In the ever-evolving story of the novel coronavirus, certainty is hard to come by.
However, experts across the world are in strong agreement as data reinforces a distressing collision of multiple pandemics: COVID-19 and chronic health conditions. As state leaders review the impact of COVID-19 and how prepared Kentucky was to deal with the crisis, the links between specific health issues and the virus are crucial to understand and address.
The effects of the interaction of COVID-19 and chronic health conditions are staggering. A study of 16,780 hospitalized COVID patients found that 77% were overweight or obese, 56% had hypertension, and 20% had diabetes. Of the 110,000 Medicare beneficiaries hospitalized with COVID-19 from February to May, 50% had diabetes.
Public health experts at the University of North Carolina-Chapel Hill have found that those with a body mass index of over 30 have a 113% greater risk of ending up in the hospital with COVID-19, a 74% increased risk of needing intensive care, and 48% increased risk of dying from the virus.
With Kentucky’s troubling health statistics, the long-term impact of the virus on individuals with chronic conditions could be significant.
Sara Jo Best, the president of the Kentucky Health Department Association, says “Public health officials in Kentucky have been concerned about the health status of our residents for quite some time. Kentucky’s population has increased rates of asthma, cancer, heart disease, diabetes, obesity, and hypertension. All of these put our people at compounded risk for negative outcomes if they become infected with COVID-19.”
How is Kentucky impacted?
In Kentucky, 36.5% of Kentucky adults are obese and about 23.8% of Kentucky children ages 10 to 17 are obese. These statistics place Kentucky in the No. 5 worst spot in the country for adults and the No. 1 worst spot for childhood obesity in that age bracket.
The state’s population affected with hypertension and diabetes also ranks in the top 10. Kentucky’s diabetes rate is the fifth highest in the U.S., and diabetes ranked seventh among the state’s leading causes of death in 2017.
Over the past 30 years, the rate of obesity has increased by 200%. In the past 20 years, diagnoses of diabetes have doubled.
On top of poor health outcomes, the financial impact chronic health conditions have on our bottom line is cause for alarm. Obesity accounts for 21% of national health care spending, which is roughly $210 billion a year. One in every seven health care dollars is spent treating diabetes and its related complications.
In 2017, the total cost of diabetes for Kentucky Medicaid beneficiaries was $117 million. That averages out to $1,156 per beneficiary. The medical cost for Medicare beneficiaries who have obesity was $2,018 higher per year than those of normal weight.
With rates of chronic disease continuing to increase, the devastating health consequences and dollar figure will only grow. That is, unless, we take action.
What do we do about it?
According to Best, “Improvements to our health status continue to be something that public health professionals across the commonwealth agree needs additional progress.”
The same alignment is true among legislators, regardless of political party, according to Rep. Kimberly Moser, who chairs the House Health and Family Services Committee. “We all have the same goals, we sometimes just have a different way of achieving those goals,” Moser said. “A lot of that is experience. Once you work in this world for a while—not just the legislative world but also health—you understand that it’s not as black and white (as it may seem).”
A good place to begin is by reducing barriers to effective treatment. One such example is access to obesity treatment, a comorbidity that is closely correlated with a long list of health conditions. The Treat and Reduce Obesity Act of 2019, sponsored by Congressman Brett Guthrie (KY-02), aims to combat obesity in older Americans by eliminating major barriers to obesity treatment and prevention. If passed, TROA will expand Medicare beneficiaries’ access to additional health care providers and will extend Medicare Part D coverage to FDA-approved obesity drugs.
Prevention and education are also key to bringing down rates over time.
The state has taken steps to help Kentuckians address the challenges we face amidst the pandemic. Chair Moser and Best both cite the tobacco-free schools legislation, HB11 (Moser), passed in 2019. This measure received support from a broad coalition that included the nonprofit Foundation for Healthy Kentucky, an influential policy organization led by President and CEO Ben Chandler. Such coalitions of community and policy leaders are critical in solving issues related to chronic health as there is no one solution.
The news around COVID-19 is consistently grim, as are the chronic disease statistics Kentucky faces. There are major implications impacting a productive workforce, state resources, and most importantly—quality of life. A silver lining to offer is this: A pandemic is increasing urgency for action. The “slow” nature of these chronic condition epidemics, relatively speaking, has allowed for a degree of complacency. COVID-19 is changing that as the global health crisis brings desperately needed attention to these issues.
Given all this, can Kentucky lead a discussion about a new era of focus on chronic illness, its complications and impact? Legislative leaders have consistently said that the 2021 session will revolve around addressing issues related to COVID-19. It’s imperative that the conversation include tackling long-standing health challenges complicated by the pandemic, with chronic disease being chief among them.