Public health experts and researchers work over the long run — and out of the spotlight — to generate vital solutions that lead to better health outcomes.
In 2020, as people worldwide remained in lockdown, public health leaders and health care providers worked nonstop to stem the tide of COVID-19. Dictionaries chose “pandemic” as their Word of the Year, social media was flooded with memes and quarantine jokes, and videoconferencing technologies changed the way people lived, worked and communicated.
For most of us, it was the first time we’d heard so much about the “coronavirus” — a virus whose variants Ralph Baric, PhD, William R. Kenan Distinguished Professor of epidemiology, had been studying for more than three decades. Thanks to their familiarity with the virus, researchers at the Baric Lab and throughout Gillings were at the nexus of pandemic response — playing a critical role in testing vaccines and treatments, predicting viral spread, and helping world leaders mitigate the pandemic’s impacts. Public health was suddenly center stage in the global spotlight.
That’s more the exception than the rule. While public health work is vital to the overall health and well-being of our society, most of the time that work is done over “the long run” — persistently, cumulatively and largely out of view of the general public.
Biostatistics
Longitudinal studies are, by their very definition, a type of research done through a long-term lens. The Collaborative Studies Coordinating Center (CSCC), housed in the Department of Biostatistics at Gillings, is home to two long-running longitudinal cohort studies that have tracked the same pools of participants over several decades, generating findings that have led to important changes in public health and in the practice of medicine.
One of the world’s most significant heart health studies, the Atherosclerosis Risk in Communities (ARIC) study, began in 1986, enrolling a cohort of nearly 16,000 adults from four United States communities and monitoring them in the years since through clinic visits, phone calls and other measures. The Hispanic Community Health Study (HCHS/SOL) began in 2006, following the health issues of nearly 16,000 Hispanic/Latinx adults.
Between them, so far, the two studies have spawned more than 3,000 publications and almost 200 ancillary studies. Their findings have led to the development of new heart medicines, helped identify risk factors for several illnesses, highlighted health disparities, and influenced clinical guidelines that doctors use to treat coronary heart disease, diabetes, stroke and chronic kidney disease.
“The original study has essentially become the infrastructure, and researchers are coming to us and saying, ‘Here’s what I’m interested in. I heard you have the best cohort — would you be willing to partner?’ That’s where a lot of the current work is being done,” says Kevin Anstrom, PhD, director of the CSCC and professor of biostatistics. “These standing cohorts have a very detailed history over a long period of time.”
Environmental sciences and engineering
Working over a long period of time is not unusual for most academic researchers, especially those hoping to influence public policy. One factor is the time-consuming nature of regulatory, legislative and policymaking processes; another challenge is translating highly complex, technical information into a navigable road map for change.
Atmospheric chemical processes, for example, have significant effects on air quality and are a major factor in climate change. Over the past three decades, Gillings’ Department of Environmental Sciences and Engineering has been a leader in advancing the scientific understanding of the atmospheric processes that create ozone and aerosols, with faculty and staff making major contributions to the field, including building the world’s first smog chamber. Over the years, multiple findings and innovations have been instrumental in creating more effective pollution controls and influencing policy change.
The School’s reputation as an air-quality leader and the fact that all the atmospheric chemistry models are tested on experiments in its smog chamber helped entice Professor Will Vizuete, PhD, a chemical engineer by training, to join the faculty in 2005. “I could do modeling anywhere in the world, but what’s nice about Gillings is that all these scientific discoveries are done in-house,” says Vizuete, who develops and runs sophisticated models that determine how aerosol and other air particles interact chemically with the atmosphere. “I have access to all that data and can incorporate that science into my work.”
Vizuete collaborates with department chemists and statisticians at Gillings, along with colleagues in other academic fields, on long-term projects that have led to key innovations. He’s also continuing to work closely with policymakers, the Environmental Protection Agency, and the oil and gas industry in Houston on air-pollution policies and strategies — a relationship that began more than 20 years ago when, as a graduate student in Texas, Vizuete developed models that led to new ozone controls. This work had a major impact, taking Houston from one of the dirtiest cities in America in 2000 to meeting national standards by 2009 and saving countless lives in the process. His more recent projects involve running models based on data from the state of Texas to determine the sources and chemical compositions of a variety of pollutants in Houston; his work will serve as the foundation for the new pollution controls and policy decisions.
Health behavior
Marissa Hall, PhD, an assistant professor in health behavior, has her eye on policy changes, too. She conducts innovative experimental research on the efficacy of warning labels on tobacco products and, more recently, on alcohol and food products. Her lab is the UNC Mini Mart, a physical convenience store on campus where her experimental studies simulate a real-world shopping experience to test how consumers react to packaging labels, shelf placement and other variables that might affect shopping choices.
Nine Latin American countries have recently adopted visually engaging, front-of-package warning labels about the nutritional composition of sugary drinks and other highly processed foods — and initial evaluations indicate consumers are buying fewer unhealthy products. Now Hall is excited about the opportunity to influence the U.S.’s path on that same topic. Last fall, the White House issued a national nutrition strategy to place front-of-package warnings on food labels; the Food and Drug Administration is now actively soliciting public feedback on the details and next steps.
“It’s a great opportunity for researchers to present our evidence and detail which studies policymakers should know about,” Hall says. “The regulatory process can take years — which means that, as a research community, we have time to do high-quality research that is independent of the FDA but can be incorporated into the body of research. It’s important that we play an active role in that process.”
In addition to submitting scientific evidence as part of the public comment period, Hall has been active in the policy world in other ways, such as participating in FDA briefings on some of her previous research, being part of national working groups, and staying in contact with advocates and policymakers interested in the issues she’s studying. She credits those interactions with helping to inform her work, thereby increasing its potential for influencing change.
Nutrition
Close relationships with advocates play a big role in ongoing public health work — and advocacy efforts often provide the push that brings much-needed visibility to important issues. Assistant Professor of Nutrition Carmina Valle, PhD, who has been working in the field of cancer prevention and control for more than 20 years, spent five years after earning her Master of Public Health degree with the National Cancer Institute (NCI). Through her work at NCI, she met cancer survivors and advocacy groups who played important roles in launching the field that has since become her life’s work.
In the mid-2000s, spurred on by active community-based advocacy groups, the NCI and Livestrong Young Adult Alliance brought members of the scientific, medical and advocacy communities together to look more closely at the unique issues that adolescents and young adults with cancer faced. The group produced the seminal reports that eventually launched the field of adolescent and young adult (AYA) oncology.
“When you listen to the stories of cancer survivors who are young adults, it’s powerful to hear about the issues they face — the isolation they felt, wanting to meet peers going through similar experiences, being treated in spaces where the other patients are either much younger or really older,” she says. “Having participated in the early meetings of the AYA oncology movement, it’s gratifying to see how far this field has come.”
As a pioneer in AYA cancer survivorship research, Valle was also one of the first scientists to study using social media as a tool to help survivors increase their physical activity or make lifestyle behavior changes. She investigates the most effective ways to use social media, activity trackers and other technology in the context of interventions to encourage survivors of adolescent and young adult cancer to engage in healthy behaviors. To this day, Valle maintains relationships with many of the advocates she met decades ago and works closely with a community advisory board of AYA survivors.
Maternal and child health
Local community leaders often are a key resource for researchers who work directly with individuals and families — and as such, they gain insights into the research process that the general public usually lacks. Kavita Singh, PhD, associate professor of maternal and child health, collaborates with families and research partners in several African countries to evaluate interventions designed to reduce maternal and infant mortality.
Many of these interventions, such as early breastfeeding and keeping a baby warm through simple skin-to-skin contact, are “natural” approaches that are found to benefit all newborns and feasible to implement in low-resource settings. Singh’s work helps countries make effective strategies and interventions more accessible to new parents regardless of their geographic locations or their financial situations.
Maternal and child health is another area of public health with an eye on future impacts. Evidence abounds that a healthy first thousand days of life, from conception to age two, is key to giving an individual a good start in life, and that early-life stress can contribute to poorer physical and mental health down the road. Singh has seen a shift in awareness of the importance of improving the health of pregnant individuals and the importance of giving children a healthy start.
“There is now more of an understanding that the first month of life can be a vulnerable time in an individual’s life and that we have newborn interventions that don’t require a lot of technology or electricity,” Singh says. “Globally, there is also more of an awareness that we need more research into developing and evaluating more of these types of newborn interventions.”
Increasing the public’s understanding of the importance of public health is an enduring challenge. Whether they are suddenly thrust into the media spotlight or continuing their work in a less public way, Gillings faculty remain dedicated to the vital mission of improving public health. They’re on it — and they’re in it for the long run.
