Neal D. Goldstein, PhD, MBI

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Dec 18, 2017

Advocacy in Epidemiology

I believe most epidemiologists feel their work has public health impact. Yet probably more so than any other constituent component of public health, [my cynical view is that] epidemiology is a field most often concerned with the science and methods as the ends in themselves. I have certainly been guilty of this. The extent to which knowledge generated in our field is disseminated is most commonly through peer reviewed scientific (academic) publication and presentation at societal meetings.

The role of the epidemiologist is not limited to just producing and publishing analyses: knowledge generation. To improve the population's health requires advocacy and activism through translational epidemiology. Khoury et al. identified four phases of translational epidemiology that occur after the core role of the epidemiology in identifying risk factors and determinants of disease:

  1. Phase 1. Applications. Moving from risk factors to identifying potential interventions to mitigate poor health outcomes.
  2. Phase 2. Guidelines. Assessing public health interventions with recommendations for practice guidelines.
  3. Phase 3. Practice. Once guidelines are created, determining their adherence in practice.
  4. Phase 4. Outcomes. Population health changes as a result of practiced guidelines.

These four phases emphasize the transition of epidemiology from the academic role of knowledge generation into the pragmatic role of knowledge application. No longer is our work concluded after the data are generated; the individual's role is to see that these data are used appropriately and have a meaningful impact.

The field of translational epidemiology requires additional skills that may not be taught in traditional research training programs. Dowdy and Pai suggest the epidemiologist serve as the "accountable health advocate" and focus on expanding the core research skill set as follows:

  • Communication. Move away from the traditional paradigm of communicating only to a scientific audience. Instead, engage a lay-audience through popular press, social media, and novel channels, to convey results of research.
  • Public health perspective. Focus on existing knowledge to improve public health through translational epidemiology, as much as traditional knowledge generation.
  • Advocacy. Synthesize previous research to identify trends, incorporate into guidelines, and study the health impact.

Focusing on communication, let's assume that we are interested in more than academic publication and presentation. Brownson et al. recently published a report entitled Getting the Word Out: New Approaches for Disseminating Public Health Science that I think is directly applicable to epidemiology, and an article that should be widely read. The authors first begin by discussing the audience: that is, after conducting a public health study, who will be the recipient of the findings? It may include public health practitioners or policy makers. For academic epidemiology we can expand this to include other researchers as we seek to advance the methods, if our work is not directly translational. Knowing the primary audience can really inform the level of detail and direct the type of communication.

Reprinted with permission from Brownson RC, Eyler AA, Harris JK, Moore JB, Tabak RG. Getting the Word Out: New Approaches for Disseminating Public Health Science. J Public Health Manag Pract. 2017 Sep 6.

Communicating with a non-academic audience requires special approaches and tools, and being advocates for public health necessitates becoming familiar with these. For example, we may use social media to promote our work, engage with the public relations office at our institution, use a blog, write briefs intended toward a policy-making audience, liaise directly with the media, and so on.

Reprinted with permission from Brownson RC, Eyler AA, Harris JK, Moore JB, Tabak RG. Getting the Word Out: New Approaches for Disseminating Public Health Science. J Public Health Manag Pract. 2017 Sep 6.

Regardless of the approach and tool, time is needed on the part of the epidemiologist. Time that is likely not available, especially given the learning curve to promote our work on some of these mediums. But investing a little time up front will certainly make advocacy efforts easier over time, such as blogging or writing policy briefs. Specifically writing non-traditional forums for publication and presentation into funding grants can also help to ensure protected time that is appropriately compensated. This may also fall under service time required by many academic positions. There are clever ways to ensure you get credit for this advocacy efforts.

Personally, I am not a huge fan of social media for advocacy for the typical researcher. Unless you are a key opinion leader or organization with an established reputation, the social networks that the individual forms tend to be very likeminded (aka homophily). Therefore the science and opinions expressed through advocacy efforts are probably directed to the wrong audience (to use a cliche, you are preaching to the choir). I think for the typical epidemiologist identifying the right stakeholders, whether they be the key opinion leaders, elected officials, or appointed positions in advocacy organizations, and forming a relationship with them is the best opportunity to get the word out regarding scientific research. I also endorse working with the PR group at your institution; at Drexel in the School of Public Health I am fortunate to have an excellent colleague who promotes the school's work extremely well. Engaging with the media by blogging on popular media websites or contacting health reporters (who are always looking for a story!) is another way to connect to a larger audience to advocate for change. We can't be expected to explore all options for disseminating research for each study, but I would challenge those epidemiologists who publish or present their work to consider selecting a single additional, nonacademic medium for advocating for public health change the next time they conduct a study that can positively promote public health.

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