Dr. Stephanie Bailey, Former Chief of Public Health Practice, CDC presents "Tale of Two Cities" at Naked Hospital 2010

1. NASHVILLE: A TALE OF TWO CITIES THE NAKED HOSPITAL ROUNDTABLE STEPHANIE BAILEY, MD,MS AUGUST 26, 2010

2. Author’s Gratitude Health Data Source Metro Health Department, Nashville, TN Former Director of Maternal Child Health, TN Dept of Health Your presence at this roundtable

3. NASHVILLE: A Tale of Two Cities Background: Healthcare and the Naked Hospital Plot: There are messages behind the numbers that need to matter – whether within the 10% or within the entire context of 100% Characters: a host of them (Nashville’s images, children, data, the 10%/the 70%/the other 20%) The Rest of the Story…to be written

4. Charles Dickens “It was the best of times, it was the worst of times…”

5. ..the rest goes like this….. “..it was the age of wisdom, it was the age of foolishness; it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way…”

6. stephanie bailey: “….these are the times we find in every local community of our nation….”

7. Nashville, TN : Athens of the South (NFL Team, Predators, Parthenon, # of institutions of higher learning)….but in our neighborhoods…(2004)

8. Keisha Dad in jail 5 siblings older teenage sister has a baby Age 6 1st grade

9. Renaldo Mother killed at age 6 Father lives in East Tennessee 3 cousins in household Age 11 6th grade

10. Kenny Father in jail 1 of 6 children Age 12 4th grade

11. Thomas Crack baby Kicked out of school for attacking teacher Kindergarten

12. Raphael Mother in jail Waited all day to talk to mentor, wanting only to tell her about seeing his sister being shot the night before Expelled at end of school year because someone said something about his mother Age 10 4th grade

13. Christopher 1 of 6 children Father on disability Suspended 2 x week, in school,for anger All brothers expelled from school 2 older/2 younger Age 12 5th grade

14. Courtney Mother incarcerated Aunt raising 7 children,none are hers Age 5 Kindergarten

15. Jarvis Two older brothers, ages 16 and 17 Lives with aunt because both parents incarcerated on drug charges October 2005, placed back in first grade… Age 6 1st Grade

16. Jackie Family has been put out of MDHA Was in room when uncle was shot Has been raped WHEN SHE GROWS UP……………………………she wants to be a doctor Age 12 4th Grade

17. Characteristics Incarceration Handicaps Violence, truancy, suspensions Mixed families Failure (academic) Needing and/or wanting attention Lack of tools Adult indifference Low self esteem

18. Nashville, TN : Healthcare Capitol But………

20. Infant Mortality Rankings (Ascending) – 1960-2002; Selected Countries (Health United States 2007) US Whites US Whites US Whites US Whites US Whites US Whites US Blacks US Blacks US Blacks US Blacks US Blacks US Blacks

21. Diagnoses of HIV Infection By Race and Ethnicity: Davidson Co., TN, 2005 - 2009PROVISIONAL DATA Data include persons with a diagnosis of HIV infection regardless of disease progression. Note: The data contained in this document are provisional, as such, statistics should not be cited for publication. Data represents actual cases and are not adjusted for reporting delays. Source: Metro Public Health Department analysis of HIV surveillance data diagnosed through December 31, 2009 as of June 18, 2010, Jeselyn Rhodes, MSPH

24. (*BMI 30, or about 30 lbs overweight for 5’4” person) Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1995, 2005 1995 1990 2005 25%–29% 15%–19% 10%–14% <10% ≥30% 20%–24% No Data

25. Nashville, TN : Music City USA …and a church on every corner………but

26. Davidson County # 1 in SYPHILIS 1999

28. Background : Major Impacts on Healthiness

29. Safer Healthier People Vulnerable People Affected Peoplewith Complications Affected People without complications (undiagnosed, asymptomatic) Background: Health Status and Healthcare Traditional healthcare Disease Care Expenditures

30. Traditional Healthcare Capable of miracles, but… Healthcare Delivery System Emphasis: end-of-life disease care Access: unaffordable & unavailable for many Results: variable & not transparent Cost: variable & not transparent Best results:not usually rewarded Value: consumers lack information when making choices about care Governmental Public Health System Health Partners Employers& Businesses

31. Safer Healthier People Vulnerable People Affected Peoplewith Complications Affected People without complications (undiagnosed, diagnosed,asymptomatic) Background: Traditional Public Health Public Health System Expenditures

32. Traditional Public Health Healthcare Delivery System Capable of miracles, but… Other Govt Agencies Capacity: under-valued and under-resourced Results: variable & not transparent Cost:variable & not transparent Best results:not usually rewarded Value:consumers lack information when making choices about tax investments Governmental Public Health System Health Partners Community & Faith-based Organizations

33. Clinical and Preventative Practice 1971, Walsh McDermott Cecil’s 13th Edition, Textbook of Medicine Pubic Health System vs. Constituency Type System 1979, 15th Edition 2010: no watchdog, same dilemma, need for correction

34. Hippocrates “the function of protecting and developing health must rank even above that of restoring it when it is impaired”

35. Safer Healthier People Vulnerable People Affected Peoplewith Complications Affected People without complications (undiagnosed, asymptomatic) The Rest of the Story: A Health System:Health Protection for Life!??? Public Health Network Healthcare Delivery System Disease Care Health Protection: Health Promotion, Prevention, and Preparedness

36. The Rest of the Story: A Value-based Health System? Healthcare Delivery System Other Govt Agencies Governmental Public Health System Health Partners Community & Faith-based Organizations Capable of miracles! Emphasis:health protection(health promotion, prevention, preparedness) as well as disease care Access:affordable & available for all Results:measured & transparent Cost:measured & transparent Best results:rewarded Value:equitable; transparent to consumers when making choices WHO Employers & Businesses Education System

37. “ When health is absentwisdom cannot reveal itselfart cannot become manifeststrengthcannot fightwealthbecomes uselessand intelligencecannot be applied.” Heruphilus 325 BC, Physician to Alexander the Great

38. Improving Health in Our Communities

39. CONCLUSION…….. “It is a far , far better thing that I (we) do, than I (we) have ever done; it is a far, far better rest that I (we) go to, than I (we) have ever known.” dickens dickens

40. THE HEALTH OF NASHVILLE ARE US!