Allison Arwady, MD, MPH, commissioner of the Chicago Department of Public Health — where, she has said, “promoting health equity drives everything we do” — delivered the keynote address for RFU’s annual all-school research consortium on March 16.
Dr. Arwady offered no PowerPoint presentation, acknowledging this as “very unusual” for a medical research talk. Her goal, she said, was to challenge researchers to explain the value of their science and “how you use the work you’re doing to work on the big problems in society.” Following are lightly edited and condensed highlights from her remarks.
Learn How to Tell a Story
It’s amazing how the scientific community across the world has come together to answer questions and collaborate to create an amazingly effective vaccine. We’ve seen in COVID, I think more clearly than ever, that it’s not enough just to have good data or to have noticed a problem, or to have highlighted a new way of thinking. We need to tell the story of that research and then implement the findings from that research.
If you want to address health inequities, if you want to fight misinformation, think about building trust in the science.
My role has certainly been to stay up on COVID research, to stay committed to it. But it’s also been about how we translate that for people who may not have as much of a science background, but who we need to include if we’re going to make sure that as a society we continue to support this research. If you want to address health inequities, if you want to fight misinformation, think about building trust in the science. And one way to build trust in the science is to cut the complex language. Say instead, “Here’s what we did to explore this question. Here’s something we didn’t know. Here’s how we think this finding should change the way we think about something, the way we prioritize something, the way we implement something. And here’s how we’re going to measure whether that has happened.”
The Science of Implementation — and Lack of It
I was always very interested in how, and whether, basic science and clinical science findings make their way into clinical practice, because what we see across medical fields is a big gap between when questions are answered or at least partially answered and the development of new treatments, new drugs, new approaches. Actual implementation is not often studied, but it is probably one of the most important things where we think about quality in health care. The neuroscientist Thomas Insel, who used to run the National Institute of Mental Health, in his book “Healing: Our Path from Mental Illness to Mental Health,” recognized after years of leading one of our top scientific institutions that a lot of the failure of our mental health system or lack thereof is because while a lot of research is happening, even best practices backed by good evidence are not being implemented. So I hope many of you are thinking about how your critical research question can be implemented.
How Science Undervalues the Role of Trust
Trust is often a word we use. Especially for people doing clinical research, there’s a lot of goals around “How do I get folks in the community to trust the work I’m doing? How do I recruit people who look like Chicago?” That’s a major challenge given the history of individual and systemic racism in the medical system and how medical research plays a role in that. A study in The Lancet1 that looked at COVID outcomes across 177 countries related to traditional measures for pandemic preparedness found that those metrics, which historically look at health system capacity and geography and data systems, were not predictive of infections. What was more predictive than most of the other metrics was levels of trust in governments and in healthcare professions and a general level of interpersonal trust connected to community.
Human Behavior: The Greatest Challenge
I’ve asked my team to also look at social science research, because what did our biggest COVID-related challenges turn out to be? In a lot of ways, it’s about behavior. What motivates people to wear a mask or not? How do we identify, among different populations with various COVID mitigations, the role politics plays — this enormous outside role and identity? What drives decisions to get vaccinated? How does social media play into this? Something that has taken up a huge amount of our time is the whole world of following what’s on social and those metrics and what rises and when, and how to address misinformation. That is a whole area of research that I knew nothing about prior to COVID, but it’s become one of our most important tools. I want us as the health department2 to think about what works, what doesn’t work, why things are being taken up, why they are not being taken up and how we expand our capacity. That evaluation piece is often not the part that we think about when we’re imagining the science.
What She Worries About
Our biggest weakness as a country when it comes to COVID is that we have trouble telling the story.3 And we’ve also seen a big drop in trust in science, in doctors, in government. And if we cannot rebuild some of this, it doesn’t matter how good and interesting our work is, because it won’t impact the big questions. There are real concerns about how we make sure that our amazing scientific work in this country continues to get financial support, and also how we fund implementation and evaluation — taking data, moving it into action and studying those outcomes. We need to be willing to publish and admit the negative findings. That’s why the paper in The Lancet is so important. We have to be honest and straightforward. I worry a lot that one of the biggest outcomes from COVID is going to be continued growth of distrust in science and public health and medicine. I urge all of you, as you continue to work on your research, to challenge yourself to share the story with regular people. Because if you can’t turn your research into something that fits what people are thinking about and talking about, people won’t recognize the importance of it. And I worry distrust will grow.
Judy Masterson is a staff writer with RFU’s Division of Marketing and Brand Management.
- Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. thelancet.com/journals/lancet/article/PIIS0140-6736(22)00172-6/fulltext
- The Chicago Department of Public Health provides guidance, services and strategies that make Chicago a healthier and safer city. chicago.gov/city/en/depts/cdph.html
- The Chicago Department of Public Health Coronavirus Response Center connects the public with resources that include testing options, vaccine providers and updated guidance on mitigation requirements. chicago.gov/city/en/sites/covid-19/home.html