Blog Global Health Center Chronic Disease Health Equity

More than just correlation: The link between poverty, health and education

Written by Mihai Dumbrava, MD-PhD candidate, Mayo Clinic School of Medicine, and the Schilsky Family Summer Research Scholar in the 2022 Institute for Public Health Summer Research Program

In an afternoon seminar for the Institute for Public Health Summer Research Program – Public & Global Health TrackKelly Harris, PhD, CCC-SLP, assistant professor of occupational therapy and surgery at WashU, spoke to the 2022 cohort. Harris is a licensed speech-language pathologist whose research aims to understand how systemic racism and health equity in educational settings influence youth achievement and opportunity. 

During her talk, Harris discussed her non-linear path to her current position leading the WUSTL Health Equity, Opportunity, and Education Research Lab. She practiced for many years as a speech pathologist before returning to complete her graduate studies in the Social Context of Urban Education, Public Health, and Child Development. She described how she explored chronic disease, child development, and educational outcomes for youth in urban and suburban contexts to understand systemic racism. 

Harris is specifically interested in the impacts of sickle cell disease and asthma on academic achievement, and how to improve health and educational equity for youth living with chronic diseases. Chronic asthma is linked with greater stress, which can affect concentration at school, relationships with peers and increases the risk of adolescent depression. Using St. Louis as a case study, Harris has shown that the zip codes included in the high asthma ‘hotspots’ are in areas with large non-White and low-income populations, whereas the areas with lower asthma rates have larger White populations and higher median household incomes. Factors that were correlated with the prevalence of childhood asthma include a more urban environment, violent crime, limited local options for primary and specialty care, and the presence of more public housing facilities.

Hotspot analysis shows the areas in St. Louis that are disproportionately affected by childhood asthma.

As a group, we discussed why evidenced-based interventions have lower implementation rates among vulnerable populations disproportionately impacted by disease and what can be done to address this discrepancy. We hypothesized that the evidence for many of these interventions comes from studies that examined groups that may not necessarily represent the populations at the highest risk. Perhaps an even more significant obstacle is how we can garner political and public support to begin to address these challenges.

While there is still much more for me to learn about this issue, I feel that the first step is to empower local community members who have a deeper understanding of the changes that really need to take place. I believe that long-term improvement of equity in educational settings and reduced burden of chronic diseases will only come if we target the root causes. Focusing on the basic needs of youth, such as their physiological needs, safety needs, and the communities where they grow, may lead to downstream benefits such as improved school achievement, reduced chronic disease, and ultimately improved outcomes for future generations.