Dr. Stephanie Bailey- "Tale of Two Cities"

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

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Dr. Stephanie Bailey- "Tale of Two Cities"

  1. 1. NASHVILLE: A TALE OF TWO CITIES<br />THE NAKED HOSPITAL ROUNDTABLE<br />STEPHANIE BAILEY, MD,MS<br />AUGUST 26, 2010<br />
  2. 2. Author’s Gratitude<br />Health Data Source<br />Metro Health Department, Nashville, TN<br />Former Director of Maternal Child Health, TN Dept of Health<br />Your presence at this roundtable<br />
  3. 3. NASHVILLE: A Tale of Two Cities<br />Background: Healthcare and the Naked Hospital<br />Plot: There are messages behind the numbers that need to matter – whether within the 10% or within the entire context of 100%<br />Characters: a host of them (Nashville’s images, children, data, the 10%/the 70%/the other 20%)<br />The Rest of the Story…to be written<br />
  4. 4. Charles Dickens<br />“It was the best of times, it was the worst of times…”<br />
  5. 5. ..the rest goes like this…..<br />“..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…” <br />
  6. 6. stephanie bailey:<br />“….these are the times we find in every local community of our nation….”<br />
  7. 7. Nashville, TN : Athens of the South<br />(NFL Team, Predators, Parthenon, # of institutions of higher learning)….but in our neighborhoods…(2004) <br />
  8. 8. Keisha<br />Dad in jail<br />5 siblings<br />older teenage sister has a baby<br />Age 6<br />1st grade<br />
  9. 9. Renaldo<br />Mother killed at age 6<br />Father lives in East Tennessee<br />3 cousins in household<br />Age 11<br />6th grade<br />
  10. 10. Kenny<br />Father in jail<br />1 of 6 children<br />Age 12<br />4th grade<br />
  11. 11. Thomas<br />Crack baby<br />Kicked out of school for attacking teacher<br />Kindergarten<br />
  12. 12. Raphael<br />Mother in jail<br />Waited all day to talk to mentor, wanting only to tell her about seeing his sister being shot the night before<br />Expelled at end of school year because someone said something about his mother<br />Age 10<br />4th grade<br />
  13. 13. Christopher<br />1 of 6 children<br />Father on disability<br />Suspended 2 x week, in school,for anger<br />All brothers expelled from school<br />2 older/2 younger<br />Age 12<br />5th grade<br />
  14. 14. Courtney<br />Mother incarcerated<br />Aunt raising 7 children,none are hers<br />Age 5<br />Kindergarten<br />
  15. 15. Jarvis<br />Two older brothers, ages 16 and 17<br />Lives with aunt because both parents incarcerated on drug charges<br />October 2005, placed back in first grade…<br />Age 6<br />1st Grade<br />
  16. 16. Jackie<br />Family has been put out of MDHA<br />Was in room when uncle was shot<br />Has been raped<br />WHEN SHE GROWS UP……………………………she wants to be a doctor<br />Age 12<br />4th Grade<br />
  17. 17. Characteristics<br />Incarceration<br />Handicaps<br />Violence, truancy, suspensions<br />Mixed families<br />Failure (academic)<br />Needing and/or wanting attention<br />Lack of tools<br />Adult indifference<br />Low self esteem<br />
  18. 18. Nashville, TN : Healthcare Capitol<br />But………<br />
  19. 19.
  20. 20. Infant Mortality Rankings (Ascending) – 1960-2002; Selected Countries (Health United States 2007)<br />US<br />Whites<br />US<br />Whites<br />US<br />Whites<br />US<br />Whites<br />US<br />Whites<br />US<br />Whites<br />US<br /> Blacks<br />US<br /> Blacks<br />US<br /> Blacks<br />US<br /> Blacks<br />US<br /> Blacks<br />US<br /> Blacks<br />
  21. 21. Diagnoses of HIV Infection By Race and Ethnicity: Davidson Co., TN, 2005 - 2009PROVISIONAL DATA<br />Data include persons with a diagnosis of HIV infection regardless of disease progression.<br />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. <br />Source: Metro Public Health Department analysis of HIV surveillance data diagnosed through December 31, 2009 as of June 18, 2010, Jeselyn Rhodes, MSPH<br />
  22. 22.
  23. 23.
  24. 24. (*BMI 30, or about 30 lbs overweight for 5’4” person)<br />Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1995, 2005<br />1995<br />1990<br />2005<br />25%–29%<br />15%–19%<br />10%–14% <br /><10%<br />≥30%<br />20%–24%<br />No Data<br />
  25. 25. Nashville, TN : Music City USA<br />…and a church on every corner………but <br />
  26. 26. Davidson County # 1 in SYPHILIS 1999<br />
  27. 27.
  28. 28. Background : Major Impacts on Healthiness<br />
  29. 29. Safer<br />Healthier<br />People<br />Vulnerable<br />People<br />Affected Peoplewith Complications<br />Affected People without complications<br />(undiagnosed, asymptomatic)<br />Background: Health Status and Healthcare<br />Traditional healthcare<br />Disease Care<br />Expenditures<br />
  30. 30. Traditional Healthcare<br />Capable of miracles, but…<br />Healthcare<br />Delivery<br />System<br />Emphasis: end-of-life disease care <br />Access: unaffordable & unavailable for many<br />Results: variable & not transparent<br />Cost: variable & not transparent<br />Best results:not usually rewarded<br />Value: consumers lack information when making choices about care<br />Governmental <br />Public Health<br />System<br />Health<br />Partners<br />Employers&<br />Businesses<br />
  31. 31. Safer<br />Healthier<br />People<br />Vulnerable<br />People<br />Affected Peoplewith Complications<br />Affected People without complications<br />(undiagnosed, diagnosed,asymptomatic)<br />Background: Traditional Public Health<br />Public Health System Expenditures<br />
  32. 32. Traditional Public Health<br />Healthcare<br />Delivery<br />System<br />Capable of miracles, but…<br />Other Govt <br />Agencies<br />Capacity: under-valued and under-resourced <br />Results: variable & not transparent<br />Cost:variable & not transparent<br />Best results:not usually rewarded<br />Value:consumers lack information when making choices about tax investments<br />Governmental <br />Public Health<br />System<br />Health<br />Partners<br />Community &<br />Faith-based <br />Organizations<br />
  33. 33. Clinical and Preventative Practice<br />1971, Walsh McDermott<br />Cecil’s 13th Edition, Textbook of Medicine<br />Pubic Health System vs. Constituency Type System<br />1979, 15th Edition<br />2010: no watchdog, same dilemma, need for correction<br />
  34. 34. Hippocrates<br />“the function of protecting and developing health must rank even above that of restoring it when it is impaired”<br />
  35. 35. Safer<br />Healthier<br />People<br />Vulnerable<br />People<br />Affected Peoplewith Complications<br />Affected People without complications<br />(undiagnosed, asymptomatic)<br />The Rest of the Story: A Health System:Health Protection for Life!???<br />Public Health Network <br />Healthcare Delivery System<br />Disease Care<br />Health Protection: Health Promotion, <br />Prevention, and Preparedness<br />
  36. 36. The Rest of the Story: <br />A Value-based Health System?<br />Healthcare<br />Delivery<br />System<br />Other Govt <br />Agencies<br />Governmental <br />Public Health<br />System<br />Health<br />Partners<br />Community &<br />Faith-based <br />Organizations<br />Capable of miracles!<br />Emphasis:health protection(health promotion, prevention, preparedness) as well as disease care<br />Access:affordable & available for all<br />Results:measured & transparent<br />Cost:measured & transparent<br />Best results:rewarded<br />Value:equitable; transparent to consumers when making choices<br />WHO<br />Employers &<br />Businesses<br />Education<br />System<br />
  37. 37. “ When health is absentwisdom cannot reveal itselfart cannot become manifeststrengthcannot fightwealthbecomes uselessand intelligencecannot be applied.”<br />Heruphilus 325 BC,<br />Physician to Alexander the Great<br />
  38. 38. Improving Health in Our Communities<br />
  39. 39. CONCLUSION……..<br />“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.”<br />dickens<br />dickens<br />
  40. 40. THE HEALTH OF NASHVILLE <br />ARE US!<br />

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