Williamson County near Nashville excels in well-being within a struggling state.
FRANKLIN, TENN. – WHEN she moved here in the late 1990s, Marta Fugett, a transplanted New Yorker by way of Nashville, embraced her new life in leafy-green Williamson County: Her house was a bargain, her kids’ suburban school district had a great reputation and her husband had an easy commute to his job in downtown Music City.
“The police are great – definitely low-crime, access to parks, still more of a small-town feel,” says Fugett, ticking off the reasons that helped her convince her mother and sister to leave the Big Apple for a home near hers among the sprawling cattle ranches and gently rolling hills of central Tennessee last year.
Chatting inside CoolSprings Galleria, an upscale shopping mall on Franklin’s edge, Fugett says it’s easy to understand why her adopted community is one of the top places for community health nationwide and the best in the Volunteer State, according to U.S. News’ second annual Healthiest Communities rankings.
Assessed across 81 metrics in 10 categories including local economy, population health, and community vitality, Williamson County had the 22nd-highest overall score in the country, and was the only Tennessee locality to crack the Healthiest Communities top 500. Quality housing, access to health care and a highly educated population are among the reasons the county southeast of Nashville scores so well – and is one of the fastest-growing localities in the state.
Long considered among the most exclusive communities in central Tennessee, Williamson County’s success is arguably more impressive set against health-related data from the rest of the state. A predominantly white Republican Party stronghold, Tennessee continues to reject Medicaid expansion under the Affordable Care Act, restricting health care access for thousands of poor and low-income state residents. It scores poorly in national measures of poverty rates and percentage of residents with college degrees. Three in 10 adult Tennesseans struggle with obesity and, at over 22 percent, the state cigarette smoking rate for adults is well above the national mark of 14 percent.
Yet on a Healthiest Communities map that identifies hot spots for community health problems, Williamson County is a bright blue, high-performing island in a pale-orange state, and on average performs more than 40 points better than the seven other Tennessee counties it borders.
The Nashville suburb “is a very desirable area for many reasons,” says Bethany Wrye, an assistant professor of community and public health at Middle Tennessee State University in nearby Murfreesboro, in Rutherford County.
“It’s a beautiful environment, it’s got proximity to Nashville” in neighboring Davidson County, she says. “Many families want to be there for the great schools, upscale amenities including shopping and restaurants, and it has a reputation for being where the country music celebrities live.” Those who have called Williamson County home include superstar couple Tim McGraw and Faith Hill, as well as Keith Urban and his wife, Oscar-winning actress Nicole Kidman.
There’s little question that Williamson County’s wealth and its abundance of college-educated residents – two data points that often translate to positive health outcomes – are key to its impressive Healthiest Communities scores.
Census estimates peg the county’s median household income at more than $103,000, more than twice the state mark. About 60 percent of its residents age 25 and older hold at least a bachelor’s degree – an indicator of white-collar employment that comes with medical insurance. Coupled with its below-average smoking and obesity rates, Williamson has become an outpost of generally positive health outcomes in a state with serious issues.
Moreover, Williamson County boasts dozens of indoor and outdoor park and recreational facilities, “and has paved and unpaved greenway systems running throughout,” says Angie Bowman, a population health professor and Wyre’s colleague at Middle Tennessee State University. “There are also numerous city-owned parks within the county, an abundance of green space, walkable communities, and privately-owned parks and recreation facilities. There is ample opportunity for outdoor physical activity in most areas of Williamson County.”
The county also has above-average participation in volunteer organizations, says Pam Bryant, president of United Way of Williamson County.
“We’re very fortunate to work in an area where people are generous, financially and with their time,” says Bryant, whose organization helps coordinate nonprofit social services, ranging from after-school activities for children to drug treatment efforts. Residents who volunteer their time and donate money, she says, contribute to the area’s overall sense of well-being and help improve community health.
“It makes a difference twofold,” Bryant says. “Individuals love to give back to the community. It makes us feel better about ourselves. And anytime you’re giving someone a hand up, that makes their day better.”
Yet Bryant doesn’t hesitate when asked about the biggest public health challenges Williamson County faces.
“Affordable housing and transportation,” she says, noting those were among residents’ top concerns in a countywide survey United Way conducted a few years ago. “That stood out to everybody.”
Another concern is “the need for behavioral health services,” particularly in county schools, Bryant says. Underscoring that need: suicides, including among teens and young adults. In 2017, the county saw three suicides occur among those 10 to 19 years old, according to state data – two more than the year before and two shy of the 2017 total in neighboring and more heavily populated Davidson County.
“Williamson County stands out in Tennessee for its wealth and education, but the county is not immune to anxiety, depression and a growing number of suicide deaths,” according to a special report this year by The Tennessean, Nashville’s major daily newspaper. “There are suicide risk factors – like alcohol and substance abuse, isolation and financial struggles – and Williamson shows that high quality of life does not eradicate these issues.”
Franklin Mayor Ken Moore told the newspaper that focusing on mental health is one of his administration’s top priorities. “At the very least, we can promote activity around the topic,” he said. “No one wants to talk about mental health. It’s a serious problem in my mind.”
Nor has Williamson County avoided the opioid crisis that has ravaged the nation, seeing 30 total drug overdose deaths in 2017. Twenty-four deaths involved opioids for a rate of 12 per 100,000 people – not far off the national mark of 14.9 per 100,000 for 2017. The year before, the county recorded 294 outpatient visits and 130 inpatient stays for nonfatal overdoses.
Another way to measure the impact of the opioid crisis is the number of babies born with opioid-related neonatal abstinence syndrome, says Bowman, the Middle Tennessee State population health professor. She says data from the Tennessee Department of Health shows the rise of NAS in Williamson County from 2013 to 2015 was similar to that of Davidson County.
“These markers indicate that the opioid epidemic is just as prevalent in Williamson County as it is in most other places in the U.S.,” Bowman says.
Meanwhile, the warp-speed development of nearby Nashville has triggered a residual boom of sorts that could cause long-term growing pains for the region.
Music City’s legendary honky-tonks now compete with new craft brew pubs, upscale diners and hipster coffee shops cropping up across the city. Its two major sports teams – the NHL’s Nashville Predators and the NFL’s Tennessee Titans – slow traffic to a crawl at game times. And the glittering downtown skyline, already crowded with construction cranes, soon will add an Amazon operations center to its ranks, bringing some 5,000 new jobs with it.
“You know, thank God our master bedroom is on the first level,” she says, contemplating how her life could change as she ages. “Because we’re going to have to stay where we’re at.”
The Nashville area’s explosive growth also has spilled into Rutherford County, which soon could compete with Williamson County as a health oasis. With Middle Tennessee State in its county seat, Murfreesboro, Rutherford placed just behind Williamson as the third-fastest-growing county in Tennessee from 2010 to 2017, per census data, and is an attractive draw for businesses.
“Places where you’d be driving, (you’d) see nothing but farms,” says Jennifer, an Uber driver who preferred not to use her last name. “Now there’s like, a mall and an apartment complex. It’s insane.”
Murfreesboro, her once quiet home, “has gotten so big that to get from one side to the other, it can take you 30 minutes to an hour,” says Jennifer, who also operates her own commercial cleaning service. “Some areas I’ve been driving through and I’m seeing ‘for sale’ signs on farmland and I’m like, ‘Welp, there’s another apartment complex coming in.'”
Though “it makes me a little bit sad” to see farms disappearing, she adds, “I know we’re growing and we need places to put all the people.”