Sequatchie County, Tennessee

CASE STUDIES

149

Everybody feels like they’re in it together, and there’s a lot of collaboration 

and helping each other.

 —Beth Delaney, Community Development Director, Southeast

 Regional Health Office

Referred to as the “Hang Gliding Capital of the East,” Sequatchie County, Tennessee, draws operators of 

the unpowered aircraft from around the world with its favorable flying conditions and aerial views. 

Located in the Sequatchie Valley—which is known for its beautiful landscape and moderate climate—the 

county is home to a growing number of affluent retirees and urbanites from other states who are attracted 

to the area’s natural amenities and proximity to Chattanooga. As a result, the county of 14,431 people has 

grown rapidly, its population rising 28.3 percent from 1990 to 2000 and 24.1 percent from 2000 to 2010.

The county’s many faith-based communities have a strong presence and take an active role in promoting 

health. Of note is the large Seventh-Day Adventist (SDA) community, whose members are encouraged to 

eat a mainly vegetarian diet, get regular exercise, avoid tobacco and alcohol, get adequate rest, seek 

Kiri Hughes is a farmer and owner of Hughes Produce in Sequatchie County, a Bright Spot community in which nutrition has been

identified as a health value shared among groups. 

© Nancy Henderson
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

150

preventive medical care, and make efforts to help preserve the environment. Health is also promoted in 

the county through school programs, civic groups, and health care services. 

Sequatchie County is among the ten percent of Appalachian counties—and one of seven counties in

Appalachian Tennessee—identified as a Bright Spot, performing better than expected across 14 of 19 

health outcome measures. Most notably, Sequatchie County performed better than expected on the 

following five measures:

 Poisoning mortality: 35 percent better than expected

 Injury mortality: 20 percent better than expected

 Stroke mortality: 20 percent better than expected

 Heart disease mortality: 17 percent better than expected

 Heart disease hospitalizations: 15 percent better than expected

These better-than-expected results are likely influenced by local conditions and initiatives created by the 

county to improve overall well-being. Field research indicates that retirees, faith leaders, and health care 

organizations are playing a critical role in improving both the health and economic well-being of the 

county. 

Sequatchie County’s classification as a Bright Spot means that, on average, the county performed better 

than expected on a number of health outcome measures, given its characteristics and resources—that is, 

the socioeconomics, demographics, behaviors, health care facilities, and other factors that influence health 

outcomes. It does not mean that residents here enjoy excellent health. In fact, the county still lags behind 

national performance on a number of health outcomes. Like other counties with limited resources, Bright 

Spot counties face challenges to attaining good health outcomes. Sequatchie County’s performance, 

however, indicates that certain county conditions or programs may be helping generate better-thanexpected outcomes—and that other resource-challenged Appalachian counties may benefit from adopting 

similar initiatives.1

 1 See Table 34 in the data appendix at the end of this case study for a full list of actual health outcomes for 

Sequatchie County compared with predicted outcomes. For details on the outcome measures, see the data files

accompanying the report Identifying Bright Spots in Appalachian Health: Statistical Analysis.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES 

151 

COUNTY OVERVIEW 

Figure 12: Map - Bright Spot Community Sequatchie County, Tennessee 

Sequatchie County represents a metropolitan county in South Central Appalachia. 

It is one of seven Bright Spot communities in Appalachian Tennessee. 

Sequatchie County sits in the Sequatchie Valley, just west of the Cumberland Plateau, about 45 minutes 

from Chattanooga and near the southern Tennessee border. 

Once known for coal mining and large agricultural businesses, this 250-square-mile county is rapidly 

changing. Half of its workforce commutes to jobs outside of the county, and its residents live in five main 

communities: Dunlap, the county seat; Lone Oak; Brush Creek; Cagle; and Lewis Chapel. Household 

income in 2014 was $44,111, compared with $56,135 nationally. 

Twenty percent of county residents are age 65 or older, compared with 15 percent of the U.S. population. 

In fact, in Sequatchie retirees are called “half-backers” because many retired from northern states to 

Florida and then returned halfway back to settle in the county. 

Of Sequatchie’s residents, 97 percent are white; less than one percent are black. About 47 percent of 

adults in the county have at least some college education, compared with 63.3 percent nationally. The 

unemployment rate in 2014 was 7.4 percent, compared with 6.5 percent regionally and 6.2 percent 

GEORGIA

SOUTH 

CAROLINA

NORTH CAROLINA

ALABAMA

MISSISSIPPI

TENNESSEE

KENTUCKY

OHIO PENNSYLVANIA

MARYLAND

VIRGINIA

NEW YORK

WEST

VIRGINIA

Sequatchie County, TN

Northern

Southern

Central

South Central

North Central

0 100 50

Miles
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

152

nationally. And in 2014, just over 18 percent of county residents had incomes below the federal poverty 

level, compared with 15.6 percent of the U.S. population.

2

 

Major highways run through Sequatchie County, giving a large portion of its population ready access to 

health care services in Pikeville (Erlanger Bledsoe Hospital), Jasper (Parkridge Hospital, formerly 

Grandview Medical), and Chattanooga (Erlanger, Parkridge East, Kindred, and Memorial Hospitals). Like 

some other Bright Spot communities—such as Tioga County, New York; Madison County, North 

Carolina; and Wirt County, West Virginia—Sequatchie has limited medical facilities of its own, but it has 

access to medical services in adjacent counties that are a short driving distance away.

A DEEPER LOOK AT SEQUATCHIE COUNTY: COMMUNITY STRENGTHS

As in other Bright Spot communities, faith leaders, health care organizations, and social service agencies 

in Sequatchie County are collaborating and sharing resources to provide a range of health care, public 

health, and social services. These collaborative efforts emphasize the importance of healthy food and 

provide opportunities to help residents pursue healthy behaviors. Additionally, two groups have a 

significant impact on how residents view and value health: a steadily growing retiree community whose 

members have higher income levels, and a very active faith community. 

Field work helped identify local practices in Sequatchie County that appear to be contributing to overall 

health, document effective practices that could be replicated in other counties, and identify promising 

practices and strategies that should be explored further.3 Specifically, the research found these 

characteristics and strategies in Sequatchie County:

 Shared health values among groups: The larger community reflects the shared health priorities 

of smaller groups. Faith-based groups, most notably, but also the school system and civic groups,

are active and invested in the health outcomes of their members. Good nutrition, for example, is a 

shared health value.

 Collaboration and sharing of resources: A nearly-30-year-old health council includes members 

from every sector and meets monthly to discuss and address issues impacting the community. 

Sequatchie’s single regional school campus also promotes a countywide sense of community.

 Access to health services: The efforts of a regional hospital and larger district health department 

improve access to preventive and acute care. The area’s mental and behavioral health programs 

work not only to deliver health services in a community setting, but they also serve to integrate 

social services. Additionally, area employers demonstrate strong support for the health of their 

employees through wellness and healthy living incentive programs.

 Volunteer engagement: A theme of engagement is noted in many sectors and is made possible 

in part with the help of a strong retirement community.

Like other Bright Spots communities, Sequatchie County has initiatives and efforts that fall into several 

overarching categories: leadership, cross-sector collaboration, local providers committed to public health, 

and an active faith community.

 2 Table 32 in the Sequatchie County data appendix at the end of this case study provides a quantitative profile of 

county characteristics.

3 For a full explanation of the methodology, see Appendix B: Research Approach. For a list of key informants 

interviewed for this county, see Table 33 in the data appendix at the end of this case study.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

153

Community Leaders Engaged in Health Initiatives

The field research found strong evidence in Sequatchie County of leaders from all walks of life working 

to promote health. 

For example, the efforts of county officials and residents to get the Erlanger Health System to establish 

a medical facility in Dunlap reflects the value they place on health. In its first year of operation, Erlanger 

Sequatchie Valley served 9,000 patients, nearly double the expected number. In 2016, it served 24,000 

patients. This level of service suggests not only a need for, but also a strong desire to seek, care and to use 

local health care resources. The success of the Sequatchie facility prompted local leaders to approach 

Erlanger again about establishing a larger, regional hospital in Dunlap. Erlanger agreed, and plans are 

now moving forward. In December 2016, Dunlap city commissioners contributed $10,000 for preliminary 

work for the new facility.

There are also strong local leaders at the grassroots level who are committed to addressing substance 

abuse. Churches, schools, and law enforcement are working to provide rehabilitation assistance to 

residents in need and to reduce risky behaviors in the community.

The local school board has shown strong leadership by endorsing the Coordinated School Health (CSH) 

program, which was created by the state legislature in 2000 and fully implemented statewide in 2007. It 

mandates school-based activities in eight areas: health education; health services; nutrition; physical 

education; healthy school environment; school counseling, psychological, and social services; student, 

family, and community involvement; and school staff wellness. 

CSH’s health-promotion efforts include providing annual student health screenings to identify issues 

related to obesity, vision, hearing, blood pressure, and dentition; employing educational programs to 

combat tobacco addiction, bullying, and drunk driving; holding bicycle safety courses; and offering 

exercise and stress-reduction classes for school employees. It also helps educators get health information 

into parents’ hands and out into the community. CSH pursues the goal of educating parents by publishing 

a quarterly newsletter that is sent home to them, and regularly distributing flyers about health-related 

issues and events in the community. The program also collaborates with the University of Tennessee 

Extension Service and Step Up Sequatchie to improve exercise facilities and physical education offerings 

in the schools.

The CSH program is popular with students, parents, and church groups, and its events are well attended.

Notably, the Sequatchie County Board of Education has officially expressed support for the statemandated program. 

In influx of affluent retirees into the community in recent decades may also contribute to the number of 

community leaders who show a shared value for health. These relative newcomers have gotten involved

in local business, politics, and civic affairs, bringing their ideas and skills; many have higher levels of 

education, and perhaps more health-conscious lifestyles. This “in-migration” of a more affluent 

population also seems to have created new markets for fitness and health care facilities that have 

benefited, and will continue to benefit, all of Sequatchie County’s residents.

Finally, in Sequatchie County there is strong employer support for employee health. The county’s major 

employers are the public school system, the Southeast Tennessee Human Resource Agency (SETHRA), 

Walmart, Mann+Hummel, NHC Healthcare, Bledsoe Telephone Cooperative, and the Sequatchie Valley 

Electric Cooperative. These employers all provide some level of health insurance or other wellness 

benefits for their full-time employees. Additionally, the Bledsoe Telephone Cooperative offers weight-
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

154

loss programs, free flu shots, and 100 percent coverage for preventive care. The Sequatchie Valley 

Electric Cooperative sponsors an annual senior expo where people age 55 and older can get free health 

information and free screenings for high blood pressure and cholesterol. SETHRA offers employees a 

“teledoc” option that allows them to consult with physicians online on a 24/7 basis. The Sequatchie CSH 

program provides teachers and other school staff with exercise and relaxation classes. 

Cross-Sector Collaboration

Cross-sector change agents in the Sequatchie community come from across the county and include 

residents, public officials, employers, schools, faith-based organizations, members of the health care 

sector, community-based organizations, and others. 

One example is the Sequatchie Health Council, a 40-member group established 28 years ago that 

includes representatives of local businesses, social service agencies, the county health department, the 

county commission, schools, local media, medical offices, and the Tennessee Department of Health. 

Council members meet monthly to identify local health issues and find ways to address them. Past 

projects have focused on tobacco control, obesity, substance abuse, suicide prevention, and nutrition 

education. In addition, the group has sponsored many health fairs and health screening events over the 

years. One of the health council’s recent projects, Step Up Sequatchie: Improve Your Health One Step 

at a Time, has brought together volunteers who organize events that help people quit smoking, promote 

healthier eating, and encourage physical activity. The formation and ongoing efforts of the health council

and of Step Up Sequatchie are indicators that Sequatchie residents place a high value on health.

The Sequatchie school system and its partners are another valuable health promotion resource. A 

significant part of this value lies in the work done through the CSH program, which serves the student 

population, school employees, and, by extension, family members. It may also be a beneficial factor that 

Sequatchie County’s public schools—elementary, middle, and high—are housed in one location, an 

arrangement that aids coordination of health promotion efforts within the school system. The centralized 

schools, as one interviewee suggested, function as a kind of hub for distribution of public health 

information.

The Sequatchie County schools also attend to the nutritional needs of students by providing free breakfast 

and lunch, regardless of family income level. In addition, the schools partner with a local food bank to 

provide free fruits and vegetables that students can take home to their families. 

In this small community, the school system serves as a hub for promoting health through preventive 

screening, physical activity, classroom and public education, and nutrition. 

Local Providers Committed to Public Health

In 2014, at the urging of county officials and residents, Erlanger Health System, based in Chattanooga 

and affiliated with the University of Tennessee College of Medicine, opened a satellite facility—Erlanger 

Sequatchie Valley—in Dunlap. This facility provides 24/7 emergency services, primary care, and weekly 

clinics for cardiology, orthopedics, and women’s health. As noted previously, in 2016 Erlanger 

Sequatchie Valley treated more than 24,000 patients. Given that apparent level of need, the Erlanger 

system sought regulatory approval to build a regional hospital in Dunlap. Sequatchie County has since 

issued bonds to finance construction of the new $32.6 million hospital, which will include 25 beds, and a 

new 3.0 Tesla MRI to provide magnetic resonance imaging services.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

155 

Erlanger is also replacing Erlanger Bledsoe, a small “community and safety net” hospital it has operated

in Pikeville (Bledsoe County), 20 miles north of Dunlap, since July 2014. The planned $4.3 million 

Emergency Center will create better access to care for a medically underserved population in the entire 

Sequatchie Valley, including Bledsoe, Sequatchie, and Grundy Counties. The project is being financed 

with tax-exempt bonds issued by Bledsoe County, and Erlanger will lease and operate the new facility to

repay the bonds.

In the past, the area benefited from care provided by an emergency room in Dunlap associated with

the Grandview Medical Center in Jasper (Marion County), and from the Bledsoe facility, which dates 

to 1971. When Grandview closed the Dunlap emergency room in 2010, Sequatchie residents 

successfully lobbied Erlanger to establish the Sequatchie Valley facility, a reflection of strong local

concern for health.

Erlanger Hospital in Chattanooga, one of the largest public hospitals in the United States, also plays an

important role in supporting the community’s health. It provides comprehensive hospital services,

including a level-one trauma center, a nationally renowned stroke center, and a shock-trauma intensive 

care unit. Sequatchie County residents in need of emergency care can get to the facility in 35 minutes by

ambulance. The LIFE FORCE Air Medical emergency helicopter service—established by Erlanger in

1988 and now operated under contract by Med-Trans Corp.—has a helipad in Dunlap and can get patients 

to Chattanooga in minutes. Sequatchie also contracts with Puckett EMS, based in Austell, Georgia, to

provide countywide emergency services. These local and regional emergency response resources, in

providing access to expedited treatment, may contribute to Sequatchie County’s better-than-expected 

performance for poisoning mortality, injury mortality, and stroke mortality. 

Active Faith Community

Sequatchie County’s faith-based communities take an active role in promoting health. Since 2008, the 

Sequatchie Ministerial Association, a consortium of 19 local churches, has been providing supplemental 

social services to the county’s low-income residents. The association helps people pay utility bills, 

provides a jail ministry, and operates a food bank. For a time, the United Methodist Church in Chapel 

Hill, Tennessee, provided a physician-staffed free clinic. The United Methodist Church in Dunlap offers 

yoga and relaxation classes. The Dunlap Seventh-Day Adventist Church hosts the monthly “Dinner with a 

Doctor” program, which brings medical expertise and advice to the general public. 

Local resident and SDA leader Charles Cleveland founded the nonprofit Health Education Resources, which promotes preventive 

health care.

© Nancy Henderson
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

156

Sequatchie County’s churches also raise funds for people who need help with medical bills or postdisaster recovery (such as when a tornado struck in November 2016). Several churches operate volunteer 

programs that provide free transportation to medical appointments. 

The school-based CSH program works with church groups to distribute health information (e.g., about 

health fairs, preventive screenings, exercise programs, and nutrition) to county residents. Sending flyers 

to congregations is a locally effective way to get the word out.

In particular, the large Seventh-Day Adventist community plays a significant role. There are two SDA 

churches in Dunlap, and two in surrounding counties. The church also runs a K–12 school in Dunlap that 

is open to the public. According to estimates, SDA members may account for up to 10 percent of the 

county population. This is significant not just because of the local health-related activities the SDA 

church members support—potluck meals for low-income people, Dinner with a Doctor, participation in 

health fairs—but also because of the health practices promoted by SDA teachings.

Based on the principle that “the body is the temple of the Holy Spirit,” the SDA church advocates the 

importance of a healthy diet, regular exercise, and avoiding the use of tobacco and alcohol. These prohealth practices are associated with the exceptional longevity of SDA members. But the church not only 

has a strong internal culture of health; it also embraces the mission of extending this culture into society at 

large. Locally, resident and SDA leader Charles Cleveland founded Health Education Resources, a 

nonprofit organization that promotes preventive medicine worldwide.

Another example of the power of faith-based communities to promote health is the Tennessee governor’s 

recent initiative to partner with churches to support the work of Project Lifeline, a state-sponsored, multicounty addiction recovery program. Project Lifeline was established to reduce stigma related to the 

disease of addiction and increase community support for policies that provide for treatment and recovery 

services. It has also been designed to serve as a vital resource in an area overwhelmed by the country’s 

opioid epidemic.

Taken together, the efforts of faith groups in Sequatchie County affirm the importance of community 

health and, through practical actions, bolster it.

CREATING A CULTURE OF HEALTH IN SEQUATCHIE COUNTY

Sequatchie County is changing rapidly as both its demographics and its economy shift. A renewed 

cultural focus on health and well-being is part of that shift, as a broad range of players work to promote 

the value of maintaining health. This can be seen in the faith-based communities advocating for healthy 

behaviors, including undertaking physical activity and working toward better nutrition; local 

organizations addressing substance abuse; and schools offering parents, teachers, and students 

opportunities to learn about and practice healthy behaviors.

Important evidence of the value Sequatchie County residents place on health is the strong endorsement of 

the school board for the work of the CSH program in schools. While a state-mandated health promotion 

effort could have met with local resistance, just the opposite has occurred in Sequatchie. Those 

interviewed as part of this case study’s field work described the CSH program as popular with students, 

parents, and church groups.

Like many other employers in the county, the schools provide teachers and other employees with 

important health benefits in addition to insurance coverage. These benefits included access to wellness 

programs and opportunities for physical activity. And beyond urging their congregants to live healthier 
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

157

lives, the county’s faith community provide essential health-related supports to individuals and families

who need them, including free meals and health care services as well as help with utility bills. 

The civic engagement among newly arrived retirees is also benefiting, and will continue to benefit, all of 

Sequatchie County’s residents. Many of the retirees are active across the county—taking an interest in 

local issues, joining local churches, and pursuing volunteer opportunities. 

The changes that residents of Sequatchie County are likely noticing may be helping to create some betterthan-expected health outcomes, and reinforcing the value that the people who live here place on health. 
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

158

REFERENCES

Agency for Healthcare Research and Quality. (2011). Chapter 9: Access to Health Care, 2011 National 

Healthcare Quality Report. Retrieved from Agency for Healthcare Research and Quality: 

https://www.ahrq.gov/research/findings/nhqrdr/nhqr11/chap9.html

Chandra, A., J. Acosta, K. Carman, T. Dubowitz, L. Leviton, L. Martin, A. Plough, et al. (2016). Building 

a National Culture of Health. Retrieved from rand.org: 

http://www.rand.org/content/dam/rand/pubs/research_reports/RR1100/RR1199/RAND_RR1199.pdf

Egede, L. E. (2006, June). Race, Ethnicity, Culture, and Disparities in Health Care. Journal of General 

Internal Medicine, 21(6), 667-669. doi:10.1111/j.1525-1497.2006.0512.x

Ellison, A. (2016, February 09). Hospital CFO Report: 6 common characteristics of hospitals vulnerable 

to closure. Retrieved July 27, 2017, from: 

http://www.beckershospitalreview.com/finance/6-common-characteristics-of-hospitals-vulnerable-toclosure.html

Fessner, Dave. "Erlanger Gets Approval to Build Hospital in Dunlap, Tenn." Times Free Press, December 

13, 2017.

Holmes, G. Mark, Nancy M. Lane, Thomas A. Arcury, Michael L. Schwalbe, Randy Randolph, John 

Frank, Sharita Thomas, et. al. 2018. Identifying Bright Spots in Appalachian Health: Statistical Analysis.

Washington, D.C.: Appalachian Regional Commission.

Institute of Medicine (US) Committee. (1990). Medicare: A Strategy for Quality Assurance (Vol. 1). (K. 

Lohr, Ed.) Washington (D.C.): National Academies Press (US). Retrieved from 

https://www.ncbi.nlm.nih.gov/books/NBK235460/

Loma Linda University School of Public Health. (2017, September 1). Findings for AHS-2. Retrieved 

from Adventist Health Studies 

https://publichealth.llu.edu/adventist-health-studies/findings/findings-ahs-2

Marshall, Julie L., Logan Thomas, Nancy M. Lane, G. Mark Holmes, Thomas A. Arcury, Randy 

Randolph, Pam Silberman, et al. 2017. Health Disparities in Appalachia. Washington, D.C.: Appalachian 

Regional Commission.

Office of Disease Prevention and Health Promotion. US DHHS. (2017). Healthy People / 2020 Topics & 

Objectives/ Access to Health Services. Retrieved July 27, 2017, from Healthy People. gov: 

https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

Willet, W. (2003). Lessons from dietary studies in Adventists and questions for the future. American 

Journal Clinical Nutrition, 539S–543S.

World Health Organization. (2017). The determinants of health. Retrieved from World Health 

Organization: Health Impact Assessment: 

http://www.who.int/hia/evidence/doh/en/
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

159

APPENDIX: SEQUATCHIE COUNTY DATA

Table 32: Sequatchie County Characteristics

Characteristic Sequatchie County United States

Population, 2010–2014 14,431 314,107,084

Percent population change, 2010–2015 4.90% 4.10%

Median age, 2015 41.7 37.8

Percent of persons over age 65, 2015 19.80% 14.90%

Median household income, 2014 $44,111 $56,135

Per capita income in past 12 months (in 2015 

dollars), 2011–2015 $21,818 $28,930

Unemployment rate, 2014 7.4% 6.2%

Percent persons in poverty, 2014 18.70% 15.6%

Percent white alone, 2015 97.00% 77.10%

Percent black alone, 2015 0.80% 13.30%

Percent adults with at least some college, 2010–

2014 47.29% 63.27%

Distance to nearest large population center from 

county center

Chattanooga, TN- 26.4 

miles N/A

ARC designations, fiscal year 2017

Transitional

South Central 

Appalachia

N/A

Source: These data are compiled from the U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics, 

2014, and the U.S. Census Bureau American Community Survey Selected Social Characteristics, General Economic 

Characteristics, Demographic and Housing Characteristics, and Educational Attainment Tables for years 2010–2014 

and 2011–2015.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

160

Table 33: Sequatchie County Key Informants

Name Location Title Organization Interview 

Date

Donna Condra Dunlap Field Management 

Director

Department of Health 

and Human Services 4/24/2014

Stephanie Boynton Dunlap Chief Executive Officer

Erlanger Sequatchie 

Valley Emergency 

Department

4/24/2017

Rolanda Green Dunlap Coordinator School 

Health

Sequatchie Board of 

Education 4/24/2017

Karen Shepherd, 

MD Dunlap County Coroner Sequatchie County 4/25/2017

Jan Frechette Dunlap Director Sequatchie Health 

Council 4/25/2017

Beth Delaney Dunlap Community 

Development Director

Sequatchie Health 

Council 4/26/2017

Dave Hodges Dunlap

Project LifeLine 

Coordinator, Region 3 

South

Franklin Prevention 

Coalition 4/26/2017
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

161

Table 34: Sequatchie County Health Outcomes – Actual vs. Predicted

Outcome Measure Actual Predicted

Percentage 

Difference

(negative = 

better)

Poisoning mortality per 100,000 people, 2008–2014 18.61 28.74 -35.3%

Injury mortality per 100,000 people, 2008–2014 65.05 81.41 -20.1%

Stroke mortality per 100,000 people, 2008–2014 40.50 50.68 -20.1%

Heart disease mortality per 100,000 people, 2008–

2014 192.95 232.14 -16.9%

Heart disease hospitalizations per 1,000 Medicare 

beneficiaries, 2012 56.40 66.31 -14.9%

Suicide mortality per 100,000 people, 2008–2014 14.09 16.55 -14.9%

Opioid prescriptions as a percent of Part D claims, 

2013 4.97 5.59 -11.1%

Percentage of obese adults (>30 BMI), 2012 30.0% 33.2% -9.7%

Years of potential life lost, 2011–2013 9,977 10,992 -9.2%

COPD mortality per 100,000 people, 2008–2014 71.13 76.56 -7.1%

Physically unhealthy days per month per person, 2014 4.80 5.03 -4.6%

Percentage of Medicare beneficiaries w/ depression, 

2012 18.10% 18.72% -3.3%

Percentage of adults with diabetes, 2012 13.30% 13.47% -1.2%

Mentally unhealthy days per month per person, 2014 4.70 4.73 -0.6%

Average Medicare condition score, 2013 1.02 1.01 1.0%

Low-birth-weight births (<2,500g) per 1,000 births, 

2007–2013 10.62 10.39 2.2%

Cancer mortality per 100,000 people, 2008–2014 230.91 222.67 3.7%

Percentage of excessive drinkers, 2014 11.3% 10.8% 4.5%

Infant mortality per 1,000 births, 2008–2014 7.60 7.14 6.4%

Notes:

Percentage Difference = 100 * [ (Actual / Predicted) – 1]

Green = County value was better than predicted

For details on the outcome measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

162

Table 35: Sequatchie County Health Drivers vs. National Median

Driver Measure Lower is 

Better?

National 

Median

Sequatchie 

County

Air pollution (average daily particulate matter 2.5), 

2011 Yes 11.87 13.63 

Average travel time to work in minutes, 2010–

2014 Yes 22.82 32.69 

Chlamydia incidence rate per 100,000, 2013 Yes 287.16 214.93 

Dentists per 100,000 population, 2014 No 37.45 20.41 

Economic index, fiscal year 2017 Yes 108.79 122.84 

Full-service restaurants per 1,000, 2012 No 0.68 0.35 

Grocery stores per 1,000 residents, 2012 No 0.20 --

Median household income, 2014 No $45,226.00 $44,111.00 

Mental health providers per 100,000 population, 

2015 No 80.00 20.41 

Percentage of adults currently smoking, 2014 Yes 17.8% 23.2%

Percentage of adults not physically active, 2012 Yes 27.7% 35.6%

Percentage of adults with at least some college, 

2010–2014 No 56.3% 47.3%

Income inequality ratio,4 2010–2014 Yes 4.4% 5.4%

Percentage of diabetics with A1C testing, 2012 No 85.4% 82.8%

Percentage of doctors who e-prescribe, 2014 No 65.0% 86.0%

Percentage of eligibles enrolled in SNAP, 2014 No 78.0% 92.0%

Percentage of households with income below 

poverty, 2014 Yes 15.8% 18.7%

Percentage of Medicare women with recent 

mammogram, 2013 No 61.0% 52.0%

Percentage of population with access to places for 

physical activity, 2011 and 2014 No 61.9% 43.1%

Percentage of total population in social assistant 

jobs, 2013 N/A 0.01% --

Percentage receiving disability OASDI and/or SSI, 

2014 Yes 5.4% 9.7%

Percentage spending >30% of income on housing, 

2010–2014 Yes 29.0% 29.7%

Percentage w/ no car, low access, 2010–2014 Yes 19.7% 0.1%

Primary care physicians per 100,000 population, 

2013 No 48.54 20.45 

 4 Income inequality is the ratio of household income at the 80th percentile to that at the 20th percentile. A higher 

ratio reflects greater division between the top and the bottom of the income spectrum.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Sequatchie County, Tennessee | CASE STUDIES

163

Driver Measure Lower is 

Better?

National 

Median

Sequatchie 

County

Social associations per 10,000 population, 2013 No 12.68 5.45 

Specialist physicians per 100,000 population, 

2013 No 25.93 --

Students per teacher, 2013–2014 Yes 14.13 16.03 

Teenage births per 1,000, 2007–2013 Yes 39.96 60.42 

Uninsured rate for people under 65, 2013 Yes 17.24 16.10 

Notes:

Green = County value was better than national median

For details on the driver measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.