In order for Tennessee to receive more A’s when it comes to health status and programming, new Department of Health Commissioner Susan R. Cooper believes it may require a heavy concentration on “C’s”: communication, cooperation and collaboration.

The first nurse to hold Tennessee’s highest ranking health job, Commissioner Cooper plans to bring the teamwork skills honed on the unit floor to state government. She said that in nursing she found each team member brought something different to the table and that combining their expertise heightened outcomes.

To maximize the impact of programming and stretch state dollars, she said it was important to ask questions such as, “Where can we collaborate? Where can we leverage resources? Where can we put our collective knowledge to work?”

Cooper also noted a “can-do” attitude is an essential element in continuing the state’s recent momentum in making incremental improvements in national health status rankings.

“‘Can’t’ should be a word taken out of our vocabulary. I want us to approach every problem with ‘how can’ … ‘how can we do that?’” she stressed. “That’s what nurses do … we figure out how to get things done.”

To foster this collaborative environment, Cooper began issuing invitations to key provider groups immediately following her January 20 installation. Her main objective was to gain insight into the issues each group faces and assess how her department can serve them. “I think nurses are very good about listening.

I think I should be a facilitator of the dialogue that takes place … my job is to invite people to the table,” she explained.

Having said that, Cooper added she realized that different stakeholders wouldn’t always see eye-to-eye on the issues. In those cases, she said it was her job to “foster an environment where it’s OK to disagree.” Despite differing points of view, she believes it is often possible for the various stakeholders — consumers, providers and legislators — to find some common ground.

While Commissioner Cooper has made it clear she wants her department to be seen as responsive to its constituency’s needs, she said in the end her decisions must be rooted in fact rather than emotion.

“I have to make data-driven decisions based on the evidence,” she said, adding the goal is for the state to create evidence based public policy grounded in the sciences and to gage success through measurable outcomes.

“I’ve really taken a serious look at what the role of the commissioner of health is … it’s to protect the health of the citizens of the state, promote wellness, and work on programs that will improve the health status of all Tennesseans,” she outlined.

Her leadership of the state’s safety net program and then later Project Diabetes and GetFitTN reflect her desire to implement manageable, measurable change with a focus on both treatment and prevention.

“We’ve got to put goals within reach of people,” she said. “If you think about our GetFitTN program, we really built a platform around fitness. We’re not asking everyone to be marathon runners … start wherever you are and incrementally increase moving toward the goal of 30 minutes of regular physical activity per day.”

Targeting behavioral changes to reduce chronic risk is a central component in the programming Cooper envisions.

“This is a good place for a nurse. We bring to the table a focus on prevention and wellness,” she said.

Programs related to fitness, nutrition, alcohol abuse and tobacco use are all expected to reap long-term rewards when it comes to the overall health of Tennesseans. Last fall, the Department of Health rolled out a new program geared toward tobacco cessation. In the State-of-the-State address in February, Governor Bredesen outlined his plan to increase the tobacco tax to add funding for education and health-related activities.

Cooper said the governor “very clearly understands the benefits of health promotion.” She added that her department welcomed the opportunity to collaborate with the Department of Education to roll out programming that could ingrain good habits into a new generation.

“Health does not happen in isolation,” she pointed out. “Health and education are very closely linked.”

Already the schools have begun making changes that could have a lifelong impact on students including enhancing the nutritional value of school lunches, increasing the number of minutes of physical activity during the school day, limiting vending machine offerings and involving corporate partners to implement new walking programs.

“If you want to change the health status of the state, you can’t do it one person at a time. We have to move back at least one generation so we have to focus on the children,” Cooper said. She added, “The literature indicates that to make lifestyle behavioral changes long lasting, you need to get to them (children) before the age of 12.”

All of these positive steps helped the state receive one of its first A’s when it comes to health. Tennessee was one of only six states to receive top marks in the fight against childhood obesity.

However, Cooper readily admitted the A’s were all too few when it comes to the state’s health rankings. Just a few weeks into her four-year tenure, it was evident the commissioner was keenly aware of the vast amount of work that lay ahead.

“You don’t get anywhere by dreaming small … you have to dream big,” she said. “Every minute not used wisely to address the health status of our citizens is a wasted minute for me. I don’t want to lose an opportunity.”

March 2007

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