How our methods shape our work in community health research

Written by Erin Kent

On September 16, 2007, Gary Taubes published an editorial piece entitled “Do We Really Know What Makes Us Healthy” in The New York Times. His paper reviewed the relative public health benefits brought forth by the field of epidemiology, and in addition contrasted the strength of evidence via randomized controlled clinical trials and observational epidemiologic studies. In one concluding statement, Taubes writes “In the process [of trying to make sense of common chronic diseases], the perception of what epidemiologic research can legitimately accomplish– by the public, the press, and perhaps by many epidemiologists themselves– may have run far ahead of the reality.”

The American College of Epidemiology promptly sent a reply, reminding the readership of the impact epidemiology has had in advancing public health. Further, Taubes’ editorial generated lively discussion among practicing epidemiologists from all sectors. In one such discussion, the question about the roles and responsibilities of scientists in the realm of public education was evaluated, and a question was revisited: do scientists have an obligation to educate the public about their claims? Or more practically speaking, should scientists make a point to communicate with popular journalists, and if so, how?

Two issues arising from these questions which have strong theoretical implications for the health science disciplines. One involves ethical questions regarding the roles and responsibilities of scientists in the dissemination of their findings, and the other involves the validity of the constructs we create in the social and health sciences.

There seems to be a growing division in persona between scientist and layperson.

Epidemiology has contributed much to the advancement of health, primarily in establishing scientific approaches to investigate root causes and contributions to disease and other adverse health outcomes. It is also true that there is a good degree of public mistrust of the functionality of the field; yet why is there such a divide? Further, whose responsibility is it to narrow this gap? These become questions of public responsibility, or more aptly, public service, discipline wide.

Given the structurally close but culturally tense relationship that the field of epidemiology has with the field (or domain) of public health, the implications that epidemiologists may have duties above and beyond adherence to the scientific method become charged, if not ideological. Pure epidemiologists (those with doctorates of philosophy, not doctorates of medicine) do not pledge oaths like physicians do. On the surface, it seems rather brash to suggest that epidemiologists aren’t necessarily beholden to serving the public; aren’t they invested in improving health through rigorous inquiry? But in practice, if such was the case, why isn’t there agreement that epidemiologists have some level of responsibility to see that their findings are understood by the masses?

In consideration of an ethical continuum in the realm of dissemination, broader agreement about the unethical would be expected for those scientists who engaged willfully in behavior that seems more entirely motivated out of self-gain. For example, scientists who suppress findings that would potentially mar a funder’s public image or those who allow political sentiments to interfere with the research dissemination process would be easily labeled unethical. But what about milder transgressions, such as unintentionally withholding findings, due to a perceived lack of translatability? Or even more simply, failing to write for the public because funds, time, and resources are not readily available (or budgeted for)? The situational factors, or context-dependence, probably weigh heavily on if and how scientists opt to publish their findings.

Related to these ethical questions are implications about what counts as knowledge. Here I will make an over-generalizing distinction between expert knowledge and local knowledge. Expert knowledge, which most of us are more familiar with, stems from formal training in a discipline that involves building facts, theories and methodologies all from previous expert knowledge. Local knowledge, on the other hand has been characterized as knowledge without origination in professional techniques, but rather casual speculation and experience (Corburn, 2005). Both are real and both are important; but in reality, a politic and hierarchy exists between both types of knowledge.

This hegemony is reinforced by assumptions from all sides: researchers are the “real experts,” and community members must be guided by them.

Some cite the continued and growing distance between “experts” and the public, and evidence of the divide abounds with many consequences. Public wariness, if not mistrust, of science can serve to diminish resources necessary to scientific inquiry. Progress in science relies on both financial and social capital; take away either, and societies are left to explain phenomena by other means. How can we reconcile these two typologies of knowledge? Perhaps we need to revisit the importance and weight of local knowledge. For one, sustained positive change relies on the provision of control over capacity building by communities themselves (Altman, 1996).

Even more specifically, how should we construct our constructs? Where do we gather the information needed to develop our theories, to build our models? The backdrop behind the realm of theory development is colored with spectrums bordered by extreme ends: reductionism vs. constructivism, inductive theory vs. deductive theory, individualism vs. collectivism, to name a few. Although theory may arise independently from empirical work, often I think grand (or even middle-range theorists) neglect to think about how methods may shape their work.