcare infrastructure in this rural area. That gives us an advantage over most other parts of rural America, but again, it’s only 20% of the answer to community health. The other 80% are all these other organizations that help people live better lives. Again, we are fortunate in western Kentucky to have many very capable and dedicated organizations like that who have been doing wonderful work for our people for many years. We have most of the resources we need to bring about the new future we seek. That is why I believe that we can make these changes. We have the resources. If it can be done anywhere in rural America, it can be done here. We just have to work together to build a better future.

There you have it. That is the proposal, in very broad strokes.