Public Health

Public Health is the science and art of protecting and improving the health of communities through education, the promotion of healthy lifestyles, and research on disease and injury prevention. Treating the entire community as a patient helps us to both communally and individually achieve better health. The dramatic achievements of public health in the 20th century have improved our quality of life: an increase in life expectancy, worldwide reduction in infant and child mortality, and the elimination or reduction of many communicable diseases.

In Middle Tennessee an increase in preventive medicine and advanced medical technology has resulted in increased life expectancy and improved health for many residents. However, significant health disparities exist, resulting in poor health status often related to economic status, race, and/or gender.

Socioeconomic status is a strong predictor of health and longevity. Researchers have found that with each step taken down the socioeconomic ladder, health is generally poorer and life expectancy shorter. The public policy implications of this research become more pronounced with the growing disparity between rich and poor. Whether national or local, every policy decision that affects social, educational, and financial status also affects health.

In 2010, Tennessee ranked 42nd overall in national health rankings by state. This reflects a change of +2 since 2009 (when it was ranked 44th), but there is clearly still much to be done to improve public health in our state. While Tennessee’s strengths included a low prevalence of binge drinking and high immunization coverage, our challenges include a strikingly high rate of obesity and a high violent crime rate. Roughly 1 in 3 Tennesseans are obese. Our high infant mortality rate means 8.5 deaths per 1,000 live births.

Health disparities in Tennessee are not only socioeconomic, but largely racial as well: obesity is more prevalent among African-Americans (at 41.1%) than whites (at 29.8%). The prevalence of diabetes varies by race and ethnicity in the state; 12.6% of African-Americans have diabetes compared to 10.9% of non-Hispanic whites.


Key Public Health Battles

National public health battles range from containing deadly contagious diseases to pushing for healthier lifestyles, from reducing incidences of preventable diseases to minimizing the consequences of catastrophic events, from providing the basics of sanitation to safe food and water. Consider that:

  • Approximately 80–90% of all cancers may be influenced by environmental and lifestyle triggers.1 While many of these triggers are still unknown, some of them, such as asbestos, are being eliminated as a result of public health initiatives.
  • Eating out probably isn't a perk you attribute to public health, but an unsafe food supply, such as the recent E.coli outbreak of bagged spinach, can affect the health of anyone, anywhere. Public health officials worked quickly to contain the E.coli outbreak in August 2007 across 26 states, limiting the number of those affected to under 200.2
  • According to the Department of Health and Human Services, secondhand smoke causes approximately 3,000 lung cancer deaths annually.3 Thanks to public health efforts that linked secondhand smoke to cancer and advocated for smoke-free zones, steps are being taken to save lives. Following New York state's smoke-free law, employees of restaurants and bars saw a 78% decrease in cotinine levels (a measure of their secondhand smoke exposure).4
  • The true dangers of an innocent donut became much more apparent thanks to public health. Trans fats are a major contributor to coronary heart disease – the number one cause of death in America. Public health efforts to discourage the use of trans fat in restaurants and decrease other heart disease risk factors have contributed to a 60% decrease in the death rates from the disease since 1950.5
  • Driving to work in the morning would be a lot more dangerous without public health efforts to promote motor vehicle safety standards like airbags and to change personal behavior to encourage seat belt use. Since being required by law 31 years ago, seat belts have saved over 135,000 lives and prevented over 3.8 million injuries.6
  • Old age used to mean being a senior citizen by age 40, but public health has changed that. Improvements in water, sanitation and nutrition have been largely responsible for increasing life expectancy in the US from 47 years in 1900 to 78.2 years in 2007.7 That's an increase of over 66% that resulted from efforts to improve health conditions and behaviors.8
  • The flu is a public health issue. In the United States, influenza causes an annual average of 36,000 deaths, ranking it 7th among all causes of death.9 Public health laboratory technicians, researchers and administrators work together each year to prevent flu disease and death.
  • The percentage of overweight children has soared to epidemic proportions in the past 20 years, with approximately 18% of children affected.10 Public health officials promote consistent exercise and proper diet as ways for children to improve their physical health.

(examples taken from This is Public Health,



Effects of the Recession

The current economic recession has resulted in fewer people having access to health care, due largely to the increased unemployment rate in Middle Tennessee and across the country. The combination of unemployment, underemployment and lack of health care access has serious consequences for effected families in our communities. A series of recent studies by Kaiser Family Foundation, a private foundation focused on major health care issues, confirms that not only are individuals and families struggling, employers are also struggling with the burden of growing health care costs. This indicates that further erosion of job-based healthcare coverage is likely.

Unemployment and underemployments also means fewer dollars in Tennesseans pockets, leading us to make less expensive, and often less healthy food choices, leading to weight gain and health problems. To learn about this issue, please see the Hunger and Food Security issue overview at



Take Action

Working together to improve the community health of Middle Tennessee involves a cycle of activities: assessing needs and resources, picking priorities, finding programs and policies that work, implementing strategies, and evaluating efforts. Depending on the progress your community has already made, you can enter this cycle at any point. Additional resources are available to help you take action.




National Foster Parent Association

Siloam Health

Interfaith Dental Clinic

County Health Rankings

This Is Public Health Campaign from ASPH

What is Public Health Project

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    1. Nelson, Nancy. The Majority of Cancers Are Linked to the Environment. Benchmarks. 2004; 4(3).

    2. Centers for Disease Control and Prevention. Update on Multi-State Outbreak of E. coli O157:H7 Infections from Fresh Spinach, October 6, 2006.

   3. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 [cited 2006 Oct 23].

   4. Farrelly MC, Nonnemaker JM, Chou R, Hyland A, Peterson KK, Bauer UE. Changes in Hospitality Workers' Exposure to Secondhand Smoke Following the Implementation of New York's Smoke-Free Law. Tobacco Control. 2005;14(4):236–241.

   5. Morbidity and Mortality Weekly Report. Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and Stroke -- United States, 1900-1999. 1999; 48(30): 649-656.

   6. National Highway Traffic Safety Administration. Economic Impact of Crashes. 2002.

   7. United Nations World Population Propsects: 2006 revision – Table A.17 for 2005-2010.

   8. Morbidity and Mortality Weekly Report. Ten Great Public Health Achievements -- United States, 1900-1999. 1999; 48(12): 241-243.

   9. Centers for Disease Control and Prevention. Key Facts About Seasonal Influenza. 2007.

   10. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295:1549-1555.