Healthy Cities Integrative Seminar
3/22/2023
Jon Zelner
[email protected]
epibayes.io
Infectious disease epidemiologist.
Social epidemiologist/sociologist (UM Sociology PhD 2011).
Spatial analysis/transmission modeling.
Infection inequity.
Discuss what it means to take a systems perspective on public health problems in cities and communities.
Talk about how epidemiological systems models have, and have not, dealt well with social inequity before - and during - the COVID-19 pandemic.
Highlight why developing mathematical and spatial models that reflect a diversity of understandings about how disease systems work is essential for health equity.
From Enserink and Kupferschmidt, Science 2020
Represent explicit ideas about how transmission systems work.
Explore the relative contributions of individual, spatial, and social/environmental relationships to transmission risks.
Let us take a systems perspective on infectious diseases.
Diagram showing relationships between COVID-19 transmission and public and policy response.
But what does this actually show us? What is the point of using these tools?
Cumulative incidence of COVID-19 in Michigan 3/2020-3/2022 (from covidmapping.org)
“Pandemic preparedness is a continuous process of planning, exercising, revising and translating into action national and sub-national pandemic preparedness and response plans. A pandemic plan is thus a living document which is reviewed regularly and revised if necessary…based on the lessons learnt from outbreaks or a pandemic, or from a simulation exercise.”
Models can let us:
Intuition pumps are cunningly designed [thought experiments, which] focus the reader’s attention on “the important” features, and…deflect the reader from bogging down in hard-to-follow details. (From Dennett, 1984)
So why were we not prepared for these easy-to-foresee inequities?
Susceptibility is uniformly distributed across the population.
Host and pathogen biology are the most important factors in determining infectiousness.
Protective health behaviors equally available to everyone.
Socio-spatial differences in exposure by race and wealth are dwarfed by these biological factors.
Modelers don’t have to believe these things are true for them to end up in our models!
[M]ental models and empirical data keep each other in check - [Sir Peter Medawar] described them respectively as the ‘bride’ and ‘groom’ of science — and scientific progress in any discipline occurs by the back-and-forth dialogue between their two ‘voices’.”
From Greenhalgh 2021: Miasmas, mental models and preventive public health
Key Questions:
What perspective do these groups have in common?
COVID-19 disparities are not the fault of those who are experiencing them, but rather reflect social policies and systems that create health disparities in good times and inflate them in a crisis. The US must develop a new kind of “herd immunity,” whereby resistance to the spread of poor health in the population occurs when a sufficiently high proportion of individuals, across all racial, ethnic, and social class groups, are protected from and thus “immune” to negative social determinants.
From Williams & Cooper, “COVID-19 and Health Equity—A New Kind of “Herd Immunity”, JAMA, 6/23/2020
Zelner et al. (2022), There are no equal opportunity infectors. PLOS Computational Biology
From Nande et al. “The effect of eviction moratoria on the transmission of SARS-CoV-2”, Nature Communications, 2021
It matters who is developing the model.
Spatial and transmission modeling in epidemiology need to reflect diveristy in intellectual perspectives
And life experiences
And economic and political interests
If you’re interested in learning more about our work, check our lab site at epibayes.io
Get in touch at [email protected]
!