McCreary County, Kentucky

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45

What I think makes it a Bright Spot is that we do see ourselves—the whole 

county—as a community, and that we do come together.

—Kay Morrow, Director, McCreary County Public Library

The only Kentucky county without an incorporated city, McCreary County is a place where everyone 

knows everyone. As in many communities in Appalachia, residents here have seen their way of life shift 

dramatically as a result of the boom and bust of the coal and timber industries and declining economic

opportunities.

Despite living in one of the poorest counties in the state and the country, McCreary residents harbor a 

sense of hope for untapped potential. They embody the Kentucky commonwealth’s motto “United We 

Stand, Divided We Fall.” McCreary County may face many challenges, but this tight-knit community 

draws upon its collective strength and common goals to improve health across the county.

In downtown Whitley City, the county seat, the courthouse yard sprawls across the street from the local 

library, both welcoming venues in a community that is striving to reinvent itself as an outdoor-activity 

destination. 

The Big South Fork of the Cumberland River in McCreary County

Treewoman8 / Creative Commons 2.0 Generic
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McCreary County is home to approximately 18,000 people, and the population is predominantly white. Its 

poverty rate is triple the national rate, and the unemployment rate is 10.6 percent, much higher than the 

national average of 6.2 percent. 

McCreary County is among the ten percent of Appalachian counties—and one of nine counties in 

Appalachian Kentucky—identified as a Bright Spot, performing better than expected on 14 out of 19 

different health outcome measures. Notably, McCreary County performed better than expected on:

 Injury mortality: 40 percent better than expected

 Stroke mortality: 37 percent better than expected

 Poisoning mortality: 34 percent better than expected 

 Percentage of Medicare beneficiaries with depression: 19 percent better than expected

 Years of potential life lost: 15 percent better than expected

McCreary County’s classification as a Bright Spot means that, on average, the county performed better 

than expected on a number of health outcome measures, given its characteristics and resources—that is, 

the socioeconomics, demographics, behaviors, health care facilities, and other factors that influence health 

outcomes. It does not mean that all residents here enjoy excellent health. McCreary County still lags

behind national rates on many health-related indicators. Like other counties with limited resources, Bright 

Spot counties face challenges to attaining good health outcomes. McCreary County’s performance, 

however, indicates that certain county conditions or programs may be helping generate better-thanexpected outcomes—and that other resource-challenged Appalachian counties may benefit from adopting 

similar initiatives.1

 1 See Table 10 in the data appendix at the end of this case study for a full list of actual health outcomes for 

McCreary County compared with predicted outcomes. For details on the outcome measures, see the data files

accompanying the report Identifying Bright Spots in Appalachian Health: Statistical Analysis.
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COUNTY OVERVIEW 

 

Figure 6: Map - Bright Spot Community McCreary County, Kentucky 

McCreary County represents a nonmetropolitan county in Central Appalachia. It is one of

nine Bright Spot counties in Appalachian Kentucky.

McCreary County is in southeastern Kentucky along the border of northeastern Tennessee. This nearly500-square-mile area is encompassed by two outdoor gems: the Daniel Boone National Forest and the Big 

South Fork National River and Recreation Area. A place that offers cliffs, gorges, waterfalls, rock 

shelters, and natural stone arches, McCreary County is trying to reinvent itself as a tourist destination for 

outdoor activities. Public-sector institutions have a heavy presence here, and the majority of land in this 

tiny county—the forest, the park, and the prison outside of Pine Knot—is owned or managed by the 

federal government. Because federal land isn’t taxable, the small amount of remaining private property 

provides a small tax base for local revenue. 

Like many Appalachian counties, McCreary was once heavily dependent on coal mining, but the last 

mine closed in 1994. Jobs here are scarce. Most residents here work in government jobs, including for the 

U.S. Penitentiary and the county school system. Although the county lacks a hospital or major health 

center, health care is the fifth-largest field of employment. Residents work in clinics, mental health 

GEORGIA

SOUTH 

CAROLINA

NORTH CAROLINA

ALABAMA

MISSISSIPPI

TENNESSEE

KENTUCKY

OHIO PENNSYLVANIA

MARYLAND

VIRGINIA

NEW YORK

WEST

VIRGINIA

McCreary County, KY

Northern

Southern

Central

South Central

North Central

0 100 50

Miles
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facilities, home health, and nursing home care. Outdoor Venture Corporation, a military-grade shelter and 

related equipment manufacturer, supplies jobs via defense and private national contracts. 

Educational achievement is a challenge here. Some 72 percent of residents have finished high school, and 

only 7.5 percent have completed college, a figure much lower than the state rate and the national average. 

Slightly more than 40 percent of adults have had some college education, compared with 63.2 percent 

nationally.

Classified as economically distressed by the Appalachian Regional Commission in fiscal year 2017, 

McCreary County’s median household income of $24,265 is 43 percent of the national average. The per

capita income of $10,880 makes it one of the poorest counties in the United States. About 47 percent of 

people here live in poverty, compared with 15.6 percent nationally. Residents rely heavily on government 

assistance: some 85 percent of eligible residents are enrolled in the Supplemental Nutrition Assistance 

Program (SNAP), and 17.4 percent are receiving Supplemental Security Income (SSI) or disability 

benefits—rates much higher than the national average.

2

A DEEPER LOOK AT MCCREARY COUNTY: COMMUNITY STRENGTHS

The people who live in McCreary County have a strong tradition of working together and leveraging 

resources in creative ways to solve challenges and address gaps. They do this through perseverance and

by pooling resources and creating partnerships. There is a deep commitment of neighbors eager to help 

neighbors in McCreary County.

Field work helped identify local practices that appear to be contributing to overall health, document 

effective practices that could be replicated in other counties, and identify promising practices and 

strategies that should be explored further.3 Specifically, the research identified these characteristics and 

strategies in McCreary County:

 Intra-county cooperation and resource sharing: The absence of a hospital or major health 

center forces McCreary residents to pool resources and focus on efficiency. The community is 

close-knit, with a strong local volunteer culture and initiatives focused on perceived community 

health issues. The library, religious organizations, and organizations that deliver health care 

services appear strongly connected to each other and to the community at large.

 Presence and sustainability of community-focused nonprofits: Nonprofit organizations 

depend on the support of the communities they seek to help. The longevity of the nonprofits in 

McCreary County indicates strong community support and a higher likelihood that the nonprofits

have aligned with the specific needs of the community by matching the values and culture of its 

residents. It is also apparent that some nonprofits, like the Christian Care Center, are serving as 

safety net institutions. 

 Strong integration of health services and systems: McCreary County benefits from cooperation 

among a regional health department, emergency medical services, a home health agency, a 

nursing home, a mental health program, and primary care clinics that work together to provide 

 2 Table 8 in the McCreary County data appendix at the end of this case study provides a quantitative profile of 

county characteristics.

3 For a full explanation of the methodology, see Appendix B: Research Approach. For a list of key informants 

interviewed for this county, see Table 9 in the data appendix at the end of this case study.
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essential primary, preventive, and chronic health care. Adanta, the behavioral health and 

substance abuse program, has strong partnerships with the court and school systems.

 Making health a shared value: McCreary County leaders recognize the benefits of a healthy 

lifestyle. Elected officials invest in wellness programs, health care services, and recreation, and 

encourage residents to eat fresh, nutritious foods and take advantage of the natural environment to 

increase their physical activity. The county has also invested in the library as a resource center for 

health and social support information.

Like other Bright Spot counties explored in this report, McCreary County has used a variety of 

approaches to elevate the physical, social, and economic health of its residents. These actions fall into 

four overarching categories of leadership, cross-sector collaboration, resource sharing, and local providers 

committed to public health.

Community Leaders Engaged in Health Initiatives

Strong, sustained leadership was evident in all of the Bright Spot counties studied. In McCreary County, 

leaders are seen in all walks of life—from the local librarian and minister to a county official, a social 

worker, and a local emergency medicine professional. 

One example is Kay Morrow, who runs the McCreary County 

Public Library. The library serves as an important connector 

and resource to residents, community groups, organizations, 

businesses, churches, and schools. When residents enter, they 

are exposed to literature addressing drug abuse, infant care, 

upcoming health-focused community events, and details of 

library programs. A trained social worker, Morrow helps 

residents apply for utility subsidies and health insurance via the 

library’s computers. The library’s meeting room serves as a 

place for healthy-cooking classes, seminars on finance, and

family reunions. Always eager to make a better life for residents 

here, Morrow is spearheading efforts to rebuild the crumbling 

sidewalks downtown, secure more lighting at night, and 

organize a downtown walking club to boost physical activity. 

Another example is Sue Singleton, who oversees the 

McCreary County Christian Care Center’s food pantry. 

She has seen too many needed programs wither. But that hasn’t 

deterred this dynamic grandmother from pushing for services 

she knows residents need, including a needle exchange program

for intravenous drug users. Each day the center provides food to 

those in need; and medical services—including supplying 

medicine to residents without insurance or means to pay—are 

made possible due to donations from local business, churches, 

individuals, and small grants. The food pantry is open four days 

a week and supports more than 700 families each month. 

And there is also Reverend Braxton King, who directs a 

nonprofit community center called Lord’s Gym, which provides

gym participants with support and preventive information about 

© Joyce Pinson 

Kay Morrow, director of the McCreary 

County Public Library

© Joyce Pinson 

Sue Singleton, director of the McCreary 

County Christian Care Center
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substance abuse to combat the drug epidemic in a county where drug abuse and the rise of hepatitis are 

major concerns. Local churches work with Reverend King on other health initiatives aimed at promoting 

healthy behaviors among young people and providing support for those in need. About 150 children

participate. 

These are some of the people who with dignity, resolve, and a sense of humor help position McCreary 

County as a model of success despite its challenges. This cohesive group could easily succeed in a more 

economically vibrant community but choose to stay—because McCreary County is home.

Cross-Sector Collaboration 

McCreary County offers creative examples of how organizations work together to break down barriers 

that stand in the way of good health. For example, the Christian Care Center is consistently engaging 

with the community beyond its walls. Though it is primarily a food bank, the center also offers free overthe-counter medicine and medical supply rentals. The McCreary County Public Library is also a great

example of an organization doing all that it can to promote health. Director Kay Morrow understands that 

the library is an important component of a community that can offer a lot more than books. It actively 

works to promote community events and is an important driver of creating a healthier and more equitable 

McCreary County. 

And McCreary residents have learned to be creative with how they promote health. Churches play a big 

role here, encouraging congregants to participate in walking groups and become physically active to stay 

healthy and reduce chronic disease. They also use social media to convey local health information. 

The Adanta Regional Prevention Center is a great example of how organizations work across sectors. 

The center’s reach is the ten-county Lake Cumberland Area. In McCreary County, the program focuses 

Reverend Braxton King, director of the nonprofit community center Lord’s Gym. 

© Joyce Pinson 
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on suicide prevention and substance abuse prevention and provides clinical services and access to other 

regional resources. Adanta has worked with the McCreary County fiscal court on a countywide smokefree-air ordinance and other population health policies. It is also involved in the care and support of 

pregnant women through the Kids Now Plus Program, which offers classes to teach pregnant women how 

to improve their chances of having a successful birth. It provides incentives to encourage women to attend 

the classes and provides food and baby items to help children get a healthy start. Kids Now Plus also 

offers case management assistance, transportation to doctor visits, housing, and other health-related 

classes.

Adanta also works closely with schools, 

advocating for the implementation of 

evidence-based programs by teachers. Sherri 

Estes, program director for the McCreary 

County Clinic, which is where Adanta is 

situated, says relationships with local teachers 

are key to the program’s success. Teachers 

know the families and the impact that 

substance abuse is having on them, she says, 

adding that teachers see the struggles students 

are facing—they are unfocused in school, 

falling asleep in class because they didn’t get 

a full night’s sleep, or hungry. Estes says the 

teachers are aware of what kinds of things 

kids are going through and what can be 

done to help them. 

Adanta also works with a community-based coalition to achieve goals. This enables it to work with key 

stakeholders in the community and make sure everybody is working together on planning efforts around 

health. 

Resource Sharing 

The absence of a hospital or major health center forces McCreary County residents to pool resources and 

focus on social connectedness. The library, religious organizations, and organizations that deliver health 

care services appear strongly linked to each other and to the community at large. Clinics, a home health 

agency, a nursing home, and a mental health program are the main source of care options for McCreary

County residents. Outside the county, the Lake Cumberland District Health Department and a 25-bed 

critical access hospital in neighboring Wayne County provide primary, preventive, emergency, and 

surgical care. 

McCreary County is a close-knit community with a strong local volunteer culture and initiatives focused 

on addressing community health challenges like drug abuse, diabetes, and chronic disease. At one time, it 

had a formal interagency council that met monthly to share initiatives and resources, but the council has 

not met in five years, and a substance abuse coalition is trying to revive it. In the meantime, an informal 

council has developed to address substance abuse, while multiple community-based programs have 

organized to combat substance abuse and support behavioral health. Most involve nonprofits—such as 

Lord’s Gym, Christian Care Center, and the Adanta Regional Prevention Center—that rely on 

fundraising, volunteers, and/or government subsidies. 

© Joyce Pinson 

Adanta works closely with McCreary County schools to help families 

prevent substance abuse.
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Though most organizations appear to struggle with budget constraints, constant fundraising, and limited 

purchasing power, there is strong evidence of committed local leaders who derive satisfaction from 

helping people. For example, many residents here lack access to transportation to health care facilities. A 

regional transportation program, Rural Transit Enterprises Coordinated, is a volunteer group that

provides on-demand transport services for residents in need. There also appears to be strong cooperation 

among organizations on critical issues like substance abuse and child development. 

According to Jimmy Barnett of the McCreary County Emergency Medical Services (EMS), grants from 

Assistance for Firefighters, Homeland Security, the South Kentucky Rural Electric Cooperative 

Corporation, and the U.S. Department of Agriculture Rural Development bolster health programs in the 

county. Barnett said the EMS program is working to build a stronger relationship with Somerset 

Community College in neighboring Pulaski County. He also says there is collaboration between county 

and state road crews to clear thoroughfares specifically to permit ambulance access.

Local Providers Committed to Public Health

As the sole source of emergency medical transport, the McCreary 

County EMS provides a much-needed service to the community. 

During the winter, a combination of weather and terrain make 

travel in the county hazardous. When conditions are too 

treacherous even for the four-wheel-drive ambulance, EMS calls 

on the fire department to provide more capable vehicles.

EMS is more than a transport provider, however. Coordinator 

Jimmy Barnett often visits high schools to teach students about

overall health, warning signs of disease, healthy eating habits, and 

the benefits of proper exercise. Barnett finds students are often 

very interested in this information and usually ask numerous 

questions regarding the health of their parents and grandparents. 

But while the county is known for its exceptional EMS training 

program, it doesn’t reap all of the benefits it could from it. Recruits 

often train here and then leave to work in an adjacent county that 

offers higher pay. There is a frustration that the program has 

become a virtual revolving door rather than a place to build a 

stable work staff that can support local needs. 

Tracy Aaron, health education director for the Lake Cumberland District Health Department, manages 

all health educators in McCreary County as well as health education–related programs and initiatives. 

During her 22 years with the department, she has overseen a county health assessment, community health 

improvement plans, and nutrition and physical activity initiatives. She is also responsible for maintaining,

supporting, and facilitating coalition development in the county. Aaron is credited for spearheading many 

of the health initiatives in the county, including a focus on school-age children, providing them with 

education on reproductive health, tobacco use cessation, and risky behavior prevention. The district health 

department also employs a child care health consultant who provides education, technical assistance, and 

training for the county’s licensed child care providers and those certified to provide in-home care. And it

supports preventive initiatives like the farmers’ market and smoke-free restaurants.

© Joyce Pinson 

Jimmy Barnett, coordinator, McCreary 

County EMS
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Aaron summarized the health education efforts this way: 

There is a lot of education that goes on out there...and education is wonderful. But it’s 

taking that next step. It’s got to be an easy something that I’m going to do for me to be 

healthier. There [have been] changes made—McCreary has become a certified ‘trail town’

in the last two years. The farmers’ market has started in the past two years. We have 

encouraged and worked with restaurants that have voluntarily gone smoke free. Work sites 

have done that, too. So, we are making progress in the community when we think about the 

health of the communities.

Health department employees are eager to highlight McCreary County as 

embracing better health. Even elected Judge Executive Douglas 

Stephens— who compares his position to that of a mayor—enthusiastically 

touts the importance of Appalachian heirloom vegetables and the creation 

of a new food economy based around local agriculture. The fledgling 

farmers’ market here shows signs of growth. But with extension service 

programs stretched to the limit here, the local food movement will have to 

be championed by other organizations. 

Although Stephens laments that a wellness program offered to county 

employees was discontinued due to lack of participation, there is a push to 

get residents here to be more physically active. With nearly 22 percent of 

the population under 18, there is much concern about the health care of 

children. Street banners encourage residents to “Hike, Bike, Paddle, Get 

Outside Yourself” to take advantage of outdoor living. The McCreary 

County Cooperative Extension sponsors a walking/hiking club, and,

with more tourists visiting the county to hike, local residents are 

beginning to engage in outdoors activity as well. 

There are many organizations working on educating the community on the benefits of fresh and nutritious 

foods—evidenced by the growing farmers’ market and the many county residents who continue to garden 

and can their own fresh vegetables. Hunting and fishing for food is still a big part of the community. 

Kristina’s Kitchen, a health-food bakery and vegetarian café, sells nutritious food five days a week and 

offers free instruction on cooking meals. Programs like Grow Appalachia and Community Farm Alliance 

are strengthening the infrastructure to grow the farmers’ market and teach new ways to recruit farmers 

and increase production. 

© Joyce Pinson 

Street banners encourage residents 

to undertake outdoor activity.
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CREATING A CULTURE OF HEALTH IN MCCREARY COUNTY

People who live in McCreary County are committed to making it a good place to live, work, and 

visit. While poverty is high and jobs are scarce, the strong sense of community is what keeps people 

focused on improvement every day. They recognize that a creative use of limited resources, commitment, 

and collaboration are vital ingredients for success. They work together to create local dynamic networks 

and programs, and will partner with organizations outside the county when needed.

Residents share a sense of connection, faith, and 

resourcefulness that can take many forms, including 

community networking at the grocery store, the local 

church, club meetings, the library, or the Friday night 

football game. 

McCreary County is changing as it reinvents itself as a 

tourist spot for outdoor enthusiasts. But the county 

continues to focus on trying to create opportunities for 

better health by encouraging neighbors to work 

together on solutions and fostering strong social 

connections so residents feel supported.

By harnessing all of its strengths, from tapping into the 

potential of residents to engaging with and sustaining leaders to stretching limited resources in creative 

ways, McCreary County is finding new avenues to make sure health and well-being remain a top priority 

for everyone who lives there. 

© Joyce Pinson 

Lake Cumberland District Health Department health 

education director Tracy Aaron; nurse supervisor Jeanne 

Gaskin; and office manager Kim Tucker 
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REFERENCES

Agency for Healthcare Research and Quality. 2011. “Chapter 9: Access to Health Care, 2011 National 

Healthcare Quality Report.” Agency for Healthcare Research and Quality.

https://www.ahrq.gov/research/findings/nhqrdr/nhqr11/chap9.html

Dewalt, Darren A, Nancy Berkman, Stacey Sheridan, Kathleen Lohr and Michael Pignone. 2004. 

“Literacy and Health Outcomes: A Systematic Review of the Literature.” Journal of Internal Medicine 12 

(December 19): 1228-1239. Accessed July 2017.

Hamoudi, Amar, and Jennifer Beam Dowd. 2013. “Physical Health Effects of the Housing Boom: QuasiExperimental Evidence from the Health and Retirement Study.” American Journal of Public Health 1039-

1045.

Hilbrand, Sonja, David A. Coall, Denis Gerstorf, and Ralph Hertwig. 2017. “Caregiving within and 

beyond the family is associated with lower mortality for the caregiver: A prospective study.” Evolution 

and Human Behavior 397-402.

Holmes, G. Mark, Nancy M. Lane, Thomas A. Arcury, Michael L. Schwalbe, Randy Randolph, John 

Frank, Sharita Thomas, et. al. 2018. Identifying Bright Spots in Appalachian Health: Statistical Analysis.

Washington, D.C.: Appalachian Regional Commission.

Kentucky Department of Travel. 2017. McCreary County Tourist Commission.

http://www.kentuckytourism.com/mccreary-county-tourist-commission/4177/

Lake Cumberland District Health Department. 2014. “2014 Community Health Assessment.” Lake 

Cumberland District Health Department. Accessed March 2017. 

https://www.lcdhd.org/wp-content/uploads/2016/09/LCDHD-McCREARY-2014-web.pdf

Marshall, Julie L., Logan Thomas, Nancy M. Lane, G. Mark Holmes, Thomas A. Arcury, Randy 

Randolph, Pam Silberman, et al. 2017. Health Disparities in Appalachia. Washington, D.C.: Appalachian 

Regional Commission. 

U. S. Census. 2015. Single Parent Households with Children as a Percentage of Households with 

Children in McCreary County, KY. Retrieved from FRED. Accessed July 11, 2017. 

https://fred.stlouisfed.org/series/S1101SPHOUSE021147
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APPENDIX: MCCREARY COUNTY DATA

Table 8: McCreary County Characteristics 

Characteristic McCreary County United States

Population, 2010–2014 18,073 314,107,084

Percent population change, 2010–2015 -2.3% 4.1%

Median age, 2015 38.6 37.8

Percent population over age 65, 2015 14.1% 14.9%

Median household income, 2014 $ 24,265 $ 56,135

Per capita income in past 12 months (in 2015 

dollars), 2011–2015 $ 10,880 $ 28,930

Unemployment rate, 2014 10.6% 6.2%

Percent persons in poverty, 2014 47.0% 15.6%

Percent white alone, 2015 91.2% 77.1%

Percent black alone, 2015 6.3% 13.3%

Percent adults with at least some college, 2010–

2014 40.11% 63.27%

Distance to nearest large population center from 

county center Somerset, KY – 32.9 mi. N/A

ARC designations, fiscal year 2017 Distressed

Central Appalachia N/A

Source: These data are compiled from the U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics,

2014, and the U.S. Census Bureau American Community Survey Selected Social Characteristics, General Economic 

Characteristics, Demographic and Housing Characteristics, and Educational Attainment Tables for years 2010–2014 

and 2011–2015.
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Table 9: McCreary County Key Informants

Name Location Title Organization Interview 

Date

Rev. Braxton King Pine Knot Director Lord’s Gym 9/26/2016

Sue Singleton Whitley City Director Christian Care Center 9/26/2016

Douglas E. 

Stephens Whitley City County Judge

McCreary County Office of 

Economic and Community 

Development

9/26/2016

Jimmy Barnett Whitley City EMS Manager McCreary County EMS 9/26/2016

Brandy Rowe Whitley City

District Health 

Coordinator / 

School Nurse

McCreary County Board of 

Education 9/27/2016

Kay Morrow Whitley City Director McCreary County Public 

Library 9/27/2016

Tracy Aaron Whitley City Health Education 

Director

McCreary County Health 

Department / Lake 

Cumberland District Health 

Department

9/27/2016

Sherry Estes Whitley City Program Director 

Drug Prevention Program –

Adanta Regional Prevention 

Center 

9/27/2016
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Table 10: McCreary County Health Outcomes – Actual vs. Predicted

Outcome Measure Actual Predicted

Percentage 

Difference

(negative = 

better)

Injury mortality per 100,000 people, 2008–2014 53.75 89.15 -39.7%

Stroke mortality per 100,000 people, 2008–2014 28.89 45.51 -36.5%

Poisoning mortality per 100,000 people, 2008–2014 30.80 46.95 -34.4%

Percentage of Medicare beneficiaries w/ depression, 

2012 17.20% 21.11% -18.5%

Years of potential life lost, 2011–2013 10,959 12,915 -15.1%

Infant mortality per 1,000 births, 2008–2014 7.30 8.47 -13.8%

Low-birth-weight births (<2,500g) per 1,000 births, 

2007–2013 9.91 11.23 -11.8%

Cancer mortality per 100,000 people, 2008–2014 238.78 270.15 -11.6%

Heart disease hospitalizations per 1,000 Medicare 

beneficiaries, 2012 68.70 76.79 -10.5%

Heart disease mortality per 100,000 people, 2008–

2014 259.94 278.04 -6.5%

COPD mortality per 100,000 people, 2008–2014 101.18 105.85 -4.4%

Percentage of excessive drinkers, 2014 10.30% 10.76% -4.3%

Percentage of obese adults (>30 BMI), 2012 34.2% 34.7% -1.4%

Average Medicare condition score, 2013 1.057 1.061 -0.3%

Physically unhealthy days per month per person, 2014 6.50 6.38 1.9%

Mentally unhealthy days per month per person, 2014 5.10 4.96 2.8%

Opioid prescriptions as a percent of Part D claims, 

2013 5.64 5.45 3.4%

Suicide mortality per 100,000 people, 2008–2014 15.82 14.29 10.7%

Percentage of adults with diabetes, 2012 15.30% 12.43% 23.1%

Notes:

Percentage Difference = 100 * [ (Actual / Predicted) – 1]

Green = County value was better than predicted

For details on the outcome measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.
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Table 11: McCreary County Health Drivers vs. National Median

Driver Measure Lower is 

Better?

National 

Median

McCreary

County

Air pollution (average daily particulate matter 2.5), 

2011 Yes 11.87 13.30

Average travel time to work in minutes, 2010–2014 Yes 22.82 28.55

Chlamydia incidence rate per 100,000, 2013 Yes 287.16 232.44

Dentists per 100,000 population, 2014 No 37.45 5.60

Economic index, fiscal year 2017 Yes 108.79 237.71

Full-service restaurants per 1,000, 2012 No 0.68 0.28

Grocery stores per 1,000 residents, 2012 No 0.20 0.22

Median household income, 2014 No $45,226 $24,265

Mental health providers per 100,000 population, 2015 No 80.00 78.13

Percentage of adults currently smoking, 2014 Yes 17.8% 33.3%

Percentage of adults not physically active, 2012 Yes 27.7% 28.4%

Percentage of adults with at least some college, 

2010–2014 No 56.3% 40.1%

Income inequality ratio,4 2010–2014 Yes 4.4% 5.6%

Percentage of diabetics with A1C testing, 2012 No 85.4% 86.0%

Percentage of doctors who e-prescribe, 2014 No 65.0% 47.0%

Percentage of eligibles enrolled in SNAP, 2014 No 78.0% 85.0%

Percentage of households with income below poverty, 

2014 Yes 15.8% 47.0%

Percentage of Medicare women with recent 

mammogram, 2013 No 61.0% 39.0%

Percentage of population with access to places for 

physical activity, 2011 and 2014 No 61.9% 100.0%

Percentage of total population in social assistant jobs, 

2013 N/A 0.01% 0.00%

Percentage receiving disability OASDI and/or SSI, 

2014 Yes 5.4% 17.4%

Percentage spending >30% of income on housing, 

2010–2014 Yes 29.0% 40.4%

Percentage w/ no car, low access, 2010–2014 Yes 19.7% 4.7%

Primary care physicians per 100,000 population, 2013 No 48.54 27.78 

 4 Income inequality is the ratio of household income at the 80th percentile to that at the 20th percentile. A higher 

ratio reflects greater division between the top and the bottom of the income spectrum.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA McCreary County, Kentucky | CASE STUDIES

60

Driver Measure Lower is 

Better?

National 

Median

McCreary

County

Social associations per 10,000 population, 2013 No 12.68 3.34 

Specialist physicians per 100,000 population, 2013 No 25.93 5.53 

Students per teacher, 2013–2014 Yes 14.13 16.50 

Teenage births per 1,000, 2007–2013 Yes 39.96 83.48 

Uninsured rate for people under 65, 2013 Yes 17.24 20.85 

Notes:

Green = County value was better than national median

For details on the driver measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.