As Public Scholars, we have the privilege of building more meaningful and deeper connections with the community. As a health equity researcher, it is important for me to align my work with public values and learn from as many different perspectives and lived experiences as I can. To me, meaningful public engagement is a two-way street. We learn from each other, and hopefully, that will lead to more relevant and useful research outputs.
Research Description
Chronic lung diseases are the second leading cause of hospitalization in Canada. Spirometry, a breathing test that measures how forcefully patients can exhale, is the most common test to diagnose and treat these conditions and is also used to assess fitness for employment and monitor occupational health. However, the history of spirometry is fraught with racism. In the 18th century, pro-slavery scientists in the United States noted that on average, Black Americans had lower lung function compared to white Americans and weaponized this observation to claim that Black bodies were inferior. This racist view persisted for a century, but after the civil rights movement, the lower lung function in racialized people was increasingly thought to be normal, leading to race-specific lung function reference equations. However, differences in lung function could also be due to early-life exposure to pollution and other complex environmental and social factors that disproportionately affect racialized populations. There is a risk that race-based reference equations could lead to underdiagnosis in racialized populations. In recent years, increased awareness of structural racism and disparities affecting racialized populations has led to calls to revisit race in medical algorithms. In 2023, leading respiratory medical societies endorsed a race-neutral lung function equation that removed the explicit use of race at the cost of reduced precision. However, fairness consequences of the new equation for different populations remain unknown, and the debate around the inclusion of race in spirometry has continued.
My doctoral thesis is on measuring the contribution of health disparities to the racial gaps in lung function and evaluating the fairness consequences of the recent transition from race-specific to race-neutral reference equations. In doing so, I draw on recent advances in algorithmic fairness literature and parallels in other medical specialties while paying attention to the historical and social context and downstream consequences. There are significant gaps in the public discourse surrounding the inclusion of race in spirometry reference values. So far, these debates have mostly been American-centric, and we do not know Canadian patients' perspectives. Additionally, Indigenous viewpoints have been entirely disregarded. Public discussions and debates lack nuance and are increasingly oversimplified. However, recent studies have revealed that the issue is much more complex than a binary question of whether race should be included in medical algorithms. Recent systematic reviews suggest algorithms can mitigate, perpetuate, or exacerbate racial disparities regardless of whether they explicitly use race as a predictor or not. To address these gaps, I have partnered with Legacy for Airway Health (LAH), a physician-led Vancouver-based organization with expertise in patient engagement and experienced journalists to produce short and high-quality media content to empower the public to have a more nuanced understanding of the issues around the inclusion of race in medical algorithms.
What does being a Public Scholar mean to you?
As Public Scholars, we have the privilege of building more meaningful and deeper connections with the community. As a health equity researcher, it is important for me to align my work with public values and learn from as many different perspectives and lived experiences as I can. To me, meaningful public engagement is a two-way street. We learn from each other, and hopefully, that will lead to more relevant and useful research outputs. This is especially important when it comes to communities that have been marginalized historically and whose values and concerns have not been recognized and taken into account in medical research. Many Indigenous and racialized peoples and communities have valid reasons to distrust researchers and medical institutions, as they have been harmed by research that prioritized the interests of the powerful at their expense, or worse, used to justify racism and colonialism.
In what ways do you think the PhD experience can be re-imagined with the Public Scholars Initiative?
The Public Scholars Initiative invites researchers to think broadly about the relevance and societal impact of their work. This requires us to closely examine biases and value judgments that go into our research. More often than that, scientific objectivity is nothing more than an illusion. From the choice of what we study to our methodological choices and decisions around what to publish, where to publish, and how to frame our results, there are so many value judgments and biases that affect our work. Public engagement allows us to see our work from different perspectives, become more conscious of the value choices that we are making, and find strategies to acknowledge and manage value judgments. The Public Scholars Initiative also encourages non-traditional research outputs which might be much more immediately useful to the wider society than a technical, scientific publication.
How do you envision connecting your PhD work with broader career possibilities?
Beyond academic careers, my PhD work on health equity and algorithmic harm is closely related to existing and emerging roles and career possibilities in government (public health, AI regulation and governance), healthcare (decision tool deployment, chief health AI officer), and tech (responsible AI and health equity researcher, product manager) sectors, so I hope I can have a range of possibilities for my future career.
How does your research engage with the larger community and social partners?
My research focuses on racial equity and algorithmic harm, which have been highlighted by public and grassroots movements. I am partnering with multiple patient and community groups to seek advice and feedback about my work. The goal of my project is to develop nuanced and high-quality educational media content and evaluate them in partnership with community groups.
Why did you decide to pursue a graduate degree?
Before starting this PhD, I worked for six years as a staff researcher at UBC which was rewarding, but I also wanted the freedom to work on what I was most interested in. The PhD allowed me to focus on the fairness and equity implications of medical algorithms, which I thought was a challenging and incredibly important topic, as these algorithms affect millions of patients.
Why did you choose to come to British Columbia and study at UBC?
Before starting my program, I had the privilege of working, living, and studying as an uninvited guest on the ancestral unceded territory of the xʷməθkʷəy̓əm (Musqueam) Nation at UBC for a few years. And what can I say, it is the most beautiful place! UBC is also a global leader in respiratory medicine, and I had connections that could facilitate patient and community engagement. All of this provided a perfect opportunity for me to work on the fairness of medical algorithms in respiratory medicine.
