LexBeWell is an action group of LEX-CHIP made up of community partners and stakeholders who focus on identifying barriers to food security, mental health, healthy eating, and physical activity in Lexington-Fayette County and finding ways to ensure all community members have access to care and an overall healthy environment.
ACCESS TO CARE
Access to care includes coverage in a health care system, access to a health care location, and access to a trustworthy healthcare provider. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and to get their health needs met.
Access to health care is important for improving quality of life and eliminating disparities in health. When people are able to get preventive care or treatment for their health conditions, they have better health outcomes and increased productivity. The uninsured are less likely to have primary care providers than the insured. They also receive less preventive care, dental care, chronic disease management, and behavioral health counseling. Those without insurance are often diagnosed and treated, leading to worse health outcomes, lower quality of life, and higher mortality rates. Barriers to access (including cost, health insurance, and availability) lead to delays in care, preventable hospitalizations, and unmet health needs.
Health behaviors and choices have the power to lessen disadvantages due to genetic predisposition or a poor physical environment.
Physical Activity, Healthy Eating, and Access to Achieve Both
Behaviors such as poor diet and lack of exercise contribute to chronic disease risk. Adequate nutrition and physical activity are vital for promoting vibrant health.
Insufficient nutrition in children can slow growth and development, while excessive caloric intake can lead to being overweight and obesity. Inadequate physical activity alone can contribute to increased risk of heart disease and some forms of cancer. In combination with a poor diet, those chances increase even more.
Tobacco use remains the leading cause of preventable death and disability in the United States. Tobacco use is a risk factor for nearly all of the nation’s leading causes of death, including cardiovascular disease, stroke, lung cancer, and Chronic Obstructive Pulmonary Disease (COPD). Each year, smoking kills over 480,000 Americans, and secondhand smoke causes approximately 7,330 deaths from lung cancer and 33,950 deaths from heart disease.
Kentucky and West Virginia trade places for the nation’s highest annual smoking rate. Each year more than 8,000 Kentuckians die of tobacco-related illnesses. Lung cancer is the most well-known cause of death from smoking, but more smokers than nonsmokers die from cardiovascular disease. Annually, Medicaid and Medicare costs exceed approximately $1.2 billion for treatment of Kentuckians suffering smoking-related diseases and conditions. Smoking costs each of the four million people
living in Kentucky $300 a year.
Smokeless tobacco, while less lethal than smoked tobacco, can lead to various cancers, gum and teeth problems, and nicotine addiction. A rapid increase in e-cigarette use poses potential health threats and the possibility of extreme nicotine addiction that are not yet understood. Nearly 40% of adults ages 18-45 in Kentucky have “vaped.”
Smoke-free environments that include use of e-cigarettes and improved access to tobacco cessation programs consistently reduce high rates of heart disease, stroke, respiratory diseases, and many of the cancers attributed to tobacco use.
Doctors usually define overweight as a condition in which a person’s weight is 10%-20% higher than the recommended weight for a particular height, or as a body mass index (BMI) of 25 to 30.1
Obesity is defined as a condition in which a person’s weight is 20% or more above recommended weight or as a BMI of 30 or more. Morbid obesity means a person is either 50%-100% over recommended weight, more than 100 pounds over normal weight, or sufficiently overweight to severely interfere with health or normal functioning.
The prevalence of obesity has increased gradually across the nation over the last decade. Studies estimate that the annual costs of obesity-related illness are$190.2 billion or nearly 21% of annual medical spending in the United States. This number is expected to rise as statistics show that today’s obese children have an increased chance of being tomorrow’s obese adults. Lexington-Fayette County saw an increase of 0.9% from 2012 to 2013.2 This equates to a total of 27.3% of Fayette County adults with obesity in 2013. Obesity is a complex issue to address due to the number of contributing factors.
A few of the contributing behavioral factors include:
• Physical inactivity
• Minimal fruit and vegetable consumption
• Food marketing and promotion
Contributing environmental factors include:
• Lack of access to full-service grocery stores
• Increasing cost of healthy foods
• Lower cost of unhealthy foods
• Lack of access to safe play and exercise
Obesity is a serious concern because of its correlation with poorer mental health outcomes, reduced quality of life, and is one of the leading causes of death in the US and worldwide. It is important to reduce obesity as this is a key factor in the prevention of certain chronic diseases, including heart disease, some forms of cancer, and diabetes.
Oral health means being free from mouth pain, tooth decay, tooth loss, oral and throat cancer, and other diseases that affect the mouth. Cavities (also called tooth decay) are one of the most common chronic conditions in the US. By age 34, more than 80% of people have had at least one cavity.1 More than 40% of adults have felt pain in their mouth in the last year. On average, the nation spends more than $113 billion a year on costs related to dental care.1 More than $6 billion of productivity is lost each year because people miss work to get dental care.
Statewide, the report states that children eligible for free or reduced lunch are more likely to have visited the dentist due to pain or a previous condition than children who are not eligible (17% vs. 8%).2 Low-income children are more likely to have longer intervals between visits (78% with a visit in the past year compared to 90% for middle/upper income) as well as African-American children (73% with a visit in the past year, compared to 81% Hispanic/Latino and 84% White).
In 2014, 38% of adults age 18-64 had not had a dental visit in the past year. For years 2011-2012, 17.5% of children aged 5-19 years had untreated dental cavities. Some social factors that contribute to these differences are lifestyle behaviors such as tobacco use, frequency of alcohol use, and poor dietary choices. Just as they affect general health, these behaviors can affect oral health. The economic factors that often relate to poor oral health include access to health services and an individual’s ability to get and keep dental insurance.
CHRONIC DISEASE & CANCER
Chronic diseases, such as heart disease and cancer, are leading causes of morbidity and mortality in Fayette County and Kentucky. Chronic disease can result in disability and premature death, but may be preventable or controllable. One can reduce the risk of developing a chronic disease by increasing their physical activity, decreasing their tobacco use, eating healthy food, and taking part in preventive screenings.
Cardiovascular Health (Heart disease)
When looking at the health of a community, cardiovascular health must be considered
since it is one of the leading causes of death in the community, state, and nation.
Cardiovascular disease includes diseases of the heart and blood vessels in the body.
Examples of such diseases are: coronary heart disease, heart failure, sudden cardiac
death, and hypertensive heart disease. It is also directly related to other public health
issues and indicators. Obesity, smoking, diabetes, inactivity, and poor nutrition are
all risk factors for these diseases and all affect health outcomes among high risk
Diabetes is a serious illness that increases the risk for stroke and heart attack, blindness, kidney disease, and other chronic conditions. Overall, the risk for death among people with diabetes is about twice that of people of similar age without diabetes. Type 2 diabetes is largely preventable.
• Obesity or overweight
• Ethnic background
• Women with Polycystic Ovary Syndrome (PCOS)
• Sedentary lifestyle
• Family history
• Gestational diabetes
• Age greater than 45
As rates of overweight and obese individuals increase, diabetes also continues to become
more prevalent in the US. Diabetes presents as one of three types: Type 1, Type 2 and gestational diabetes. Diabetes is a chronic disease and is a large cause of morbidity and mortality in the US. Complications from diabetes can include stroke, kidney failure, nerve damage, blindness, and lower limb amputations.
Cancer continues to be one of the leading causes of death in Fayette County and Kentucky. Cancer may develop from genetic predispositions, tobacco use, obesity, sun and UV exposure, and other environmental factors. A person’s cancer risk can be reduced by receiving appropriate cancer screenings. Lung cancer is the leading cause of cancer deaths in Fayette County, followed by colon and breast cancers.
When referring to data, incidence and mortality are two different types of statistics. Incidence, is how often something (in the graphs below, cancer) occurs over a certain time period. Whereas, the mortality rate is the number of deaths that occur from a certain cause over a time period. The graphs below show how often lung, breast, and colon cancer occur (incidence) versus how many deaths occur (mortality rate) because of the cancer.
Mental health is important at every stage of life. When a person has a strong sense of self and well-being, they are more likely to lead a productive life. This includes maintaining relationships, partaking in behaviors that lead to positive health outcomes, and having the ability to adapt to changes, and coping with adverse events when they arise.
Recently, mental health has come to the forefront of national conversations. Overall health not only depends on physical health, but also mental health. Residents of Fayette County report on average 3.9 mental unhealthy days in the previous 30 days of when asked. The average for Kentucky was 4.6, compared with 2.9 days nationwide.
Mental health services are available in the community, but the complexities of insurance, levels of care, and eligibility can confuse consumers and prevent them from seeking the help that they need.
Alzheimer’s disease, the most common form of dementia, is currently the sixth leading
cause of death in the US as well as Kentucky. While there is a strong linkage between
heredity and age to the onset of Alzheimer’s disease, there is evidence emerging that
shows the same risk factors for heart disease and stroke may also increase the
risk for Alzheimer’s. Additionally, evidence is increasing that healthy living and consistent physical, mental, and social activities can be protective factors against the disabling disease.
Asthma is the most common chronic lung disease of children and causes significant morbidity and missed school days. Asthma is a disease that affects the lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack. It is important to minimize triggers in your environment that can make asthma worse. The most common asthma triggers are tobacco smoke, dust mites, outdoor air pollution, pets, mold, and smoke from burning wood or grass.
Clean air, safe food, and clean water play a critical role in protecting health, as does eliminating exposure to toxic substances such as lead and radon. Clean air, safe water, safe/affordable housing, and effective multi-model public transportation systems shape our community-built environment and impact our ability to make healthy choices.
Outdoor air pollution is associated with increased asthma rates and can aggravate asthma, emphysema, chronic bronchitis, decreased lung function, and increase the risk of premature death from heart or lung disease.
Indoor air quality is another indicator of the physical environment. Non-smokers exposed to secondhand smoke take in nicotine and other toxic chemicals just like smokers do. The more secondhand smoke that is inhaled, the higher the level of
these harmful chemicals will be in the body.
Asthma, which affects nearly 40 million Americans, can be exacerbated by indoor allergens such as mold and dust, and in some cases asthma can be attributed to poor home ventilation or other indoor air quality concerns.
Trihalomethanes and haloacetic acids are common byproducts of drinking water disinfection.1 Measurements of these chemicals can be used as an indicator of water quality. Their presence indicates potentially harmful compounds present in water due to disinfection with chlorine. Humans can be exposed to these chemicals by drinking water, as well as by contact through the mouth, skin, and airways. Over time, high exposure levels of these chemicals may lead to adverse health effects such as trouble with the central nervous system, liver, and kidneys, as well as an increased cancer risk.
Standards have been set by the World Health Organization and the Environmental Protection Agency for acceptable levels of these chemicals in drinking water. The maximum acceptable levels are 80 μg/L for trihalomethanes and 60 μg/L for haloacetic
acids in a public water system. The figure below shows the trends for these chemicals in the major public water supply for Fayette County.
Housing structures can protect us from extreme weather and provide safe environments for families and individuals to live, learn, grow, and form social bonds. However, houses and apartments can also be unhealthy or unsafe environments. Approximately one in four homes in the US is estimated to contain lead-based paint or lead plumbing; lead exposure can impair brain and nervous system development.1 See page 5 for the percentage of houses built prior to 1980 as an indicator of potential in-home lead exposures.
Today, at least four million households have children living in them that are being exposed to high levels of lead. There are approximately half a million US children ages one to five with blood lead levels above five micrograms per deciliter (μg/dl). No safe blood lead level in children has been identified. Lead exposure can affect nearly every system in the body. Because lead exposure often occurs with no obvious symptoms, it frequently goes unrecognized.
MATERNAL, INFANT, & CHILD HEALTH
The health and well-being of mothers, infants, and children are vitally important. They not only reflect the current health status of individuals and communities, but also serve as predictors for the health of the next generation and provide insight for future public health challenges in the health care system.
Maternal health refers to the health of women during pregnancy, childbirth, and postpartum. Family planning, preconception, prenatal, and postnatal care reduce maternal morbidity and mortality due to hemorrhage, infection, high blood pressure,
unsafe abortion, and obstructed labor. Pregnancy provides opportunities to identify existing health risks in women and to prevent future health problems for women and their children. Early identification of these health risks can prevent harm from diseases including hypertension, heart disease, diabetes, depression, certain genetic conditions, sexually transmitted diseases, tobacco use and alcohol abuse, inadequate nutrition, and unhealthy weight.
Breastfeeding provides many benefits for both mothers and their children. It provides all the energy an infant requires for the first months of life, as well as salubrious hormones and antibodies that are unique to breast milk. Studies have shown that breastfeeding can reduce risk of childhood leukemia, atopic dermatitis, as well as sudden infant death syndrome (SIDS). Conversely, infants who are formula-fed are more likely to have ear infections, diarrhea, necrotizing enterocolitis, lower respiratory tract infections, asthma, downstream obesity, and type 2 diabetes. Breastfeeding demonstrates positive effects on the mother as well as the baby. Postmenopausal women in the US who breastfed less than 12 months during their reproductive years had higher risk for developing cardiovascular disease, diabetes, hyperlipidemia, and hypertension.
Women who smoke while pregnant are increasing the chance that their child will have certain health defects. Not only is there an increase in the incidence of tissue damage in the unborn child, developmental delays, and pre-term birth, studies suggest a relationship between smoking and miscarriage. Babies who are exposed to second hand smoke after birth have weaker lungs and are three times more likely to die from SIDS.
SEXUALLY TRANSMITTED INFECTION
Sexual activity is one of the most important health behaviors in dictating downstream health effects, and one of the most important consequences due to sexual activity is sexually transmitted infections (STIs). STIs are diseases acquired by sexual contact, and are caused by bacteria, parasites, or viruses. There are more than 20 identified agents of sexually transmitted diseases, including chlamydia, gonorrhea, genital herpes, HIV/AIDS, HPV, and syphilis. STIs are a concern because they are associated with health problems and long-term consequences, most often in women, including pelvic inflammatory disease, infertility, ectopic pregnancy, cervical cancer, pre-term birth, and infection of the newborn during birth.
Every year Chlamydia is the number one reportable STI in the US and Gonorrhea is typically second or third. Hence, STIs are much more common than other infectious agents in this country. With the exception of HPV, there are currently no preventive
vaccines for STI agents.
While STIs have been persistent over the last century, like diseases as a whole, they are undergoing changes in presentation and control. For example, increasing public concern has been directed at emerging drug-resistant STIs. Gonorrhea, the second-most widespread STI, is becoming progressively resistant to the antibiotics used to treat it. Resistant strains significantly reduce the effectiveness of treatment and increase the risk of population-wide transmission. With few efficacious antibiotic options left, it is important that coordinated public health policies and research and development of new
treatments are developed.
HIV has also seen marked changes since its discovery in 1981. At the beginning of the HIV pandemic, HIV spread like a typical communicable disease without an effective treatment or cure, killing many who were infected and causing fear in the unaffected. Now, with anti-viral cocktails, people infected with HIV/AIDS are living longer and changing the way HIV/AIDS is viewed. While these drugs can control the infection, they do not result in a cure. However, in 2007 the CDC estimated that one out of six HIV infections showed drug resistance. Further, 2% of these were resistant to two or more current anti-viral treatments, posing a problem for newly-acquired HIV cases and their drug treatment and control programs.
Though infectious disease prevalence has decreased, due to their ever-changing nature, continued efforts should be made to control or eradicate them. It is important to note that while infectious disease in decreasing in the US, STI cases are increasing in general. This increase could be due to increases in actual infections or increased rates/sensitivity of testing.