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Advancing the Science to Improve Population Health: Proceedings of a Workshop (2017)

Chapter: 3 Research in Practice: Opportunities and Challenges

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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
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3

Research in Practice: Opportunities and Challenges

The first panel discussion of the workshop focused on population health research in practice. Maya Brennan, vice president for housing at the Urban Land Institute Terwilliger Center for Housing, shared several examples of cases where putting research into practice resulted in policy change, promising dialogue, or unintentional outcomes. David Holtgrave, professor and chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, examined the role of population health research in the development of policies that contributed to the decline in AIDS-related deaths in the United States. Brendan Nyhan, assistant professor in the Department of Government at Dartmouth College, highlighted the importance of effective communication in informing health policy action on controversial issues. Lisa Simpson, president and CEO of AcademyHealth, discussed motivating and incentivizing researchers to focus not just on knowledge generation but also on knowledge transfer. Main points from the session are summarized in Box 3-1.

POPULATION HEALTH AND HOUSING1

The website How Housing Matters is focused on collating the existing research on the importance of housing for health, education, and

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1 This section is based on the presentation by Maya Brennan, vice president for housing, Urban Land Institute Terwilliger Center for Housing, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

economic well-being, and on disseminating this information to foster evidence-based action to promote quality, affordable housing.2 Where a person lives matters for his or her health opportunities and for many of the drivers of health, Brennan said. Housing affordability is the core issue. People who cannot find affordable housing that is the right size for their family and near enough to their work are often unable to pay for necessities such as food and medication. Housing affordability affects stress, stability (e.g., eviction, relocation), and quality of the home (e.g.,

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2 How Housing Matters is operated by the Urban Land Institute Terwilliger Center for Housing, with funding from the MacArthur Foundation. See http://howhousingmatters.org (accessed May 30, 2017).

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

lead paint, pest infestations). Housing affordability also influences the character of a neighborhood, and many families in the United States find it impossible to afford a home in a low-crime, high-opportunity neighborhood. Housing is a portal to opportunity, Brennan said, and she shared three examples of putting research into practice with varying outcomes.

Best-Case Scenario: When Evidence Improves Policy

An influential 2002 report by Culhane and colleagues found that the costs of service provision by a variety of public agencies in New York State were reduced when homeless persons were placed into supportive housing, and that the savings from reduced use of public services fully covered the cost of the housing (Culhane et al., 2002). These findings led to major changes in the thinking about ending chronic homelessness, Brennan said, and spurred further research on a “housing first” approach. This approach does not mandate that a homeless person be on medication, or off drugs or alcohol, to receive housing; housing is provided as the base through which they can then access other services that allow them to thrive. The research on ending homelessness was popularized by Gladwell in an article in The New Yorker (Gladwell, 2006). The article told the tale of Murray, a homeless New Yorker who cost the city $1 million as a result of his many hospital admissions and use of other services.

This research has been very influential in changing policy and outcomes, Brennan said, in part because the cost-saving aspect attracts the attention of policy makers, and in part because of the coverage in the popular press. Federal and local efforts to end homelessness have led to a 21 percent reduction in the number of chronically homeless in the United States between 2010 and 2014, and a 33 percent reduction in the number of chronically homeless veterans over the same period, she said.

Promising Results: When Evidence Affects the Dialogue

An extensive body of research has established the connection between living in high-poverty neighborhoods and poor health outcomes, including preterm birth, heart disease, obesity, mental illness, and other conditions. The Moving to Opportunity (MTO) demonstration project in the 1990s provided a cohort of public housing residents in five different cities with vouchers to relocate to more affluent neighborhoods. Brennan noted that MTO followed a similar effort that was the result of a racial discrimination suit against the City of Chicago. In the legal settlement of the Gautreaux case, families living in public housing were given specific vouchers to be able to move from a primarily minority area to a primarily white area. The difference for MTO, Brennan pointed out, was that it was

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

focused on moving to more affluent neighborhoods rather than to more white or integrated neighborhoods.3

Health and other outcomes of those moving to an opportunity neighborhood (i.e., a low-poverty neighborhood) were tracked. After 10 to 15 years, there was an estimated 34 percent reduction in new cases of diabetes in the families that had moved, which Brennan noted was comparable to the reductions seen in medical interventions designed to treat diabetes. Families that moved were also less likely to have severe obesity, physical limitations, or psychological distress.

Although the health benefits of leaving concentrated poverty continue to influence policy, Brennan noted that there are barriers to implementation. One challenge is “not in my backyard” syndrome or “NIMBYism.” Current residents stated they did not want “those people coming here”; therefore, the MTO ended after the initial demonstration period and never became a full program. Another challenge was a backlash from the communities of color because relocation raises concerns about urban renewal, which often means homes and communities torn apart and devalued. Although these two negative forces could in the end limit the potential of the MTO study to effect change, the study has substantially influenced the policy debate about relocation and revitalization, Brennan said.

Unintentional Harm: The Importance of Framing the Research Questions Correctly

As a cautionary tale, Brennan described a 2012 health impact assessment (HIA) of the U.S. Department of Housing and Urban Development (HUD) Rental Assistance Demonstration, a pilot program to convert public housing to privately owned, affordable housing. There is a $25.6 million backlog of repairs needed for public housing. Families are living in terrible conditions in housing that the federal government is paying for but that it is not paying to adequately repair, she said. The HIA analyzed the Rental Assistance Demonstration as if it were a relocation program instead of a quality improvement/housing rehabilitation program, despite the fact that families would have been able to stay there. Newspaper articles suggested that the program would privatize public housing in a way that would create instability. As a result, HUD finds itself constantly having to reinforce what this program is actually about. Brennan concluded that this is an example of how not framing the

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3 For a discussion of the so-called Gautreaux One vs. Gautreaux Two/Moving to Opportunity program, see Duncan, G. J., and A. Zuberi. 2006. Mobility lessons from Gautreaux and moving to opportunity. Northwestern Journal of Law & Social Policy 1(1):110-126, http://scholarlycommons.law.northwestern.edu/njlsp/vol1/iss1/5 (accessed May 30, 2017).

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

research question correctly, and framing it from a mistaken standpoint, can potentially harm policy outcomes.

PREVENTING HIV TRANSMISSION: A BRIEF HISTORY4

Holtgrave reflected on how research contributed to reducing the incidence of HIV in the United States. The first U.S. cases of HIV infection began to emerge in the late 1970s, peaking at about 130,000 new infections per year in the mid-1980s, and then leveling off to about 50,000 new infections each year by the early 1990s (Hall et al., 2008). The most recent data from the Centers for Disease Control and Prevention (CDC) estimated that incidence was still roughly at 50,000 new cases per year for 2007 through 2010 (CDC, 2012). Another way of looking at the spread of HIV is transmission rate, which Holtgrave explained as the incidence to prevalence ratio. The transmission rate was very high early in the epidemic, but it has remained very low since the early 1990s (Holtgrave et al., 2009).

With the advent of new treatments in 1995 and 1996, the annual death rate from AIDS was lower than expected (based on incidence). Holtgrave suggested that this decline in AIDS deaths was caused by the combination of past prevention efforts and new treatments (Holtgrave, 2005). In the mid- to late 1980s and early 1990s, a variety of prevention tools were available:

  • new information about modes of transmission
  • social activism as a direct result of the tremendous health disparities
  • information campaigns
  • behavioral interventions, such as promoting condom use
  • HIV testing coupled with risk-reduction counseling
  • syringe exchange
  • housing
  • food security and social support
  • behavioral factors in care

Holtgrave highlighted some of the population health research that might have led to this decline in deaths from AIDS. Early in the epidemic, it was not clear how HIV was transmitted, and behavioral epidemiology research helped to elucidate that one major mode of transmission was sexual contact (Auerbach et al., 1984). This research defined the initial U.S.

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4 This section is based on the presentation by David Holtgrave, professor and chair of the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

response to HIV. He added that the CDC website lists 84 evidence-based risk-reduction behavioral interventions for HIV prevention.5 Behavioral intervention trials were undertaken in the late 1980s and early 1990s, and in the early 1990s CDC instituted HIV prevention community planning (Holtgrave et al., 1996). Each jurisdiction in the United States was tasked with devising an HIV prevention plan built directly on the evidence-based literature. This was a very direct link between science and local priority setting, Holtgrave said.

The first licensed HIV antibody test became available in 1985, and the first confirmatory Western blot test was available in 1987. Also in 1987, CDC released its first counseling and testing guidelines for the field (CDC, 1987). There is a large and complex literature on the effects of counseling and testing, Holtgrave said. He shared one example, a clinical study of behavior change and sexually transmitted disease incidence among HIV seronegative individuals as a function of receiving counseling and testing, which found that counseling did have an effect on reducing risky behavior and sexually transmitted infection incidence (Kamb et al., 1998). Another way to look at the effects of counseling and testing is to assess the transmission rate at the population level. Holtgrave studied transmission rates for persons who were unaware of, and aware of, their HIV infection. Among those who were aware, transmission rates were broken down according to viral load (suppressed or unsuppressed) and risk behaviors with a serodiscordant partner (Hall et al., 2013).

The final example described by Holtgrave was needle exchange, which began in the United States in the late 1980s. The federal government stopped funding needle exchange programs in the late 1990s, despite their proven effectiveness in preventing HIV transmission and no evidence they led to increased drug use.6 However, there are ongoing state, local, and privately funded needle exchange programs (CDC, 2010). Holtgrave shared a slide juxtaposing graphs of HIV incidence in New York between 1990 and 2002 alongside the mean number of needles distributed during the same time, showing an inversely proportional relationship.

Currently, only about 30 percent of the 1.2 million people in the United States living with HIV have suppressed virus. There are major gaps in care, Holtgrave said, and addressing this gap is the focus of the new U.S. National HIV/AIDS Strategy7 through 2020, which was

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5 See http://www.cdc.gov/hiv/prevention/research/compendium/rr/complete.html (accessed May 30, 2017).

6 See, for example, Nguyen et al., 2014.

7 The three goals of the strategy are (1) reducing HIV incidence, (2) increasing access to care and optimizing health outcomes, and (3) reducing HIV-related health disparities (see https://obamawhitehouse.archives.gov/the-press-office/2015/07/30/fact-sheet-national-hivaids-strategy-updated-2020 (accessed June 7, 2017).

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
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released in July 2015.8 Based on lessons learned and new knowledge from research, the strategy details actions focused on key populations, geographic areas, and treatment and prevention practices. The target outcomes for 2020 include many important population health research opportunities, Holtgrave concluded.

WHY FACTS DO NOT ALWAYS CHANGE PEOPLE’S MINDS9

People frequently believe things that are not true, Nyhan said, and it can be very difficult to change their minds, especially about controversial issues. Widespread misinformation is often accepted as fact despite clear and overwhelming evidence to the contrary. As examples, Nyhan mentioned the Patient Protection and Affordable Care Act (ACA) myth of “death panels” and false claims that vaccines are poisoning children. Further research is needed into why this happens and how best to deal with it, Nyhan said.

The instinct of most scientists is that people who are misinformed lack the correct information, and if they are provided with that information they will update their beliefs and attitudes, Nyhan said. This is sometimes called the deficit model of science communication. Unfortunately, just supplying accurate information often does not solve the problem. People often resist factual information about issues that are controversial or implicate aspects of their identity, Nyhan explained. This reaction is an example of what psychologists call disconfirmation bias, our fundamental tendency as humans to be unduly skeptical of information that contradicts our existing beliefs and attitudes.

Nyhan shared examples of how some of the efforts undertaken to try to correct widespread myths may be ineffective or even counterproductive. One well-known example from the field of political science was the supposed threat of weapons of mass destruction (WMDs) from Iraq before the U.S. invasion. Following testimony by then-Secretary of State Colin Powell before the United Nations that Iraq had WMDs, a U.S. government report ultimately found no WMDs or active WMD programs. Nonetheless, the misperception that Iraq had WMDs persisted for years after the Iraq war despite massive overwhelming evidence to the contrary that was very widely circulated. Nyhan and his coauthor Jason Reifler investigated what might have happened if the media had been more

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8 See https://www.hiv.gov/federal-response/national-hiv-aids-strategy/nhas-update (accessed June 7, 2017).

9 This section is based on the presentation by Brendan Nyhan, assistant professor, Department of Government, Dartmouth College, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

aggressive in fact-checking claims that were still being made after the war suggesting Iraq had WMDs at the time of the U.S. invasion (Nyhan and Reifler, 2010). They experimentally manipulated an article to provide corrective information (i.e., that in fact the official report of the U.S. government said there were no WMDs or WMD programs). Relative to a controlled condition where people did not see the corrective information, belief in the misperception went down among liberals presented with the experimental article. Nyhan noted that liberals were less likely to believe this myth in the first place. Among conservatives, who were more likely to believe the myth to begin with, the opposite reaction occurred. Their belief in the myth approximately doubled when they were provided with the corrective information (Nyhan and Reifler, 2010). Nyhan dubbed this the “backfire effect,” which he said is driven by disconfirmation bias. He noted that similar results were found when he studied beliefs about the myth of death panels in the ACA (Nyhan et al., 2013).

There are similar concerns about misinformation in health. For example, an infamous 1998 Lancet article by Wakefield et al. (1998) falsely alleged a link between the measles, mumps, and rubella vaccine and autism. The article was subsequently retracted by the Lancet in 2010, and the lead author was discredited and stripped of his medical license, but this myth persists to this day in the debate over vaccines. More than half of parents in the United States say they are worried about serious adverse effects of vaccines, and one-quarter of parents agree or strongly agree that some vaccines cause autism in healthy children (Freed et al., 2010). The question, Nyhan said, is what can be done about such widespread misinformation—is corrective information the right way to promote vaccines? Again, our instinct is to provide parents who are hesitant about vaccines with evidence that vaccines do not cause autism, he said, but this approach has not been experimentally validated. CDC, for instance, has taken this approach and provides information refuting vaccine myths on its website, including studies debunking the vaccine–autism myth.10

To investigate the efficacy of this approach, Nyhan and his coauthors studied the effects of correcting autism myths in a nationally representative survey of parents with children under age 18 (Nyhan et al., 2014). Although the corrective information resulted in fewer parents expressing agreement with the myth that vaccines cause autism, parents who received it were also less likely to say they would vaccinate a future child relative to a control group. This effect was concentrated among the parents who had the least favorable attitudes toward vaccines, which Nyhan said suggests it was the result of counterarguing caused by disconfirmation bias. Parents may accept that vaccines do not cause autism, but they

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10 See http://www.cdc.gov/vaccinesafety/concerns/autism.html (accessed May 30, 2017).

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

bring to mind other concerns that make them less likely to intend to vaccinate their children.

In conclusion, Nyhan said that research is needed on how to communicate most effectively about controversial issues that inform practice and health policy. The myth-busting approach may be appealing and intuitive, but it runs the risk of entrenching these beliefs more deeply or generating counterproductive responses. It may be more effective, he suggested, to use sources perceived as credible by people to address their concerns. Someone who has a personal relationship of trust may also be a more effective advocate. For vaccines, parents overwhelmingly respond that their child’s doctor is their most trusted source of information, not government agencies or scientists (Freed et al., 2011). Similarly, experts who oppose the ACA would likely be perceived as more credible in saying there are no death panels than experts who support it. It is important to consider who might be the most effective advocate in communicating controversial information as well as the messages being delivered. Simply providing science and facts is rarely an effective approach.

TRANSLATING POPULATION HEALTH RESEARCH INTO POLICY AND PRACTICE11

In population health research, as with many other fields, researchers are trained to produce peer-reviewed publications, secure research grants, make conference presentations, and teach, and there are clear incentives—financial and professional—that drive researchers to pursue those activities, Simpson began. Although behavioral economics is often discussed as an approach to get patients or providers to change behaviors and advance health, Simpson suggested that it could also be applied to modifying the behaviors of researchers. Academic institutions are entrenched in tradition and difficult to change, but she suggested that a new paradigm of scholarship is emerging, one that is interdisciplinary, includes nonacademic partners in problem identification, and includes a focus on knowledge transfer (Phaneuf et al., 2007).

AcademyHealth is the professional society for health services research, and population health has been a focus of the association, Simpson noted. She referred participants to a 2010 study by AcademyHealth that highlighted the challenges of translating research findings into policy and practice and discussed the role of academic incentives in applied health services research and knowledge transfer (Pittman et al., 2010). Although

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11 This section is based on the presentation by Lisa Simpson, president and CEO, AcademyHealth, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

the situation is better now than it was 5 years ago, she said, there are many pressures on the academic sector. Increasingly, there is recognition of the need for academic medical centers to focus on the population health of the surrounding community (Gourevitch, 2014; Szilagyi et al., 2014). There are increasing demands on academic medical centers to serve the public good and be accountable for contributing to community and population health (e.g., the requirement for tax-exempt 501(c)(3) institutions to demonstrate community benefit). Federal initiatives, such as clinical translational science awards, also emphasize community engagement. Under the ACA, accountable care organizations are also measured and rewarded based on contributions to population health. Overall this shift is an opportunity for the country to do a much better job on knowledge translation, she said.

One dimension of knowledge translation is research impact assessment; in other words, what difference did the research make? There is a growing interest among public and private funders in research impact assessment, so that the limited funding available for research can be put to the best use and provide the most societal benefits (Holbrook and Frodeman, 2011). Traditional tools to evaluate research impact include bibliometrics (e.g., how often is the work cited, downloaded?), case studies, economic cost–benefit analyses, and peer review/assessment by scientific panels of the impact of the science from a particular department (Jones and Grant, 2013). Another approach is the “payback framework,” a multidimensional model for paybacks from research, including contributions to knowledge, benefits to future research and research use, benefits from informing policy development, health and health-sector benefits, and broader economic benefits (Donovan and Hanney, 2011).

Funders are also developing assessment approaches. The Research Excellence Framework is a new peer-assessment system for evaluating the quality of research in UK higher education institutions.12 The Research Excellence Framework defines impact as “any effect on, change, or benefit to the economy, society, culture, public policy or services, health, the environment, or quality of life, beyond academia,” Simpson said. The outcome of this assessment is used for funding allocation, accountability, and benchmarking. There is a very direct link between demonstrating impact and the level of research funding academic institutions receive, she explained. The assessment is based on the quality of the research outputs (65 percent), the impact of the research beyond academia (20 percent), and the research environment (15 percent).

In the United States, merit review of proposals by the National Science Foundation (NSF) includes intellectual merit (e.g., importance, inno-

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12 See http://www.ref.ac.uk (accessed May 30, 2017).

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

vation), and broader impacts (e.g., societal impacts). The NSF uses the Broader Impacts Criterion (BIC). The BIC outcomes considered during evaluation of proposals are

  • teaching and education;
  • broadening participation of underrepresented groups;
  • enhancing infrastructure;
  • public dissemination;
  • other benefits to society;
  • improved national security;
  • increased economic competiveness; and
  • increased partnerships between academia, industry, and others.

No metric is perfect, Simpson said, and effective assessment of research impact involves both quantitative and qualitative strategies. These can be labor intensive and cost prohibitive, she noted. In general, while Australia, Canada, and the United Kingdom have made significant strides in evaluating research impact and using the results as part of future research funding allocations, the United States lags behind, Simpson said. To date, demonstration of measurable population or community impact from prior research is not a criterion for future research funding at the National Institutes of Health or other U.S. governmental agencies. In addition, knowledge transfer activities are still not rewarded in traditional academic incentives in the United States, including the promotion and tenure processes of most academic institutions. Demonstrating impact may be particularly challenging for population health research, given the time lag to realize population health outcomes. There is an opportunity for population health researchers to consider the impact of their work in new ways that will resonate with funders and the public, she concluded.

DISCUSSION

During the open discussion that followed the panel presentation, participants expanded on the topics of incentives and approaches to drive translation of research findings, the value of partnerships, the influence of social media as a communication channel, and additional issues around assessing the impact of research.

Driving Translation

Lantz raised a concern that incentives for impactful work might drive researchers toward the “low-hanging fruit” or the easy wins that demonstrate impact, and dissuade researchers from studying some of the more

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

complex issues in public health. Simpson agreed and suggested looking to other countries (e.g., the UK Research Excellence Framework) for lessons learned and unintended consequences. Brennan reported from anonymous conversations with grantees that, while they may be required to demonstrate some policy relevance of their research, many of them still say their focus is to look for the truth, not to change anything. Incentives are needed to ensure that there is a research base as part of the change process.

It was pointed out that one of the recommendations in the Institute of Medicine report The CTSA Program at NIH: Opportunities for Advancing Clinical and Translational Research was to engage the community across the research spectrum (IOM, 2013). While there is a focus on proving that research has an impact on community health in the end, it is much more difficult as one moves back in the spectrum, the participant said. Simpson said there is an opportunity to learn from each other, but information sharing has been difficult, and lack of knowledge about the progress being made is slowing replication and additional learning.

A consultant with AcademyHealth observed that there is an assumption that simply doing a demonstration project will lead others to implement the knowledge, or that placing an innovation in an innovations exchange will lead to others picking it up. She suggested that there needs to be more explicit thought about how dissemination and translation could happen, and funding for the translation. Holtgrave added that there should be investment in research on how best to translate findings.

A participant pointed out that, during the early days of the HIV epidemic, learning and doing were co-occurring, applying research findings with a focus on reducing deaths. She suggested that a learning-and-doing strategy is essential for population health, but noted the risks of moving ahead with an approach that may not work and could, as discussed, add to the myths as a result of asking the wrong question. Holtgrave agreed and noted that the updated strategy for HIV is more focused on explicit metrics, which is helpful for managing both process and outcomes (e.g., whether approaches are making a difference in meeting diagnoses goals, access to treatment goals). If an approach is not working, different approaches should be tried. Simpson emphasized the importance of deimplementation, that is, how to stop doing things that are not working. This can be very challenging in the policy context, she noted, because once a policy is enacted it can be very difficult to reverse it. Brennan agreed and added that the challenges of deimplementation hold doubly true in the context of housing—affecting both one’s actual home and one’s neighborhood.

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
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The Role of Partnerships

A participant who was a former state public health official said that researchers often sought letters of support for their funding proposals, but there was no collaboration and after the grants were awarded, no tieback to state health department efforts on the same topics. She suggested there could be much greater impact if researchers engaged with state and local public health officials. Simpson agreed and noted that it is not the culture of research to develop questions with the end user, although that is starting to change with the push toward community-based participatory research. She repeated that until that type of research is rewarded (e.g., promotion, tenure, funding), it will continue to be very limited. Holtgrave echoed the importance of research in partnership with public health agencies. He observed that in the social sciences, these partnerships are becoming more valued now because they offer opportunities for access to data and for conducting studies that would be otherwise impossible. Nyhan raised the role of the private sector in partnerships to translate research into practice.

Getting the Information to the Public: Social Media

A participant asked about the role of the information environment (e.g., social media, citizen science, social participation) in shaping the way people think about scientific evidence. Nyhan responded that people have long believed in various conspiracy theories and misinformation, and in many cases, social media platforms reflect the same issues that have moved through other channels of communication in the past. These issues are perhaps more visible now, and circulate more rapidly, because of social media. There have also been cycles of thinking that social media could be used to more efficiently deliver information to people to change their minds, followed by pessimistic views that there is so much misinformation to try to counter. Nyhan said that social media needs to be considered within the larger context of what is known about how people process information. In this regard, he noted that most people actually are not interested enough to look at any of these issues in depth online. For those who are interested, they can readily find information to support their preexisting view.

Assessing Impact

Krieger pointed out that the health equity component can easily be overlooked in trying to understand the impact of research on population health. For example, it is important to understand how HIV is affecting some populations more than others (e.g., African Americans). Another

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×

aspect to consider is differences in the timelines of effect, specifically, that the effects for population health will not occur as fast as those for clinical research. The bench-to-bedside timeline for a treatment is not the metric for timelines for changing health inequities in a population. Holtgrave agreed that the issue of health equity is key, as is the need to consider and balance both short-term and longer-term effects of research. The updated National HIV/AIDS Strategy calls for a reduction in new diagnoses, but he said that the epidemic of undiagnosed young, black, gay men is so severe in Baltimore that there is a need for increased diagnosis over the next 6 months so there can be a reduction in the longer term. Simpson also agreed, and underscored the need for frank conversations on issues of equity.

Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
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Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
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Page 18
Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
Page 19
Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
Page 20
Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
Page 21
Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
Page 22
Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
Page 23
Suggested Citation:"3 Research in Practice: Opportunities and Challenges." National Academies of Sciences, Engineering, and Medicine. 2017. Advancing the Science to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23541.
×
Page 24
Next: 4 Building a Population Health Research Agenda: Views from the Field »
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In September 2015, the National Academies of Sciences, Engineering, and Medicine hosted a workshop to explore the basic and translational research needs for population health science, and to discuss specific research priorities and actions to foster population health improvement. The workshop was designed to provide frameworks for understanding population health research and its role in shaping and having an effect on population health, identify individual and institutional facilitators and challenges regarding the production, communication, and use of research for population health improvement, and identify key areas for future research critical to the advancement of population health improvement. This publication summarizes the presentations and discussions from the workshop.

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