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Menu Labeling, Infant Mortality, Obesity, Mosquito Control, STDs

From health clinic operation to restaurant inspections... smoking-cessation education to approval of swimming pool plans... tracking infectious diseases to animal and pest control –– the duties of the Metro Nashville Department of Health are among the most varied and challenging in local government. Leading the department's charge to protect the health of those in Davidson County is William S. Paul, MD, who moved from Chicago to Nashville two years ago to take the job of executive director.

"Tying it together and communicating about it is part of the excitement and also part of the challenge," Paul said. "It ranges from vehicle-emissions testing and air quality to tall grass and weeds, keeping kids immunized and preparing for pandemics." And, he added, doing it all while riding herd on expenditures of taxpayer dollars.

Paul succeeded Stephanie Bailey, MD, who left the Health Department for the Centers for Disease Control and Prevention in Atlanta. "There was a lot going for this department when I came in," he recalled. Paul said two of his earliest moves were to "stabilize" animal care and control services and department initiatives regarding mosquito-borne illnesses, particularly West Nile virus. Those improvement strategies included better communication, particularly when it came to pesticide spraying for mosquito control.

That subject is right up the director's alley. Board certified in both internal medicine and infectious diseases, Paul served two years at the CDC himself, as an epidemic intelligence services officer in the Division of Vector-Borne Infectious Disease. Also, during his nearly 15 years with the Chicago Department of Public Health, he was what he called the "ringleader" of the Windy City's response to West Nile virus in 2002, when the city recorded more than 200 cases of the disease and 22 deaths.

"It helped to have that background moving here, but it's also been a little bit anticlimactic," he acknowledged. "We have an occasional case, but Nashville, Davidson County and Middle Tennessee generally have been very lucky on the disease front with mosquitoes. We don't seem to have the ingredients of major outbreaks for West Nile virus or some of the other mosquito-borne infections, at least we haven't so far."

Paul added the department is better targeting its mosquito-control efforts and only spraying "when we think the circumstances really reflect a high risk to people of getting mosquito-borne disease. But the fact is, the risk has always been quite low here."

Paul said department experts are eyeing with concern a rise in cases of tuberculosis and sexually transmitted diseases. "These things have not gone away," he said. "We had a slight uptick in TB in the last year, and we really need partnership with physicians and hospitals in the community to make sure that we're doing adequate management of TB patients and their contacts."

The same is true of syphilis, which Paul called "the great imitator" because its symptoms can mimic other problems. In the last two years, twice as many cases of primary and secondary syphilis were recorded as in the previous two years. "A lot of it has been in men who have sex with men, but just in the last year or so, we're starting to see an increasing number of cases in women again," he said.

When it comes to flu, a killer particularly of the very young and the elderly, this past flu season was "low key" and in fact one of the mildest seasons in years. That's good news, Paul said, yet that good news must be tempered with concern that there was "less than usual" interest in getting flu shots. Another positive note is that shots were available in more places this year, he added.

While acute health problems are top department worries, tackling chronic disorders, including those caused by unhealthy lifestyle choices such as tobacco use, is a growing department responsibility.

In an attempt to harness the community's ever-expanding obesity epidemic, Paul recommended to the Metro Board of Health that it pass a rule requiring chain restaurants to include calorie information on its menus. The board did just that in early March. Although Metro lawyers said the board was well within its scope to take such action, some members of Metro Council disagreed and introduced an ordinance voiding the menu-labeling requirement. The same is true for some members of the state legislature, who have championed a bill that would prohibit menu-labeling statewide. On the flip side, Gov. Bredesen and Tennessee Health Commissioner Susan Cooper are pushing statewide legislation that is much like the Metro board's rule. While Paul has found himself in the middle of this political firestorm, he stands fast in his conviction that menu labeling will improve Nashvillians' health. And that's his job.

"In the ideal world, it's everywhere," Paul said about menu labeling. "In the ideal world, it's a national solution, but sometimes you wait a very long time for that. It's a popular thing. Anywhere people have asked the public, 60-to-80 percent are in favor of putting calorie information on menus. We've had lots of great support from physicians and medical personnel who actually are dealing on the front lines with the obesity epidemic. I think we will see something like this that becomes a tool for consumers to help them in making diet choices through the day. Exactly how this is all going to work out, we're not sure."

Meanwhile, Paul said changes must be made incrementally and unswervingly, such as healthier lunches and more physical activity in schools and more sidewalks, greenways and parks in communities.

"There's a whole movement in Nashville right now to look at neighborhoods where it's easier to find junk food than it is to find quality food and finding ways to get grocery stores and fresh foods into every neighborhood," he said.

Yet, strolling to a nearby store isn't always so easy for many on days when air quality is poor, and Paul said controlling ozone "certainly meshes with the mayor's vision of a greener Nashville... The major driver of ozone, which is a trigger for asthma and a variety of respiratory conditions, is the number of miles we travel in our vehicles. It's the amount of driving around we do. So it's going to take a lot of time but also awareness."

Protecting the youngest among us is another department priority under Paul's leadership. "We will not rest until we have eliminated disparities in infant mortality, because it's just not acceptable to us that an African American baby is twice as likely to die in the first year as a white baby," he said. While medical care is one factor, there are others, including the health status of women before they become pregnant. "Are women really empowered to keep themselves healthy and in as good a condition as possible before they have a baby?" Paul asked. "It's a matter of individual choices but also putting systems in place to look at environments where people are living and making sure that our neighborhoods are as healthy as they can be."

He added, "Clearly, we can't do our job without the help of community physicians and hospitals. It's really important that we maintain that connection in order to be more successful in making Nashville a healthier place."

Born in Chicago, Paul grew up in its suburbs and then attended Stanford University, where he earned a bachelor's degree in biological sciences. He attended medical school at the University of Illinois, where he also earned a master's of public health.

Paul and his wife, Tonya, have three children, ages 15, 12 and 9. In what little spare time he has, he sings tenor in his church choir and runs to improve his own health. He enjoyed the Country Music ½ Marathon so much last year, that he tackled it again in April. "Once in a while, when I'm not shuttling children," he said, "I'll ride my bike to work."

Tags:

caloric menu labeling, Metro Nashville Department of Health, public health, William S. Paul

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