Virtual ARM

Good morning and welcome to the 2021 Annual Research Meeting! Boy, do I miss seeing you in person and an overflowing hall of familiar and new faces! But I am so pleased to be together again – to reflect on the year we have experienced and learn from all of you. As I prepared for today, I thought about the question that I have often asked myself these last 15 months – when will we return to normal?

However, “Nothing could be worse than a return to normality.”

That’s the final line of the penultimate paragraph in a breathtaking essay by Arundhati Roy in April 2020, just as the worldwide pandemic was digging in. Back when it was unimaginable that 600 thousand Americans and three-and-a-half million people worldwide would die. Before the deaths of George Floyd and Breonna Taylor, and so many more, and the protests and national awakening that followed, an awakening to the blight of racism.

The last year and a half has revealed the weak spots in our relationships, culture, organizations, and systems just as surely as it called on our strengths, gifts, and humanity to break through. AcademyHealth and the fields of health services research and health policy (HSR) have also been challenged, and as we collectively take our first tentative steps into a changed world, we do so knowing that the ‘normal’ of 2019 no longer exists, we can’t go back. We must go forward.

The question for us is what does “forward” mean for health services research? What have we learned about how we do our work – what needs to change and what is good? Did we collectively meet this moment?

I think the answer is yes, and no.

First, what is good: we continue to hear about how many in our field were able to quickly adapt and respond to new and pressing demands from their stakeholder partners. We saw new funding opportunities and the rapid launch of new datasets to understand the pandemic’s impact. We also saw the growing recognition in our public discourse of the need for science to drive decisions.

But we also saw just how out of step our research ecosystem is with today’s needs and how much must still change. As a field, we have been settled into a system that has worked for some very well-- but has not delivered the impact for all that I think HSR should. The things we normalized along the way – our doctrines about what counts as evidence, our accepted ways of career advancement based on individual success, our failure to reward impact, the data we have collected – and more importantly what data we chose to NOT collect, and even the kinds of questions we have been asking – all of this has become so established in the tableau of standard research practice that we rarely question them. I think we should.

And then we have the research culture in which we work. In 2020, the Wellcome Trust in the UK published the results of the largest global study ever of research culture. They found that researchers are passionate about their work and thrive when the culture around them is collaborative and inclusive and leadership is transparent and open. Unfortunately, this is not the case for many researchers, especially underrepresented researchers. The intense competition – whether to secure grants, or to publish – has created an aggressive and harmful culture overall and far too many have experienced exploitation, discrimination, and harassment.

We see the impact of this research culture in the U.S. in the growing time it takes to secure one’s first R01, in the number of derivative studies that are funded in lieu of the higher risk, potentially higher impact ones, and in the number of Black investigators speaking out about their experiences and some even abandoning a research career. The specific challenges in our field will be the topic of a session on Wednesday, where students will present the findings of study they conducted on this topic which includes the results of a survey of 2020 ARM attendees.

Now, you may think that this characterization of our field is too pessimistic, and that I am not acknowledging our successes. And we will see these successes reflected in the terrific agenda of the next 4 days. So maybe I am being overly pessimistic, but I am also impatient. I have been at this for almost 30 years and I see so much richness, passion, creativity and commitment to making health and healthcare better for all. And yet the evidence is all around us - we still have the health outcomes and inequities we have. We must do better.

As researchers, clinicians, policymakers, advocates and members of this community, we collectively have the resources, talents, and skills to help make a better, more equitable, and more just normal, the new reality.

More than that, I believe we have an obligation to use evidence to make change. Our is a multi-disciplinary, applied field so what exactly are we doing if our work is not helping make health and health care more accessible, affordable, equitable, and efficient for all people?

We know that every system is perfectly designed to achieve the results it gets, and so to drive impact, we must do much more to examine upstream causes of the poor outcomes we have – like the social and political determinants of health and squarely confronting structural racism, privilege, and power dynamics. We must then use this knowledge to inform the design of interventions and evaluate their effectiveness. The challenges of health care costs, access and quality are very much still with us, but as Albert Einstein said “We cannot solve our problems with the same thinking we used when we created them”.

We must think differently, and that includes addressing the incentives – funding, promotion, recognition – that shape our own behaviors and successes.

As the professional home for health services research and health policy, and your voice in Washington, this is AcademyHealth’s charge. This afternoon, I encourage you to attend a session where the recommendations from an Advisory Group on Diversity, Equity and Inclusion will be presented during a town hall session. We are going to keep pushing for more impact and equity.

In closing, I want to leave you with a final thought and challenge from Arundhati Roy’s article. It has stuck with me these 15 months, and I hope it stays with you also. She concludes, and I quote,

“Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.”

Thank you very much for the work that you do and your engagement in this fight for a better field and a better world.

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