PROBLEM STATEMENTS:

(a) In urban cities from Nashville, Memphis, Chattanooga, Knoxville, Jackson, and Clarksville, Tennesseans are living out of their cars and hotels, living under bridges, living in drug-infested environments, with debilitating sores on their feet, eating out of garbage cans, with matted hair and unbathed bodies, raped in alleys, elders eating cat food, gang affiliations, human trafficking, domestic violence, child prostitution and sexual exploitation, pollutants being released daily, living in crime riddled neighborhoods, dilapidated homes with holes in the roof, children living in food deserts and going to school with empty bellies. The government is squandering tax incentives, tax breaks, and payment-in-lieu-of-taxes to billionaires while the poor struggle to stay alive and survive. The invisible souls...

(b) Urban neglect in Tennessee is characterized by growing homelessness, abandoned properties, and infrastructure strain, with significant issues in major cities like Nashville and Memphis. The state is experiencing a surge in homeless encampments, leading to safety issues and, in 2022, becoming the first state to criminalize camping on public property.

(c) Nearly 50% of Black Middle Tennesseans live below the poverty level, according to a new report by the Urban League. The report shows Black Middle Tennesseans experience about 36% less economic well-being than white residents and struggle with obtaining housing.

(d) For many Nashvillians, affordable and stable housing is just one of many challenges. The Urban League of Middle Tennessee's (Nashville, TN) inaugural State of Black Middle Tennessee report reveals significant economic hardships facing the Black community.

(e) Tennessee has a lower life expectancy than most other states, ranking 45th in the nation.

(f) Specific areas of concern include deaths from chronic conditions, vaccine-preventable illnesses, homicide, suicide, and overdose.

(g) Ensure affordable access to primary care for all Tennesseans through expanded funding and presumptive eligibility for uninsured adult healthcare programs such as Safety Net and TennCare.

(h) Encourage development of a primary care “home” for all individuals, providing a trusted source of health information as well as a vital linkage to preventive services.

(i) Provide support for community-led behavioral health interventions to reduce locally elevated rates of homicide, suicide, and overdose.

(j) Support continued production and dissemination of culturally appropriate health education materials and outreach campaigns for a variety of chronic diseases, nutrition, mental health interventions, and other health prevention topics.

Aspects of Urban Neglect in Tennessee:

• Homelessness Crisis & Tent Cities: Nashville has faced challenges with long-standing, unsanitary homeless camps ("Old Tent City") marked by crime and lack of resources, prompting efforts to close them. Homelessness is also increasing in suburban and rural areas like Ashland City.

• Declining Infrastructure & Safety: Many areas are experiencing increased neglect, with reports of accumulated trash and dilapidated, vacant homes.

• Criminalization of Homelessness: Tennessee has implemented strict measures, making it a felony to camp on public property, and continues to pass laws targeting the unhoused.

• Vacant Property and Blight: In cities like Memphis, "urban sprawl" has led to a lower population density in urban cores, leading to widespread blight and a need for improved management of abandoned properties.

• Rural-Urban Disparities: The neglect is not solely confined to cities; rural areas face severe deficits in affordable housing, transportation, and services, trapping families in substandard conditions.

Current Efforts and Challenges:

• Housing Initiatives: Nashville has launched a $50 million housing-first plan to address homelessness by attempting to provide housing for residents of encampments.

• Combatting Blight: The state has developed strategies to manage blighted, tax-delinquent properties to turn them into productive use, often through non-profits.

• Service Gaps: Despite these efforts, community advocates report insufficient resources for health services, leading to instances of child neglect and health crises within homeless populations.

• Children found neglected, malnourished in Nashville .

  Mar 18, 2025 — it's sad, you know it's very sad, and the high cost of homelessness. tonight Old Tent City downtown continues to cause problems.

• Why is Memphis so empty?

  Sep 12, 2024 — 100% agreement for multiple reasons: * Memphis exploded geographically between 1970 and 2010, ballooning from about 100sqmi to over...

• Dealing with Blight: Strategies for Tennessee's Communities.

  Forced Tax Sales. Owners of blighted properties often neglect to pay their property taxes and become delinquent. When that happens.

Discriminatory Policies and Practices that Have Caused Harm to Underserved and Marginalized Communities

Although many cities are struggling with blight, the success of other cities indicates that current laws are generally adequate. It may be advantageous to extend statewide some programs that are now limited to certain cities.

Blight, always an issue of community concern, is even more so now because of the recent housing crisis and the downturn in the economy. In response to concerns expressed by several local communities, the 107th General Assembly considered a number of bills addressing blight, two of which were referred to the Tennessee Advisory Commission on Intergovernmental Relations (TACIR) for study. Although many cities are struggling with blight, the success of others indicates that current laws are generally adequate. The diffi culty for most local governments is fi nding the resources to use them successfully. State law gives municipalities and counties a number of tools for alleviating blight, some more widely used than others. While the laws are adequate on the whole, four of them apply only to certain jurisdictions: • The Neighborhood Preservation Act, which allows any neighbor or interested party to sue the owner of a property not maintained to community standards, applies in Davidson and Shelby counties. • The Residential Rental Inspection law, which authorizes a municipality to establish a residential rental inspection program for deteriorated or deteriorating rental properties, applies in Davidson County and in the city of Oak Ridge. • The Vacant Properties Acquisition Act, which authorizes the use of eminent domain to acquire, hold, manage, and dispose of vacant blighted property, applies in only ten counties.1 • The Local Enterprise Zones law allows certain local governments2 to provide incentives and exemptions to qualifi ed businesses and residents in depressed areas, including exemptions from any local rule or regulation other than health and safety provisions. It may be advantageous to extend these laws to other jurisdictions by making them applicable statewide. State law also authorizes municipalities, but not counties, to establish an offi ce of administrative.

Legislative Action by the 107th General Assembly Senate Joint Resolution 103 (McNally, Kyle, Marrero), passed by the Senate in 2011, directed the Commission to • study the overall effects on local governments when blighted properties are left vacant; • recommend solutions that will assist such local governments to return such properties to benefi cial reuse; and • report its fi ndings and recommendations, including any proposed legislation or interim reports upon conclusion of its study, to the Chairmen of the Finance, Ways and Means Committees of the Senate and the House of Representatives. The impetus for this study came out of Oak Ridge, which has a unique history. It was founded as the site for a uranium enrichment facility that was a part of the World War II era Manhattan Project, the operation that produced the world’s fi rst atomic bomb.

Tens of thousands of workers were brought into the area between 1942 and 1945 to build and staff the facility now known as the Oak Ridge National Laboratory. To accommodate the massive number of workers that were moved into the “secret city,” houses were either brought into the area or erected on site. The houses, most of them small, were meant to be temporary dwelling units. Plans were to move them out when the war was over. However, the temporary dwelling units were never moved. Instead, they were sold to private owners, and the units sit there still today, some vacant, some occupied. The buildings are now more than 70 years old, and they are in various stages of disrepair. Many are owned by absentee landlords and are not properly maintained.4 The House State and Local Government Committee referred another blight-related bill to TACIR for study during the 2012 session. House Bill 2996 (Parkinson) [Senate Bill 2933 (Norris, Campfi eld)] requires municipalities that cite property owners under slum clearance or vacant properties acquisition ordinances to report the owners and addresses of those properties to the Secretary of State for publication on the Secretary of State’s website until such condition is cured. No other state maintains a website listing, but several cities do, which suggests that a web listing of this type may be effective at the local level. It is not clear that it would be equally effective at the state level. Moreover, it would be diffi cult, if not impossible, to ensure the consistency and completeness of a statewide list that depends on submission of information by the hundreds of cities and counties across the state.

Governments have struggled to defi ne blight for years. The Great Depression fostered early efforts by local, state, and federal offi cials to defi ne blight, although at that time the term “slum” was used. The Hoover administration, at a housing conference in 1930, defi ned a slum as “a residential area where the houses and conditions of life are of such a squalid and wretched character and which hence has become a social liability to the community.”5 In language that later appeared in the National Housing Act of 1937, the National Association of Housing Offi cials defi ned a slum as “an area in which predominate dwellings that either because of dilapidation, obsolescence, overcrowding, poor arrangement or design, lack of ventilation, light or sanitary facilities or a combination of these factors, are detrimental to the safety, health, morals, and comfort of the inhabitants thereof.

Effects of Blight: The negative effects of blighted properties and structures are well documented, as are the significant community costs associated with these properties. For example, a Brookings Institution study found that abandoned or vacant properties heighten the need for fire and police services, code enforcement, property maintenance and demolition, and increase government expenditures.

Current State Laws and How They are Used: Several Tennessee laws are being used effectively to combat blight. The City of Springfield, in Robertson County, for example, has used an aggressive code enforcement program to demolish and rehabilitate blighted properties. This is something it has been able to do largely because the downturn in the housing market and the falloff in construction, with its consequent decline in building permit applications, freed up staff in its codes department to focus on blighted properties. Memphis has successfully instituted its “Campaign to End Blight” under the Neighborhood Preservation Act, and Metro Nashville’s Department of Codes Administration has used the Residential Rental Inspections Act successfully to inspect and upgrade rental properties. Although the Neighborhood Preservation Act and the Residential Rental Inspections Act have been successful in Memphis and Nashville, these laws apply only to limited jurisdictions and cannot be used elsewhere. The Acquisition of Vacant Properties Act is also limited, applying only to ten counties.

Code Enforcement

Redevelopment of Blighted Areas Numerous strategies for redeveloping blighted areas are available to local governments under current law, including incentives to improve depressed areas, special assessments to fund improvements in central business districts, and outright acquisition of blighted properties for redevelopment. In addition, the legislature created a pilot program in Oak Ridge allowing the city to establish a land bank to acquire and hold property for future development. Local Enterprise Zones in Depressed Areas. In areas of pervasive poverty, unemployment, and general distress as defined in state law, certain local governments can establish enterprise zones governed by a corporate board with broad authority to acquire, manage, and dispose of property and make loans and grants to improve public safety. 30 This authority is limited to the state’s fourteen home rule cities, three metropolitan governments, and the two counties with a charter form of government under Title 5, Chapter 1, Part 2 of the state code. These local governments can also provide incentives and exemptions to qualified businesses and residents in the zone, including exemptions from any local rule or regulation other than health and safety provisions.31 There are two enterprise zones in the state, one in Nashville and one in Memphis.

Housing Authorities: Acting under a redevelopment plan adopted by a municipality or agency designated by it, housing authorities may acquire blighted areas or other real property “for the purpose of removing, preventing, or reducing blight, blighting factors, or the causes of blight” and redevelop it.35 Under this law, the authority can completely redevelop properties and whole sections of a community. Despite the difficulty they often face in obtaining funds, housing authorities around the state are working hard to fight blight in their communities.

Acquisition of Vacant Property: Local governments in ten counties41 may declare that an area is blighted or deteriorated and establish a vacant property review committee to certify the specific properties in the area that meet the statutory definition of blighted or deteriorated. To be certified as blighted or deteriorated, the properties must be vacant, and the owners must have been given a chance to eliminate the conditions that violate local codes or law.42 Metro Nashville has adopted a spot blight ordinance under the authority granted by this part and has appointed a Vacant Properties Review Commission to certify that identified properties are in fact, blighted.

Land Bank Pilot Program. In 2012, the General Assembly created the Tennessee Local Land Bank Pilot Program,44 authorizing the City of Oak Ridge to create a land bank corporation with broad powers to acquire, hold, improve, and convey any interest in real property. 45 The Comptroller’s Office is directed to monitor the land bank for three years and recommend whether the pilot project should be continued, expanded, or discontinued, together with any legislative actions necessary to do so. Oak Ridge is in the initial stages of establishing the program. Land bank corporations can be used as a legal and financial mechanism to return vacant, abandoned, and tax-foreclosed properties to productive use through rehabilitation, demolition, or redevelopment and then sell them. According to a study by the University of Michigan, “successful land bank programs revitalize blighted neighborhoods and direct reinvestment back into these neighborhoods to support their long-term community vision.

Proposed Statewide Listing of Blighted Properties Representative Antonio Parkinson introduced House Bill 2996 [Senate Bill 2933 (Norris, Campfield)] because he has great concern about vacant or marginally occupied commercial property that is owned by out-of-town or out-of-state owners. This legislation would require municipalities with slum clearance or vacant properties acquisition ordinances to report to the Secretary of State the street address and owner of any commercial property found to violate those ordinances.

Cities making such reports would also be required to notify the Secretary promptly when the violation was cured. The Secretary would then be required to publish the property owner’s name and the address of the property on the Secretary of State’s website and remove the information when so notifi ed. According to the fi scal note, this would cost the state over $25,000 annually. Representative Parkinson believes that posting the owners’ names on this website will spur remedial actions.

Other States’ Laws All states have laws to combat blight. However, with foreclosures and abandonment of properties on the rise, along with a sluggish economy, legislatures are revisiting these laws to determine whether they are suffi cient or new legislation is needed to help local governments deal with blighted properties. Some states have passed new legislation to levy a state fi ne on blighted property, while others have enacted laws to provide tax incentives for the demolition or renovation of these properties. Tennessee has neither of these provisions.

Urban Economic Disparities

Urban disparities in Tennessee are pronounced, with major hubs like Nashville and Memphis experiencing high economic growth alongside severe disparities in income, housing affordability, and racial equity. While urban areas generally have lower poverty rates than rural areas, nearly 50% of Black residents in Middle Tennessee live below the poverty level, facing significant housing instability as rapid growth increases costs.

Tennessee urban areas face significant, deeply rooted disparities, with roughly 50% of Black residents in Middle Tennessee and Knoxville living below the poverty level. While urban counties generally have higher median incomes ($68,778) than rural ones ($55,869), racial inequality results in a stark economic divide, lower homeownership rates, and a 47% lower home value for Black families in major cities.

Urban Disparities (Nashville, Knoxville, Memphis, Chattanooga)

• Poverty and Race: In Knoxville, 43% of African-Americans live in poverty, over double the national average. In Nashville, rapid growth is exacerbating economic gaps for the Black community.

• Housing and Wealth: Historic zoning and redlining have led to long-term disparities in homeownership. White homes in Tennessee's major cities were found to be worth an estimated 47% more than Black-owned homes.

• Economic Disparities: A report found nearly 50% of Black Middle Tennesseans live below the poverty level.

• Healthcare: Urban areas show better access than rural, but within cities, low-income and minority neighborhoods face higher rates of chronic illness.

Urban Disparities in Tennessee (2025-2026)

• Racial and Economic Gaps in Cities: In Nashville, a study indicates that Black communities face greater financial challenges, with nearly 50% of Black Middle Tennesseans living in poverty. Black residents in this region experience approximately 36% less economic well-being than their white counterparts.

• Housing Affordability Crisis: Over 70% of Nashville residents cite affordable housing as the top city issue, with 82% believing they cannot afford to purchase a home in Davidson County.

• Rapid Growth Impact: Rapid growth in cities like Nashville is widening the economic gap, contributing to increased housing anxiety and making residents feel the city is moving in the wrong direction.

• Structural Disparities: Zoning rules and rapid development have led to gentrification, making it difficult for low-income residents to afford housing even with initiatives like Accessory Dwelling Unit (ADU) overlays.

• Middle Tennessee generally experiences lower poverty and higher incomes than other areas, yet still houses significant disparities within its urban centers.

• Poverty Rates: While lower than rural, urban areas still hold 67% of the state's total impoverished population due to density.

Urban vs. Rural Disparities

• Income: Urban counties have a higher median household income ($68,778) compared to rural counties ($55,869).

• Poverty Rates: Rural counties have higher poverty rates (16.5%) compared to urban counties (13.9%).

• Healthcare Access: Rural areas suffer from fewer providers and higher mortality rates from cancer, heart disease, and stroke compared to urban areas.

• Education: Rural schools often lack support staff, and rural Black and Latino students are significantly less likely to score well on college entrance exams.

URBAN HEALTH DISPARITIES

PROBLEM STATEMENTS

(1) Overview of Health Disparities in Tennessee: Healthy life expectancy is an important measure of the overall health of a population. Unfortunately, Tennesseans experience shorter life expectancy than the residents of the United States as a whole. Tennessee faces numerous health challenges, with generally poorer health outcomes than those of most other states. The high prevalence of chronic conditions, including obesity, diabetes, and hypertension, presents a major concern, as do the rates of substance misuse, suicide, and infant and maternal mortality. This comparatively poor health represents both a social and an economic burden for the state’s residents. Thus, improvement in health outcomes creates the potential for economic gains, in addition to improved well-being.

(2) Although these poor outcomes can and do afflict Tennesseans across the spectrum of demographic groups, the worst health outcomes are frequently borne by the state’s most vulnerable residents. There are notable differences in life expectancy and numerous other health outcomes across racial, ethnic, gender, and geographic lines within Tennessee. Such preventable differences in health between groups, termed health disparities, have grown out of a complex and long-standing set of inequalities and are sustained and exacerbated by lack of access to healthcare and preventive services.

(3) Urban Health Disparities: Urban health disparities in Tennessee are significant, with metropolitan areas like Memphis and Nashville facing high rates of chronic conditions, obesity, diabetes, and hypertension, particularly affecting Black and Hispanic residents. These disparities are driven by social determinants of health (SDoH), including economic hardship, limited access to care, and environmental factors such as air pollution and food insecurity.

(4) Health is essential to every individual’s well-being and ability to participate fully in the activities of daily life, such as education, economic participation, and religious, cultural, or civic engagement. Poor health can become a serious obstacle, potentially leading to suffering, disability, inability to earn a living, and loss of life.

(5) Health holds great importance in the lives of all Tennesseans, yet good health is not equitably distributed across the Tennessee population.

ATWATER'S GOAL AND STRATEGIES

(a) The measures are considered in light of racial, ethnic, gender, and urban/rural variations, with recommendations for action to decrease the disparity in health outcomes between these groups.

(b) Narrowing the gap in preventable health differences across population groups represents an important focus for improving quality of life, personal and community achievement, and economic prosperity.

(c) Early and continuous public involvement brings diverse viewpoints and values into the decision-making process and helps to ensure that the public feels vested in the process going forward.

(d) provides context for the unique challenges different communities face as well as the issues that unite all Tennesseans in the search for healthy lives.

(e) The residents of Tennessee experience poorer life expectancy than the residents of most other states. Additionally, there are many significant differences in this outcome across racial, ethnic, gender, and geographic lines within Tennessee.

(f) Health disparities are preventable differences in health between population groups that stem from broader inequities. While there are multiple definitions of the term “health disparities,” the unifying concept is that differences in health outcomes may be associated with social, economic, or environmental disadvantages that adversely affect groups of people in a systematic and measurable way.

(g) Differences may also be linked with disparities in healthcare, including health insurance coverage, affordability, availability of care, access to and use of care, and quality of care.

(i) Differences in health outcomes have also been observed in relation to a wide range of social factors such as educational attainment, nutritional security, spaces and opportunities for physical activity, language barriers, health literacy, social trust, access to healthcare, and ability to navigate the healthcare system.

(j) Resolving health disparities requires addressing these underlying factors for individuals and populations. Importantly, because equity is not the same as equality, in order to bring health outcomes into alignment, those individuals and populations with fewer resources may need more opportunities and efforts expended to improve their health.

(k) Improvement in health outcomes for all residents creates the potential for significant economic gains, as well as improved well-being and healthy life expectancy.

(l) Atwater aims for the state to become a national leader in ensuring equitable healthcare access to achieve its vision: Housing, Healthcare, and Healthy Living. Make Tennessee Whole Again!

Mental Health Initiatives

(a) Adverse Community Experiences

(b) Post-traumatic Syndrome