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Aman Chopra: Folks, welcome back to another episode of the "I AM GPH" podcast. Today we're back with another double interview. We have Sarah Taylor and Ben Spoer. Sarah actually just graduated in 2024, which is when we are filming this video. Sarah made it and Sarah's back right after graduation for another episode, for an episode for Sarah. Ben Spoer was in the first PhD program here at NYU, back in 2019 is when he graduated. I don't wanna introduce them anymore, but all I'll say is that they've been exploring the vital role of local health and shaping community interventions, and there's something called the City Health Dashboard that we're gonna learn about today and the difference in insights that make a real difference in our neighborhoods and how data can influence that. Most of you are encouraged to think global when it's global public health, but what's interesting about today's podcast is we can start thinking local in order to impact the global. And what is it like to think locally in order to target globally is what we're very excited about. Ben Spoer, Sarah Taylor, welcome to the "IAM GPH" podcast. We're glad to have you here.
Sarah Taylor: Yes, thanks for having me.
Ben Spoer: Yeah, thanks for the invite.
Aman Chopra: So I expected both of, you're working on a similar project or both of you're collaborating with each other, both of you're GPH grads in different ways, and you have connected, but you have never met each other. The first time your meeting is on this podcast.
Sarah Taylor: Yes.
Aman Chopra: Which is very fascinating. So for the audiences and for yourselves, we'll start with Sarah, introduce yourself. What do you do? Try to simplify it for a 4-year-old if you can.
Sarah Taylor: Yes, absolutely. So my name is Sarah Taylor. I graduated with my Master in Public Health from NYU in May of 2024. My group was the Community Health Science and Practice, and I currently work as a local health outreach coordinator for the township of Maplewood and South Orange Village, which are fairly small towns within Essex County, New Jersey. So fairly close, big commuter town. And I work to help plan health events, go through data to get community-based interventions off the ground and really just work with the communities to see what they need and do our best to cater to those needs.
Aman Chopra: What is it you do on a day, on a day-to-day basis? Like, what is a day in the life for you? What did you graduate in that got you over there?
Sarah Taylor: I found this through my applied practice experience that I had to have for my masters.
Aman Chopra: Oh, cool.
Sarah Taylor: So yeah, I was actually sitting in biostatistics one day. I was struggling. I hadn't found one yet. And there's that big group panic of everyone all at once from all the different schools here are trying to find that internship. And I thought, you know, so much of public health is local. It's not just always the big organizations. And I decided to reach out to my local health department and they took me under their wing as an intern for the summer. I worked on a project examining our community refrigerator that had just launched the year before. So I was looking at how viable it was, sustainable, and what changes could be made to improve it. So that was my big project that summer. And the person who had been the local health outreach coordinator prior to me had left in the spring. So it thankfully very quickly turned into a full-time job for me.
Aman Chopra: Wow.
Sarah Taylor: So my day-to-day, local public health is a lot of big projects. So working with data sets that, you know, NYU puts out, City Health Dashboard, but the day-to-day of a local health department also involves calls about animal control.
Aman Chopra: Yeah.
Sarah Taylor: Chronic diseases that come up, community needs. So so much of local health is responsive. So that's really my day to day. I love it. Every day is different. You never know what you're gonna walk into. You're gonna get some crazy emails about these are people's lives.
Aman Chopra: Yeah.
Sarah Taylor: So I am always responding to that, going out into the community. I work with our nurses, our social workers, just to cater to the needs.
Aman Chopra: Did this applied practice that you got into for, from the internship and everything, influence you specializing in community health? Or that's always what you wanted to do?
Sarah Taylor: Yeah, I loved community health before that. So I'm originally from Alabama. And so much public health is obviously not as always welcomed there completely. You know, it can be a bit stigmatized, to say the least. So I even found out about public health through an actual community intervention that a doctor, Dr. Edward Partridge in Birmingham, Alabama had done to get women breast cancer screening in the Black Belt region. And that's how I first fell in love with community health interventions. I worked in a hospital during the pandemic and we saw the same people coming in and out every week. And that's really what inspired me to wanna be on the community level.
Aman Chopra: Wow.
Sarah Taylor: There needed to be those changes in the people that cared about each individual face in the crowd. And that's the part of public health that I fell in love with. And so it was definitely worked out. I've loved getting to be a part of my community now that I'm here and just getting to give back and learn people's stories and figure out exactly how they can be heard and responded to. I think that's a big part about public health. You know, there's a big need for the giants in public health and there's also a big need for the people on the ground too.
Aman Chopra: I love this. It was very specific early on and you kind of developed it from that experience back home for yourself.
Sarah Taylor: Yes, for sure.
Aman Chopra: Love to hear that. Man. Ben, what about you? So what was your PhD in? When did you start? What made you even do that PhD and how are you where you are right now? How did that journey take place?
Ben Spoer: Yes, good question. I just did the breath thing. I'm an elder millennial I guess, so I'm totally susceptible to the big deep breath.
Aman Chopra: I didn't mean to make you notice it.
Ben Spoer: I was, as you said, amongst the first doctoral cohort that matriculated from GPH. I finished my PhD in spring 2019. I initially entered the program interested in doing community-based participatory research, which is closer to the sort of work that you're describing. I had done some of that work in my master's at Columbia and midway through, pivoted almost 90 degrees to geospatial epidemiology or spatial epi. And spatial epi is primarily concerned with how do the built environments or environments that we move through every day, at the very local level, affect our health outcomes. So the examples that most people are probably most familiar with are walkability and food deserts or food swamps. If you don't have a grocery store or a place to get fresh foods nearby, then you probably don't have access to those fresh foods in the way that you would if there was a grocery store nearby. And when we exit the realm of popular understanding is when we start thinking about what does it mean to be nearby in a city like New York City versus a township like Maplewood where people might drive more. The thing that I noticed about this research is that there was a strong belief that local context matters deeply, which I think all of us have this instinctual agreement with. And the research itself produced these sort of mixed and sometimes contradictory findings. And there was not consensus on what is the right way to measure people's neighborhoods. We couldn't get a real solid handle on how do we understand the parts of the world people interact with. So I did a bunch of, I did a PhD on that topic and towards the end of my PhD, I became aware of a project called the City Health Dashboard. The City Health Dashboard is a freely available, public-facing public health data website that currently provides data for over 1100 US cities. And we have neighborhood-level data proxied by census tracts, which are a statistical geographic unit used by the census. Could do a whole podcast on the madness of administrative geographies. But we want people to listen to this. So we won't go there. And yeah, enroll in the course, we'll do a course about it. So the City Health Dashboard provides, depending on the month and the year, around 40 metrics of health and health-related drivers, right? And some of those health-related drivers are things that we would commonly understand contribute to health, like poverty. If you are living under the poverty line, it's hard to get to the doctor, nonetheless afford the doctor fees. Or if, you know, fresh fruit and vegetables are more expensive than Twinkies and easily reheatable food. And also if you're working two minimum wage jobs, you probably don't have time to cook a big, fresh meal every day. And so those are sort of the social determinants of health stuff that we think about. Then we have very classic public health surveillance like mortality, natality health behaviors. So when I started, we had 500 cities and the project had just launched. And you know, here we are five years later, we've more than doubled the number of cities. We've added a bunch of metrics. We've added a whole other website for congressional districts. And through that congressional district's website, we have every census tract in the country. So we have national coverage. My role there, I recently became a program director. And it's sort of twofold. It's making sure that the numbers we put onto the website are as valid and reliable as we can possibly make them, acknowledging that most of them come from data sources that are collected and analyzed by, you know, big governmental agencies. It's very expensive and complicated to get data for the whole country. So one of our big data sources is the US Census, and then also how do we get the website into the hands of the people who need it. And that's where the link between Sarah and I arises is that in addition to our continuing campaign to add new geographies to the website, we also work closely with smaller cities who can apply to be included on the website through what we call our Put Us on the Map Challenge. And these cities, we look for buy-in from these cities for a couple reasons. One, it's always wonderful to know who will be using our data and how they propose to use it. Also, these cities often lack the resources to put someone on the payroll that can just do data, nonetheless, just do data from these large, national data sources. And so frequently, it's the case that these cities will have done some data collection at some point. They did a survey or they participated in a state program that let them ask a few, like, really key questions of their residents. And they're able to translate that into information. And we also live in a moment in which you wake up and your watch tells you how well you slept last night. And so, you know, a community health needs assessment from 2003 starts to feel stale. And in my experience, these smaller cities are confronted with a sort of triangulated problem that they know they need up-to-date data, they don't have the resources they need to get that data. And there's a bunch of other stuff that is a higher priority, like you were saying, animal control. Are people getting enough food? And so our role, as I understand it, is to increase data accessibility. And if we're lucky also data literacy through our technical document educational materials. By taking these large, sometimes difficult to access national data sets and translating them into an easy-to-use website where folks like Sarah can go on and say, you know, here's where the most impoverished neighborhoods in my city are. That's where I should put a community fridge. One of the other things we're conscious of is that we are, like, in Midtown Manhattan creating a tool for the whole country. And so places like Alabama, Birmingham, Maplewood, many other cities, what our data reveal is already known to these places. We are often giving folks the numbers they need to back up the things they've already learned from interacting with city residents or having lived there for a while. It is also the case that we sometimes reveal something to these folks through our data or I should say the data reveal something to these folks. But in general, we are trying to empower folks who already know what's going on. And sometimes I think it does help reveal new information, but we're not experts in anyone's local context. So it's really an empowerment and translational tool.
Aman Chopra: How do you collect this data?
Ben Spoer: We don't do any primary data collection. We don't go out and we are not calling anybody, right? Our three major data sources are the US Census, which anyone can download if they've got a computer. Understanding it is a different project. Then a project called CDC PLACES, which is run by the CDC. And what they do is they take one of their large national surveys, the BRFSS, Behavioral Risk Factor Surveillance System, and they take the county-level estimates that they get from BRFSS and downscale them to neighborhoods using some regression techniques that function more like imputmentation. Impute, imputmentation. Well, you know?
Aman Chopra: Yeah, I've never heard that word either.
Ben Spoer: Subtitle it.
Aman Chopra: Yeah.
Sarah Taylor: Yeah.
Ben Spoer: Imputed, they impute the data. Okay, I'm gonna start that one over. They take their county-level estimates and use some downscaling techniques to generate neighborhood or census tract level estimates. And then we also go to the Restricted Data Center at Baruch College on 23rd. And after getting some security clearances, analyze the country's birth and death records to produce mortality and natality data. And then we have a couple of smaller data sets that, some of which we pay for, some of which are freely available as well. So our major role is taking these data that are tough to access unless you've got a public health degree or a data science degree and making them more accessible to people who need them.
Aman Chopra: Wow. I have a question for both of you, and it's a very vague question. Answer it as you choose to. How do you view data?
Sarah Taylor: Okay. Wow.
Aman Chopra: Perhaps what's your relationship with data when I say that word in public health?
Sarah Taylor: Yeah, for me, you touched on this a little bit, we know the stories we hear, we know as public health professionals what is going on and the linkages. But for me at least, data is a way to add a caption to a picture.
Aman Chopra: Nice.
Sarah Taylor: To add a story to a still image that we know what we see and now here's the exact numbers. We know that there's a massive gap. Here's how we can show it to you. And this is, in my opinion though, some may disagree, it's like, you know, indisputable, it is what it is. Data is data. It's always changing, but it's just a nice, invaluable thing to have on the local level, on the national level. There's never enough. Absolutely never enough. And for me, I'm sure you may be able to give more of, like, this expanded.
Ben Spoer: Well, I like the caption of still image. You know, I think for a lot of folks, it provides needed context through which they can better understand the world. My team always makes fun of me for totally weird analogies, and I'm gonna do one here. So I hope that at least one of them listens to this and gets it. For me, I think data is like a fancy new medical procedure or device or a new drug. There's this excitement or charge around it and this feeling that if we just had the data, we could answer all the problems, fix all the issues, and then you get your hands on it and then it's like the data are in your hand. You've got the new medical device and it's like, "Well, we've put a lot of work into this thing though we're not quite sure what the efficacy is." That's why we do real world trials for new drugs. Because as much as we can explore thoughtfully in a phase three trial, your understanding changes a little bit once you put it out into the world. And it never quite seems to be the panacea that it was sold to be, right? Because data are a tool to improve a specific issue, but they're not a skeleton key. Right? Like, when penicillin showed up, it was the first antibiotic. It revolutionized everything. It's hard to discover penicillin again. It's hard to find the piece of data that is, like, the key to the kingdom, is the wonder drug. And also we have to be really responsible with it because if you put into the world a medical device or a drug or whatever that doesn't quite work or works differently than you say it does, there is the potential to cause harm. And we have to be conscious of that. So, you know, I think used correctly, it functions the way you describe, it adds needed context to things we already understand, and used incorrectly, it can be dangerous as well.
Aman Chopra: I like that answer a lot from both of you. A lot of students, I would assume come into GPH now, you know, they have this dream that's more of a serving role in their mindset, but then they have to take all these data classes over here and what is the point of all of this? Why so much math? Why so much when my heart is in something else? And I'm realizing as I interview a lot of people, is that data, data, data, data, data keeps coming up again and again, you all are doing more math in the math department at some point. It's really fascinating to see how much work that goes into it to understand these complex issues, to simplify them. I'd love to hear a story. I know you mentioned something before the interview about voter turnout. Can you tell us more about that?
Ben Spoer: Yeah, I do wanna address the frisson you described between what from our hearts draw us into public health versus what is required of our minds when we get here. And then I'll talk about voter turnout.
Aman Chopra: Of course.
Ben Spoer: I'm teaching intro to epi starting in September. This is 2024, so September, 2024. This is next month. And I think that I want to prepare my students for the dissonance you've just described. And I spoke at my graduation and the thing I said is public health work is social justice work, right? It's equity of whatever stripe is most important to you. You can work on that type of equity. And it's explicitly trying to lift up folks who are otherwise pushed down by society. And then you have to calculate an odds ratio. And you might develop some resentment about that because boy, did I not come here to figure out a two by two table. And so I think that public health exists at this interesting intersection between statistics, specifically biostats, and that's where the math comes from. And increasingly that's where the data comes from. Then surveillance, right, where surveillance is tough 'cause it feels more and more ominous the more that we collect data about people without asking them.
Sarah Taylor: Big Brother.
Ben Spoer: Big Brother, right? We being society, not we being public health.
Sarah Taylor: Yeah.
Aman Chopra: Wait, can you explain that more? This Big Brother thing? It seems like a term that everyone at GPH knows.
Sarah Taylor: No, it references "1984".
Ben Spoer: George Orwell's "1984".
Ben Spoer: Oh, okay. Yeah, Big Brother is the surveillance state, right?
Aman Chopra: Okay, I got it.
Ben Spoer: And so, you know, it's like you can't download a game to play during your commute on the subway without signing away every piece of information you generate via your phone.
Aman Chopra: Agreed. Agreed, okay, got you.
Ben Spoer: I think where the Big Brother thing breaks down is that it's less and less the government and more private industry that is surveilling us in unethical ways.
Aman Chopra: Ah.
Ben Spoer: But public health I think exists, like, we've got this stats, the biostats where we calculate these odds ratios and do the numbers. We've got public health monitoring where we try to keep an eye on disease outbreaks and incidents of disease and differences in disease across population groups. And then we've got sociology or medical anthropology where we generate theories as to why it is that there are differences across socioeconomic, racial/ethnic, biological sex groups in these different types of disease. And I think a lot of times, it's these sociological feelings that pull people into public health. Why is it that things are different? That's what pulled me into neighborhood health because for me, it was pretty clear why someone who has less money than someone else might not be able to access health resources. But the walkability and food access and all that was a little bit more mind blowing. And then I had to learn math, which I still resent, and now I'm gonna be teaching more and more of the surveillance techniques, which I think are fascinating. And also one of those things that if you get 'em wrong, you can't do anything else. So it's like foundational. So in terms of voter turnout, if we're gonna position voter turnout in terms of this, here's voter turnout, we're gonna position in terms of this why intersection I've described, it's sort of a surveillance issue in that we need to have reliable systems that'll tell us who voted and where they lived when they voted, right, so we can generate a place-based estimate of voter turnout. Then there's the stats issue. And the issue with this metric was not so much do we use this type of regression model or that type of regression model. It was the spatial methods, and I didn't work on this directly. It was one of my brilliant team members, Yuruo Li. Yuruo set up a system that geocoded voter information to their administrative geography, their census tract and geocoding, if you ever tried it, it's really complicated because though it seems simple to use a database to translate an address into a latlong, it's like if someone spelled their name, their address street name...
Aman Chopra: Latlong, latitude, longitude.
Ben Spoer: Latitude, longitude, we use XY.
Aman Chopra: XY, okay.
Ben Spoer: Yeah. Like, oh, if someone spelled their street name a little wrong or it was hard to read their handwriting. One of my favorites is that in New York City, in most of the boroughs, you write the address by the borough, Brooklyn, Manhattan. In Queens, you write it by the town name, you write Astoria.
Aman Chopra: Oh, interesting.
Ben Spoer: And if you don't get that right, then it's gonna be hard for the software to decode your address, even though it's a totally normal way to write one's address. And then we have the sociological angle, which is we have voter turnout as a proxy of social participation, as a secondary proxy of social cohesion. The Surgeon General recently released a report about social cohesion and the epidemic of loneliness. And there are not great social cohesion data available, but we believe that if people are participating in society more, there's likely more social cohesion. And there's some research out there on this. And voting is a indicator of social participation. So we also happen to release it in an election year. I'll let the pundit, I'll let the pundits make up minds, but you know, this metric is from the 2020 election and the campaigns have more updated information. So really do think about it as a social cohesion-related metric.
Aman Chopra: That's awesome. I mean, so much goes into it, right? And you're describing it and simplifying it in less than two, three minutes. But in reality, this is months and years worth of work that's going into one small project. I'm curious to hear from a local side, Sarah, I'd love to hear a story perhaps when you got interesting data that came your way or you got an email, you know, like you said, crazy stuff keeps coming your way. How did you react to something that surprised you? Like, you got this piece of information, what did you do about it at your job?
Sarah Taylor: Yeah, so I think that's the beautiful thing. I'm on the receiving end of these amazing and mind-boggling data projects. I think public health requires all of the fields to work together. So it does take epidemiologists, it takes people that are excellent at the coding and decoding of data to then give it to people who also work specifically, like, with populations. And so for me, when we first received our City Health Dashboard access through the Put Us on the Map Challenge, it was amazing. You know, we know what neighborhoods we have more social service calls in. We have that personal, like, data. We know where there's income disparities and we have a pretty high level of income disparity 'cause we have commuters who work in the city who come out there as the suburbs. And we also have people who, you know, they're just doing their best to support their children there. You know, they don't know where they're getting their next meal. And I think that's the beauty of having City Health Dashboard is we're finally able to connect the health indicators with actual health outcomes. So for me, what was so surprising for us is we actually have a 10-year life expectancy disparity across census tracts, which is not a small number by my personal, like, understanding of it. And the same thing with we found out, you know, what neighborhoods and census tracts have higher levels of diabetes or, you know, poor heart health. And for us, we've been able to take that and change our long standing practices. So I found that our previous, we do a health fair every year. A big part of local public health is getting your community out, having health screenings, having local organizations all there for people to see. And in the previous years, I noticed where we had it, we weren't really getting our priority populations. You know, we weren't getting our families that had immigrated here. We weren't getting families with, you know, children. It was a very different thing. And so once we got the City Health Dashboard data, we were actually able to move the location of our health fair just by one census tract. And we doubled our participation. We got our priority populations out there. You know, we have a decent number of Haitian immigrants that had come into our community and we actually had people there that represented the whole Maplewood that we as public health professionals know exists. And that's been big for us. We're finally able to change where we offer our monthly health screenings. We're working on getting into these populations. And that's the big part. So much of public health does have to be centralized. So, you know, we have to have national support, we have to have national buy-in, but there also has to be this localization aspect of it. And we touched on it, the funding is brutal. There is no funding in local departments for someone to really gather data or be dedicated to it. My department, at least, is completely pretty much funded by a grant introduced during the pandemic. So it grew from a environmental health officer and nurse to now we're able to have social workers, health outreach coordinators, and work on these bigger projects. So we are at the mercy of funding on the local level. But that's what's beautiful about these accessible platforms. There's also that community buy-in, for the first time, our older adult population was excited about health data in our town, which was so cool for them. I gave them an overview of how to use it, but there was finally an accessible platform where they could click through and see what was going on in their neighborhoods. And to get older adults involved in that level of technological change has been amazing for me. Like, I just think that's so special and such a telling thing. So I think a lot of it is reactionary, but it's been really big to be able to make these changes to reach our people that we need to.
Ben Spoer: Well, and, you know, you said in your intro, students here are encouraged to think globally and we're thinking locally. When you say you moved the health fair by one census tract, I promised I wouldn't do a lecture on statistical geographies.
Aman Chopra: Can't hold yourself back.
Ben Spoer: But...
Sarah Taylor: I set you up.
Ben Spoer: That's probably like a half mile.
Sarah Taylor: It is. It's opposite sides of a pretty large avenue. It's literally one park over.
Aman Chopra: One census tract is half a mile and...
Ben Spoer: You're gonna fall through the trap door...
Aman Chopra: Okay.
Sarah Taylor: Yeah.
Ben Spoer: Over here. Yeah, I'll give you the headline, but go ahead.
Sarah Taylor: Yeah, it's not far, you know, 15 minute difference of a walk, five minute drive.
Aman Chopra: Wow.
Sarah Taylor: Through a neighborhood with stop signs.
Aman Chopra: Wow.
Sarah Taylor: So that's what's so big about this is, you know, we can see that. I can create a visualization of where we need to add a new kiosk for flyers of what neighborhoods we need to make sure to send mailers out to.
Aman Chopra: Yeah.
Sarah Taylor: It's been big, but...
Ben Spoer: It's been big because it's small.
Sarah Taylor: Yes, it is. It's big because it's small. Absolutely.
Ben Spoer: Yeah. A census tract, because I've been baited thoroughly by both of you, it's one of the smaller statistical geographies that the census maintains for comparisons across years, right? So it's made for its mathematical properties. The boundaries are drawn to include around 4,000 people, but it can range from 1500 to 6,000. They also consider natural geographic boundaries like rivers and cliff faces, if you're in the Palisades, or sometimes built environment boundaries like train tracks. They also consider what they believe to be neighborhoods. Right? And so in a lot of this research and the work we do, we say that they proxy neighborhoods because they're in some ways meant to and because they're about the right size for most places, geographic size for most places. But in a city with high population density like New York City, you're gonna get 4,000 people in a very small geographic area and in a place that's more spread out, even a large city that's more spread out like Los Angeles or a city with small population density, I'm guessing like Maplewood township, the geographic boundaries for a census tract will be bigger. But we never expect them to get to the point that they'll be even close to half a county of equivalent. You know, they're meant to be pretty contained.
Aman Chopra: I'd like to ask both of you one question. This is the first podcast that I've done where we're encouraged to think locally, and I'd love for both of you to give a small message to those students out there, those listeners that might be in that camp where I'm encouraged to think global, but what does local mean? Like, what is the value of local public health, if you will, in this situation?
Ben Spoer: And the audience are students at GPH?
Aman Chopra: It could be anyone, but most likely our viewers are students at GPH, incoming, graduated, current.
Ben Spoer: Great. Do you wanna go first or should I?
Sarah Taylor: Yeah.
Aman Chopra: Just FYI, I've been hearing that professors have been sharing clips of this podcast in their classes. So you all might be a clip with this answer.
Sarah Taylor: Oh, nice. Hello.
Ben Spoer: Hello.
Sarah Taylor: Yeah. So for me, local, it's a beautiful thing. So is global, but I think it, like I said, public health requires all aspects, but to me, on a local level, it's the building blocks. You know, we need a global and national direction, but policy change, attitude change, behavior change, and just growth happens in neighborhoods, it happens on the local level. And I think even from talking with some of your team who writes up the impact stories, it's always nice to hear you're working on these large projects, but like, this is getting to the local level. You know, some people give you county-level data and they say, "Here you go, this is our gift." And you can't always do much with that. You know, you can't move your health fair a census tract over from that. And that's the beauty is that I can look at this family that calls in and I can say, you know, this is public health helping you. There's a video. It's, like, one starfish on the beach that you're, like, getting back into the water. But that's what matters is these people's everyday lives, you're actually getting to address these social determinants of health. And I think sometimes on the larger scale, it can be hard to see the differences made. But that's something that's been so rewarding for me on the local level, is to be able to coordinate with these families and know that they now have the resources that, you know, we worked with them that now they don't, their living conditions are better. They have access to food, their children have a way to get to school. That is all also public health. And the beauty of community health for me on the local level.
Ben Spoer: Yeah, I'm gonna give a much more long-winded answer that is better captured probably by what you said. But one of the things we study at GPH that I studied when I was here are public health theory models, right? And one popular one is the social ecological model, which is always sort of drawn like an amphitheater, right? Where at the nucleus, you know, on the stage of the amphitheater, you have the individual and then you have their immediate context like their family and friends. Then you have their local social context like neighborhoods and cities. Then you have the nation. Then you have the whole world, right? And what you're describing is that students are encouraged to think at this very outer rung round of the socioecological model. There's another popular model called the Theory of Healthful Behavior Change, which I think is the Erickson one, where it's sort of, you sort of don't know you're thinking about it, you're in this pre-contemplation phase, and then you're thinking about making a health change and then you're making the change and then you're maintaining the change. And it's much more textured than that. But you know, it's sort of this linear process through which you change how you act so you can be more healthful. I think it came out around smoking cessation. This field encompasses both things where you think about the whole world and then we're like, "How do we convince this person to put down the cigarettes or the vape?" And all of these health outcomes are rolled up from questions we ask individuals, right? The individuals are always affected by these other contexts. And so the context of someone getting river blindness in Africa is a lot different than the context of someone dying of a heart attack in Washington DC, right? But that all starts with local occurrences. And when you talk to some, when you talk to somebody about getting their next meal, you're operating at a local level, right? And so I think that there's an extent to which it's a perfect dichotomy because it's difficult to think globally and locally simultaneously. You have to use different tools. And in another sense, the other side of that coin is that it's a false dichotomy, right? These are two-way dags, right? If you're gonna draw how they influence other, they're an arrow going both ways. And these global policies are meant to improve things at the individual level. And so it's kind of like, how do you slice it? I think it's a rare privilege, for me personally, to work on a project that translates the national into the local, right? That empowers places to take local action based on these large national data sets. So really I've reached the point that academics inevitably reach whenever they open their mouths, which is it all depends. It's all relative. Whatever you think is best. And there's a little truth to that.
Sarah Taylor: I would love to just add to that. Like, it's empower any student thinking about it. For me it was a decision to email, you know, it was a passion I'd had, but it was a decision to reach out to my local health department. I would love to empower any student thinking about it to entertain the idea of working locally. It doesn't have to be a big name. I'm a big advocate, everything is public health. You name it, we'll take it on and, you know, think outside the box, work with your communities and you can really tailor a message and just get out there. And then you end up getting to work on awesome ends of projects with great organizations and great resources.
Ben Spoer: Also, you know, this idea of operating locally is not unusual in the public health field. Like, our funder, Robert Wood Johnson Foundation, they fund big national data projects like us. And they also fund a lot of, like, we want to improve this specific thing in our community, right? We need to work on this problem. And because our funder facilitates it, we are able to work closely with some places like Maplewood and see the on the ground impact, which is a huge relief because it's easy to get lost in the spreadsheets and data bytes and all that. So I would like to second what you said is the further removed you get from the local context, the more abstract your input feels. And that can be a struggle sometimes.
Aman Chopra: While I have 5,000 questions that have come up right now, I feel this is a great place to end for people to think about what it means to be local and in public health. And even though this is the "IAM Global Public Health" podcast, I appreciate both of you for sharing, number one, what census is all about.
Ben Spoer: That was only a micron.
Aman Chopra: A micron.
Sarah Taylor: Your epidemiology class. There's so much to look forward to expanding.
Ben Spoer: Yeah, or just drop it if you didn't like that.
Aman Chopra: And definitely what local is all about. I'm sure a lot of people are gonna be Googling. You sparked some interest and inspiration in a lot of incoming students, current students, students that have passed, what it means, what public health means to each of them. You both have definitely expanded their mind. Sarah and Ben, thanks for being on the podcast. It's really, really awesome or interesting to see how you two have met for the first time, but it feels like you've been collaborating for a long time. And that's what public health minds are all about when I see something like this happen.
Sarah Taylor: Absolutely, yeah, thanks for having us.
Ben Spoer: Yeah, thanks.
Aman Chopra: Folks, that's Ben Spoer and Sarah Taylor. Put some comments down below what you got out of this episode and we'll have all this stuff in the description. We'll see you in the next one. Take care.