Murfreesboro Post

Dr. Mark Kestner: Tennessee is not feeling OK in national rankings

Right now, we are in the early days of college football season.  That means football fans everywhere are debating how their teams are ranked. 

As I write this, the Tennessee Volunteers are ranked either No. 9 or No. 11, depending on who is doing the rating.  Being ranked around 10th best in the country is not bad.


Our health status rating is at the opposite end of the spectrum. Tennessee is ranked in the bottom 10 states in terms of how healthy we are.  Folks, that is not good.  Right now, we are ranked No. 45 out of 50.  That means only five states have poorer health than Tennessee.

That is terrible.

Last year we were ranked No. 44.  Instead of making any substantial improvements, we actually moved one place further down the rankings.

Tennessee residents are in poorer health statistically than 90% of the country.

Our state also has a dismal ranking in violent crime, ranking in the worst five states consistently in recent years.  Currently we live in the state with the third-highest number of violent crimes per 100,000 people.

Individually, many readers may report that their personal health is above average and that violent crime is not something that they are particularly concerned about.  But there are many areas that are plagued by personal and property crime.  There are also areas that fare worse than the rest of the state in terms of the overall health of the area residents.

Several factors have been blamed for the ranking.  Some factors may have a political aspect, such as how Medicaid or TennCare is managed, how accessible healthcare is to everyone in the state, and whether state funds are being well directed to make a real difference in our citizens’ health or whether the money is being wasted.

There are also cultural aspects that are likely involved.  For example, it is impossible to ignore the fact that eight of the top 10 least healthy states are located in the Southeast, including West Virginia, Mississippi, Kentucky, Alabama, Arkansas, Tennessee, Louisiana, and South Carolina.

Hmmm.  Could it be something to do with the health habits and lifestyles we favor in the Southeast?

Obesity is a significant factor.  Looking at the rates with the highest percentage of obesity looks similar.  Here are the top seven: West Virginia: 40.6% ,  Kentucky: 40.3% ,  Alabama: 39.9%,  Oklahoma: 39.4%,  Mississippi: 39.1%,  Arkansas: 38.7%,  Louisiana: 38.6%

Notice who’s missing from this list?  Tennessee comes in at No. 19.

Obviously, obesity can be a major contributor to poor health.  More than a third of Tennesseans are clinically obese.

There are plenty of other factors to focus on as well.  Tennessee ranks in the worst 10 states in number of narcotic prescriptions, drug overdose deaths and illicit drug use statistics.  Illegal drugs including the particularly deadly fentanyl, meth, heroin and others, as well as overused prescription opioids are continuing to grow worse.

One might think that the relative ranking of personal income level would be tied closely to health rankings.   Tennessee ranks No. 32 overall in personal income.  Although there is certainly room for improvement in our income, there are states that rank below us in income that have substantially better health scores.

In the personal habits category, one particularly damaging practice is tobacco smoking.  After decades of convincing information that tobacco is a certain, slow killer being readily available to anyone, it amazes me that so many people still use tobacco.  Yet, 20% of adults smoke tobacco in Tennessee.

In teens, the practice is shifting.  Only about 5% smoke traditional cigarettes.  About 20 percent are using e-cigarettes.  E-cigarettes do not usually contain tobacco per se.  However, they contain nicotine obtained from tobacco along with several other chemicals and micro particles that have unknown health risks.

Tobacco use is a major contributor to chronic health problems and early deaths in Tennessee, whether it is by smoking or other tobacco use habits such as chewing or dipping.    Over 35% of all cancer deaths in Tennessee are related to smoking tobacco.

Smoking kills more people than motor vehicle collisions, alcohol, AIDS, illegal drugs, murders, and suicides … COMBINED.

It may not be a surprise at this point to read that Tennessee also ranks low in terms of physical fitness.  We rank sixth-worst in our level of physical activity.  The other states that hold the lowest ranking are typically consistent with the states that have the poorest health ranking overall.  In other words, there appears to be a strong link between low levels of physical activity and poor health. 

Mental health status should be considered as well.  Unfortunately, we do not shine in this area either.  We are ranked overall in the worst ten states in terms of mental health.  In depression, we are ranked fourth worst.  Mental health and physical health are so closely integrated that it is not really possible to consider one aspect without the other.

Other factors such as poverty level and access to health care are related to circumstances not readily modified by the individual.  

In the past decade or so, the state administration and legislators have taken actions to attempt to address all the factors mentioned in this article.  My hope is that the actions taken to date, along with any future efforts to provide resources, education and influence will begin to bring about more positive results.

Dr. Mark Kestner is a licensed chiropractic physician and acupuncturist with 30-plus years of experience focused primarily on treating complex and chronic spine, joint and neurological conditions in Murfreesboro. His office is at 1435 NW Broad St. Contact him at