When I was first asked this question, my answer was simple and straight-forward. I knew that the major factors impacting our health are our behaviors — smoking, poor diet, lack of physical activity and, increasingly, substance abuse. My advice in those early years was that we needed to change our behaviors, especially as they relate to smoking.
Smoking is the leading preventable cause of death in the United States, and Tennessee has one of the highest smoking rates in the nation. Smoking rates in Central Appalachia, including Northeast Tennessee and Southwest Virginia, are much higher than the country as a whole. The cost to the region—in health care, lost productivity and, most importantly, in the incredible devastation of families and communities—is hard to fathom.
Over the years, I realized my initial answer was short-sighted. While smoking, and other unhealthy behaviors, are clearly the major contributors to early disease and death in our country and our region, there are factors that lead people to smoke, to be less active and even factors that lead to substance abuse.
We know people with lower levels of education and less economic opportunities are more likely to smoke, less likely to eat healthy diets and more likely to engage in less physical activity. With that in mind, a few years ago, I changed my answer to suggest the most important thing we could do to improve health in the region is improve educational achievement and enhance economic opportunity.
These two factors, of course, go hand-in-hand.
To get a better job, people often need more education. It takes a robust tax base — which results from a strong economy — to support the types of programs schools need to help students succeed. We know that when they occur together — more educational achievement AND more economic opportunities — people’s health and well-being improve. Importantly, we know communities with greater educational achievement and higher income typically have lower smoking rates, lower obesity rates and more physical activity. They are, in short, healthier.
So many of the challenges facing our region persist from one generation to another. A child’s educational achievement often reflects the parents’ level of education. A child born into a poor family is very likely to remain poor for his or her entire life. Parental smoking is one of the factors that predicts a young adult’s decision to start smoking — and the list goes on-and-on.
The inter-generational cycles of poor health, poverty and lack of education are pervasive and well-documented. With this fact in mind, I have come to believe the most important thing we can do to improve health in the region is launch a concerted regional effort to disrupt the inter-generational cycles that limit the lifetime opportunities of so many children in our region.
With the merging of our region’s health systems, and the desire by both states to assure this merger has a long-lasting impact on the health status of the region, we have a remarkable opportunity to truly impact health in the region.
If we pool all of our regional efforts, and combine them with additional support from the states, the federal government as well as from regional and national foundations, and then apply a laser-like focus on disrupting the inter-generational cycles that significantly damage the children of our region, we have a unique and unprecedented opportunity to dramatically impact the health of this region.
This will require more focus on these issues than is currently anticipated. It will require the many community-service organizations in our region to work together on a small number of high impact priorities and it will require regional businesses to work together toward the common goal of giving every child in this region a better chance at a healthy and productive life.
If all of us work together to assure that, from the time a woman becomes pregnant to the time her child is ready to enter school, both of them have the knowledge, skills and opportunities to live the healthiest, most productive and most rewarding life possible, then we all benefit as our region becomes healthier, richer and more productive.
Dr. Randy Wykoff is the dean of East Tennessee State University’s College of Public Health.