What has it meant for me to be an epidemiologist in 2020?

The year 2020 has brought three things to me as an epidemiologist: (1) a deeper understanding of what epidemiology is and what it contributes; (2) a reinforcement of the importance of social inequalities as one of the key drivers of health across and within populations; and (3) the importance of communication with and through media.

I am a social epidemiologist interested in urban health inequities, especially related to nutrition-related chronic diseases. I was born and raised in Spain, and trained (and living for the last 7 years) on the East Coast of the US. These intersecting professional and personal identities have created a vortex of emotions, worries, motivation, and drive during 2020. When the COVID-19 outbreak was starting to become the center of all news reports, I kept thinking that I did not have much to contribute to these conversations; experts in infectious disease dynamics doing modeling had all of the knowledge and tools. It took me a while to get out of my own self-imposed professional silo. My stance shifted on 30 March, with a Twitter thread by Dr. Dominique Heinke¹, where she highlighted that all epidemiologists can play a role in explaining many basic concepts common through the discipline. We have seen it with basic concepts such as sensitivity and specificity, the importance of understanding person, place, and time, and the role of societal arrangements in generating specific distributions of disease in populations.

Central to my identity as a social epidemiologist is a claim that the distribution of disease across and within populations results from mass influences acting on the population as a whole². Some of the critical mass influences driving disease include our economic and social organization: capitalism, racism, colonialism, and patriarchy³. These structures generate inequities in access to resources, leading to disease and health inequities⁴. While these concepts are the bread and butter of my usual epidemiologic work, it took me a while to connect the dots and apply them to the COVID-19 pandemic. On March 30th, while watching the webinar “Implications of the Pandemic for Health Equity”⁵, I heard Dr. Sharrelle Barber mention that most COVID-19 testing in Philadelphia was happening in wealthy neighborhoods while the consequences of the pandemic were going to be felt in the most vulnerable areas. It wasn’t long until data started becoming available, and we clearly saw how testing was lower and positivity ratios and incidence rates higher in more deprived areas, and how minoritized groups had much higher hospitalization and mortality rates nationwide.

During all these months, one of the most time-consuming yet rewarding activities I’ve had the privilege to participate in is outreach with media, both local and national, in the US and in Spain. Earlier this year, I attended a media training organized by my institution and got one specific thing out of it: “media is like a loudspeaker, you are talking to the audience, not the journalist.” During these months, I have taken that to heart and have tried to attend as many journalists as possible to make epidemiologic concepts, especially around health inequities, accessible to the public. Above all, the COVID-19 pandemic has solidified a vision in my mind that was already there: one of the primary roles of social epidemiology is to set the narrative around health inequities to a narrative about injustice and macro-level factors driving disease distributions within and between populations. COVID-19 has shown that one of our crucial tasks as social epidemiologists is to set this narrative, both within the general field of epidemiology and for the general public.