I recently read a Time magazine interview[i] with Dr. Rochelle Walensky, Director of the U.S. Centers for Disease Control and Prevention, regarding her efforts to change the CDC and fix its “dramatic mistakes” during COVID 19. In the interview Walensky shared that a recent in-depth review of CDC revealed, among other things, the challenges of the agency’s current orientation towards knowledge sharing. As she put it, “This agency has been developed on an infrastructure of academia: one that is publication-driven, and one that generally talks to scientists, public-health experts, and academics. We learned that we are no longer simply an agency for public-health officials. We have to be an agency for the American people.” I understand her concern. The issues of audience, voice, public policy and knowledge mobilization and dissemination have been focal points within practitioner research, action research and participatory research circles for decades now, with discussions of the limitations of disengaged academia domination often paired with consideration of the importance of other, more democratized approaches to knowledge production and sharing.[ii] Walensky’s comments may represent a broadening of attention to these issues within one of the world’s preeminent health agencies. CDC plays a crucial role in fighting diseases globally and is the US governmental health agency mandated to protect the health of all Americans; hence, the interest of the agency’s director is not a small matter.[iii]
What might it mean for CDC to loosen or even break the stranglehold of the “infrastructure of academia”? What would it look like to broaden conversations about critical issues of public health policy so that they extend beyond the current knowledge supply chain of publications by “scientists, public-health experts, and academics”? Three thoughts came to mind for me in relation to Walensky’s concern. All three thoughts point to the importance of examining broader contexts for concern about knowledge creation and dissemination.
1. The communication issue is much broader than public health and is not limited to simple dissemination of scientific ‘findings.’
2. The decline in trust, not just of scientific research but in key societal institutions in general, is a partisan-fueled divide.
3. Efforts to break the one-sided dominance of academia must be broad-based, innovative, inclusive of independent community-based initiatives, grounded in confronting the partisan-fueled divide, and be granted adequate support by the agencies seeking to transform themselves.
Expert Knowledge Production and Science Communication Gaps
The gap between academia-based knowledge production and dissemination and public perceptions of the value of scientific research in health care has widened in the past 6-7 years.[iv] Most recently, a 2022 survey by the Pew Research Center found that the share of respondents with a great deal of confidence in scientists to act in the public’s best interests is down 10 percentage points (from 39% to 29%) from 2020 to 2022. Another recent report discusses polling indicating that the number of people believing that science has “made life more difficult” increased by 50 percent from 2009 to 2015.[v] The dates here are important; although public perceptions of how the COVID pandemic has been handled may account for much of the most recent decline in confidence, it cannot account for all of the decline. In fact, an overall decline in public confidence in both science and academia over the past few decades has been noted.[vi] For example, while 41% of respondents in a 2006 nationwide poll indicated “a lot of confidence” in higher education, by 2014 the percentage had declined to 14%.[vii]
Furthermore, this decline in public confidence extends to a broad range of social, economic and political institutions, not just health care. One study reports that currently an average of just 33% of U.S. adults express “a great deal” or “quite a lot” of confidence in 14 key institutions, including among others both the medical system and public schools.[viii] Tom Nichols, the American writer and academic specialist in international affairs has described the crumbling of trust in science and academia in the context of “the death of expertise.”[ix] In his view, the assertion by growing numbers of people that their personal opinions hold equal weight to the opinions of experts is dangerous and amounts to a concerted campaign against “established knowledge.” His defense of expertise as a driver of established knowledge is passionate and well-informed.
However, the trend lines of decreasing confidence have remained low since the early 1990s. In this sense, the issue raised by Walensky is not merely one of communication, although this certainly plays an important part. Growing evidence indicates that the issue extends to the very core of our beliefs in institutions as providers of public services and to the broad questioning of all aspects of social responsibilities in democratic societies; this extension likely reflects what historian Daniel Rogers explores as the socio-political dynamics associated with an “age of fracture.”[x] In other words, when living in a time in which our collective purposes and meanings have become “unhinged and uncertain” how could we not see a decline in confidence in the broad array of institutions built up around those purposes and meanings over long periods of the nation’s history? Newly elected Alaskan Congresswoman Mary Peltola, the first Alaska Native elected to Congress, recently asserted that the strong base of support for Trumpism in her state “is reflective of the fact that there is a universal feeling now of disenfranchisement, of being forgotten, of being ignored.” In her view, this is “not something that should be dismissed . . . We should find a way to make sure everyone feels that they’re being heard.”[xi] This sentiment is surely a part of the challenge CDC faces; there are simply far too many people who just do not feel in any meaningful way that they are being heard in relation to health care, and as the broader research indicates, in relation to a wide array of social institutions charged with responding to critical social issues. They resent a one-way communication that dictates what they should be concerned about and what actions they should take in regards to those concerns.
The Partisan-fueled Divide
My second point is that the decline in trust, not just of scientific research but in key societal institutions in general, is a partisan-fueled divide. The evidence of this is quite convincing and troubling.[xii] A few days ago the above-referenced Tom Nichols asserted in an MSNBC interview that if Republicans win control of Congress in November, the US will become ‘paralyzed,’ with Republicans ‘playing to their base’ of right-wing extremists.[xiii] This likely will include, in my view, the introduction of anti-science legislation and the holding of far-ranging and unhinged hearings based on misinformation and far right ideological posturing and conspiracy pandering that further undermine public trust in social institutions. As a civil servant, Dr. Rochelle Walensky is not at liberty to provide public commentary on such considerations, although I doubt she is unaware of them. In academic circles, a 2022 Report details the partisan divide between Democrats and Republicans regarding views of medical science and science in general.[xiv] In addition, a 2022 Perspective published in the Proceedings of the National Academy of Sciences (PNAS) examines the dismissal of scientific evidence and the formation of antiscience attitudes in relation to what the authors see as the current “crisis of attitudes due to both effective persuasion by anti-science sources and ineffective persuasion by scientific or ‘proscience’ sources.” (p.1).[xv] The authors include a discussion of how politics drives antiscience attitudes, including the role of today’s toxic and potent political influences. Importantly, they also discuss “counteractive strategies” for increasing the acceptance of scientific information, improving the practices of ‘science communicators’ and bridging the gaps between antiscience and proscience forces. These strategies may be particularly useful for Dr. Walensky in her efforts to lead CDC in new directions of science communication and will require careful study by CDC staff and policy makers.
Challenging the Infrastructure of Academia
And this leads to my third point. Walensky’s recognition of the importance of improved communication with the American people will need to be translated into practical support and action for the development of alternative infrastructures for knowledge creation and sharing. What will this look like? The CDC will continue to need the knowledge created through the work of scientists, public health experts, and academics, without a doubt. In this regard, the continuation of significant funding for such research is a priority. As discussed above, however, whether or not this priority is realized depends on a Partisan reckoning. If the Republican Party gains control of the Congress under the overarching ideology of its now dominant extreme right-wing populism, it would be highly unlikely that this priority will be achieved. If the Democrats retain control of Congress, on the other hand, the more challenging issue for Walensky will be what action she will take in supporting alternative infrastructures for science communication and broadened perspectives on the inclusion of diverse epistemological frames of reference and forms of engagements with communities as a part of such communications.
At present there is very little evidence of support within the public sector for the kinds of alternative infrastructure that can help address Walensky’s concern regarding CDC communications. The needed alternatives must give voice to practice-based research evidence[xvi] gathered through valid means and should reflect more consciously democratic and civic-literacy oriented writing and knowledge mobilization and dissemination. A major challenge here is that the current call for pushing back against the now dominant infrastructure of knowledge production and dissemination in academia, namely the calls for ‘engaged research’ and community-engaged research[xvii] at present are dominated by academia. Although a step in the right direction, to date these calls are ill-equipped in practical terms to building the knowledge democracies needed for restoring trust between campuses and communities, honoring diverse voices in the decision-making most relevant to conducting research that reflects community needs and issues, and strengthening practitioner-led research as a valid form of knowledge creation. In other words, the calls for engaged research fall short precisely because they are grounded in the dominant paradigms of academia.[xviii] At a minimum, support is needed for demonstrating the capacity of non-academia-based knowledge production and dissemination infrastructures to make an impact on attitudes towards science and public services.
In this sense, the question of ‘what’s to be done’ is, of course, an issue of ‘follow the money.’ At present the National Institutes of Health (NIH), like CDC, a division within the Department of Health and Human Services, spends more than 80% of its $45 billion dollar budget on research.[xix] Even a half of 1% of the current budget would mean $225 million for support of community-based and non-academia-based knowledge production and dissemination infrastructure initiatives. Such initiatives could have BOTH a research focus and a community-based engagement and communications focus as defined from the ground up rather than from the top down.
Where such alternatives do exist, such as Social Publishers Foundation (SPF), they are inadequately resourced at present. Yet even in the face of this difficulty, many smaller scale initiatives maintain their commitments to strengthening local as well as global capacities for creating and mobilizing knowledge produced by practitioners working in local contexts to enhance social progress and individual wellbeing. However, for SPF as well as for other alternative infrastructures for knowledge production and dissemination, the impact of the work being done would be greatly enhanced by resources to implement the kind of multi-faceted counteractive strategies for addressing antiscience attitudes discussed in the previously mentioned PNAS commentary. These strategies need resources to support community-based, multi-disciplinary, and interactive virtual and in-person social initiatives to increase the perception of scientific information sources as credible. In addition, initiatives to support building capacity for scientists to be more empathetic and better communicators, projects to train currently marginalized populations to plan and conduct research within their communities and to mobilize communities to increase their general scientific literacy are needed. Overall, the problem faced by those committed to strengthening our collective capacities to ‘handle’ expertise and contribute to balancing expert opinion within a broader framework of respecting diverse epistemologies and democratizing knowledge as a basis for public discourse and policy making is multifaceted; similarly, finding solutions to this problem will need to be multifaced and should not be undertaken only within the current infrastructures of academia. Determined efforts by both academic institutions as well as alternative knowledge production and dissemination locales are needed now to gain and sustain public trust in relation to the creation and application of knowledge to the search for creative solutions to a whole range of pressing issues, with the alternative frameworks deserving the support of all the country’s prominent institutions.
[i] Alice Park (September 12/19, 2022), 8 Questions. Time, p. 80.
[ii] For example, 2019 special Issue of Educational Action Research (Vol. 27 #1 and #3). Also see Biesta (2010). Why What Works Still Won’t Work: From Evidence-Based Education to Value-Based Education. doi: 10.1007/s11217-010-9191-x. Also, Hall and Tandon (2021). Social Responsibility and Community Based Research in Higher Education Institutions. Doi: 10.1163/9789004459076_001; and, Tandon, R. (2014). Community and civil society as sources of knowledge. World report on higher education. Palgrave.
[iv] Compare, for example, 2015 and 2022 Pew Research Center findings – https://www.pewresearch.org/science/2015/01/29/public-and-scientists-views-on-science-and-society/#:~:text=Overall%20the%20American%20public%20tends,has%20made%20life%20more%20difficult; and https://www.pewresearch.org/science/2022/02/15/americans-trust-in-scientists-other-groups-declines/
[v] (Dis)trust in Science – Scientific American Blog Network
[vi] https://blogs.scientificamerican.com/observations/dis-trust-in-science; https://www.scientificamerican.com/article/the-antiscience-movement-is-escalating-going-global-and-killing-thousands/.
[vii] Confidence in Higher Education, Occupational Status, and Perceived Problems (aaup.org)
[ix] Nichols, T. (2017). The Death of Expertise. Oxford University Press.
[x] Rodgers, D. T. (2011). Age of Fracture. Harvard Press.
[xi] Cortelissa, E. (September 26/Oct. 3, 2022), 7 Questions, Time, p. 80.
[xii] https://www.brookings.edu/blog/brown-center-chalkboard/2022/08/29/what-if-americans-sour-on-public-education/; and https://news.uchicago.edu/story/trust-science-becoming-more-polarized-survey-finds
[xiv] https://www.pewresearch.org/science/2022/02/15/americans-trust-in-scientists-other-groups-declines/; https://news.uchicago.edu/story/trust-science-becoming-more-polarized-survey-finds
[xv] Phillip-Muller, Lee, and Petty (2022). https://doi.org/10.1073/pnas.2120755119
[xvi] Hong, E., & Rowell, L. (2019). Challenging knowledge monopoly in education in the U.S. through democratizing knowledge production and dissemination. Educational Action Research, 27(1), 125-143.
[xvii] https://ucr.edu/what-community-engaged-research; and https://www.brown.edu/academics/college/swearer/engaged-research
[xviii] See Rowell & Hong (2017). Knowledge Democracy and Action Research: Pathways for the Twenty-First Century. In Rowell, Bruce, Shosh & Riel (eds.). The Palgrave International Handbook of Action Research. Palgrave Handbooks.