| Curing What Ails Kentuckians
By Randy Weckman
We have met
the enemy and he is us.
from Walt Kellys Pogo comic strip tells us a great deal
about the health of many of us in Kentucky. We are indeed our
own worst enemies when it comes to doing the right things for
our well-being. You might say that many of us in Kentucky are
killing ourselves slowly.
On many, way too many, measures, Kentuckians are among those at
the top of the list of death due tosdue to heart attack,
stroke, diabetes, and some cancers. A new initiative will help
us lower Kentuckys standing in the death due tos by
modifying our lifestyles.
The intent of the Kentucky Health Education Extension Leadership
(HEEL) program is to help us live better and longer. Funded through
an $800,000 grant from the U.S. Department of Agriculture, a partnership
between UKs College of Agriculture and the Kentucky School
of Public Health will educate Kentuckians on how to improve their
health by changing the behaviors that adversely affect healthlike
smoking and eating too much of the wrong things. Sen. Mitch McConnell
led the effort to secure the grant.
In the partnership, the Kentucky School of Public Health will
provide the latest, science-based strategies and technologies
for county Extension agents to use in educating Kentuckians about
healthy lifestyles that help prevent diseases.
County Extension agents have a long and successful history
of providing people with information they need to make their lives
better. The infrastructure of having Extension offices in each
county, coupled with the dedication of Extension agents to teaching
good ideas to people, will assure that information on living longer,
healthier lives will be brought to the people of Kentucky.
said Bonnie Tanner, assistant director for Family and Consumer
It was Tanner, along with Doug Scutchfield, M.D., director of
the Kentucky School of Public Health, who had the idea to link
the Cooperative Extension Service and the Kentucky School of Public
Health to make Kentuckians a healthier lot.
We in Extension have both the infrastructure and the know-how
to bring new information to people where they live, Tanner
said. And the school of public health has the technical expertise
of working with people to help them make vital health-care decisions.
Together, we will help Kentuckians learn to take better care of
program, which will begin in July 2002, will work like this:
three health specialists - two headquartered in the Kentucky School
of Public Health and one at Kentucky State University - and 10
health educators will work with Extensionagents to put educational
programs together to bring health information to the citizens
choices can a be touchy subject - its hard for people to
listen to lectures about eating way too much for their own good
or not exercising enough - the program will involve the expertise
of UK sociologist Richard Clayton to teach agents how to talk
with people about changing what sometimes is a lifetime of unhealthful
For most of us, its okay for someone to talk generally
about lifestyle changes, but when it is about us, personally,
it becomes meddling. Furthermore, its one thing to know
that you need to change your behavior for your own good, butquite
another to implement those changes on a continuing basis,
Clayton said. He also said that making better lifestyle choices
can be tough for many reasons, including our own past.
Doug Scutchfield, M.D., director of the
Kentucky School of Public Health, and Bonnie Tanner, assistant
director for Family and Consumer Sciences, lead the partnership
that aims to help Kentuckians make lifestyle changes for better
we have the accumulation of thousands of years working against
us. The truth is the selection of genes during those millennia
has yielded a makeup that works great if you are chasing your
food through the plains every day, but not well at all if you
get your daily rations presented to you supersized, he said.
Clayton sees his role as advising Extension agents on strategies
to make an impact on individuals and ultimately on the health
rates of the entire state.
We can tell people at risk for diabetes, for example, to
monitor their diets and activity levels, but unless we give them
really basic methods such as how to keep records of their activities,
they are likely to remain non-compliant. If we provide them with
the recipe for success in fighting diabetes and other diseases,
they are much more likely to make the lifestyle changes they need
to be healthy, he said.
Rates, High Cost
Kentucky stands eighth in the United States in prevalence of diabetes.
It also ranks fourth in the United States and Washington, D.C.
in cancer death rates, with a third more cancer deaths than the
national average. Just last year, 21,000 Kentuckians were diagnosed
Kentucky ranks seventh in the nation in death rates due to heart
disease, stroke, and other cardiovascular diseases. Each day,
43 Kentuckians die from cardiovascular disease.
ranks among the leaders in the nation in the rates for smoking,
obesity, poor nutrition, and inadequate exercise. Each of these
behaviors is related to diabetes, cardiovascular disease, and
One estimate is that diabetes alone costs Kentuckians about $1.7
billion each year in medical care costs and loss of productivity.
The most prevalent type of diabetesType 2, formerly known
as adult onset diabetesaccounts for between 90 and 95 percent
of cases and can generally be prevented, and often controlled,
through healthy lifestyle choices. About 180,000 Kentucky adults
(roughly six percent) have been diagnosed with diabetes; another
89,000 have diabetes but havent been diagnosed.
With an increased prevalence of obesity among youngsters, Type
2 diabetes is now being seen increasingly in children.
Type 2 diabetes
is generally caused by a cluster of factors linked to obesity.
A healthful diet coupled with a more active lifestyle can help
prevent Type 2 diabetesand sometimes even control it. The
cost of treatment for one diabetic for one year is about $1,300
in insulin costs alone.
The cost of preventing many of the diseases common in Kentucky
is so much less than caring for people who develop them,
said Dr. Scutchfield. If we were to take the cost of just
diabetes alone in Kentucky and average it across all Kentuckians,
each of us would pay more than $500 per year for it, he
If 10 percent of the current number of Type 2 diabetics were able
to avoid developing the diseaseor were able to control itthrough
exercise and diet, the savings in medical costs would be many
times (212 times) the cost of the
cannot afford not to take better care of themselves, Tanner
But the HEEL
program isnt just about cost effectiveness in health care;
HEEL involves wrestling and whipping what UK President Lee Todd
calls the Kentucky Uglies. Pretty much since he became leader
of the University, President Todd has been talking about marshaling
the universitys talents toward fighting the Kentucky Uglies
(including poverty, poor health care, and illiteracy). Collectively,
these keep many Kentucky families at the low end of the social
spectrum. This program focuses on one of those Kentucky Uglies:
poor health, which affects the others in the Ugly family.
The Kentucky Uglies are an interrelated constellation of factors.
People who dont feel well often have poor work records.
Poor work records manifest themselves in lower incomes, which
in turn affect the ability to seek and pay for medical care. The
cycle is vicious, if not pernicious.
We can help people live healthier, more productive lives.
And if we can do that, maybe can start to eliminate all of the
Kentucky Uglies, Tanner said.
three specialists who will lead the Health Education Extension
Leadership program (HEEL) come to the project with
solid experience in both community health and education.
of them, Zaida R. Belendez and Linda A. Jackson Jouridine, will
fill permanently-funded joint faculty positions in the UK College
of Agriculture and the UK College of Medicine. The joint appointment
signals a groundbreaking collaboration between the two colleges
to help Kentuckians improve their health.
A third specialist, Vivian Lasley-Bibbs, will work out of the
Cooperative Extension Program at Kentucky State University as
KSUs arm in the statewide project.
her bachelors degree from the University of Oregon and her
doctorate in nursing from Case Western Reserve University.
Belendez was assistant professor in the UK College of Medicines
Department of Preventive Medicine and Environmental Health and
served as assistant director of Migrant Outreach Programs for
UKs Southeast Center for Agricultural Health and Injury
Prevention. In that capacity she developed programs in health
access for the Kentucky Childrens Health Insurance Program
and outreach to disabled farm workers. Before holding that faculty
position, Belendez was in the Kentuckys Department for Public
Health as a nurse consultant to First Steps, Kentuckys early
childhood intervention system.
professional interests include developing a way to monitor injuries
to farm workers and a recent application to the Robert Wood Johnson
Foundation for a grant to develop language services in Central
Jouridine was most recently in the Texas A&M University System
as assistant professor and Extension health specialist for the
Texas Agricultural Extension Service.
In that capacity
she led in development of Extension educational programs on health
and wellness with emphasis on maternal-child and adolescent health.
She provided support to county Extension personnel in developing
programs in areas including infant health, parent education, at-risk
youth, maternal and child health, indoor air quality, and prevention
of drug use.
earned, from James Madison University, her bachelors degree
in psychology and a masters degree in counselor education.
She earned her doctorate in counselor education from the University
of Virginia. She has been a postdoctoral fellow in cardiovascular
epidemiology at Howard University.
Vivian Lasley-Bibbs serves as the state Extension specialist for
health at Kentucky State University, serving as a resource for
county Extension offices. She is currently working with the Black
Community Church Health Project, which is assessing how Kentucky
compares to national figures that show a disparity in the health
care provided to minorities compared to the general population.
earned a bachelors degree at Kentucky State University and
a masters degree in public health from the University of
Michigan. She is also a graduate of the physicians assistants
program in the UK College of Allied Health.
She has worked as an epidemiologist for the Department of the
U.S. Army at Walter Reed Army Institute of Research and at UKs
Markey Cancer Center in the Department of Pathology.