Studying Social Networks to Address Health Inequities with Michelle Birkett, PhD

“I'm also really interested in helping the center to be a national resource for understanding the social and structural drivers of health by measurement tools like Network Canvas, by the modeling and analytic expertise of my team and my trainees and just in trying to bring folks together, bring scientists and community members together. I think there's a lot that we are doing that's sort of on the forefront and I hope to continue that and allow us to be a resource for others.” — Michelle Birkett, PhD 

• Associate Professor, Medical Social Sciences in the Division of Determinants of Health and of Preventive Medicine 
• Director, Center for Computational and Social Sciences in Health (COMPASS), Institute for AI and Medicine 
• Director, CONNECT Complex Systems and Health Disparities Research Program, Northwestern University,

As a public health scientist, Birkett’s work integrates a systems science perspective with transdisciplinary collaboration and community engagement. Her multiple breakthrough initiatives address health disparities among marginalized populations with innovative tools, such as Network Canvas, to create new paradigms of thinking when it comes to structural inequities that shape health outcomes. 

• Beginning her studies in engineering, Birkett eventually discovered her passion for systems thinking could be applied to public health issues, aligning with her eventual degree in counseling psychology.  
• While it’s known that gender and sexual minority individuals suffer from worse physical and mental health, she says little is understood about what shapes their exact pathways. 
• Instead of merely focusing on the individuals who have these health disparities, a systems science perspective allows for a broader perspective, looking instead at the social and the structural inequities around these marginalized individuals that are shaping their health. 
• Transdisciplinary collaboration is central to the CONNECT program, which Birkett leads. The research program provides a systems approach to health disparities that requires research and investigation from multiple disciplinary perspectives, including non-academic stakeholders. 
• To answer the urgent need for better analytic tools in this arena, Birkett spearheaded the development of a free but highly effective data capture tool, Network Canvas, to help synthesize mass amounts of quantitative data, now used by over 40 NIH funded studies.  
• The NIH has recently awarded the project a $3.2 million grant to convert the program to a cloud-based model. 
• Network Canvas has been extremely instrumental in targeting systemic drivers of the spread of HIV, particularly in studies looking at racially diverse men who have sex with men. It’s also been used successfully with The Justice Community Opioid Innovation Network, with NIH-funded Covid-19 research, as well as 40 other NIH funded projects.  
• Birkett also leads the NIH-funded SILOS project (Structural Inequities across Layers Of Social-Context as Drivers of HIV and Substance Use), which will not only capture data from 2,700 marginalized participants across five U.S. cities, but will implement a robust community engagement effort. 
• Recently Birkett was named director of The Center for Computational and Social Sciences and Health or COMPASS in the Institute for AI and Medicine at Northwestern which is meant to foster connection between data science and social science and population health. 
• Birkett celebrates Northwestern as an ideal home for transdisciplinary research, noting how her research has benefited especially from The Northwestern Institute on Complex Systems, The Institute for Policy Research, and The Institute for AI and Medicine. 

Recorded on October 21, 2024. 

Additional Reading 

• Check out the new center website for Center for Computational and Social Sciences and Health.
• Read Birkett's message as director of COMPASS.
• Review a publication in the International Journal of Epidemiology by Birkett.

Target Audience

Academic/Research, Multiple specialties

Learning Objectives

At the conclusion of this activity, participants will be able to:

1. Identify the research interests and initiatives of Feinberg faculty.
2. Discuss new updates in clinical and translational research.

Accreditation Statement

The Northwestern University Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

The Northwestern University Feinberg School of Medicine designates this Enduring Material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Board of Surgery Continuous Certification Program

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement(s) of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

Disclosure Statement

Michelle Birkett, PhD, has nothing to disclose. Course director, Robert Rosa, MD, has nothing to disclose. Planning committee member, Erin Spain, has nothing to disclose. FSM’s CME Leadership, Review Committee, and Staff have no relevant financial relationships with ineligible companies to disclose.

All the relevant financial relationships for these individuals have been mitigated.

[00:00:00] Erin Spain, MS: This is Breakthroughs, a podcast from Northwestern University Feinberg School of Medicine. I'm Erin Spain, host of the show. Understanding the systemic drivers of health disparities within marginalized populations is complex. It's known that stigma is indeed a root cause, but little is actually understood about the exact pathways that ultimately shape health outcomes. Michelle Birkett an associate professor of medical, social sciences, and preventive medicine at Feinberg joins me to talk about this topic and how she uses network and quantitative methodologies to investigate this issue and understand the social contextual influence of stigma on health and wellbeing of marginalized populations, in particular sexual and gender minority youth. She leads several NIH-funded studies we will be discussing today. Including network canvas, an open-source software, which helps researchers capture social network data. She is also the director of the connect research program within the Northwestern Institute for sexual and gender minority health and wellbeing. Welcome to the show, Michelle. 

[00:01:23] Michelle Birkett, PhD: Thanks for having me. 

[00:01:24] Erin Spain, MS: Let's start with a little bit about you. You're actually a trained adolescent health psychologist. What drew you into research and specifically using complex network data in the research setting? 

[00:01:36] Michelle Birkett, PhD: So, I actually, I started off in engineering in my training. I was always really interested in using math to understand systems and the way that happened originally was within engineering, but pretty quickly I realized that it wasn't the right fit for me and I started exploring other things. And I really found psychology and specifically counseling psychology as just to be this wonderful fit because not only did it feel very impactful in terms of studying the mental health, the physical health of populations, but I got this really fantastic training in trying to understand how systems impacted individuals and how to use you know, a multi-level perspective and how to use this data at these different levels, at family levels, at peer levels, at school levels, how we can start to understand how individuals are embedded within these systems and how their health is impacted. And I was especially drawn to adolescents. I'm, kind of, always drawn to folks who were just highly impacted by these structures who didn't have a lot of power sort of within themselves. And it felt especially important and that kind of grew into looking at sexual and gender minority populations and racial minority populations. 

[00:02:41] Erin Spain, MS: Well, while it's understood that health disparities are heavily linked to stigma, little is known about the exact pathways. Tell me about why this is so hard to track these disparities. 

[00:02:52] Michelle Birkett, PhD: Absolutely. So, the way that health disparities develop, we don't really know why this happens yet. We know across the board across a number of different marginalized populations, whether it's racial minorities, sexual and gender minorities, folks who have lower SES. We know that those populations have worse health, whether it's mental health, physical health, infectious disease. A lot of my work is within HIV, but we don't yet have a good understanding of why that happens. And I think one of the reasons we don't have that good understanding is because we are so used to there being one specific pathway that causes a disease to happen. What ends up happening is that within the drivers of population health are really complex. And oftentimes it's the result of many things. It's the result of these intersecting individual, relational, environmental processes. And a system science perspective, it's different sort way, a different shift in the paradigm of understanding this work, away from one specific pathway instead of focusing on how an entire system fits together to produce health within a particular population. I think a systems level understanding, it allows us to remove our focus on just the individuals who have these health disparities and instead to be thinking about what are all the social and the structural inequities around these marginalized individuals that are shaping their health. So it's not racial or sexual or gender minority individuals themselves, it's their peer relationships. It's the different relationships they might have with their families. It might be the societal reactions that they experience on a day to day that shape their health and expose them to risk. That might look like a lack of social support. That might look like increased likelihood for rejection by families or employers, or it might look like not having access to neighborhoods that will allow them to be healthy. It might mean that their housing quality might be a little bit worse. There are innumerable things that I could be listing here. And this system's perspective allows you to take more of a broader look across all these things to start to think about how are things like racism and homophobia and poverty, how are these structural things actually affecting people on a day to day in numerous ways. 

[00:05:03] Erin Spain, MS: So a systems perspective is important, but you also say that transdisciplinary collaboration is also key to understanding this complex issue. Tell me more about that. 

[00:05:15] Michelle Birkett, PhD: I think that it's so essential 'cause no one domain or discipline has a full understanding. It doesn't have the full picture. When we're talking about these real world challenges, we really need have a lot of people at this table to be working together. So that means, when I say transdisciplinary, I mean bringing together and integrating knowledge from a lot of different academic disciplines, and also bringing in folks who are non-academic stakeholders to try to address some real-world challenges. And really to do that in equal partnership with each other in order to amplify the voices of folks who may be usually left out of a lot of collaborations that involve academic partners. Uniting social scientists and health researchers, they bring this in-depth knowledge of the populations and the systems that they're researching. And then you can also bring in folks with the analytic expertise and the methodological expertise. It's not easy to do this kind of work. Collaboration across disciplines is not easy, especially within academic settings oftentimes 'cause there's so many different competing priorities. But it's so important. We have to be in the same spaces. We have to start to build trust with each other and learn each other's languages and uncover each other's perspectives and priorities so we can start to work together and do really transformational work. 

[00:06:32] Erin Spain, MS: And it's not only about having the right team of people, but about having the right tools as well, accurately measuring multiple complex social systems, this is still fairly new, and the tools are still being designed to capture and work with this data. Now, you've been part of this with your own research, Network Canvas, for example, has been an enormous success as a free software tool for researchers. Tell me about Network Canvas and this urgent need for data capture tools. 

[00:06:59] Michelle Birkett, PhD: When I got into the space as a psychologist who was really interested in understanding health disparities with quantitative data, I needed a way of understanding the people around the populations I was interested in and to measure that really efficiently and to be able to have this strong, empirical understanding. But there weren't a lot of tools out there. And so, within Network Canvas, I lead a team of folks who have just done a fantastic job in terms of building, supporting the software over the years. It is a free and open source tool. It's supported by the NIH and the NIH Office of Data Science Strategy. It has been experiencing broad uptake by the research community and it allows for researchers to design their own network instruments and deploy it. So, you know, folks are able to design their own studies, and so far, it's only been available for several years now, but already we've seen over 40 NIH funded studies that are utilizing Network Canvas currently in the field. And it's growing quickly. It's been fantastic to see. And I feel really proud of just the ability to help other scientists begin to incorporate this perspective in and allow them to bring network data into their analyses. 

[00:08:17] Erin Spain, MS: One success story I wanna talk about is how Network Canvas has been central to understanding drivers of the spread of HIV and other infectious diseases. Explain how the software is helping move the needle forward in understanding HIV in this system's context. 

[00:08:33] Michelle Birkett, PhD: With Network Canvas, we've been able to get really good data on the kinds of people that the folks that we're interested in, mostly men who have sex with men, racially diverse men who have sex with men. Information about the kind of folks that they tend to be connected to. So that might be social relationships, that might be sexual relationships. It also allows us to get an understanding of the kind of places that people go, not just where people live, but like where they go to socially, the kinds of physical spaces that they're utilizing. And by getting that understanding, we can see across the populations how, especially for the most marginalized folks, so these are folks at the intersection of multiple marginalized identities. So black, Hispanic, trans individuals. We can see differences in where people live, in where they go, in where they spend their time, and who they're connected to, and how these differences allow certain populations, especially the most marginalized populations, to be pulled together in ways that amplify infectious disease risk. So when infectious disease enters a certain community, it spreads faster because of these relationships. This is what we're seeing within HIV. This is also something folks will be familiar with the huge disparities within COVID with some populations being so impacted. So what this tool is allowing us to do is to better target. So often within public health, the area that we focus on in terms of our interventions, it's often at an individual level. So it's often things like, you know, within HIV we might be thinking of condoms. We might be thinking of folks, maybe they don't have the knowledge, so let's put them into a training. But what we're actually seeing is that if we look at an individual level, the most marginalized populations, they're not doing things differently. We actually see that at the individual level are doing things either more safely, better. They're using condoms just as much, if not more. They are getting tested just as much. And so if we want to alleviate disparities, that might look like instead trying to examine the allocation of resources by neighborhood, by venue. So that might be like certain places that are very important to target. It's starting to understand the fact that there's so much racial segregation and not just like in neighborhoods that people live, but also in the places people go, in the schools people attend, that these are also ways of racism impacting and increasing the disparities in health. And that until that we start to have less segregation in these spaces, and that until the resources are more proportionally allocated across these levels, we're never going to impact disparities. And I think this is the importance of this is that this fundamental understanding of the mechanisms that are driving is so essential before we can even think to start to intervening in a way that's going to actually alleviate disparities. 

[00:11:23] Erin Spain, MS: You actually received a $3.2 million grant from the National Institute on drug abuse of the NIH to make a cloud-based version of this software making it even more accessible to researchers. Where do you see this going? 

[00:11:35] Michelle Birkett, PhD: This is really exciting and this is something that, especially during Covid, we were wrapping up our first R01, building the tool, but it was a tool that required it to be used in person. And then during Covid everything switched to remote and it became so essential to be able to shift our platform online and to modernize it. And so this came right at the most perfect time. And we are in the early stages right now, but we already have a very sort of initial version called Fresco that folks are able to use currently to deploy small scale studies. And it's been fantastic. It's really going to enable this kind of work to be done and reach far more individuals than have ever been able to be reached before. 

[00:12:17] Erin Spain, MS: I am curious just in this recent last few years, what are some of the projects outside of Northwestern that you've heard of that are using this tool? 

[00:12:24] Michelle Birkett, PhD: So for example we got involved several years ago with JCOIN which is The Justice Community Opioid Innovation Network. And this was work led by Dr. Carrie Oser, trying to understand the networks of folks who are recently incarcerated and understand their networks as they got out of jail. And it's been a fantastic partnership there. We've also worked with folks within the COVID-19 funded work right after the pandemic started. Some of this was done with NIH funded large scale studies led by John Schneider and Harold Pollack. We also worked with Howard Brown, and we were one of the first, when Covid first started, they reached out to us and asked if they could utilize our tool for Covid. And we had thousands of interviews that were done before they had a more wide scale tool that they could start implementing. So for months they were using Network Canvas. And, it's been amazing to see how far this is being used. A core sort of tenant of our work is that we want people to feel safe using our tool. We try not to capture a lot of data about anything. Like we want this tool to be used and we want people to reach out to us and let us know. So a lot of this has been just people reaching out to us, telling us what they're using it for. And it's just been fantastic to see. 

[00:13:42] Erin Spain, MS: Tell me a little bit about some of the visuals that you're able to generate from this data and how that can really help drive home some of the research findings. 

[00:13:53] Dr. Michelle Birkett: A big part of this, and a lot of this is due to Joshua Melville, who is a sociologist who is also the developer of our tool. And he's just fantastic when it comes to design. And, his design sense has really influenced Network Canvas quite a bit. We really prioritize that the tool it's easy to use for researchers and it's easy to use for research participants. And so the tool is very visual, is designed to be beautiful, and to be very clean so that the participants can really focus on the task, and what they're doing is they're building a network visually, so they are drawing on a screen. It supports touchscreen. And you are building your network. You are answering questions about, who are the people in your life that are important to you, that are supportive of you? And you might be giving their names. Each of those individuals appears as a circle on the screen, and then you go through a number of different interfaces where you're answering questions about these individuals. You are dragging and dropping these circles into buckets. You are interacting with them. You're drawing connections between them, like who of these people are friends with each other or who is in conflict with each other and drawing those ties. If you were to try to do this in a typical survey, it would be very complicated. But the fact that we are doing it in this visual and trying to make everything very tangible and interactive, it just opens up the data that they're able to give and it becomes a very engaging experience for a participant completing the survey. They really seem to love it. the drawing of people's networks, it allows them an ability to see at a different level, things that they knew, but once they see it on a screen all together, it just crystallizes and they seem to generate their own insights about their network. Oftentimes when we're doing these interviews in person, people just wanna tell us their whole life story because, in the moment, they're generating these new insights. 

[00:15:53] Erin Spain, MS: I want to talk a little bit about a new project called the Silos Project, which was recently funded $3.8 million by the NIH for five years. Silos stands for Structural Inequities Across Layers of Social Context as drivers of HIV and substance use. Tell me about this project. 

[00:16:10] Michelle Birkett, PhD: I'm very excited about this work. This is expanding some initial work called chiSTIG, which was focused really on utilizing existing data from the radar cohort which is based within Chicago to look just within Chicago and this is expanding it into five cities. We are using innovative data capture with Network Canvas and sophisticated modeling to quantify segregation. So where people live and where they go and spend their time and who they're connected to and how that functions as a core driver of racial inequities in HIV. We are going to Atlanta, to New York, to Chicago, Miami, and Houston, and we're capturing 2,700 observations of young men who have sex with men, who are gonna be answering questions about where they go and where they spend their time. And what's really cool about this, it's a very large team. We are partnering with folks we've been working with for some time, at Argonne National Labs and using simulation models to understand population level differences in the interactions between marginalized people particularly multiple marginalized folks. And how those differences impact both substance use and HIV. And, the work isn't all modeling and isn't all computational, though that's a massive part of this work. But also we have a really robust plan for community engagement. And we are gonna be building community advisory boards, comprising racially diverse YMSM and trans women across all of our five cities. We are also pulling in our community our cab members from our prior study to also be part of this. So we're maintaining those relationships and they're really integral and making the success of this work. Especially in a project that's so focused on simulation and computational models, we need to figure out ways of bringing the voices of actual populations and people into this as much as we can because. Without that, I mean, I think it's part of the reason for the name Silos is that we don't want these communities to be siloed. We want as much as possible, the folks who are doing the modeling work and the folks with the lived experience to be in the same spaces and to build that understanding. 

[00:18:15] Erin Spain, MS: I mean, I feel like that's a fairly unique approach. You're working with national labs, you're using the most sophisticated technologies, but then also as you said, the people who are on the ground, you're bringing these teams together. How unique is this approach? 

[00:18:29] Michelle Birkett, PhD: I would say it's very unique, but I also think that this is absolutely the way forward. I think that I see so many more young folks and young researchers, this is exactly the pathway that they are. Especially I see a lot of racially diverse folks or folks who are in some way in a marginalized group who have this quantitative expertise and who know that the questions that are being asked and answered currently with their computational tools aren't reflective of the real world questions that need to be asked and answered. And I see more and more that people are passionate about this and breaking down boundaries and working interdisciplinary. But it's hard and it takes time and resources to do this work. 

[00:19:12] Erin Spain, MS: Given what you just said there, why is Northwestern such a good match for this type of work? Tell me about the support you have and the institutes that are in place, and the people and the tools that you have access to. How does Northwestern foster this type of work? 

[00:19:26] Michelle Birkett, PhD: I think Northwestern is just a fantastic home for transdisciplinary research. I know as a psychologist down at Feinberg, I benefited so much my mentorship that I got around campus, whether one of my mentors is Nosh Contractor who's on the north campus in communications and leads the Sonic research group. I've also benefited substantially from connections to NICO, the Northwestern Institute on Complex Systems as well as IPR. It's Institute for Policy Research. I mean, these are all places where, truly, like large challenges are being tackled by groups of folks who are working across disciplines. And to have that in addition to the support within Feinberg, especially recently with The Institute for AI and Medicine and this prioritization of data science. It's just been a really exciting place to be. I see a lot of investment in the kind of people that are doing the kinda work that I think needs to be done, and it's, it's very exciting. 

[00:20:24] Erin Spain, MS: Speaking of the Institute for AI and medicine here at Northwestern. I understand that you will be directing a center within the Institute. Tell me about that. 

[00:20:34] Michelle Birkett, PhD: This new center, the Center for Computational and Social Sciences and Health or COMPASS is really meant to foster connection between data science and social science and population health, because we believe that these connections are going to increase our capacity for doing cutting edge research, which uses social and behavioral science and computational methodology to understand the health of populations. Focuses within the center are trying to improve the ability for folks across different disciplines to collaborate, bringing in knowledge from lots of different places as well as non-academic stakeholders. And bringing them equal partnership with each other together and just uniting folks and not just across disciplines. Also thinking across campus. There's so much expertise on the North campus but also a lot of want for folks who are on the North campus to be connected to folks in the School of Medicine who have this real world understanding about, especially a lot of folks are doing so much work within Chicago itself, and folks are interested in using their computational expertise to have local impact. And just bringing folks together I think is so important. I think another part of this I'm really excited about is to train the next generation of population health scholars. So people who are diverse who can work across disciplines who are highly skilled in that responsible application of cutting edge computational methods to understand the health of populations. It doesn't happen oftentimes, either if you are focused on population health, it might be very hard for you to get training in certain computational methods. I'm thinking about network analysis, simulation, agent-based modeling, and just like the using of these different kinds of data and tools, sometimes it can be very hard. And then also for folks who are getting the training in utilizing these tools, they might have a very hard time in getting training about the ethical, the responsible application of these tools to populations. And we need both. We can't have one without the other. And I think supporting mentees who being mentored by folks across campus, it's just a no-brainer in terms of how we can make some wonderful scientists who are going to help us tackle some of these huge challenges. 

[00:22:53] Erin Spain, MS: With so many new initiatives under way. Tell me, what do you hope to see happen within your research in the next five years or 10 years? 

[00:23:00] Michelle Birkett, PhD: I'm really excited to, through the work of Silos, be able to look at some of the things we've started to look at within Chicago and to see them across other cities. I'm so excited about that. I'm also really interested in helping the center to be a national resource for understanding the social and structural drivers of health by measurement tools like Network Canvas, by the modeling and analytic expertise is of my team and my trainees and just in trying to bring folks together bring scientists and community members together I think there's a lot that we are doing that's sort of on the forefront and I hope to continue that and allow us to be a resource for others. 

[00:23:43] Erin Spain, MS: Well, thank you so much for this overview of all the work that you've been doing and what's to come, and I appreciate your time today. 

[00:23:51] Michelle Birkett, PhD: Thank you so much. 

[00:23:52] Erin Spain, MS: Thanks for listening, and be sure to subscribe to this show on Apple Podcasts or wherever you listen to podcasts. And rate and review us also for medical professionals. This episode of Breakthroughs is available for CME Credit. Go to our website, feinberg northwestern edu, and search CME.