Some healthcare can safely wait (and some can’t)

Among the many remarkable things that have happened since the COVID-19 pandemic began is that a lot of our usual medical care has simply stopped.

According to a recent study, routine testing for cervical cancer, cholesterol, and blood sugar is down nearly 70% across the country. Elective surgeries, routine physical examinations, and other screening tests have been canceled or rescheduled so that people can stay at home, avoid being around others who might be sick, and avoid unknowingly spreading the virus. Many clinics, hospitals, and doctors’ offices have been closed for weeks except for emergencies. Even if these facilities are open, there’s understandable reluctance to seek medical care where an infected person may have been just before you. So which health concerns can safely wait — and which should not?

What can wait?

It’s safe to put off some healthcare for a number of weeks or months.

• Routine screening tests. For example, a mammogram may be recommended every year or two for women at average risk of breast cancer. In that situation, it’s unlikely that having that test a few months late will affect your health. Similarly, if you’re due for a screening colonoscopy because you’ve turned 50 or your last one was 10 years ago, having it a few months late is not a risky delay. For some tests, there are alternatives you could have in the meantime. For example, there is home testing available for colon cancer screening that checks the stool for blood or abnormal DNA (findings that could indicate the presence of cancer). Each person’s situation is a bit different, so if you’re due for a screening test and can’t have it due to the pandemic, call your doctor about how to proceed.
• Routine vaccinations. Usually, it’s safe for adults to briefly put off routine vaccinations. Ask your doctor which vaccinations are time-sensitive and which can wait. For example, a shingles vaccine requires a second dose within a specific window of time after the first dose.
• Routine physical examinations. If you are feeling well and you have no pressing health concerns, delaying your exam for a few weeks or months is fine. In fact, the usefulness of routine annual physical examinations has been debated for some time, so even if you skip a year, it might not matter.
• Elective surgery. A good example is knee replacement for osteoarthritis: if you had surgery planned in April, there’s a good chance it was cancelled. That might be fine if you are able to get around and can tolerate the arthritis pain with medications. Hopefully, you can reschedule within a few weeks of the original date. But some elective surgery is more urgent than others, so review the timing with your doctor.

Thank goodness for telehealth

Video conferencing and telephone visits with doctors, nurses, and other healthcare professionals have filled the healthcare void admirably. We are realizing that a lot can be accomplished without coming into the office or hospital. Especially with the help of home equipment (such as a blood pressure cuff), you can be monitored well for hypertension, diabetes, asthma, and a host of other conditions with virtual visits. Mental health care can often be successfully provided by telehealth.

Sometimes your presence is required

Of course, some medical care simply cannot be provided by telehealth. Your doctor cannot perform procedures (such as draining an abscess) or an operation without your physical presence. A physical examination to feel a lump or search for an enlarged liver, an x-ray or other imaging test, and most blood tests require you to come in. It can be hard to evaluate a rash, look in your throat, or assess a sore joint without your being there. And if you had an abnormal test (such as a mammogram), you may be encouraged to come in for follow-up testing or evaluation. While a month or two of delay may not matter for some of these issues, for others it does.

Some healthcare cannot wait

What problems should prompt you to seek medical care even during a pandemic?

In recent months, reports from news media and healthcare providers in some parts of the US suggest that fewer people are coming to the emergency department with heart attacks, strokes, and other non-COVID health problems (see here, here, and here).

How can this be? Some problems, such as injuries from car accidents, may have become less common because people are staying in and driving less. But many conditions that land people in emergency rooms don’t go away during a pandemic. So what happened to the people having these problems?

The answer is almost surely that they are staying home and riding it out, avoiding exposure to those who might be infected with the new coronavirus, or wanting to do their part to limit emergency room overcrowding. Some may be concerned they’ll be turned away if they do show up.

But it’s risky to put off medical care for potentially serious problems, such as those on the list below. Complications of these conditions can be life-threatening, and a trip to the emergency room or urgent care is warranted.

When to seek emergency care

Call 911 or seek emergency medical care right away if you experience

• trouble breathing
• persistent chest pain or pressure, especially if you have a history of heart problems
• persistent and severe pain, such as abdominal or pelvic pain
• unexplained loss of consciousness, confusion, or a change in mental state (such as being unusually agitated or speaking incoherently)
• unexplained and persistent weakness in muscles of your arms, legs, or face that affects your ability to move or speak
• loss of vision
• an accident that impairs function, such as falling and then not being able to bear weight on your hip
• uncontrollable bleeding
• coughing up or vomiting blood
• suicidal feelings or acts.

Use your own experience as a guide. If you’ve had a serious illness in the past and now have the same worrisome symptoms, seek medical attention.

Thinking of heading to the ED?

Many emergency rooms and hospitals are crowded right now. It’s a good idea to call ahead, so the emergency providers know you’re coming and can give you advice about where to show up. If there’s time, put on a mask and wash your hands once more before leaving for the ED.

One other caveat: if you have typical symptoms of COVID-19 and your symptoms are not severe, call your doctor or local public health officials for guidance. In that situation, it may be best to avoid the emergency room; arranging testing and managing at home may be recommended.

The bottom line

The pandemic is teaching us a lot about what happens when non-urgent healthcare largely shuts down. Some of what we learn will be useful long after the pandemic is over. For example, if virtual visits are proven to be just as effective as an in-person visit, we can expect telehealth to become much more common. We may learn that we can safely take care of many chronic conditions with fewer visits. Years from now, researchers may be able to sort out what types of visits were just as good virtually and which ones were most prone to mistakes. And we might even find out that some medical care previously considered important is actually unnecessary after all.

In the meantime, here’s some advice that’s unchanged by the pandemic: if you have an emergency, seek medical care right away. And if you aren’t sure how to proceed, don’t hesitate to discuss it with your doctor.

Follow me on Twitter @RobShmerling

The post Some healthcare can safely wait (and some can’t) appeared first on Harvard Health Blog.

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Journalism in pandemic: online training for thousands of international journalists

When I taught media ethics in the University of Minnesota School of Journalism and Mass Communication, I’d be thrilled to teach in an auditorium filled with 150 students.

This week, I spoke to an online course that has more than 7,000 international journalists enrolled from more than 150 countries. That’s what I’ve been told by longtime friend Maryn McKenna – a terrific public health journalist – who invited me to speak to the course that she is leading.

It’s called, “Journalism in a pandemic: Covering COVID-19 now and in the future.”

It is a free online course offered by the Knight Center for Journalism in the Americas at the University of Texas at Austin, in partnership with the World Health Organization (WHO) and UNESCO, with support from the Knight Foundation and the United Nations Development Program (UNDP).

And here is my video appearance before all of those international journalists:

After this video first appeared, I received an email from one of the journalists.  It read:

Dear Gary, I just listened to your video done for the Knight Foundation course on covering Covid-19. It is one of the most useful and THE most inspirational talk I’ve heard for journalists in these trying times. I am based in China, working from home with a toddler (no day care) and still doing field reporting as well. Your words really helped me understand the importance of dogged reporting and gave me a reason to continue, despite how tiring it is and all the brick walls you keep hitting. Going through some of the tips shared in your site now. Hope you will get funding to restart your great work again.

That’s enough to keep me going – even without funding – for some time longer.

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Health commissioner says he's worried that too many Kentuckians think the coronavirus doesn't pose a danger to them

By Al Cross
Kentucky Health News

Dr. Steven Stack, the state commissioner of public health, said in an interview recorded Friday and broadcast Monday night that he fears Kentuckians aren't taking the coronavirus seriously enough.

"I'm very worried that the public is becoming comfortable that this is not a danger," and does not realize that only about 5 percent of Kentuckians have had the virus, he told Renee Shaw for "Kentucky Tonight" on KET.

State Health Commissioner Steven Stack, M.D.

"The entire crisis we have successfully avoided is still waiting to happen . . . in June or July," he warned, if too many Kentuckians don't take precautions.

Stack said he has seen too few masks and too little social distancing, but it's impossible to police: "We rely on the multitude of people to do what needs to be done," and they need to be educated about the risks -- and the myths, such as the notion that the virus is much like the flu.

"To say this is influenza is like saying a rowboat is a cruise ship or a fireworks display on the Fourth of July is a thermonuclear bomb," Stack said, reversing his metaphors while making his point.

Stack and Gov. Andy Beshear have repeatedly warned of a resurgence of the virus that could overwhelm hospitals and first responders. "This happened in China; this happened in northern Italy; this happened in New York," he told Shaw.

He said to protect themselves, Kentuckians shouldn't focus on what others are doing, other than to avoid them if they're not wearing a mask.

Stack acknowledged that part of Beshear's recent relaxation of some restrictions came from "a sense of what the public will tolerate."

Beshear has begin gradually lifting restrictions though the state's daily number of new cases has not been on a downward trajectory for 14 days, as called for in guidelines issued by the White House and the Centers for Disease Control and Prevention.

Beshear has justified that by saying the state finally has the capacity to test 2 percent of its population each month, as the guidelines recommend, but like other governors he now faces a possible shortage of people willing to be tested.

Stack said the state is working on ways to get faster, real-time information about the spread of the virus, and "We are going to have to hope" that it can be tracked fast enough and "the public will be responsive."

Asked if it would have been better to have had a national strategy, Stack said "I would like to have has much more cohesion across the country," because the varying rules in states make it difficult for the public to know what to do.

He repeated his advice to limit daily activities to avoid unknowingly spreading the virus, which can be most contagious before people realize they have it. He said people "should think twice about what is really important for them" as they choose where to go each day.

Appearing on the same KET program was Alison Adams, president of the Kentucky Health Department Association and director of the Buffalo Trace District Health Department. She said public- health policy is mostly about getting people to do the right thing, and viewers should think about "how much you care about your fellow Kentuckians."

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Beshear promotes contact tracing to find people with virus, 1/4 of whom may have no symptoms, and need for testing signups

Click above for a video about contact tracing in Kentucky. Official guidance is at kycovid19.ky.gov

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear spent much of his coronavirus update Monday talking about the importance of testing for the virus and tracing the contacts of people who have it -- and then their contacts -- to keep the virus in check as the state begins to re-open its economy.

"Contact tracing along with testing is absolutely critic for our re-opening and for being healthy at work," Beshear said, adding later, "It doesn't work without you buying in, without your voluntary commitment to making sure that we are safe as we reopen."

The concept is that increased testing will determine who actually has the virus, including many who are infectious but have no symptoms -- about one in four, Health Commissioner Steven Stack, noting that studies vary.

Testing leads to contact tracing: tracking down people who have been in contact with an infected person, then asking them and their contacts to isolate for two weeks, the incubation period for the virus.

All this is called for by the guidelines the White House and the Centers for Disease Control and Prevention for reopening the economy, Beshear noted.

"So when we are talking about calling you and you picking up, this isn't just me, this is the president, too," he said. This is Democrats and Republicans, federal government, state government, this is just public-health experts saying what's got to happen for us to have a safe reopening and to restart our economy without pausing it."

Beshear assured Kentuckians that any information provided through the tracing would be kept private. "Information provided is completely confidential, entirely," he said. "And we will be looking at every privacy concern out there."

He showed a video about contact tracing and noted that is not a new process, but something public-health agencies have long done to fight communicable diseases, in ways that also require significant privacy and trust of Kentuckians. We can do this the same way," he said.

The state's contact-tracing program will be led by Mark Carter, a certified public accountant with 40 years of experience in health care, most recently as CEO of Passport Health in Louisville, the state's only nonprofit Medicaid managed-care company. He was in line to become secretary of health and family services, but Eric Friedlander got that job last week after being acting secretary for five months.

Carter said, "So we have to reopen the economy, but we also have to protect our children and our families, our friends from another outbreak of covid. One of the key ways to do that, in addition to effective and expanded testing that has been accomplished, is through the contact tracing program. . . . I've always been an optimist, and I know we can have it both ways. It's not a binary choice between reopening the economy and protecting people's health. We can do both, but we need to do it together."

Health Commissioner Steven Stack stressed that the effort will require Kentuckians' cooperation. His sales pitch: "Contact tracing is the way we get back as much as possible to what normal used to be like."

But to be effective, tracing must be backed up with robust testing, Beshear said, because so many people with the virus don't have symptoms.

In particular, he pointed to two covid-19 hotspots: Ohio and Graves counties, which have had very few signups for free, Kroger-sponsored testing available this week.

He said that in Ohio County, only 87 people had signed up for testing Tuesday, 45 on Wednesday and 13 on Thursday, at a site with a capacity of 300 or more spots each day.

In Graves County, he said 136 had signed up for Tuesday and just over 55 had signed up for Wednesday and Thursday combined, with similar capacity. Testing at these locations are open to anyone in the region.

"Folks, if we are going to combat this, if we are going to reopen our economy in these areas, we've got to do better than that," he said.

Ohio and Graves counties are in Western Kentucky, the part of the state hit hardest by the virus. As of May 18, Graves County had 154 cases and 18 deaths, and Ohio County had 116 cases.

In other covid-19 news Monday: 

• Noting that gathering of 10 or fewer people will be allowed starting Friday, Beshear said, "There is a way to do it that is not safe, there is a way to do it that is safer and we want to make sure that we spend this week, all of us together, thinking through all the different ways we can protect ourselves while seeing people for the first time in a while."
• Beshear announced 122 new cases of the coronavirus on Sunday (when he did not hold a briefing) and 138 new cases today, bringing the state's adjusted total to 7,935. Click here for Sunday's daily summary and here for Monday's daily summary. 
• He reported three deaths on Sunday and nine on Monday, all in Jefferson County, raising the state's total to 346. Sunday's were men aged 68,78 and 79; Monday's were two men, 50 and 96, and seven women, aged 69, 76, 77, 79, 83, 89 and 102. 
• He said 447 covid-19 patients are in the hospital, 277 in intensive care, and 2,785 have recovered. The Lexington Herald-Leader reports that this is the highest number of people hospitalized since April 16.
• Beshear said two more Kentucky children have been diagnosed with pediatric multi-symptom inflammatory syndrome, which is associated with covid-19: a five-year old who has been allowed to return home after being hospitalized, and an 11-year-old who is in the hospital. Of last week's cases, he said a 10-year-old remains in intensive care and a 16-year-old is recovering at home.
• In long-term care facilities, 22 more residents and 19 more employees have tested positive for the virus, for respective totals of 1,004 and 423. Beshear reported two new deaths, for a total of 198 resident deaths and two staff deaths. Click here for the daily update. 
• Stack said the state continues to ramp up testing in long-term-care facilities, and this week would be testing at 23, with more than 3,000 tests expected to be completed in the next two days.  
• Signature HealthCare at Fountain Circle in Winchester, which has "a history of infection control deficiencies, including inadequate hand washing, reported on Monday that at least 13 residents and five staff have been infected," John Cheves reports for the Lexington Herald-Leader. The firm said the numbers reflect the fact that it is testing everyone in the facility. Asked if employees had unwittingly brought the virus into the facility, a spokeswoman said patients and staff are screened daily, but acknowledged that some infected people are asymptomatic. She also said some patients had exposures from medical appointments outside the facility. 
• The state's "Healthy at work" website now has guidance for barbershops, cosmetology, hair salons, tanning salons, and tattoo parlors. The businesses will be allowed to open May 25.

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Trendline for new cases of the coronavirus remains up, but Beshear says cases at two Louisville facilities skew the numbers

Kentucky Health News chart shows trendline of new cases since May 3 (where there were 173) is up.

By Al Cross
Kentucky Health News

As Kentucky prepares to allow all retail stores to open Monday, its two-week trend of new coronavirus cases is up, contrary to the federal guidelines that say such reopening shouldn't begin unless cases have shown a downward trajectory for the previous two weeks.

Gov. Andy Beshear announced 244 new cases Saturday, the second day in a row that tilted the state's two-week trendline upward. That moved Kentucky into the red "criteria not met" category on the CovidExitStrategy.org website, which monitors states' compliance with the guidelines.

The day before, the site ranked Kentucky it as yellow, "making progress." The day before that, it was one of the two states rated green, for having met the guidelines. Saturday it was one of 22 states rated red. That was all the more notable because some labs don't report test results on weekends.

CovidExitStrategy.org says Kentucky's two-week trend shows an increase of 19 percent.

Beshear couldn't be asked about the numbers because he didn't hold a news briefing Saturday. Instead, he issued a five-minute video report.

"Today we've got a higher number of cases, but thankfully we're continuing to see a lower number of deaths," he said. The two deaths brought the state's total to 334.

He noted that 94 of the new cases were from Jefferson County, and attributed that partly to outbreaks at Maryhurst, a residential treatment facility for abused and neglected girls, and the JBS meat-processing plant. Other counties reporting more than five new cases were Boone, 30; Warren, 25; Fayette, 19; Shelby, 10, and Kenton and Logan, seven each.

So far 7,688 Kentuckians have had the coronavirus, and 2,768 of have recovered from it, Beshear said. At least 129,405 people have been tested and 1,967 have been hospitalized; 438 are still in hospital and 270 are in intensive care -- a sharp uptick from recent days, when the number had been increasing slightly.

"That's up," Beshear acknowledged, "and we gotta be thinking about those folks. We gotta watch that number."

The governor reported five more deaths in long-term-care facilities, which account for most of the state's deaths but lag the other date in reporting. He said 13 more residents and 13 more employees have tested positive, as the state mounts an effort to test everyone in nursing homes.

Beshear concluded his report with an appeal to limit activities and take precautions. "If we want to reopen this economy we've got to remember there is still a virus out there that spreads aggressively and to cert populations it can be deadly, so be healthy at home," he said. "Look our for one another ... be kind to one another, be a good neighbor and I will see you Monday at 5 p.m."

The governor has stopped giving reports on Sundays, noting that reporting on weekends is incomplete.

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And now for some good news on health

When it comes to health concerns, the COVID-19 pandemic is top of mind for most people right now. And that’s for good reason.

But there is some very good non-COVID health news that may not be getting the attention it deserves. According to the CDC, the rates of six of the top 10 causes of death in this country, which account for about three-quarters of all deaths, have been declining. That’s remarkable. And these improvements are occurring despite an aging population and an obesity epidemic that affects several health conditions.

Six positive health trends

Let’s look at the trends in these conditions and their rank as causes of death in the US:

• Heart disease (#1) and stroke (#5): Deaths due to cardiovascular disease, including heart attacks and stroke, fell by about 36% between 2000 and 2014. The decline for heart disease since 2014 appears to have continued through 2018. After leveling off for several years, stroke-related deaths dropped again (by 1.3%) from 2017 to 2018.
• Cancer (#2): The drop in cancer deaths was about 2% between 2017 and 2018. Over the last 25 years it has dropped by 29%.
• Unintentional injuries (#3), including drug overdoses, and chronic lower respiratory diseases (#4), such as emphysema and asthma: Each of these categories dropped by nearly 3% from 2017 to 2018.
• Alzheimer’s disease (#6): Deaths fell 1.6%, even though the prevalence of this devastating illness is increasing.

The cholesterol connection

Another positive trend is that cholesterol levels across the US population have been moving in the right direction over the last 20 years. About 18% of Americans had a high total cholesterol in 1999; as of 2018, just 10.5% had high levels. Meanwhile, about 22% of the population had low HDL (“good”) cholesterol; that number fell to 16% in 2018. Because high total cholesterol and low HDL cholesterol are risk factors for cardiovascular disease, these improvements may at least partly explain why cardiovascular disease mortality rates are falling.

And fewer people are smoking

There’s also good news with respect to the popularity of cigarette smoking. According to the CDC, the percent of the population that smokes cigarettes is dropping significantly. In 2017 it fell to 14%, an all-time low since such statistics have been collected. This represents a steady drop from 2006, when nearly 21% of people were smokers.

Over time, fewer smokers means lower rates of smoking-related illness, including several of the top 10 causes of death like chronic lung disease, lung cancer, and cardiovascular disease.

Notably, this survey did not include vaping, which has been rapidly gaining popularity in recent years. Some former cigarette smokers are now vaping, as are many adolescents and young adults. So the good news about falling smoking rates could be at least partially offset by potential negative health consequences of vaping, including e-cigarette or vaping-associated lung injury (EVALI).

What about life expectancy?

Life expectancy in the US was estimated to be 78.7 years in 2018, a small increase from 78.6 years in 2017. Between 2014 and 2017 life expectancy had been falling in the US, largely due to suicide and unintentional injury (especially drug overdoses). While the improvement in 2018 is small, it’s still welcome news to see estimated longevity tick upward.

Some caveats

It’s worth emphasizing that the data that demonstrate these positive health trends are at least a year or two old. And, importantly, improvements in life expectancy and certain causes of death are not shared equally among all groups of people: those living in poverty and a number of ethnic and racial groups have experienced less health improvement than the population as a whole.

In addition, these trends preceded the COVID-19 pandemic, a disease that has quickly become a leading cause of death. In fact, as of April 7th, 2020, COVID-19 was the number one cause of death in the US when the number of deaths per day (rather than the yearly number) were considered.

And of course, focusing only on causes of death does not provide a complete picture of a nation’s health. Disability and quality of life are essential measures of health as well, and for many people these are more important than longevity.

The bottom line

The good news is real and reason to celebrate. Yet there is plenty of room for improvement in the health of Americans, especially for four causes of death that are not falling: influenza and pneumonia, suicide, diabetes, and kidney disease. And there is no guarantee that the positive trends will continue. My hope is that we can figure out how to make even more progress more quickly, and to extend that progress more evenly throughout the population.

Follow me on Twitter @RobShmerling

The post And now for some good news on health appeared first on Harvard Health Blog.

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County Health Rankings continue to show largest shifts in the middle rankings, familiar names at the top and bottom

The chart next to the map shows the spread of health outcomes scores (ranks) for each county (green circles) in Kentucky. It shows the size of the gap between ranked counties, is most cases small.

By Melissa Patrick
Kentucky Health News

The latest County Health Rankings report for Kentucky shows little change in the top and bottom quarters of the standings, with most of the bigger shifts among counties in the middle.

The rankings measure health outcomes, gauged by life expectancy and measures of quality of life; and health factors, such as access to physicians and areas to exercise, tobacco use, children living in poverty, violent crime, long commutes and other environmental factors. The report is issued by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Because the shifts in rankings for most counties are so small that they are statistically insignificant, the researchers have placed counties in four groups of 30 counties each, called quartiles. The rankings are meant to be viewed more as a general categorization of a county's health status, rather than making specific comparisons with counties that are relatively close in the rankings.

Top of snapshot for Adair County, first in Kentucky's alphabetical list

The report's website has a snapshot of data for each county that includes county-level data for each of the measures.

In health outcomes, 17 of the 120 counties moved up at least 10 notches since last year, and another 14 moved down at least 10. In health factors, 13 counties improved and 10 dropped at least 10 notches.

The bottom quartile for both health outcomes and factors continues to be made up almost entirely of Appalachian counties. The only exception for health outcomes is Fulton County, a poor county in the Mississippi Delta at the state's western tip. The exceptions for health factors are Fulton County and Grayson County, in west-central Kentucky.

Oldham and Boone, two of Kentucky's wealthiest counties, continue to be the top two in health outcomes, as they have been since 2011. No. 3, Spencer County, has ranked either third or fourth since 2016. Woodford County ranked fourth this year, moving up from the 14th spot in last year's rankings and Fayette County ranked fifth, moving up from 10th.

Oldham and Boone are also the top two counties in health factors, and have been since 2015. They have been in the top five since 2011. Woodford, Campbell and Scott are ranked third, fourth, and fifth, respectively, for the second year in a row.

Breathitt, Owsley and Perry counties, in that order, hold the bottom three spots for health outcomes again this year, followed by Clay and Floyd. All are in the East Kentucky Coalfield. The bottom five counties for health factors are Clay, Owsley, Wolfe, Breathitt and McCreary, all in the coalfield.

Some counties show big changes

Green County was the only county to move at least 10 slots to put it in the top quartile for health outcomes. It rose 13 notches, to 27th. The last time it was in the top quartile was in 2017, when it ranked 19th.

Taylor and Mason counties saw the greatest gains in health outcomes this year, both moving up 19 places. Taylor moved up to 38th, from 57th; and Mason moved up to 46th, from 65th.

Two counties dropped more than 10 slots to land them into the bottom quartile for health outcomes. Russell, is now 93rd, down from 77th last year; and Elliott is 101st, down from 81st.

Crittenden County saw the greatest drop in health outcomes this year, falling 26 notches, to 64th from last year's 38th spot. It also dropped 16 slots in health factors, to 88th.

Todd and Christian counties also saw big drops in outcomes, each falling 19 spots. Todd moved to 65th, from 46th; and Christian moved to 70th, from 51st.

Changes in health factors

Henry County was the only county to move at least 10 spots into the top quartile for health factors, moving up 11 notches into 27th. No county shifted by 10 or more spots into the bottom quartile for health factors.

McLean County saw the greatest gain in health factors, moving up 18 notches to 38th, from 56th last year. It moved down 16 slots in outcomes, to 89th, from 73rd.

Map shows the health-factor quartile for each county; column at right 
shows the size of the gaps between ranked counties is small.

Four counties moved up 15 spots in health factors, including Bracken, to 45th; Metcalfe, to 66th; Trigg, to 32nd; and Boyd, to 44th.

Owen County saw the biggest drop in health factors, falling 26 spots, to 60th from last year's 34th spot. It moved down four spots for outcomes, to 39th.

Marion County also showed a big drop in health factors, moving down 20 spots to 55th, from 35th. It moved down four slots for outcomes, to 54th.

The report challenges Kentucky counties to take this data and turn it into action, and offers resources to do that on the "Take Action To Improve Health" section of its website. The report says it "illustrates what we currently know when it comes to what is keeping people healthy or making them sick and shows what we can do to create healthier places to live, learn, work and play."

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