State of Tennessee


Tennessee is a southern state well known for music, which is an integral part of its culture; less well known is the state’s agricultural history.

Before the Civil War, Tennessee was among the nation’s top 10 producers of tobacco, cotton, corn, wheat, and hogs. It remains among the nation’s top five tobacco-producing states. The Volunteer State, as it is commonly known, is primarily rural, with a higher proportion of white and Black residents, compared with national averages, and fewer Hispanics. The Hispanic population is growing, having nearly doubled in the last 10 years.

Tennessee’s two major cities, Memphis and Nashville, are home to 20 percent of the state’s residents. “Noncore” counties—those with cities or towns with populations of less than 10,000—are prevalent throughout the state. These counties are the most rural areas of Tennessee. The state is divided into three culturally and geographically distinct regions, called Grand Divisions—each one comprises approximately one-third of the state’s land area. Cultural, racial, and historical differences in the state’s Grand Divisions, and variations in income and education within each region, play a significant role in the health outcomes of its residents. For example, West Tennessee comprises 39 percent Black residents, compared with 13 percent for Middle Tennessee and 6 percent for East Tennessee. West Tennessee’s economy was historically more dependent on cotton production, with its associated history of slavery, than the other two Grand Divisions. This report provides a snapshot of health and well-being issues and initiatives across Tennessee and in selected areas within the Grand Divisions: Memphis/Shelby County (West Tennessee), Nashville/Davidson County (Middle Tennessee), and throughout East Tennessee.