FAQs and History of Vital Signs

Tennessee’s Vital Signs are 12 metrics meant to measure the pulse of Tennessee’s population health. Taken together, they provide an at-a-glance view of leading indicators of health and prosperity in our state. As opposed to a ranking, where the relative value of one state’s rank versus another’s makes comparisons to a healthy standard difficult, Tennessee’s Vital Signs seek to provide an objective answer to the question, “How healthy is Tennessee?”

• In order to measure and communicate the success of Tennessee’s population health improvement efforts, TDH determined a simple scoreboard was needed. Traditionally, TDH has relied upon various national and local rankings to benchmark success in improving health. However, the relative nature of any ranking system makes it difficult to determine whether a metric with a higher rank is a good or poor outcome.
• In 2015, the National Academy of Medicine (NAM) published a report entitled Vital Signs: Core Metrics for Health and Healthcare Progress. This report sought to provide a more objective and systematic comparison of health-related metrics, and it inspired TDH to adapt the report’s approach to serve as a health scoreboard for Tennessee.
• TDH tested this approach through an extensive public engagement process throughout 2015, including nine public meetings, one in each of the state’s congressional districts. Throughout this engagement, though, participants expressed concerns with aspects of the NAM’s selected metrics, voicing a desire to give greater emphasis to measures such as oral health and behavioral health.
• As a result, TDH determined a second round of public engagement was needed to develop a scoreboard that would more accurately reflect the perspectives and priorities of people in Tennessee. In 2016, TDH held eight additional forums across the state to solicit feedback on two questions: how to define population health, and, based on that definition, how to measure population health. Participants generated hundreds of suggested metrics to be considered for a set of Tennessee-specific Vital Signs.
• TDH staff synthesized, researched and considered all suggested metrics, evaluating them for final inclusion in Tennessee’s Vital Signs based on the following criteria:
  • Data availability. Data are available at a minimum of a state level. If data aren’t available for a desired metric, TDH could pursue a course to collect that data in the future, but a different metric would need to serve as an initial Vital Sign. For example, the best currently available data for oral health at a statewide level is access to fluoridated community water systems. TDH hopes to develop and move to a future Vital Sign measuring cavities in children, though the data to support such a Vital Sign are not currently available.
  • Meaningfully upstream outcomes. Each Vital Sign influences other aspects of health, helping people see the need to move upstream to address issues early. For example, instead of drug overdose deaths, a preferred indicator is drug overdoses, which is an understandable outcome to most people while also helping inform the likelihood of future drug overdose deaths. It is also closely linked with doctor shopping and other risky behavior. By focusing on efforts to reduce the number of drug overdoses, drug overdose deaths should decrease over time while quality of life metrics should increase.
  • Collective assessment of health and prosperity. Taken together, the selected metrics present a balanced and easily understood dashboard of Tennessee’s health and prosperity. Health and prosperity are linked, so economic metrics such as per capita personal income will have an effect on Tennessee’s population health. Similarly, youth obesity and physical activity will have an effect on Tennessee’s economic performance.

Vital Signs are not directly linked to individual performance plans, but instead will guide TDH’s strategic planning efforts through the State Health Plan, County Health Assessments, and County Performance Plans. To the extent that one of these plans guides an employee’s job responsibilities, then an employee may be working directly on a Vital Sign or related issue.

• Recognizing the need for the state to coordinate its efforts to improve the health and welfare of the people of Tennessee, the General Assembly passed Public Chapter 942 in 2004.  This act created the Division of Health Planning that was charged with developing a State Health Plan. The Public Chapter required the State Health Plan to be annually revised and approved and adopted by the Governor.
• The State Health Plan exists to consider the factors that determine health, consider the resources we can utilize to improve health, and coordinate the people who lead the way toward making Tennessee healthier. The State Health Plan has been designed to organize resources, prioritize recommendations, and align and coordinate efforts to efficiently and effectively address persistent health challenges the state faces.
• The State Health Plan offers a blueprint for improving the health of people in Tennessee.

The State Plan serves as the overarching health policy document for the Department of Health and Tennessee as a whole. In this role, the SHP aligns with the mission of the Department and coordinates the efforts of various divisions around this mission.

One role of the State Health Plan is to monitor the health of the state. Previously, the State Health Plan utilized America’s Health Rankings to achieve this. Going forward, the State Health Plan will instead utilize Vital Signs to monitor the pulse of the state. Vital Signs provide an opportunity to track progress on indicators that have been identified as priorities to the Department and the state as a whole.

Vital Signs represent a very high-level view of health in Tennessee. As a result, they will not directly impact most employees’ work on a day to day basis. However, by focusing on each of our daily tasks, the work of the Tennessee Department of Health and our partners should ultimately improve our Vital Signs over time.

The Vital Signs project is committed to showing an at-a-glance view of Tennessee’s population health. As a result, the number of Vital Signs is not expected to increase; however, individual Vital Signs may change over time as new data become available or to adjust to new priorities issues.

Nope! The Big 4 are actually included as Vital Signs.

We are currently in the process of identifying proxy variables and/or small area estimates.

Great question! We are working on ways to improve receipt of data in a timely fashion so it is as relevant as possible.

Vital Signs can be thought of as the “what” while Primary Prevention Initiatives (as well as County Performance Plans) can be regarded as the “how.” In short, Vital Signs can help identify important health issues in a county, while PPIs/CPPs identify strategies for how to resolve those issues.

Vital Signs are meant to serve as outwardly facing indicators specifically for people without a public health background. If your program is not explicitly listed in the 12 Vital Signs, it is still important to TDH—and to those without a public health background, even if they don’t realize it. Because there are too many important issues to track in a short list, TDH is developing a more extensive index of indicators called Key Health Signals that will play an important role in rounding out Vital Signs. 

While high blood pressure or a fast pulse at rest might indicate a person is not well, greater context is often needed to fully understand and diagnose a problem. In the same way, Tennessee’s Vital Signs will provide a quick understanding of whether Tennessee is healthy, but in order to create a solid plan for action, more context is needed. Key Health Signals serve as a broader index of measures meant to provide context for Vital Signs and to track additional topics of interest and importance.

The TDH Office of Health Policy will continuously gather data to track Vital Signs.

Information about Vital Signs will be published in each forthcoming annual edition of the State Health Plan. Additionally, the Department is developing a webpage specific to the State Health Plan that will house an interactive dashboard for Vital Signs where details about each Vital Sign and the supporting Key Health Signals can be found.

Taken together, the selected metrics present a balanced and easily understood dashboard of Tennessee’s health and prosperity. Health and prosperity are linked, so economic metrics such as per capita personal income will have an effect on Tennessee’s population health. Similarly, youth obesity and physical activity will have an effect on Tennessee’s economic performance.