begins with one step, and so does your well-being.

Stay with us as we talk to Kentucky Medical Association President Doctor Jay Huang about small steps, big impact in your health.

Next on Kentucky Health.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy Kentucky.

>> In the 2025 annual America's Health Rankings, compiled and published by the United Health Foundation, Kentucky ranked 43rd out of 50 states in health status.

Only once in the 34 years that this report has been compiled has Kentucky been out of the bottom ten states.

And that was in 2008.

The rankings are based on multiple parameters, including socioeconomic factors, the physical environment, the quality and availability of clinical care behavior and health outcomes.

Any efforts to improve our health ranking, and by extension, our health, will require coordinated efforts and input from all stakeholders, including political leaders, the business community, health care providers, and each of us.

Taking control of our own health can at times seem to be a daunting task.

This is especially true when it comes that we lack resources, options and where to all to take charge of what's going on.

However, there are things that we can and must do that can mitigate the effects of those things that we cannot always control.

Our guest today, Doctor Huang, will guide us through some of the seemingly small steps that we can take that will have a big impact on our health.

Doctor Huang wears many hats and believe me, he does wear many hats.

He is the Chief Scientific Officer and associate dean for clinical research at University of Louisville Health.

He's the deputy director of the Louisville Clinical and Translational Research Center, and is a professor and vice chairman of the Department of Anesthesiology and Perioperative Medicine.

He is editor of the British Journal of Anesthesia, director of the American Board of Anesthesiology, director of the American Society of Anesthesiologist, and Director of Anesthesia Quality Institute.

Doctor Huang, more importantly, is the 175th president of the Kentucky Medical Association, and in his spare time, he is also a practicing anesthesia.

And let me be more specific, he's a practicing cardiac anesthesiologist.

Doctor Huang, thank you for being with us.

>> Thank you doctor.

It's a pleasure to be here again to talk about this important initiative with you.

>> How do you do it, man?

Come on.

>> I learned from the best Doctor Hixson.

>> Oh, give me a break.

Look, somewhere out there.

I know you have two children, but somewhere out there, there's somebody who wants to be number one, an anesthesiologist.

Let's just concentrate on that hat that you wear.

How does somebody go about doing that?

>> It's a it's a long it's a long journey to become anesthesiologist or to become a doctor.

In the United States, you had to go to college first for four years.

After college, you would go to medical school for four years.

Then after that, you will do anesthesia residency for four years.

And to be a cardiac anesthesiologist, you have to do one year fellowship to become cardiac anesthesiologist.

Wow.

So you think about 13 years after high school.

It's a lot of work, but it's a lot of fun, too.

I enjoyed it every single day.

>> Well, I can tell you, there's always a lot of fun having you in the operating room.

Thank you.

One of the programs, though, that Kentucky Medical Association.

And under your leadership this year you've been pushing it's called Step.

Now this is an acronym.

So tell me, what does Step stand for.

>> Thank you.

So Step stands for five key areas that we believe can really transform the health of Kentucky's.

The first S is screening.

So you want to screen for cancer.

You want to screen for any other diseases.

And the T is stand for tobacco cessation.

You want to stop smoking.

And E is for exercise and nutrition P is for physicians.

We want you to develop a relationship with your doctors so they can take care of you.

And the last S stands for stress management.

We all face stress every single day.

Managing stress is part of the key area that we can improve our health.

>> So when this program was developed, was this something that was done just here in Kentucky, or is this something that is done throughout the country?

>> Thank you.

So this program is designed by the Kentucky physicians for Kentucky patients, and it's really specifically for our state.

Kentucky has a unique patient population and we have unique challenges.

So this initiative was designed as a two year program, 2024 to 2026 really focus on the small steps, small things, not big things, not your lifestyle overhaul, but small things that can improve your health and the states certainly have a public.

Other states have public health initiatives.

This one is particular for Kentucky and other states.

We hope to set this example so other medical state medical association can learn from us, potentially use the template to improve their health.

>> So once again Kentucky is leading the way in something here.

>> Yes.

Well, I'm sorry to say that as you stated, Kentucky is not doing well on Health.

We ranked number 43rd in in the in the nation on our health status.

And also we rank 49th in exercise.

Really the the last second.

>> With all the basketball that we see playing around here.

>> And that's for the athletes, not for general Kentucky's.

We ranked 46th on tobacco use and ranked 47th on drug death.

And that's a big issue.

We try to we try to deal with as physicians.

We see the statistics play out every day in our clinics or hospitals and our open rooms.

So that's why we started this.

We're working with our charitable arm, the Kentucky Foundation for Medical Care, and we have reached over 1 million Kentucky's over the two years on this important initiative.

And we knew we have the infrastructure and trust of our communities for our physicians, our Kentucky Medical Association.

And as I said before, we realize there are many things that you cannot change overnight.

And that's why we name this as small steps and big impact.

We want you to start doing things that's incremental, that's small, that's achievable.

Then eventually lead up and add up to transformative health change for yourself.

>> You went through it a little bit with this already, but let me take you through each one of these five things.

So first tell me when we talk about screening, what kind of screening are you speaking of?

We all hear about screening for cancer, but are you looking at other types of diseases also that you might be screening 100%?

>> So screening actually is something we do pretty well in Kentucky really.

And we actually rank number 10th for colorectal cancer screening.

We rank number second for lung cancer screening.

And we need to build on this success.

And so the small steps here are pretty straightforward.

So we want you to schedule colorectal cancer screening.

We Reed age 45.

We want you to have a mammogram when you reach 40 years old.

And we want you to have a cervical cancer screening, a pap smear when you reach 21.

So those are the small things on cancer and the cancer outcome as as colorectal surgeon doctor Tuckson you you're you're you're one of the big advocate for this.

And cancer is all about screening.

If you screen early you get early treatment to do better under the other disease.

You should screen for two diabetes type two diabetes.

This is a big issue in Kentucky.

We have so many patients coming to our operating room coming for surgery without knowing they have diabetes.

>> Really.

>> When you check their glucose, it's 300 400 and that's too late.

By that time, you're already at a high risk for heart disease, high risk for kidney disease, high risk for circulations.

And the other thing is that we screen is cholesterols.

We got screen cholesterol.

There are many people walking around with high cholesterol.

Never know.

You got no symptoms until it's too late.

You had a heart attack and you have stroke and all those can happen.

So I think screening is not only for cancer but so many other things.

And check your blood pressure, right?

How many people are walking around with a high blood pressure without knowing in Kentucky, unfortunately, that's pretty sad number to look at.

>> Do you think some of the reasons why, particularly some of the other chronic illnesses, when you talk about diabetes, cardiovascular, renal disease, even, does that reflect either access to health care or lack of utilization of health care?

>> Right.

That's a really good question.

And we all know in Kentucky we're poor state.

And a lot of lot of people, especially in rural Kentucky, West Louisville, they really don't have access to health care, but even to food where food insecurity issues.

So there are so many issues on there.

And I think it's a combination.

One is whether they have those resources, they have access to those resources.

The other one, I think as a patient myself and I want to see there's also accountability issues too.

Am I doing what I'm supposed to do as a patient, as a citizen?

Am I walking my 20 minutes every day?

Am I eating healthy when I go to the restaurant?

Did I order the grilled chicken rather than fried chicken?

Although I like fried chicken so.

So I think there's really two parts of it.

There are small things that we can do.

>> Yeah, I'm sure you somehow get more than 20 minutes of walking.

>> In a day just back.

>> And.

>> Forth from the operating room.

>> Next, let's talk about the tea tobacco.

Now we are big tobacco producing state.

At least we used to be.

And as you said, we do smoke a lot.

So tell me about how does tobacco figure in in all this?

>> Sure.

I think Kentucky, we're known for tobacco and a lot of our citizens in Kentucky, the actually is a bigger part of their their livelihood than tobacco.

However, as physicians, we see the consequences every day of tobacco use.

We see patients come in with a heart attack, patients come in with a stroke and patients with amputation.

Because the tobacco use actually will block your blood vessels to the legs, to the arms, and eventually the patient will have to have amputation.

So we're not saying that you should stop smoking today.

Cold turkey.

And studies have shown that never works.

What we want you to do is really take small steps.

Maybe cut down one less cigarette a day and delay the first cigarette by 30 minutes.

Those are small things that you can do to help with your health, and we have a full respect and understanding the tobacco industry and the importance of that to Kentucky.

But as physicians, we are on the receiving end and you are on the receiving end, and we have to take our small steps to stop smoking.

>> So it's interesting.

So you mentioned about vascular problems.

So beyond looking at lung cancer, which is a huge problem, there are other illnesses that are associated with tobacco smoking that can complicate our lives.

>> That's definitely right.

So one of the major things that I see is heart attack.

So many people, if you if you smoke and just realize the blood vessel to the heart is very small, and if you smoke that blood vessels get narrower and eventually they will build plaques in there.

Really.

And that's how they develop heart attack.

So the first thing we tell the patient, if you come in with a heart attack, is you got to stop smoking.

And if you talk to our vascular surgeons, if you come in, you walk around you like hers, that's most likely you have poor circulation with that claudication.

So meaning the blood supply to your legs is not enough.

And the cause?

The major cause.

There is also smoking that causes plaque atherosclerosis building up in the blood vessels.

And eventually there's no other option.

But I have to cut the leg off, which is a terrible thing to do.

>> Yeah, you may or may not know some of the things, but when it comes to smoking cessation, are these programs readily available to people because you mentioned, you know, stop smoking or delaying the cigarette by 30 minutes, but what about other things about cessation?

>> So there are a lot of resources actually, believe it or not.

So there are smoking cessation workgroup support groups.

And you can join those groups.

And also where the place you can get most support and resources from really your doctor's office.

Talk to your doctor.

They have all the resources they can give you a prescription for nicotine replacement.

And also they can screen for potential side effects from smoking.

I think that's all tied together.

I think seeing a doctor get a resource from them would be the best thing to do.

>> Yeah, but smoking, from what I understand it is one of the well, the nicotine is one of the most addictive substances that we.

Where do your recommendations hold true for people who do the hookahs and the vaporing and the pouches or the smokeless tobacco?

Nowadays.

>> There are a lot of stuff on social media telling people weeping is safer than smoking.

Yeah, all the studies show it's not potentially be even worse.

We have we have seen so many young people coming to the hospital with vaping, and they will develop really bad lung diseases, and there are people actually die from those.

So vaping is definitely not safer than smoking.

And there are nicotine patches.

And there we physicians can prescribe to you to help to cut down smoking.

I think the key message I want to deliver here is those are not easy thing to do.

>> Yeah, those.

>> But you have to take the initiative to start somewhere.

And as anesthesiologist, when I see my patients, every single patient I tell them stop smoking.

How many have done that?

I don't know, it's hard to predict.

However, it is your body, it is your health.

And if you can do cut down the cigarette one by a day, that will work.

>> Since you mentioned about your being an anesthesiologist, we've approved the use of marijuana and some people don't think that represents a problem.

How do you see that?

As you know, putting in under the umbrella of smoking affecting people if they have to have surgery or any other things?

Is that something we need to really take a look at?

>> Definitely.

So there are studies out there.

Actually over 50% of people coming to surgery.

Are marijuana really.

It's not a it's not a rare issue.

It's a big problem.

Now the issue with marijuana is if you smoke marijuana, you come in for surgery.

There actually will mess up the anesthesia.

So because our body works differently and anesthesia.

So if you smoke marijuana, your after surgery, your chest getting sick and stomach or you'll get confused is much higher.

And cardiac disease too.

So you could have a heart attack without having those risk factors.

If you smoke marijuana.

And from sort of a behavioral health perspective, for people who are marijuana chronically, they have a significant issue with a lack of interest in anything study, work and disengagement.

And also, marijuana can be viewed as a gateway drug to and there could be could lead to additional substance abuse.

>> Let's go down to the next thing E. Well, really, I guess you couldn't quite work that in in there as far as steps is concerned.

So we just go with E. So exercise and nutrition.

Tell me about that.

>> And exercise.

So exercise can do a lot of good things for our body.

And one going to exercise your heart so you get a better cardiovascular reserve.

And I think this is something that's very important to can reduce your chance for diabetes.

Really 100%.

So when you walk when we walk actually will burn fat.

And the use of glucose.

If we don't walk, let's say we eat and we don't walk, all those glucose levels going to go up.

But when you walk, the level actually will go down significantly.

So take 20 minutes, 30 minutes walk after dinner and that will significantly help with your diabetes.

And this is all tied to to the if you look at Kentucky, this is something that we do very poorly and for a lot of reasons, some some of those are related to work.

What kind of work we do.

Some of those are related to lack of initiatives, all those things.

But to have a routine is really important.

And you don't have we don't want you to train for the marathon if you can't go for it.

But we're not asking you to train for a marathon, and we're not asking you to do dramatic changes.

It's just a 20 30 minute walk every day.

>> Well, let me ask you if if a person is not in a desk job or where they're sitting still, but rather someone who may be working in a hotel in the maintenance area or something where they're doing a great deal of walking, does that count?

As far as the exercise is concerned?

>> It does come.

It does come.

Okay.

And so really we'll have iPhone, we'll have phones.

And if you look at the phones, you look at your steps over 10,000 steps a day.

That will do a lot of benefits.

And we actually did a calculation before I come.

So if you walk 20 minutes every day, you add together, that's 120 hours of exercise every year.

And it really as a and they will do a lot of good things for your not only for your diabetes, for your cardiovascular disease and really improve your reserve.

And if unfortunately, you get sick, you actually will survive much better because you have better muscle.

Muscle mass.

>> Is walking is as good as running.

>> That's that's debatable I think.

>> Because my knees can't take running anymore.

>> Okay.

>> I think that's debatable.

I think do exercise that fits.

>> You okay.

>> And do exercise that fit you do exercise that you feel that you can work in the daily routine and you don't have to.

Everything.

Everything has prices.

Sure.

And you're running you're you're going to go on and all those but do things that you feel you're comfortable doing.

And if you have any doubt, talk to your doctor, see what's your recommendation for the best exercise for me.

And there will be more than happy to have a conversation with you.

>> If your doctor is.

If your health care worker is also doing exercising, that's what we hope, right?

Tell me about physicians, which gets us into that.

So the P part of this all and we'll come back to nutrition in a minute.

But I want to hear about what you have to say about the physicians as far as steps is concerned.

>> So for physicians, what we want to have for our Kentuckians, we want to have a relationship with their doctors.

We want to see your primary care doctor.

And every year, you should at least have one annual visit with your physicians.

So not only are they going to check your blood pressure, check all the things, but also have a conversation with them, say, hey, how can what can I do to improve the health?

And as you mentioned to as physicians, we have a lot of issues with physicians in Kentucky too.

>> Oh really?

>> We have burnout and we have physicians actually telling us they want to retire.

They don't want to be a doctor anymore.

There are a lot of factors to it.

And I'm going to talk to you about several things.

One, the payment model, right.

How physicians get paid is changed.

And now you have to see more patients in less time.

That's a lot of stress.

And then there's increase administrative burdens prior authorizations.

Now your doctor actually will have to do a lot of work with the insurance company before the procedure or the treatment is approved.

And that's a lot of additional work.

And there is a survey out there.

So every week your physicians want to do 39 prior authorizations every week.

>> So what does a prior authorization mean and how does that impact the care that that person sitting in the chair across from the.

>> Exam table?

Thank you for the question.

So this is developed by the insurance company.

So if you want to procedure and many procedures nowadays you have to get prior approval from the insurance company.

Otherwise this will not be paid or covered.

So physicians are working very hard to do that.

And we actually KMA is supporting the efforts to reduce the burdens on physicians.

Eventually what this will do is really improve the patient care, improve the access and reduce the burden for physicians.

As I said earlier, our physicians in Kentucky and there are many of them are burned out.

And this is one of the reasons and we want to reduce that.

We want your doctor to be well rested, full of energy, to take care of you.

Otherwise they cannot do the job.

>> So are we seeing a decrease in the amount of time that the physician is spending with the patient because of this?

And is that translating into worse outcomes?

I guess.

>> There's definitely so nowadays, because of prior authorization, the physicians want, they will have to work on those boundaries.

So there's a lot of time with the patient.

And to the additional people incur the cost of practice.

And if you look at Kentucky, we're having less and less private practices for that reason.

And I think we do believe it's a big issue.

We do believe that should be addressed.

>> All right.

>> The last part is S. That's the second S we have stress.

So how does stress manifest itself and how does that cause health problem.

>> And if you think about stress chronic stress can affect every system in the body.

It will affect the cardiovascular system, the immune system, the digestive system, you name it.

The list goes on and on.

When people are stressed, they are also more likely to engage in not very good behaviors smoking and drinking, substance abuse.

So anything you can do to reduce stress will be very important along that line.

What's important for stress is actually good sleep.

We don't think about it.

Good sleep will do a lot of great things for your health.

And on average adults, you should get 7 to 8 hours of sleep every night, well rested sleep and you're going to feel fresh up and your body will be better.

And it will do a lot of good things for your body.

>> You know, I must admit, the older I've gotten, the more I appreciate an afternoon nap.

And I kind of I'd want to punch that little young self who didn't want to do a nap.

But when we talk about stress, there was an interesting book called weathering.

Boy, I can't remember the author.

I've taught my head, but she talked about how stress impacts and causes the release of catecholamines and stuff causing high blood pressure.

Kidney disease.

Is this the way in which you're thinking stress can impact our health.

>> Also 100%.

So stress will increase all the hormones in your body.

Cortisol levels and all those can increase your chance for obesity, high blood pressure and diabetes.

So anything you can do to reduce stress.

>> Will be good.

>> Tell me about how do you tell somebody okay I come in stressed.

But what are the things that are causing stress.

>> And the one thing I want to say nowadays, especially for the young audience out there, is the social media.

Social media actually generates a lot of stress.

>> Really.

>> For our young people.

And set a timer or use an app to cut down your screen time.

That will reduce your stress.

That's very important.

And then time, time, time management is also critical.

We all have a lot of things to do.

I know you're very busy with a lot of things.

I have a lot of things to do.

So how can TRACK what you need to do and and set aside important things such as exercise, sleep and spending time with your family?

I think those are the three things that will significantly reduce your stress.

But it's it's something that you actually have to actively deal with it.

You don't want to be always on the receiving end.

There are so many things coming your way and you eventually will be overwhelmed.

Your body will get sick and you will not be able to do those things.

So take your time.

>> As you think about some of the things you've talked about.

What are the if you had to take everything that we've just said, what are the three biggest things that you want to get across to somebody and say, hey, this is what you need to do, what I recommend you should do?

>> I would say the the number one thing I would say, and I do this every year, go see your doctor every year and get a why is a professional rises right now.

There are so many misinformation and disinformation online on social media.

Do not believe those.

Your doctor should be the only source of truth for you, and I think they will use a lot of your stress.

Level two I would say we need exercise, we need to start moving around and we got to work.

Now.

The chairs, you actually don't need to sit.

You can stand on there and you can walk around.

There's actually actually there's a treadmill that can be put underneath your table for you to exercise while you work.

And the I think the third thing I really want to get to our audience is really we have to eat, right?

Why is it eat right?

Meaning we need we need to cut down on the unhealthy food that.

>> We eat.

>> Especially sugary drinks.

And we just had a KET webinar on the energy drinks that we drink every day.

There are so many things in there that's bad for your health sugars.

There are a lot of sugars in there and there's a lot of caffeine in there.

There are a lot of other things that you don't even know what they put in there.

So cut down those drinks.

Drink water.

Water is the best drink ever.

>> So I'm going to presume you're not eating a bag of Cheetos.

>> I do not, sir.

I want to, but I.

>> Do not want to.

But you not.

So you have a little bit better discipline than that.

>> Yes, sir.

>> Well, Doctor Wong, I got to tell you, you gave us some really interesting pointers here, and I want to thank you.

I still don't see how you get everything you get done in the course of any one day.

So this sleep thing I'm going to follow and see how often you sleep.

Thank you for being with us today.

Sometimes the more complex a problem may seem, the greater the need to look for simple, manageable solutions.

This is true regarding our health.

The steps steps that we discussed today will lead us to better health tomorrow.

If you wish to watch this show again or watch an archived version of past shows, please go to WW.

[MUSIC] If you have a question or comment about this or other shows, we can be reached at KY Health at ket.org.

I look forward to seeing you on the next Kentucky Health and I encourage you take a look at the Kentucky Medical Association website.

You can see all the information about the Steps program and how one can try to implement it and make these changes in our daily lives.

Remember, you don't have to do it all on the first day.

We need to gradually build up to it, and when you do, I'll look forward to seeing you in the next Kentucky.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy