Earlier this week, I had the pleasure of participating in TEDMED's "Facing the Facts of Childhood Obesity" Google Hangout, part of the community's Great Challenges of Health and Medicine series, which convenes individuals from various disciplines to explore "20 of the most complex, multifaceted, and insufficiently understood challenges to the health and health care of Americans."
As a pediatrician and a passionate advocate for advancing the nation's health, I was thrilled to join Risa Lavisso-Mourey, Nancy Brown, Don Schwarz, and Elissa Epel for this conversation. As tends to happen when I'm in a room full of great minds, I came away with my wheels churning and with our mission to improve health and health care through the application of evidence reaffirmed. Reflecting on this discussion, I want to emphasize one point I made during the Hangout that I find critical to the field of health services research more broadly:
To build a culture of health, we must first build a "culture of learning."
To clarify, when I say "culture," I mean an expectation, a new normal, where every innovation, every intervention, every program, and every policy is monitored and evaluated to establish whether it is actually delivering the intended impact. A new normal where every actor engaged in a program or policy development—whether a provider, program manager, policymaker, or participant—naturally asks, “How will we know if this intervention worked? How will we know that we had the effect we intended to have?”
It is only in a culture of learning that we will be able to scale up and spread those interventions that do work, adapting them to the many diverse communities in which they’re needed and—just as importantly—discarding those which do not. This will maximize our valuable, and not to mention already limited resources, to the benefit of better health and health care.
However, to accomplish this fundamental shift in thinking, we need to become better at building bridges between our scientific/evidence communities and our policy/practice communities. You’ll note that I made ‘communities’ plural, and I do so intentionally. Currently, there are too many silos within the science community; they’re bounded by disciplines and sectors, and the same is true for practice and policy.
What the obesity epidemic, both child and adult, makes abundantly clear is that we must work across these silos to succeed. We, as health services researchers, must not only bridge the traditional evidence and policy/program divide, which is already far too wide, but we must also create a vibrant, expansive, and mutually supportive community of evidence producers. We need to expand our proverbial “toolkit” of measures and study designs to enable more real-time knowledge generation, helping to drive mid-course corrections rather than waiting three to five years for the summative, final word on whether or not a given method worked. We need to recognize that the question is not solely, “Did this intervention work?” but really, “For which communities and populations did it work?” and “How and why did it work?” This is one core area in which dissemination and implementation research (also known as implementation science and a host of other terms) will truly help. (I should plug that if this is an issue of interest, please consider joining us for the 7th Annual Conference on the Science of Dissemination and Implementation on December 8-9.) Finally, we need to accelerate our ability to share what we're learning. I am continually reminded of how vast and diverse this country is, and just how much reinvention happens every day, resulting in us needlessly wasting resources when we could in fact be effectively building off the work of each other.
At the end of the day, I believe I—and AcademyHealth—are "connectors." I look forward to continuing to work with others in our field to answer the call to build a culture of learning and ultimately, achieve a "culture of health." Childhood obesity, though significant, is just one area of many that needs this more expansive, inclusive approach. Reaching this point—where we understand how to weave together health care and social, economic, and environmental solutions—will benefit not only children, but their families and communities as well.
A previous version of this message was originally posted on the Robert Wood Johnson Foundation's Leadership Network, which can be found here.