Maria C. Mora
Pinzon, MD, MS
Preventive Medicine Resident, UW-Madison, 2015-2017
After two days
of inspiring speakers, I feel motivated and encouraged for the future of health.
I know there are still opportunities and challenges of integrating
evidence-based practice and service delivery, but we are on the right path, and
I hope that I can share what I learned with you.
These were the
most common words used on Twitter in relation to the conference:
takeaway of this conference was “Engage your community”. In public health we
know that the community is an important part of our work: they are one of the
so-called stakeholders, but sometimes they are not at the table were decisions
and plans are made. Dr. America Bracho (Executive
Director of Latino Health Access) was the keynote speaker of the
conference, and she gave wonderful examples of how to engage your community. They
live the data and are the experts on the situation, and we need to see them as
such. In her organization the “promotores” (health promoters) are leaders from
the community that were recruited in the organization for their heart, then
they were trained for their job. Check out her TED talk. Here are some other examples of true community
of Nepal, Gates Foundation, and particularly Melinda
Gates’ work in contraception.
What do all of
these initiatives have in common? They asked the community what is important to
them and worked together towards a goal. These examples are not about
organizations going to a community and saying: You have a problem and here is how to solve it. They are about
organizations going to a community and saying: What do you think of your community? Do you think you have a problem? How
to you think it can be improved? Let us help you.
To put these
ideas into practice, go beyond your comfort zone and engage your community in
all stages of your research (Planning, Institutional Review Board (IRB),
Dissemination, Implementation, Evaluation), as well as other experts
(economists, social workers, anthropologists, journalists, lawyers,
policymakers, sociologists, statisticians). There are people out there that can
improve your work, and we need them to improve implementation research and
was Dr. LaMar Hasbrouck (Executive Director of The National Association of
County and City Health Officials – NACCHO), who said: “If you think that public health departments are important, please
quantify their value”. We need to
prove that what we do in public health matters and that things are better
because we are here. Because of that, it is important to engage experts early
in the process of research/implementation of any initiative. We need to
quantify what we do and the outcomes we get, Even if we show improved outcomes,
we also need to show that those outcomes are cost-effective to the society and
the economy overall. And whatever you do, don’t lose the human side of your
research, don’t lose the history, because histories compel and relate to others
in ways that data will never do.
There is so
much to be said but there is not enough time, so find below some other thoughts
and links for more information:
- Equity is not
equality. Work with your communities to decrease disparities, since some
populations will need more investment than others to improve their health
outcomes. Work with your policymakers to make sure that they understand that
dividing resources equally might not be appropriate (one-size doesn’t fit all).
communities (of practice) are not research communities (of discovery); the former
uses a feedback tool, where data is analyzed and introduced back to the system
to improve it, as shown in the graph below (The Knowledge-to-Action Framework).
- You don’t need
a randomized trial to show that your intervention works. Sometimes researchers are not the ones
applying the intervention, or randomization is not possible (e.g., living wage,
health insurance coverage). Even in those cases you can quantify and estimate
the value of your intervention. Work with people in academia, including statisticians,
to identify the best way to evaluate your program and get the word out.
is key, and it relies on leadership (#champions) and resources. You can assess
the sustainability of your program using an online tool: https://sustaintool.org/
- Social Network
Analysis (SNA): studies processes by examining links and interactions between
people, organizations and communities. It allows you to map your population and
identify targets for your interventions.
- If we need
“Translation Research” to disseminate your work, maybe it was not in the right
language to begin with. The language of your research results is key;
publishing in academic journals is appropriate, but your research needs to
reach those that live it.
- Policy has a
significant impact on people’s lives. If you want to see a change, don’t forget
to involve your policymaker or government representative.
sometimes requires “Unlearning”; that is, we may need to unlearn things that
are no longer useful or relevant. More research on this area is required.