Mental Health Month a Time to Focus on the Connection between Physical and Mental Health

(Note: This guest piece was written by Marcie Timmerman, Executive Director of Mental Health America of Kentucky)

Marcie Timmerman
Executive Director
Mental Health America of Kentucky

Mental health is essential to everyone’s overall health and well-being, and mental illnesses are common and treatable. So much of what we do physically impacts us mentally. It is important to pay attention to both your physical health and your mental health, which can help you achieve overall wellness and set you on a path to recovery.

Did you know that Mental Health America (MHA) founded May as Mental Health Month back in 1949? That means this year marks MHA’s 70th year celebrating Mental Health Month! This May, Mental Health America of Kentucky is expanding its focus from 2018 and raising awareness about the connection between physical health and mental health, through the theme #4Mind4Body. We are exploring the topics of animal companionship, spirituality and religion, humor, work-life balance, and recreation and social connections as ways to boost mental health and general wellness.

A healthy lifestyle can help to prevent the onset or worsening of mental health conditions, as well as chronic conditions like heart disease, diabetes, and obesity. It can also help people recover from these conditions. For those dealing with a chronic health condition and the people who care for them, it can be especially important to focus on mental health. When dealing with dueling diagnoses, focusing on both physical and mental health concerns can be daunting but critically important in achieving overall wellness.

There are things you can do that may help. Finding a reason to laugh, going for a walk with a friend, meditating, playing with a pet, or working from home once a week can go a long way in making you both physically and mentally healthy. The company of animals – whether as pets or service animals – can have a profound impact on a person’s quality of life and ability to recover from illnesses. A pet can be a source of comfort and can help us to live mentally healthier lives. And whether you go to church, meditate daily, or simply find time to enjoy that cup of tea each morning while checking in with yourself– it can be important to connect with your spiritual side in order to find that mind-body connection.

Mental illnesses are real, and recovery is always the goal. Living a healthy lifestyle may not be easy but can be achieved by gradually making small changes and building on those successes. Finding the balance between work and play, the ups and downs of life, physical health, and mental health, can help you on the path towards focusing both #4Mind4Body.

Everyone has mental health. Isn’t it time we start taking care of it?

Concerned about yourself or someone you love? Take a free online mental health screening here.

Recent Studies Reveal Variation in Price and Quality Among Kentucky’s Hospitals

New Hospital Safety Grade state rankings by the nonprofit The Leapfrog Group shows Kentucky ranks 33rd in overall hospital safety, holding that spot for the second time in a row. This, when paired with the new study released last week by RAND Corp., reiterates that hospitals in the Commonwealth vary in both price and quality.

In the Spring 2019 Hospital Safety Grade rankings, Kentucky’s share of “A” hospitals was just 21%, down from nearly 24% in the Fall 2018 rankings. Leapfrog uses an easy-to-digest A-F grading scale, with “A” being the best. Nearly 70% of Kentucky’s 52 hospitals received a “C” or below rating, compared to the nationwide average of 43%. A new study released by The Leapfrog Group along with the state rankings showed that avoidable deaths due to errors, accidents, injuries, and infections have an 88% greater risk at “C” hospitals and 92% greater risk at “D” and “F” hospitals.


In addition to the Leapfrog safety rankings, Kentucky was one of 25 states that was included in last week’s RAND hospital price transparency report, which for the first time used actual payments by privately insured employers to report inpatient and outpatient prices by hospital. The report shows prices as a percent of what Medicare paid for the same services, thus making these relative prices comparable across the country. The study has been a hot news item in the healthcare world, featured in publications such as The New York Times, The Wall Street Journal, and Forbes.

Kentucky ranks fourth lowest in price of the 25 states in the RAND hospital price transparency study.

Overall, Kentucky came out favorably for its relative pricing to Medicare for private insurance in the report, well under the national average of the states in the study. Of the 25 states included in the data, Kentucky ranked fourth lowest in prices paid to hospitals, at 186% of Medicare compared to the national average of 241%. Similar to what the report illuminates nationally, there is large variation in price – inpatient, outpatient, and overall – among Kentucky’s facilities.

The RAND study looked at the CMS Hospital Compare five-star rating to highlight variation on quality, and that system illuminated similar trends as Leapfrog’s new results. Looking at the CMS ratings, which, like Leapfrog, puts hospitals into five levels of performance, more of Kentucky’s facilities named in the RAND study have poor to average ratings compared to the nation as a whole – 84% compared to the nation’s 51%. This means that just 16% of Kentucky’s hospitals are considered above average or excellent by CMS Hospital Compare.


These variations in price and quality in Kentucky’s hospitals will be the focus of the Kentuckiana Health Collaborative’s June 4 Community Health Forum, which will bring in the RAND study’s leaders to dive into the results and what this means for Kentucky.

Gloria Sachdev, President and CEO for Employers’ Forum of Indiana, which partnered with RAND on the study, will walk through the study results, focusing on Kentuckiana and Kentucky’s hospital prices and how they compare to the rest of the nation. We will also hear from an employer, Indiana University, that was part of that first-year study in Indiana to discuss how seeing hospital pricing information has impacted their benefit strategy.

Although hospital pricing is important to all stakeholders, this event will be particularly relevant to those interested in employee health benefits, health plan design, and provider payment. RAND is now recruiting more participants for the next iteration of the study, so any employer or health plan that is interested in participating is encouraged to attend and for more information on what is involved.

Register today to join the conversation at the UofL Shelby Campus Founders Union Building. As with most KHC Community Health Forums, attendance is free for KHC members and $35 for non-members, which includes the program, networking, and breakfast. If you are unsure if your organization is a member of the KHC, see the full list here.

Action items to address healthcare affordability in the region identified at Community Health Forum

It’s no secret that we have a problem with healthcare affordability in this country. Each day, there are new headlines that highlight this problem. We are all familiar with these headlines. But what do we do about it?

That’s exactly what we addressed in last week’s Community Health Forum, “The Path to Affordable Healthcare.” In a different format from our typical Community Health Forum, which lasts a couple of hours, “The Path to Affordable Healthcare” was extended to a half-day event and included an interactive portion, where participants worked in groups to create action items to tackle healthcare affordability in the region.


In the first half of the day, participants listened to several speakers and panelists discuss the lack of agreement on an affordability definition, the current state of healthcare affordability in the nation and region, the drivers of healthcare affordability, the role of regional collaboration, and the barriers that keep us from achieving affordable healthcare.

There was much interesting information given and discussion had in first half of the day, including three speaker presentations and a panel loaded with healthcare experts from across the Commonwealth (see agenda here). But the highlight of the day was the creation of action items by event participants designed to help develop a community action plan to address healthcare affordability in our community.

“For me the event just reconfirmed how pivotal the KHC is to the region. Having healthcare stakeholders (purchasers, payers, hospitals, and so on) all working to together to understand each other’s needs is the only way we are going to get true change to a fragmented system. Everyone will win when our healthcare systems provide quality care, access to care at an affordable cost. Alone we can accomplish nothing. Working together we can gain everything.” -DeAnna Hall, Manager Corporate Health & Wellness, LG&E KU

Working in groups, participants brainstormed and defined goals to prioritize and improve healthcare affordability as it relates to health, price, and waste – the drivers of healthcare affordability. The action items were not limited to what the KHC could accomplish, but for the community as a whole. Given the range of viewpoints in the room, the task became an energetic exercise. Ten ideas were identified and discussed with the larger group, and participants then identified and voted on their top three selections.

The action items were outlined, in descending order of votes:

1. Create a state-wide data warehouse with claims, electronic health records, and public health data to map price and quality variation. The warehouse will be led by the state and the KHC and the data will be used to partner with the next iteration of the RAND hospital price transparency study.

2. Create a statewide collaboration to identify the top three costly chronic conditions that have a gap in care and work to close gaps through payment innovation, patient education, aligned cost and quality measures, and care coordination.

3. Participate in a self-insured transparency study for Kentucky with the current iteration of the RAND hospital price transparency study and use the results of the study in next year’s contract negotiations.

4. Conduct a three-year pilot to create a workflow redesign to integrate social determinants of health, physical health, and mental health into a quality patient care management plan in Louisville Metro.

5. Create a knowledge transfer center for employers and health plans to define health transparency and value-based purchasing, to be operated by the KHC.

6. Promote competition and consumerism to drive affordability through legislation. Educate legislators on price transparency.

7. Promote healthcare transparency and affordability across all parties by removing data barriers.

8. Improve patient engagement with health coaches or community health workers, with a focus on preventive screening in rural areas of Kentucky.

9. Create a defined pathway for musculoskeletal outcomes pricing with reduction in imaging for low back pain. Each year, focus on specific employers.

10. Educate consumers, employers, students, etc., on healthcare benefit literacy.

“Active engagement, interaction, and partnership among government, payors, employers, and providers is essential to solving the dilemma of healthcare affordability in Kentucky. While we all share a common objective to provide high quality care to the citizens of the Commonwealth, we need to start four-way conversations to listen and understand perspectives and challenges and then use this information to create productive solutions. In our workgroup I believe each member learned something new about another’s perspective. As a first-time participant I look forward to opportunities for further engagement to offer a providers perspective and contribute to real problem solving.” -David Zimba, Managing Director, Kentucky Health Collaborative, and event panelist


There is a clear want and need for better data around cost and quality in the Commonwealth. As the KHC data scientist, this is what I like to hear! It is impossible for any stakeholder – consumer, provider, plan, or other – to make informed and appropriate choices with large gaps in information. Transparency is key to healthcare affordability, as it provides insights and identifies problems. There was also a lot of talk around minimizing wasteful treatments and procedures that provide little or no benefit.

Many potential ideas were created at “The Path to Affordable Healthcare,” and the next step is to identify which can be and should be acted upon in the community. This event was held in partnership with the Network for Regional Healthcare Improvement (NRHI) to bring healthcare affordability to the forefront of healthcare transformation efforts through a campaign called Affordable Care Together. As part of that campaign, the KHC is required to create an action plan by January 15.

The KHC will take these action items back to its leadership team to determine which are appropriate for our organization to pursue. Look for more updates in the near future.

QPR Reflections: Suicide Prevention Training Hits Home

A couple of weeks ago, the Kentuckiana Health Collaborative held its September Community Health Forum. The topic was youth mental health, and the date coincided with National Suicide Prevention Week. After the Forum, the KHC hosted a Question, Persuade, Refer (QPR) training as part of a goal to set a record for people trained in one week. Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis. It was designed to equip individuals with the tools they need when someone in their life is facing a suicide crisis.

I was in that position last year, trying to convince the person I loved most in the world not to take their own life. It’s an experience I don’t wish on my worst enemy. I’m at a year of therapy and counting, and although I am a much stronger person for the experience, I wish I had never been through it.

In the end, my loved one didn’t take their life, and they got the talk therapy and medication needed to push through. Multiple people have credited me with that outcome. I’m not sure if I agree with that, but I do admit that my involvement might have had a positive impact and recognize now the power that even one individual can have in moments of crisis.

Hence the need for trainings like QPR. Suicide is the 10th leading cause of death in the United States, and it’s estimated that for every death by suicide, there are 25 more attempts. It happens more commonly than we’d like to believe. During National Suicide Prevention Week, more than 2,200 people in Louisville were trained in suicide prevention in 50 locations across the city.

I’ll admit that I was slightly disappointed by the QPR training. I guess I thought that it would reveal one magic thing that I could have said or done differently, to make the situation turn out more smoothly than it did in my case. I was disappointed to find that there is no magic bullet to be had. People are complex. These situations are complex. There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

I don’t think I was prepared for the traumatic memories that QPR would bring up. Much of the 90-minute session was devoted to recognizing the signs and behaviors of distressed loved ones. I can say that from my personal experience, what was taught in QPR related to this was almost word-for-word what I experienced. I had to leave the room more than once in tears. But I always returned, determined to see it through. Then came the disappointing part of the training. The part where I discovered that there is no perfect phrase that can talk someone off the proverbial ledge. But that doesn’t mean that we can’t have an impact on the situation. We can all create safe spaces for our loved ones to talk to us when they are struggling, and we can together get through the tough times.

I had nightmares that evening about those past traumas. But then, a funny thing happened. The nightmares that I’d been accustomed to having for the last year stopped. Situations and places that used to trigger me no longer did. And I realized that it was a direct result of the QPR training. I had long ago forgiven myself for what I had seen as failings when I was faced with the crisis, but it turns out that I didn’t need to be forgiven at all. By participating in the training, I realized that I did probably more in that situation than I should have been able to. It wasn’t blind luck that prevented my loved one from taking their life. And that was the closure that I didn’t know that I needed.

It sounds like a cliché to say that you never think it will happen to you until it does. But that’s exactly how it is. And I would recommend that anyone learn how to have that conversation and develop that vocabulary, through QPR or a similar program. Because you never know when you might need those skills.

KHC Joins Coalitions Across the Country to Address Healthcare Affordability

Kentucky, like the rest of the United States, has a problem. Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result. We pay too much for care and it is causing financial, emotional, and clinical harm to individuals, businesses, and communities.

The current situation is unsustainable; harder choices are coming. There are proven approaches to make headway, but we have to work together to achieve success. We can’t blame the current state of affordability on any individual group of people. We all created the situation. It will take all of us working together to solve it.

Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result.

The KHC has long been a trusted partner in reporting healthcare quality performance data. But you can’t address quality without also looking at value. Solving one issue in isolation does not achieve the healthcare affordability goal. Healthier populations use fewer healthcare resources. Healthier populations create more productive communities. Unnecessary services are causing clinical, emotional, and financial harm. Administrative waste is a financial burden on patients and providers while also burning out providers.

To begin the conversation locally around healthcare affordability, the KHC has joined the Network for Regional Healthcare Improvement (NRHI) and other regional coalitions across the country to bring healthcare affordability to the forefront of healthcare transformation efforts. The movement is focused on health, price, and waste — the three drivers of affordable healthcare. In joining this effort, NRHI and its coalitions like KHC will leverage their collective strengths on efforts to improve affordability while preserving and improving quality. In addition, partnering with other national entities committed to solving the healthcare affordability problem will strengthen the effectiveness and reach of these efforts.

The campaign, called Affordable Care Together, is an approach that puts communities at the center of the solution; the movement is led by neutral, non-profit conveners who build on existing, multi-stakeholder efforts to improve health, reduce price, eliminate waste, and collectively create greater awareness and solutions.

As part of Affordable Care Together, myself and KHC leaders Teresa Couts, Randa Deaton, Emily Beauregard, Don Lovasz, and Amanda Elder will join leaders from every segment of the U.S. healthcare system at the Ronald Reagan Building in Washington, D.C. for a day-long summit next week, addressing our country’s healthcare affordability crisis. We will bring back the lessons and ideas that we learn and put them to use, hosting a Community Health Forum in December called “The Path to Affordable Healthcare.” The half-day event will bring together key healthcare stakeholders and like-minded local change agents, who will help develop a community action plan to address healthcare affordability in our community.

Look in coming weeks for more content on healthcare affordability, including reflections from the summit in Washington, D.C. There are ways we can work together to change the system and make it sustainable for current and future generations. By working together, we can make a difference.

 Learn more about Affordable Care Together

Variety of Viewpoints Makes for Engaging, Motivating Bost Forum

The opioid crisis in Kentucky, and across the country, continues to be a hot topic in healthcare. For the second straight year, the Howard L. Bost Memorial Health Policy Forum, convened by the Foundation for a Healthy Kentucky, chose substance use (with a heavy emphasis on opioid use) as the theme for the day.

While some might expect a day devoted to yet more discussion around substance use in the Commonwealth to be full of familiar, tired conversations, the Bost Forum was anything but. All of the KHC’s staff members attended the forum, and each of us left chattering excitedly about the speakers that left us inspired, motivated, fired up, and more.

For each of us, different speakers provided a spark or connection. As a reflection on the day, each member of the KHC shared something that stuck with them about a particular speaker. Read KHC staff reflections in their own words below.


Keynote Speaker Barry Meier

Randa Deaton – Co-Executive Director

Over 200,000 Americans have died from overdoses related to prescription opioids from 1999-2016. This year’s Bost keynote speaker, Barry Meier, is the award-winning reporter whose special report in the New York Times created national interest in OxyContin. His 2003 book, “Pain Killer,” exposed the rise of the billion dollar pain management industry excesses and abuses, and he felt confident his reporting efforts would help solve America’s opioid crisis. Fifteen years later, the alarm bells are only now ringing within the government, and he has released an updated version of his book. His passion for holding the organizations accountable for this public health crisis could be felt through the room. More importantly, he conveyed the tragedy in waiting for the alarm bells to go off after 200,000 Americans have already died. The key takeaway was for those in public health to get in front of these dangerous public health trends to avoid this type of crisis in the future.


Breakout Discussion panelists: Alternatives to Opioids

Michele Ganote – Event and Communications Coordinator

There are many alternatives to opioids, with the obvious being over-the-counter pain relievers such as Tylenol and Advil. Each panelist discussed the many other options available for dealing with and treating chronic pain and how important it is to focus on the “why” of the pain and not just mask the pain with medication. I often hear about deep breathing or meditation for stress and anxiety, but before yesterday I hadn’t thought much about it for pain and recovery. Dr. Mel Pohl, CMO for the Las Vegas Recovery Center, suggested we all meditate daily. Meditation or mindfulness is commonly used in recovery at the Las Vegas Recovery Center. I found Danesh Mazloomdoost, MD, Wellward Regenerative Medicine, to be passionate about his work with “regenerative medicine,” a new medical field that studies how the body heals and how science can enhance this process. I look forward to reading his book, “50 Shades of Pain.” Other alternatives to opioids for patients living with chronic pain were physical therapy, massage, acupuncture, cognitive behavioral therapy (CBT), avoiding alcohol, eating healthy, keeping a positive attitude, distracting yourself from pain, and planning for a bright future.


KET Series on Addiction (Presented by host Renee Shaw)

Teresa Couts – Co-Executive Director

Shortly after lunch, Renee Shaw, KET, presented a video from the KET Series on Addiction. The video featured Butler High School in Louisville, KY, which has implemented the national program Sources of Strength. The mission is to provide the highest quality evidence-based prevention programs for suicide, violence, bullying and substance abuse by training, supporting, and empowering both peer leaders and caring adults to impact their world through the power of connection, hope, help, and strength. A group of students at Butler High School are training to save lives and improve the mental health of their fellow classmates. Butler health teacher Mary Wurst brought the group together after some of the students came to her for advice or guidance during their own struggles. Now, these students are using their experiences to give back to their classmates who might be in need. Butler is among the first Jefferson County Public Schools to help identify and support students who may be struggling. One student stated that “so many people are still alive because of this program and because of the coping mechanisms we’ve learned.”


Nancy Hale, Operation UNITE (part of the panel on Kentucky’s Addiction Burden)

Natalie Middaugh – Project Coordinator

The morning panel at the Howard L. Bost Memorial Health Policy Forum convened representatives with diverse perspectives to explore Kentucky’s addiction burden. A highlight of these perspectives was from Nancy Hale, President/CEO of Operation UNITE. Operation UNITE is a nonprofit organization serving 32 counties in eastern and southern Kentucky that utilizes a collaborative model to prevent substance abuse and facilitate recovery. It is difficult to find a conversation focused on addressing the substance and opioid use epidemic that does not emphasize the necessity of strategic partnerships. Operation UNITE is a long-standing and successful example of how these strategic partnerships can affect meaningful change.


Alex Elswick, Voices of Hope (part of the panel on Kentucky’s Addiction Burden)

Stephanie Clouser – Data Scientist

Alex Elswick, Co-Founder of the non-profit organization Voices of Hope, talked about the recovery process for substance use disorder and the importance of supporting people in recovery. Alex, himself a person in long-term recovery, said that we need to give more than lip-service to those in recovery. Everyone loves a great comeback story, but we need to support those who are actively going through treatment as well. Alex is “not in recovery because I pulled myself up by my bootstraps,” but because he had access to the resources he needed to get better, and we need to support individuals by addressing the barriers to those resources.

PRESS RELEASE: High School students examine mental health stigma in KY teens

Findings: Adult, peer views on mental health contribute to stigma

Press Release by Hayley Kappes, University of Louisville

LOUISVILLE, KY September 6, 2018 – Parents who refuse to take their children to therapy because they don’t believe in mental health treatment. School counselors who have told students to stop crying because they’re “fine.” Teens further ashamed of mental illness because of negative portrayals in the media. These are some of the experiences that a high school student group, mentored by a University of Louisville clinical psychologist, has gathered from peers across Kentucky during yearlong research into factors that contribute to mental health stigma in teens.

Allison Tu

Allison Tu, a senior at duPont Manual High School who led the student group, and Stephen O’Connor, PhD, associate director of the UofL Depression Center who guided the students in research, will present findings during the Kentuckiana Health Collaborative Community Forum on Tuesday, Sept. 11, from 8 to 10 a.m. at the UofL Clinical and Translational Research Building, 505 S. Hancock St. After the forum, a Question. Persuade. Refer. (QPR) Suicide Prevention Training by the Louisville Health Advisory Board will take place.

The student group, comprised of teens across the state, is called the Student Alliance for Mental Health Innovation and Action (StAMINA) and is supported by the Kentuckiana Health Collaborative, a nonprofit organization that aims to improve health and the health care delivery system in greater Louisville and Kentucky.

StAMINA conducted a needs assessment of the state and held focus groups in urban and rural areas with high school students and parents to uncover what interferes with students acknowledging they have mental health issues and receiving treatment. The group also interviewed mental health professionals and pediatricians.

Factors that contributed to mental health stigma among high school students included negative representation of mental health in media and stigma from peers and parents who do not have a positive attitude about mental health, Tu said. The group found differences between rural and urban residents.

“Because there is more racial and ethnic diversity in urban settings, one of the big drivers of mental health stigma is ethnic heritage,” Tu said. “African-American and Asian-American students talked a lot about how culturally, mental health was often ignored. With rural students, generally there was more stigma resulting from religious factors. Some students said they would talk to their parents about mental health issues, and their parents would respond, ‘you’re not praying enough.’”

Stephen O’Connor, PhD

Messages that parents express about mental health impact a child’s views, said O’Connor, who guided the research design, and taught the students how to lead focus groups and conduct qualitative data analysis.

“The gatekeeper for getting children to treatment is often going to be a parent, so parental views on mental health are likely going to impact whether a child is taken to treatment,” O’Connor said. “The parent also is helping the child understand what they’re experiencing, so if the parent doesn’t have a good idea about what symptoms of mental illness represent, then the child is probably not going to understand either.”

Solutions to mental health stigma among teens may include a new mental health education requirement for high school freshmen or a social media campaign to amplify the visibility of resources, said Tu, who also stressed the need for parents to be educated on mental health issues and resources available for their children.

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Hepatitis A outbreak continues to grow in Louisville, throughout the Commonwealth

(Note: This guest post was written by Lori Caloia, MD, medical director for Louisville Metro Department of Public Health and Wellness)

Map of confirmed hepatitis A cases shows where outbreaks of the virus are most prevalent.

The hepatitis A outbreak continues to grow in Louisville and throughout Kentucky. To date, 392 cases have been identified, and there have been two deaths within Jefferson County. The majority of people in these cases have the common risk factors of recreational drug use – any drug use, not just injection drug use — homelessness and insecure housing. However, about 10% of our cases have no identifiable risk factors. To complicate matters, cases of hepatitis A may go unrecognized. Some people who are infected may not show symptoms, especially early in the disease, and some may not seek medical care when they do.

Hepatitis A is a liver virus found in the stool of people with the infection and spreads when trace amounts of stool are ingested. The two best ways to protect yourself from hepatitis A are to:

  1. Practice good hand washing with warm water and soap, especially after using the bathroom and before you prepare food or eat; and
  2. Get vaccinated

The Louisville Metro Department of Public Health and Wellness (LMPHW) recommending community members protect themselves by getting vaccinated. Just one dose gives you almost complete protection in the outbreak setting! Consider how your organization can help in our community and state-wide efforts to reduce barriers to vaccination for both the general community and for the at risk groups in particular. We can all work together to end to this outbreak!

Two other important things to know and share about the hepatitis A virus:

  • Hand sanitizer is not as effective at preventing the virus as handwashing
  • A person with hepatitis A can be contagious for up to two weeks before they ever show signs or symptoms of illness

There is more information and educational materials about hepatitis A on the LMPHW website. Additionally, answers to frequently asked questions about the hepatitis A vaccine can be found on the Centers for Disease Control and Prevent website.

Louisville Coming Together to Curb the Spread of Hepatitis A

(Note: This guest post was written by Sarah Moyer, MD, MPH, director of Louisville Metro Department of Public Health and Wellness, and Lori Caloia, MD, medical director for Louisville Metro Department of Public Health and Wellness)

Map of confirmed hepatitis A cases shows where outbreaks of the virus have been most prevalent.

Louisville continues to work to control an outbreak of acute hepatitis A, which remains centered among the city’s homeless and those who use illicit drugs.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by a virus. It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Most adults with hepatitis A symptoms may experience fatigue, low appetite, stomach pain, nausea, or jaundice, that usually resolve within two months of infection; most children less than six years old and some adults do not have symptoms or have an unrecognized infection.

The best ways to prevent hepatitis A infection is to get vaccinated and to wash your hands frequently with soap and water, especially after using the bathroom or changing diapers and before eating or preparing food.

On November 21, 2017, the Kentucky Department for Public Health declared an outbreak of acute hepatitis A in several counties throughout the state, with the vast majority of cases in Louisville. The Louisville outbreak is epi-linked (shares the same genotype or genetic linkage) to a similar outbreak in San Diego, CA. Hepatitis A outbreaks are also occurring in Michigan and in Utah.

As of April 24, there had been 273 cases in Louisville with one death associated with the outbreak. There had been a total of three hepatitis A -associated deaths across the state. The Kentucky Department of Public Health has recommended that everyone living in counties affected by the outbreak be vaccinated. The Department of Public Health and Wellness continues to work with the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health to provide vaccinations for those who use illicit drugs and for the homeless. Our vaccine is designated by federal regulation specifically for these groups.

The department and its community partners have given well more than 14,000 hepatitis A immunizations at homeless shelters, homeless camps, recovery houses and at agencies such as Family Health Centers’ Phoenix Health Center. It has also provided immunizations at Metro Corrections, both at intake and in the general population of inmates. It regularly continues to provide immunizations at its syringe exchange sites, its Specialty Clinic and at the MORE Center.

Others wishing to get hepatitis A immunization should check with their insurance company on where the insurer prefers that they go to get the vaccine and what, if any, cost might be associated with it. The vaccine is widely available at local pharmacies and health care providers.

Those who do not have health insurance, can be vaccinated at:

Louisville has really come together to protect our out-of-town guests as well as residents during Derby festivities. Public Health and Wellness is teaming up with the U of L Global Health Clinic to offer below-cost immunizations to food service and hospitality businesses throughout the city. Thanks to donations from the Aetna and Anthem foundations, the cost has been reduced from $65 to $25 per dose. As of April 20, more than 1,100 food service workers from more than thirty businesses, including Churchill Downs vendors, had been immunized under this initiative. Businesses wishing to take advantage of this offer should call Dr. Ruth Carrico at 502 – 852-1324.

Like every year, the Department of Public Health and Wellness will be inspecting all food vendors at events like Derby, Oaks, and the Chow Wagons to make sure they are practicing safe food handling. While the outbreak remains centered among those who use illicit drugs and the homeless, the general population attending Derby events can protect themselves from hepatitis A by practicing good handwashing after using the restroom and before eating or drinking.

The Kentucky Derby Festival is posting signage at the various events to emphasize thorough handwashing. Hand sanitizer has been found to be not as effective as good handwashing at protecting against the hepatitis A virus, so the Derby Festival is installing hand washing stations at all events and has tripled the number of handwashing stations this this year over previous years.

The CDC has praised Louisville’s response to the hepatitis A outbreak, calling it the “gold standard” and a model for other cities to emulate.

Physicians and other healthcare providers can help to curb the spread of hepatitis A as follows:

  1. Expand your differential diagnosis. Think of hepatitis A in your patient work up, particularly if they have jaundice or the outbreak risk factors for hepatitis A of homelessness or drug use.
  2. Order a Hepatitis A IgM antibody test for confirmatory testing (a Hepatitis A Total Antibody does not help distinguish acute from prior infection or vaccination and should only be ordered to confirm immunity to HAV).
  3. Take a good history. Find out if infected patients have been in contact with anyone with hepatitis A, exactly when symptoms began (particularly jaundice, as this helps us to determine their infectious period in which they could have spread the virus to others), and where they have been living (i.e. homeless, correctional facilities or other congregate settings). Do they use drugs? Do they have other co-morbid diseases such as hepatitis B or C that may put them at risk for severe outcomes?
  4. Promptly report any suspected or laboratory confirmed case of Hepatitis A to LMPHW. Call communicable disease staff at (502) 574-6675 or fax EPID-200 form to (502) 574-5865. All communicable diseases are reportable to the health department (acute Hepatitis A within 24 hours) and the sooner we receive this information, the more time we have to contact the case patient, identify their contacts and provide post-exposure prophylaxis to contacts, further preventing disease. Please don’t rely on someone else to do this. The hospital lab reporting is often delayed. You, who are caring for the patient, are the first to suspect and often the first to respond to the positive lab result. The infection prevention nurse at your hospital can help with the reporting.
  5. Recommend hepatitis A vaccination to your patients! As a routine preventive health measure, HAV vaccine is covered by insurance. It is an incredibly effective vaccine, with 96 – 100% seroconversion within 4 weeks of vaccination. Even one dose of vaccine can be effective for up to 10 years and completion of the 2-part vaccine series confers 20 or more years of immunity.
  6. Provide post-exposure prophylaxis (PEP) to those who have been in contact with someone infected with HAV within 14 days of exposure. Healthy people age 1-40 should be provided Hepatitis A vaccine for PEP. Provide Immunoglobulin (IG) to close contacts of those with HAV if under age 1, pregnant, or if other comorbidities exist, if available. Hepatitis A vaccine should be offered to contacts if IG Is not available. The dosage of IG is 0.1mL/kg. 3,4,5
  7. Consider helping with the local efforts. There are various ways to do this:
  • Join the Medical Reserve Corps (MRC). Though some paperwork is required to be completed up front (background check), once you become a member, you can respond with any of the LMPHW efforts that are already ongoing. Joining the MRC does not obligate you to respond to future events. If you are interested in joining the MRC, please contact Kim Rogers at (502) 526-6833.
  • Work with your organization to spread the word of the outbreak and encourage involvement in response efforts. We all have competing priorities within our own organizations and having physician champions for this cause can help highlight this as a priority in your organization. If you are a leader within your organization, consider how you could assist in our outbreak response. Kentuckiana Health Collaborative members can help by ensuring the populations under their care receive vaccine. Increasing communications with those within their organization on how they can receive the vaccination is instrumental in this process.
  • Identify additional locations where vaccination may be needed. If you are involved in community organizations or events that serve at-risk populations, let us know! We have found many locations such as churches and food pantries that have allowed us to reach those with vaccine that we might not have reached otherwise.
  • Donate money or items to help with vaccine efforts. Thank you to those partners who have already been generous donors, including Anthem, Aetna, and the many businesses who have provided immunizations for their workers.

For more information or to get involved in the HAV outbreak response, please contact us at or






Minority Health Month Brings Focus to Groups that Often Have Health Disparities

Minority Health Month, held each year in April, is a time to learn more about the health status of racial and ethnic minority populations and to raise awareness of the health disparities that continue to affect racial and ethnic minorities. As an African-American female born with benign ethnic neutropenia, a blood disorder characterized by white blood cell counts that are persistently below the normal range of those with people of Caucasian descent, I adhere to suggested preventive clinical guidelines and annual health exams. A large proportion of healthy African-Americans have this blood disorder. With a family history of colon cancer, diabetes, and breast cancer, it is important for me to take personal responsibility for my health.

In 2010, I started my doctoral degree in education and completed my dissertation, Predicting Adherence to Mammography Screening Practices among African-American Women, in 2014. I chose this topic because African-American women were disproportionately dying from breast cancer at a higher rate than other ethnic groups in Louisville, KY. You can see from the graph that there is a wide disparity between black Louisville residents and white Louisville residents in breast cancer deaths.

Breast cancer is a leading cause of cancer death among women in the United States. According to the American Cancer Society, about 1 in 8 women will develop breast cancer and about 1 in 36 women will die from breast cancer. If look at current Jefferson County data, those statistics have improved overall and the disparity gap is narrowing. However, African-American women still have a higher death rate.

According to the Susan G. Komen organization, overall nationally, breast cancer incidence (rate of new cases) is slightly lower among black women than among white women. However, breast cancer mortality is higher in black/African-American women. Lower screening rates in the past may be one possible reason for the difference in survival rates today. Black women now have slightly higher rates of mammography screening than other women. Even after accounting for differences in income, past screening rates, and access to care, black/African-American women are diagnosed with more advanced breast cancers and have worse survival than white American women. More research focusing on the differences in reproductive factors and breast cancer biology is needed to close the mortality disparity gap among African-American women and other ethnic groups. I proud to say that my sister is a 23 year breast cancer survivor!

Men, don’t stop reading! Minority Health Month focuses on all minorities, not just women. My father and sister are both living with Type 2 diabetes; my father has had two lower-limbs amputated. Members of some racial and ethnic minority groups are more likely to have diagnosed diabetes than non-Hispanic white individuals. The Centers for Disease Control and Prevention reported among adults, American Indians/Alaska Natives had the highest age-adjusted rates of diagnosed diabetes among all racial and ethnic groups examined.

Diabetes-related complications can be serious, costly, and deadly. They include heart disease, stroke, kidney damage (chronic kidney disease and kidney failure), blindness, and amputations of the legs and feet. People with diabetes can better manage their condition and improve their health by following preventive care practices. These practices include receiving annual foot and eye exams and attending diabetes self-management classes.

Kentucky has the seventh highest adult obesity rate in the nation, according to The State of Obesity: Better Policies for a Healthier America, released August 2017. Kentucky’s adult obesity rate is currently 34 percent, up from 22 percent in 2000 and from 13 percent in 1990. While Kentucky is trending in the wrong direction, black residents are leading the obesity figures. There are many socioeconomic reasons for this trend. Jefferson County is trending in the right direction. The Louisville Metro Behavioral Risk Factor Surveillance Survey (BRFSS) for the 2016 measurement period, maintained by Louisville Metro Public Health, reported overall obesity rates at 31 percent, down from 33 percent in 2015.

Several of my friends have been diagnosed with prostate cancer. Prostate cancer develops mainly in older men, although it can affect women in very rare cases. The American Cancer Society reports about 1 man in 7 will be diagnosed with prostate cancer during his lifetime. What may be surprising is that race and ethnicity significantly influence who gets prostate cancer and who dies from it. African-American men have, by far, the highest incidence of the disease: they are roughly 1.6 times more likely to develop prostate cancer than whites and 2.6 times more likely than Asian Americans. The gap in mortality rates is even more dramatic – African-Americans are more than twice as likely to die of prostate cancer as whites and about five times more likely to die of it than Asian-Americans. The high incidences of prostate cancer in African-American men holds true for those living in Jefferson County.

Health disparities affect everyone. Healthcare providers, policymakers, private sectors, and public sectors must all collaborate on initiatives to reduce disparities, advance equity, and strengthen the health and well-being of not only minorities, but all ethnic groups.