Per Capita Personal Income

        Per capita personal income is a measurement of annual incoming dollars from all sources per person. This metric can be an indicator of socioeconomic well-being both at an individual level and a population level. Wealth and health are directly related, often described as the “wealth-health gradient.” This gradient shows that as wealth increases incrementally, health in turn increases incrementally. Those who have greater income can add years to their life, relative to those who face the challenges associated with chronic poverty. Poverty is a measure of income, and is an important indicator for many federal, state, and local assistance programs.  

        In 2018, the annual per capita personal income was $47,179 in Tennessee, with county averages ranging from $23,175 to $95,339. The average income for rural counties in Tennessee is just $36,377.  Tennessee ranks 32nd in income inequality—a metric that compares income for the top 20% of earners to that of the bottom 20% of earners. Income inequality is growing rapidly in the United States, something research shows plays a role in negative health outcomes for entire communities.   

        Both situational (acute) and generational (chronic) poverty have significant impacts on short and long-term health outcomes. Causes of situational poverty may include injury and illness, divorce, sudden unemployment, natural disasters, or death of a family member. Conversely, cyclical poverty can be caused and sustained through inter-generational family income, educational attainment and literacy, access to reliable transportation, access to affordable child care, access to health care, and incarceration and the justice system.  

        Toxic stress and childhood trauma can be both a cause of chronic, generational poverty and also a mechanism through which poverty affects long-term health outcomes. For example, low-income individuals often work two to three jobs in order to support themselves and their families. This leads to “poverty of time,” a term that describes how poor families are less able to engage in healthy behaviors like physical activity, reading to their children, and cooking a nutritious meal because most of their time is diverted to working. Additionally, those who experience chronic poverty may succumb to “diseases of despair,” a key driver in the current opioid crisis.   

        There are disparities pertaining to per capita personal income that may create gaps in both wealth and population health outcomes. These disparities primarily involve an individual’s or population’s status of race, ethnicity, gender, citizenship and language skills, neighborhood housing characteristics, geography, the built environment, and food deserts, among other qualities. Geographic disparities in income and resource inequalities are particularly prevalent in high-density urban cores and very low-density rural areas.  Low-income neighborhoods are more often subject to food deserts, lack healthy built environment infrastructure, and suffer from underfunded public school systems.    

        Housing is the largest monthly expenditure for most individuals and families, and provides a good example of how income, policy, race, and history intersect to impact health in modern times. Historically, housing policies and real estate practices have been racially discriminatory through  “steering” families of color toward particular residential areas, shifting resources away from immigrant communities and populations of color to white middle-class neighborhoods, and predatory loan practices that often target minority families. i These disadvantaged neighborhoods are more prone to high rates of rental properties, foreclosures, and unhealthy homes. Residential segregation also impacts public school quality through zoning policies and tax funding, and continues to have significant health implications for people of color and rural Tennessee communities.   

Vital Sign Actions Guide

The following are lists of intervention strategies that you, your health council, and other local stakeholders could use to address per capital personal income in your community.  


1. Accountable Care Community 

The Centers for Medicare and Medicaid Services supports 31 Accountable Health Communities across the U.S. The Accountable Health Community Model brings together clinical services and social services to serve the physical, mental, and social needs of individuals in the healthcare setting. The coordination of providers brings together organizations that provide aid for housing, food, utility bills, and transportation. Currently, Ballad Health (East TN) is the only participating Accountable Care Community in Tennessee. 


2. Adult Literacy Classes

As one of the main predictors of child literacy skills, adult literacy is crucial for parents of young children. Consider partnering with adult literacy programs in your county to support family literacy or start an adult literacy program if your county doesn’t already have one. 


3. Broadband Access

Low-income neighborhoods, particularly in low-density rural geographies, are often disproportionately disadvantaged by a lack of broadband access. Without adequate internet access, low-income families are restricted in telemedicine, education, participation in the online economy, and employment among other disadvantages. Major barriers to broadband access include price and physical equipment.  Expanding access to neighborhoods in need of broadband may include purchasing equipment, community classes on how to use digital equipment, or subscription subsidies. 


4. Community Financial Resources

Recommended by the Annie E. Casey Foundation, Community Financial Resources is a financial coaching and resource program that improves financial stability and allows families to build up their wealth. Services offered by Community Financial Resources include and employee financial wellness program, financial products for induvial such as a visa debit card with money management services, and education for parents, employees, young adults, and individuals reentering society after incarceration. 


5. English Language Program 

Families who aren’t proficient in the English language are disadvantaged in several ways—lower educational attainment, poor health and decreased health literacy, and limited employment opportunities. English language classes can create opportunities for families to prosper. Consider working with healthcare providers, schools, and employers to market existing English language classes for youth and adults.


6. Establish a Housing Trust Fund/Community Land Trust

Housing Trust Funds are set up by state or local governments and are dedicated to maintaining affordable housing for individuals and families. Shared equity refers to the use of these funds to partially subsidize a home for a low-income family. This can occur through a low-interest loan from the Housing Trust Fund or by separating the land from the sale of the house (the Land Trust purchases and retains the land, maintaining an affordable home price). There are currently three cities with Housing Trust Funds in Tennessee—Chattanooga, Knoxville, and Nashville. 


7. Establish a Land Bank

 A Land Bank is a governmental or nonprofit entity that converts vacant lots into productive use. Vacant lots often drag down neighborhood value and increase local instances of crime. By establishing a Land Bank, these unattractive properties can be developed according to neighborhood or community development plans. Additionally, a land trust is able to clear a property from back taxes or a clouded title, making it more attractive for individual sale. Land Banks are one way to address long-term community revitalization in low-income neighborhoods. There are currently three land banks in Tennessee—Chattanooga, Shelby County, and Oak Ridge. 


8. Full Day Kindergarten Program

Kindergarten and early learning programs are a key predictor of later literacy and learning, including high school graduation and success in adulthood. Full day kindergarten programs that serve low-income, minority students are crucial to academic success and breaking the cycle of poverty. These programs serve children ages four to six years, for five to six hours per day five days per week. 


9. Homebuyer Education

Research shows that individuals who attend a homebuyer’s education course are significantly less likely to lose their homes to foreclosure than those who don’t attend a course. Offering homebuyer education courses in community settings, such as colleges and universities, large employers, faith-based organizations, and family community centers (e.g. YMCA) can increase the proportion of individuals and families who are prepared to buy a home and help them avoid foreclosure in the future.


10. Increasing Access to Transportation 

Research has shown that transportation is a key resource in breaking the cycle of poverty. Transportation can affect an individual’s employment, healthcare, and education, among other essential services. Programming that increases access to transportation in rural areas can come in a variety of models—public transit, volunteer drivers, coordinated services, ridesharing, etc. There are also ways in which a community can mitigate the effects of lack of transportation, such as mobile health clinics and telehealth, active transportation infrastructure, and home visiting.


11. Junior Achievement

Junior Achievement is a program that educates youth about work-readiness, entrepreneurship, and financial literacy skills. Training adolescents on the importance of money management and financial literacy may help to deter low-income individuals from falling into debt and avoid predatory lending companies. 


12. Poverty Simulation 

A poverty simulation guides a group of participants through an exercise that is meant to simulate the challenges that an individual or family faces due to poverty. The goals of a poverty simulation are to promote awareness of poverty, increase participants’ understanding of the challenges associated with poverty, and inspire local change. 


1. Access to Health Built Environment Grants (TDH) 

Purpose: The Tennessee Department of Health offers two grants through the Office of Primary Prevention to increase options for daily physical activity—the Access to Health through Healthy Active Built Environment grants. One round is not competitive and is distributed to all 95 counties, and the other round is competitive and application based.  These grants can be used for park improvement, playgrounds, trails, outdoor fitness equipment and other projects that encourage outdoor physical activity through the built environment.

Duration: One year (non-competitive); two years (competitive)

Amount: $20,000 per county (non-competitive); Up to $85,000 (competitive)


2. Appalachian Regional Commission 

Purpose: Grants and funding are awarded by the Appalachian Regional Commission (ARC) focusing on economic opportunities, ready workforce, critical infrastructure, natural and cultural assets, and leadership and community capacity. Tennessee (Eastern Appalachian region) is among 12 other states that are eligible to receive funding from ARC. Specifically, ARC provides grant funding in order to “strengthen Appalachia’s community and economic development potential by leveraging the Region’s natural and cultural heritage assets.”

Duration: Varies 

Amount: Up to $4,000,000; Varies 


3. Community Development Block Grant 

Purpose: The Community Development Block Grant (CDBG) Entitlement Program provides annual grants on a formula basis to entitled cities and counties to develop viable urban communities by providing decent housing and a suitable living environment, and by expanding economic opportunities, principally for low- and moderate-income persons. The U.S. Department of Housing and Urban Development (HUD) awards these grants to entitlement community grantees to carry out a wide range of community development activities directed toward revitalizing neighborhoods, economic development, and providing improved community facilities and services.

Duration: 1 to 3 years 

Amount: Up to $1,500,000; Varies 


4. Community Foundations 

Purpose: Community Foundations offer small grants that focus on community-driven change in Tennessee. The Community Foundations in Tennessee include Appalachian Community Fund, The Community Foundation of Greater Chattanooga, Community Foundation of Greater Memphis, Community Foundation of Middle Tennessee, Knox County Community Foundation, and East Tennessee Foundation. Most of these foundations consider healthy youth development as a focus area of grant funding.

Duration: Varies 

Amount: Varies 


5. Community Service Block Grant 

Purpose: The Community Services Block Grant is a federally funded grant program that supports initiatives that combat poverty in local communities. The program’s goal is to provide services to low-income individuals, such as job development, adult education, and self-sufficiency programs. Funds are awarded through Community Action agencies and are based on identified local needs of a community.

Duration: One year 

Amount: Varies 


6. Delta Regional Authority Grants 

Purpose: The Delta Regional Authority provides grant funding for communities along the lower Mississippi River Delta, including 21 counties in West Tennessee. The goals for the DRA grants are to create inclusive communities, develop long-term economic development, and produce meaningful opportunities for residents in the Delta counties. 

Duration: One year

Amount: Up to $200,000


7. Dollar General Literacy Foundation 

Purpose: The Dollar General Literacy Foundation supports youth literacy through grant funding in several priority areas. Funded areas include implementing or expanding literacy programs, purchasing technology or equipment, purchasing books or materials for literacy programs, and summer literacy programs for Pre-K through 12th grade students who are below grade level reading or who have learning disabilities. The foundation also supports family literacy programs. 

Duration: Varies 

Amount: Up to $3,000 (summer reading); Up ti $15,000 (family literacy) 


8. Tennessee Arts Commission 

Purpose:  The Tennessee Arts Commission supports community design through the Creative Placemaking Grant. Through placemaking, communities can reimagine the use of public spaces in order to encourage collaboration and shared values. Examples of public spaces that can maximize placemaking include parks, downtown squares, waterfronts, markets, and college campuses. This type of community design promotes local business commerce, tourism, and positive social interaction that can help to mitigate the effects of poverty. 

Duration: One year 

Amount: $5,000- $8,000 or $10,000 (two + towns together)


9. Tennessee Center for Health Workforce Development (Community Incentive Grant) 

Purpose: The Community Incentive grant is administered by the Tennessee Center for Health Workforce Development to provide funding for underserved, rural hospitals and recruit healthcare professionals. This grant can be used for signing bonuses, technology, relocation expenses, and loan repayment, among other things. Eligible hospitals must serve at least 30% TennCare or uninsured patients. 

Duration: One year 

Amount: $30,000


10. Tennessee Department of Children's Services 

Purpose: The Tennessee Department of Children’s Services has announced a funding opportunity for programs, project, and activities related to Tennessee’s Building Strong Brains initiative. This initiative aims to address Adverse Childhood Experiences (ACEs) by promoting safe, stable and nurturing relationships between infants/children and their care takers. ACEs are a strong predictor of early childhood brain development, and thus greatly affect grade level reading proficiency. 

Duration: One year, with oppotunity for renew 

Amount: Up to $200,000


11. Tennessee Department of Economic and Community Development Grant 

Purpose: The goals of the TNECD investment fund program are to develop the entrepreneurial infrastructure across the state, to attract new capital to Tennessee and to diversify the state’s economy and create jobs through the development of “innovation clusters” which result in new companies being spun off.

Duration: Varies

Amount: Varies 


12. Tennessee Department of Tourist Development 

Purpose: The Tennessee Department of Tourist Development supports several grants that aim to increase tourism by providing funding for marketing, infrastructure, and outdoor recreation among other projects. Tourism raises up local economies by providing jobs and bringing in outside sources of revenue. 

Duration: Varies

Amount: Varies 


13. Tennessee State Library and Archives 

Purpose: The Tennessee State Library and Archives administers federal funding to museums and libraries in Tennessee through the Library Services and Technology Act. These grants are used to expand library services as well as provide family literacy classes. State funding is also available for increasing technology in local libraries. 

Duration: Varies

Amount: Up to $7,000


14. Transportation Alternatives Program (TDOT) 

Purpose:  The Tennessee Department of Transportation awards grants annually to communities for projects that improve access and provide a better quality of life for Tennesseans by increasing access to alternate modes of transportation. Grants must be applied for through local planning organizations. Projects may include management of sidewalks, bike lanes, abandoned railways, scenic overlooks, and other activities to improve access. Additionally, the Tennessee Department of Transportation funds cities and counties that fall outside of an MPO planning boundary in order to develop community transportation plans for future transportation systems, land use, and growth management. 

Duration: $250,000 - $1,000,000 (general); up to $125,000 (transportation planning)

Amount: 1 year 


15. Walmart Community Grant Program 

Purpose: The Walmart Foundation awards grants to local nonprofits, governmental entities, schools, and faith-based organizations for projects addressing multiple areas of community development. Specifically, grants are given out to fund initiatives that address education for low income individuals and families, as well as community and economic development. 

Duration: One year 

Amount: $250- $5,000


1. Attendance Awareness Month 

Attendance Works is a national organization combatting the effects of chronic absenteeism in students. Chronic absenteeism (missing more than 10% of classes in a school year) has lasting, detrimental outcomes. It is a leading predictor of decreased literacy skills and high school graduation rates. Attendance Awareness Month is a campaign that seeks to educate people about the harmful outcomes of chronic absenteeism. Click on the link for printable materials and social media tools. 


2. Campaign for Youth Justice

The Campaign for Youth Justice seeks to educate the public on the harmful effects of juvenile detention on youth’s development, health, and future prosperity. This campaign is dedicated to ending youth involvement in the adult criminal justice system. 


3. National Healthy Homes Month 

 National Healthy Homes Month is celebrated in June, and seeks to raise awareness about home quality and safety. Low-income families more often live in homes that lead to poor health outcomes. This month can be used to educate the public on the topic of environmental justice and health disparities as they relate to healthy homes. Click on the link for a calendar of events and social media resources. 


4. Promote Supplemental Nutrition Assistance Proram and Summer Food Service Program 

The SNAP and SFSP programs are federally funded to increase access to food for low-income families. SNAP helps to supplement food budgets year-round through food stamp vouchers. SFSP provides meals to adolescents who qualify for free or reduced lunch during the critical summer months when school is out. Promoting these programs to families or potential SFSP sponsors could help to mitigate the effects of inadequate access to nutrition for low-income families. 


5. Promote Tennessee Housing Development Agency (THDA) Services 

The Tennessee Housing Development Agency serves Tennesseans by working to increase and retain the amount of affordable housing for low-income residents. Programs with THDA focus on expanding and supporting homeownership through providing new affordable housing, financial assistance, and supporting the rehabilitation of existing affordable housing. Promoting programs such as the Great Choice Home Loans, Down Payment Assistance, and Homebuyer Education can help community members afford to be homeowners in their own communities. 


1. Chronic Absenteeism Reduction Policies/Trauma Informed Training

Local school boards and individual schools can work to reduce the number of children who are chronically absent (those who miss more than 10% of school days in a school year). When students miss school for any reason, they miss important instruction and class time. Policies can address student absenteeism by encouraging an up-to-date and comprehensive attendance reporting system, decreasing unnecessary out-of-school suspensions, and creating safe and welcoming school environments that engage parents in the classroom. See the source below for policy brief and other recommendations. Schools can also be mindful of students struggling with their home lives by engaging in trauma informed policies through training. By training staff to handle students with trauma-informed care, the effects of Adverse Childhood Experiences can be lessened.


2. Community Disaster Response Plan 

Research shows that natural disasters often cause much greater detriment to low-income communities. These neighborhoods typically lack the resources to prevent damage and recover quickly, and are often located in geographical areas that are subject to more severe weather. By creating or updating an existing community response plan, a county can bring social services together to provide for these low-income communities in times of natural disasters. A comprehensive plan should involve coordination of clinical services, mental health care, food support, emergency housing, and other social services in the community. 


3. Create a Strategic Plan for Parks and Greenways 

Creating or updating a city’s strategic plan for parks and greenways is a great way to assess the local demographics of a community, what parks and greenways already exist, and what groups or areas lack adequate outdoor space. A strategic plan for a community should include experts and stakeholders from various fields (some ideas include the local Health Department, School Board, local MPO, Chamber of Commerce, the housing sector, parks and recreation, and more). Furthermore, public engagement is an integral part of the planning process to ensure that the people being served have a voice in the development of community assets.  See the Nashville Parks and Greenways Master Plan in the source below for an example of a strategic plan and the process.


4. School District Inclusionary Zoning 

Public schools today are still very much segregated in terms of race and socioeconomic status. When school zoning policies don’t take into account socioeconomic status integration, schools that serve primarily low-income students often have fewer resources to offer than schools that primarily serve higher-income, white students. Students who attend schools with fewer resources are less likely to graduate, attend college, or break the cycle of generational poverty. School district zoning policies should take into consideration socioeconomic status, in order to bring balance to student populations. 


5. School Integration Policies 

School districts can pursue other policies that aim to integration students of all socioeconomic statuses. One example is inclusionary transportation policies. In addition to allowing students of low-income to transfer to schools that serve high-income families, schools can also provide free transportation to students who qualify for free and reduced lunch so that they may attend their school of choice. 


6. Zoning Policies to Increase Walkability and Connectivity 

Access to parks and greenways is increased when community members are willing and able to walk to a park from their homes, schools, or place of employment. Several factors can lead to safer, more walkable routes to parks including proper sidewalks and lighting, lower speed limits for adjacent traffic, shade to mediate warmer weather, and adequate pedestrian signage. These zoning policies increase access to green spaces particularly for low-income residents without alternate modes of transportation. 


1. Screen for Adverse Childhood Experiences 

Adverse Childhood Experiences (ACEs) are stressful or traumatic events, such as neglect or abuse, that occur during the formative stages of adolescence. It’s important that health care providers screen their patients for ACEs in order to refer them to services or provide better care in the clinical setting.


2. Screen for Poverty and Refer to Resources 

Healthcare providers are in a unique position to screen families for social determinants of health, including poverty. The American Academy of Pediatrics recommends that pediatricians address financial stability of families with young children. In addition to screening families and individuals for poverty, healthcare providers should also maintain staff members who are able to connect low-income families with local resources and community organizations. 


*State employees are prohibited from engaging in
political activity not directly a part of that person’s employment during any
period when the person should be conducting business of the state (Tenn. Code
Ann. § 2- 19-207). For further information on State Employee Political
Participation, please visit: 

This document is not a Department endorsement of legislative policy.