LEXINGTON, Ky. (June 27, 2025) — When it comes to a child’s health, a family’s zip code can matter as much as their genetic code. The everyday environment plays a powerful role in shaping a child’s future; too often, the reality of their overall health can be determined before they are even born.

According to the 2024 Kentucky Kids Count survey released by Kentucky Youth Advocates, 20.6% of children live in poverty, and 44% come from low-income families. While those numbers have decreased over the years, factors such as economic insecurity have a negative impact on a child’s mental, physical and emotional well-being. The effects are indelible and can be hard to reverse in adulthood.

“That’s at least 6 to 7% above the national average,” said Scottie B. Day, M.D., physician-in-chief of Kentucky Children’s Hospital. “When people think about the socioeconomic causes, they think of Appalachia, but it’s in cities like Lexington too. There are parts of Fayette County where your life expectancy is different based on your zip code.”

While Kentucky has made great strides in improving social determinants of health, such as improving the overall economy, increasing access to health care and investing in local communities, it still ranks in the lower half nationally for major health disparities such as heart disease, lung cancer and diabetes.

As the state’s flagship university, the University of Kentucky recently launched the Advancing Kentucky Together Network, an initiative dedicated to bringing together health care providers, policy makers and communities to build a healthier, stronger Kentucky. By addressing clinical quality and access, workforce education and community outreach, UK can be a leader in improving the health of all Kentuckians — especially the littlest ones.

As Day often remarks, healthy children grow into healthy adults. By addressing the health disparities in the pediatric population early, those children will be better equipped to manage their health throughout their lives. Part of KCH’s role this new state-wide initiative includes bringing Bethany Hodge, M.D., as the vice-chair of population health & strategy for KCH. Her background in both pediatrics and public health gives her a unique perspective into how to address health inequities on a large scale.

For Hodge, that starts with examining the small scale.

“There have been improvements made, but a lot of the time, it comes from looking at how we’re operating within our families and communities, and how those situations are helping or not helping kids reach their full potential,” Hodge said. “The urgent issues are the things that involve the environment they’re growing up in and the barriers the whole family faces.”

In the field of public health, experts often refer to the ‘upstream/downstream’ parable. In the story, the protagonist comes across a person drowning in the river. After pulling him to safety, he sees more and more people in the river. After rescuing them all, the protagonist goes upstream to see why so many are falling into the river in the first place. This story has become a model for explaining how ‘upstream’ behaviors, such as food or housing insecurity, lead to downstream consequences like chronic illness.

“That’s always a question for pediatricians,” said Hodge. “How far upstream can we go with prevention? What does it look like to prevent hospitalization or a bad outcome, so that the diagnosis or disease doesn’t happen in the first place? What investments can we put there so that the downstream effects never happen?”

One of the most pressing “upstream” issues is access to care. As the top hospital in Kentucky, UK HealthCare receives the most critical patients — adults and children — from Central and Eastern Kentucky. The barriers aren’t easy to overcome; the drive to Lexington, paying for overnight accommodations and taking time off work are examples of significant barriers families face.

One way UK HealthCare addresses these issues is by strengthening relationships with local hospitals through the affiliate networks. Decades of research have shown that patients have better outcomes when they are close to home, especially when they are under the care of their local physicians whom they know and trust. The newly launched KCH Affiliate Network connects KCH specialists with local providers through education and training opportunities.

“There’s a scarcity of pediatric specialists in the country, and it’s not getting any better,” said Day. “Some local hospitals may not even have pediatricians and won’t admit children. The network empowers local facilities and gives them the skills, information and capabilities so they can move along in children’s care areas. Different places have different needs, and the network lets them be whatever the right thing is for their community.”

Empowering local providers mitigates some of the downstream issues, but according to Hodge, there is only so much one doctor in one community can do. Seventy-five percent of children in Kentucky live in counties that don’t have enough primary care providers. Thousands of children are in foster care, and much of the state still grapples with the opioid crisis.

“When you start looking for those upstream things, it can feel like it’s beyond the capacity of a pediatrician to do anything about that,” she said. “That’s why we have to keep partnering with people across these different areas because at the end of the day, the place where it all triangulates is that child and the lifelong effects on them.”

Hodge previously worked in the Kentucky Department Public Health and believes that a collaboration between the state and the flagship university can make significant strides in stemming those upstream issues. With the state’s ability to collect and analyze population data and the university’s vast network of providers, educators and researchers, “we can really put legs underneath it and see where we can go.”

Citing the concept of reverse innovation, one approach Hodge has is to zoom in on the macro level and see what’s working on the community level.

“It can be tempting to drop in with your team of doctors and nurses and provide a service, but that can be a negative disruption, and you’re not building capacity,” she said. “But there’s this community and it’s doing something awesome; how are they doing it and how are they getting such great outcomes? We can go to those communities and say teach me your ways, then figure out how to apply it to a bigger system.”

Such a method is less expensive than throwing money into a one-size-fits-most approach. With feedback and modification, a successful vaccination campaign developed in rural Perry County could be scaled up for metropolitan Louisville. Listening is key, says Hodge. Meeting providers, families and communities where they are and assessing their individual needs — what they are experiencing downstream — can, in turn, lead to innovations in addressing the core issues all Kentuckians face.