Despite having some of the best health care companies in world, the people who live and work in Tennessee are not healthy.

Bad habits

Too many of us are too fat. Tennessee has the worst childhood obesity rate in the USA, and the fifth-worst adult obesity rate.

There are only seven states where residents smoke more cigarettes.

Tennesseans have more opioid prescriptions than all but one other state. (All rankings from Think Tennessee’s State of Our State

And, compared to other states, Tennesseans don’t like to exercise, ranking sixth from the bottom in the percentage of adults who exercise regularly (according to a recent Gallup poll.)

Equal poor health

It’s no surprise that our bad habits contribute to some disappointing health statistics.

Tennesseans suffer from heath disease and diabetes, ranking sixth worst in those measurements.

The state ranks near the bottom in the number of babies born with low birth weight and infant mortality.

What can we do?

There are many factors that impact whether Tennesseans can improve their overall health.

Adequate health insurance is a significant factor. Tennessee ranks 40th in the number people who do not have health insurance. However, the state does a much better job of making sure its children have health insurance, ranking 22nd.

Being able to access health care is also crucial, and some parts of Tennessee have watched their local hospitals close. Nine hospitals have closed in rural Tennessee counties, which is the second-highest rate in the nation. Another six rural hospitals are likely to close in the near future, the Tennessee Hospital Association states.

The challenges to improve the physical well-being of Tennesseans belie the regular good news headlines that tout the state’s economic well-being.

As voters prepare to vote in the August primaries, the 124-member newspapers of the Tennessee Press Association are working together to present a forum for the major candidates in the gubernatorial and senate races to address challenges. This month, the TPA asked candidates about their ideas to make Tennessee a healthier state.

You can read their answers in the accompanying story.

Incentives

“One of the most important things our elected leaders can do is to make sure the incentives are there along with the flexibility to address these challenges,” said Craig Becker, president and CEO of the 136-member Tennessee Hospital Association.

“The business models for hospitals and health care providers is changing, but the regulations and incentives have not,” Becker said.

Local hospitals have long been economic engines for their communities, but how health care delivery, technology and the cost of health care are forcing many changes.

“Smaller communities are going to have to adjust,” Becker said. “And that is where government can help.”

Instead of incentives that focus on taking care of sick people, smaller communities should be encouraged to focus on improving health in their community. It is an effort, he said, that requires a lot of coordination. Getting schools involved to help children, and their parents, make healthy lifestyle choices – eating better, exercising more, and smoking less – is just one example.

But to make that work, the financial incentives have to be there.

Insurance

One of the most debated solutions to improving Tennesseans health is expanding the number of people who are insured by TennCare, the state’s Medicaid insurance program.

In 2015, the Tennessee General Assembly rejected a proposed plan from Gov. Bill Haslam to expand TennCare using federal funds authorized under the Affordable Care Act that would have insured about 200,000 Tennesseans who were not eligible for TennCare.

The Affordable Care Act, which was President Barack Obama’s signature legislation to expand health insurance coverage (hence the popular name, Obamacare), faces challenges too as President Donald Trump’s Department of Justice has decided not to defend the act in lawsuits filed by many states.

With or without the ACA, Tennessee must address the challenges that make its people among the least healthy in the United States.

Frank Daniels is a writer living in Clarksville. A former editor, columnist and business executive, he is a member of the N.C. Journalism Hall of Fame. You reach him at [email protected]