By Randy Weckman

We have met the enemy and he is us.

That line from Walt Kelly’s 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 to’s—due to heart attack, stroke, diabetes, and some cancers. A new initiative will help us lower Kentucky’s standing in the death due to’s 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 UK’s 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 health—like 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 Sciences.
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 themselves.”

Healthy Choices

The 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 of Kentucky.

Because lifestyle choices can a be touchy subject - it’s 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 habits.
“For most of us, it’s okay for someone to talk generally about lifestyle changes, but when it is about us, personally, it becomes meddling. Furthermore, it’s 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 health.

“Genetically, 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.

High 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 with cancer.
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.
Why?

Kentucky 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 cancer.
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 diabetes—Type 2, formerly known as adult onset diabetes—accounts 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 haven’t been diagnosed.
With an increased prevalence of obesity among youngsters, Type 2 diabetes is now being seen increasingly in children.

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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 diabetes—and 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 said.
If 10 percent of the current number of Type 2 diabetics were able to avoid developing the disease—or were able to control it—through exercise and diet, the savings in medical costs would be many times (212 times) the cost of the entire program.

“Kentuckians cannot afford not to take better care of themselves,” Tanner said.

The Kentucky Uglies

But the HEEL program isn’t 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 university’s 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 don’t 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.

The 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.
Two 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 KSU’s arm in the statewide project.

Belendez earned her bachelor’s degree from the University of Oregon and her doctorate in nursing from Case Western Reserve University.

Most recently Belendez was assistant professor in the UK College of Medicine’s Department of Preventive Medicine and Environmental Health and served as assistant director of Migrant Outreach Programs for UK’s Southeast Center for Agricultural Health and Injury Prevention. In that capacity she developed programs in health access for the Kentucky Children’s Health Insurance Program and outreach to disabled farm workers. Before holding that faculty position, Belendez was in the Kentucky’s Department for Public Health as a nurse consultant to First Steps, Kentucky’s early childhood intervention system.

Her current 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 Kentucky.
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.

Jouridine earned, from James Madison University, her bachelor’s degree in psychology and a master’s 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.

Lasley-Bibbs earned a bachelor’s degree at Kentucky State University and a master’s degree in public health from the University of Michigan. She is also a graduate of the physician’s 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 UK’s Markey Cancer Center in the Department of Pathology.

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