Written by Kianna Zucker, BA candidate in cognitive neuroscience at Washington University in St. Louis and the Stephanie and Chris Doerr Summer Research Scholar for the Institute for Public Health Summer Research Program
On June 29, I had the opportunity to listen to William Powderly, MD, the Larry J. Shapiro Director for the Institute for Public Health speak to students in the summer program’s Public & Global Health Track. His discussion relating to the U.N.’s Sustainable Development Goal 17, (to strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development), highlighted the importance of considering implementation science when addressing health outcomes. Scientific discovery drives our understanding of diseases and the treatments that save countless lives. The United States is committed to discovery, spending nearly 32.3 billion dollars on medical research. However, the United States’ life expectancy lies behind most of its economic equivalents and is even lower within specific communities, such as those of lower socioeconomic backgrounds and people of color. For example, the street Delmar Boulevard shows both a socioeconomic and racial divide in St. Louis and, due to a history of housing segregation and discrimination, life expectancy drops by nearly 20 years from areas south of this street to the north.
Without understanding how to implement discoveries into communities, marginalized populations will continue to be more affected by health issues than those who are privileged, and health outcomes such as life expectancy rate will not improve—regardless of the quality of our medical research. Although evidence-based interventions exist, the gap between clinical discovery and implementing it into practice can take several years. The gap stems from two issues: first, the process of bringing a therapy from laboratories to humans, and second, understanding how to deliver the treatment to specific communities.
The case study of HIV in the United States, and its disproportionate harm to specific communities, exemplifies the need for stronger implementation science. There is a greater risk of acquiring HIV in certain parts of the country, affecting people of color and poorer communities at a much higher rate. When thinking of the elimination of HIV across the country, implementation scientists cannot just use a broad stroke approach. Instead, they must focus on the specific populations that are not being reached. Powderly argued that there is a greater need to conduct testing specifically on these at-risk populations while maintaining and providing care for people who are HIV positive. Improving outcomes for people with HIV does not require discoveries—antiviral therapy already exists, controlling the deadly consequences of HIV. Instead, HIV serves as an implementation challenge. Long-term investment and recognition of HIV treatment as being a global partnership is necessary, including working with communities to understand what works and training scientists and providers.
In addition, Powderly stressed that we must think of implementation science in a new way to fully address these gaps and improve public health outcomes. While understanding the biology that leads to disease and biological responses to disease is crucial, they must be studied in the context of demography and human behavior. Humans are not rats. No matter what is found in a laboratory, humans live in a social context that has implications for their biology and can completely change prior assumptions. Social conditions, policies, and issues such as systemic racism influence health, and we must address these fundamental issues in society to understand our treatments’ impact across different communities.