Walking the Walk ... Mayor Karl Dean doesn’t just talk a good game about fitness. He actually burned up the pavement and the miles with Nashvillians as part of his ‘Walk 100 Miles’ initiative.

Making the healthy choices easier.

That’s the crux of a multi-pronged strategy by Metro government to make Nashville a healthier place. Banking heavily on the “ounce of prevention” mantra, the initiative is dubbed NashVitality and encompasses a variety of programs to encourage citizen wellness.

“We have this dream that Nashville will become a destination for people interested in being healthy and active. We are the healthcare capital, so why should we not be the healthy living capital?” asked William S. Paul, MD, director of the Nashville Public Health Department.

A Little History

First, there was Healthy Nashville, a program of the mayor’s office that dates back more than a decade to the Phil Bredesen administration. Through the years, the Healthy Nashville Leadership Council, appointed by the mayor, identified the priorities of healthy eating and active living, tobacco cessation and eliminating health disparities and then set in motion activities such as walkathons and community gardens to accomplish those goals.

In the last couple of years, though, Healthy Nashville has become just one of several programs under the umbrella of NashVitality, which Paul described as “a brand that ties them all together with a positive feeling about Nashville.”

NashVitality is not one organization or one effort, Paul noted. “It’s a movement of people who are taking steps, whether in businesses, neighborhoods or schools, to make the healthy choice the easy choice and making the healthy choice the more normal choice,” he said. “You shouldn’t have to be a hero to be healthy. You shouldn’t have to take extraordinary measures. It should be fairly ordinary for people to eat healthy food and get physical activity, not something that just highly super-motivated people do.”

The Power of a Grant

NashVitality was born in 2009, thanks to a two-year, $7.5 million federal grant from the Department of Health and Human Services. Nashville was one of only 44 communities nationwide to receive funds from the Communities Putting Prevention to Work (CPPW) campaign, which is a $373 million program of the 2009 federal stimulus package. Nashville’s grant money is administered through Paul’s department.

“The idea was to focus particularly on communities that had made some progress and see if additional, significant investment in prevention over a short period of time could have an impact on health parameters and ultimately reduce healthcare costs,” Paul explained.

The focus for CPPW grants is less on individual behaviors and more on places, policies, environments and systems that might be a detriment to prevention strategies and individual wellness. Paul said Nashville’s CPPW efforts are targeting neighborhoods, schools, workplaces and places of worship. Specific campaign initiatives include:

• Share the Road: a campaign to promote safe use of roads by bicyclists and motorists.
• Gold Sneaker: a best-practice program integrating physical activity and healthy eating into Head Start classrooms, thus building lifelong skills for healthy living.
• Nashville Bike Share: a program allowing residents to check out a free bicycle at the downtown Music City Star Riverfront station or the Shelby Bottoms Nature Center. Residents need only register for access to the bikes, dubbed “City Cruisers.” An additional 100 bikes will soon be added to the fleet.
• Urban Gardens: gardening that allows older generations to teach the younger generation how to grow healthy foods.
• Healthy Corner Markets: an initiative to make it possible for corner stores in “food desert” neighborhoods to carry fresh and healthy food items.
• A media campaign to tie the elements of the project together and promote sustained improvements in healthy eating and active living was also launched.

One of the most recent additions to this list – and one that has enjoyed a surge in popularity and media coverage – is Mayor Karl Dean’s “Walk 100 Miles” challenge.

Strolling with Dean

With a history during his administration of frequently joining community residents for neighborhood walks, the idea of a targeted challenge to get Nashvillians moving was one that Dean embraced. Thus, Walk 100 Miles was born in April, and a series of 29 walks ranging from one to 10 miles was mapped out. When the final walk was completed on July 9, more than 4,000 Nashvillians had joined the mayor to walk more than 100,000 miles. About 500 walkers logged all 100 miles.

“I get annoyed when I read these rankings that say we’re a sedentary state. I don’t think we are,” Dean said the day before the final 7.9-mile trek along the Shelby Bottoms Greenway. “We’ve invested lots of money into having a very beautiful and sophisticated parks system and great greenways. We have a lot of active people here. During our organized walks, we run into scores of people on the greenway biking, skating, walking, running. People are using them, and this city wants to do things together.”

Yet, Dean acknowledged that Tennessee’s health statistics are far from the best. In fact, data released in July by the Trust for America’s Health said waistlines of Tennesseans grew faster in the last 15 years than residents in all but two other states. During that time, the state’s obesity rate doubled to 32 percent.

“I really do think there is a huge interest in Tennessee, and in Nashville in particular, to confront this issue about more healthy living. Whether it’s eating better or exercising more, I think people realize that we need to begin to change some of our habits,” Dean said. “This is also a huge issue for the entire country in terms of healthcare costs. It adds a great deal to the costs of governments and businesses.”

Dean said that, in recent years, Metro has increased its investment in parks and greenways by about $20 million. In April, Dean unveiled the city’s first comprehensive Open Space Plan and earmarked $5 million for land acquisition. The city also is funding more sidewalks and bikeways. “I signed an executive order saying that streets must be designed for consideration of pedestrians, bikeways and transit,” he said.

Dean noted there’s another twist to Nashville’s healthy-living push: public safety. “If people are going to take advantage of our parks and greenways, if people are going to ride mass transit, if people are going to walk around downtown, then we have to have a safe city,” he said. “Nothing works unless the city’s safe. We’re not there where we need to be, but we’re making progress.”

From a Physician’s Perspective

Paul is quick to concede that when he was in active practice, he didn’t give as much thought as he should to his patients’ environments. Were they safe in their neighborhoods and workplaces? Were healthy foods available? Were opportunities for exercise just a pipe dream? “Once a physician has gone out to the neighborhoods their patients live in, oftentimes it’s a real eye-opener,” Paul acknowledged. And he encouraged doctors to consider taking a drive.

“We’ve gotten to a place in healthcare where there are a lot of costs, and then we look around and ask, ‘Well, how healthy are we for all the money we’re spending?’ Our health doesn’t seem to be getting better right now, so I think there needs to be a realization that it’s not all about diagnosis and treatment and medical care,” Paul said. “There are other aspects to health that are upstream, that are more in the prevention realm.”

Physicians, according to Paul, can play an advocacy role, and they will be more effective if they understand the “context” of their patients. “What we’re trying to do with public health now is change the context,” he said, “so that it’s easier to be healthy.”

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