Dr. Stephanie Bailey- "Tale of Two Cities"

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

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

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

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

..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…”

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

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

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

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

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

Thomas
Crack baby
Kicked out of school for attacking teacher
Kindergarten

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

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

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

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

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

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

Nashville, TN : Healthcare Capitol
But………

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

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

(*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

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

Davidson County # 1 in SYPHILIS 1999

Background : Major Impacts on Healthiness

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

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

Safer
Healthier
People
Vulnerable
People
(undiagnosed, diagnosed,asymptomatic)
Background: Traditional Public Health
Public Health System Expenditures

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

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

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

Safer
Healthier
People
Vulnerable
People
(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

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

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

Improving Health in Our Communities

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

THE HEALTH OF NASHVILLE
ARE US!

Dr. Stephanie Bailey- "Tale of Two Cities"

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