New coalition encourages healthy eating, supports local farms

This recent University of Kentucky press release highlights some of CEDIK’s research and how it is making an impact on local farmers and food systems here in the Bluegrass:

By Carol Lea Spence, University of Kentucky Agricultural Communication Specialist

A successful coalition in Madison, Wisconsin, has sparked the interest of a group of local food advocates in Lexington, so much so that they started a similar pilot project at the University of Kentucky. The program joins employee wellness and community supported agriculture—a true town and gown initiative that stands to benefit a great number of people, its advocates believe.

Tim Woods, UK agricultural economics professor, returned enthused from a trip to Madison where he explored the success of the FairShare Community Supported Agriculture Coalition. For the past 20 years, FairShare has used a voucher system to link consumers with local farmers who produce a bounty of fresh, nutritious food. A wide number of organizations, including the University of Wisconsin, distribute the vouchers to their employees.

“This past year, they (FairShare) offered 9,300 vouchers to employees across Madison,” Woods said. “That’s in the area of $6 million in revenue to those CSA farms just in the Madison area.”

Woods believes a program like this in Central Kentucky could be a huge benefit for local farmers who are considering offering CSAs as well as consumers who are looking at making healthier food choices.

“We find so few kinds of interventions that will really encourage such a broad base of change in diet, change in lifestyle, change in focus on nutrition,” he said. “Joining a CSA really seems to pull lots and lots of levers.”

So Woods and College of Agriculture, Food and Environment colleagues Alison Davis, Jairus Rossi and James Allen approached the folks in UK’s Health and Wellness program to partner on a study in 2015. Funded by a U.S. Department of Agriculture Farm Market Promotion grant, Health and Wellness recruited 90 UK employees to enroll in an organic CSA program. The UKAg researchers conducted an evaluation test and control study, preliminary results of which show interesting trends.

There was a definite shift among participants toward preparing whole food versus processed, and more folks ate at home than they did before enrolling in a CSA. There was also an increase in the daily average fruit and vegetable consumption.

Interestingly, Woods said, participants’ most common reasons for joining a CSA were not health-related. Instead, people joined to gain access to better quality food, to support farms and farmers and to help their families eat better. Yet at the end of the study, CSA shareholders reported better health outcomes in such areas as annual doctor visits, monthly pharmacy expenditures, and perceived health.

That’s what appeals to UK Health and Wellness manager Jody Ensman.

“Our mission statement is to improve the health and well-being of the UK community that we serve,” she said. “We try to do that through education, empowerment and providing resources to become healthier, so this just fit right in line.”

Building on the findings of the research study, the pilot program will continue through the 2016 growing season, with a slightly expanded participation, with Health and Wellness providing $200 vouchers to participants.

Vanessa Oliver, a dietician with Health and Wellness, said this program has the ability to change how people eat.

“Historically, people in the U.S. don’t eat enough produce in general, specifically vegetables,” she said. “But now they have this box (from a CSA) that they pick up weekly, and they have to use these vegetables. They’ve paid for it, and it’s sitting in the kitchen; they don’t want it to go to waste.”

Oliver provides the education to help people break through their comfort barriers. With a meet-and-greet between future share owners and farmers to help participants choose a share that’s best for them and then through cooking demonstrations, videos and Kentucky Proud recipes, she battles the nervousness that many people experience when faced with unfamiliar food.

Education is not just for the consumer. Woods said a big part of the program will be to educate farmers on how to do a CSA, which he said is much more difficult than selling at a farmers market.

The College of Agriculture, Food and Environment, with its own organic CSA at the Horticulture Research Farm, already has experience in the field, laying a strong foundation for educational programming for producers who want to learn how to manage a CSA program.

“This program could create some really great opportunities for our local producers,” Woods said. “My own view of it is this CSA voucher thing has as much opportunity to invigorate the local food system as almost anything.”

Mac Stone, chair of the Organic Association of Kentucky and also a member of the family that owns and operates Elmwood Stock Farm, which has offered a CSA for 13 years, said that nationally, the CSA business model has about a 50 or 60 percent renewal rate.

“This (voucher program) is a very useful tool to help CSA farms gain and retain membership,” Stone said. “If it’s easier for farms to get their members, it also increases the conversation about healthy eating and how to cook healthy foods with a new subset of the population—people who weren’t farmers market customers or foodies to begin with.”

The Organic Association of Kentucky became involved to support farmers in their transition to organic production methods.

“If we’re going to meet this kind of demand, we need more farmers, so the farm community is going to have to step up in order to keep up, if the wellness programs see the benefits that we think they’re going to see,” Stone said.

The farms for the second year of the pilot program include the UK CSA Program, Elmwood Stock Farm, Sustainable Harvest Farm, Lazy 8 Stock Farm and Rootbound Farm.

The UK pilot voucher program is the first step in what could be a larger program that benefits employees in other companies, as well as more farmers in the wider Bluegrass region. All of this takes coordination, however, so Bluegrass Harvest was formed. Part of the Bluegrass Local Food Initiatives of Community Ventures, a nonprofit organization whose mission is to provide people with opportunities they might not normally have, Bluegrass Harvest was designed with the FairShare Coalition template in mind.

“In Madison, Wisconsin, they had a handful of farmers and 275 shares the first year, and now they have 57 organic farmers and 9,300 shares,” said Sandy Canon, president of Bluegrass Local Food Initiatives. “The potential for growth is extraordinary. The potential for stabilizing farmer income is extraordinary, and the opportunity to increase health outcomes for the good is extraordinary.”

Already, wellness programs in other companies have contacted Canon to see about starting a voucher program for their employees.

“I am really jazzed about it. There are just no down sides,” she said.

As the data for UKAg’s CSA study is analyzed, results will be posted online at For more information about Bluegrass Harvest, visit their website,


Jairus Rossi, 859-227-2431; Tim Woods, 859-257-7270; Jody Ensman, 859-257-3363

How Far Away is Your Hospital?

By Lucia Ona, James Allen IV, and Karyn Loughrin, former CEDIK GIS Associate

Having a hospital nearby is important for many reasons. They have a positive economic impact in the communities where they are established. Hospitals also have services and equipment that clinics and doctors’ offices do not, and are usually where you go in the case of a health emergency. In Kentucky, however, rural hospitals are facing many financial pressures threatening to affect the lives and health of many Kentuckians by reducing the availability of hospital care in the areas where they serve.[i]

Based on that worrying thought, we decided to explore hospital access in Kentucky by asking: how far away is the nearest hospital? To answer this question we started by mapping all the general medical and surgical hospitals in Kentucky and in the surrounding states as shown below.


As you might expect, we found a higher presence of hospitals in the urban centers where there is a higher concentration of people. Other than that, it appears—at first glance—as if Kentucky hospitals are spread out evenly across the state. But does that mean these hospitals are easy to access over Kentucky’s winding rural roads?

To look closer, we wanted to find out if there are any areas farther than a 20 minute drive away from the mapped hospitals. We chose 20 minutes because, in an emergency, you don’t want to travel longer than that—a long ambulance ride is associated with increased risk of death.[ii] The map below shows shades all of the areas within a 20 minute drive. As you can see, there are many gaps in eastern and western Kentucky. We even looked at a 30 minute drive time—referred to by the US Department of Health and Human Services as “excessively distance”[iii]—and some gaps still remained.


However, perhaps those gaps above are unpopulated—if no one lives on that land, then no one is being denied access to a hospital. To test this, we decided to find out how far away is the nearest hospital from each Kentucky city. We define each city on the map by the location its city hall; while we recognize that some populated settlements do not have a city hall, we figured this was a good place to start. We discovered that unlike most metropolitan areas, some of the towns in the rural areas do not have hospital nearby. Although the average drive distance from city hall to the closest hospital is 1.6 miles, there are cases where the nearest hospital from city hall is located more than 20 miles away! The map below highlights all of the city halls that are more than 10 miles from the nearest hospital, many of which are located in far western Kentucky.KYCityHalls_DistHospital


In many areas in rural Kentucky, accessing a hospital remains challenging. Ideally, rural residents should be able to conveniently and confidently use services such as primary care, dental, behavioral health, emergency, and public health services.[iv] This is something important to think about particularly because it has been shown that rural residents tend to be less healthy, older, lower-income and more likely to have a chronic illness than urban dwellers which may increase the need for health care services.[v]

So how do we improve access to healthcare in rural Kentucky, particularly to hospitals? In 2014, CEDIK completed a study where we estimated willingness-to-pay for attributes of rural healthcare facilities.[vi]  We found that Kentucky residents were willing to pay $225 more annually to support a hospital relative to a rural health clinic. While acceptance of Medicaid/Medicare was the most valued attribute, we also saw that having full diagnostic services, an emergency room, and 24-hour/7-day-per-week access were also highly valued. If we can no longer afford to keep our rural hospitals open, maybe we should consider equipping our rural health clinics with some of these attributes (e.g., longer hours, diagnostic services) as a way to extend care to those in need.

Correction: Maps were updated on February 12, 2016 to with a revised list of hospitals after crosschecking with the American Hospital Directory. We apologize for any inconvenience and thank our readers for pointing out our mistake!


[i] Kentucky Hospital Association. Code Blue: Many Kentucky Hospitals Struggling Financially Due to Health System Changes. April 2015.

[ii] Nicholl J, West J, Goodacre S, Turner J. The relationship between distance to hospital and patient mortality in emergencies: an observational study. Emerg Med J 2007 Sep; 24(9): 665-8.

[iii] “Guidelines for Primary Medical Care/Dental HPSA Designation.” Health Resources and Services Administration. U.S. Department of Health and Human Services. Available at:

[iv] Rural Health Information Hub. Healthcare Access in Rural Communities. Available at:

[v] Glasgow N, Morton LW, Johnson NE, eds. Critical Issues in Rural Health. Ames, IA: Blackwell Publishing Professional. 2004.

[vi] Allen IV, J., Davis, A., Hu W., Owusu-Amankwah, E. (2014)Residents’ Willingness-to-pay for attributes of rural health care facilities in Kentucky. The Journal of Rural Health 00(2014) 1-12.

Kentucky Schools Fight Obesity

By Karyn Loughrin, former CEDIK GIS Associate, and Karen Fawcett

Many schools are taking a stand against childhood obesity through different avenues such as implementing nationwide, state or local policies to provide healthier food and promote physical activity for students.The Healthy, Hunger-Free Kids Act of 2010 requires schools to raise their nutrition standards during school hours. The meal standards were developed to not only offer healthy meal options, but to allow schools the flexibility to prepare meals that are familiar to kids from the many culturally diverse backgrounds across the nation. As of September 2015, 95% of schools in the US were serving meals that met these standards (USDA/c). In Kentucky, this potentially impacts the 536,182 children participating in the National School Lunch Program and the 307,332 enrolled in the School Breakfast Program as of October 2015 (USDA/a). For low-income children, this program can be a significant portion of their diet during the school week. The map below shows the percent of children  who qualify for free or reduced-price school meals at this county level.

FreeandReducedMealsSchools are also increasing or maintaining physical activities in school to combat an increase in physical inactivity between 2011-2015 shown in the next map below. Kentucky currently has physical education and activity requirements during school hours. Kentucky also participates in shared use agreements allowing students access to school property after hours for recreation and physical activity. Shared use agreements are common in today’s environment and promoted nationally, though some schools are not utilizing this practice due to liability, security and maintenance concerns (Safe Routes to School).PhysicalInactivitySchools are also working on incorporating healthier, locally grown food through the Farm-to-School program. Approximately 702 individual schools in 60 Kentucky districts participated in the Farm-to-School program in the 2011-2012 school year, impacting over 350,000 children in Kentucky. Over $1.6 million school food dollars was invested in Kentucky communities during that time, and 61% of schools say they will buy more local food in the future. Additionally, Kentucky schools planted 35 edible schoolyard gardens providing fresh food as well as an educational opportunity (USDA/b). Encouraging nutritious eating—including adherence to the new US dietary guidelines release last month—can help prevent chronic diseases like obesity, heart disease and type 2 diabetes. In this way, the schoolyard garden program helped children eat healthier, increased their food literacy and turned their cafeteria into a classroom.FarmtoSchool
There are numerous programs available to encourage healthy children in Kentucky, only a few of which have been highlighted here. Some programs focus on improving food intake with nutritious and local foods while others attempt to encourage physical activity during and outside school hours. By taking a stand against childhood obesity and utilizing these programs, we are working to raise healthier children across Kentucky.


Safe Routes to School: National Partnership. “Share Use of School and Community Facilities”. (accessed January 12, 2016).

USDA/a. Food and Nutrition Service. “Child Nutrition Tables”. (accessed January 12, 2016).

USDA/b. Food and Nutrition Service. “The Farm-to-School Census: Kentucky”. (accessed January 12, 2016).

USDA/c. Office of Communications. “Fact Sheet: School Serving, Kids Eating Healthier School Meals Thanks to Healthy, Hunger-Free Kids Act”. (accessed January 12, 2016).

What is demand for local foods in Lexington KY?

By Jairus Rossi and James Allen IV

Demand for local farm products is on the rise in Fayette County, Kentucky, according to an new assessment by researchers from the University of Kentucky’s Community and Economic Development Initiative of Kentucky (CEDIK). The study conducted 49 in-depth interviews with buyers and producers in the local food system to determine the total dollar amount of Kentucky-based farm product purchased in Fayette County during 2014 and map out the pathways food travels from farm to table. Interviewees included restaurateurs, retailers, institution and hotel procurement agents, farmers’ market staff, processors and distributors. Click to read the executive summary or full report.


Overall, buyers in Fayette County acquired an estimated $14.2 million worth of Kentucky farm products in 2014—money that went directly to local farmers (Figure 1). Based on growth estimates provided by interviewees, this demand is expected to grow to $20-24 million by 2020. Restaurants are currently the largest buyers of Kentucky farm products with $5.5 million in purchasing. In 2014, retailers, institutions (e.g., schools, universities, hospitals), and hotels purchased $3 million, $1.5 million, and $1 million respectively. Producers who sell directly to consumers through Community Supported Agriculture (CSA) programs and farm markets totaled around $3.2 million in sales.


Purchasers in each channel expect growth of at least 5% per year, though restaurants and institutions could increase purchasing by 10% annually overall. Direct-to-consumer farms speculate that their market channel could achieve even higher growth—up to 15% per year—due to increased consumer familiarity with direct markets. By 2020, expected purchasing in restaurants, retail outlets, institutions, and hotels is estimated to be around $8 million, $4.5 million, $2.5 million, and $1.3 million respectively.

Based on these purchasing data, the researchers estimated the final consumer value of local foods once resold by restaurants, retailers, and other purchasers. In Fayette County, consumers spent an estimated $34.1 million on local foods in 2014 and will spend a projected $51 million in 2020. Estimates of end-user purchasing for restaurants were generated by assuming that 30% of a restaurant item’s menu cost goes toward the purchasing of that item’s ingredients. Estimates of end-user purchasing for retail outlets were generated by assuming that 70% of the total cost covers the original purchase from the farmer.

During interviews with those involved in local food market channels, respondents identified four major issues which must be addressed to satisfy unmet demand.

  1. Wholesale purchasers say that Kentucky farmers generally cannot provide a sufficient and consistent supply of produce and protein that meets a certain price point and standard quality. As Kentucky’s climate and comparatively short growing season are one factor in limiting supply, more research into production planning and season extension strategies is recommended.
  2. Price disparities between local and non-local products are a major barrier for increasing local food procurement. Respondents identified the absence of critical food system infrastructures as the reason for this price disparity, though there was not consensus about what would facilitate local sourcing. As such, research into what processing, manufacturing, and distribution infrastructures may help Kentucky farmers compete with national and global producers.
  3. There is concern that general consumers do not understand these impacts of seasonality on what can be acquired locally or why certain production methods may command price premiums, suggesting the need for diverse consumer education programs.
  4. There is also a need for improved communication practices that can help producers and buyers understand more clearly on each other’s expectations in quality, price, quantity, and product presentation. Local food coordinators and other advocates are crucial to this effort.

Click here to see the University of Kentucky press release.

You can also read the executive summary or the full report to learn more about this assessment of Fayette County’s local food system.

Do Kentucky Counties Support Their Entrepreneurs?

By James Allen IV and Shaheer Burney

Economic development often focuses on recruiting large companies that bring a lot of jobs all at once, so it is sometimes easy to forget that the vast majority of businesses in Kentucky are microenterprises with less than 5 employees (see CEDIK’s Small Business County Profiles for specific stats on your county). Given the significant role of small businesses in employment, it is important that we understand reasons for and challenges to entrepreneurship.

For this reason, CEDIK led the implementation of a USDA-funded Kentucky Entrepreneurship Survey, which collected data from over 1,400 Kentuckians on what makes an entrepreneur successful. The survey asked a series of questions to gauge individual’s perception of entrepreneurship in their county. In the sample, about 72% of respondents agreed that their county is generally supportive of entrepreneurs. The map below shows how this perception varied across Kentucky; Southwest Kentucky respondents mostly believe that their county is supportive of entrepreneurs, while many Eastern Kentucky respondents were less optimistic.


What might cause a person to think that their county is or is not supportive of entrepreneurs? Follow-up questions about the political culture of a county provide some valuable insight. In the figure below, we look at statements agreed to by each group. Overall, responses suggest that supportive counties have strong Chambers of Commerce and civic groups, while unsupportive counties struggle with local governments that are fixated on economic development strategies to prioritize large companies over entrepreneurs. Additionally, of those respondents who are or had been entrepreneurs, about 35% of respondents indicated that dealing with government regulations was very or somewhat problematic—a higher percentage than those who said that acquiring startup funds was problematic.


These results call for local governments to reassess their policies toward entrepreneurs in order to help facilitate growth in the local businesses. Already, CEDIK has founded Grow Kentucky (in partnership with Kentucky’s Small Business Development Centers), an Economic Gardening network that prioritizes “growing our own” businesses in Kentucky. Since July 2014, we have worked one-on-one with 15 Kentucky companies and provided resources and expertise customized to their respective industries. With these new results from the Kentucky Entrepreneurship Survey, CEDIK plans to also focus on identifying which local policies can best support entrepreneurs.


Burney, Shaheer, and Alison F Davis. 2015. Determinants of Entrepreneurship from the Kentucky Entrepreneurship Survey. CEDIK working paper. University of Kentucky.

What’s valued in a rural health care facility?

By James Allen IV, CEDIK Research Director

This year, members of our CEDIK Research Team published a thought-provoking article in the The Journal of Rural Health: Residents’ Willingness-to-Pay for Attributes of Rural Health Care Facilities. Here is a short preview of our results:

“Table 5 displays the willingness-to-pay (labeled as WTP) associated with each attribute. The willingness-to-pay represents the estimated fee that the average rural household is willing to pay annually in order to maintain the presence of that attribute in their county health care facility relative to the baseline option. The columns presenting low and high willingness-to-pay (labeled Low WTP and High WTP, respectively) are the willingness-to-pay estimate’s 2.5% and 97.5% quantiles … Below, we discuss how the willingness-to-pay estimates reveal which attributes are the most valued by the respondents. Then, we combine attributes and their willingness-to-pay estimates into attribute bundles resembling rural health care facilities in order to discuss which types of facilities are most valued by the respondents.”


Interested? Want more information? Click here to go to the full article or read the abstract below:


Context: As today’s rural hospitals have struggled with financial sustainability for the past 2 decades, it is critical to understand their value relative to alternatives, such as rural health clinics and private practices.

Purpose: To estimate the willingness-to-pay for specific attributes of rural health care facilities in rural Kentucky in order to determine which services and operational characteristics are most valued by rural residents.

Methodology: We fitted choice experiment data from 769 respondents in 10 rural Kentucky counties to a conditional logit model and used the results to estimate willingness-to-pay for attributes in several categories, including hours open, types of insurance accepted, and availability of health care professionals and specialized care.

Findings: Acceptance of Medicaid/Medicare with use of a sliding fee scale versus acceptance of only private insurance was the most valued attribute. Presence of full diagnostic services, an emergency room, and 24-hour / 7-day-per-week access were also highly valued. Conversely, the presence of specialized care, such as physical therapy, cancer care, or dialysis, is not valued. In total, respondents were willing to pay $225 more annually to support a hospital relative to a rural health clinic.

Conclusion: Rural Kentuckians value the services, convenience, and security that rural hospitals offer, though they are not willing to pay more for specialized care that may be available in larger medical treatment centers. The results also inform which attributes might be added to existing rural health facilities to make them more valuable to local residents.

Thanks to the Kentucky Hospital Association for funding this study and to The Journal of Rural Health for permission to disseminate these findings.


Allen, J. E., Davis, A. F., Hu, W. and Owusu-Amankwah, E. (2015), Residents’ Willingness-to-Pay for Attributes of Rural Health Care Facilities. The Journal of Rural Health, 31: 7–18. doi: 10.1111/jrh.12080

Education: Where does Kentucky rank & why does it matter?

By Simona Balazs, CEDIK Research Associate

September is the time of year when our children sharpen their pencils, throw on their backpacks, and run to catch the bus that takes them back to school. Staying in school is important not only for your child’s personal development, but also for fostering economic growth within your community. To see how your county compares, check out CEDIK’s new Education County Data Profiles!

Having a higher educated work force is important for states because it will improve productivity, raise the quality of jobs and increase economic growth. But not all states are on equal footing. Some have higher educational attainment than others. Data from Census/American Consumer Survey (ACS) 2009-2013 survey shows that Kentucky ranks 47th among US states in educational attainment. The graph below shows the educational attainment for adults (age 25 and over) in the US. The states are ranked based on the percent of adults with a Bachelor’s degree. Unfortunately, Kentucky ranks among the last by that criterion. While 83% of Kentucky adults have a high school diploma (or equivalent), only 22% have a Bachelor’s degree.


Although Kentucky ranks 47th among US states in educational attainment, studies show that Kentucky’s educational and economic status has improved in the last decade (UK/CBER, 2015). Data also show that Kentucky’s total population with Bachelor’s degree or higher has increased by 20% over the last decade, and that overall per capita income has increased by 34% (EMSI, 2015). The following table shows education level, unemployment rate and average annual earnings for the state of Kentucky. Overall, the average annual earnings increase and the unemployment rate decreases as one increases their educational attainment.


The map below illustrates the geographic distribution of Bachelor’s degree attainment and per capita income at the county level. On the map, darker shades of blue mean that the percent of adults with at least a Bachelor’s degree is higher in that county, and the larger the bubble’s size, the higher per capita income in that county.

educblog_fig3Though this map suggests a link between educational attainment and income, it does not mean that a county’s education level is the only factor impacting per capita income. But in general, research (referenced below) suggests higher educational achievement leads to an increase in earnings and employment, better health and lower public assistance. Individuals are willing to achieve higher levels of education because, on average, they can earn more and get higher quality jobs. For many, additional schooling can also be a source of social mobility. One study looking at the impact of education on economic growth stated that a “more educated labor force is more mobile and adaptable, can learn new tasks and new skills more easily, and can use a wider range of technologies and sophisticated equipment” (Dickens, 2006).

Educational attainment is important to the economy. The fact that Kentucky ranks 47th in Bachelor’s degree attainment should motivate state policymakers to improve access to college education in order to keep Kentucky’s economy competitive and growing. Interested individuals can also see how education impacts your local economy by checking out CEDIK’s new Education County Data Profiles!


Aghion, P. & all (2009). The Causal Impact of Education on Economic Growth: Evidence from U.S.. Brookings Papers on Economic Activity.

Dickens, W. T. & all (2006). The Effects of Investing in Early Education on Economic Growth. Washington: The Brookings Institution.

Economic Modeling Specialists Intl. (EMSI), 2015.

Hanushek, E.A. & L. Woessmann. (2010). Education and Economic Growth. International Encyclopedia of Education. Vol. 2, pp. 245-252.

OECD. (2012). Education at a Glance: Highlights. OECD.

University of Kentucky/CBER (2015). Kentucky Annual Economic Report. UK/CBER.

U.S. Census/American Consumer Survey (ACS), 2009-2013.