The Tennessee Department of Health Mission: Protect, promote and improve the health and prosperity of people in Tennessee. All 6.45 million Tennesseans, along with those who visit our state, are touched directly or indirectly by TDH operations. One in five, some 1.4 million people, are directly served each year through a network of 89 rural and six metropolitan county health departments, while others are impacted by inspections of restaurants, healthcare and related facilities; registration or receipt of vital records; protection from communicable illness; licensing of health professionals; specialized laboratory testing and other many other services and programs.
Protecting people’s health by preventing problems that contribute to illness, disease and injury is the overall emphasis of the department. Key responsibilities include screening for and immunizing children against diseases; providing and assuring a safety net of care, particularly in medically underserved populations and areas of Tennessee; offering early prenatal care and proper nutrition to pregnant women and young children; and assuring restaurants, hotels, health facilities and health professionals meet requirements and standards established in Tennessee code. The regulatory work performed by the department impacts more than ten percent of Tennessee’s gross domestic product and more than 14 percent of its workforce.
The greatest causes of premature death and preventable illness are closely related to the way we live—what and how much we eat, whether we use tobacco, how much we exercise, and what we do to protect our safety. The department emphasizes health protection, primarily preventing illness and injury from occurring in the first place. By promoting healthy lifestyles that avoid health risks and educating Tennesseans about the rewards we enjoy when we protect the health of our communities, our families and ourselves, we are all able to enjoy better health.
The organizational structure of the Tennessee Department of Health, shown below, begins with the people of Tennessee. Under the leadership of Governor Bill Haslam, our department implements and maintains programs and services that benefit the health and wellbeing of those we proudly serve. The leadership of the department is a small group of talented individuals who manage important assignments and who share a common mission: To protect, promote and improve the health and prosperity of people in Tennessee.
In 2013, the Tennessee Department of Health celebrated its official 90th birthday, having been created by the State Legislature in February, 1923. The department’s history goes back earlier as a State Board of Health was created by law in 1877 to combat epidemics, form county boards of health, address school sanitation and maintain vital records of births and deaths in the state.
Activities and responsibilities have changed and grown through the years as health needs, public health and health care have evolved. In 1983, the department’s name was changed from the Department of Public Health to the Department of Health and Environment to more clearly reflect its broad functions. As part of the state’s increased focus on environmental protection and conservation, the environmental programs were transferred in 1991 to the new Department of Environment and Conservation. The department’s name was then changed to the Department of Health.
Here are some significant dates in our history:
Legislation enacted establishing a state medical society, which later became the Tennessee State Medical Society and then the Tennessee Medical Association.
County courts are given authority (chapter 225, section 9) by the state legislature to combat smallpox by “such measures as it may think best to put a stop to same.”
Tennessee State Medical Association sponsored legislation which created the State Board of Health. The law was passed by the General Assembly March 26, 1877, and signed into law that same night. Primary activities included combatting epidemics, working on school sanitation, maintaining vital records of births and deaths in the state.
From August to November of 1878, 5,150 people in Memphis died from Yellow Fever.
The first vital statistics law for Tennessee was passed, requiring registration of marriages, births and deaths. The law was repealed 20 months later. Another vital statistics law was passed in 1909; it too was repealed within 20 months. The service went into effect Jan. 1, 1914, and has operated continuously since then.
Elizabeth Simmons is the first public health nurse in Tennessee.
The Division of Vital Statistics was established by law (Chapter 30, Public Acts of 1913), passed and approved April 2, 1913. The “Vital Statistics Law” was aimed at recording, tabulating and analyzing birth and death certificates.
Tennessee law 3109a1 stipulates all jail physicians must be a graduate of a “reputable medical school.”
Blount County established the first full-time county health department.
Tennessee’s death rate is 164.8 per 1,000 population, compared to 113.1 for the United States.
Legislation creates the Tennessee Department of Health (beginning Feb. 1, 1923).
Local Health Service organized, functions as part of the Department of Health’s central administration. Two goals: 1. Stimulation of interest in and the organization of new local health department; 2. Maintaining those units now organized and providing administrative and technical service to assure their growth and usefulness to the areas served.
The Division of Laboratories was created on a full-time basis in 1925, with the main facility in Nashville and branch labs in Memphis, Chattanooga and Knoxville. Additional branch labs were opened in Johnson City (1928) and Jackson (1942).
A milk sanitarian was added to the staff of the Tennessee Department of Health. At the time, 48.3 percent of milk was pasteurized (it rose to 74.6 percent in 1937).
Between 1927 and 1937, a total of 65,895 approved privies were constructed, many by Works Progress Administration (WPA) workers.
There were 83 nurses employed by local health departments. By 1952, the number would rise to 231.
Tennessee has 23 full time county health departments.
Crippled Children’s Services organized under the State Department of Institutions, until being placed under the supervision of the Department of Health by the Reorganization Act of 1937.
Between 1934 and 1935, Department of Health state laboratories examined 2,506 animal heads for rabies.
Tennessee State Health Department moves all central staff into newly remodeled building at 420 6th Avenue North in Nashville – the first real home for the department.
July 1, 1935, through January, 1936, money comes from the Rockefeller Foundation.
Between July 11 and December 26, a total of 370 cases of poliomyelitis reported in west Tennessee.
Dental hygiene unit organized in late 1936 to create a general awareness for preventive and corrective dental care in younger age groups and to provide emergency and important dental services to school and preschool children who are unable to pay for these services.
Diphtheria notification slips send out for the first time, featuring greeting cards stating the importance of diphtheria immunizations.
Disastrous floods in late January causes suspension of all routine activities in the central office and in counties adjacent to the Mississippi River, with all efforts direct toward meeting emergency needs.
Midwives, who attend approximately 13 percent of all live births in Tennessee, are brought under the jurisdiction of local health departments. They are taught to: “take sanitary precautions, to use silver nitrate in the eyes of newborn, to report births, to refrain from making physical examinations and to procure medical aid in any abnormal case.
A program for postgraduate medical instruction in obstetrics was begun in Tennessee Jan. 1, 1937, sponsored and financed by the Tennessee Department of Health, the Tennessee Medical Association, the University of Tennessee Medical School, Vanderbilt University Medical School and the Commonwealth Fund.
Tennessee and North Carolina become first states to have birth control clinics associated with health and welfare services. Tennessee’s first was in Nashville.
The Tennessee Public Health Association was chartered Oct. 14, 1939, tracing its roots to the Conference of Public Health Workers in 1926.
Tennessee has 56 full time county health departments.
Effective July 1, 1941, a new law went effect requiring brides and grooms to have a pre-marital examination, including blood test for syphilis (the law had been passed in 1939). Many couples skirted the law by going to another state to be married.
Largest outbreak of acute poliomyelitis ever in Tennessee: 522 cases in the summer and fall.
U.S. Army begins series of maneuvers involving 850,000 soldiers in middle Tennessee. Tennessee gains dubious distinction of being the first state where the May Act is put in place in 1942, a federal law cracking down on prostitution around military installations. Free antisyphillitic drugs provided to all physicians in Tennessee to help combat venereal diseases.
Lanham Act makes federal funds available “for quarantine of promiscuous women infected with V.D.” The first facility was the Knoxville Isolation Hospital in the county workhouse.
Last confirmed case of smallpox in Tennessee.
Stream Pollution Control Board established by the Tennessee General Assembly to “protect all waters of the state for all reasonable and necessary uses.”
U.S. Congress appropriates money for fluoride programs; 23 counties in Tennessee have demonstration projects.
Tennessee General Assembly appropriates funds for a cancer control program, aimed at early detection instead of palliative or terminal care.
First soil studies done to pinpoint source of histoplasmosis in Tennessee.
A total of 7.5 percent of all lives births in Tennessee were premature.
The population of Tennessee reached 3,291,718.
Average monthly salary of nurses in Tennessee is $222.
There were 1,874 cases of Whooping Cough in Tennessee.
Tennessee Tuberculosis Hospital in Chattanooga accepts its first patients October 22, 1951. Other TB hospitals built in Tennessee include West Tennessee Tuberculosis in Memphis (October, 1948), East Tennessee Tuberculosis Hospital and Field Service in Knoxville (January 15, 1951), Middle Tennessee Tuberculosis Hospital in Nashville (1953). In 1951, the average daily census of all state tuberculosis hospitals was 630. The Learline Reave Sanatorium was the first state-owned tuberculosis hospital in Tennessee. The 32-bed facility in Greeneville closed April 30, 1951; it had been operated by the state since April 1, 1942.
The Tennessee Department of Health creates an Office of Public Health Education; its director was interviewed on WSM TV, believed to be the first television interview involving a TDH employee.
Tennessee Department of Health authorities are notified a railroad shipment of hides infected with anthrax was coming to west Tennessee. The authorities work with the tannery to oversee processing (soaking in a solution containing sodium bifluoride).
Veterans of overseas combat are believed to be a prime factor for the state’s number of malaria cases: 168.
Anti-rabies law passed.
Tennessee General Assembly creates a hospital service for the indigent program, administered by the Department of Health.
There were 6,293 cases of measles in Tennessee.
An influenza outbreak occurs in the fall and winter, with 180,164 cases reported and a death rate of 8.7 per 1,000 population. It is the largest outbreak in Tennessee since 1918.
The Tennessee Department of Health initiates an Accident Prevention Service to gather information on “existing hazards and unsafe practices.”
Tennessee becomes the second state in the nation to appropriate state funds for heart disease control.
Tennessee experiences the highest incidence of infectious hepatitis in its history: 2,100 cases.
A total of 357 residents die from tuberculosis in Tennessee.
Rabid foxes are blamed for the majority of animal rabies cases in Tennessee: 205 reported.
The State Legislature passed a Post Mortem Examination Act that went into effect July 1, 1961. Under the general supervision of the Chief Medical Examiner, medical examiners functioned in 88 counties, investigating causes of death.
Thousands across Tennessee participate in the Sabin Oral Sundays program – going to schools and other locations for sugar cubes saturated with Sabin vaccine to prevent poliomyelitis.
The first planned parenthood clinic in Tennessee opened in Williamson County in January, 1964.
A total of 251 residents die from tuberculosis in Tennessee.
Approximately 73 percent of Tennessee’s population gets it water from public sources instead of private wells and springs.
First years since records were kept that Tennessee had no reported cases of diphtheria or poliomyelitis.
Medicare services begin in Tennessee July 1, 1966, with 81 county health departments certified as Home Health agencies and qualified to collect from the Social Security Administration funds for home nursing care to eligible citizens more than 65 years of age.
Tennessee’s death rate is 6.1 per 100,000 population, compared to 3.9 per 1,000 for the United States.
The Tennessee Legislature passes a law requiring children to be immunized before they could be registered for school. The required vaccinations included diphtheria, measles, poliomyelitis, smallpox, tetanus and whooping cough.
With the opening of a health department in Lewis County, Tennessee had, for the first time, a health department in every county.
The birth rate for Tennesseans was 17.5 per 1,000 population.
Tennessee air pollution control regulations go into effect Aug. 9, 1969. The Tennessee Department of Public Health’s Division of Air Pollution Control monitored air quality via 50 air sampling stations and mobile air testing laboratory.
Tennessee Medicaid – Title XIX program – is implemented to provide medical services to “categorically needy” individuals.
There were 21 cases of measles reported in Tennessee.
The Tennessee Legislature passes a bill requiring licensing of nursing home administrators.
WIC (Women, Infants and Children) supplemental feeding program started in 15 counties of Tennessee.
Record low number of TB cases (854) prompts discussions to close all state-operated TB hospitals.
State participates in national effort to immunize against Swine Flu.
The General Assembly passes the Tennessee Child Passenger Protection Act of 1977, making Tennessee the first state in the nation to enact a law designed to protect passengers from death and serious injury. It went into effect Jan. 1, 1978, and required parents to package or restrain children und age four in federally approved child restraint systems while riding in family owned vehicles on Tennessee streets and highways.
Epidemiology section involved in study of Legionnaire’s Disease outbreak in Kingsport area.
Tennessee public health workers distributed potassium iodide to residents within five miles of two TVA nuclear power plants, to protect against harmful effects of radiation. A total of homes accepted the tablets.
AIDS reporting in Tennessee begins (HIV reporting began in 1992).
The Tennessee Department of Health has a name change to become the Department of Health and Environment.
There are 49 tuberculosis deaths in Tennessee (compared to 1,072 in the 1936-1937 fiscal year).
The Tennessee Department of Health and Environment has a name change to become the Tennessee Department of Health.
First case of West Nile Virus in humans in Tennessee, spurring additional aggressive efforts to control insect populations.
Tennessee Department of Health officials identify sentinel case in national outbreak of fungal meningitis associated with contaminated medicine.
Tuberculosis and sexually transmitted diseases, including HIV/AIDS, continue to pose significant health threats in Tennessee. Local health departments provide testing, counseling, treatment and contact tracing to control the spread of these diseases. The Department has placed emphasis on care coordination for individuals living with HIV/AIDS. In its effort to promote childhood immunizations, the Department provides immunizations, tracks immunization rates through the Tennessee Immunization Registry, provides outreach to encourage parents to immunize their children, and is involved in coordinating the distribution of vaccine to private providers through the federal Vaccines for Children program. Flu and pneumonia immunizations, tetanus-diphtheria boosters, and hepatitis B vaccines are also available to adults at local health departments. The Department is involved in the investigation of disease outbreaks, contact tracing to control the spread of communicable diseases, and activities to assess the risk of exposure to occupational and environmental hazards. Information obtained through these efforts and surveillance activities guide the development of policies and procedures to protect the public from health threats.
This initiative is targeted at decreasing youth violence, alcohol and drug use, school dropouts, and teen pregnancy. The initiative provides early intervention services designed to protect children from risk factors common to the four targeted problems.
The goals of the section are to eliminate health disparities and increase years and quality of life for all Tennesseans. These goals are accomplished by emphasizing the importance of healthy choices, by promoting healthy behaviors through wellness, lifestyle, tobacco prevention and cessation initiatives, and through disease prevention and management efforts that target specific disease prevention strategies, coupled with disease management initiatives. The healthy and safe communities component promotes comprehensive health education, injury prevention and control programs, rape and sexual assault prevention programs, and poison control programs. Improvement of community health systems is a major focus area as well. Local health councils and the community diagnosis process regularly assess the priority health issues in Tennessee communities and seek to build initiatives that address these issues. The Rural Health and Health Access offices seek to augment underserved communities by recruiting providers for communities and by assuring adequate systems of care.
This area’s activities include inspection of food service establishments, camps, hotels and motels, bed and breakfast establishments, tattoo parlors, and public swimming pools. It also conducts environmental surveys in schools and child care facilities and monitors rabies control.
Oral disease prevention services in schools throughout the state include oral health education, the application of dental sealants, dental screening and referral, school-based fluoride programs, and daily tooth brushing programs. Fluoridation of public water supplies is another key component of the preventive dental program. Clinical dental services are provided in selected local health departments and in community initiative sites to complement needs of specific geographic areas. Mobile dental clinics provide dental services at school sites to high-risk children in select regions of the state. Oral Health Services partners with public health nurses to implement an early childhood caries intervention program involving fluoride varnish application, dental screening and education for children and parents.
The State Public Health Laboratory and its two regional laboratories across the state provide valuable support of public health issues such as newborn testing, disease prevention, and a clean environment. The laboratories provide services to program areas within the Department, local health departments, hospitals, independent laboratories, other state departments, physicians, dentists, and clinics. In addition, they provide public health services that are not available from other sources, such as rabies testing. The public health labs are a part of the National Laboratory Response Network that is the laboratory component of homeland security for analyzing specimens related to terrorism.
The Department is responsible for assuring quality in health manpower and health care facilities. The Department helps administer state laws that require health care professionals to meet certain standards. Doctors, nurses, dentists, and other health care professionals are licensed by regulatory boards. Disciplinary action is taken if state standards are violated.
Hospitals, nursing homes, ambulatory surgical treatment centers, and other health care facilities are also licensed by the Department. In addition, facilities are assessed and certified for participation in the Medicare and Medicaid programs. Ambulance services and emergency medical personnel across the state are checked to ensure that quality standards are met when emergency medical services are needed, and medical laboratories and personnel are tested and licensed.
The maternal and child population has long been a focal point of public health programs. Local health departments provide a wide variety of services aimed at reducing the infant mortality rate, lowering the adolescent pregnancy rate, encouraging early entry into prenatal care, and reducing childhood morbidity. Services include screening and follow-up for children with potential lead poisoning, outreach, intensive case management, family planning, prenatal care, mammography screening, and the development of comprehensive school health programs. Routine screening of all newborns for hearing problems, certain metabolic and inherited disorders and a regional genetic program are other important maternal and child health services. The Department has placed particular emphasis on care coordination for children with severe or chronic medical needs. Services include payment for certain medical or health-related services, home visitation, interaction with schools, coordination among multiple medical providers, assistance in accessing needed social and medical services, and education and support.
Local health departments administer programs that provide supplemental foods to low-income, pregnant, breast-feeding and postpartum women, infants, and children. In some counties, supplemental foods are also provided to the elderly. Nutrition education on how to use these foods as part of a good daily diet is also provided. A variety of preventive and therapeutic community nutrition services are provided to Tennessee citizens.
The Office of Minority Health (OMH) advocates for the development of culturally competent policies, programs, and services to respond to the health needs of minority Tennesseans and address health disparities due to race, ethnicity, age, gender, geography, poverty, or culture. Technical assistance and consultation are provided to state agencies, community organizations, and health professionals to address related concerns that impact the health of constituent populations. The OMH funds, on a limited basis, community programs that target at-risk youth through academic, skill-building, and recreational activities. The OMH collaborates with public and private sector entities to build working coalitions and networks for improved health care access, quality, and information dissemination to minority communities across the state.
The Department collects and analyzes information for the entire Tennessee population relative to such health status indicators as infant mortality, low birthweight, adequacy of prenatal care services, morbidity and mortality from disease and injury, immunization status of children, adolescent pregnancy rates, and lead toxicity in children. Statewide registries for cancer incidence, birth defects, and traumatic brain injuries, and several large data collection systems are the mechanisms used to obtain this information. The resulting data is analyzed for the purpose of informing policy and shaping the health care delivery system in the state in order to respond to identified needs and to promote and protect the health of the citizens.
Local health departments in all 95 counties offer a variety of preventive services. Comprehensive primary care services are provided in selected health departments based on the needs of the community. Clinics are staffed with physicians or mid-level practitioners working under supervision and protocol. Local health departments participate in TennCare and other insurance programs.
In addition to supporting the TennCare program by participating as service providers in the managed care organizations’ provider networks, local health departments provide other services related to TennCare. These services include outreach activities to identify and assist with presumptive enrollment of pregnant women and presumptive enrollment of women who test positive for breast or cervical cancer who need and qualify for TennCare but are not yet enrolled. Local health departments also provide advocacy activities to educate enrollees concerning covered benefits and the managed care system and assistance in accessing medically necessary services. Care coordination and home visitation services are available for high-risk TennCare families with special health care needs. The health departments provide dental screening services to school children and early and periodic screening, diagnosis, and treatment to children under age 21 pursuant to an arrangement with TennCare. The Department also provides outreach to TennCare children through a centralized call center and community outreach program.
The Department maintains a central registry of births, deaths, fetal deaths, marriages, divorces, adoptions, and legitimations in the state. Certified copies of these records are available at the Vital Records Office in Nashville, at selected county sites, and on the Vital Records Web site.