Can ‘Suggestion-Box Science’ Make Public Health More Useful?

FLORA LICHTMAN: This is Science Friday. I’m Flora Lichtman. I don’t need to tell you that public health policy is a confusing mess right now. Layoffs and shakeups at major government agencies, funding uncertainty, skepticism about vaccines, experts, and institutions. All of this has left some scientists and epidemiologists doing some soul searching and asking the most basic questions about their role and relationship with the public, which is why we wanted to talk to Dr. Erica Walker, an epidemiologist at Brown University who has a perspective on how to do public health better.

Erica studies the relationship between community health and environmental exposures. She started off studying noise pollution, and after finding that her research wasn’t serving people as she hoped it would, she pivoted. She broadened her scope to include other sources of pollution, like water, and became more focused on how to include people in her research in the hopes of being more impactful. Today, we’re going to hear that story. Erica, welcome to Science Friday.

ERICA WALKER: Thank you for having me. It’s so great to be here.

FLORA LICHTMAN: I heard that your path into public health got started with noisy neighbors upstairs. Tell us the story.

ERICA WALKER: Yes. So, I basically lived in this basement apartment. I was a starving artist, and that apartment was my studio. And it had been quiet up until this family moved upstairs to me. And they had these two small kids that ran across their floor, which is my ceiling, for 24 hours a day. And it sounds like heavy elephants for 30-pound kids. I don’t how they manage to sound like heavy elephants.

FLORA LICHTMAN: As the parent of heavy elephant small children, I know how they do.

ERICA WALKER: So I realized that I was going nowhere. I would call my landlord. I would complain directly to my neighbors. But then I realized it was just crazy. And I had a trusted mentor who was like, Erica, I really think you would like this field called public health. And I was like, what the hell is public health? I’ve never heard of it. And so I did a little research and I realized there were two public health schools. I applied to both, got in and became a scientist.

FLORA LICHTMAN: So you got in. You became a scientist. And I’ve heard you call this your selfish scientist era.

ERICA WALKER: Yes.

FLORA LICHTMAN: Unpack that for me.

ERICA WALKER: So at that time, I was still thinking about noise issues, and I was going into the situation saying I’m going to slay these community noise beasts. And I was studying noise, and I was as a doctoral student. And so I had gotten to the point where I was getting ready to defend my oral proposal. And I got there, and I failed.

So I’m probably one of the only people that will openly admit that, yes, I failed my oral proposal, my oral dissertation proposal, and that made me do some soul searching. I had to go back to the drawing board. And then I was like, this is kind of like when I moved out of that selfish science phase and really kind of wanted to dig deep into noise issues.

So I put up a survey, like a Google form survey, in the city of Boston, and I was just like, hey, are you bothered by noise? And I got so many responses. And through those responses, that kind of really helped me to move from selfish science to community science.

And there were like other people in other communities, dealing with aircraft noise or living next to a busy highway. And I thought I could win this battle for myself, or I could really dig deep into this and try to win battles for other people that felt like they had no place to turn to when they were dealing with noise issues in their communities. So I went around the city and measured sound levels in the city of Boston at 400 locations.

So I also made it a point in my research to interview people, incorporate those survey responses into all of these objective measurements. So the culmination was I graded each one of the neighborhoods in the city of Boston like as a report card. So I gave them these report card grades as 2016 Boston Noise Report. That’s what it was called.

And so I went to a conference, a noise conference, a local one in Boston. And I remember I was standing at the podium, and there was this guy like in my side view. And he was kind of pacing back and forth, and I was like, this guy looks like he’s mad at me.

And so as soon as I got off the podium, this guy came up to me, and he was like, hey, you graded my neighborhood as an A+. And I went to a community meeting to complain about aircraft noise. And the official that was leading the meeting was, like, well Noise in the City graded your neighborhood as an A. And he was like, I never knew about your research. I never participated in your surveys. I looked at your map. You didn’t measure noise at my house.

So how could you grade my neighborhood as an A+? And I apologized, but he was angry. I just remember spit like on the side of his lip.

He was angry, and he was shaking. And that made me realize here I was in my doctoral studies, struggling to understand noise. I thought I made a valiant effort to do that, and I left that man out. So I felt incredibly guilty about not including him and wanted to make sure that my science moving forward included people like him, and I didn’t cause unnecessary harm.

And so I entered this phase called ride sharing science. I went from selfish science to ride sharing science like destination, public health, noise focus. I’m going to pick up these additional travelers along the way. We may not be going to the same destination, but we’ll be going in a similar direction. So I wouldn’t miss that angry guy.

FLORA LICHTMAN: After the break, I want to pivot a little bit and talk about your life if you’re OK with that.

ERICA WALKER: Yeah, absolutely.

FLORA LICHTMAN: Stay with us. Can I ask you a little bit about your origin story?

ERICA WALKER: Yes, absolutely. Yeah. I’m an open book.

FLORA LICHTMAN: You grew up in Mississippi. Will you tell me a little bit about how you grew up and how it shaped your perspective on public health?

ERICA WALKER: Yeah, absolutely. So I was actually born and raised in Jackson, Mississippi. I grew up incredibly poor. And so for me, public health was all of those studies that my parents enrolled us in that we would give them our blood, our spit, our surveys, and they gave us like maybe $50.

And we never heard from them again. It was like showing up to collect things, but not really following up after that and noticing that things around me never changed. I was still poor despite these studies, wanting to investigate and address all of these issues, but nothing ever changed. And as a matter of fact, it got worse. So I was a big non-believer in public health when I was growing up.

FLORA LICHTMAN: Really? Yes, absolutely.

ERICA WALKER: I didn’t it was called public health, but whatever that was, I didn’t believe in it.

FLORA LICHTMAN: And you actually went back to where you grew up, and you did a research project there. What exactly were you looking into?

ERICA WALKER: OK, so one of the things that we don’t realize, especially when we’re living in a place like Massachusetts, like Massachusetts is so adequately resourced, there’s an expert around every corner. There’s a data set that you don’t have to search hard for. There’s just so much knowledge and infrastructure. And I felt guilty. I’m like, so could I be successful there? So I took all of my resources and was like, I’m going back to Mississippi. But as soon as I got there, I was confronted with a water crisis. So I was like, I don’t how I was going to get people to care about noise when they literally have brown water coming from their faucets.

FLORA LICHTMAN: You went, and you were like, I’m going to– I want to do my noise work. This is the issue that I have invested in in my career and my education. And you got there, and they were like, noise is not the problem.

ERICA WALKER: Correct. So I was like, I’m going to pivot. And I had a very, very, very understanding funder. So like we ended up pivoting to do water, but I think it was so beautiful because I learned a lot about water. I actually learned a lot about all of the other infrastructural failures in Mississippi and in the process of trying to study water quality, something I didn’t know. And I learned a lot about what people felt about research, what people felt was missing. And I used that to do something different.

The quintessential example was when we would do these water tests, and people would be like, OK, thanks for the water test. But your lab’s name is Community Noise Lab. Why is it named that? And I was like, well, actually, we were supposed to come down here and study noise. And then they would ask questions about noise.

And they’d be like, oh, yeah, by the way, they’re building this data center down the street from me. I’ve been hearing that they’re loud. Can you come and put up a monitor before it happens so we can see the difference?

And so while we were passing out water samples, people were asking us about noise, and I felt like I got a more organic buy-in and just being like, hey, I’m from Brown University. Can I put a noise sensor in your yard? By being with my people in my home state and them asking those kinds of questions and seeing that I was able to help solve a problem, I was able to get more organic buy-in. The thing that I actually really wanted to do, it was noise.

FLORA LICHTMAN: And you could actually do the rideshare version of your work.

ERICA WALKER: Yes. And so it sort of reiterates the point that as public health researchers, I mean, we need to have an organic connection to the communities that we’re working with. And actually people need to us there. So like we typically start studies based on our own personal questions.

And believe it or not, because we don’t have the organic connections to the communities, we typically end up farming out that organic connection. So we go find a community organization that has a connection, and through them, we give them money to carry out our stuff. And I’m just like that– yeah, I can’t. It bothers me a great deal. And we’re going to force this community to address my research questions. And I think that that’s a very bad way of doing research.

FLORA LICHTMAN: Is that the point? Is that the philosophy encapsulated that the questions that scientists should be studying should start with the people who are going to be served by this research? Is that it?

ERICA WALKER: Yes. And they should be the people. I think that we should have another type of science, a suggestion box science. We should be working on the questions that people want us to work on because we wouldn’t have to convince funders or community people that this work is relevant. I don’t how much more powerful it could be than to say, I’m here because the community wants me to be here.

FLORA LICHTMAN: Is that a radical idea?

ERICA WALKER: Unfortunately, it is. From like funders to the professors to college university administrators, it really is. Because what I’ve been so baffled by is like in a school of public health, when you talk about community, it’s automatically something that’s not tenurable. I mean, I can’t. My interview question when I applied for my job was like, how do we tenure somebody like you, Erica? And I’m like I don’t know. Maybe you don’t. I don’t know. But who knows.

FLORA LICHTMAN: I don’t even know where to start. Because when I think about some of the systemic problems we’re facing right now, these giant, giant challenges that we talk about on this show again and again and again, you can see how there might be a connection to some of those trust issues.

ERICA WALKER: Yes, I think we have created these trust issues. And I think until we admit it, we’re going to be running further away from the problems and not addressing them.

So I think we have to admit, as public health researchers, we typically don’t leave the communities that we operate in better off. We don’t build infrastructure. We don’t think in terms of sustainability. And honestly, the things that we’re promoted on are just anti public health. We’re promoted by the number of manuscripts that we get published that are typically behind a paywall.

We are promoted by the funding that we can obtain, but we’re not funded by impact. Impact are these very individual things. But when it comes to public, the impact could should be how has your work impacted people in a meaningful, tangible way? And if we actually solve a problem, then we don’t get any more funding. So like there’s actually this kind of perverse incentive.

Like, no, I don’t need to solve the problem, and I need to waste as much time as possible because that means another three to five years of funding. And there’s no incentive for us to actually solve problems or address issues, because what am I going to do next if I can’t get– if I can’t milk this for all the funding that I can get? So there’s this perverse individual incentive in the university structure. And honestly, if we solve the problem, that means no more grant funding. That means I have to do something else. And to me, that’s weird. It’s weird.

FLORA LICHTMAN: I mean, I have two questions. One, you’re at a fancy university, and you are very clear about this being your mission. Is that a sign that things are changing? Or I guess more generally, do you think things will change in this field?

ERICA WALKER: So I think there have been some recent policies that have forced us to address some very fundamental things, like fancy universities depend on government funding for their survival. So through that process of really coming down on the efficiency of government funding, I think it has forced us to take a step back and look at what we’re doing.

So I think that that has actually been great. It has forced us to reflect. But are things going to change? I mean, according to my last promotional review, probably not. But more importantly, I don’t think things are going to change because I still don’t think that we believe that we’re doing anything wrong. I still feel like we believe that it is the papers. It’s the grant applications. It’s the personal successes as a professor that matter. But until we believe that we need to do this a different kind of way, then I don’t think so.

But I am appreciative for the opportunity to reflect, at least with federal funding, to reflect on the impact of this, of what we’re getting money for. I’m very appreciative for that.

FLORA LICHTMAN: We really don’t hear that a lot.

ERICA WALKER: I know. That’s what I told you. I will say this. Like I don’t want to come across like I’m preaching because I was wrong about the money approach up until a few days ago. I think that public health, we just feel like we’re right. Once we get that PhD, we’re right. And like, we’re never going to be wrong again. So I don’t want to come across like this is the way. Because I can guarantee you a year from now, because of my experiences between now and then, I’m going to have learned so much and will update.

FLORA LICHTMAN: I love that sentiment so much, and I think, to me, it gets at one of the heart, one of the core things that I love about science, which is that it humbles us.

ERICA WALKER: Yes, yes. It’s like we’ve forgotten the scientific process. But I feel like once we get that PhD, we forget that life is an iterative process. And I think we’re not open to revising and resubmitting. We do it when it comes to grants. We do it when it comes to papers, but for some reason, it doesn’t apply when it comes to our methodology, to science, our approach to community. And in a place like public health, I feel like that’s a very dangerous way of thinking. So I just want to put that out there. I’ve been wrong up until yesterday, and I’m going to be wrong a million times after this. But I am open to revising, improving, and resubmitting.

FLORA LICHTMAN: Erica, thank you so much for taking the time to talk to us today.

ERICA WALKER: Thank you.

FLORA LICHTMAN: I really appreciate it. Dr. Erica Walker, assistant professor of epidemiology at Brown University, where she runs the Community Noise Lab. This episode was produced by D. Peter Schmidt. Thank you for listening. I’m Flora Lichtman.

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