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Why People in Poor, Rural, African American Mississippi Counties Live 23 Years Less On Average Than People From Monaco


Mississippi has the lowest life-expectancy in the country (average – 74.8 years) and Hawaii has the highest. Hawaiians live seven years longer, on average. The U.S. average is 78.2 years. The rural, poor and African-American counties along the Western edge of Mississippi have an average life-expectancy that is eleven years less that the U.S. average (67.2) which is 15 years less than Hawaiians live on average (see Table 1 below).

However, Hawaiians are not doing that great.  The U.S. average life-expectancy is ranked 50th in world. In contrast, these Mississippi counties, have an average life-expectancy  which would be ranked 158th(next to Bhutan) where the average annual income is only $1,000.

Also, this isn’t a new this isn’t a new problem where public health officials haven’t had adequate time to figure out what the problem is.  The death rates in these counties have been high for many years.

Why are the death rates so high?   According to ABC news, even though we have better health care, it’s caused by Mississippian’s poor diets. Naked Capitalism, CNN, Discovery News, The Economist, Health Day and CBS  quoted an expert who said high obesity rates in these counties or other lifestyle factors are responsible for the problem.  These reports also stated what the problem was not due to ethnicity and not one report suggested that the health care system (e.g., lack of health insurance) might play a role.  ABC news stated that these people were receiving quality care.

Compared with other counties in Mississippi and nationally, these counties have very high rates of diabetes, obesity and physical inactivity. The last column in the Table 1shows the average number of years of life which is eleven years less than the national average of 78.5 years.

Table 1 Physical Activity, Obesity and Diabetes
County – Obesity1 Inactivity2 Diabetes3 Life4
Bolivar – 39.2% – 31.1% – 13.3% – 67.8
Coahoma – 45% – 36.1% – 14.7% – 66.9
Holmes – 40% – 35.4% – 14.1% 67.2
Jefferson – 44.9% – 37.2% – 15.3% – 67.9
Quitman – 44.1% – 34.8% – 15.1% – 66.1
Sharkey – 40.2% – 35.2% – 13.3% – 67.6
SunFlower – 41.4% – 34.6% – 14.4% – 67.3

1 Percentage of county that is obese
2 Percentage of county that is physically inactive
3 Percentage of population diagnosed with diabetes
4 Life-expectancy

However, these counties have a lot of problems not mentioned in these news articles. For example, Mississippi has the highest teen birth rate, and ranks last in infant mortality, low birthweights, premature infants and preterm births. Infant mortality and low birthweights are associated with younger mothers which suggest lack of access to birth control and counseling for young women.

These counties also report excessive deaths due to heart disease,  cancer(not-lung), kidney, blood poisoning, hypertension and homicide.  Obesity isn’t a risk factor for homicide, blood poisoning or cancer.

Poverty also influences life-expectancy. The poor live five years less on average. Monaco has the world’s highest GDP and highest median income,  also has the highest life-expectancy(90 years).  Similarly, those who live the longest in the U.S., live on some very expensive real estate Hawaii which is in part why Hawaiins live longer than people who live in other states.  In contrast, Mississippi ranks 50th among the states in terms of personal income per capita and median income, and it ranks first in child poverty.

National Public Radio(NPR) also suggested that obesity was the problem in Holmes County. However, they also pointed out that poor people often choose the least expensive foods which are also the foods linked to obesity. Clearly, poverty creates greater lifestyle problems but what NPR missed is that it also creates problems with the quality of health care, access to  services and increases the liklihood you will live in more polluted areas.

Mississippi ranks 44th for lack of health insurance, 48th in preventable hospitalizations and primary care physicians(82.2 per 100,000 people compared with 149 nationally), 35th in checking for cholesterol and 49th for annual dentist visits.

The data in the counties with the lowest life expectancies lacked access to health care.  Nearly, 30% of the population is uninsured in the counties in Table 2.  The quality of care was low as well.  The number of preventable hospitalizations is more than double and in some cases triple the national average.  There was also less preventive care.  Women received 25% less mamographies in these counties. These counties averaged 192 physicians less per 100,000 residents than the national average.  In the Delta, which includes most of these counties with the highest mortality rates, the Mississippi Department of Health estimates that half of H.I.V.-positive Mississippians currently don’t receive treatment. Lack of access to care wasn’t mentioned in any of the newspaper reports except for ABC news which said these counties had excellent care!

Table 2: Access to Healthcare & Water Quality
County – Access1 Water2 Uninsured3 Hosp4 Mam5
Bolivar – 125.9 – 61 – -27% – +76 – -24%
Coahoma – 145.3 – 66.9 – 28% – +85 – -26%
Holmes – 77 – 27 – 30% – +32 – -23%
Jefferson – 44.9 – 33 – 23% – +89 – -29%
Quitman – 60.8 – 33 – -29% – +135 – -31%
Sharkey – 61 33 – 29% – +55 – -16%
SunFlower – 37.4 – 33 – 31% – +75 – -31%

1 Number of physicians/100,000. National average is 271.
2 EPA water score. A higher score is better. National average is 55.
3 Percentage of county without health insurance
4 Number of preventable days hospitals above national average of 49
5 Percentage of county receiving mamographies – national average(74%)

Mississippi ranks 49th in water quality.  The drinking water in these counties is polluted with radium and uranium and inadequately monitored. Water quality data for these Mississippi counties is out of date.  Out of 2,379 counties in the U.S., Coahoma County ranks 2,370th  in water quality, Bolivar County is 2,316st and Sunflower County is 2,308th. As noted above, cancer rates are very high in these counties.

Yet, Mississippi has a record number of water quality violations since 2004.  Since 2004, they found that Mississippi received 23,125 violations for failures to monitor water quality regularly and 1,690 violations for failure to report information to public and state agencies. There were 558 violations water violations for having too many contaminants and 268 violations relating to national primary drinking water regulations. There were 485 violations for failure to monitor for the Coliform bacteria and 70 repeated failures. There were 60 violations for failures to report information to the public.

These data suggest that Mississippi doesn’t care about its water quality.  The state of New York has 5.7 times more people than the state of Mississippi but fewer water violations. Most states had less than one tenth as many violations as Mississippi.

In August, a former long time operator of several waste water and drinking water systems in North Mississippi, pled guilty  to one count of submitting false material statements in regard to operation of various publicly owned waste water treatment facilities and public drinking water systems and to one count of failing to establish and maintain records, make reports, and sample effluents as required by the Clean Water Act.  According to the Justice Department, these’ actions threatened water quality and drinking water safety.


Water quality and pollution is an even more severe problem in the low life-expectancy counties in Mississippi than it is statewide.  These facts were also no mentioned in any newspaper reports.

Table 3 shows that pollution counties with low life-expectancies.

Table 3. 2005 EPA National-Scale Air Toxics Assessment Risk Estimates
County ~ Cancer ~ Neuro ~ Res. ~ Form.
MISSISSIPPI ~ 54% 70% 31% 62%
BOLIVAR ~ 78% 72% 64% 64%
COAHOMA ~ 98% 99% 69% 64%
HOLMES ~ 71% 68% 65% 69%
JEFFERSON ~ 71% 50% 62% 70%
QUITMAN1 ~ 78% 77% 63% 68%
SHARKEY2 ~ 44% 89% 63% 89%
SUNFLOWER ~ 75% 54% 58% 63%

Neuro. = Neurological Problems
Res. Respiratory Problems
Form. = Formaldehyde Formaldehyde may cause respiratory problems and cancer.
EPA data
1 EPA used Tallahatchie county assessments for this estimate
2 EPA used Washington county assessments for this estimate
In Table 3, percentages are percentiles ranking of counties and States from 0 (lowest) to 100 (highest) except for Formaldehyde which is an estimate of the probability that cases of cancer will develop.

These news reports also lied when they claimed that ethnicity wasn’t an issue when African Americans in Mississippi are dying from AIDS at a rate 64 percent higher than the nation’s average and  over 60% of the people in these counties are African-American.  What has occurred in these counties is a classic example of institutional racism.

So what is the solution to these problems?. Recently, an exceptional New York Times article suggested  a community health model that insures equal treatment for everyone regardless of income.  Similar models have worked in the U.S. for violence prevention. That is, you have to have a model that targets the people who need care and a system that doesn’t divert money elsewhere.  You need reporters like Susan Hansen who wrote the New York Times article and editors that accept such pieces like Dean Robinson of the New York Times.  You also need to let people know they can’y trust reporters from most news sources.

Theses reporters are writing about a world that doesn’t exist and their using the Fundamental Attribution Error to guide their thinking.  The Fundamental Attribution Error argues that people tend to blame victims for their problems.  Since people tend to blame overweight people for being overweight.  The reporters are focusing on the issue that most denigrates the victims of poverty, lack of health care and pollution.

You can click here to find out about your water but don’t forget about the people living in these Mississippi counties.

The Affordable Care Act will not address quality of care or public health issues.  Race, environmental and water problems are not being addressed at the state or federal levels.

If you’re a woman, you have additional cause for alarm.  The report from the Institute for Health Metrics and Evaluation (IHME) that was cited and quoted by most newspapers found

” Across US counties, life expectancy in 2009 ranged from 66.1 to 81.6 years for men and 73.5 to 86.0 years for women. From 1989 to 2009, life expectancy for men improved by 4.6 years on average but only by 2.7 years for women.

In 661 counties, life expectancy has stopped dead or went backwards for women since 1999.”




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Dr. Todd Miller persuasion, health care, justice and intelligent civil dialogue.