The five leading causes of death in Shelby County are heart disease, cancer, cerebrovascular disease, chronic lower respiratory tract disease, and unintentional injuries such as drug overdoses and motor vehicle crashes. 

Those are the official causes, according to the Shelby County Commission District Health Profile for 2022. 

But what might be considered the underlying conditions of those causes are discrepancies in income, housing, education, pollution and community resources. 

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“We all agree that where we live, work, play and are educated has a major impact on our health outcomes and those social forces that impact our health and our ability to get health care,” said Dr. Robin Womeodu, senior vice president and chief academic officer at Methodist Le Bonheur Healthcare in Memphis. 

Across Shelby County, the average life expectancy ranges from a high of 84.6 years in a census tract in Collierville and a low of 65.3 years in a neighborhood near Presidents Island. 

Womeodu said by the time people are admitted to her hospital, it’s too late for prevention: They are often in the later stages of chronic illness. 

“We are seeing the end point of the social forces and social determinants,” she said of her hospital patients. 

Those social determinants refer to the conditions in which residents are born, grow, live, work and age. Essentially, everything about a person’s environment can play a role in their health and longevity: Pollution, the number of nearby grocery stores or fast-food restaurants, age of housing stock, crime rates and access to health care facilities, among other factors. 

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In the desert 

Life expectancy at birth is considered a key indicator of a population’s overall health, with longer life expectancy tied to factors such as safety, better access to health care, availability of fresh foods, dependable transportation and a quality education. 

According to the U.S. Small-Area Life Expectancy Estimates Project, which estimated life spans by state and census tracts for 2010-2015, those factors vary wildly between Shelby County neighborhoods. 

For instance, food deserts — neighborhoods where access to fresh, nutritious and affordable food is scarce — are scattered across Memphis. 

“Grocery stores have left the inner cities or they were never there to begin with,” said Debra Bartelli, research associate professor of Urban Health at the University of Memphis School of Public Health. “So, we have a lot of food deserts in Memphis. South Memphis, Orange Mound and a number of other neighborhoods experience this.”

Orange Mound falls into two different census tracts. In one, No. 67, the estimated life expectancy was 66 years. In the other, tract 68, the life expectancy was 68 years.

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Within the borders of Orange Mound, there is no large, full-scale grocery store. Residents without reliable transportation have to utilize dollar stores and small neighborhood markets such as Carnes Mini Market. 

The cost of placing supermarkets in food deserts can deter larger grocery chains from setting up shop. So can factors such as potential revenue as well as higher costs for security, insurance, building maintenance and employee training.

According to experts, residents without convenient access to grocery stores often end up purchasing what’s readily available at nearby gas stations, convenience stores and fast food restaurants: energy-dense foods high in carbohydrates, fat, sugar and/or sodium.

“When you look at chronic disease, hypertension and obesity, that’s tied to what foods are available and affordable,” Bartelli said. 

A similar situation occurs with health care facilities. 

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“We find that access to things like certified mammography facilities are much less available in areas that have concentrated poverty with higher percentages of Black residents,” said Shelley White-Means, executive director of CHEER, the Consortium for Health Education, Economic Empowerment and Research based at the University of Tennessee Health Science Center in Memphis. 

Reliable transportation can help overcome some of these barriers to better health. In addition to connecting residents to full service grocery stores and medical facilities, transportation improves access to better and more jobs, which can improve socioeconomic mobility as well as provide health insurance. 

“Look at the Poplar (Avenue) corridor,” Bartelli said. “It has a lot of grocery stores and other services, and a lot of the area’s health care. It’s not easy to get to when you have to rely on a bus and you have to take a day off just to go for a 15-minute doctor’s appointment, especially when you’re not compensated for it and you have to lose a day’s pay.” 

The impact of violence and trauma 

Bertelli said safety issues also pose a challenge to health and quality of life in many of the county’s neighborhoods. 

In August of 2022, Charlie Caswell Jr., a longtime pastor and community activist, was elected to represent District 6 on the Shelby County Commission. His district on the north side of Shelby County includes Bartlett Woods, Old Bartlett Park and parts of Berclair and Frayser among other neighborhoods.

There, the median household income is $34,346 — 34% lower than Shelby County’s overall median household income — and the poverty level is 27%. The child poverty level there is 39%. 

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Caswell himself is no stranger to childhood poverty. One of 17 siblings, he grew up in the 1980s in Dixie Homes, a public housing development built in the New Deal era on Poplar Avenue between Ayers Street and Decatur Street near what is now the Medical District. 

As a teenager, Caswell was repeatedly exposed to violent crime. 

“It was a time when crack cocaine was real big on the scene,” he said. “At 14 years old, I witnessed one of my friends killed over a drug deal right in front of me, and sat there for three hours until they came and got his body. The next year, when I was 15 years old, I had another friend shot in the head in front of me over a drug deal.” 

“Grocery stores have left the inner cities or they were never there to begin with.”

Debra Bartelli
University of Memphis School of Public Health

Black teens and young men are at a heightened risk of death by violence. In 2020, the Black homicide victimization rate was nearly four times the overall homicide victimization rate, according to a report from The Violence Policy Center.

The same report said 86% of Black homicide victims were male, with an average age of 32, and about 90% were killed by gunfire. 

In addition to cutting lives short, those incidences of violence leave witnesses such as Caswell struggling with many aspects of their lives that impact health, including education. As a high schooler, Caswell was often sent to the office at school for not focusing.

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“I was shut down,” he said. “That trauma affected me. I just thought I was going to die in that community. Children are still waking up to this every day. There’s a lot of hopelessness.” 

As a pastor, Caswell’s spiritual counseling sessions often turn into discussions of unhealed trauma. 

“In the Black community, the Black church is where many of us go for issues, so it’s important to have pastors and their leadership teams become trauma informed,” he said. “Many of our communities have been dealing with historically generations of trauma. We’ve failed to really address some of those environmental and other ills in our community.”

Caswell has committed himself to educating other community leaders about ACEs, or what’s known as adverse childhood experiences, which include events like witnessing community violence. 

“When you live in poverty and you’re exposed to violence and crime, your body is constantly dealing with these fight-or-flight kind of adrenaline surges,” said Bartelli, whose research at the University of Memphis School of Public Health includes how ACEs impact health. 

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“That stress has an impact on your body and drives up the likelihood that you’re going to have heart disease and high cholesterol,” she said. “Community violence and all of those factors work together. It’s a big system, and it’s hard to disentangle that system.”

Caswell, who also serves on the Shelby County Board of Health, said trauma is integral to any discussion of life expectancy, and it must be addressed through counseling and resources. 

“That can help prevent some later tragedies in life,” he said. “Being in politics and on the board of health now, I’m seeing how disinvestments have gone unaddressed for years in many of these communities, looking at where people were born and where they died and how they died. What is predictable is preventable.”

Emerging from the pandemic

Local experts agree that one of the most valuable solutions for improving quality of life for Shelby County residents requires embedding community-focused organizations and resources in high-need neighborhoods, where residents can easily access support. 

“People desire to improve but they face too many barriers,” White-Means said. “It’s becoming impossible on their own, they need help and support — just a little hand up.” 

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The average U.S. life expectancy actually declined in 2021 from the year before, according to provisional data from the CDC, and it pushed the country’s life expectancy to its lowest level since 1996. 

That decline was driven in part by the COVID-19 pandemic though deaths from drug overdoses, heart disease, strokes, chronic liver disease, suicide and homicide also contributed. 

Womeodu said the pandemic also shed light on the inadequacies of the nation’s public education system. 

“Education, particularly public education, is one of the significant health care forces in our community,” she said. “If you look at high school graduation rates, that drives so much in life in the United States, including your ability to get a good job and your ability to have health insurance and access to care.”

The Economic Policy Institute said the pandemic exacerbated opportunities gaps that put low-income students at a disadvantage compared to their more affluent peers. Those gaps included access to food and nutrition, housing, financial relief measured and health care. 

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“Education has always been an interest to me because it is a less costly means to address generational poverty,” said Shayla Kolheim of United Way of the Mid-South, who previously worked with the Tennessee Higher Education Commission. “If we get the algorithm right to appropriately support and resource students, then we position them for higher-wage, high-demand employment opportunities.”

Kolheim is the director of United Way’s Driving the Dream, one of the Mid-South’s largest collaborations to address problems associated with poverty. As part of the initiative, about 130 agencies support clients by connecting them to the resources they need to move towards economic mobility, then stability. 

Kolheim said Driving the Dream has a “focus on economic mobility for some of the more vulnerable populations and members, some that are impacted by poverty – even though I tend to believe that there isn’t a population in Memphis that is not impacted by poverty.” 

Cumulative data shows that 44% of those clients have more stable employment and 62% report higher incomes. 

“A lot of times when we talk about poverty, we speak about people and we don’t always speak about policies,” Kolheim said. “Policies encourage things like homeownership. … Poverty impacts people, but one of the ways we can impact it is through paying attention to the policies.” 

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And evidence-based health policy can have a tremendous impact on health and wellbeing. Dr. Michelle Taylor, director of the Shelby County Health Department, said health equity should be a community priority. 

“This is the type of work that was put on hold during the pandemic, and definitely didn’t get as much attention and focus,” she said. “Now, as we pivot into the next chapter in Shelby County health department’s history, we’re really looking at those differences, talking about it, educating the public about it, and then talking about solutions.”