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TB Challenge: Partnering to Eliminate TB in African Americans
Setting the Course for Action: A Chief Perspective
Michael
Fraser, Public Health Advisor, Field Services and Evaluation Branch
Return to Spring 2007 Main Menu
 Stephanie B.C. Bailey, M.D., MSHSA, is Chief of Public Health
Practice at the Centers for Disease Control and Prevention (CDC). As
Chief of Public Health Practice, Dr. Bailey is responsible for
assuring the U.S. public health system is strengthened and that CDC
provide leadership in building and supporting public health
infrastructure to improve overall public health system performance.
The Office of the Chief of Public Health Practice serves as an
advocate, guardian, promoter and conscience of public health
practice throughout CDC and in the larger public health community.
Michael Fraser (MF): Dr. Bailey, you have had an impressive career
in public health. In your last position as the Director of the
Metropolitan Health Department in Nashville, Tennessee, you
accomplished so much over your 11-year tenure. What inspired you to
join CDC in October of last year?
Dr. Bailey: Two things. Given my professional journey, joining CDC
was an “inescapable summons.” And, from my interview with Dr. Gerberding, I really buy into and see the vision that she has set
forth.
MF: You have joined CDC in the Office of the Chief of Public Health
Practice (OCPHP). Can you explain the responsibility of this office
and what you and your team are charged to do?
Dr. Bailey: For many, internally and externally, OCPHP is the
“connection to the practice.” The mission of the office is to
advance achievement of CDC's health protection goals through
science-based, practice-oriented standards, policies, and legal
tools. In working terms, this means that this office serves as an
advocate, guardian, promoter, and conscience of public health
practice throughout CDC and in the larger public health community. A
key OCPHP strategy is to ensure coordination and synergy between
CDC's scientific and practice activities and their support for
practitioners, policy makers, and partners throughout the public
health system. Key foci include performance standards,
accreditation, workforce, infrastructure, community engagement,
public health, law, policy development, best practices and the
science of that practice, public health systems research, and public
health practice improvement strategies. The venue to facilitate the
discussion of practice issues will be the newly established Public
Health Practice Council.
MF: Dr. Bailey, in the state of Tennessee you spear-headed an
initiative, Bridges to Care (BTC), that linked thousands of
uninsured Tennesseans to health care through a public/private
consortium. Can you tell us how you did it, the challenges you
faced, and what led to the successful outcomes from these
initiatives?
Dr. Bailey: This effort was accomplished because everyone involved
recognized the reality of the impact of having 42,000 uninsured
persons in Davidson County and committed to the broader vision to
address this. The true engagement of stakeholders led to a mission
and a deliberate strategy for the city. As partners committed to
this effort, we all committed resources, time, and effort. This led
to continuous successful outcomes. Our target was to enroll 4,000
uninsured in the first year; by the end of the first quarter of the
first year, we had enrolled 8,000. Our target for BTC Plus, the
system of specialty services, was 3,000 slots within the first year,
and at the end of that year we had 4,200 slots. Some of the
challenges presented themselves mostly upfront: fear of taking this
on; the perception of already being at capacity; and, what would be
the cost? Also, there were issues around protection of turf,
constraints of procedures, and convincing others who needed to be
persuaded.
Michael Fraser (MF): Dr. Bailey, you have had an impressive career
in public health. In your last position as the Director of the
Metropolitan Health Department in Nashville, Tennessee, you
accomplished so much over your 11-year tenure. What inspired you to
join CDC in October of last year?
Dr. Bailey: Two things. Given my professional journey, joining CDC
was an “inescapable summons.” And, from my interview with Dr. Gerberding, I really buy into and see the vision that she has set
forth.
MF: You have joined CDC in the Office of the Chief of Public Health
Practice (OCPHP). Can you explain the responsibility of this office
and what you and your team are charged to do?
Dr. Bailey: For many, internally and externally, OCPHP is the
“connection to the practice.” The mission of the office is to
advance achievement of CDC's health protection goals through
science-based, practice-oriented standards, policies, and legal
tools. In working terms, this means that this office serves as an
advocate, guardian, promoter, and conscience of public health
practice throughout CDC and in the larger public health community. A
key OCPHP strategy is to ensure coordination and synergy between
CDC's scientific and practice activities and their support for
practitioners, policy makers, and partners throughout the public
health system. Key foci include performance standards,
accreditation, workforce, infrastructure, community engagement,
public health, law, policy development, best practices and the
science of that practice, public health systems research, and public
health practice improvement strategies. The venue to facilitate the
discussion of practice issues will be the newly established Public
Health Practice Council.
MF: Dr. Bailey, in the state of Tennessee you spear-headed an
initiative, Bridges to Care (BTC), that linked thousands of
uninsured Tennesseans to health care through a public/private
consortium. Can you tell us how you did it, the challenges you
faced, and what led to the successful outcomes from these
initiatives?
Dr. Bailey: This effort was accomplished because everyone involved
recognized the reality of the impact of having 42,000 uninsured
persons in Davidson County and committed to the broader vision to
address this. The true engagement of stakeholders led to a mission
and a deliberate strategy for the city. As partners committed to
this effort, we all committed resources, time, and effort. This led
to continuous successful outcomes. Our target was to enroll 4,000
uninsured in the first year; by the end of the first quarter of the
first year, we had enrolled 8,000. Our target for BTC Plus, the
system of specialty services, was 3,000 slots within the first year,
and at the end of that year we had 4,200 slots. Some of the
challenges presented themselves mostly upfront: fear of taking this
on; the perception of already being at capacity; and, what would be
the cost? Also, there were issues around protection of turf,
constraints of procedures, and convincing others who needed to be
persuaded. Everyone at high levels stayed committed. Today, the
system has enrolled about 33,000 persons of the original 42,000; has
committed funding from the city government, all the hospitals, the
local foundations, and still is receiving some Healthy Communities
Access Program funds; the return on investment has been shown; and
two new clinics have been established to meet the demand. It is
governed by a 501C3 (the term “tax exempt,” when used in reference
to nonprofit organizations) and is used as a platform to address
disparity issues of medical and preventive practice; and is a model
for the state to address access issues secondary to TennCare's
enrollment policy in June '05. Partnerships with significant
partners in the city have enhanced the effectiveness of this system
(e.g., the local food chain, mental health community providers, and
Nashville's Medical Society). Michael, thank you for allowing me to
talk about this wonderful initiative that really changed the way
things were done in Nashville.
MF: While serving as Director of the Metropolitan Health Department
in Nashville, you served on CDC's Advisory Council for the
Elimination of Tuberculosis (ACET) from 1999 until 2003. During this
time, ACET called to attention the historically high rates of TB in
U.S.-born blacks that resulted in CDC funding three demonstration
projects in 2002 to target and intensify TB elimination activities
in the African-American community. Dr. Bailey, what fueled the fire in 2002 to address
historically high TB rates in this community?
Dr. Bailey: It was, and is really, a disgrace to still have TB, home
grown, and concentrated in specific areas (the Southeast and a few
cities outside of the Southeast) and among blacks, particularly when
TB is still relatively responsive to drugs. TB was decreasing
everywhere, and more and more counties were reporting no TB, but in
the Southeast, it was not. It seemed that with a little bit of extra
“oomph” we could do something about this trend and even reach the
definition for elimination.
MF: Considering the significant decreases in federal funding for TB
control and prevention, and for that matter decreases at the state
and local level, how do our programs maximize public health efforts
for desired health outcomes during these times of crisis?
Dr. Bailey: There will never be enough money. You posed the question
correctly as to how does the program maximize public health efforts
for desired health outcomes during these times of crisis? Clearly,
by maximizing the assets of a community, as evidenced above in an
earlier answer. While there are a lot of priorities for a local
community, the low- hanging fruit could be found in addressing the
TB incidence. The approach benefits other issues if true community
engagement happens and the messages are clear. Those communities
that have come together for efforts such as eliminating syphilis,
Racial and Ethnic Approaches to Community Health (REACH) relative to
the articulated health disparities, Step Up to Better Health,
Mobilizing for Action through Planning and Partnerships (MAPP), are
assuring access to care are coalesced in a sustainable way that will
allow them to take on and eliminate the impact of home-grown TB.
MF: Dr. Bailey, CDC and RTI International sponsored a summit, “Stop
TB in the African-American Community,” in May of last year, where
some 100 participants from the African-American community came
together to learn about TB; participants later participated in
breakout groups to develop strategies and action steps to take back
to their respective areas to raise awareness about TB. In addition,
three of the TB project areas that were funded by CDC to reduce TB
in African-American communities launched social marketing campaigns.
Other TB project areas use World TB Day to promote community
awareness through health fairs and other forums to raise awareness
about TB. What else can be done to mobilize around this disease so
that TB gets the attention and the provision for resources that will
be needed for elimination?
Dr. Bailey: Again, I think the processes and structures are in place
and tapping into them to cause impact may be a strategy. For
example, we still need to tap the National Association of Local
Boards of Health who governs the local health departments. We also
need to ask what mayors would want to have TB increasing in their
city. They like to compare with other cities and like to rank higher
than their colleagues, but not on some things like tuberculosis. So,
the U.S. Conference of Mayors may need to adopt the agenda. How do
you tie livability reports to living without TB? I think the
strategic engagement of the black community as you have done in the
past requires deliberate and ongoing follow-up to monitor the
strategic planning and results that come from it. TB is a
tremendously social and local phenomenon. Supporting the broader
vision and message to eliminate disparities will get to addressing
TB.
MF: Dr. Bailey, over the course of your career, you have served as a
faculty member at some of the nation's finest historically black
colleges and universities, one of which is Meharry Medical College.
From your experience, is the medical school curriculum addressing
the social and cultural factors that can influence health outcomes,
and are these schools and other schools like the University of North
Carolina at Chapel Hill, where you have served, including TB in
their medical school curriculum?
Dr. Bailey: To this question, let me just say that there is a lot of
room for improvement.
MF: Thank you Dr. Bailey. We wish you all the best in your position
here at CDC.
Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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