Hey everyone, we're taking a short break from our usual Complicating the Narrative episodes to launch a summer mini-series. It's called Building Better Ways of Knowing. In a moment, I will share more about the initiative and then you will hear from some of our guests answering two questions about the future of public health. New episodes drop every Tuesday starting June 16th.
The field of public health has had real accomplishments to its name. Over the past century, we've built a substantial body of evidence on what shapes health. We've seen life expectancy rise and suffering from many diseases decline across the world. And yet, profound gaps persist. There remains a 20-year life difference and in life expectancy between countries and across counties in the US and within cities like this one we're in right now, St. Louis, and many of the leading causes for premature death remain preventable, like smoking, but not fixed yet. So the question is, are we producing the right kind of evidence in the right way to actually move the needle on these gaps? That's the question at the heart of the Better Ways of Knowing initiative, a multi-year project funded by the Robert Wood Johnson Foundation, led by the Healthier Futures Lab, directed by myself and Dean Sandro Galea at Washington University in St. Louis School of Public Health in collaboration with the Alliance for Health Policy and Systems Research at the World Health Organization. Over three years, we're convening leading thinkers across disciplines from public health to economics to sociology to anthropology and many other disciplines as well as practitioners, community leaders, social media influencers and policy makers to ask are the population health science knowledge systems built for the problems we're facing today. This first convening brought together researchers across disciplines as well as community organizers to wrestle with the questions like do we have values that shape what we study and do those type of values also shape what we ignore in our research? How do the systems that fund, rank and publish research expand or constrain the questions we are able to ask? What would it look like to actually build an evidence base that holds complexity rather than flatten it? We don't have all the answers, but we believe that through convenings like this one and other efforts across the globe that examine the structures shaping knowledge production, we can build something better. We can produce knowledge that is more rigorous, more responsive, and more consequential for the health of populations. That's the work. And we hope that many of you who are concerned about the health of populations can join us.
What stood out to you from these two days of discussion and exchange of ideas?
Well, this was an amazing session and so much had happened since our meeting in the fall of 2024 in Geneva that was where some of these ideas were first discussed. And to see both a continuation of the excitement but also in the context of a very changed world and country now, having a mix of interdisciplinary folks for someone like me who've been an academic, who've been a public health practitioner now in philanthropy, and kind of a intellectual generalist, it's brought a lot of really interesting themes together. So it's like really super to have philosophers in the room and, I mean, I used to be a practicing epidemiologist now I'm more of an administrator. So it's really good to get back to, you know, when I used to be a real scientist and hear some of that dialogue going on. So it's and all I think is we're gravitating toward how do we get the university, how do we get philanthropy, how do we get public health better aligned to get effective information to solve these problems and not pretend that just what we write in our books and our academic papers is enough.
Yeah, I think public health is going through a lot of some might say crisis, some might say upheaval, some might say radical transformation. It's been kind of like a dizzying thing to get one's head around. I've certainly thought about what the future of public health might look like after this kind of upheaval subsides a bit. And so this conference has been actually a real opportunity for me to get my head around some issues that have been kind of, you know, bouncing around in my mind, but that I haven't really kind of fully fleshed out. Questions like what the proper role of the federal government is going to be, what the role of the private sector is going to be, the role of technology, whether conventional ways of measuring productivity and quality are actually the right ways, whether we have all the right people and the right mix of folks in the room when we're trying to decide how we're going to go tackle an issue, what those issues even are. So, I've had a really kind of great time just kind of pondering this with a mix of people and I really like the mix too. The mix is really wide cross-disciplinary, cross-methods mix. Sometimes in these public health conferences, you know, it's like a dozen statisticians or epidemiologists and they all kind of have a uniformity. This is nice because we get I think we profit from kind of that difference, that heterogeneity among us. So I've had a great time.
I've really been enjoying the convening. In academia, we are often siloed not only in various disciplines in different units within a university, but also between the university and the broader community or policy makers. And so one of the really wonderful things about this convening is that it brings together lots of different scholars from very different methodologies, very different parts of universities, but also in conversation with people who are deeply involved in communities with people who work in policy every day. And so being able to break down those barriers between the different parts of the university and the community is most helpful in thinking about how do we answer these very important questions and also how do we put ourselves in the best position to really make change and promote these really important healthcare interventions.
The convening today has been a little soul food for me. I feel like my field of public health is going through a time of tremendous change. And people respond to that in different ways. Some people kind of turtle, go into denial, get a little paralyzed. Some people freak out a little bit. And I'm attracted to a group like this that says, "Let's see disruption as an opportunity and think about how we can grow, innovate, make things better, find new opportunities." And so it's been exciting to hear from diverse stakeholders like community groups who say, "Hey, you guys at universities, you have challenges, but you also have data and you also have ideas and you have ways that you can still provide value in new ways to community partners and to population health."
This is a very interesting convening of people coming from different walks of life and different perspectives who are trying to understand whether there's better ways to know, better ways to get reliable evidence that is actionable, that can make a difference for people for science for the community. I think that there's lots of different perspectives, some of them complimentary, some of them perhaps to be debated. There's lots of things that we still do not know and we're struggling to understand. But I think that it's been very illuminating and very stimulating so far. I think that the effort is focused on trying to make a difference for people in the streets and there's a realization that science is the best thing that can happen to humans but sometimes it is detached from humans. It is about curiosity, about blue sky, about very fancy equations and very fancy modeling. Which is fine to some extent, but I think that we need to make a difference also for the average person, for the average member of our community. And this is the type of convening that has such a goal. And I think that I'm very proud to be part of this effort and I hope that some of these ideas that will emerge, will really reach out to make a difference for the average citizen in our community.
I very much appreciated the rich discussion today and I think what was really surprising to me was how much consensus emerged when you bring together experts who come from really different disciplinary backgrounds and are providing a really different set of expertise. There's a lot of disagreement but then also the consensus that emerges around the importance of community-based research and the importance of ensuring that our values align with the types of research activities that we engage in. I learned a lot from the people in the room, especially people who are coming from really different areas of these worlds that intersect from academia, to government, to funders, to community. And so I felt like it was an activity that we need to be doing more of. You know, these types of really deep and rich conversations that we don't give a lot of space for. But I do think that this is the only way that we're really going to make progress on advancing the goals of public health that we all believe need to be done so urgently.
What do you think needs to happen to strengthen how we produce and use knowledge in population health?
Well, firstly, it's really important that we don't talk about communities, but we actually talk with communities and all their diversity. And it's been great over the last couple of days to have Sara and Darren who brought their own perspectives working from and with communities, right? And they've produced a very strong voice about what communities don't appreciate about the way say universities or other research institutions function, right? So I think that's very important. I think one of the things we need to do is that, there's a lot of status in the sort of institutions that produce knowledge and research. But as this world is changing, we should reflect on what are we good at, but what aren't we so good at? And we need to practice followership as much as leadership, right? So it's not about us just talking to communities, but it's us respecting communities, other groups as equal partners in knowledge generation. Actually, there are some things they're much better at generating knowledge and they're already doing it without our permission. And I think if we can do that, have a respectful conversation, reflect on our failings, reflect on what we're good at and realize that, as the ties say, you really need the knowledge producers, the social movements, the politicians, you need all of society to come together to create transformational change. The best thing about this gathering and this meeting is that most of the people here I don't know and these people from different disciplines, from different perspectives, people who disagree. And that's what's made it such an interesting meeting to reflect on how we can better create and deploy public health knowledge to improve health equity. And that's been such, like people have jelled together so well, it's been so interesting, and really people have had full attention. So, as I said, complete pleasure. This meeting has really been like the brainstorming part of this program and then there'll be other meetings which will aim to engage other groups. Our part is the Alliance is that we are supporting work, community-driven research in four other countries. We got 185 applications and we're so excited how that can contribute lessons from around the world. Other places facing similar challenges about the limits of knowledge or the need to generate knowledge in different ways. And then we will bring that together, learn from lessons in this country in the United States, and then together hopefully chart better ways of knowing together.
I think there's so many of us who are passionate about finding solutions to complex challenges and I think deep down we all care about our communities and we all want to see things change and and become better and I think for the longest we've had this barrier of working on our own, in our own spheres, whether it's academia and research, where you're generating so much information, but then you're just kind of living with this information and it's not really going out. Or on the community side, where you're dealing with daily challenges and you could benefit from research and information to really accelerate the work that you're doing. We need this connective tissue and convenings like this one create the opportunity for something like that. I think because we've been working in silos for so long we can become a little hopeless feeling like we're doing all this work but things are not changing. I think conferences and summits, all of it is so valuable on an individual like professional development level. Because of my background in news in local journalism, we report on these challenges, we tell these stories. Yet we're not really equipping the community with tools to do something about it. And I think academia has a key role in this problem solving. I've been to many conferences and been to many convenings. I've been part of many conversations. We still struggle with seeing these stories through. So I really hope that this convening can be a catalyst to what could be, as opposed to what has been. And can we, in a few years, look back and say that conversation was a start to a transformational journey that we all took that now led us to a place where things are a little bit different.
It feels like there's alignment on problems and even what I was a little surprised about was urgency. Feels like people actually care about this, which is awesome. I guess like my concern, it feels like these lead to more conversations that lead to more conversations and that by the time we arrive at a solution, we're late to the party and or have done more damage than good through the process. So what I'm looking forward to is how these conversations translate into tangible solutions. That from these conversations tomorrow, I hope that we get to hear more of the synthesis and like a playbook style, like what's next then? Like, all right, cool. We're all excited. We're all going to go to different parts of the world. Now, what? I just would love to see more of this. I think that seeing all these people come into the room who would not usually be in the room together talking, about these challenges, it made me think who else should be in the room. There's other, you know, students, others who might be good leaders in the room. But this is just a really, really great start and it felt like people were comfortable not agreeing on everything and it felt like people were very, very much so also comfortable with learning and adapting and being open-minded to seeing something new. So I hope to see more of these.
First, this meeting has been absolutely fascinating and I commend the organizers for thinking of the need to hold the meeting and for organizing it. The importance of being sophisticated about the issue of community because community can be used and misused in multiple ways. A community can be used by people to, and it is used by people to refer to almost any collection of human beings. And so we need to be mindful of that. And we need to raise the question, who is it who defines a community? And who is it who defines who is it in the community that we go to as representative of the community? People often assume that it's the most grassroots people in the community, but sometimes it really should be leaders within the community. We need to be very mindful about how the conclusions from this meeting could potentially be used for malevolent purposes. So, for example, as we question the limitations of traditional science and we elevate the importance of the knowledge that comes from communities that isn't packaged in the ways that science, scientific knowledge has been packaged and doesn't come from methodologies like those that we've all been trained in. For example, put forward knowledge, community knowledge of how vaccines are harmful to people. Put out a very fancy publication, very attractive publication of testimonials from lots of different individuals about how they had a vaccination and then they felt sick afterwards. Thinking about the potential the ways that the results of this meeting could be used that would be harmful. That is not a reason not to move forward with it, but it is a reason to move forward with caution and with our eyes wide open.
This podcast was edited by Zach Linhares and Catalina Melendez Contreras with marketing by Kinkini Bhaduri. Complicating the Narrative is supported by the WashU Bursky School of Public Health and this miniseries is part of the Building Better Ways of Knowing project funded by the Robert Wood Johnson Foundation. If this conversation was useful to you, please pass it along to a colleague who cares about the future of public health. Thank you for listening.
The field of public health has had real accomplishments to its name. Over the past century, we've built a substantial body of evidence on what shapes health. We've seen life expectancy rise and suffering from many diseases decline across the world. And yet, profound gaps persist. There remains a 20-year life difference and in life expectancy between countries and across counties in the US and within cities like this one we're in right now, St. Louis, and many of the leading causes for premature death remain preventable, like smoking, but not fixed yet. So the question is, are we producing the right kind of evidence in the right way to actually move the needle on these gaps? That's the question at the heart of the Better Ways of Knowing initiative, a multi-year project funded by the Robert Wood Johnson Foundation, led by the Healthier Futures Lab, directed by myself and Dean Sandro Galea at Washington University in St. Louis School of Public Health in collaboration with the Alliance for Health Policy and Systems Research at the World Health Organization. Over three years, we're convening leading thinkers across disciplines from public health to economics to sociology to anthropology and many other disciplines as well as practitioners, community leaders, social media influencers and policy makers to ask are the population health science knowledge systems built for the problems we're facing today. This first convening brought together researchers across disciplines as well as community organizers to wrestle with the questions like do we have values that shape what we study and do those type of values also shape what we ignore in our research? How do the systems that fund, rank and publish research expand or constrain the questions we are able to ask? What would it look like to actually build an evidence base that holds complexity rather than flatten it? We don't have all the answers, but we believe that through convenings like this one and other efforts across the globe that examine the structures shaping knowledge production, we can build something better. We can produce knowledge that is more rigorous, more responsive, and more consequential for the health of populations. That's the work. And we hope that many of you who are concerned about the health of populations can join us.
What stood out to you from these two days of discussion and exchange of ideas?
Well, this was an amazing session and so much had happened since our meeting in the fall of 2024 in Geneva that was where some of these ideas were first discussed. And to see both a continuation of the excitement but also in the context of a very changed world and country now, having a mix of interdisciplinary folks for someone like me who've been an academic, who've been a public health practitioner now in philanthropy, and kind of a intellectual generalist, it's brought a lot of really interesting themes together. So it's like really super to have philosophers in the room and, I mean, I used to be a practicing epidemiologist now I'm more of an administrator. So it's really good to get back to, you know, when I used to be a real scientist and hear some of that dialogue going on. So it's and all I think is we're gravitating toward how do we get the university, how do we get philanthropy, how do we get public health better aligned to get effective information to solve these problems and not pretend that just what we write in our books and our academic papers is enough.
Yeah, I think public health is going through a lot of some might say crisis, some might say upheaval, some might say radical transformation. It's been kind of like a dizzying thing to get one's head around. I've certainly thought about what the future of public health might look like after this kind of upheaval subsides a bit. And so this conference has been actually a real opportunity for me to get my head around some issues that have been kind of, you know, bouncing around in my mind, but that I haven't really kind of fully fleshed out. Questions like what the proper role of the federal government is going to be, what the role of the private sector is going to be, the role of technology, whether conventional ways of measuring productivity and quality are actually the right ways, whether we have all the right people and the right mix of folks in the room when we're trying to decide how we're going to go tackle an issue, what those issues even are. So, I've had a really kind of great time just kind of pondering this with a mix of people and I really like the mix too. The mix is really wide cross-disciplinary, cross-methods mix. Sometimes in these public health conferences, you know, it's like a dozen statisticians or epidemiologists and they all kind of have a uniformity. This is nice because we get I think we profit from kind of that difference, that heterogeneity among us. So I've had a great time.
I've really been enjoying the convening. In academia, we are often siloed not only in various disciplines in different units within a university, but also between the university and the broader community or policy makers. And so one of the really wonderful things about this convening is that it brings together lots of different scholars from very different methodologies, very different parts of universities, but also in conversation with people who are deeply involved in communities with people who work in policy every day. And so being able to break down those barriers between the different parts of the university and the community is most helpful in thinking about how do we answer these very important questions and also how do we put ourselves in the best position to really make change and promote these really important healthcare interventions.
The convening today has been a little soul food for me. I feel like my field of public health is going through a time of tremendous change. And people respond to that in different ways. Some people kind of turtle, go into denial, get a little paralyzed. Some people freak out a little bit. And I'm attracted to a group like this that says, "Let's see disruption as an opportunity and think about how we can grow, innovate, make things better, find new opportunities." And so it's been exciting to hear from diverse stakeholders like community groups who say, "Hey, you guys at universities, you have challenges, but you also have data and you also have ideas and you have ways that you can still provide value in new ways to community partners and to population health."
This is a very interesting convening of people coming from different walks of life and different perspectives who are trying to understand whether there's better ways to know, better ways to get reliable evidence that is actionable, that can make a difference for people for science for the community. I think that there's lots of different perspectives, some of them complimentary, some of them perhaps to be debated. There's lots of things that we still do not know and we're struggling to understand. But I think that it's been very illuminating and very stimulating so far. I think that the effort is focused on trying to make a difference for people in the streets and there's a realization that science is the best thing that can happen to humans but sometimes it is detached from humans. It is about curiosity, about blue sky, about very fancy equations and very fancy modeling. Which is fine to some extent, but I think that we need to make a difference also for the average person, for the average member of our community. And this is the type of convening that has such a goal. And I think that I'm very proud to be part of this effort and I hope that some of these ideas that will emerge, will really reach out to make a difference for the average citizen in our community.
I very much appreciated the rich discussion today and I think what was really surprising to me was how much consensus emerged when you bring together experts who come from really different disciplinary backgrounds and are providing a really different set of expertise. There's a lot of disagreement but then also the consensus that emerges around the importance of community-based research and the importance of ensuring that our values align with the types of research activities that we engage in. I learned a lot from the people in the room, especially people who are coming from really different areas of these worlds that intersect from academia, to government, to funders, to community. And so I felt like it was an activity that we need to be doing more of. You know, these types of really deep and rich conversations that we don't give a lot of space for. But I do think that this is the only way that we're really going to make progress on advancing the goals of public health that we all believe need to be done so urgently.
What do you think needs to happen to strengthen how we produce and use knowledge in population health?
Well, firstly, it's really important that we don't talk about communities, but we actually talk with communities and all their diversity. And it's been great over the last couple of days to have Sara and Darren who brought their own perspectives working from and with communities, right? And they've produced a very strong voice about what communities don't appreciate about the way say universities or other research institutions function, right? So I think that's very important. I think one of the things we need to do is that, there's a lot of status in the sort of institutions that produce knowledge and research. But as this world is changing, we should reflect on what are we good at, but what aren't we so good at? And we need to practice followership as much as leadership, right? So it's not about us just talking to communities, but it's us respecting communities, other groups as equal partners in knowledge generation. Actually, there are some things they're much better at generating knowledge and they're already doing it without our permission. And I think if we can do that, have a respectful conversation, reflect on our failings, reflect on what we're good at and realize that, as the ties say, you really need the knowledge producers, the social movements, the politicians, you need all of society to come together to create transformational change. The best thing about this gathering and this meeting is that most of the people here I don't know and these people from different disciplines, from different perspectives, people who disagree. And that's what's made it such an interesting meeting to reflect on how we can better create and deploy public health knowledge to improve health equity. And that's been such, like people have jelled together so well, it's been so interesting, and really people have had full attention. So, as I said, complete pleasure. This meeting has really been like the brainstorming part of this program and then there'll be other meetings which will aim to engage other groups. Our part is the Alliance is that we are supporting work, community-driven research in four other countries. We got 185 applications and we're so excited how that can contribute lessons from around the world. Other places facing similar challenges about the limits of knowledge or the need to generate knowledge in different ways. And then we will bring that together, learn from lessons in this country in the United States, and then together hopefully chart better ways of knowing together.
I think there's so many of us who are passionate about finding solutions to complex challenges and I think deep down we all care about our communities and we all want to see things change and and become better and I think for the longest we've had this barrier of working on our own, in our own spheres, whether it's academia and research, where you're generating so much information, but then you're just kind of living with this information and it's not really going out. Or on the community side, where you're dealing with daily challenges and you could benefit from research and information to really accelerate the work that you're doing. We need this connective tissue and convenings like this one create the opportunity for something like that. I think because we've been working in silos for so long we can become a little hopeless feeling like we're doing all this work but things are not changing. I think conferences and summits, all of it is so valuable on an individual like professional development level. Because of my background in news in local journalism, we report on these challenges, we tell these stories. Yet we're not really equipping the community with tools to do something about it. And I think academia has a key role in this problem solving. I've been to many conferences and been to many convenings. I've been part of many conversations. We still struggle with seeing these stories through. So I really hope that this convening can be a catalyst to what could be, as opposed to what has been. And can we, in a few years, look back and say that conversation was a start to a transformational journey that we all took that now led us to a place where things are a little bit different.
It feels like there's alignment on problems and even what I was a little surprised about was urgency. Feels like people actually care about this, which is awesome. I guess like my concern, it feels like these lead to more conversations that lead to more conversations and that by the time we arrive at a solution, we're late to the party and or have done more damage than good through the process. So what I'm looking forward to is how these conversations translate into tangible solutions. That from these conversations tomorrow, I hope that we get to hear more of the synthesis and like a playbook style, like what's next then? Like, all right, cool. We're all excited. We're all going to go to different parts of the world. Now, what? I just would love to see more of this. I think that seeing all these people come into the room who would not usually be in the room together talking, about these challenges, it made me think who else should be in the room. There's other, you know, students, others who might be good leaders in the room. But this is just a really, really great start and it felt like people were comfortable not agreeing on everything and it felt like people were very, very much so also comfortable with learning and adapting and being open-minded to seeing something new. So I hope to see more of these.
First, this meeting has been absolutely fascinating and I commend the organizers for thinking of the need to hold the meeting and for organizing it. The importance of being sophisticated about the issue of community because community can be used and misused in multiple ways. A community can be used by people to, and it is used by people to refer to almost any collection of human beings. And so we need to be mindful of that. And we need to raise the question, who is it who defines a community? And who is it who defines who is it in the community that we go to as representative of the community? People often assume that it's the most grassroots people in the community, but sometimes it really should be leaders within the community. We need to be very mindful about how the conclusions from this meeting could potentially be used for malevolent purposes. So, for example, as we question the limitations of traditional science and we elevate the importance of the knowledge that comes from communities that isn't packaged in the ways that science, scientific knowledge has been packaged and doesn't come from methodologies like those that we've all been trained in. For example, put forward knowledge, community knowledge of how vaccines are harmful to people. Put out a very fancy publication, very attractive publication of testimonials from lots of different individuals about how they had a vaccination and then they felt sick afterwards. Thinking about the potential the ways that the results of this meeting could be used that would be harmful. That is not a reason not to move forward with it, but it is a reason to move forward with caution and with our eyes wide open.
This podcast was edited by Zach Linhares and Catalina Melendez Contreras with marketing by Kinkini Bhaduri. Complicating the Narrative is supported by the WashU Bursky School of Public Health and this miniseries is part of the Building Better Ways of Knowing project funded by the Robert Wood Johnson Foundation. If this conversation was useful to you, please pass it along to a colleague who cares about the future of public health. Thank you for listening.
