Metropolitan Nashville/Davidson County Health Department, TN
Description of Sites / Initial Thoughts about the Use of MAPP
Davidson County, which includes the city of Nashville, is the second most populous county in Tennessee, with an estimated population of 535,000. Race/ethnicity estimates are 73 percent white, 25 percent black, and 2% other. Tennessee has a state centralized public health system—local health department staff members are state employees, except in the metropolitan areas of Chattanooga, Knoxville, Memphis, and Nashville.
A six-member board of health (BOH) governs the Metropolitan Health Department of Nashville and Davidson County (MHD). BOH members include a physician, a psychiatrist, a lawyer, and two community representatives, each serving five-year terms. The BOH views MAPP as a tool for aiding its work.
With nearly 500 employees and more than 40 programs, the health department is focused on the delivery of population-based services. In 1995, under the leadership of Stephanie Bailey, the health department made the commitment to population-based services and began to transition out of primary care. The MHD reorganized and developed the Division of Health Promotion, the Division of Epidemiology, and reduced the number of clinics providing direct services. The MHD used APEXPH and reviewed APEXCPH; it also initiated Healthy Nashville, a process similar to MAPP. The process resulted in five coalitions working to implement the plan. Although the coalitions are still active, minimal work has been accomplished since Healthy Nashville's implementation owing to a lack of community buy-in and a lack of health department staff to focus on the process. The MHD views MAPP as a way to reconnect with the community and engage in a sustainable process.
In addition to its experience with assessment, the MHD is experienced in coalition and partnership building. Nearly the entire health promotion staff is involved in at least one partnership. Ironically, Nashville's strength of partnership development may be its biggest challenge. Nashville has shown the ability to form sustainable and productive partnerships; however, these partnerships and coalitions have developed from a project or health issue. The greatest challenge is integrating the work of all of the coalitions into one process. Executive management is hoping that MAPP can provide overarching direction for all of the existing health improvement initiatives.