Cooper Featured Speaker at Unveiling of American Rankings
When the 21st edition of America’s Health Rankings® was unveiled in December, the featured speaker was none other than Tennessee’s own Commissioner of Health Susan R. Cooper, MSN, RN. (See related story below.)
For some, it might have seemed a curious choice … after all, Tennessee ranks much closer to the bottom than the top when it comes to national health status. Scratch the surface, however, and the choice makes perfect sense. Although ranked 42 out of 50, Tennessee leads the nation in a couple of key indicators and has shown year-over-year improvement as residents make a concerted effort to work toward improved health.
“Since 2005, we have consistently moved up in America’s Health Rankings. Our journey began at number 48, and this year we celebrate moving to number 42,” Cooper said in her opening remarks. “Now, most folks would ask, ‘Why in the world are you doing the happy dance about being number 42?’ The answer lies in the individual metrics and the significant improvements that we have made.”
She noted that by addressing the determinants of health, Tennessee has set the stage to show continued improvement. Cooper said the annual rankings report has served as a marker to help the state set priorities in the quest for better health. She also pointed out that in such a system, some state will always be first and another state last so it’s important not to miss the individual, often discreet, improvements being made nationwide.
Cooper noted Tennessee … like many states … has seen improvements this past year in rates of smoking, binge drinking, violent crime, high school graduation and preventable hospitalizations. Concurrently, there have been nationwide improvements in outcome measures as related to deaths from cardiovascular disease, infant mortality and premature deaths.
“It’s not often a Southern state gets to say they are #1 or #2 in anything, but we actually had the highest immunization rate in the nation, and we had the second lowest rate in the nation of binge drinking,” Cooper proudly noted.
What is behind Tennessee’s slow but steady ascent in health rankings? Cooper said the state has taken a number of innovative approaches to address population health. The self-study began at a time when Tennessee had its most expansive insurance coverage.
“What was troubling was that we found that access to insurance was … and is … very important, but it seemed to be important for access to clinical care and not necessarily access to health because with that expansive insurance coverage, we found ourselves 48th out of 50 states,” Cooper said. “We knew something had to change. We took the stance that healthcare was a downstream proposition; and in order to impact health outcomes and healthcare, we needed to work our way upstream and address health.”
Cooper said a decision was made to create social change … not just by raising awareness but also by helping Tennesseans take definitive steps toward changing behaviors that led to poor health. The fundamentals of the sea change were based in what Cooper referred to as the three P’s — policy, programs and partnerships.
“Our strategy was built on supporting evidence-based initiatives that would improve physical activity and nutrition, as well as support tobacco prevention and cessation activities,” she told the audience. Changing these three behaviors, she pointed out, impacted the most prevalent diseases and chronic conditions including cardiovascular disease, diabetes, man cancers, lung disease and depression.
Cooper credited both Governor Bredesen and the Tennessee Legislature with making hard decisions that ultimately have had a positive impact on the health of their constituents. “Using the ‘health in all policies approach,’” she explained, “policies were enacted and implemented across the silos of government to support physical activity, nutrition and tobacco prevention.”
In the past few years, Tennessee has enacted legislation aimed at preventing diabetes and improving outcomes for those living with the disease, set nutritional standards for school meals and vending machine offerings, required schoolchildren get at least 90 minutes of physical activity a week, created a built environment that supports walking and includes sidewalks that actually lead somewhere, and implemented smoking bans in an effort to become a smoke-free Tennessee.
“Moving policy in a tobacco state was … um … an opportunity,” she said, eliciting laughter from the audience of public health professionals. Cooper added state legislators showed great fortitude in making tough decisions considering tobacco is the leading cash crop in Tennessee. The policies have proven effective with the adult tobacco usage rate dropping from 26.7 percent in 2006 to 22 percent in 2009. “Pretty rocking for a tobacco state!” Cooper proclaimed.
In addition to tobacco prevention and cessation, Cooper said the centerpiece of the nutrition and physical activity platform was the creation of Get Fit Tennessee. “We found that messaging was important and that words mattered, and we kept our message simple. We needed all Tennesseans … every Tennessean … to start where they were in their own personal journey to better health.” She added the message resonated because it wasn’t asking someone to get off the couch and run a marathon … simply get up and walk 10 minutes today and build on that, make one small change in your diet … take one small step at a time. “It seems pretty simple, but it takes all of us working together.”
She added it is essential to create an environment in which the healthy choice is the easy choice and the affordable choice. Cooper also noted, “A running theme for our job is that we set people up to succeed; we do not set them up to fail.” To that end, she said the staff has worked closely with partners in the community and with businesses to ensure compliance with new laws, launch workplace initiatives, and create teachable moments.
Cooper concluded by saying she was excited about the many innovative programs in Tennessee that are netting real results. She added, however, that moves toward better health outcomes don’t just happen. “It takes focus. It takes determination, and it takes a fundamental belief that wherever you are in these rankings you can change … and you can change for the good.” Cooper added the work being done in Tennessee transcends traditional silos and integrates the public and private sector.
“Without the groundswell of public support at the individual, resident level, we would not have been able to take action and change behaviors,” she said. “My sincere thanks go to all Tennesseans who helped us turn the tide to make Tennessee a healthier state.” She added, “Obviously, our work is not done. We see many opportunities for improvements. We want to hold our gains but continue to improve health outcomes. We look forward to additional success in the coming years.”
How Tennessee Fares in the Rankings
Overall 2010 Ranking: 42
Strengths: high immunization coverage (94.1 percent of children ages 19-35 months), low prevalence of binge drinking (8.8 percent of population), low geographic disparity within the state (9.5 percent), ready availability of primary care physicians (121.2 per 100,000 population).
Challenges: high prevalence of obesity (32.8 percent of population), high rate of preventable hospitalizations (87.7 percent discharges per 1,000 Medicare enrollees), high violent crime rate (668 offenses per 100,000 population), high infant mortality rate (8.5 deaths per 1,000 live births), high rate of cancer deaths (215.3 per 100,000 population) and high rate of cardiovascular deaths (326.4 per 100,000 population).
Significant Changes: While still high, the violent crime rate decreased from 722 to 668 per 100,000 population in the past year; the number of preventable hospitalizations declined from 100.6 to 87.7 discharges per 1,000 Medicare enrollees; smoking prevalence decreased from 26.7 percent to 22 percent over five years. However, the number of poor physical health days (in the previous 30 days) increased from 3.7 to 4.6 days.
General Observation: Tennessee ranks higher for determinants than for outcomes. However, this indicates that overall healthiness should improve over time.
For More Information: Go online to www.americashealthrankings.org