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.

References:

Safe Routes to School: National Partnership. “Share Use of School and Community Facilities”.  http://saferoutespartnership.org/state/bestpractices/shareduse (accessed January 12, 2016).

USDA/a. Food and Nutrition Service. “Child Nutrition Tables”. http://www.fns.usda.gov/pd/child-nutrition-tables (accessed January 12, 2016).

USDA/b. Food and Nutrition Service. “The Farm-to-School Census: Kentucky”. http://www.fns.usda.gov/farmtoschool/census#/state/ky (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”. http://www.usda.gov/wps/portal/usda/usdahome?contentidonly=true&contentid=2015/09/0242.xml (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.

FayetteLocalFood_image

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.

Figure1_PurchasingMarketChannel

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.

Map

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.

Chart

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.

References:

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.”

JRH_Results

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

Abstract:

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.

References:

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.

educblog_fig1

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.

educblog_fig2

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!

References:

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. http://www.economicmodeling.com/data/.

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. https://www.census.gov/programs-surveys/acs/

CEDIK Evaluates 6 Years of ARC’s Diverse Health Programs

By Karen Fawcett, CEDIK Program Associate, and James Allen IV

Recently, the Appalachian Regional Commission (ARC) released an evaluative report of their 202 health projects funded over a six year period. The Community and Economic Development Initiative of Kentucky (CEDIK), together with UK College of Pharmacy, and UK Center for Business and Economic Research (CBER) assessed and provided recommendations for enhancing ARC’s health programming by analyzing past programming and conducting case studies. In addition, suggestions were presented to help guide future ARC funding strategies and priorities.

ARC invested over $30.9 million into health projects between the years 2004-2010. In this report, projects were grouped into three primary project types: Healthcare Access, Clinical Services and Health Promotion. The 90 Healthcare Access projects focused on expanding accessibility to healthcare providers by supporting the training of healthcare professionals or by directly increasing access to healthcare providers via telehealth or a new facility. The 45 Clinical Services projects sought to improve the quality of healthcare by improving or adding to the services that a healthcare facility offered. Finally, the 67 Health Promotion projects attempted to educate the public about healthy behaviors and encourage their participation. CEDIK used these categories, and others, to compare funding and impacts across different types of projects.ARCtable

Appalachia is a diverse region made up of 420 counties and 13 states extending more than 1,000 miles, from southern New York to northeastern Mississippi, and is home to more than 25 million people. About 42% of the Appalachian Region’s population is rural, compared with 20% of the national population. The goal of ARC’s health projects are to improve health status throughout the region while providing extra support to particular areas of need. This large CEDIK evaluation of the health projects funded by the ARC contributes significant data, critiques and recommendations useful not only to ARC but to other Appalachian health care programs as well.

ARC_Health_Projects_Type

An online survey was utilized to help obtain updated project performance data and summarized results. Key findings from the online survey include:

  • Over 60% of surveyed projects claimed that their work would not have been undertaken if not for ARC funding and over 95% of respondents claimed that, without ARC funding, the project would have been canceled, downsized, or delayed by more than a year.
  • About 38% of surveyed projects created and/or retained jobs in the local economy, and employment of healthcare professionals in grantee organizations today is higher, on average, than before ARC funding.
  • Almost 50% of surveyed projects claimed that the ARC project funding helped to attract additional government or philanthropic funding.
  • About 92% of medical and other equipment purchased with ARC funding is still in good condition and has significant impacts on program participants and medical patients throughout Appalachia.

Additionally, 13 case studies relied on interviews and personal correspondence to explore the unique aspects of particular programs and view some reoccurring points pertaining to ARC’s health programming. Key findings from the case studies include:

  • Sharing of best practices or technical expertise across similar project could improve cost efficiency and program effectiveness.
  • Evidence of community support prior to funding was a clear indicator of a project’s success, large impacts and sustainability.
  • Case studies reinforced that ARC is viewed as an important and helpful regional partner, especially due to their presence in each state.

Qualitative and observational data make valuable contributions to evaluations of any kind, and especially for a group of projects as diverse as those in ARC’s health programming. Throughout the evaluation, two themes emerged that may influence the discussion for the strategic direction for ARC’s health programming: 1) Large projects that create something new make it easier to attribute future outputs, and 2) Seed money for innovative but complex projects are essential because of the lack of initial support from other funding sources. Both themes suggest a strategic direction for ARC health projects that involves investing in a large or small new projects because it can simplify output and outcome tracking as well as attribution to the original investment.

For other organizations working in Appalachia, our findings suggest that evidence of community support is often linked with increased community awareness and likelihood of success for small projects. While for large projects, involvement of institutional leadership in the planning and implementation of the project is associated with an increased likelihood of success. Useful data for other groups interested in health programming within the Appalachian Region can be found in the ARC County Profiles created for this evaluation. All counties in the Appalachian Region are available to view by clicking on this link https://www.dropbox.com/sh/wsstsj0ynlmo0vp/AABeGKcD8Pob4cWCfUdg4fjga?dl=0.

Aging in Kentucky, part 2

By Lucia Ona, CEDIK Research Associate

In the previous blogpost (Aging in Kentucky, part 1), we discussed and showed evidence that Kentucky’s rural communities—much like the rest of the country—are, in fact, aging. In this post, we go one step further and ask: why is Kentucky’s population aging? There are three causes of changes in population: fertility, mortality, and migration. At the national level, the process of population aging is due primarily to long-term declines in the fertility rate and to improvements in mortality, especially among older people (Haaga, 2004).

During the last decade, population losses and slow growth were prevalent throughout the mountain communities of Eastern Kentucky and the river communities of Western Kentucky. In these areas, negative population momentum has been building for decades. Out-migration over generations has reduced the youth population and suppressed natural increase through fertility (Price, 2011). Out-migration has also resulted in brain drain for rural areas because newcomers to the rural areas of the state have been traditionally less educated than the ones leaving (Price, 1996).

The map below shows projection of net migration for the counties of Kentucky for the period 2010-2015. Net migration for a given geographic area is the difference between in-migration and out-migration during a specified time frame. The red-orange counties are experiencing negative migration. It can be seen that several counties both in the Eastern and the Western parts of the state show negative migration patterns—meaning that more people have migrated out of the area than have migrated into it. NetMigrationBlueOrangeGoing further, the map below shows net migration patterns at the county level for the Kentucky counties in the period 2000-2010 by age groups. The red counties have lost both the populations 19 and younger and 65 to 79, the yellow counties that have lost population 19 and younger but have gained population between 65 and 79, the blue counties have gained 19 and younger but lost population between 65 and 79, and the green counties gained both the youngest group of population and the population between 65 and 79. It is interesting to see that there are several rural counties that are attracting population 65 to 79 years old back to their communities. This may be because elders return to their place of origin to be among family and friends or enjoy living in a centrally located state with balanced weather and amenities.

NetMigrationByAgeGroup

Fertility, mortality and migration have each contributed to the aging population nationwide and within Kentucky communities. While the challenges of supporting an aging population are immense—including the access to financial security, social security, health, and an enabling and supportive environment—it is important to remember that the presence of a growing older population is also an opportunity. For example, older populations are associated with reduced crime and in many cases with a more environmentally friendly lifestyle. According to the Kentucky Elder Readiness Initiative of Kentucky (KERI) elders should not be viewed as dependents but community resources (KERI, 2009). Crucial priority actions involving all actors in society will need to be taken to maximize the opportunity of the aging population.

“Trees grow stronger over the years, rivers wider. Likewise, with age, human beings gain immeasurable depth and breadth of experience and wisdom. That is why older persons should be not only respected and revered; they should be utilized as the rich resource to society that they are.” Former United Nations Secretary-General Kofi Annan

References

Haaga, J. 2004. The Aging of Appalachia. Demographic and Socioeconomic Change in Appalachia. Population Reference Bureau, Kentucky.

Elder Readiness Initiative (KERI). 2009. Anticipating the gifts and needs of older Kentuckians in http://kltprc.info/pubs/KERI/KERI_Brief_2.pdf

Price, M. 1996. Migration in Kentucky: Will the Circle Be Unbroken? In Exploring the Frontier of the Future: How Kentucky Will Live, Learn and Work.

Price, M. 2011. Kentucky Population Growth: What Did the 2010 Census Tell Us? Kentucky State Data Center.