“Tennessee is illustrative of many states experiencing challenges with promoting health at the state level in a politically fraught environment.”
—RAND Corporation
Report Publish Date: October 2022
This report summarizes Tennessee’s health, wellbeing, and equity journey from 2016 to 2021, as part of the Robert Wood Johnson Foundation (RWJF) Sentinel Communities Surveillance project.
Through legislation, task forces, and economic development, the Tennessee had expanded access to health care and related services in rural areas.
During the period studied, the state was focused on preventing chronic disease, addressing mental health and substance use, and advancing livability and quality of life. The state has tended to focus on “treatment and cures,” the authors say, “rather than prevention and addressing the social determinants of health.”
Begun in 2016, RWJF’s Sentinel Communities Surveillance project tracks how a Culture of Health is developing in 29 communities across the country. The authors wanted to describe key challenges, opportunities, and insights in Tennessee.
The authors gathered information from phone interviews with Sentinel Community leaders; online, published, and local materials and media about the communities; and data sources including the Census Bureau’s American Community Survey, the CDC’s Behavioral Risk Factor Surveillance System, County Health Rankings, and state and local data collection systems.
For this report, the authors conducted 56 hourlong, semi-structured interviews between early 2017 and spring 2022. Interviewees came from several different types of organizations and sectors
“Tennessee is illustrative of many states experiencing challenges with promoting health at the state level in a politically fraught environment.”
—RAND Corporation
“Tennessee’s journey may be informative to other communities who have been challenged by a resistance to government intervention in health and a politicization of health and equity topics,” the authors write.
$2,700,000
Awarded on: 04/01/2022
Timeframe: 2022-2025
Grant number: 79462
Location: Santa Monica, CA
Tennessee is an Appalachian state that experiences stark urban/rural divides. The state has struggled with high rates of chronic disease; and substance use and mental health concerns have grown in recent years. State agencies—including the Tennessee Departments of Health, Mental Health and Substance Abuse Services, and Education—have led collaborative efforts to improve health and drivers of well-being in the state. Over the past five years, leadership of some efforts to address chronic disease has changed hands; and investments and services to address mental health and the opioid epidemic have increased. Economic development—particularly in rural areas—remains a top priority; and the approach to state-level educational attainment efforts has shifted. These efforts are illustrative of the health narrative in the state, which centers on a perception that health is an individual responsibility, that the government should play a limited role, and that education and economic development are pathways to well-being. Equity has been perceived as a partisan issue in Tennessee for many years, and stakeholders have learned to hone their communications strategies to advocate for structural changes in politically palatable ways. Incremental investments have helped more Tennesseans access needed physical and mental health services; though the state still struggles with low enrollment in government benefits programs relative to eligibility and ongoing well-being challenges—especially in its rural communities.
Robert Wood Johnson Foundation, October 2022
This study and report was conducted and created by:
A library of research and perspectives about Sentinel Communities, 30 diverse communities around the country.
See how you can pave the way to a future where health is no longer a privilege, but a right.