Tennessee Department of Health initiatives working to improve overall health outcomes

Tennessee Nurse, Spring, 2008 by Cathy R. Taylor, Susan R. Cooper

Compared to other states, Tennessee currently ranks 46th for overall health outcomes--a poor showing and completely unacceptable to the state's public health leadership. Armed with strong evidence that better lifestyle and behavior choices are critical to improving this ranking, two statewide initiatives are taking aim at major contributors--our poor dietary choices and sedentary lifestyles.

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Governor Phil Bredesen launched GetFitTN in the fall of 2006. GetFitTN is a public health awareness program targeting the rising epidemic of type 2 diabetes and obesity. An alarming 28.8% of Tennesseans are obese. Obesity is a known precursor for diabetes, cancer, cardiovascular disease, and many other chronic illnesses. According to the U.S. Surgeon General, adults need a total of 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week, yet in Tennessee, only about 36% of adults get the recommended amount of activity, while about one-third are not active at all. Perhaps even more alarming, the percentage of overweight youth has more than doubled since 1980, and in fact, Tennessee now posts the fourth highest number of high school students who are overweight or at risk for overweight. Championed by Commissioner of Health, Susan R. Cooper, MSN, RN, GetFitTN events across the state enable individuals, communities and schools to challenge one another to GetFit by making healthy food choices and engaging in physical fitness competitions. www.GetfitTN.com is a website launched to raise awareness and encourage participants to "start where they are, move more, and eat better." In February, a new fitness tracker was added to the site so that individuals can keep track of their personal fitness activities and goals. Via the website, participants can log in to query nutrition and fitness experts for advice, enter individual challenges, join fitness teams, and create their own competitions by challenging others. Use of the website is free to all Tennesseans.

Also launched in 2006, the goal of the Tennessee Center for Diabetes Prevention and Health Promotion's Project Diabetes is to halt the proliferation of diabetes and its complications in our state. Diabetes and associated complications (vision loss, kidney failure, lower extremity amputation, cardiovascular disease, premature death, and many others) can be prevented or postponed with healthy lifestyle choices and standard therapies, yet Tennessee suffers a notably high diabetes burden. More than 500,000 Tennesseans have diabetes and more than twice that number are at risk for developing diabetes. To date, the Center has approved funding for 41 innovative, evidence-based projects focused on preventing and treating pre-diabetes and diabetes for a total of more than $4 million. Grants of up to $50,000 each were awarded to seed development of innovative ideas and building partnerships and infrastructure to support future diabetes-related interventions. Implementation grants for up to $250,000 each were awarded for new programs or for expanding existing programs or services to new populations. Successful applicants targeted high risk population groups such as the uninsured, described novel but sound methods based on best practices, and outlined realistic goals with strong evaluation components. All programs will collect a standardized set of diabetes-related measures based on the Centers for Disease Control Behavioral Risk Factor Surveillance Survey, and planning grant recipients are expected to request implementation funding in subsequent funding cycles.

Projects are geographically spread across the state with several located in each grand division. A variety of prevention, treatment, and combination prevention plus treatment approaches are included. The projects target diverse populations and include minority groups, school-aged children, teens, adults, caregivers, and health care professionals and students. For example, Vanderbilt University and East Tennessee State University are partnering to design and test new diabetes nutrition counseling curricula for dietetic interns, while nurse faculty at the University of Tennessee Health Science Center are testing cultural competency-related curriculum changes targeting improved diabetes self-management among Hispanics. Other projects will:

* Create worksite and community-based physical fitness opportunities and competitive challenges

* Develop strategies to reduce the diabetes burden among adults with developmental challenges

* Evaluate a telehealth intervention designed to improve diabetes self-care in an underserved, rural area of the state

* Establish standardized diabetes education centers in rural, underserved areas of the state

* Increase access to dilated retinal screenings and develop specialty care networks for patients with identified pathology

* Create Step teams to enhance physical activity in inner city youth

* Launch an interactive, web-based wellness site for teens.