Community Context and Challenges

  • Tennessee’s reliance on and long commitment to tobacco continues to affect the health and well-being of its residents; in 2015, 22% of Tennesseans smoked compared with 18% nationwide.

  • Tennessee ranks 43rd out of 50 states for overall health; while the state’s overall obesity rate (31%) is comparable to the national average (30%), obesity and chronic disease disproportionately affect black and Hispanic residents.

  • Low educational attainment and high poverty rates are more prevalent in the state’s rural counties.

  • Only 25% of Tennesseans have a bachelor’s degree or higher, compared with 18% of black residents and 13% of the Hispanic population.

  • Tennessee is home to some of the nation’s best health care systems, with 87% of the population covered by health insurance; however, health care is more accessible in urban areas, and a majority of counties are medically underserved.

Community Actions: A First Look

Spurred by its most pressing health challenges, communities across Tennessee are investing in a wide variety of cross-sector initiatives.

Within the state and its three regions, leaders have formed innovative partnerships to address these and other issues and have mobilized a variety of stakeholders, including elected officials; public health departments; other government agencies, such as transportation and city planning departments; development districts; parks and recreation departments; law enforcement; departments of public works; advocates; nonprofit organizations; businesses and chambers of commerce; hospitals; universities; foundations; and schools. Those partnerships are working to address these issues at the state and local levels using a variety of strategies.


These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gauge ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

Going Forward: Questions for Consideration

Initial analyses point to numerous health challenges facing Tennessee, many of which are directly tied to disparities by income, education, region, and race/ethnicity. State, regional, and local agencies, along with private-sector partners, have taken steps to address their priority health concerns of obesity and tobacco use. The state is making progress in tackling childhood obesity by decreasing the percentage of students who are overweight or obese and increasing the percentage of students who are engaging in physical activity. The state has implemented some tobacco reduction efforts, but these are not always evidence-based or implemented with sufficient intensity or reach. The demographic, cultural, and geographic features of each region present unique challenges relating to the health and well-being of residents, which require varied approaches to developing and implementing local initiatives. Urban counties, such as Shelby and Davidson, have developed several large-scale initiatives involving multiple sectors, which include approaches such as policy change, integration of treatment and prevention, and changes to the built environment. Leaders in many urban counties have also been able to take advantage of resources and partnerships available to them through local universities. Rural counties, on the other hand, appear to be more dependent on regional, statewide, and national programs. Additional surveillance, data and information gathering, analysis, and reporting will examine the extent to which Tennessee’s initiatives are addressing the state’s priority health concerns, particularly among racial/ethnic minorities and populations with low incomes and low educational attainment. Future reports will also delve into the interaction between race/ethnicity, urban setting, and regional outcomes.

 

Ongoing questions for the state and each region include the following:

State

  • What factors contribute to the rural/urban disparities in socioeconomic and health outcomes? How does urban setting and race/ethnicity affect differences in outcomes by Grand Division? To what extent do approaches to advancing community health and well-being vary across Grand Divisions, and how are these being tailored to address population characteristics within each region?

  • To what extent do Tennessee stakeholders and residents share a common understanding of health inequities and how to address them, and to what extent does this differ across regions of the state? What efforts, if any, are being made to engage Tennessee’s underserved residents in the process of planning and implementing initiatives to address inequities?

  • What cross-sector collaborations are in place to reduce inequities in the urban and rural regions of the state? What collaborations exist in each region and what types of cross-regional collaborations exist (e.g., partnerships among rural counties across the state)? Who is involved and how?

  • How is Tennessee working to improve access to health care in underserved areas of the state?

  • To what extent have the state’s health priorities been integrated into the missions, goals, and actions of non-health-related organizations or sectors? In what ways are organizations in non-health sectors working to address health inequities? Are there specific efforts that are aimed to improve the health and well-being of certain groups experiencing disparities?

  • What initiatives exist across the state to improve infrastructure and modify the built environment to improve health and well-being?

  • To what extent are the Tennessee Livability Collaborative and the Healthier Tennessee Workplaces initiative affecting the health and well-being of Tennessee residents?

Grand Divisions

West Tennessee (Memphis/Shelby County)

  • In what ways are the voices of the large black population of this county incorporated into local decision-making processes about health and well-being? What is the status of leadership for this traditionally marginalized group?

  • What cross-sector collaborations are in place to meet the health care needs of the large proportion of uninsured residents in Memphis/Shelby County?

Middle Tennessee (Nashville/Davidson County)

  • In what ways is Middle Tennessee addressing the built environment as a part of its effort to build a Culture of Health and how have these efforts affected the health and well-being of residents? What changes to the built environment are planned in the near future?

  • How has leadership from the mayor’s office influenced Nashville’s path toward a Culture of Health?

  • In what ways has the presence of several major universities facilitated cross-sector collaboration in the Nashville area? What other influential partnerships, coalitions, or initiatives involve the universities?

East Tennessee (Knox, Hamilton, Washington, and Noncore Counties)

  • How is East Tennessee working to improve access to health care in medically underserved Appalachia? To what extent are mobile health clinics reaching the noncore counties with the greatest provider shortages in Appalachia?

  • What factors contribute to the rural/urban disparities in educational attainment? What is Tennessee doing to improve educational attainment in rural Appalachia?

Ongoing questions for the state and each region include the following:

State

  • What factors contribute to the rural/urban disparities in socioeconomic and health outcomes? How does urban setting and race/ethnicity affect differences in outcomes by Grand Division? To what extent do approaches to advancing community health and well-being vary across Grand Divisions, and how are these being tailored to address population characteristics within each region?

  • To what extent do Tennessee stakeholders and residents share a common understanding of health inequities and how to address them, and to what extent does this differ across regions of the state? What efforts, if any, are being made to engage Tennessee’s underserved residents in the process of planning and implementing initiatives to address inequities?

  • What cross-sector collaborations are in place to reduce inequities in the urban and rural regions of the state? What collaborations exist in each region and what types of cross-regional collaborations exist (e.g., partnerships among rural counties across the state)? Who is involved and how?

  • How is Tennessee working to improve access to health care in underserved areas of the state?

  • To what extent have the state’s health priorities been integrated into the missions, goals, and actions of non-health-related organizations or sectors? In what ways are organizations in non-health sectors working to address health inequities? Are there specific efforts that are aimed to improve the health and well-being of certain groups experiencing disparities?

  • What initiatives exist across the state to improve infrastructure and modify the built environment to improve health and well-being?

  • To what extent are the Tennessee Livability Collaborative and the Healthier Tennessee Workplaces initiative affecting the health and well-being of Tennessee residents?

Grand Divisions

West Tennessee (Memphis/Shelby County)

  • In what ways are the voices of the large black population of this county incorporated into local decision-making processes about health and well-being? What is the status of leadership for this traditionally marginalized group?

  • What cross-sector collaborations are in place to meet the health care needs of the large proportion of uninsured residents in Memphis/Shelby County?

Middle Tennessee (Nashville/Davidson County)

  • In what ways is Middle Tennessee addressing the built environment as a part of its effort to build a Culture of Health and how have these efforts affected the health and well-being of residents? What changes to the built environment are planned in the near future?

  • How has leadership from the mayor’s office influenced Nashville’s path toward a Culture of Health?

  • In what ways has the presence of several major universities facilitated cross-sector collaboration in the Nashville area? What other influential partnerships, coalitions, or initiatives involve the universities?

East Tennessee (Knox, Hamilton, Washington, and Noncore Counties)

  • How is East Tennessee working to improve access to health care in medically underserved Appalachia? To what extent are mobile health clinics reaching the noncore counties with the greatest provider shortages in Appalachia?

  • What factors contribute to the rural/urban disparities in educational attainment? What is Tennessee doing to improve educational attainment in rural Appalachia?

Ongoing questions for the state and each region include the following:

State

  • What factors contribute to the rural/urban disparities in socioeconomic and health outcomes? How does urban setting and race/ethnicity affect differences in outcomes by Grand Division? To what extent do approaches to advancing community health and well-being vary across Grand Divisions, and how are these being tailored to address population characteristics within each region?

  • To what extent do Tennessee stakeholders and residents share a common understanding of health inequities and how to address them, and to what extent does this differ across regions of the state? What efforts, if any, are being made to engage Tennessee’s underserved residents in the process of planning and implementing initiatives to address inequities?

  • What cross-sector collaborations are in place to reduce inequities in the urban and rural regions of the state? What collaborations exist in each region and what types of cross-regional collaborations exist (e.g., partnerships among rural counties across the state)? Who is involved and how?

  • How is Tennessee working to improve access to health care in underserved areas of the state?

  • To what extent have the state’s health priorities been integrated into the missions, goals, and actions of non-health-related organizations or sectors? In what ways are organizations in non-health sectors working to address health inequities? Are there specific efforts that are aimed to improve the health and well-being of certain groups experiencing disparities?

  • What initiatives exist across the state to improve infrastructure and modify the built environment to improve health and well-being?

  • To what extent are the Tennessee Livability Collaborative and the Healthier Tennessee Workplaces initiative affecting the health and well-being of Tennessee residents?

Grand Divisions

West Tennessee (Memphis/Shelby County)

  • In what ways are the voices of the large black population of this county incorporated into local decision-making processes about health and well-being? What is the status of leadership for this traditionally marginalized group?

  • What cross-sector collaborations are in place to meet the health care needs of the large proportion of uninsured residents in Memphis/Shelby County?

Middle Tennessee (Nashville/Davidson County)

  • In what ways is Middle Tennessee addressing the built environment as a part of its effort to build a Culture of Health and how have these efforts affected the health and well-being of residents? What changes to the built environment are planned in the near future?

  • How has leadership from the mayor’s office influenced Nashville’s path toward a Culture of Health?

  • In what ways has the presence of several major universities facilitated cross-sector collaboration in the Nashville area? What other influential partnerships, coalitions, or initiatives involve the universities?

East Tennessee (Knox, Hamilton, Washington, and Noncore Counties)

  • How is East Tennessee working to improve access to health care in medically underserved Appalachia? To what extent are mobile health clinics reaching the noncore counties with the greatest provider shortages in Appalachia?

  • What factors contribute to the rural/urban disparities in educational attainment? What is Tennessee doing to improve educational attainment in rural Appalachia?

Ongoing questions for the state and each region include the following:

State

  • What factors contribute to the rural/urban disparities in socioeconomic and health outcomes? How does urban setting and race/ethnicity affect differences in outcomes by Grand Division? To what extent do approaches to advancing community health and well-being vary across Grand Divisions, and how are these being tailored to address population characteristics within each region?

  • To what extent do Tennessee stakeholders and residents share a common understanding of health inequities and how to address them, and to what extent does this differ across regions of the state? What efforts, if any, are being made to engage Tennessee’s underserved residents in the process of planning and implementing initiatives to address inequities?

  • What cross-sector collaborations are in place to reduce inequities in the urban and rural regions of the state? What collaborations exist in each region and what types of cross-regional collaborations exist (e.g., partnerships among rural counties across the state)? Who is involved and how?

  • How is Tennessee working to improve access to health care in underserved areas of the state?

  • To what extent have the state’s health priorities been integrated into the missions, goals, and actions of non-health-related organizations or sectors? In what ways are organizations in non-health sectors working to address health inequities? Are there specific efforts that are aimed to improve the health and well-being of certain groups experiencing disparities?

  • What initiatives exist across the state to improve infrastructure and modify the built environment to improve health and well-being?

  • To what extent are the Tennessee Livability Collaborative and the Healthier Tennessee Workplaces initiative affecting the health and well-being of Tennessee residents?

Grand Divisions

West Tennessee (Memphis/Shelby County)

  • In what ways are the voices of the large black population of this county incorporated into local decision-making processes about health and well-being? What is the status of leadership for this traditionally marginalized group?

  • What cross-sector collaborations are in place to meet the health care needs of the large proportion of uninsured residents in Memphis/Shelby County?

Middle Tennessee (Nashville/Davidson County)

  • In what ways is Middle Tennessee addressing the built environment as a part of its effort to build a Culture of Health and how have these efforts affected the health and well-being of residents? What changes to the built environment are planned in the near future?

  • How has leadership from the mayor’s office influenced Nashville’s path toward a Culture of Health?

  • In what ways has the presence of several major universities facilitated cross-sector collaboration in the Nashville area? What other influential partnerships, coalitions, or initiatives involve the universities?

East Tennessee (Knox, Hamilton, Washington, and Noncore Counties)

  • How is East Tennessee working to improve access to health care in medically underserved Appalachia? To what extent are mobile health clinics reaching the noncore counties with the greatest provider shortages in Appalachia?

  • What factors contribute to the rural/urban disparities in educational attainment? What is Tennessee doing to improve educational attainment in rural Appalachia?

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