A new report highlights what Tennessee could focus on to improve the health of its residents.

The America's Health Rankings 2022 report from United Healthcare ranks Tennessee 44th among states for health outcomes. The state's notable challenges include high numbers of smokers and people with multiple chronic health conditions, as well as premature death rates.

Michele Johnson, executive director of the Tennessee Justice Center, thinks the state is not moving in the right direction because elected officials are not prioritizing and making policies to serve everyone.

"And the top of that list would be Medicaid expansion, refusing to bring back our dollars so that we can have comprehensive coverage for all Tennesseans," Johnson contended. "And that impacts not just those that are covered, but it impacts all of us."

Johnson added she is concerned about what might happen when the pandemic public health emergency expires in the spring. She estimates about 350,000 Tennesseans will lose their health insurance, and believes expanding Medicaid would strengthen the state's health care infrastructure and economy.

The report mentions violent crime as a health factor, and it's on the rise across the country as well as in Tennessee. Tennessee ranks 48th, the same as last year. Nationally, deaths due to firearm injury have significantly increased. Johnson recommended the state find ways to help those who are struggling in order to prevent crime.

"If you want to decrease violence, you have to increase people's basic needs being met," Johnson argued. "There's lots of research that show if you address people's basic needs -- food, health care, and housing -- then the violent crimes go down."

Dr. Rhonda Randall, chief medical officer for UnitedHealthcare employer and individual, said the report shows the full impact of the pandemic, and the most disheartening aspect may be how drug deaths in the U.S. increased by 30%.

In Tennessee, more than 2,300 people died from opioid overdoses in 2020. Nationally, about 70% of the drug deaths are opioid-related.

Randall noted in most cases, it's a nonprescription opioid.

"That means nearly 92,000 additional people died in the United States due to drug injury and overdose compared to the prior year," Randall reported. "The CDC is starting to show that's declined in the last three months now, but we really want to follow it really closely before we call that a trend."

Randall emphasized drug deaths were among all races and ethnicity, but there were some significant health care disparities, with higher rates among multiracial and African Americans.

Cancer rates are on the rise, and doctors are noticing specific types in younger age groups. There are more than 100 different types of cancer with various risk factors.

The 2023 Ohio Annual Cancer Report, the latest data available, reveals the disease is the second most common cause of death. Breast, lung and colon cancer top the list as the most frequently diagnosed cancers in the state.

Dr. Raphael Cuomo, University of California San Diego professor and epidemiologist, said studies show over the last few decades, external factors are behind the upswing in cancer cases.

"We're seeing some of the sharpest increases in colorectal, breast and pancreatic cancers, especially in adults under 50, particularly those in their 30s and 40s," he explained. "So, the speed at which these cases are climbing suggests that lifestyle and environment, and not genetics, are driving the increase."

Cuomo said the influx of high-sugar, low-fiber ultra-processed foods, smoking and alcohol consumption is emerging as a frontrunner for increasing the risk of developing cancer. He says better lifestyle choices to reduce obesity and boost physical activity levels can lower the odds of receiving a cancer diagnosis.

The effects of PFAS, known as "forever chemicals," on the environment is well documented. Cuomo advises Ohioans to reduce their direct exposure to products containing PFAS and other endocrine-disrupting pollutants. He also suggests avoiding plastic containers -- especially items made with Bisphenol-A, a chemical that mimics the estrogen hormone in the body.

"A good water filter can also help reduce PFAS exposure," he said. "Switching to personal-care products that don't have parabens or phthalates is another step you can take. There have been some phthalates, such as diethylhexyl, which has been classified by the WHO as a possible human carcinogen."

Diethylhexyl is also found in manufacturing food, beverage and tobacco products, fabrics, lawn care items, textiles and leather products. Further research on the effects of regular exposure to these items shows a link to kidney cancer. Cuomo suggests avoiding nonstick cookware, another source of PFAS chemicals.

Washington state's Tribal Foundational Public Health Service is the first dedicated funding for tribes to advance public health initiatives.

In Gov. Bob Ferguson's proposed budget, it faces the risk of losing crucial funding.

Jessica McKee, Tribal Foundational Public Health Service coordinator for the American Indian Health Commission, said after the state increased funding for the service in the last biennium to $200,000 per year per tribe, some tribes were able to create their first dedicated public health position. She stressed cuts to the service would be a blow.

"If there's a reduction and the steering committee decides that some of that money has to come back from the tribes, they might not be able to maintain their public health person anymore," McKee pointed out. "That's a big deal. "

McKee said the service funds foundational aspects of public health, such as tracking maternal and child health, environmental health and communicable disease surveillance.

With a recently confirmed measles case in King County, McKee is concerned potential loss of funding for the service, coupled with the Trump administration's policies on immunizations, could create a significant public health challenge.

"If those funding streams are to be cut on top of people being vaccine hesitant, we could have a perfect storm of MMR breakouts all over the place," McKee explained.

Mckee noted a strength of the service is the funding is flexible and each tribe chooses its own public health priorities. Some tribes may be able to expand existing efforts such as training clinic staff in infection prevention. Others may use new resources to hire public health staff to write health codes.

"It is one of the opportunities for funding that really feels like it's honoring tribal sovereignty," McKee observed. "That's not always the case with funding."

Advocates are urging Maryland lawmakers to support a bill that would approve medical aid in dying for people who are terminally ill.

A poll last December found more than 70% of Marylanders supported medical aid-in-dying legislation - and more than 60% said they want that option for themselves if they were terminally ill.

Donna Smith, campaign director with the end-of-life care advocacy group Compassion & Choices, said the End of Life Option Act is about creating options for people -- options that are available to those in 10 states and the District of Columbia.

"It's just an option. No one is forced to do anything," said Smith. "The doctors aren't forced to be involved, to write a prescription; the pharmacists aren't forced to do anything. It's just an option for the very few who need it."

Opponents of the bill worry some people may be coerced into pursuing aid in dying, and some religious groups believe it violates what they view as the sanctity of life.

Advocates have tried to pass medical aid-in-dying legislation for 11 years in Maryland. In 2019, the legislation failed on the floor of the Senate in a 23-23 tie. The bill did narrowly pass in the House of Delegates.

Smith said this time, early whip counts of lawmakers show the legislation has the support to pass the General Assembly.

Smith said many of her volunteers have been terminally ill people, who spend their last days advocating for this legislation. She added she is trying to explain to lawmakers the consequences of not approving the bill.

"Their inaction leads directly to people suffering, and I want them to understand that," said Smith. "Because, personally, I'm tired of going to funerals and sending flowers because they have not acted."

Medical aid-in-dying legislation has strong support across party lines. Polling shows more than two-thirds of Republicans support the legislation, as do more than 70% of Democrats and Independents.