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By: Marcus J. Hopkins August 2nd, 2023
The Appalachian Learning Initiative (APPLI, pronounced like "apply") launched our #PublicHealth research in November 2022 to highlight health disparities in Appalachian states, counties, and independent Virginia cities. Last month, we doubled down on our research, analysis, and advocacy in the Public Health space by updating our existing data and gathering new data to add to our growing work.
As we began putting together county-level maps of health outcomes, we began to notice a significant trend:
In counties with higher percentages of adults reading at or below an 8th Grade level, the incidence, prevalence, and mortality rates of several health conditions and behaviors were significantly higher than the national average.
This is known as a "correlation"—when two quantifiable measures are related, but one does not necessarily cause the other to occur. When one measure causes an outcome to occur, this is called "causation."
An excellent rule of thumb when measuring the correlation between two factors is that "correlation is not causation": essentially, just because the two factors are related—in this case, low levels of adult literacy and the incidence of Chronic Obstructive Pulmonary Disease (COPD, pictured right).
To measure the relationship between two sets of factors, we use what is called the Pearson Correlation Coefficient formula.
This formula takes two sets of numbers, measures the relationship between those two sets, and produces a ratio between the two sets on a scale from -1 to 1. This can give us three possible results:
If the ratio is 0, that means there is no correlation between the two factors
A positive number ranging from 0.1 to 1.0 indicates that, as one variable increases, the other variable will increase. This range is broken into three sectors:
A negative number ranging from -0.1 to -1.0 indicates that, as one variable increases, the other variable will decrease.
The further the correlation coefficient ("r") from zero, the stronger the correlation.
Adult Literacy and Health Outcome Correlations in Appalachia
We first noticed this trend when one of APPLI Board of Directors Vice-President, Matt Cox, Ph.D., Founder and CEO of Greenlink Analytics—an Atlanta-based 501(c)(3) non-profit organization working that combines expert knowledge, data analytics, and machine learning to solve the most pressing climate and social issues, including energy burdens and pollution impacts, with the goal of improving lives and the environment—asked us about the correlation between low adult literacy rates and the incidence of adult obesity in late 2022.
This led us to begin running the Pearson correlation coefficient formula to evaluate the relationship between our county-level data sets for our adult literacy levels and the public health measure data we had been collecting.
We found that the Pearson coefficient for several conditions was 0.6 or higher, including:
Current Adult Smokers: 0.8
Adult Asthma: 0.6
Adult Obesity: 0.7
Adult Diabetes: 0.7
COPD: 0.7
Coronary Heart Disease: 0.8
APPLI has recently submitted an abstract to the West Virginia Clinical and Translational Science Institute (WVCTSI)'s annual public health conference in October 2023, where we hope to present our findings.
What These Correlations Mean for Educators
One of the primary reasons why APPLI began looking at correlations between adult literacy and public health measures is because we fundamentally believe that the Social Determinants of Health—in this case, "Education"—do not just result in better or worse health outcomes, but that those outcomes reciprocally impact the ability of Appalachian to address the underlying determinants, themselves.
The question is often asked, "How can we expect patients to adhere to strict medication regimens if they don't have stable housing or have low health literacy?" We believe the reverse is also true: "How can we expect people experiencing poor health to focus on improving their housing stability, much less their ability to read and do math?"
We hope that this research will allow for Community-Based Organizations (CBOs), academic institutions, and healthcare providers to begin identifying counties where opportunities exist to provide both educational and public health interventions in collaboration.
So, what does this look like? It looks like a physician noticing that their patient is struggling with reading and linking that patient to educational services to help improve their literacy. It looks like an educator teaching adult learners how improving their literacy skills could potentially help to improve their health. It looks like health and education fairs providing attendees with information to address both educational and health disparities.
Be sure to check out APPLI across our social media channels to view our latest infographics and video, and please remember to like and share this blog and our posts with your networks.