Lead poisoning has serious health consequences. According to the Mayo Clinic, “Exposure to even low levels of lead can cause damage over time, especially in children. The greatest risk is to brain development, where irreversible damage may occur. Higher levels can damage the kidneys and nervous system in both children and adults. Very high lead levels may cause seizures, unconsciousness and possibly death.” Using a method developed by epidemiologists from the Washington State Department of Public Health, we produced a county-level map of Kentucky showing the estimated relative risk for lead exposure. This method, which has been widely embraced by environmental health experts associated with the Center for Disease Control and the American Public Health Association, uses two variables to assign relative risk: the age of the houses (which predicts the likelihood of lead paint) and poverty; the environmental health literature finds that kids are more likely to come into contact with lead in older houses and that living in conditions of poverty elevates the risk. Risk levels are not uniform within a county; that is, not everyone in Jefferson County will be at the highest level of risk. Likewise, not everyone in Warren County will be at the lowest level. Instead, the map illustrates the estimated average lead risk level at the county level.
Lead Risk by Kentucky County Risk Quintiles Lowest Risk Low to Medium Medium Medium to High Highest Risk Source: Estimated by Rex Bray and Timothy Bianco using a method developed by Vox and Rad Cunninghnam, Washington State Dept. of Health <http://www.vox.com/a/lead‐exposure‐risk‐map>.
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ENTUCKY’S HEALTH SHORT- comings are well-known— America’s Health Rankings 2019, delineates our high rates of drug overdose deaths, chronic disease, and disability, by ranking the state 43rd overall. It lists areas considered to be strengths (i.e., high percentage of high school graduation, low prevalence of excessive drinking, low violent crime rate), as well as its challenges (i.e., high prevalence of physical inactivity, high prevalence of frequent mental distress, high cancer death rate).Some of the findings in the America’s Health Rankings 2019 report concerning Kentucky include: since 2012, obesity has increased 20%, from 30.4% to 36.6% of adults; in the past 10 years, drug deaths have increased 96%, from 16.4 to 32.2 deaths per 100,000 population; since 2010, the percentage of the population without health insurance decreased 66%, from 16.1% to 5.5%; in the past three years, frequent mental distress increased 21%, from 13.8% to 16.7% of adults; in the past two years, mental health providers increased 17%, from 194.6 to 227.5 per 100,000 population; and in the past four years, diabetes increased 10%, from 12.5% to 13.7% of adults.
There were 1,336 drug overdose deaths in Kentucky during 2018, down from 1,628 in 2017—much of it fueled by opioids. While the growing opioid crisis garners increased attention, chronic diseases are responsible for 7 of 10 deaths each year and drive most of the nation’s health care costs. Among Kentucky’s prime working-age adults, smoking (28%),
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obesity (42%), and physical inactivity (28%) put many at risk for chronic disease. Overall, around 29 percent of Kentucky’s prime working-age adults exhibit multiple chronic disease-causing behaviors, and these risk factors lead to higher absenteeism at work and increase employer costs. The Milken Institute has estimated that the economic toll of chronic disease on the Kentucky economy measured in the billions of dollars, reflecting the cost of treating avoidable medical expenses as well as the resulting lower labor force productivity and subsequent lower economic growth rates.
Kentucky’s poor health outcomes have large economic effects and societal consequences. At the most basic level, good health enables workers to be more productive. Indirectly, higher levels of health facilitate, for example, more education and schooling, which directly affects economic outcomes. Conversely, poor health can lead to premature death, lower workforce participation, higher public assistance costs, and less-than-optimal worker productivity. Studies have found, for instance, that labor time lost due to health reasons totals in the billions of dollars per year in lost economic output. Moreover, given the importance of workforce quality on firm location decisions, communities with high disability rates and poor health status are at a competitive disadvantage. For these reasons, investments in improving the health outcomes of individuals and communities can and do have vital and long-lasting economic benefits.
Investments to improve health outcomes in Kentucky can exert important economic benefits. Our analyses suggest that opioid abuse has reduced Kentucky’s labor force participation rate by 1.3 to 3.1 percentage points. This translates to a loss of 23,100 to 55,200 workers, $1.0 to $2.8 billion in earnings, and $63 to $169 million in state tax revenues—a considerable economic toll. When we analyze the economic consequences of smoking on Kentucky, we identify effects in three areas—reduced wages for smokers who work, reduced employment among smokers (a loss of 28,500 workers) and increased premature deaths for smokers. Combined, the impact of smoking in Kentucky’s reduces total earnings by $1.8 billion to $2.9 billion annually and its state tax revenues by $111 million to $176 million annually. Likewise, there are significant costs associated with other chronic diseases, like diabetes.
Factors like job stability, educational attainment, and neighborhood safety exert a strong influence over health outcomes. By addressing the place-based, social determinants of health in Kentucky communities, policy makers have the opportunity to improve the health of, and by extension economic outcomes for, citizens of the Commonwealth. The findings are clear—poor health can have deleterious economic effects, while good health can improve earnings, employment, and one’s quality of life.
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The health of individuals is affected by many factors, including, of course, individual behaviors regarding diet and exercise, but also including community characteristics. The U.S. Department of Health and Human Services advances a “place-based” framework under the auspices of the Healthy People 2020 initiative to explain and understand the factors affecting health outcomes. This framework includes five principal areas that constitute the social determinants of health: economic stability; education; social and community context; health and health care; and neighborhood and built environment. Using 24 separate factors organized into these five categories, we estimate the strength of the social determinants of health at the county level. Using a technique known as principal component analysis, we rank Kentucky’s 120 counties into quartiles, or four equal groups, by analyzing variables that include, but are not limited to, the poverty rate, the rate of successful transition to adult life after high school graduation, the number of community associations, the number of various types of health care providers, and environmental conditions such as air and water quality. Together, these factors reflect critical elements in our social and physical environments that affect individual health. Counties in Central and Western Kentucky show the best outcomes, with less favorable outcomes in Eastern Kentucky.