This year has been a very active one in terms of health care events in Kentucky. A troubling rise in heroin and opioid addiction continues to wreak havoc in many communities across the state, and several environmental crises have surfaced to threaten populations in eastern and central Kentucky. In Louisville and elsewhere, gun violence has also increased, taxing the resources of hospitals and medical personnel.
On the brighter side, coordinated efforts made over the past 10 to 15 years by policy leaders in the state’s medical community have begun to show positive results, by way of lower incidence and mortality rates for certain types of cancer in Kentucky.
In this episode of Kentucky Health, Dr. Tuckson speaks with the commissioner of the Kentucky Department of Public Health about health care advances the state has made in recent years as well as the challenges that remain.
Hiram Polk served in the Department of Surgery at the University of Louisville from 1971 to 2005. He was an endowed professor and chair of that department and is now professor emeritus. Among many other service positions and awards, Dr. Polk served as a fellow at the Lister Institute of Preventive Medicine in London and at the Pasteur Institute in Paris. He also once served as Kentucky chair of the American Cancer Society and a member of the Prichard Committee for Academic Excellence.
Polk has great hope that initiatives made in the early 2000s by government officials and medical professionals to improve Kentucky’s overall health metrics will have a positive, long-term effect.
“I have to bet on it, I have to believe in it,” says Polk. “That’s my bias.”
Worrying Trends: Gun Violence and the Drug Epidemic
Polk says that he has witnessed a marked increase in gun violence in Kentucky, particularly in Louisville in recent years. He has heard from former colleagues still working in emergency rooms and surgical units that the increase of arrivals suffering from major gunshot wound trauma has reached a crisis level.
“There was a time, eight or ten years ago, when there might be one of the eight or nine patients … with a gunshot wound,” he says. “Now, the vast majority are gunshot victims. So, that’s taken the most precious hospital beds in Louisville … not to mention the ones who are dead on arrival.”
To Polk, much of the gun violence is tied to the devastating heroin and opioid epidemic that is sweeping the nation, and is especially prevalent in Kentucky. He acknowledges that the crisis grew in part due to over-prescribing of medications back in the late 1990s, saying that “I think that some of our colleagues in medicine sure did help start this fire.”
As commissioner of public health, Polk says that he is committed to improving his department’s coordination of a thorough and effective response to the drug epidemic. This involves outreach and a willingness to adapt policies that some might view as controversial, such as educating medical personnel on how to administer the overdose reversal drug naloxone and offering clean needle exchange programs for addicts.
The needle exchange programs will help reduce the spike in diseases associated with intravenous drug use like Hepatitis C, which Polk says costs $150,000 per year/per person to treat. One idea Polk and his staff are currently considering involves deploying an emergency pharmaceutical trailer to parts of the state where the drug epidemic is particularly intense.
“We’re going to try to get a community pharmacy where we can get out and continue to dispense, whether people like it or not, clean needles and syringes, and then try to help some of these people who want to come down off of this stuff,” he adds.
Polk believes that the mental health aspect of drug addiction has been under-emphasized in treatment, and that’s something he wants to change. “There’s a tremendous opportunity for medical and social workers with a psychological background in this right now, a huge need,” he says.
Increasing Environmental Risks
In recent months, environmental calamities in Estill, Greenup, and Montgomery counties have refocused attention on the grave impacts toxins can have on public health. Illegal dumping of radioactive waste by out-of-state oil and gas companies in Estill and Greenup county landfills has spurred a public health outcry in that eastern Kentucky region. Last summer, officials in Mt. Sterling found increased levels of arsenic in a residential area, which had been buried over 30 years ago following a wood plant’s closing but has resurfaced in the soil.
Polk recalls the infamous Maxey Flats radioactive waste dump near Morehead, which was used from the 1960s to the mid-1970s as a containment site for hazardous materials and was found to have major leakage. Final construction to cap the Maxey Flats area is currently being finished after years of disputes between state and federal agencies and private companies.
“Now we know enough to feel that the long-terms effects of any of these events can come back to haunt us, and they surely have,” Polk says. For him, Maxey Flats is a cautionary tale that should make government officials across all departments take their responsibilities as stewards of public safety seriously. He adds that his department has a duty to accurately determine the threat level posed to public health by a contaminated environmental situation, and then remediate it.
The Keys to Improving Kentucky’s Health
On a more positive note, Polk says that breast cancer and colon cancer rates in Kentucky have dropped over the past 15 years. More access to screening and improved tests for both cancers have been major factors, he says.
In addition to maintaining that momentum, one of Polk’s objectives as commissioner is to improve lung cancer screening tests and rates in Kentucky, which has for decades led the nation in tobacco use.
“Particularly women, young women who’ve smoked, they’re the ones who are at the highest risk of all,” he says. “A woman is nearly twice as likely, measured by per pack years of smoking, to get lung cancer than a man. That’s not widely known. And we need to really focus some of that screening for example on young women who’ve had 20 years of smoking. That would be a place to start.”
Ultimately, a far-reaching and permanent turnaround in Kentucky’s health care fortunes will not occur unless the public becomes educated about best practices for healthy living. “You can think of all the things we need, but I can’t think of any one of them that’s not tied to education,” he says.
Polk says that discussion over state government’s role in promoting health education has a long history, recalling an initiative started by Gov. Wendell Ford in the 1970s to educate young children. He believes that it is absolutely essential to reach children at an early age and instruct them on what to embrace (balanced diet, moderate exercise) and what to avoid (smoking, drugs, alcohol) as they grow up.
Polk commends officials in Newport Independent Schools and in Warren County Public Schools who are currently developing pilot public health education programs. He wants to see these types of initiatives spread throughout the commonwealth.
“I would love to believe that we could take what’s gone on in Newport and in Warren County, and talk about if we could get four or five more districts, and see if that would really work in a different place and a different time,” he says. “That experiment’s got to be done in more places.”
