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

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 and 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 brought in 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. Thank you for having me. It's so great to be here. I heard that your path into public health got started with noisy neighbors upstairs.

Tell us the story.

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 for me and they had these two small kids that ran across their floor, which is my ceiling for like 24 hours a day. And it sounds like Elif's heavy elephants, but like 30 pound kids. I don't know how they manage to sound like heavy elephants.

I did as as the parent of heavy elephant, small children, I know how they do. So I realized that I was going nowhere. I would call my landlord, you know, I would complain directly to my neighbors, but then I realized like it was just crazy.

“And I had a trusted mentor who was like, Erica, I really think you would like this”

feel called public health. He was like, what the hell was public health? I'd never heard of it. That's why I did a little research. And I realized there were two public health schools I applied to both, gotten in and became

a scientist. Okay. So you got in. You became a scientist. And I've heard you call this your selfish scientist era.

Yes. I'm packed that for me. Yes. So at that time, I was still thinking about, you know, noise issues. And I was sort of going into the situations and like, I'm going to slay these community

noise piece and I was studying noise and I was, you know, as a doctoral student. And so I got into the point where I was getting ready to defend my oral proposal. And I got there and I failed. So like, 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 like go back to the drawing board. And then I was like, I'm, this is kind of like when I moved out of like 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, like 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 like community science. And there are like other people in other communities, you know, 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 like 400 locations. So I also made it a point in my research to interview people and 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 like 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 sitting at the podium and there was this guy 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. So as soon as I got off the podium, this guy came up to me and he was like, hey, you graded by neighborhood as an A plus. 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 plus?

I could just remember spit like on the sun in the blue.

He was like, angry and like he was shaking. And you know, 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 self-rescience 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.

After the break, I want to pivot a little bit and talk about your life if you're okay with that. Absolutely. Stay with us.

“Can I ask you a little bit about your origin story?”

Yes. Absolutely. Yeah. I 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? 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 bucks

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.

Really? Yes. Absolutely. I didn't know it was called public health, but whatever that was, I didn't believe in it.

You actually went back to where you grew up and you did a research project there. What exactly were you looking into? Okay, so one of the things that we don't realize, especially when we're living in a place like Massachusetts, like Massachusetts, just so adequately resource, 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 know. I was going to get people to care about noise when they literally had brown water coming from their faucets." So you came, you went and you were like, "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, "I don't, noise is not the problem." Correct. So I was like, "I'm just going to, 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 kind of do something different.

The quintessential example was when we would do these water tests and people would be like, "Okay, 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 for me. I've been here in that they're loud. Can you come and put up a monitor before it happens so we can see the difference?" And so like, 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. I put a noise sensor in your yard by being with, you know, my people in my home state." And then asking those kinds of questions and seeing that I was able to solve a problem, I was able to get more organic buy-in, the thing that I actually really wanted to do was noise. Right.

“And you could actually do the ride share version, right?”

Correct. Of your work. Yes. And so like it sort of reiterates the point that as public health researchers,

And actually people need to need us there.

So like we typically start studies based on our own personal questions. And you know, 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.”

Is that kind of the point, you know, that is, 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? Yes.

And they should be the people. I think that we should have another type of science, a suggestion box science. Like 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 know how much more powerful it could be than to say, I'm here because the community

wants me to be here. Is that a radical idea? Unfortunately, it is from like funders to the professors to a college administrator, university administrators, it really is, because it would have been so baffled by, it's like in a school of public health.

When you talk about community, it's automatically something that's not ten-year-old. I can't, my interview question when I applied for my job was like, how do we tin your somebody like you, Erica? And I'm like, I don't know. Maybe you don't.

I don't know. Who knows?

“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 challenges that we talk about in the show again and again

you know, you can see how there might be a connection to some of those trust issues. 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 it in better off. When you 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

“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. You know, like, so 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, if I can't milk this for all the funding that I can get. So there's, like, 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, that's weird.

It's weird. I mean, I have two questions, one, you know, 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?

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, right? So through that process of really coming down in 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 is actually being great. It has forced us to reflect, but our things are going to change. I mean, according to my last promotional review,

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 than 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. We really don't hear that a lot. I don't know. I don't want to come across like I'm preaching because I was wrong about my 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 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. I love that sentiment so much and I think, to me, it gets at one of the sort of core things that I love about science, which is that it humbles us.

Yes. Yes. Like we forgot in the scientific process, but I feel like as once we get that PhD, we forget

“that life is an iterative process and I think we're not open to revising and resimitting.”

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 resimitting. Erica, thank you so much for taking the time to talk to us today. Thank you. 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 Deep Peter Schmitt. Thank you for listening. I'm Floor Lichtman. [BLANK_AUDIO]