Tennessee has remained among the worst states for overall health since America's Health Rankings began ranking the states in 1990. The most recent edition ranked Tennessee as 42nd among the states. While this is an improvement over the state's ranking of 48th in 2008, it continues a decade's long trend of dismal ratings. Many of the state's issues identified in the rankings, such as high rates of violent crime, low birth weight infants, and infant mortality, also characterize health in Hamilton County. These, along with obesity, smoking, and the percentage of children living in poverty, were identified as issues in the Ochs Center's 2013 State of Chattanooga Health Report.
It is tempting to rely on public service messages and programs to encourage people to engage in healthier habits in order to improve the state's and the region's health. The problem with these approaches is that they often don't work. Behavior change is hard, especially when it involves ingrained habits such as poor eating, lack of exercise and smoking. Such approaches also fail to take into account the background conditions that lead to poor health.
An important addition to our understanding may be found in a National Institutes of Health sponsored study completed last year. "Shorter Lives, Poorer Health" found that the U.S. ranks far poorer on several key health measures than most European countries and Japan. Interestingly, the same health issues that are identified as problems for the U.S. are also problems for Tennessee; namely, low birth weight infants, violent crime, and obesity. This makes our poor rating even harder to accept, for it means we are among the least healthy states in a generally unhealthy nation.
Several findings of Shorter Lives, Poorer Health are helpful when considering Tennessee. The study found, for example, that even affluent, insured Americans suffer from poorer health than those in similar groups in the comparison countries. Higher rates of disease and premature death in the U.S. are not reserved for the poor, but for the middle class and wealthy as well. The authors of the report suggest that social and economic differences are contributing factors to the poorer health of the nation. The gap between the rich and the poor is more pronounced in the U.S., and there is an increasing number of children in poverty. In looking at Tennessee, it is likely not a coincidence that we do poorly on such measures as income disparity, social mobility and children in poverty. There is a high probability that the poor will remain poor in Tennessee, and this negatively impacts the health of all of us.
Improving the overall health of the state and of the region means not only encouraging people to adopt healthier habits. It also means improving opportunities for the disadvantaged. In addition to safer streets, we need to ensure that educational and economic opportunities are available throughout the region, and to find ways that help people avail themselves of these opportunities. We need to understand that poverty and wide income disparities are unhealthy not just for the poor, but for all Tennesseans.
Dr. Rick Mathis is a health researcher and writer and was the principal author of the Ochs Center's 2013 State of the Region Report on Health.