Data, Meet Curiosity: Finding Bright Spots in Appalachia

Apr 1, 2015, 9:20 AM, Posted by David Krol

There are so many opportunities to connect the wealth of data we have at our fingertips and to start asking new questions. David Krol tells his story about how he took this approach to find bright spots in Appalachia.

If you close your eyes and picture Appalachia, what do you see? The images that often arose first in my mind were those from LIFE Magazine’s 1964 photo essay on the war on poverty. Photojournalist John Dominis gave the nation a face to the plight of Appalachian communities in Eastern Kentucky, and poverty and economic hardship have long been central to an outsider’s understanding of the region ever since. But through my work at the Foundation, I knew this narrative was only one part of the region’s rich and diverse story. I knew there was a different story to be told, and so I wanted to shine a light on these bright spots that demonstrate how health can flourish across Appalachia.

I began this journey by seeing what the data could tell me. As I was reviewing the Appalachian Regional Commission (ARC) website, I stumbled across county-level data on economic status. ARC’s index-based county economic classification system compares economic indicators like poverty and unemployment rates with national averages and then ranks each county.  Those data allow the ARC to categorize counties along a spectrum: distressed or at-risk at the lower end, and competitive or “attainment” (economically flourishing) at the higher end. A self-described “data nerd,” curiosity led me to overlay their county index with the annual County Health Rankings just to see what I could find when I compared the two.  

What I expected to find was that the most economically distressed counties in Appalachia would also be in the lowest quartiles of health outcomes and factors for their states. For the most part, my hypothesis was true. But what excited me most was that there were counties that, though distressed economically, were in the top quartile of their state in health factors or outcomes.

Why was that? Was it true? What was it about Wirt County, West Virginia; Pickett County, Tennessee; and Oktibbeha County, Mississippi, that helped them overcome significant economic challenges towards better health outcomes when similarly distressed counties in the same state did not? Did they have major hospitals or a University? Could it be explained by the efforts of local leadership? Were there other factors at play beyond poverty and health care access? And what implications did this have for neighboring counties?

Seeing these unexpected outliers reminded me of the positive deviance approach to social change. This approach is rooted in the belief that communities have the best solutions to the problems they face—as opposed to solutions driven by outside experts. The first application of this was in Vietnam during the 1990s, with incredible results. Save the Children was asked to address the country’s high child malnutrition rates. At the start of the project, around 60% of children under the age of five suffered from malnutrition. After identifying households without malnourished children, qualitative research methods were used to find out what these families were doing differently with the same amount of resources as their peers. Using that information, they developed and implemented local solutions incorporating lessons learned from individual behaviors and cultural norms. Two years into the project, malnutrition rates fell by 80%.

I asked myself, “What if we did the same thing in Appalachia?”

Armed with the county data, insight and support from my colleagues Hilary Heishman and Vanessa Farrell, and the will to find out more, I knew we’d need local experts to bring this research project to life. I’m thrilled to say that the Appalachian Regional Commission and Foundation for a Health Kentucky were equally excited about this project as we were. For me, they are critical institutions because, as community members, they know the region and are committed to the vision of finding homegrown solutions for all of Appalachia. Together we’ll be funding an integrated approach to finding the answers to why these bright spots in the region have positive health outcomes despite economic hardship and lack of resources. It’s an opportunity to “go beyond the data.. to community conversations about what’s important,” as Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, put it. It’s a new Appalachian story we can’t wait to tell.

We’re only at the beginning of this project, and I don’t know what we’ll find. But I do know that we live in a data-rich world that has the potential to tell us so much about the communities we live in. The County Health Rankings and Appalachian Regional Commission economic index are prime examples. There are so many opportunities to connect the wealth of information we have at our fingertips and to start asking new questions. Quantitative data can get only get us so far—it’s up to us to ask those critical questions of “Why? How? What can be done?” It’s up to us to turn data into action.

David M. Krol, MD, MPH, FAAP, a former senior program officer for the Robert Wood Johnson Foundation who is passionate about child health and well-being, leadership, and oral health.