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Health demography

“Health” is a broad field that includes epidemiologists working at the Centers for Disease Control (CDC), program managers at development agencies, and physicians working in clinical settings. These are just a few archetypal examples of roles in the health field, but there are many others which all share in common a focus on birth, morbidity, and mortality — especially monitoring diseases and developing, operationalizing, and distributing treatments. Applied demographers working in the health field bring strong backgrounds in critical thinking and demographic principles, based on highly flexible training in the demographic framework including the usage of straightforward statistical, demographic, and survey methodologies. This expertise is highly desirable for a team in the health field, as this expertise may be uncommon or less than rigorous in the average healthcare specialist.

The demographic framework — the principles, processes, and experiences which a demographer must master — is broadly applicable because it provides coherent strategies to be used at all stages of a research project, from developing methodologies to communicating results. The demographic framework’s broad applicability may make it seem like applied demographers are agnostic to the type of research they are conducting, or that the demographic framework has a certain supraposition, but that is not the case. Rather, the unique embeddability, usefulness, and impactfulness of the demographic framework — the salience, not genericization — is what makes applied demographers in many fields useful, especially in health. Working across many projects (both good and bad) informs and improves the applied demographer’s ability to look at health data, sharpening their acuity rather than diffusing or blunting it. This has important impacts, too. The benefit of a demographic approach with morbidity and mortality, for example, can literally save lives through segmented prevention efforts and even treatments, and may uncover patterns that are not readily apparent without crosstabs of demographic characteristics prepared by a trusty applied demographer.

Dr. Anderson — chief of the mortality statistics branch for the National Center for Health Statistics at the CDC — looks at the demographic framework (and its practice by an applied demography) as crucial for his team. His work focuses on disease classification, requiring expertise on how coding is used and the statistical needs which must be met by the classifications. Applied demography engenders critical thinking, and training in methods is also useful. Thinking demographically — applying the demographic framework — means, in his opinion, to be able to boil down information without losing the core of what must be communicated. When hired into his role, his predecessor decided it was this training — not any familiarity with the teachable specifics of the role — which made Dr. Anderson a viable candidate. Similarly, when doing hiring, Dr. Anderson stated he does not necessarily look for someone with lots of experience with mortality data, but rather someone smart, analytical, and methodological — qualities which are a sort of connoisseurship and can be adapted to freshly learned material, but are themselves cultivated through extensive and hard-to-replace training. Most federal statistical agencies are willing to train in the subject matter, if they are sure the person can pick it up quickly and deal with the methodological issues. Information that Dr. Anderson’s team publishes becomes part of the historical record of the United States, and the demographic profile of the United States is based on birth, death, and migration data to see how populations change. Although he does not mention it specifically, this highlights the issue of trust and credibility mentioned by Drs. Frost and Bedford below. However, Dr. Anderson does mention that the tension between the trustworthiness of the applied demography and the potential untrustworthiness of the data provided to the practitioner. For example, most of his work relies on death certificates, but sometimes medical errors are under-reported. His team must find a substantive answer to this challenge, as well as other challenges, through the demographic framework’s attention to methodologies and the heterogenization of populations to parse out specific and addressable problems.

Like Dr. Anderson, Dr. Frost also turned to the flexibility of applied demography as a defining point: an applied demographer will never know where their training might take them. Dr. Frost, a policy analyst at the Population Reference Bureau, has had a globe-trotting career which reflects her point literally and figuratively. She describes her work as filling the gap between academic research and demography on one side, and implementation and decision-making on the other side. People making decisions often lack demographic backgrounds, requiring applied demographers to bring the translations and capacity-building necessary for decision-makers to understand data and become informed. Additionally, the sociological principles in demography give the practitioner an ability to see social problems, map challenges across spaces and population segmentations, and ultimately tackle a specific problem. This helps with designing development programs and successfully competing them against other programs, including setting reach targets. There are many types of reporting which are generally very rigid and non-malleable snapshots of recent data, and there are also many multi-country, multi-year, deeply-interpreted reports that unfortunately rely on older data by the time they are published. The applied demographer, however, will need to use both these types of reports — with their respective shortcomings — to look at the best strategies for the immediate present or even a forecasted estimate of the future, especially when working with health and all the turbulent changes that can arise with diseases. Following this, the applied demographer is also involved with monitoring and evaluation. As Dr. Frost’s projects (and many other projects) are funded by governments through taxpayer dollars, she is accountable to ensuring programs are comprehensively and honestly evaluated. For this, the unique role of an applied demographer has elevated saliency. Demographic concepts — e.g. of populations with an unmet need, or the demographic dividend — come directly out of the demographic framework. These concepts demonstrate how the demographic framework can add complexity and understanding — leading ultimately to refinement, incisiveness, and powerfulness — for finding solutions to social problems. Dr. Frost gives the example of reducing rates of new HIV infections. It is one thing to fund broad prevention, but another thing to recognize which countries have the highest infection rates, where demographic groups are mostly being infected, and the ways they are being exposed to seropositive individuals. This type of knowledge results in more research-driven programs, and a more durable, cohortized, and descriptive measurement of results. Despite this sophistication, the mathematical tools used by many applied demographers are quite basic — in some cases, mostly consisting of rates, which are essentially just fractions as Dr. Frost joking describes them. However, her overall training includes the practicable ability to make determinations across many projects, and have a clarity of vision that allows her to effectively serve as a senior analyst supervising many projects.

Dr. Bedford, an epidemiologist at the CDC, also mentions flexibility as a key quality of his academic background as it relates to his career. His observations about applied demography and the demographic framework reinforce many other practitioners’ perspectives. His focus is on making sure data is collected correctly, analyzed correctly, and displayed in a way people understand. He oversees a project, but also does data quality analysis for multiple projects. In data quality analysis, he does not come up with programs, and he does not implement programs, but he answers the question, “Is this program doing what it is supposed to?” As mentioned earlier, however, the role of an applied demographer is uniquely embeddable. Dr. Bedford advises as early as the proposal stage, helping ascertain the measurability and evaluability of a program — and even the pre-proposal stage, helping analyze the very research and principles upon which a program builds its proposal. As a trained demographer, Dr. Bedford can answer questions about where information comes from, and whether it is good information for a particular inquiry. Like other practitioners, he reiterates that the mathematical models he uses are not extraordinarily complex — mostly, there are rates and ratios and their meanings. In this way, the demographic framework means using simple demographic tools to answer deep questions. This speaks to the role of the applied demographer in thinking through challenges to find speedy and precise solutions, including avoiding untranslatable and highly complex possibilities. While many practitioners in the health field such as medical doctors and epidemiologists enhance their careers by focusing on limited areas and a limited number of projects, a practitioner of the demographic framework takes the opposite course: greater experience across a broader range within a particular field helps the applied demographer be more useful, not less useful, especially to team which may be arrow-sharp but almost myopically specialized.

Applied demography, according to various practitioners in the health field, is increasingly sought-after by organizations. The reasons why shed light on its uniqueness compared to academic demography. While the idea of explanatory power and limited resources is fairly universal in applied demography, the uniqueness of applied demography is also about how it relates to altogether different fields and not just to academic demography. Dr. Bedford mentioned that agencies used to try programs without rigorous competition and evaluation, but now applied demographers are one of the types of researchers hired to see if programs are actually making changes. Sociologists may also fill these roles, but applied demographers are unique in their heightened training in discerning good and bad data, and the communication of results. Dr. Frost sheds additional light on this unique role of applied demography: when entering any meeting, she has immediate credibility and influence because of her background in applied demography. She is trusted to be able to evaluate not just the demographic characteristics that are part of a project, but the underlying data and other aspects. Dr. Bedford also mentioned time: applied demography is characterized by a paucity of time. This means that drilling down deep into results with a fine-tooth comb is highly unlikely, but application of a broad range of tools and experiences still allows practitioners to provide persuasive, authoritative, and communicable judgments of whatever is available — and to maintain a vision about moving forward.