‘We Need to Listen First’.

More than two-thirds of the world’s population will live in cities by the year 2050, according to the World Health Organization.

Although cities offer economic opportunities and services, they continue to grapple with health disparities that exist largely among low-income and minority communities and stem from unequal access to transportation, affordable health care, stable housing, healthy food, and safe environments.

On Tuesday, June 4, the School of Public Health will hold a Dean’s Seminar, titled “A Conversation About Cities and Health” featuring a panel of experts who will explore how cities can generate health and equal access to services among all populations. Panelists include Julie Morita, Commissioner of the Chicago Department of Public Health, LaQuandra Nesbitt, director of the District of Columbia Department of Health, and Monica Valdes Lupi (SPH’99), executive director of the Boston Public Health Commission.

The discussion will be moderated by Lisa Simpson, president and CEO of AcademyHealth, a leading organization that advances health services research and health policy to improve health and the performance of the health system. Simpson is also a pediatrician and health services researcher.

Ahead of the event, Simpson spoke about the health challenges that children in urban cities experience, as well as how researchers can translate their data effectively to shape health policies that reduce health disparities and inequities in urban environments.

How did you chart your career path from pediatrics, to health policy, and then health services research?

My interest in pediatrics emerged in medical school when I spent the summer as a medical student working in a hospital in the Ivory Coast. I saw clearly that there were always sick children no matter where you went, so it really appealed to my interest and potential career.

I became interested in policy while I was working in the Hawaii state health department as the director of the maternal and child health program. I learned early on just how important the policy process was in determining whether or not I not only had the resources to address women and children’s needs, but also the range of programs that we could deliver.

My interest in research emerged when I was doing a post-doctoral program at the Institute for Health Policy Studies at the University of California, San Francisco, where I really learned the role of health services research in informing policy and practice.

From the perspective of a pediatrician, what are one or two of the more pressing health challenges that children in cities face today?

An issue that faces children in both urban and rural settings, is that of health equity and health disparities—for children as for all others, health outcomes are different based on your zip code, or your racial, ethnic, or language background.

It’s also important to recognize that the issues for younger children are quite different from those for adolescents and young adults, and I don’t want to forget our adolescents when we talk about children. An issue that is very much in the news is adolescents’ mental health and behavioral health. It’s just one aspect of the broader mental health and wellbeing aspects for adolescents. Behavioral health also drives healthcare costs among adolescents, particularly among Medicaid programs, so that’s also an area of concern.

The other emerging priority across the life course perspective, is the issue of adverse childhood experiences (ACEs), and how that influences the rest of a child and young adult’s life—and not just their mental and behavioral health, but also their health outcomes and illness and healthcare cost. The more recent links and understanding of the impact of trauma on the brain and brain science is helping us understand and recognize ACEs in a way that we have not before.

How do you present complex data in a way that does not reduce human lives to statistics and percentages?  

You need your data, research, findings, and evidence, because data makes you credible. But it’s your stories that make you memorable.

Narrative is so powerful when explaining the meaning behind the data because people connect emotionally with those stories and are much more likely to act on the evidence.  That calls for mixed methods research and using a personal story to illustrate the data story and the policy story.

When one is thinking about informing and changing policy, it’s also important to use a body of evidence. Any one study has a set of limitations, and when you make policy, you’re affecting thousands, if not millions of lives, so you want to make sure that the policy rests on a body of evidence that is directionally consistent. This has been made easier by the growth in systematic reviews in the last decade, in both the policy and clinical sectors.

It is also important to build trusted relationships with policy makers and policy intermediaries. Individual researchers and others in academic settings may or may not have the skills to communicate their research findings to policymakers, but there are many who work in this world of knowledge brokers, also called policy intermediaries, who can help distill and communicate the findings for policy audiences.

A number of researchers want to work directly with policymakers, and it’s very important that the research community recognize that it is not a one-time conversation. You build a relationship with policymakers over time by addressing their questions and meeting their needs, so they understand the value that you bring, and the data and the evidence is framed by that context.

From climate change to health care, many issues that affect the health of people in both cities and rural environments are politically charged. As a researcher, how do you convince the public to accept facts and evidence over personal feelings and biases?

This is certainly a challenge to the entire scientific community. Climate science has been at the forefront of this, as it was more politically charged earlier than traditional healthcare policy.

I think we’ve learned a lot from our colleagues in the climate science and climate policy community about various approaches, and what does and does not work. Contrary to the myth that we just need to bring the evidence forward, it’s not that simple. That could backfire. Presenting data and facts that are counter to entry-level beliefs and anchors only solidifies the resistance of the audience.

So there is a critical need to understand your audience and frame your findings appropriately. You need to understand the values and frame of reference that your intended audience has, and then frame the findings in relation to those constructs and preferences.

As a research community, we need to listen first, understand our audiences better, use the power of narrative, and recognize that one set of messages or messengers will not suit all.

—Jillian McKoy