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Moracco has been a faculty member at the Gillings School since 2008, where she has held several important leadership positions and been acknowledged as an outstanding teacher, mentor, practitioner and researcher. She is also an alumna of the Gillings School, where she earned both her Master of Public Health and doctoral degrees. Her research and practice are centered on violence prevention with a focus on gender-based violence in both local and global settings.

She was honored with the University’s Edward Kidder Graham Faculty Service Award in 2021 in acknowledgment of her dedication to the reduction and prevention of domestic and other types of gender-based violence. Skilled in intervention development and evaluation, Moracco is an expert in community-based engagement, in which stakeholders are active participants in the design and evaluation of interventions that meet their community’s needs.

“As Chair, my priorities will be to protect and enhance our efforts toward building an inclusive, equitable environment for Carolina’s faculty, staff and students; safeguard the integrity of the role of faculty in decision-making; and advocate for full and timely information-sharing in matters that concern faculty,” Moracco said in her statement.

UNC’s chair of the faculty has the following duties, in addition to those that may be determined by the chancellor or Faculty Council:

• To serve as chair pro tempore of the Faculty Council and of the General Faculty,
• To make an annual report to the Faculty Council on the state of the faculty, and
• To represent the chancellor in all academic matters whenever requested by the chancellor.

If you wish to contact Professor Moracco regarding faculty governance-related matters, please email facultychair@unc.edu or call the Office of Faculty Governance at 919-962-2146.

This issue of Carolina Public Health magazine discusses why the world needs public health. A related question that I answer often in my role as dean is, “What is public health?”

I’m always tempted to respond: “What isn’t?”

After three years of living in a pandemic, many people identify public health through epidemiology. Yes! Creating vaccines and sharing masking guidance are essential public health tasks. However, that’s not all epidemiologists do, nor does it represent the whole of this field.

Public health is also keeping workers safe on the job, improving traffic patterns to reduce car wrecks, getting healthy food to hungry kids, testing street drugs for dangerous additives and planning ahead to mitigate the effects of climate change.

And that’s not nearly all. We also make birth safer, ensure communities have clean drinking water, design well-run clinical trials, support people through healthy lifestyle changes and advocate for policies that mean everyone can visit a health care provider when they need to.

If any of these examples surprises you, you’re not alone. Public health is so all-encompassing that I genuinely believe it touches every other field — not only the health sciences, like medicine, pharmacy and dentistry, but also chemistry, communications, city planning and more.

Here is the ultimate goal of public health: We want people to lead safe and healthy lives. That means instead of investing directly in patient care, public health invests in improving well-being.

Here’s one example of the public health mindset, explained beautifully by Master of Public Health student Callia Cox, who is studying to become a registered dietitian:

“I realized in order to effectively help people eat better, I had to gain the skills to figure out each individual’s top priority. Someone worrying about eviction just can’t focus on getting more vegetables in their diet.”

This approach of addressing people’s most pressing needs first is why, to my mind, public health is the foundational layer in the pyramid of overall health and well-being. Our work creates a sturdy base upon which individuals and whole societies can then build additional layers, such as increasing generational wealth, exploring self-care and enjoying long, fulfilling lives.

As the pandemic reaches a different phase, many people are turning their gaze away from public health. We are, however, still in the middle of multiple crises: systemic racism, poor mental health and opioid misuse, to name a few. Our work is by no means done.

As the epic quest to achieve health and well-being for all continues on a global scale, I am reinvigorated every day by what I witness all around me at the Gillings School.

When a student tests water samples for toxins in one of our labs, when a staff member connects a worried parent with community resources, when a faculty researcher presents evidence to support a national policy change — this is public health in action.

For me, these efforts are also the source of boundless hope.

Dr. Nancy Messonnier
Dean and Bryson Distinguished Professor in Public Health
UNC Gillings School of Global Public Health

Under the pressure of time, uncertainty and withering scrutiny, public health efforts confronted an unprecedented viral threat, aided the rapid development of revolutionary therapeutics and vaccine technology, and helped us understand our role in caring for one another. As the United States confronted the impacts of structural racism, public health played a necessary part in finding new solutions to improve health inequities.

Though we are called public health, we have endured on the periphery of public awareness — working to prevent illnesses, deaths and disasters that are difficult to measure when they do not occur. When COVID-19 brought our school into the spotlight, the world saw the strength of our values: cooperation, inclusion, equity, empathy and perseverance.

But this experience has not been without challenges. Preventable illness and death have caused suffering for millions. The number of people whose lives have been altered by long COVID increases every day. Our health care systems are strained, and lack of public health funding and organization have prevented proactive responses. We are still chipping away at the structural barriers to health care access, systemic equity, climate change, clean water and many other factors that impact our well-being.

Furthermore, a crisis of trust has polarized the public. Experiences of racism, discrimination and economic hardship have led to medical mistrust. Disinformation and lack of public health communication have led to confusion about what is fact. Distrust in the institutions once thought unassailable — the schools, doctors, media and governments that are so important to a healthy society — have left many feeling fractured and disheartened.

As this issue of Carolina Public Health will demonstrate, public health is no stranger to these challenges. Indeed, it is the institution with the knowledge, resources and practices best suited to tackle them. The world needs public health because our foundation is rooted in the very values necessary to design evidence-based solutions, adapt to adversity and collaborate for the common good.

The world needs public health, because we are the future-minded researchers who work behind the scenes to prevent disease, prepare for disasters, promote health and prolong life.

The world needs public health, because we are the advocates for policies that are informed by evidence and rooted in equity and inclusion.

The world needs public health, because we are the partners who elevate community voices and approach health solutions from new perspectives.

The world needs public health, because we are the practitioners who work locally and globally, with an understanding that our impact must support human rights and reduce harm.

And the world needs public health, because we are the communicators who strive to educate with empathy, trust and accuracy.

At the Gillings School, we aim to instill public health leaders with knowledge and skills that reflect these institutional values. And we strive to live these values as we press forward in the journey toward lasting change.

But our work does not end if we stumble on the road to that change.

On the contrary, that is when
our work begins anew.

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.

Many faculty and researchers at the UNC Gillings School of Global Public Health are exploring the social drivers that increase rates of chronic disease among vulnerable and marginalized populations.

Chantel Martin, PhD, assistant professor of epidemiology at the Gillings School, is currently studying the impact of neighborhood social conditions and environmental toxins on inequalities in chronic disease risk and the underlying biological mechanisms linking neighborhood conditions to health.

Both historical and present-day policies around residential segregation have created disadvantaged neighborhoods. People residing in disadvantaged neighborhoods face limited access to economic opportunities, quality health care and healthy food choices. They also face higher levels of crime and policing and more environmental toxins. All these social factors have a profound impact on well-being and mean that no one’s health exists in a vacuum.

“Individual health is structurally patterned and embedded within contexts. An individual approach to health neglects the socio-political and economic contexts that shape health,” said Martin.

“Racism is a unique chronic stressor that can dysregulate the body’s homeostasis.”

— Anissa I. Vines, PhD

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Deshira Wallace, PhD, assistant professor of health behavior, examines how various sources of stress, including racism, can affect the management of conditions like Type 2 diabetes and contribute to cardiovascular disease risk. For example, if an individual thinks that they might be stopped because of their skin color, they may feel less safe running outside and struggle to engage in the recommended physical activities to manage their diabetes.

“People are exposed to physical, social and political factors that change the calculus on how they can control their individual health,” said Wallace. “If we focus on individual health, then we are not fulfilling our public health mission to facilitate environments that reduce disproportionate risks and barriers to allow individuals to live the lives they want to live.”

Wallace’s work also explores the impact that policies, such as migration policies, have on health. Discrimination against the Latinx community can create barriers to important services like health insurance. It also makes it harder to obtain essential needs, like a driver’s license, which is often necessary to access quality health care and other services.

Anissa I. Vines, PhD, associate professor of epidemiology, also researches social drivers of health inequity but with a focus on psychosocial stressors in the lives of Black women. Her work includes the study of racism both as a chronic stressor and a determinant of other stressors on health issues, including depression and the increased incidence of uterine fibroids.

“Racism is a unique chronic stressor that can dysregulate the body’s homeostasis, or state of balance, leading to adverse mental and physical outcomes,” said Vines. “Racism operates at the individual level, but it also influences other stressors, too. For example, discriminatory practices and policies in schools and neighborhoods thwart economic opportunity and contribute to high effort coping. Because of this, racism has an intergenerational influence on determinants of health.”

Researchers at the Gillings School are hopeful that public health leaders can put these learnings into practice to positively impact public health.

“With research linking structural and institutional racism to health inequities, it’s now important to identify effective policies and multilevel interventions to reduce and, ultimately, eliminate health inequities,” said Martin.

O.J. McGhee, MA, is an associate director for the School’s Instructional Media Services and End-User Support teams. Since his arrival at Gillings, he has been the mastermind behind the production of the School’s annual Minority Health Conference keynote broadcast and the National Health Equity Research Webcast. McGhee’s also been heavily involved in efforts to promote a culture of inclusiveness throughout campus.

“O.J. is genuine — genuinely dedicated to doing good,” says Vic Schoenbach, PhD, epidemiology professor emeritus who helped initiate the Minority Health Conference Keynote broadcasts and later worked closely with McGhee on them. “The more I worked with him, the more I realized that his technical knowledge, judgment and people skills were way better than mine. His dedication to the conference broadcasts’ success led him to go many extra miles on our behalf.”

Going the extra mile comes naturally to McGhee, whose first name is Onegaa (mwan-ga), a Swahili pronunciation that means to “shine a light.” He earned a bachelor’s in mass media arts from Clark Atlanta University, where he played football and worked at the school’s TV station. He won a public broadcasting fellowship to Ohio University for a master’s in telecommunications management and is pursuing a doctoral degree in educational leadership from UNC Wilmington. His career has included jobs at Black Entertainment Television, the Black College Satellite Network as well as Florida A&M University, and adjunct professorships at Morgan State and NC State Universities.

After arriving at UNC in 2001, McGhee got involved on campus in various ways, such as coaching club football, PA announcer for the women’s basketball team and joining the Campus Safety Commission. His most visible role has been as a leader of the Carolina Black Caucus, which has promoted, advocated and celebrated UNC Black faculty and staff since 1974.

McGhee was on its executive committee for nearly a decade and served as chair from 2015-2018, a time when conversations about race in America were intensifying. Among his achievements as chair were working with local leaders to install a grave marker in the Old Chapel Hill Cemetery in remembrance of the 361 unmarked African American graves there and petitioning for the removal of the confederate statue “Silent Sam” from McCorkle Place.

“Because of his unwavering and genuine concern for the advancement of his peers and students alike, I could not think of a more fitting individual to carry the banner of leader for the Carolina Black Caucus,” says DeVetta Holman-Copeland, PhD, UNC’s Coordinator of Resiliency and Student Success and a caucus executive committee member. “His determination is relentless, but it is O.J.’s kind spirit that leaves such a lasting impression. He is a full-circle, inclusive, servant leader committed to the growth of people and their communities.”

McGhee’s work in social justice started early. Growing up in southeast Washington, D.C., he accompanied his mother to Union Temple Baptist Church, which was active in the Black liberation movement. He remembers participating in protests against apartheid at the South African Embassy and marches to observe Dr. Martin Luther King Jr.’s birthday as a federal holiday.

“I was involved in those kinds of activities early on in life,” says McGhee, who lives in Raleigh with his wife, Kimberly. Their daughter, Kyla, is a freshman journalism student at Carolina. “At first I was a foot soldier and then began taking on more leadership roles.”

His leadership has led to multiple awards recognizing his excellence in technology and in working toward a more inclusive campus, including the University’s 2019 Staff Diversity Award, the Black Alumni Reunion’s Hortense McClinton Staff Award and the UNC IT Team Award. But one of the biggest rewards for McGhee is to work at a School that aims to promote equity and humanity.

“Being in this environment — in terms of what public health is and stands for — is one of the reasons I really enjoy working at Gillings,” McGhee says. “The faculty, staff and students all exemplify what I think we as a society should be working toward.”

“Ensuring that people have access to the water they need, where they need it, when they need it is amazingly complicated — there is no silver bullet,” says Salzberg, who is the Don and Jennifer Holzworth Distinguished Professor in the Gillings School’s Department of Environmental Sciences and Engineering (ESE) and has led the Institute for the past four years. “Even something you would think is simple, like putting a tap in someone’s house or building a well in a community, happens within a broader hydrological, social, technical, financial, and political context that can make things complicated fast. There are all sorts of factors that go into providing water services that are affordable, sustainable and equitable.”

As members of The Water Institute, several ESE faculty members — Professor Howard Weinberg, PhD; Assistant Professor Michael Fisher, PhD; Assistant Professor Musa Manga, PhD; and Associate Professor Joe Brown, PhD, PE — investigate the public health aspects of this complicated problem, such as chemical and fecal contaminants, water sanitation and treatment, and environmental health microbiology.
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"It’s a step toward helping build global awareness and capacity to address some of these challenges around lead and drinking water. It’s also a perfect example of using science and evidence to drive policy."

— Aaron Salzberg, PhD
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The complexity of water is also why global solutions are important. Salzberg — who, in his prior role at the United States Department of State, worked with the United Nations (UN), the G7 and other international partners to establish global practices promoting sustainable and integrated management of water resources on a global scale — has put his extensive global leadership experience to work at the Institute, which in the past few years has:

• Led the development of the first hydrological research strategy for the World Meteorological Organization, the only intergovernmental body that deals with water, weather and climate. The idea behind the strategy is to prioritize research on hydrological services and provide a platform to discuss how countries need to manage issues at the nexus of water, climate and weather.
• Worked closely with the Biden Administration to develop the White House Action Plan on Global Water Security, elevating water security as a priority issue of the U.S. government.
• Collaborated with international partners to catalyze action around lead and drinking water, which has produced a global pledge that commits governments to take the necessary steps to eradicate lead in drinking water by 2040. The Global Lead Pledge was launched in March at the UN 2023 Water Conference — the largest UN hosted meeting on water in nearly 50 years.

“These are some really exciting things that we’ve been able to do that are transformational on a global scale,” Salzberg says. “The UN proposal is supported by the World Health Organization, UNICEF, several countries including Ghana, Uganda and South Africa, and a host of other partners. It’s a step toward helping build global awareness and capacity to address some of these challenges around lead and drinking water. It’s also a perfect example of using science and evidence to drive policy.”

Closer to home, Salzberg convened a working group of faculty to develop a strategy to help the North Carolina Department of Environmental Quality determine how best to invest federal COVID-19 recovery funds in infrastructure improvements that increase access to safe drinking water and sanitation services in disadvantaged communities across the state. The Institute is also working with a private company to test emerging technologies that make it easier and most cost-effective detect lead in water.

“The Water Institute is a bit of an anathema within academia because we’re really trying to unite science, policy and practice,” Salzberg says. “The practice component is not where many faculty traditionally spend much of their time — but that’s not the case at Gillings. A lot of faculty here focus on implementation science and are engaged in the field because at the end of the day they want to see their science improve public health, so they work really hard to tie their research to practice. That’s why I love the fact that the Water Institute is embedded within Gillings — it’s the right fit.”

Francesca Tripodi, PhD, is an assistant professor at the UNC School of Information and Library Science and media scholar whose research examines the relationship between social media, political partisanship and democratic participation, revealing how Google and Wikipedia are manipulated for political gains. “A lot of my research thinks about the ways in which the way we see the world shapes the kinds of keywords that we put into search bars.”

“For example, in the Google search bar, your inputs are your geographic location or your search history, but your results are primarily driven by the keywords that you put in — what is your query? They then match this query with what information scientists refer to as ‘relevance,’ and this relevance is highly connected to the keywords that you start with.”

The problem, however, is that these keywords can be quite polarized, and even the most enlightened among us might not be aware of our own implicit biases.

A simple but helpful example is what happens when you search “illegal alien” versus “undocumented worker.” You will get dramatically different returns that likely confirm your existing beliefs because they’re driven by relevance. Tripodi explains, “Google is taking those words and attempting to match them with all the information that they have stored in their database. So those keywords are going to largely drive the results that are returned. We tend to think of Google as a giant library, but they’re not really a helpful librarian. They’re a multi-million-dollar industry driven by stakeholder interests.”

Author Kurt Anderson won a Peabody Award for his work as host of public radio’s “Studio 360.” His 2017 book Fantasyland: How America Went Haywire — A 500-Year History explores the theory that America has always been a place where people were attracted to impossible “land of milk and honey” dreams.

“The large problem is when we, as a society, can’t agree on facts,” he said. Clearly, that presents a problem when dealing with public health crises. Opinions can trump facts, sometimes with deadly results.

Cynthia Miller-Idriss, PhD, is a professor at the school of public affairs at American University in Washington, D.C., where she is the director of the Polarization and Extremism Research and Innovation Lab, or PERIL.

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“Conspiracy theories don’t just operate by one person going into YouTube and getting down a rabbit hole of bad information. The notion that communities believed bad information has been around for as long as time.”

— Francesca Tripodi, PhD

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She points to massive disinformation campaigns that are undermining faith in elections and confidence in the electoral system. In terms of public health, the undermining of scientific expertise also contributes to threats against health care workers and county officials who set health mandates.

Of course, one of the biggest accelerants of disinformation and conspiracies is the rise of the internet, specifically Google. As Anderson observes, “Google search came along in September 1998. What else happened in 1998? The false medical study arguing that vaccines cause autism. That was a perfect first case study of how falsehood and panicky viral belief gets out of control thanks to this new mechanism we have, which is to say, the internet. And here we find ourselves 25 years on, and we still don’t know how to drive this car.” Disruptive artificial intelligence chatbots like ChatGPT further blur the lines between fact and fiction in ways that are not yet well-understood but pose potential threats to getting at the truth.

Noel Brewer, PhD, is the Gillings Distinguished Professor in the Department of Health Behavior at the Gillings School. His research focuses on three main areas: ways to increase vaccine uptake, communication about the harms of vaping and smoking and risk perception, and appropriate use of cancer screening tests. While he agrees that the impact of social media and the internet is undeniable, he calls its effects more “lumpy.” Brewer says, “Vaccination rates in the United States are still very high. The CDC has been very effective in that regard. Other countries have not fared so well.”

In terms of social media, however, Brewer takes a nuanced view. The target of social media is not always an individual. It can often times be policy makers and social media can give the impression that there is a lot of support for something, or the decay of support for something else, leading them to vote against public health legislation. “The tempo has definitely increased around bills being introduced to undo vaccination requirements for school children.”

It’s been said that nature abhors a vacuum. The same might be true on the internet, but these vacuums are known as “data voids.” A data void is when little to no good information about a subject exists online. And when there are these kinds of pockets of returns, it allows them to be manipulated very easily. Tripodi explains, “Conspiracy theorists are really good at maximizing and taking advantage of data voids. This relates back to my concept of how you see the world shapes your keywords to begin with. In other words, if you Google, “are vaccines safe?” with a question mark, the CDC has preemptively filled that void with a lot of good information that tells you they’re pretty safe. But what if I belong to a mom group on Facebook like Parents Against Vaccination? I’m not going to Google “are vaccines safe?” because I’m part of a community that says they’re not.”

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“Vaccination rates in the US are still very high. The CDC has been very effective in that regard. Other countries have not fared so well.”

— Noel Brewer, PhD

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“The way Google orders information and its desire to help drive search and best match your query is not an environment that’s going to expose you to good information if your starting point is a place where good information doesn’t exist. That’s the fundamental relationship to public health crises.”

Having a more nuanced understanding of how search works is important because all of us are so reliant on it. We have the ability to change how we search, not just what we search. But we also have the ability to approach these difficult conversations with greater kindness, empathy and understanding. The foundation for belief in any conspiracy theory or misinformation campaign springs from a desire for agency, community and to make sense of a confusing world.

Anderson is optimistic. “I am somewhat hopeful that the younger people, digital natives, are less easily hoodwinked. As opposed to us older folks who may think, ‘It’s on my computer along with ABC News, so it must be true.’ That’s part of the problem and that’s where we are right now.”  

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The Pivot Podcast: Confronting Misinformation in Public Health

To learn more about the impact of conspiracy theories on public health, check out our Pivot episode “How Are Conspiracy Theories Public Health Crises?” Host Matthew Chamberlin speaks with experts in the study of the effects of disinformation. Just search “Pivot Gillings” on your favorite podcast app.

In many growing cities in Africa, housing has not kept pace with rapid city expansion. This has left many families to live in informal communities — low-income areas where homes are not durable and lack protection from flooding or high temperatures. The strain of climate change makes it difficult for utilities to provide adequate sanitation and ventilation to these areas, putting residents at risk of flood damage, water-borne diseases and overheating.

Sarah Lebu, a doctoral student in environmental sciences and engineering, focuses her research at the intersection of climate change and city planning to understand how these affect sanitation. Born in Kenya, her work is centralized in Eastern Africa, including Nairobi, where approximately 60–70% of people live in informal communities with few toilets and minimal infrastructure for drainage or clean water.

“Many of these services are sold,” Lebu said. “Imagine having to buy every ounce of water you drink or pay to use the toilet each time you go. It’s very expensive.”

Plans for city development don’t always take residents into consideration: whether homes are susceptible to flooding, whether toilets are available, or whether unique health needs of women, children, people with disabilities and other groups are met. In many ways, her work is one of environmental justice, collaborating with communities to map structural inequities and alert city leaders.

“When governments operate like a community doesn’t exist, we need to get them to understand the conditions there,” she explained. “The best people to articulate that are the residents themselves.”

As an undergraduate, Lebu studied wildlife health in Uganda during the 2010 anthrax outbreak. It led her to study public health and city planning in Berkley, California, before coming to UNC-Chapel Hill. She believes her public health training helped her synthesize the technical and people skills needed to understand resident needs, identify trusted community leaders and support them with data to make a compelling case to policymakers.

“In this work, cultural humility is critical. I am just a facilitator — contributing and learning from the community. I’m not the expert there.”

Lebu explored this approach during a project in Mathare, an informal settlement in Nairobi, where only one in seven households had a toilet. After going door to door, she found that most people acknowledged the need for better sanitation, but they couldn’t make decisions about their homes because they were tenants of landowners who lived miles away.

“We learned to build a chain of communication, where we talked to women who were home while their husbands were at work. And then we would meet husbands who would help us meet the landowners.”

This approach has driven policy breakthroughs, as she saw in her work to help the informal community of Mukuru in Nairobi attain a Special Planning Area designation that would halt potentially harmful development activities. Lebu’s team worked with non-governmental representatives to identify natural leaders in Mukuru, collaborate on a map of community health risks and bring that information to city hall.

“That was a powerful blueprint to guide other informal settlements in the area. And after that, we started creating a master plan where we consider not just health but how we can prevent health impacts to communities affected by industry or pollution.”

She currently works with the UNC Water Institute, alongside Jennifer and Don Holzworth Distinguished Professor Aaron Salzberg, PhD, Associate Professor Joe Brown, PhD, PE, and Assistant Professor Musa Manga, PhD. Her work models how extreme rainfall and flooding will affect sanitation and uses participatory methods to understand what that impact will look like in communities. She stresses the need for decolonization in global health through research practices that reflect cultural humility and explore issues often overlooked.

“People talk about diarrhea or cholera,” she explained, “but women also report high rates of sexual violence, because they encounter predators while walking long distances to toilets on unlit streets. Women and children also adjust their diets because they can’t go to the bathroom at night, which results in urinary tract infections. I want to ensure that these are not forgotten in the sanitation sector.”

For Lebu — who grew up in a rural town near Lake Victoria and experienced sanitation challenges in the water there — it has been powerful to see the circle of inclusion broadening. Being able to attend professional conferences and co-author studies alongside local community members brings her optimism for the future.

“Getting people to speak up and be part of the solution is important. I think public health is moving more in that direction, and I really appreciate that.”