How Comprehensive Community-Wide Hypertension Data Are Inspiring Heath Equity

It’s no secret that the best data often begets the best policy, especially when it comes to community health and wellness. Having accurate, timely, and well-informed data is often the difference maker that allows communities to dramatically move the needle on health disparities.

When it comes to health disparities, the city of Nashville can – and must – do better. Nashville is known nationally as a health services capital, yet our own community health and well-being statistics rank far worse than the cities we compete with on a daily basis.

For many, this comes as a surprise. Nashville is filled with top-level academic institutions, nationally renowned hospitals, and tremendous economic growth, and it is home to some of the largest health and hospital systems in the country. But when compared to cities like Austin, Charlotte, Denver, and Dallas, we have the worst life expectancy and highest rates of infant mortality, smoking, and number of poor mental health days by far.

_{Figure 1: Compared to all “sister” cities, Nashville ranks the absolute worst – or close to it – in measures of life expectancy, infant mortality, smoking, physical inactivity, number of poor mental health days, and obesity, according to recent data from the Robert Wood Johnson Foundation.}

How can Nashville, an otherwise thriving city, work to ensure that every single one of our community members has an opportunity for a healthy life?

To start, Nashville needs to more deliberately cultivate a culture of health where our public health infrastructure is complementary to our economic prosperity and our public health wellness is comparable to that of our economy. Building this forward-looking culture requires a comprehensive, community inspired data platform that can accurately identify health challenges, inspire appropriate interventions, and, ultimately, combat disparities and improve health outcomes.

The Vision

Six years ago, I worked with NashvilleHealth, a community-based nonprofit focused on improving the health and wellness of every single Nashvillian, to propose a comprehensive, trusted, sustainable platform for health data collection and analyses that would be a part of a larger vision to move the needle on Nashville’s health disparities. Here is what we said in 2016:

“Currently, no centralized data platform for multi-sector health, demographic, and social determinant data for Nashville-Davidson County exists. Such information and its ongoing accumulation and analysis are fundamental to accurately identifying barriers to better health, to smartly designing interventions, and to measuring and tracking outcomes. It has the potential to save societal healthcare costs (and thereby offset some of its operational costs) and enhance our community’s understanding of underserved populations.”

What Nashville needed was to establish a user-friendly, privacy-protected, dynamic database to enable and facilitate substantially improving the health and well-being of our community. Though we have much work to do to make this vision a true reality, Nashville has made tremendous progress since this initial proposal.

The Progress

NashvilleHealth took the first step. In 2019 NashvilleHealth, in partnership with the Nashville Metro Public Health Department, conducted a countywide Community Health and Well-being Survey to identify and document Nashville’s health challenges. As the first comprehensive health survey conducted in Davidson County in over 18 years, it unveiled harsh health disparities among our most vulnerable and clearly identified key health challenges fundamental to achieving sustainable growth and prosperity.

Of these, the hypertension (high blood pressure, which is a preventable cause of morbidity and mortality) data were some of the most alarming:

• African Americans were most likely to report high blood pressure (47.6%), nearly twice that of White Nashvillians and considerably higher than Hispanic/Latino adults who were least likely to indicate this condition (11.4%).
• Education levels were tied to hypertension prevalence, with lower levels of hypertension reported for college graduates (17.7%) and those with graduate or professional degrees (23.4%) than for persons with less than a high school education (39.6%).
• Unemployed persons were nearly twice as likely to report hypertension than those employed (45.3% compared to 23.0% respectively).
• Though not statistically significant, lower incomes reported higher prevalence of hypertension.
• North Nashville and Northwest Nashville, two communities that have been historically underserved, were the two zones with the highest prevalence of hypertension.

This type of real-time, comprehensive data was necessary to cultivating NashvilleHealth’s mission and has the power to catalyze true, life-altering impact. Its limitation is that the data are gathered at a single point in time. To build on these data, NashvilleHealth and I reached out to Belmont University in 2021 to once again propose a comprehensive and sustainable data center that would positively impact the wellness of our community.

After meeting with the Dean of Belmont’s Massey College of Business, Dr. Sarah Fisher Gardial, in June 2021, followed by a meeting with the university’s then-newly appointed President, Dr. Greg Jones, in July, Belmont leadership immediately saw the necessity of a comprehensive, open data warehouse dedicated to identifying our region’s health disparities and inspiring measurable, reproducible action.

The university took on this endeavor with much alacrity under the guidance of Dr. Charles Apigian, the Executive Director of the Belmont Data Collaborative. Over the course of the last year, the collaborative, working with the American Heart Association, BlueCross BlueShield of Tennessee, Change Healthcare, NTT DATA, Inc, and many others, has worked around the clock to compile data from not only the city of Nashville itself but the entire state of Tennessee. In doing so, they have taken another major step toward achieving our vision for a publicly available and interactive data warehouse.

Moreover, the NashvilleHealth hypertension data – and hypertension data from many other community-minded contributors – were collected, compiled and analyzed as a part of an initial report on the state of hypertension in Nashville. The report estimates that in both direct and indirect costs, hypertension costs the city of Nashville over $126 million a year. It also identified key hypertension disparities within Nashville by race, ZIP code, and health insurance status and generated a map of where we should focus our attention and resources.

While the report itself is only the first fully fledged product from Belmont’s data collaborative, its findings – along with those gained from NashvilleHealth’s critical initial community survey – have effectively set the stage for sustainable and impactful community-wide hypertension initiatives that will propel our city toward a more equitable and healthier future. And a healthier community means more fulfilling lives for each of us and generations to follow.

These data reveal disheartening disparities that will appropriately inform specific interventions to help ensure every Nashvillian has an opportunity to be healthy. Current, accurate, and robust data do not only lead to good policy – they also lead to measurable and meaningful impact, building a bridge between inequities and downstream health outcomes and fortifying a true culture of health and wellness.

_{The author wishes to thank, among others, the visionary support of Caroline Young, Neil de Crescenzo, Molly Sudderth, President Doug Jones, Mark Yancy, and Dr. Charlie Apigian for their numerous contributions to creating a health and well-being data warehouse for Tennessee.}