Saturday, May 21, 2016

Population health data science, complexity, and health equity---Reflections from a local health official

I was honored to be invited to speak at the Stanford Center for Population Health Sciences Annual Colloquium on October 26, 2015. They have an exciting new transdisciplinary program to improve the health of populations.

I covered three related areas: population health data science, complex adaptive social systems, and health equity. I ended my talk by focusing on the inter-generational, lifecourse transmission of the effects of trauma to children ages 0 to 5 and how this contributes to racial health inequities.

Here was my thesis:
  1. For the new field of population health data science we must focus on transforming health relevant data into actionable knowledge. To produce actionable knowledge we must integrate methods from the fields of human-centered design, decision sciences, and behavioral economics. In a sense we must start backwards. In the traditional approach we focus on studying populations to discover average solutions ("one size fits most"). Actionable knowledge must be user- and context-centered, and account for individual variation. We use emerging technologies to make this faster, cheaper, better, and actionable.
  2. Human populations are complex adaptive social systems (CASS). To tackle the toughest challenges (e.g., health inequities) requires CASS approaches. How we conceptualize CASS frame how we study and test solutions. To understand CASS we must leverage computational modeling. From this laboratory we learn that simple rules can produce very complex phenomena. We are humbled to know that existing “real world” data are only one realization of many possible realizations. "Off the shelf" solutions do not exist; we must iterate to a solution through community engagement, experimentation, and continuous improvement (e.g., collective impact). 
  3. Our ultimate goal is to mobilize and transform communities. This starts by learning how to transform ourselves, our teams, and our organizations through testing and learning (“continuous improvement”). In public health the approaches we use to transform communities and inform policy decisions include health impact assessment, collective impact, and community-based participatory approaches. These key approaches add capability to our toolbox public health methods. Collective impact for transforming CASS problems has received enormous attention---and deservedly so. Collective impact is continuous improvement methods applied at a social scale for CASS problems. Collective impact embraces the challenges of complexity, and methodically focuses on collaboration and community transformation through a common agenda, shared measurement, mutually-reinforcing activities, continuous communication and improvement, and backbone support.
  4. Our main population health agenda must be to eliminate racial health inequities. Our collective priority must be to interrupt the inter-generational transmission of the effects of trauma (toxic stress) on young children. Toxic stress alters the brains, bodies, and behaviors of young children, thereby permanently affecting memory, judgment, self-regulation, and physiology. This results in higher risk behaviors and adult chronic diseases. Furthermore, Black/African Americans are traumatized throughout their lives by racism and discrimination. This focus---inter-generational transmission of toxic stress---enables us to prioritize and target social policies and social determinants of health with the biggest potential to eliminate the “childhood roots of adult health inequities.”

Summary slide

  1. Population health data science
    1. Start backwards (understand individual and group decision-making!)
    2. Focus on actionable knowledge (Advise--Predict--Discover--Describe)
    3. Focus on human-centered design (“precision public health”)
  2. Transforming complex social systems
    1. Understand complex adaptive systems (requires humility)
    2. Transform self, teams, organizations, communities (in that order:
    3. requires continuous improvement, taking risks, learning from failures)
  3. Tackling population health inequities
    1. Inter-generational transmission of trauma
    2. Toxic stress alters brain, body, and behavior
    3. Life course of trauma, racism, and discrimination
    4. 4Ps of public health: prevent, protect, prepare, promote
    5. 6Ps of complex systems: people, policy, place, program, provider, parents

Slide presentation




Video presentation

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