SCOTUS Decision to Overturn Roe v. Wade

Co-authored by Dr. Jodie Guest, Vice Chair of the Department of Epidemiology, Dr. Michael Kramer, Director of Emory’s Maternal and Child Health Center of Excellence, and Dr. Tim Lash, Chair of the Department of Epidemiology. 

Bodily autonomy, including reproductive choices, is a fundamental human right. Abortion is an essential type of healthcare that has been constitutionally protected as a privacy right in the United States for fifty years. These same constitutional privacy protections underlie many important freedoms that had previously been denied equal protections under the law. The recent decision to overturn Roe v. Wade reverses an important federal right protecting all US people who can become pregnant, upwards of 70 million people, and will trigger an extensive public health crisis. This crisis will disproportionately adversely affect those who have been historically marginalized, such as people of color, adolescents, and the socioeconomically disadvantaged.

The US already has the highest pregnancy-related mortality risk of all high-income countries, a risk that has been increasing for two decades while decreasing globally. There are stark differences in pregnancy-related mortality risk in the US, as risks are highest among Black people who are pregnant, rural communities, and in the southeast. States that had restricted abortion access prior to the reversal have experienced a 38% increase in pregnancy-related mortality from 2007-2015, reaching a risk twice that of the already elevated risks suffered overall in the US.¹ Denying access to abortion also creates economic hardships, such as food insecurity and unstable housing,^2,3 that lasts for years, further stressing health and wellbeing. Children born as a result of abortion denial are more likely to live below the poverty level, more likely to miss developmental milestones, and more likely to be raised without family support.^2,4 The Supreme Court reversal will likely cause the epidemic of pregnancy-related deaths and hardships already seen in the US to escalate rapidly, and to exacerbate health inequities in the US over many generations.

We offer the following resources assembled by experts at the Society for Epidemiologic Research for those who want to learn more.

Some of the darkest stains on the US constitutional aspirations have come from ink spilled by its Supreme Court. Information is power, but these past tragic decisions tell us that we should be clear-eyed about the long road ahead to restore this fundamental right to protect all people who can become pregnant in the US. As public health researchers and practitioners, we must be focused and determined to combat this public health crisis.

References

1. Hawkins SS, Ghiani M, Harper S, Baum CF, Kaufman JS. Impact of state-level changes on maternal mortality: a population-based, quasi-experimental study. February 2020. American Journal of Preventive Medicine, 58(2):165-174.
2. Foster DG, Ralph LJ, Biggs MA, Gerdts C, Roberts SCM, Glymour MA. Socioeconomic outcomes of women who receive and women who are denied wanted abortions. March 2018. American Journal of Public Health, 108(3):407-413.
3. Miller S, Wherry LR, Foster DG. The Economic consequences of being denied an abortion. January 2020. The National Bureau of Economic Research, NBER Working Paper No. 26662.
4. Foster DG, Biggs MA, Raifman S, Gipson JD, Kimport K, Rocca CH. Comparison of health, development, maternal bonding, and poverty among children born after denial of abortion vs after pregnancies subsequent to an abortion. September 2018. JAMA Pediatrics, 172(11):1053-1060.

To the Class of 2021

By Jodie L. Guest, PhD, MPH

Our first day in class, August 28, 2019, came with table nametags, so I could learn every one of your names.  It also came with a questionnaire asking a few additional questions including, “I would like you to know: __________” and space for you to share anything you wanted. I still have these 161 forms in my office.  They made me laugh, they made me happy, they gave me information to help know you, and they explained silly and important things that make each of you unique. One of you told me you had to walk between classes and so would be late, and likely sweaty. Some of you shared your uneasiness with the beginning of grad school and specifically called out math, English speaking skills, and a new location as anxiety-provoking. I learned about your excitement to get started, your love of chocolate, and that you are a first generation college student. One of you wanted my cats to have their fair share of time on my slides and not just my dogs and several of you told me about your talented dogs and their tricks (hello, Estes, who can close the door by herself!).

As a class, you have endured the oddest of school circumstances. On one hand, you started your public health career during the vaping lung epidemic. As we finished your first semester, I said, “it’s incredible to study public health during an epidemic.” By March of your second semester, we traded the vaping epidemic for a pandemic the likes of which I hope we do not see again in our lifetime.  You were moved to fully online classes with just a few days’ notice. We never expected your second year would still be so heavily impacted by the SARS-CoV-2 pandemic or that so many would suffer and die.  Vaping lung was gone and everything was COVID-19. You watched people on social media become experts in your new field, with training or not. You got a crash course in science messaging including disastrous messaging that cost lives.

Between zoom classes, hybrid classes, APEs and thesis work, you engaged with this pandemic in important ways. You cared for family members and each other. You volunteered at the local health department doing contact tracing or at testing events. You supported COVID-19 studies by collecting samples and doing data analysis. You supported communities by handing out masks, providing translated prevention materials, and smiling behind your masks. You countered conspiracy theories on social media and used your new vocabulary to synthesize the rapidly growing and changing understanding of COVID-19. Concurrently, due to continuous violence towards and deaths of black men and women, transgendered persons and the Asian community, you helped push us all to declare racism as a public health crisis. You asked us to be better and work harder as anti-racists.  You led us and we, as individual people and as a community, will continue this good and hard work.

So my thoughts as you graduate?  First, you are a special, remarkable class of good humans.  That cannot be said enough. Second, I think it is clear that the world needs you. We need you as our trained public health colleagues and we need you as the engaged, compassionate, and persistent group of people who have both persevered and succeeded during the wildest of times. My next thought is to urge you to not shy away from politics in public health but to fight to get it back on bipartisan footing. Find good trouble and lead with science. My last thought for you is to ask you to continue to share yourselves. Each of you has a different story, a different lens and that is what makes the world beautiful. 

It has been an honor to know each of you, to work alongside you, and to learn from you.

Dr. Jodie L. Guest (PhD, MPH) is the Vice Chair of the Department of Epidemiology and serves as a Research Professor. Dr. Guest is also on the leadership team for the Emory COVID Response Collaborative (ECRC) and leads the COVID-19 Outbreak Response Team. 

The Boring History of EmoryEPI

No one wants to sit through a boring lecture. If given the option between teachers, at least in undergrad, it was common to check around and see who was “the best.”  When I arrived at Emory for my masters, my first class in epidemiology was taught by our department chair, Dr. John Boring. It was a constant source of amusement for us that someone who taught with such an infectious and passionate style carried the name of what no one wants from a teacher.

He walked into the room on the first day and we realized quickly he was, in fact, not boring at all. Instead, we were in the presence of a storyteller and a gifted teacher. His gifts in the classroom were many, as he spread his love for epidemiology across Emory’s campus teaching both at Rollins and at the School of Medicine. He was completely delighted when he saw us comprehend a concept or ask an insightful question and would exclaim, “Yes, yes yes!” He received (and deserved) many accolades in his 46 years of teaching at Emory including the Rollins School of Public Health Professor of the Year 5 times, the Thomas F. Sellers Jr. M.D. Award for being a role model, and Emory’s highest faculty honor, the Thomas Jefferson Award.

Where it all began

Our department, and our entire school, exists in large part because of Dr. Boring. He taught at Emory for 46 years – more than 4 decades of inspiring clinicians and then public health practitioners to save the world. Beginning in the mid-1970s, he taught in the master’s of community health program. After Rollins was established as a school in 1990, Dr. Boring chaired the Department of Epidemiology. Under his guidance, the curriculum evolved, the doctoral program was formed, and enrollment grew. Also under his guidance, the importance of mentoring students was modeled, established, and developed into the culture of the department we still have today.

The 4 C’s of Mentorship

I know how much I have benefitted from the model of mentorship Dr. Boring put in place. By definition, a mentor is “an experienced and trusted advisor.” To me, that definition doesn’t really describe the full importance of what a mentorship relationship can mean. There are also the three C’s of mentorship that add color to the mentor/mentee relationship, consultant, counselor and cheerleader. I think students are looking for, and need, all three when they reach out to faculty for advice and opportunities. But if I could add a C to that list, I would add connection. I love talking about epidemiology with students, supporting their goals, providing advice when asked, and always cheerleading. The fundamental component to all of that for me is connection, whether in the classroom or while mentoring, and is one of the reasons I find academia so fulfilling. I also think these relationships have influence beyond their structured time together.

The Science of the Denominator

Dr. Boring taught the first epidemiology class I ever took, the one I now teach.  As recently as 2016, Dr. Boring gave the opening lecture of EPI530 for my students. Many years after the first time I heard him give that lecture, I was still inspired. It took me back to that class where I first learned about our science. Even as a guest lecturer, he still exuded that same excitement about what he was sure epidemiologists could do to make the world safer. He still was passionate about denominators (“This is the science of the denominator!”). And he told my students, the ones I was only teaching because he inspired me so, “Persistence. You collect data- all of it. And you keep looking for evidence. Keep at it because you can save lives.” I wish I could punctuate that last sentence the way he said it. I can hear it in my head and it was filled with such conviction, belief and hope.  You will save lives. 

An Enduring Legacy

Dr. Boring passed away at the age of 90 two weeks ago. He left an indelible mark on our department and the world of epidemiology. He taught, mentored and inspired generations of fledgling epidemiologists. To me, he was the best teacher I ever had. I was privileged that this man who always taught in a blue shirt and tie, with his huge smile, booming laugh and his left sleeve rolled up, became my friend. We texted often but I did not get to see him this year due to the pandemic. His love of epidemiology and teaching changed the course of my life.

The continued influence of my mentors such as Dr. Boring really cannot be overstated. When I shared the sad news of his passing with a former colleague of ours, the comment was, “I carry some of him with me.” How simple. How profound. I hope I do, too.

Teamwork

In your coursework at Rollins, you will often be asked to complete group work either in the form of larger projects or smaller discussion groups. After Rollins, being able to enhance the work of a team will be an invaluable skillset in the professional setting. Public health is a field that needs to communicate effectively with other science fields, policy makers and the public to gain support for recommendations. Collaborative relationships are necessary for success and in public health, success means saving lives and increasing quality of life.

When I think of teamwork, I think of the African Proverb:

“If you want to go quickly, go alone.  If you want to go far, go together.”

While group assignments are not always met with excitement, they are a great way to practice teamwork and flex skills that help everyone succeed. Teamwork is everyone’s responsibility and will be an important skill in your career. Some important traits that I seek out in good team members include accountability, commitment, flexibility and optimism.

Accountability and commitment

Every individual on a team has an enormous effect on a team’s dynamic and its performance. While a leader might seem like the person who can solely guide a team to success, I believe each member plays a significant role in deciding how the team will function. It does not take many team members to lead a talented group towards dysfunction. Individuals are ultimately responsible for deciding whether the team will be stymied by this dysfunction or will hold each other and themselves accountable to being functional and high performing.

This commitment to high standards can be coached, but a team is so much more effective if this comes from each individual in a team. You want team members who are committed to the goal and to each other. This commitment includes supporting each other. When others need help, every team member should be aware of those needs and willing to provide their support. This commitment to each other is an essential ingredient in successful teams.

Flexibility and optimism

Team members also need to be flexible. When talented individuals with different approaches, ideas, and skills are brought together on a team, some conflict will be inevitable. The most effective teams have members who actively seek out and include others in making key decisions and solving problems creatively. They understand that having a diversity of opinions leads to optimal solutions and that you need to listen to these ideas and experiences of others because they will stretch you, challenge you, and call on you to empathize. In that context, disagreement is a blessing, not a curse. If you truly value the opinions and input of others, your team will benefit as a whole, and each member will grow.

I also believe successful teams approach the team’s goals and the future optimistically. Optimism tends to lead to more energy about a project and is an approach that feeds connection and commitment. It is much easier to be committed to a team that is forward thinking, flexible in opinion, and filled with the expectation of good work together.

Teamwork in action

It is certainly true that teamwork is not always easier than working alone, but the benefits of a connected and hardworking team can be immense. The next time you are part of a team, consider how you engage to support teammates and the goals of the team. Practice being the teammate you want to have. Connect, support, listen, encourage and motivate each other. These skills will serve you well both in school and in your career. 

[Insert Specialty Here]

“I am an HIV researcher” 

Until recently, it was unlikely someone you met, or your family at Thanksgiving dinner, would know what epidemiology was and what we do. But even now, it’s still unlikely people will know the breadth of work done by epidemiologists – everything from cardiovascular damage due to pervasive stress, to cancer research, sleep, maternal health, and a wide variety of infectious diseases.

Throughout my career, I have often taken the shortcut of saying, “I am an HIV researcher” although that commonly has to be followed by explanations of not doing bench science. Lately, as I spend much of my time doing COVID-19 work, I am described, and describing myself, more as an infectious disease epidemiologist which harkens back to my first research jobs in graduate school. So, even today, you could say my “specialty” in epidemiology continues to evolve – representing a combination of my personal experiences, my interests, and the context of the world at present. For students and early career epidemiologists, there are a seemingly infinite number of directions to go with your skillset, and deciding which of these avenues fits you best is often more of a journey than a choice. 

So, how do we all find our area of interest?

Some students come to Rollins with very targeted goals; I was not one of them. I did not come to graduate school determined to do HIV work, although I was drawn to infectious diseases. Some students come to try out different areas of research and I fall into this category. I took electives in other disease specialties until I could honestly say ID was my thing, and I learned with every one of these courses both new information and methods, and what I did or did not see myself doing my entire career. While you consider which electives to take, make sure to review the Department’s Areas of EPI document on Canvas, which provides some helpful background on many of the common subspecialties within epidemiology and which courses fall into those categories. 

When I think about how I decided to specialize in HIV epidemiology, there are really two reasons and two influential people involved in this story. The reasons are timing and opportunity and the people are my uncle and my mentor.

Timing and my uncle – the personal connection:

Going into public health in the 1990s, it felt cliché to be interested in HIV/AIDS and this alone made me not want to pursue this topic. Yet, it was a deeply personal area and one that has informed much of my thoughts about public health since. Students who have taken HIV Epidemiology with me have heard me speak about my Uncle Bill.

I was in high school when he called my mom, his sister, to let her know that his longtime roommate had been diagnosed with AIDS. It was a call that not only told our family that he was sick but also one that told us his roommate was his partner, a relationship that had not been clearly understood in our family for decades. As a kid, I recall watching my family learn to love all of who my uncle was. There was never any doubt that my family loved him, but I still look at that time as a sad realization that he had not been able to share all of who he was with us for so very long. We were fortunate to have more than four years left with him before he, too, died of HIV.

We all have experiences that shape us and even though I was not consciously pursuing the field of HIV epidemiology because of Uncle Bill, the impact his life has had on my career is deep.

Opportunity and my mentor:

When I arrived at Emory for my masters, I began work at the Atlanta VA Medical Center on several infectious disease studies in the Emerging Infectious Disease Program with CDC. I learned a tremendous amount about writing questionnaires, problems with skip patterns, and the willingness of hospitalized patients to participate in studies. I also learned that it can take over 680 cold calls to find a control for a case of Group B Strep and that food borne illnesses are interesting but were not my passion.

Every study I worked on taught me something and brought me in contact with interesting, dedicated, and very smart researchers. One of these investigators, Dr. David Rimland, became my thesis advisor. I still recall the first day I met David although I had no way of knowing the opportunities he would provide for me and the truly remarkable ways he would influence my career. When given the chance to do my thesis work using the HIV cohort he had followed since 1982 at the Atlanta VA, I jumped at the opportunity. 

It is important to note that I did take a 13-month detour to work at the American Cancer Society but missed work in the HIV world the entire time I was gone. I still remember making the phone call to David asking if he had a position to work with him again, but this time specifically in HIV research. Thankfully, he said yes and I returned home. To me, home had become the quirky VA hospital, people I admired, a rich set of data, HIV research, and working with my mentor. In the 17 years I worked in the VA HIV clinic, we fought every day to improve lives of those we served in our clinic and all people living with HIV. There is no doubt that the way I approach research and my love for the work I do has been heavily influenced by working with David. I learned, I made mistakes, and I grew all under his supportive mentorship.  

I admire our students who come to graduate school with a true vision for their work. I encourage each of you to explore other fields just for a class or two, or even for a guest lecture. There is so much to learn and so many ways to connect specialty fields. And for those who are searching for your passion, it is out there. Speak to faculty about how we found our field of work. Most have a story to share about their journey and how their lens on the world has influenced their work. Most of these stories are about connection; connection to diseases, specialty areas, or important mentors who both guide us and offer their connections to us as we pursue our careers.

Looking back, it seems obvious that losing my uncle to HIV, and watching him combat stigma that was so deeply pervasive during the first years of the epidemic, is why my career took the path that it did. But my journey also needed the influence of a great HIV researcher and mentor to find its true course. As the adage goes: hindsight is 20/20, and the arc of your own story is unlikely to be clear from the outset. However, if you commit to exploring new avenues, seek out mentors, and connect your past experiences to your curiosity, your path in epidemiology will reveal itself. 

Imposter Syndrome

I love the beginning of the semester. As a faculty member, there is so much planning to prepare for the journey and yet I still feel that same excitement I had as a student beginning new classes. As a student, I remember excitedly looking at a syllabus for a new class; the roadmap for the trip a class will take during the semester with highlights and instructions listed. With new colored pens, sticky notes, and new notebooks, I would feel sure this was the semester I would stay organized, keep artfully exquisite notes, and never question my purpose in taking a class.

I also fully recall the feeling when moments of doubt trickle in. That first lecture when concepts no longer click, when your homework answers do not reflect your understanding (or perhaps they fully reflect your lack of understanding), and the dread of the first exam where you will find out how well you have been doing and rank your results against your peers. That dread can also speak to another fear: do I belong here and when will someone realize I don’t – the Imposter Syndrome.

Silent but Pervasive

Imposter syndrome is a common phrase these days and a prevalent feeling in graduate school. Imposter Syndrome is defined as feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence regardless of external proof of their competence and, often, their mastery. Ironically, this is more common among high achieving, highly successful people. And to be clear, this is not the same as low self-esteem or a lack of self-confidence. In fact, some researchers have linked it with perfectionism, especially in women and among academics.

At least 30% of millennials currently experience some feelings of imposter syndrome and as much as 70% of people will experience it at least once in their lives. 

Recently, you may have seen celebrities normalizing imposter syndrome and sharing that they too suffer from feelings of inadequacy despite their earned position. Michelle Obama discussed still feeling like an imposter in 2018 while sitting on the stage at the Royal Festival Hall in London. That’s right, a lawyer who graduated from Princeton and Harvard Law School, the author of a #1 New York Times bestseller that sold out in a few days, a woman who went on a book tour across the world, and the former first lady doubts her abilities and shares her surprise that people want to listen to her. If you have ever had these feelings of “being found out,” you are in some very good company.

Many studies agree that up to one third of millennials are affected by the phenomenon and some have estimated that 70% of people will experience at least one episode of Impostor Syndrome in their lives (Gravois, 2007), where they doubt their abilities and accomplishments, regardless of how successful they are and despite evidence to the contrary. 

“Do I belong here and when will someone realize I don’t?”

Seeking an antidote

So what can you do to mitigate the negative effects of Imposter Syndrome?

First, you need to recognize these feelings for being the undermining forces that they are (several researchers in the UK call them gremlins, and I admit that I love that visual. If you think about the movie, gremlins are small and annoying but not altogether as awful). 

Accept that you are not supposed to know everything, especially at the beginning of a semester or graduate program. I have been working in HIV research for two decades and I do not know everything and I never will. No one does. How liberating is that?

Put your feelings in context. Most people have moments where they don’t feel confident and self-doubt can be a normal reaction. Graduate school is a prime opportunity for this. But take a look around you, as you sit in your classrooms, virtually or literally, and settle into the beginning of a semester. If you feel a trickle of doubt about being in the right place or being “found out,” odds are that one of the people on either side of you (socially distance and 6 feet away), is feeling the same. When the doubt hits you, talk to people you are close with and get support. Opening up to someone about being unsure of your abilities in graduate school is good for your mental health and you will almost surely find that you are not alone.

Lastly, be kind to yourself. Self-doubt tears down our confidence and lets those inner (gremlin) voices get loud. Graduate school is hard. Moving to a new city is hard. Being a first generation student is hard. Living through a pandemic is hard and is making all of the other hard things harder. And living at a time in our country where we are confronting racial justice issues brings up insecurities and decades or demeaning messaging. So be kind to yourself and acknowledge this: you are in one of the premier schools of public health in this country at a time when we could not need well-trained, justice-minded epidemiologists more. You are not here by accident. We read your application. We read your recommendations. We picked you and we want you here. We are here to support you, learn with you and from you, and to cheer you on.

You belong here.

Community Partnerships

Building partnerships is a skill set that is critical in public health and yet not commonly taught directly. I do not recall ever taking a class that specifically discussed relationship building in graduate school, but now so much of my work and work in the community is based on partnerships. What I do remember is how people dreaded group projects and how students still are not always thrilled when they are presented in class as the next assignment. So why is that?  Perhaps it is more efficient to do assignments alone. For that reason, solo work can be great, but for me, the most fulfilling work I have done since graduate school has involved collaboration and connections.

For the past two months, I have been fortunate to be part of a team working on the COVID-19 response in Hall County, a community hard hit by the pandemic. The outbreak in Hall County is centered in the Hispanic community, where close community living and tight working space in factories make social distancing hard. The interesting thing about leading the outbreak response from Emory’s side is that before this partnership, I had no connections to Hall County. Nevertheless, I was able to build this partnership based on previous work in similar communities and a shared common goal: We want to change the course of the COVID-19 epidemic in a hard-hit community that already was struggling with generations of disparities and inequities.

From training to impact. Our Outbreak Response Team began work today with a #COVID19 testing event at a poultry plant in Hall County. So proud to work with this group from @EmoryEPI @EmoryRollins. #PublicHealthinAction@lisa_chung @GarlowNellie @zoeschneider112 and gang pic.twitter.com/gesiMRZ7Ue

— Jodie L. Guest (@Jlguest) May 14, 2020

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This partnership began with a phone call from a leader in Hall County asking for help with their outbreak response.  Not all partnerships begin with a specific request but most are built from some level of need, even if it is for a shared greater good. That first contact should promote open dialogue and explore opportunities of engagement. Allow yourself to imagine a collaboration that doesn’t yet exist. For Hall County, the request was wide open; they sought any kind of support and connection. After listening, doing some research, and setting some overarching goals, our partnership took off and has led to a commitment to working together and building a system of support for a community in need that did not exist before. Even with the acceleration of an outbreak, building this kind of community partnership calls for a few essential building blocks: connection, engagement, and communication.

Build relationships

The best partnerships are sustained by committed relationships. While this is always the important first step, pandemics do not allow for a long ramp of getting to know each other. However, a shared vision of making lives better can quickly set your connection. But even with common goals, a strong, lasting relationship won’t form without actively working on the continuous process of connecting.

Show up and listen

Much of our work in Hall County has been about listening to the need rather than expecting we know what it is. While there are some obvious needs we could anticipate, like the need to reinforce prevention messages, provide COVID-19 testing and tracing, and isolation when needed in high-risk communities, there are nuances to those needs we would not have known if we did not get into the community and talk with its members. We would not have guessed that solid prevention messages, appropriately translated, would still not be hitting their mark because of a lack of literacy that requires messages to be less than five written words. We found that concerns about immigration make options for quarantine incredibly complex. Interventions, even those with the best designs, will likely fail without a dedication to the nuances inherent to that community.

Communicate regularly and with intention

Sharing feedback builds trust and helps us learn and become better leaders and partners. This is a way of keeping communication open so that when problems arise, you can approach the solution together. Especially in a time of fast-paced engagement, be open to quick and varying methods of communication but do not move so fast that you are not consistently communicating.

The last critical component for partnerships is the belief that together we can increase our impact. I have no doubt that the best collaborations create something bigger than what could have been done individually. There has been a lot of trauma in our world this Spring, but there have been some amazing moments to celebrate as well. Collective cooperation working towards a common goal and an energy around building partnerships is certainly a win. We are better together.

The ‘Rockstars’ of 2020

What to do in the time of a pandemic?

So much has happened in the last 5 weeks in the US (longer for other parts of the world, to be sure) and for each of us. We have watched an epidemic unfolding before our eyes. When you are in school studying epidemiology, this is both a movie happening in real life and the core of the very reason you decided to pursue a career in public health. Epidemiologists are making headlines everywhere and your parents, grandparents and friends who were never quite sure what we did (and asked you repeatedly at Thanksgiving dinner) now can talk at length about the work epidemiologists are doing. According to the New York Times on 3/9/20, with regards to COVID-19, epidemiologists are the new rock stars of our current era.

“Epidemiologists, in the main, are assuming it can no longer be contained, and that we should all be responsibly thinking about next steps so that hospitals don’t become overwhelmed. Many of them are worth following on Twitter. Epidemiologists are the new rock stars.”

– Jennifer Senior, Opinion Columnist, New York Times

So let’s talk about what life has been like as an epidemiologist, or one in training, since the end of February. You have had at least one semester considering the ways epidemiologists work, think, and produce data to protect populations or reduce risks. Our thoughts are filled with ideas about how to make the human experience better, either through improving safety, reducing risks, diminishing inequities, or calling out harms. We spent the fall considering the awful side effects of vaping and how epidemiologic data were used to rapidly change policies. That seemed like a once-in-a-lifetime epidemic to happen during your graduate training. Who knew that late winter would give us a much more formidable opponent?

COVID-19, the illness that comes from SARS-CoV-2, was named a pandemic by WHO on 3/11/20. By that time, it had ravaged much of China, having only been first reported on 12/31/19 and named COVID-19 on 2/11/20. Epidemiologists sprang into action taking a wide look at conditions and the myriad of influences that need to be examined. 

One of my favorite parts of epidemiology is that it sits at the intersection of politics, social justice, human behavior, and science.

Conditions are influenced by human behavior, travel, and our climate and these issues needed to be considered immediately. Our singular aim is to improve conditions and keep people safe but epidemiologists found themselves at odds with much of the information being presented by leadership in the US. As the public health world set out prevention measures, they were questioned as being too vast, hard to follow, and invasive to our lifestyle. Epidemiologists were asked to prove they would work, but that is not how this is done when we are talking about a brand new, rapidly spreading pandemic. Here is the interesting thing about enacting changes, particularly prevention measures. You cannot prove that prevention measures work after the fact, precisely because they worked.

Much of public health is about making changes to better human life, but without much attention. It is impossible to determine the number of lives saved from epidemiologic research, yet it is unquestionable that our discipline has saved millions from infectious and non-communicable diseases through the implementation of interventions and preventative programs. In fact, the CDC credits epidemiologists with adding 25 years to the average life expectancy of people living in the US since the early 1950s.¹ This alone, a truly unfathomable accomplishment, is mostly forgotten as evidenced by the 21^st century rise in the anti-vax movement. Yet, in our work, the forgotten past and the unrealized outcomes are our principal indicators of success. Long, healthy lives, not fanfare, signal our victory. 

And yet this week the New York Times has called us rock stars and a new article from the Atlantic on 3/25/20 suggests that this pandemic could elevate public health to the centerpiece of foreign policy while the next generation of kids write school essays about growing up to be epidemiologists. This is not the kind of attention we normally get, but since February, I have answered more texts, phone calls and messages asking for interpretation of data, opinions and travel/health advice than I normally get in a year (or a decade).

Our training to understand and use data to protect our communities has not been needed more in my lifetime…

and you are joining our profession at an incredible moment. It is our responsibility to use our current platform thoughtfully and to own what we do not know, because there is a lot about COVID-19 we are still learning daily. Let’s use our skills wisely, and in a steadfast way that does not bend to the whim of politics, but instead affirms what we know, loudly if needed, and names what we still need to determine as quickly and accurately as possible to protect our world. If we do so with disciplined science and ultimately succeed in preventing a much worse outcome, it is likely the world will scarcely remember our contributions. I do believe, however, we are showing a new generation exactly what it means to make a difference in the world through epidemiology.

The EPI-Curious Society

This PROspective is a love story about books, fascinating people and topics that matter.  Have you ever had the chance to share one of your favorite activities with some of your favorite people and then have really interesting conversations on topics you are passionate about while you are doing it?  For me, this beautiful spot where these collide has a new name – The EPI-Curious Society.

“I am always thrilled to find a great read and love to talk about what I have read, particularly when it moves me or changes the way I think.“

I love to read and have for as long as I can remember. When I was in elementary school, my mom would tell me I had to go outside to play during the summer instead of sitting in my room reading. She was truly trying to limit my reading time!  So I packed my books and outside I went… to read. 

“There is no doubt that sharing books together and challenging the way we think has deepened my understanding of the stories of life.”

These days, I spend a lot of time reading papers but I still carve out time for books and have become quite enamored with audio books I can listen to in my car or while cooking. I am always thrilled to find a great read and love to talk about what I have read, particularly when it moves me or changes the way I think.  Some of my closest friends are my six book club buddies. We have been together reading, debating, traveling and supporting each other in life for 20 years. There is no doubt that sharing books together and challenging the way we think has deepened my understanding of the stories of life.

“Our students are passionate, good humans who are engaged and interested.”

Next we add in our Emory Epidemiology students. Wow. I really am inspired by them and the way they think, their experiences, and the questions they ask. Our students are passionate, good humans who are engaged and interested. It’s a gift to know them and I was truly getting a bit blue thinking of them moving on and out of EPI530. We had spent a semester talking about the vaping crisis or the latest NPR story all while learning and growing in knowledge about epidemiology and I was not ready to have our conversations end.

So here comes the leap. Would you be willing to give up your lunch time to join me to talk about books? The response was exciting and two wonderful student leaders came forward to help set this up. Being researchers, we quickly surveyed for interest, best day of the week, book suggestions, and a name for our new book club. With the blend of a couple name suggestions, The EPI-Curious Society was born, a book was picked, and the date was set for our first meeting. 

“Learning from our past and talking about our different perspectives is fundamental to doing good work.“

Our first book, ‘The Immortal Life of Henrietta Lacks’ by Rebecca Skloot has led to a fascinating discussion about research ethics,racial inequities, the individual people affected by research, and the strides made for public health. Learning from our past and talking about our different perspectives is fundamental to doing good work.       

The EPI-Curious Society now gets top billing as one of my favorite things. 

What do you get when you spend lunch discussing the ethics of human subjects research, social inequities & medical advancements with a dedicated group of @EmoryEPI superstars? The #Epicurioussociety bookclub! What a treat to be reunited with these students. ?#readingforfun pic.twitter.com/cP4XofBAgr

— Jodie L. Guest (@Jlguest) January 22, 2020

If you are a current EPI student and would like to join the EPI-Curious Society, please email sarah [dot] johnson2 [at] emory [dot] edu to be added to our listserv for information about meetings and books.

To build your list of interesting books, several faculty in the Department of Epidemiology have also created a list of their top reads from the past year, which are presented below:

Educated, A memoir

The Undoing Project: A Friendship That Changed Our Minds

The Book of Why

The Influential Mind: What the Brain Reveals About Our Power to Change Others

Thinking Fast, and Slow

How Not to Be Wrong: The Power of Mathematical Thinking

Just Mercy

The Theory That Would Not Die: How Bayes’ Rule Cracked the Enigma Code, Hunted Down Russian Submarines, and Emerged Triumphant from Two Centuries of Controversy

The Sun Does Shine

An American Sickness: How Healthcare Became Big Business

Dying of Whiteness

Even on your worst day, you can be a student’s best hope

What were your favorite books of 2019? Tell us in the comments below!

Didn’t see something here that caught your eye? Browse some of our favorite book lists from the last year:

• NYT 100 Notable books of 2019 
• NPR’s Book Concierge
• Bill Gates 2019 Book list