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How environment affects health in Tennessee

When you walk out of your house, what do you see?

Is it a yard, some trees, and a few kids riding bikes?

Or is it an abandoned house, cracked sidewalks, and trash blowing down the street?

It’s different for every Tennessean, but one thing is the same for all of us: your environment matters.

Where you live and work affects your health — physical and emotional — as well as your safety and economic well-being. 

“When we think about ‘our environment,’ often we think about air and water because those are the things we’re familiar with, and those things do matter,” says Dr. Debra Bartelli of the University of Memphis’ School of Public Health. “But the issue is really much bigger than that. There are a lot of factors, from walkability and the built environment to crime and safety, that play a part in environmental health.”   

Here are a few of the biggest factors influencing environmental health in Tennessee.


Cities with a lot of green space and trees have better air quality because the trees absorb pollutants and generate oxygen,  which produces fresher air.

Like many parts of the South, Tennessee is highly dependent on cars. Their emissions, in addition to emissions from diesel trucks and coal-fired power plants, affect our air. According to the American Lung Association’s 2018 “State of the Air” report, many of our urban centers report high ozone days (days when weather conditions + pollution = harmful health effects). The grades for the counties surrounding Tennessee’s biggest cities were:

  • Knoxville: C
  • Chattanooga: C
  • Nashville: D
  • Memphis: F

However, the report does give all Tennessee counties that measure high-particulate pollution passing grades, which is an improvement over past years.  

The grades for high-particulate pollution by county were:

  • Knox County: D
  • Hamilton County: B
  • Davidson County: B
  • Shelby County: B

Counties graded for high-particulate pollution 

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Map credit: Knox News. Click on counties on the map above to learn more about their high-particulate pollution.


Stormwater runoff

Cities that lack sufficient green space may not allow for proper runoff of stormwater, which contains pesticides, fertilizers and other contaminants that flow into our streams, rivers and lakes.

Standing water

Standing water also breeds mosquitos, which carry disease. Mosquitos are particularly problematic in Tennessee due to our proximity to and high volume of lakes and rivers.

In Memphis, drinking water is above average in quality because Shelby County draws its water from the Memphis Sand aquifer, which has a natural filtration system that sifts out impurities.


With coal-fired power plants still in operation in Tennessee, pollution is a problem. If coal ash, a highly toxic byproduct of coal production, isn’t properly or effectively stored, it can contaminate groundwater or create toxic waste spills. In 2008, the worst coal-ash spill in American history happened just outside of Knoxville.

Overall, Tennessee’s lakes and rivers vary in terms of pollution. In Memphis, the Mississippi River is polluted from industrial waste and sewage overflows, and the Cumberland River in Nashville and the Tennessee River in Knoxville face similar challenges.

The Tennessee Department of Environment and Conservation (TDEC) has estimated that:

  • 30% of Tennessee’s streams are of such poor water quality that they can’t support healthy fish and aquatic wildlife 
  • Nearly 40% are not fit for human recreation
  • Tennesseans pay higher utility bills as a result of pollution because more resources must go towards water treatment 

Open space

“Cities that have less open space have more problems,” says Dr. Bartelli.

“That open space includes green spaces but also public basketball courts, dog runs, and so on. If you have a city that’s all concrete, you have problems such as heat islands and concerns about where all the stormwater runoff goes. More importantly, where do the people go?”

Any open piece of land that is not covered by buildings and is accessible to the public is considered an open space.  These can include:

  • Schoolyards
  • Playgrounds
  • Plazas
  • Public seating areas
  • Vacant lots
  • Green spaces

Green spaces are parks, gardens, cemeteries and other areas completely or partially covered by grass, trees, or vegetation.  Studies have shown that greening of vacant urban land can decrease depression from 40-60%, especially in resource-limited urban settings, which means these spaces are important to both our physical and mental health. Blue spaces — bodies of water including lakes, rivers and oceans that are visible from where you live — are part of the same equation.

Currently, The Trust for Public Land ranks only the 100 largest U.S. cities for their use of green space.

  • Nashville ranks 54
  • Memphis ranks 91

Park coverage is a part of that equation, and you can visit ParkScore to see an interactive map of each city.

In Memphis, there is a plan in place — Memphis 3.0 — to build the city up and not out in its third century, and to anchor it around neighborhoods that are connected to one another.


When neighborhoods are poorly-maintained or full of vacant, boarded-up houses, it affects safety. Those environments can invite crime or make people feel unsafe walking around.

“Sidewalks and lighting are so important,” says. Dr. Bartelli. “Areas that have well-lit streets and good, working sidewalks make people more likely to walk.”


“What can you really walk to from your house?” asks Dr. Bartelli. “That’s one of the most important questions related to walkability.”

Safety and sidewalks are important, but there are also two other key questions you have to answer:

  1. Are there destinations worth walking to?
  2. Is there is connectivity between neighborhoods?

“What you don’t want to be faced with is, ‘Well I can walk from here to here, but then I’ll have to get in a car,’” says Dr. Bartelli. “‘And then I can walk from here to there, but then I’ll need to call an Uber.’ Those considerations make a big difference.”

Walk Score grades cities out of 100. Cities like New York (89) and Chicago (79) score very high, while Southern cities tend to score lower (Atlanta scores 49). Tennessee’s 4 largest cities all have a Walk Score between 28 and 37:

  • Nashville: 28
  • Chattanooga: 29
  • Knoxville: 31
  • Memphis: 37

Tennessee cities are addressing that in many ways, specifically by adding and expanding greenlines, building public green spaces and adding bikeshare programs. You can check your walkability score here.

Walking group, Crosstown Concourse Memphis, TN. African American, Loyola sweatshirt Johnella Ingram African American, tall, white tshirt under jacket: Joy Gilmer White: pink sweater Claudia Haltom White: Dark sweater vest Amy Mulroy
One of the unique stairwells at Crosstown Concourse

Built environment

“If you live in a place that’s not attractive or safe, why would you want to get out and walk it?” asks Dr. Bartelli. “It’s really as simple as that.”

The built environment includes all the physical elements of where we live and work — homes, buildings, streets, open spaces. It affects our ability to walk, run or play, of course, but it also affects our mood. People are drawn to attractive spaces, and it’s important to consider what’s visually pleasing when we build new things. 

In Memphis, for example, some zoning rules dictate that commercial buildings can’t have a parking lot in front on street level, and some green space has to be incorporated. The city is also looking at the subtle ways activity is encouraged, or discouraged, by our environment.

“Think about where a stairwell is placed in a hotel or a garage,” Dr. Bartelli says. “Often they’re on the interior all walled in, which can be scary and uninviting. That makes you less likely to take the stairs. At Memphis’ Crosstown Concourse, for example, the stairwells were designed to be beautiful and inviting. In fact, the elevators are actually hard to find, so people are more likely to take the stairs. It’s a small change, but it’s one that matters. That’s how Tennessee is going to get where we need to go.”

Groundbreaking at BlueCross HealthyPlace in Memphis

BlueCross Healthy Places

The BlueCross Healthy Place program provides neighborhoods with communal spaces for healthy activities, improving the overall well-being of Tennesseans. The first BlueCross Healthy Place project is revitalizing David Carnes Park in Memphis. Click here to learn more about how the BlueCross BlueShield of Tennessee Health Foundation will invest up to $5.4 million in the Whitehaven neighborhood park.

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