Biostatistics IS Public Health!

This week, I had the pleasure of hearing Dr. Tom Farley speak to our school’s incoming students about his book Saving Gotham, A Billionaire Mayor, Activist Doctors, and the Fight for 8 Million Lives. As part of our orientation activities, we assigned the students to read Dr. Farley’s book about the monumental strides New York City took to improve the public’s health. If you’re not from these here parts, you may not know that Dr. Farley served as the NYC Health Commissioner from 2009-2014 under Mayor Michael Bloomberg. He is now the Philadelphia Health Commissioner and is also an amazing resource for our School of Public Health.

The book, an exciting work of non-fiction, chronicles the NYC Health Department’s efforts to reduce the rates of smoking, limit the intake of salt and sugar, and eliminate trans fats (among other programs) in NYC. The stories Dr. Farley tells, and the characters in them, unfold as if reading fiction, except that these stories really happened, and these characters actually made them happen. As I read the book, I couldn’t wait to find out what was going to happen, even though I already knew what happened. I could recall the late-night comedians ridiculing the Mayor’s efforts to reduce sugar-sweetened beverage intake, and remember when calorie labeling on menus went into effect. The work done by the NYC Health Department during that time was incredible – important life-saving and precedent setting efforts. It was public health at its finest (editors note: some could argue the health department was overreaching their authority – this is a topic for another time!). Many themes emerged from the book. You can pick your favorite for discussion: leadership, politics, teamwork. However, what was most striking to me was the display of how truly interdisciplinary real public health is. Not a single one of these policy changes (or proposed changes) could have happened without a diverse team of public health professionals: folks who analyze the scientific data, someone to translate the research into lives saved; an expert in policy development; someone who could work with the communities to implement changes; someone to hold focus groups and someone else to analyze the outcomes from those focus groups… the list could go on and on. In order to effect change, each public health discipline is equally important.

So what? We all know that the world is becoming more interdisciplinary, right? Maybe… while I was reading this book, there was also a very important discussion circulating among the Chairs of Biostatistics Departments about the role of statistics in public health. Recently, the Council on Education for Public Health (CEPH), the accrediting body for Schools of Public Health, presented the proposed revised criteria for accreditation. While setting out to  develop criteria that get away from the five core disciplines of public health, and moving towards criteria that allow flexibility and creativity in curriculum (both of which are good things), CEPH has essentially erased Biostatistics from their accreditation criteria (NOT a good thing). This is of great concern to many of us, because if the accrediting body ceases to recognize Biostatistics as a core component of a public health education, where does that leave us? I’ll come back to that question.biostatistics-is-public-health

For many years, I have jokingly referred to Biostatistics as the “bastard child” of public health. Biostatisticians are not like their colleagues in other public health disciplines in a lot of ways. Students receiving MS or PhD degrees in biostatistics don’t typically have to take courses in the breadth of public health disciplines, like Master’s of Public Health students do. Among faculty, it is unusual for a biostatistician to get a large grant for which they’re the primary investigator – often their PIships come from methods grants that are typically smaller in dollar amounts or they are funded through collaborative research. It is also typical for a biostatistician to have many fewer first authored manuscripts in methodological areas, and perhaps many more second authored manuscripts in which they act as the collaborating statistician. Some biostatisticians find their collaborators mainly in medical schools or cancer centers, and some biostatistics departments are located in these clinical departments or divisions. However, there are many, many Biostatisticians who are true public health professionals – developing methods or collaborating on studies that are concerned with addressing public health challenges. I believe that most of my colleagues would consider themselves public health professionals, I certainly do (even though a good portion of my collaborations are clinical). Because what we do is integral to the process of improving the health of the public. And this has only become more and more evident through these discussions among the chairs, the activities we’ve been conducting among our students, and my day-to-day life interacting with the faculty in my school.

Despite biostatistics’ differences from other public health disciplines, biostatistics is an integral part of the field. Biostatisticians are trained to help translate data into answers (see a great interview here about what biostatisticians do and how biostatistics fits into public health), through the appropriate application of statistical methods. But biostatisticians can (and do) do much more than that. Biostatisticians can help determine appropriate data collection instruments, ensure appropriate data collection methods, and assess whether outcomes are suitable for answering the questions of interest. To be clear, there are many public health professionals who are not trained in biostatistics who have many of these skills as well. However, beyond that, as the field of public health grows and the questions we are trying to answer become more complicated, the methods we are currently using may no longer fit the questions we ask. Biostatisticians have a large role in developing new methods to address the increasingly complicated public health questions. Without biostatistics, public health will stagnate.

So back to the question – where does this omission of biostatistics from the CEPH guidelines leave us? Our first step is to try to modify the proposed guidelines to be more inclusive – many of the biostatistics Chairs submitted comments to the CEPH council and we produced letters signed by the many of the Chairs, and the Presidents of the American Statistical Association (ASA) and the East North American Region of the International Biometrics Society (ENAR). Talking points for conversations with Deans were developed, and plans to continue discussions among the Chairs were made. These strides are important and hopefully will have impact on the guidelines, but if they don’t, the results could be disastrous for public health. As public health becomes more interdisciplinary, it is important to ensure that each discipline continues to grow, or there is a real danger that biostatistics could lose its identity. And that would be a shame, because biostatistics is public health.

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