Following the people and events that make up the research community at Duke

Category: Statistics Page 1 of 5

What Happens When You Give People Money?

What happens when you give people money? Dr. Aisha Nyandoro and Natalie Foster know: through their research, they’ve seen the impacts of guaranteed income firsthand.

On November 9, as part of the Duke Center for Child and Family Policy’s Sulzberger Distinguished Lecture series, these experts discussed their work and what we can learn from it at “What Happens When You Give People Money: The Future of Economic Security for Children and Families.”

Natalie Foster

Foster, co-founder and co-chair of the Economic Security Project, began with the big idea of guaranteed income. Before the pandemic, wealth and income inequality were at all-time highs — disparities that “can be traced back to the origins of racialized capitalism.” But recently, things have gotten even harder. Wages have remained stagnant despite increases in productivity — and despite inflation, making it harder to afford things like rent. Foster denounced the “strong ideology that says that lack of security in this system is a personal failing. That if you can’t pull yourself up, there’s something wrong with you.” There’s something wrong with the system, Foster said. “People are working. The economy isn’t.”

Foster explained that the 1996 “Personal Responsibility and Work Opportunity Reconciliation Act” fundamentally changed welfare by converting the old New Deal-era unlimited grant program into the flat-funded block grant we now know as TANF, leaving determination of eligibility to state discretion and generally “making welfare more punitive.” The Act, Foster said, was built on racist stereotypes, like that of the welfare queen. To make matters worse, it was passed against the backdrop of a persistent devaluation of the labor of people of color

Foster said that even though there didn’t appear to be room in these political conditions to do things differently, she had the “audacity to imagine something else: the ‘adjacent possible.’” She wanted to give cash to people directly, ensuring an income floor regardless of whatever crises that may abound.

Foster worked with the mayor of Stockton, California on the Stockton Economic Empowerment Demonstration (SEED), which provided 125 Stockton residents with $500 monthly payments for two years. 

Dr. Aisha Nyandoro

Foster was connected by a mutual friend to Nyandoro, the CEO of Springboard to Opportunities. Nyandoro had launched The Magnolia Mother’s Trust, which provides low-income Black mothers in Jackson, Mississippi with $1,000 monthly payments for one year. 

With The Magnolia Mother’s Trust, Nyandoro sought to shift away from economic policy “rooted in ‘what is,’ and toward ‘what could be.’” This concept has a rich history, she said, and includes the work of Martin Luther King Jr. and the Black Panthers. She had a specific ‘what if’ in mind: “What if when Black women told us what they needed, we believed them?” What if we sought to overturn the very structures that keep these people down, and subverted the “paternalistic nature of the social safety net”? 

Nyandoro stated that as a researcher, when she has questions, she “goes back to the people.” When she did, she found that although people’s needs were individual, “cash was ubiquitous” — cash was a solution that could address every single one of the problems that she heard. Giving cash directly could help combat a system that “penalizes people for being poor, rather than trying to lift them out of poverty.” 

Why low-income Black mothers? Nyandoro explained that in order to do the work of economic liberation, one must identify what’s wrong with the system. In this case, that meant identifying those who are the most negatively impacted by the system, and using what limited resources are available to help them specifically.

Nyandoro turned to her findings: giving people cash works. These mothers are often working tirelessly, holding down two or three jobs and struggling to make ends meet. After receiving the money, people continue to work and often do so at higher rates (a major fear of opponents of guaranteed income). As a result, their income is often doubled — with life-changing results

Beyond the numbers, Nyandoro emphasized that “we are seeing joy. We don’t talk about joy enough as it relates to Black women.” This money allowed Black women to feel free, to be entrepreneurial: to “dare to dream for the first time — for themselves and for their families.” 

She referenced Chimamanda Ngozi Adichie’s famous speech “The Danger of a Single Story,” explaining that in order to change the narrative, “we need to change the narrator.” It’s time to think about whose voices we center.

In Jackson, Mississippi and Stockton, California, the pair had carried out research about the ‘adjacent possible.’ They’d used cities and states as “laboratories in democracy.” Foster said that their work was paving the way for gradual advances in guaranteed income — slowly, but surely. Then, the pandemic hit.

Suddenly, ideas that had recently been dismissed as too radical were viewed as necessary. Often unable to work, people needed money fast in order to put food on the table and cover their most urgent needs. The federal government rose to the challenge with the American Rescue Plan, providing stimulus checks and pandemic unemployment insurance, plus expanding the Child Tax Credit. “The ‘adjacent possible’”, Foster said, “had become the possible.”

The country saw an “immediate drop in poverty.” The pandemic was revealing, said Foster. It revealed that cash provides time, stress reduction, and resilience. It revealed that cash serves as a tool to create economic security and “build back better.” Above all, it revealed that “poverty is a policy choice that we’re currently making. We could make a different policy choice in order to eliminate it.”

The pandemic also revealed that stimulus checks and the Child Tax Credit were “very popular policies.” Nyandoro has observed support in the form of petitions for monthly cash transfers, the founding of organizations like Mayors for a Guaranteed Income and Guaranteed Income Community of Practice, and the launch of over a hundred guaranteed income pilots of some sort. All these efforts, Nyandoro said, are pushing toward “the same North Star”: centering the needs of families and achieving economic liberation through federal policy.

Foster turned the discussion toward next steps: “these victories have been immense, but could disappear” if the Build Back Better Act does not pass. The Act includes a year-long extension of the expanded Child Tax Credit, a key instantiation of guaranteed income. The Child Tax Credit has bipartisan support

If the extension of the Child Tax Credit passes, then according to Foster, guaranteed income is one step closer to becoming a cornerstone of social policy. This would be a “nail in the coffin of the way we’ve done policy for the last fifty years — that you’re only worth what you do in the world. Every human has dignity and worth, and we have the opportunity to build a policy that says just that.” 

Nyandoro agreed with Foster. As an anti-poverty advocate, she believes in a world without poverty: a world where “everyone can have a life of dignity for themselves and their families.” She believes that the ‘adjacent possible’ is achievable if “we can move beyond our own individual needs in order to view life as a collective, where prosperity is shared rather than hoarded.” She ended by quoting Toni Morrison: “if you have some power, then your job is to empower someone else.”

Last Friday, the House voted to pass the Build Back Better Act, which now heads to the Senate.

Post by Zella Hanson

“News for the Rich, White, and Blue”: Nikki Usher on her new book and the state of American journalism

Erik Carter

News organizations are facing an economic crisis

In their battle for survival, they are “realigning their priorities in ways that favor audiences who are willing to pay.” And those who are willing to pay tend to be rich, white, and politically blue.

On November 3, as part of the DeWitt Wallace Center’s Fall 2021 Information Inequalities Speaker Series, author and University of Illinois associate professor Nikki Usher discussed her new book News for the Rich, White, and Blue: How Place and Power Distort American Journalism.

Usher began by explaining that as newspapers face “market failure,” only non-geographical news is in a position to survive. As news becomes a private good (The Washington Post, The Atlantic, and The New York Times come to mind), the result is inconsistent and unequal access to news. 

According to Usher, 1800 local communities lack any regular access to local news. Usher stated that political consequences result when news organizations pull back from places that don’t exhibit that aforementioned willingness to pay. 

She gave an example of one such consequence: many journalists had their “heads in the sand” about the rising tides of populism in rural America. As a result, they were blindsided when Trump won the election. But the win simply revealed what had been the case all along. 

The New York Times editor Dean Baquet acknowledged this after the election: “We’ve got to do a much better job of being on the road, out in the country… and remind ourselves that New York is not the real world.”

Usher said that another consequence of the delocalization of news is reduced trust: only 11% of Republicans say they trust the media a great deal or a fair amount. Additionally, when places lose news, they grow more polarized, with reductions in split-ticket voting. 

Usher said that she practices a kind of “gestalt scholarship,” employing the tools of ethnography and lived experience as well as quantitative data. She dipped into this side of her research, recounting a few anecdotes which represent the “materiality” of the loss of local news.

In 2018, the LA Times moved from its Downtown home, near Skid Row, to El Segundo. The move was not without controversy. In a 2018 editorial, an anonymous author wrote that “location matters, on both a physical and symbolic level, and… moving the headquarters far away from the local power base and the most important entities and stories the Times covers… is the wrong choice.” 

The Miami Herald’s old home got demolished in 2015. Now the newsroom is near the airport, across from a cow pasture. “It’s bad for the psyche for there to be no building to exist for people to see every day,” said an editor. (A recent bit of unnerving news regarding the future of the Herald and journalism at large.)

Usher then stated that newsrooms are “places of power” that are becoming “increasingly inhospitable places for those who are non-white and who lack financial resources.” 

In June 2020, The Philadelphia Inquirer’s top editor resigned after the publication of an article with the headline “Buildings Matter, Too,” led to a walkout by dozens of staff members. At the LA Times, Latinx journalists penned an open letter drawing attention to the fact that its 13% Latinx newsroom does not reflect its nearly 50% Latinx community. In Detroit, the disparity is even worse: an 80% Black population is served by a newsroom that is only 14% Black. 

In 1968, the Kerner Commission put down a series of recommendations to improve diversity, noting that the journalistic profession was “shockingly backward” in its absence of Black journalists. The American Society of News Editors set a target date for newsrooms to be at parity with the populations they represented: 2000. They’ve since pushed the deadline to 2025. 

It’s not looking good. That’s because, according to Usher, newsrooms aren’t hiring, and “when newsrooms don’t hire, they don’t hire minority journalists.”

Usher also touched on the “death of the working class reporter.” Increasingly, the only young people who are not deterred by journalism’s instability and lack of lucrativity are those who come from copious amounts of privilege. Add this to the inability of poorer students to pursue resume-building journalism activities alongside work-study jobs, and the preference of news outlets for the oft-wealthy students of elite universities, and one can see why “journalism is becoming a profession for the elite.” 

Usher said that when “newsrooms become bastions of privilege, [that’s] bad news.” Losing journalists who come from blue-collar backgrounds means losing the ability to “empathize” with a whole set of experiences.

Usher said that as news revenue goes increasingly digital, reliance on those willing to pay is even more pronounced, with “consequences for equity in access and geographically specific news coverage.” She referenced The New York Times, whose rise “mirrors the rise in inequality” of access to news. “They know they’re leaving people behind,” Usher said. She quoted Dean Baquet, who acknowledged that 98% of Americans “were now excluded from The New York Times’ journalism and might well have to do with substandard information.”

Usher also discussed “Goldilock newspapers” — not too big, not too small, but just right for survival according to the “upside-down logic” of digital advertising. The problem is that, as Mike Wilson of the Dallas Morning News put it, “the pursuit of digital subscriptions has honed our focus on what we’re covering” — sometimes to the detriment of local readers. As a result of this phenomenon, Usher has seen reduced coverage in places considered too low-income to get advertisers. In one instance, she saw a dismissal of concerns about ad- and malware clunking up the computers of those with inferior Internet access because “those people are less likely to subscribe anyway.” 

Where does this leave us? Usher identified a few potential solutions. She reiterated calls for more inclusive newsrooms, and added her own call for higher-ed financial aid reform so that lower-income students can have a fighting chance at pursuing journalism. She discussed the need for a “post newspaper consciousness” — to acknowledge that we cannot save the newspaper, but we can identify what journalism does best and save those “special parts.” 

She left the audience with a final recommendation: journalism should “embrace the partisan media system.” Usher clarified her position: the news media like The New York Times “hides behind a veil of neutrality,” when this is only an (unconvincing) illusion. “People want to see them advocate for social justice,” she said, and she agrees. Usher doesn’t think polarization is inherently bad “if it’s polarization toward social justice and breaking down systemic inequality.”

“There’s no use assuaging people who have given up and aren’t listening. And then you have lots of people unsubscribing because the phony neutrality was irritating them,” Usher said. For organizations like the Times, the veil of neutrality is looking like a lose-lose.

She advised them to “go for those who are still listening. And just own it.”

Post by Zella Hanson

The COVID-19 ‘Endgame’ Depends on Where You Live

In February of 2020, no one could have fathomed that the very next month would usher in the COVID-19 pandemic – an era of global history that has (to date) resulted in 5 million deaths, 240 million cases, trillions of dollars lost, and the worsening of every inequality imaginable.

And while scientists and governments have worked together to make incredible advances in vaccine technology, access, and distribution, it goes without saying that there is more work to be done to finally put the pieces of an exhausted global society back together. On Tuesday, October 12th, the Duke Global Health Institute (DGHI) brought together three leaders in global health to discuss what those next steps should be.

The panel discussion, which was moderated by Dr. Krishna Udayakumar of the DGHI, was titled “The COVID-19 Endgame: Where are we headed, and when will we get there?” The panelists were Dr. Ann Lindstrand, who is the World Health Organization’s unit head for the Essential Program on Immunization; Dr. Ayoade Alakija, who is the co-chair of the African Vaccine Delivery Alliance and founder of the Emergency Coordination Center in Nigeria; and Alberto Valenzuela, who is the Executive Director of the Pan American and Parapan American Games Legacy Project.

Dr. Ayoade Alakija
Dr. Ann Linstrand
Alberto Valenzuela

Dr. Lindstrand began by setting the stage and highlighting what are undoubted successes on a global level. 6.5 billion doses of the vaccine have been administered around the world, and the vaccines have impressive effectiveness given the speed with which they were developed. Yet undergirding all of this is the elephant in the room that, sitting in a 1st-world country, we don’t think about: high-income countries have administered 32 times more doses per inhabitant compared to low-income countries.

Graph from Dr. Ann Lindstrand

This vaccine inequity has been exacerbated by already weak health security systems, vaccine nationalism, and lackluster political commitment. And while the WHO is slated to enormously ramp up supplies of vaccines in Q4 of 2021 and Q1 of 2022, it doesn’t mitigate the damage to the socioeconomic welfare of people that COVID-19 has already had. Dr. Lindstrand outlines the three waves of socioeconomic impact we will see, but expressed concern that “we’re already beginning to see the first wave pan out.” 

Diagram from Dr. Ann Lindstrand

Dr. Alakija took this discussion a step further, asserting that COVID-19 is poised to become the disease of low-income countries. “If you’re living in the US or EU,” she remarked, “You’re heading into the ‘Roaring 20s’. If you live in the Global South, COVID-19 is going to become your future.”

To this point, Dr. Alakija emphasized that the only reason this is the status quo is because in her eyes, the world failed to do what was right when it should have. In her home country of Nigeria, she highlighted that out of a population of 210 million people, 5.1 million people have received the vaccine – and of those 5.1 million, just 2 million — one percent — have been double-vaccinated. “It really is a case of keeping those down further down, while giving booster doses to those that have already been vaccinated,” she said. “We don’t have diagnostic data, so people are slipping underwater and the world has no idea.”

It’s worth noting that Nigeria houses some of the megacities of the world, not just in the African continent. So according to Dr. Alakija, “we don’t solve this with a medical lens, we solve this with a whole-of-society lens.” We must, she argued, because in an interconnected world, no one exists in isolation.

Alberto Valenzuela’s work is a great example of this. In 2019, his team led organizing efforts for the Pan American Games in Lima, relying on extensive partnerships between public organizations and corporations. In 2020, though, as the world shifted, the government called on the team to transition into something much different – COVID-19 relief efforts in the country.

The results are staggering. In just 5 weeks, the Pan American and Parapan American Games Legacy Project built 10 hospitals in 5 regions of the country. The implementation of 31 vaccination centers throughout the country resulted in a tripling of the number of people vaccinated per day in Lima. To him, this work “proves what’s possible when private and public sectors merge.” In other words, remarkable things happen when all of society tackles a societal issue.

Slide from Alberto Valenzuela

So where do we go from here? Perhaps the biggest thing that stood out was the need to empower low-income countries to make decisions that are best for them. In Dr. Alakija’s words, “we need to lose the charity model in favor of a partnership model.” Dr. Lindstrand pointed out that there’s a deep know-how in the Global South of how to roll out mass-vaccination efforts – but only when we “lay down our organizational hats” can we move to what Dr. Lindstrand termed “more coordination and less confusion.” Valenzuela emphasized the need to integrate many sectors, not just healthcare, to mobilize the COVID-19 response in countries. But above all, Dr. Alakija said, “there will be no endgame until we have equity, inclusion, and health justice.” 

Post by Meghna Datta, Class of 2023

The Black Wealth Gap in Modern Day America

“White Americans have been provided with up escalators they can ride to reach their goals without hurdles. Meanwhile, Black Americans have been forced onto down escalators which they must run-up to reach their destination.”

The Samuel Dubois Cook Center on Social Equity at Duke University recently released a striking report on Black wealth in America, entitled “Still Running Up the Down Escalator: How Narratives Shape our Understanding of Racial Wealth Inequality,” This 36-page report, written by Natasha Hicks, Fenaba Addo, Anne Prince, and William Darity examines the stark inequalities in the economic situation of Black Americans.

The cover page of the 36-page, in-depth report, published earlier this fall.

“Despite a decade of philanthropic investment and renewed attention from progressive elected officials, policymakers, and advocates, we have yet to make discernible progress in ensuring Black families have the power and freedom wealth bestows,” the report says (page 1).

“The typical Black household’s wealth (in 2019) was $24,100; for White households, it was $188,200. This translates into the typical Black household holding about 12 cents for every dollar of wealth held by the typical White family– a disparity that has remained largely unchanged since 1989 (Kent and Ricketts, 2020).” ( page 6)

Black families are disproportionately shut out of access to opportunities that would improve generational wealth, such as home loans, business loans/ownership, and financial assets. Because of the long history of these inequalities, Black wealth in America has improved little in the last 10 years.

The report continues by analyzing how Covid-19, the worst Pandemic in US History, has widened the wealth gap in America.

“Racial wealth inequality remains a persistent defining American issue, particularly in the wake of the COVID-19 pandemic’s disproportionate toll on the physical and financial health of Black people,” the report says. “The COVID-19 pandemic and the corresponding economic crisis have only exacerbated what was already a collective failing by policymakers and elected officials, who continue to invest in solutions focused on individual behavior instead of systems change.”

Covid-19 placed over 114 million people into unemployment over the course of the pandemic, with an overrepresentation of Black Americans in these figures. The figures below were published in the report to highlight the number of liquid assets and wealth available to white families versus black families in 2019, just one year before the pandemic.

This figure taken from the report shows the median liquid assets by race and income. ( figure 1, page 8)
This figure taken from the report shows the median wealth accumulated by race and wealth quintiles. (figure 2, page 8)

As illustrated by these figures, the average White family in America maintains a leg up financially through both income and assets, which is why when the pandemic hit, black Americans were the ones disproportionately affected. Without access to high wealth modules or liquid assets to lean on, the economic wealth gap in America grew bigger.

The next part of the report talked about how false narratives in America regarding economic inequality is leading to unsuccessful aims of correction. In America, it’s a common theme to assume the problems faced by Black Americans are a cultural or personal issue, instead of a systemic one.

“Harmful narratives that characterize Black Americans as unintelligent, lazy, and criminal reinforce the notion that racial wealth disparities between Black and White households arise from differences in culture, values, skills, and behavior.” (page 10) Themes of anti-Blackness and personal responsibility, or a bootstrap mentality, were key systemic factors noted in the report. These factors impacted almost every aspect of Black America, including education, homeownership, entrepreneurship, family structure, and income and employment.

The report concludes by bringing up tangible solutions for these structural problems.

“The past year of crises is exposing the fact that we created systems, rules, and policies that actively and intentionally harm Black people. In order to truly address racial wealth inequality and the impact of the COVID-19 crisis, policymakers and funders must move away from solutions focused on behavioral changes and individual choices. Rather, they must take bold actions (backed by large scale financial investments) to shift dominant narratives and reimagine economic structures that support, uplift and protect Black people.” (page 23)

The authors make four broad proposals: shift harmful narratives, eliminate the racial wealth gap, dismantle extractive policies, and design programs to seed intergenerational wealth.

Economic disparities in America are a systemic issue, not a cultural or personal one. This report examines the interplay between this issue and the current pandemic, maintaining that the only way to create tangible change is through systemic solutions.

“America offers a false promise of equal opportunity and individual agency. For Black Americans, making all the right choices does not equal all the right outcomes. Just as wealth-building for White people in America was by design and government action, we need intentional and structural wealth-building strategies for Black Americans with investments compared to those given to White Americans. This requires a paradigm shift to truly tackle racial wealth inequality.” (page 36)

Written by Skylar Hughes, Class of 2025

New Blogger Shariar Vaez-Ghaemi: Arts and Artificial Intelligence

Hi! My name is Shariar. My friends usually pronounce that as Shaw-Ree-Awr, and my parents pronounce it as a Share-Ee-Awr, but feel free to mentally process my name as “Sher-Rye-Eer,” “Shor-yor-ior-ior-ior-ior,” or whatever phonetic concoction your heart desires. I always tell people that there’s no right way to interpret language, especially if you’re an AI (which you might be).

Speaking of AI, I’m excited to study statistics and mathematics at Duke! This dream was born out of my high school research internship with New York Times bestselling author Jonah Berger, through which I immersed myself in the applications of machine learning to the social sciences. Since Dr. Berger and I completed our ML-guided study of the social psychology of communicative language, I’ve injected statistical learning techniques into my investigations of political science, finance, and even fantasy football.

Unwinding in the orchestra room after a performance

When I’m not cramped behind a Jupyter Notebook or re-reading a particularly long research abstract for the fourth time, I’m often pursuing a completely different interest: the creative arts. I’m an orchestral clarinetist and quasi-jazz pianist by training, but my proudest artistic endeavours have involved cinema. During high school, I wrote and directed three short films, including a post-apocalyptic dystopian comedy and a silent rendition of the epic poem “Epopeya de la Gitana.”

I often get asked whether there’s any bridge between machine learning and the creative arts*, to which the answer is yes! In fact, as part of my entry project for Duke-based developer team Apollo Endeavours, I created a statistical language model that writes original poetry. Wandering
Mind, as I call the system, is just one example of the many ways that artificial intelligence can do what we once considered exclusively-human tasks. The program isn’t quite as talented as Frost or Dickinson, but it’s much better at writing poetry than I am.

In a movie production (I’m the one wearing a Totoro onesie)

I look forward to presenting invigorating research topics to blog readers for the next year or more. Though machine learning is my scientific expertise, my investigations could transcend all boundaries of discipline, so you may see me passionately explaining biology experiments, environmental studies, or even macroeconomic forecasts. Go Blue Devils!

(* In truth, I almost never get asked this question by real people unless I say, “You know, there’s actually a connection between machine learning and arts.”)

By Shariar Vaez-Ghaemi, Class of 2025

Child Protective Services Do Work, But They Are Unevenly Distributed

Roughly one in seven  New York City children suffer confirmed mistreatment at home and many are placed in foster care. But relatively few children are permanently separated from their parents by the termination of parental rights, according to new research from Duke University and Rutgers University-Newark.

The data points to a relative success story in the world of child welfare, said Chris Wildeman, a Duke University sociologist and co-author of the research. In New York City, child welfare specialists intervene often in abuse and neglect cases but are often able to avoid terminating parental rights, even when they do remove the child from the home, Wildeman added.

Wildeman’s co-authors are Kieran Healy, a Duke sociologist, and Frank Edwards and Sara Wakefield from the School of Criminal Justice at Rutgers University – Newark.

In New York City, roughly two in five children will be involved in an investigation by their local child protective services office; one in seven will experience confirmed maltreatment, one in 35 will be placed in foster care. (Dallas Clemons)

“I think the core takeaway there is that New York is the prime example of taking maltreatment seriously and intervening as a system,” Wildeman said. “But also taking seriously the idea that permanent termination of parental rights totally closes off any chance for family reunification, so only doing it in the most extreme circumstances.”

The peer-reviewed study, appearing the week of July 19 in the Proceedings of the National Academy of Sciences, derives from an analysis of child welfare data from the nation’s 20 most populous counties. (The New York data is from all five boroughs because the entire city’s child welfare system is under a single governing umbrella)

The study looked at how often children were the subject of a child services investigation; suffered confirmed mistreatment, were placed in foster care, and removed permanently from their homes through the termination of parental rights.

Nationally, roughly one in three children will be involved in an investigation by their local child protective services office; one in eight will experience maltreatment, one in 17 will be placed in foster care and one in 100 will have parental rights terminated, according to the study.

In New York City, roughly two in five children will be involved in an investigation by their local child protective services office; one in seven will experience confirmed maltreatment, one in 35 will be placed in foster care and one in 600 will have parental rights terminated, according to the study.

Nationally, one in 100 parents will have their rights terminated, while in New York that figure is one in 600. (Dallas Clemons)

“The system is functioning more the way many child welfare advocates would like it to function,” Wildeman said. “Make sure you identify maltreatment, but attempt to use services rather than foster care treatment, at least initially, and then only terminating parental rights in only the most extreme circumstances. And trying to be aware of racial disparities in those processes.”

CITATION:  “Contact with Child Protective Services is Pervasive but Unequally Distributed by Race and Ethnicity in Large US Counties,” PNAS, July 19, 2021. DOI: 10.1073/pnas.2106272118

Post by Eric Ferreri , Duke University Communications

Increasing Access to Care with the Help of Big Data

Artificial intelligence (AI) and data science have the potential to revolutionize global health. But what exactly is AI and what hurdles stand in the way of more widespread integration of big data in global health? Duke’s Global Health Institute (DGHI) hosted a Think Global webinar Wednesday, February 17th to dive into these questions and more.  

The webinar’s panelists were Andy Tatem (Ph.D), Joao Vissoci (Ph.D.), and Eric Laber (Ph.D.), moderated by DGHI’s Director of Research Design and Analysis Core, Liz Turner (Ph.D.).  Tatem is a professor of spatial demography and epidemiology at the University of South Hampton and director of WorldPop. Vissoci is an assistant professor of surgery and global health at Duke University. Laber is a professor of statistical science and bioinformatics at Duke.

Panelist moderator, Lisa Turner

Tatem, Vissoci, and Laber all use data science to address issues in the global health realm. Tatem’s work largely utilizes geospatial data sets to help inform global health decisions like vaccine distribution within a certain geographic area. Vissoci, who works with the GEMINI Lab at Duke (Global Emergency Medicine Innovation and Implementation Research), tries to leverage secondary data from health systems in order to understand issues of access to and distribution of care, as well as care delivery. Laber is interested in improving decision-making processes in healthcare spaces, attempting to help health professionals synthesize very complex data via AI.

All of their work is vital to modern biomedicine and healthcare, but, Turner said, “AI means a lot of different things to a lot of different people.” Laber defined AI in healthcare simply as using data to make healthcare better. “From a data science perspective,” Vissoci said, “[it is] synthesizing data … an automated way to give us back information.” This returned info is digestible trends and understandings derived from very big, very complex data sets. Tatem stated that AI has already “revolutionized what we can do” and said it is “powerful if it is directed in the right way.”

A screenshot from worldpop.org

We often get sucked into a science-fiction version of AI, Laber said, but in actuality it is not some dystopian future but a set of tools that maximizes what can be derived from data.

However, as Tatem stated, “[AI] is not a magic, press a button” scenario where you get automatic results. A huge part of work for researchers like Tatem, Vissoci, and Laber is the “harmonization” of working with data producers, understanding data quality, integrating data sets, cleaning data, and other “back-end” processes.

This comes with many caveats.

“Bias is a huge problem,” said Laber. Vissoci reinforced this, stating that the models built from AI and data science are going to represent what data sources they are able to access – bias included. “We need better work in getting better data,” Vissoci said.

Further, there must be more up-front listening to and communication with “end-users from the very start” of projects, Tatem outlined. By taking a step back and listening, tools created through AI and data science may be better met with actual uptake and less skepticism or distrust. Vissoci said that “direct engagement with the people on the ground” transforms data into meaningful information.

Better structures for meandering privacy issues must also be developed. “A major overhaul is still needed,” said Laber. This includes things like better consent processes for patients’ to understand how their data is being used, although Tatem said this becomes “very complex” when integrating data.

Nonetheless the future looks promising and each panelist feels confident that the benefits will outweigh the difficulties that are yet to come in introducing big data to global health. One cool example Vissoci gave of an ongoing project deals with the influence of environmental change through deforestation in the Brazilian Amazon on the impacts of Indigenous populations. Through work with “heavy multidimensional data,” Vissoci and his team also have been able to optimize scarcely distributed Covid vaccine resource “to use in areas where they can have the most impact.”

Laber envisions a world with reduced or even no clinical trials if “randomization and experimentation” are integrated directly into healthcare systems. Tatem noted how he has seen extreme growth in the field in just the last 10 to 15 years, which seems only to be accelerating.

A lot of this work has to do with making better decisions about allocating resources, as Turner stated in the beginning of the panel. In an age of reassessment about equity and access, AI and data science could serve to bring both to the field of global health.

Post by Cydney Livingston

Student Team Quantifies Housing Discrimination in Durham

Home values and race have an intimate connection in Durham, NC. From 1940 to 2020, if mean home values in Black-majority Census tracts had appreciated at rates equal to those in white Census tracts, the mean home value for homes in Black tracts would be $94,642 higher than it is.

That’s the disappointing, but perhaps not shocking, finding of a Duke Data+ team.

Because housing accounts for the biggest portion of wealth for families that fall outside of the top 10% of wealth in the U.S., this figure on home values represents a pervasive racial divide in wealth.

What started as a Data+ project in the summer of 2020 has expanded into an ongoing exploration of the connection between persistent wealth disparities across racial lines through housing. Omer Ali (Ph.D.), a postdoctoral associate with The Samuel Dubois Cook Center on Social Equity, is leading undergraduates Nicholas Datto and Pei Yi Zhuo in the continuation of their initial work. The trio presented an in-depth analysis of their work and methods Friday, February 5th during a Data Dialogue.

The team used a multitude of data to conduct their analyses, including the 1940 Census, Durham County records, CoreLogic data for home sales and NC voter registrations. Aside from the nearly $100,000 difference between mean home values between Black census tracts (defined as >50% Black homeowners from 1940-2020) and white census tracts (defined as >50% white homeowners from 1940-2020), Ali, Datto, and Zhou also found that over the last 10 years, home values have risen in Black neighborhoods as they have been losing Black residents. Within Census tracts, the team said that Black home-buyers in Durham occupy the least valuable homes.

Home Owners Loan Corporation data

Datto introduced the concept of redlining — systemic housing discrimination — and explained how this historic issue persists. From 1930-1940, the Home Owners’ Loan Corporation (HOLC) and Federal Housing Administration (FHA) designated certain neighborhoods unsuitable for mortgage lending. Neighborhoods were given a desirability grade from A to D, with D being the lowest.

In 1940, no neighborhoods with Black residents were designated as either A or B districts. That meant areas with non-white residents were considered more risky and thus less likely to receive FHA-guaranteed mortgages.

Datto explained that these historic classifications persist because the team found significant differences in the amount of accumulated home value over time by neighborhood rating. We are “seeing long-lasting effects of these redlined maps on homeowners in Durham, “ said Datto, with even “significant differences between white [and non-white] homeowners, even in C and D neighborhoods.”

Zhou explained the significance of tracking the changes of each Census tract – Black, white, or integrated – over the last 50 years. The “white-black disparity [in home value] has grown by 287%” in this time period, he said. Homes of comparable structural design and apparent worth are much less valuable for simply existing in Black neighborhoods and being owned by Black people. And the problem has only expanded.

Along with differences in home value, both Black and white neighborhoods have seen a decline in Black homeowners in the 21st Century, pointing to a larger issue at hand. Though the work done so far merely documents these trends, rather than looking for correlation that may get at the underlying causes of the home-value disparity, the trends pair closely with other regions across the country being impacted by gentrification.

“Home values are going up in Black neighborhoods, but the number of Black people in those neighborhoods is going down,” said Datto.

Ali pointed out that there are evaluation practices that include evaluation of the neighborhood “as opposed to the structural properties of the home.” When a house is being evaluated, he said a home of similar structure owned by white homeowners would never be chosen as a comparator for a Latinx- or Black-owned home. This perpetuates historical disparities, as “minority neighborhoods have been historically undervalued” it is a compounding, systemic cycle.

The team hopes to export their methodology to a much larger scale. Thus far, this has presented some back-end issues with data and computer science, however “there is nothing in the analysis itself that couldn’t be [applied to other geographical locations,” they said.

Large socioeconomic racial disparities prevail in the U.S., from gaps in unemployment to infant mortality to incarceration rates to life expectancy itself. Though it should come as no surprise that home-values represent another area of inequity, work like Ali, Datto, and Zhou are conducting needs more traction, support, and expansion.

Post by Cydney Livingston

Quantifying the effects of structural racism on health

Photo from Scholars@Duke

America is getting both older and Blacker. The proportion of non-white older adults is increasing, and by 2050 the majority of elderly people will be racial minorities. In his Langford Lecture “Who gets sick and why? How racial inequality gets under the skin” on November 10, Professor Tyson H. Brown discussed the importance of studying older minorities when learning about human health. His current project aims to address gaps in research by quantifying effects of structural racism on health. 

Health disparities result in unnecessary fatalities. Dr. Brown estimates that if we took away racial disparities in health, we could avoid 229 premature deaths per day. Health disparities also have substantial economic costs that add up to about 200 billion dollars annually. Dr. Brown explained that the effects of structural racism are so deadly because it is complex and not the same as the overt, intentional, interpersonal racism that most people think of. Thus, it is easier to ignore or to halt attempts to fix structural racism. Dr. Brown’s study posits that structural racism has five key tenets: it is multifaceted, interconnected, an institutionalized system, involves relational subordination and manifests in racial inequalities in life chances. 

A motivator for Brown’s research was that less than 1% of studies of the effects of race on health have focused on structural racism, even though macro level structural racism has deleterious effects on health of Black people. When thinking about inequalities, the traditional mode of thinking is the group that dominates (in this case, white people) receives all benefits and the subordinates (in Dr. Brown’s study, Black people) receive all of the negative effects of racism. In this mode of thinking, whites actively benefit from social inequality. However, Dr. Brown discussed another theory: that structural racism and its effects on health undermines the fabric of our entire society and has negative impacts on both whites and Blacks. It is possible for whites to be harmed by structural racism, but not to the same extent as Black people. 

Dr. Brown identified states as “important institutional actors that affect population health.” As a part of his research, he made a state level index of structural racism based off of data from 2010. The index was composed of nine indicators of structural racism, which combine to make an overall index of structural racism in states. In mapping out structural racism across the domains, the results were not what most people might expect. According to Dr. Brown’s study, structural racism tends to be highest in the midwest of the United States, rather than the south. These higher levels of structural racism were associated with worse self-rated health: one standard deviation increase in level of structural racism correlated with the equivalent of two standard deviation increases in age. In other words, a person who is affected by structural racism has similar self-rated health to people two age categories above them who do not experience negative effects of structural racism. 

As the structural racism index increases, the Black-white difference in COVID-19 related deaths also increases. Overall, Dr. Brown found that structural racism is a key driver of inequalities in COVID-19 deaths between whites and Blacks. Looking forward, Dr. Brown is interested in learning more about how contemporary forms of racism contribute to inequality—such as searching racial slurs on Google and implicit bias, both of which are high in the southern United States. 

After his discussion, colleagues raised questions about what can be done to eliminate negative effects of structural racism. Dr. Brown listed options such as rent protection, COVID-19 test sites in lower income communities and another stimulus bill. He also explained that the distribution of a COVID-19 vaccine needs to be done in an ethical manner and not exclude those who are less fortunate who really need the vaccine. We also need better data collection in general—the more we know about the effects of structural racism, the better we will be able to adapt equity practices to mitigate harm on Black communities.

By Victoria Priester

Contact Tracing Is a Call for Ingenuity and Innovation

The sudden need for contact-tracing technologies to address the Covid-19 pandemic is inspiring some miraculous human ingenuity.

Wednesday, December 16th, Rodney Jenkins, Praudman Jain, and Kartik Nayak discussed Covid-19 contact tracing and the role of new technologies in a forum organized by the Duke Mobile App Gateway team.

Jenkins is the Health Director of Durham County’s Department of Public Health, Jain is CEO and founder of Vibrent Health. And Nayak is an Assistant Professor in Duke’s Computer Science department. The panel was hosted by Leatrice Martin (M.B.A.), Senior Program Coordinator for Duke’s Mobile App Gateway with Duke’s Clinical and Translational Science Institute.

Contact tracing is critical to slowing the spread of Covid, and Jenkins says it’s not going away anytime soon. Jenkins, who only began his position with Durham County Public Health in January 2020, said Durham County’s contact tracing has been… interesting. As the virus approached Durham, “Durham County suffered a severe malware attack that really rendered platforms…useless.”

Eventually, though, the department developed its own method of tracing through trial and error. North Carolina’s Department of Health and Human Services (NC HHS), like many other health departments across the nation in March, was scrambling to adjust. NC HHS was not able to provide support for Durham’s contact tracing until July, when Jenkins identified a serious need for reinforcement due to disproportionate Covid cases amongst Latinx community members. In the meantime, Durham county received help from Duke’s Physician Assistant students and the Blue Cross Blue Shield Foundation. They expanded their team of five to 95 individuals investigating and tracing Durham County’s positive cases.

Rodney Jenkins MPH is the health director of the Durham County Public Health Department.

Jenkins proclaimed contact tracing as “sacred to public health” and a necessary element to “boxing in” Covid-19 – along with widespread testing.

Durham’s tracing tool is conducted through a HIPPA-compliant, secure online portal. Data about individuals is loaded into the system, transmitted to the contact tracing team, and then the team calls close contacts to enable a quick quarantine response. The department had to “make a huge jump very quickly,” said Jenkins. It was this speedy development and integration of new technology that has helped Durham County Public Health better manage the pandemic.

Jain, along with colleague Rachele Peterson, spoke about his company, Vibrent Health.  Vibrent, which was recently awarded a five-year grant from the National Institutes of Health’s ‘ll of Us Research Program, is focused on creating and dispersing digital and mobile platforms for public health.

Naturally, this includes a new focus on Covid. With renewed interest in and dependency on contact tracing, Jain says there is a need for different tools to help various stakeholders – from researchers to citizens to government.  He believes technology can “become the underlying infrastructure for accelerating science.”

Vibrent identified needs for a national tracing model, including the labor intensity of manual processes, disparate tools, and lack of automation.

Peterson said that as we “are all painfully aware,” the U.S. was not prepared for Covid, resulting in no national tracing solution. She offered that the success of tracing has been mostly due to efforts of “local heroes” like Jenkins. Through their five-year award, Vibrent is developing a next-generation tracing solution that they hope will better target infectious spread, optimize response time, reduce labor burden in managing spread, and increase public trust.

Along with an online digital interface, the company is partnering with Virginia Commonwealth University to work on a statistical modeling system. Peterson likened their idea to the Waze navigation app, which relies on users to add important, real-time data. They hope to offer a visualization tool to identify individuals in close contact with infected or high-risk persons and identify places or routes where users are at higher risk.

Nayak closed the panel by discussing his work on a project complementary to contact tracing, dubbed Poirot. Poirot will use aggregated private contact summary data. Because physical distancing is key to preventing Covid spread, Nayak said it is both important and difficult to measure physical interactions through contact events due to privacy concerns over sensitive data. Using Duke as the case study, Poirot will help decision makers answer questions about which buildings have the most contact events or which populations – faculty versus students – are at higher risk. The technology can also help individuals identify how many daily contacts they have or the safest time of day to visit a particular building.

Nayak said users will only be able to learn about their own contact events, as well as aggregate stats, while decision makers can only access aggregate statistics and have no ability to link data to individuals.

Users will log into a Duke server and then privately upload their data using a technology called blinded tokens. Contact events will be discovered with the help of continuously changing, random identifiers with data summation at intermittent intervals. Data processing will use multiparty computation and differential privacy to ensure information is delinked from individuals. The tool is expected for release in the spring.

Screenshot of Duke’s Mobile App Gateway site.

Although we are just starting vaccination, the need for nationwide resources “will be ongoing,” Martin said.

We should continue to embrace contact tracing because widespread vaccination will take time, Jenkins said.

Jenkins, Jain, and Nayak are but a few who have stepped up to respond innovatively to Covid. It becomes increasingly apparent that we will continue to need individuals like them, as well as their technological tools, to ease the burden of an overworked and unprepared health system as the pandemic prevails in America.

Post by Cydney Livingston

Page 1 of 5

Powered by WordPress & Theme by Anders Norén