Designing for Health: How Nashville’s Leaders Are Reconnecting Planning, Policy and Community Well-Being

From Left: Gary Gaston, Civic Design Center; Leslie Meehan, Tennessee Department of Health; and Dr. Alex Jahangir, Vanderbilt University Medical Center

By Jaclyn Tidwell | Programs & Strategy for Cumberland Region Tomorrow 

This blog is the first of a series based on the November 2025 Power of 10 Summit. 

For decades, the fields of public health, urban planning and community design have drifted apart — a separation that has left cities with fractured systems, inequitable investments and chronic conditions that no amount of medical care alone can fix. But in Nashville and across Middle Tennessee, a growing coalition of planners, health officials and medical leaders is working to bring these disciplines back together. Their goal: build communities where residents can thrive, not just survive.

At the recent Power of 10 Summit, three leaders — Gary Gaston, CEO of the Nashville Civic Design Center; Leslie Meehan, Director of the Office of Primary Prevention at the Tennessee Department of Health; and Dr. Alex Jahangir, Orthopaedic Trauma Surgeon and Senior Vice President at Vanderbilt University Medical Center — explored how design, health and policy intersect, and what the ten-county Middle Tennessee region must prioritize in the decade ahead.

How Design and Health Became Disconnected — and Why It Matters Now

Until the mid-20th century, public health and city planning were inseparable. Cities battled cholera, overcrowding and unsafe conditions by redesigning streets, parks and sanitation systems. But after World War II, as planning became increasingly car-centered and medicine increasingly clinical, the professions diverged.

That disconnect still shapes American cities today. Chronic diseases rise where walkability is low. Life expectancy shifts block by block. And entire communities bear the weight of disinvestment, lack of transportation options, and unstable housing.

Gary Gaston recalls his own turning point: hearing a public health physician describe an elderly Atlanta woman forced to walk along a dangerous roadway in extreme heat. If she had died, the cause of death would have been “heat stroke” or “trauma,” he said — but the true cause would have been the built environment.

That insight drove the Civic Design Center to develop “Shaping Healthy Communities,” a publication that reframed Nashville as a case study in how design can advance public health in urban, suburban and rural settings.

Two Decades of Change: Nashville Then and Now

Twenty years ago, Nashville was on the cusp of transformation.

Leslie Meehan, then a planner, remembers developers stunned by the city’s fast review timelines and lack of impact fees — signs the city was primed for rapid growth. Sidewalks were scarce. Mixed-use development barely existed. Parks and public amenities were unevenly distributed — pristine in some neighborhoods, neglected in others.

Yet even then, the seeds of change were emerging. The city was beginning to discuss form-based codes, ADA compliance, and the idea that rights-of-way should serve more than cars.

Dr. Jahangir offers a sobering reminder: despite booming growth, Nashville still lags its peer cities in life expectancy, infant mortality, hypertension and obesity. In ZIP codes just miles apart, life expectancy can vary by more than 16 years.

“We haven’t turned the tide yet,” he says. “But we are finally acknowledging why these disparities exist — and that healthcare alone can’t solve them.”

Public Health Steps Into the Built Environment

Meehan and the Tennessee Department of Health have spent the past decade reshaping what public health can influence. Instead of focusing solely on vaccines and clinics, the department now supports:

• Healthy Built Environment Grants

Money once reserved for healthcare access now funds greenways, farmers markets, small parks and active-transportation improvements. Demand has been overwhelming: 13 applications for every available grant.

• Health Development Coordinators

These hybrid planner–public health roles help communities — especially rural ones with limited staff — write grants, interpret data and design projects. Tennessee received 400+ applications from 30 states for just seven positions.

• Housing as Healthcare

During COVID-19, eviction-prevention efforts opened the door to broader conversations about housing stability as a public health imperative. Tennessee is now exploring partnerships with healthcare systems and faith communities — two major landholders — to build affordable housing and supportive environments.

Healthcare systems nationwide are recognizing that investing in housing can reduce hospital costs and improve outcomes. Nashville is beginning to follow suit.

• Hospitals as Community Anchors

For Vanderbilt, says Dr. Jahangir, the shift has been profound. Rather than concentrating services in downtown Nashville, the medical center is expanding into surrounding counties to keep care closer to home and build lasting community partnerships.

Under federal rules for nonprofit hospitals, Vanderbilt and other systems now conduct Community Health Needs Assessments, gathering data on food insecurity, chronic disease and demographic trends — data that can guide local policymakers.

Most importantly, health systems are learning to collaborate rather than operate in silos. Jahangir highlights a local hypertension initiative that dramatically reduced rates in a targeted population by aligning medical providers, food-access organizations, universities and data partners.

“No one had to stretch beyond their mission,” he says. “They just had to work together.”

What a Healthy Community Actually Looks Like

When asked to define a “healthy community,” the panelists emphasized:

• Choices — where to live, how to get around, what to do.

• Safety — not just from crime, but from traffic danger, heat, and environmental hazards.

• Opportunity — good schools, stable housing, meaningful work.

• Thriving public spaces — streets and parks that welcome everyone.

• Life expectancy that matches or exceeds state and national norms.

  
  

The Biggest Barriers — and the Next Frontiers

Looking ahead 10–20 years, panelists identified several priorities:

1. Housing Must Come First

Without stable housing, healthcare, education and job access fall apart. Tennessee needs more tools — from zoning fixes to incentives — to support affordable, attainable housing in both urban and rural areas.

2. Break Down Silos Across Sectors

Designers, planners, health departments, healthcare systems, housing agencies and community leaders must plan together — not sequentially or separately.

3. Build Complete, Safe, Connected Networks

Nashville has expanded its greenways and bikeways dramatically, but safe street design — including protected lanes and pedestrian improvements — must accelerate as Vision Zero moves forward.

4. Streamline Development While Maintaining Equity

Lengthy rezoning processes and inconsistent community benefits discourage the very types of housing and mixed-use projects Middle Tennessee needs. But speeding up must be paired with better standards and clearer expectations.

5. Use Data to Target Action

Hyperlocal data on chronic disease, crashes, food insecurity and housing instability allows cities to start small — pilot projects, specific corridors, high-need ZIP codes — and scale what works.

6. Invest Locally, Not Just in Big Announcements

State and local governments must pair the economic incentives offered to major employers with equal support for small businesses, neighborhoods and local development.

A Region That Plans — and Acts — Together

Perhaps the biggest shift over the past quarter-century is cultural: regional leaders finally recognize that health, design and economic prosperity are interconnected — and that no city or county can address them alone.

As Gaston puts it, “our challenges don’t stop at county lines.” The move from multidisciplinary to transdisciplinary collaboration — where ideas, tools and goals merge — is emerging as the region’s most powerful strategy.

Conclusion: Designing a Healthier Future

Middle Tennessee’s story mirrors challenges faced throughout the U.S.: rapid growth alongside deep inequities; world-class medical institutions in cities where life expectancy remains stubbornly uneven; and communities trying to reconcile economic expansion with long-term health.

But Nashville also shows what’s possible when planners, doctors, policymakers and residents work together. A healthier region isn’t built through medicine alone — it’s built through housing, transportation, public space, collaboration, and a willingness to rethink how communities grow.