Rob Santos

Greetings, fellow statisticians. First, I would like to acknowledge that, in April, I was nominated by President Joe Biden to be the next director of the US Census Bureau. I have been deeply moved by and am appreciative for the messages of support I have received. I have not yet been scheduled for a Senate committee hearing. If confirmed, I will serve my country proudly, uphold our nation’s Constitution, and do all I can to further the scientific integrity of the Census Bureau and federal statistical system more generally. I am a huge fan of both. In fact, as a young professional statistician, I often dreamed of working at the US Census Bureau—an institution I believe stands at the pinnacle of scientific excellence. I am honored and humbled that I might get a chance to serve in a position of leadership.

If/when I am confirmed, I will have the privilege of serving you, the statistical community, the public, and our nation in a different capacity than I do now. But until then, I will continue to proudly serve as your 2021 ASA president. So, let’s turn to the president’s corner.

For this issue, I’d like to illustrate how one might flip a research framework to create opportunity through a new perspective. I sometimes do this when working on policy issues as a reality check to the underlying premises of the issue at hand. For context, consider this excerpt from my blog last month:

About two decades ago, I was asked to review a National Academies (NAS) report, titled Eliminating Health Disparities: Measurement and Data Needs. I eagerly anticipated the recommendations for future directions in research and data collection. And the panel report revealed some excellent recommendations. However, I believe the panel missed an opportunity for which I provided commentary: the need to collect data on health care providers and institutions in addition to clients as part of a comprehensive, systemic health disparity assessment.

My thinking was that health disparities are affected by both access to care and the quality of care delivered. And with regard to the latter, the quality of care is a direct outcome of a two-way interaction between health care workers/institutions and their clients. Moreover, health care institutions and their staff are naturally influenced by societal constructs such as how racial and ethnic minorities are served in the health system (e.g., with or without health insurance, steering to specific facilities). This even includes how vulnerable populations are portrayed in everyday life.

The NAS report recommendations focused exclusively on collecting better, more accurate, and standardized data on clients—the recipients of health care. Indeed, there was much that could be improved in this regard. In my review, I “flipped the research framework” to consider how health providers and their institutions (and broader society) have a role in health disparities. I thought to myself, “What data could be collected on the health care providers as well as their institutions that could inform health disparities and guide improvements in health care?”

My thinking was influenced by a health care research study in the 1990s. As I recall, it focused on health care providers and concluded a common sense finding: In situations where the health care providers learned and used some Spanish to interact with their Spanish-speaking patients, both client satisfaction and health care outcomes improved compared to care provided by monolingual English-speaking providers.

While most might think, “of course,” and move on, I saw something different. Given the growing demographic diversity of the US population and the blossoming of our multicultural nation, it seemed important to capture data on how society is acculturating to its wonderfully diverse population. Acculturation works both ways in an evolving society, yet the research world focuses on one side of the coin all too often, so to speak. Flipping the research framework to incorporate both the provider and patient could shed light on how culturally relevant interactions between patients and providers could improve health and reduce disparities.

Many times, statistical evaluations focus on a vulnerable group undergoing some program to make them behave differently without really understanding the root causes of the underlying behaviors. With critical thinking and discussion between statisticians and substantive researchers at the design stage, perhaps more inclusive research frameworks can be adopted, leading to enhanced insights and better outcomes.

Alas, my alternative perspective did not warrant a revision to the report, probably because it was considered outside the scope of the charge. I understood and was disappointed, but I still consider it an opportunity loss.

Fast forward to 2021, when I recently gave a keynote at Drexel University’s inaugural Population Health Symposium. The conference theme was the intersection of racism and health. Here, too, I chose to flip the research framework in my speech. Health programs aimed at Blacks, Indigenous people, and people of color (BIPOC) are typically couched in a framework of altering BIPOC client behaviors (e.g., alter dietary intake, strict adherence to prescription regimens). Yet the role of the providers and society more generally is not considered part of an integrated, interactive, two-player system.

Client health outcomes are influenced by the interaction between two sets of players: (1) the persons seeking health care and (2) health providers and their institutions. And let’s not forget greater society, essentially an extension of (2).

Health research to identify and reduce disparities—and structural racism—would be more effective by addressing both players, not just those who are oppressed. You see, everyone is a victim in a structurally racist society. That is why our nation’s reckoning with systemic/institutional racism—including the ongoing justice, equity, diversity, and inclusion (JEDI) efforts of the ASA—is so critical. We all have a role to play and work to do to improve things. Yet our policy research all too often bifurcates programs and research studies into some exclusively focused on providers and others focused only on clients. Moreover, we should recognize and address the role of greater society in reinforcing structural/institutional racism; it is typically ignored altogether.

Yes, statisticians are in an awesome position to offer critical thinking to statistical studies in all fields of research. We can flip the research framework by conversing with the research team and asking questions about the nature of the phenomena being studied, the populations involved and their interactions, as well as the appropriate measures and rationale behind expected outcomes. We can start with a systemic, encompassing framework that recognizes and “treats” all the players involved in an interactive system.

Simply having those conversations with researchers could lead to better framing of questions and ultimately more effective research designs, measures, and insightful inferences. Give it a try sometime!