Meeting the Moment

At the Brown School of Public Health, where Nunn has been doing innovative community work since 2011, she says she has been fortunate to be supported by mentors and colleagues. In 2020, Nunn and Philip Chan MD, associate professor of medicine and of behavioral and social sciences, started the Open Door Health clinic to serve Rhode Island’s LGBTQ+ community. Their goal was to create a welcoming, affirming environment, where patients receive LGBTQ+-focused primary care, sexual health, and STI testing.

At the time, Rhode Island was one of 13 states without an LGBTQ health clinic. Decorated with bright colors and sophisticated art more likely to be found in a club than a health facility, every facet of the clinic is designed to offer medical care in an affirming and upbeat environment. Years of research shaped the clinic’s approach, including on barriers to sexual health care access, on what types of services were most needed, and on the best environment for making LGBTQ+ clients feel safe and welcome.

Open Door Health opened on March 2, two days after Rhode Island’s first COVID case was diagnosed. Forced to find its feet during the early days of the pandemic, Open Door—like every other public health facility—faced staff shortages and obstacles to offering services. But it also found opportunities. The clinic opened one of the first community-based testing sites in the state with assistance and training by the Rhode Island National Guard. Today, the clinic is flourishing while meeting its mission. Forty percent of its clients are Hispanic/Latinx, and ten percent of all new HIV diagnoses in the state in 2021 came from Open Door Health.

When monkeypox arrived, for Nunn it felt like another tidal wave. But there was no question about whether Open Door would tackle another epidemic. “Look, everyone is short staffed and exhausted,” says Nunn. “But when monkeypox came, we had no hesitation. This is our tribe, these are the people we serve. There was no other option than to be responsive.”

Despite a short supply of monkeypox vaccine, the clinic committed to vaccinating every one of its eligible patients. In the first two weeks of August 2022, the clinic had administered 500 doses and diagnosed about half of the cases in the state. It was the only clinic with a monkeypox prevention and treatment campaign—informed by the qualitative research Nunn conducted in bars earlier in the month.

Open Door Health is emblematic of Nunn’s applied public health work over the course of her career. The daughter of two civil rights leaders in Little Rock, Arkansas, she says social justice is in her blood. She attended the first desegregated high school in the city and studied to be an ethnographer. Now 44, and with two children of her own, her drive to make a difference is as strong as ever. “Stasis is not an option. I want to make a difference. I’m judicious in what I choose, but I try to hit a home run when I commit.”

Nunn holds up Nourish Rhode Island as another example of how research can be applied to direct policy action. The Retail SNAP Incentive Program, which garnered a major policy win in 2021 with an $11.1M investment by the Rhode Island legislature, provides an automatic 50% discount on fresh fruit and vegetables for all SNAP recipients throughout the state when paying with their benefits at grocery stores. This program was based on research from Food on the Move, the Rhode Island Public Health Institute’s mobile produce market that serves over 5,000 low-income Rhode Islanders every year and has been associated with dramatic improvements in healthy eating behaviors among SNAP recipients.

Will Goedel has been dreaming of maps since he was six and his grandfather gave him an atlas. Young Will spent hours turning the pages and poring over the maps. At the time, no one in his family had ever been to college, and he had no way of knowing that his love for maps would direct his career and life’s work.

By the time he went to college at NYU, Goedel planned to be an LGBTQ+ primary care physician. His college days were also the early days of pre-exposure prophylaxis (or PrEP), a medicine taken to prevent contracting HIV. Despite being highly effective, there was disagreement in the medical community about how best to use PrEP, which meant distribution was limited. “We couldn’t understand why our friends were getting diagnosed with HIV when there was this treatment. They hadn’t been able to access it,” says Goedel.

Eventually, public health felt more relevant than medicine to Goedel. With a double major in public health and sociology, he turned to studying neighborhoods using GIS mapping systems. His interests focused on how cities and neighborhoods worked, and how historical disinvestments in the country led to deep inequalities. Eventually, inspired in part by questions of access and equity that HIV had raised for him, Goedel turned his attention to marrying GIS systems and public health. He did his undergraduate work at NYU and earned a Ph.D. in epidemiology from the Brown School of Public Health.

During his graduate work, he came to value the University’s approach to applied research. “One of the things I value about Brown is that things are always done with a partner that can make a change based on the work we do. The collaboration between the School and the public health department was essentially baked into the doctoral work I was doing.”

On June 1, 2020, Goedel joined the faculty at Brown University. “It was all hands on deck,” he says of entering his new position during COVID. In addition to online teaching, he jumped into developing GIS mapping applications to identify which neighborhoods in Rhode Island were susceptible to health disparities, and where additional testing and outreach was needed.

When vaccines became available, this same type of analysis was used to inform decisions on where to distribute vaccines. Goedel still updates a map every two weeks with the latest COVID data. This data serves many purposes: it helps direct vaccines and boosters, directs media attention, and informs partnerships.

Goedel’s work has been parlayed into setting up data academies, where public health clinicians, advocates, and community health workers learn how to use data to better do their jobs. He calls these “data soundbites.”

“We want to find and train data champions,” he says. “Pairing data with storytelling in a way that allows people to make their case feels like one of the most important things I can do.”

When monkeypox was discovered and began to spread, Goedel found another outlet for his GIS work on health data in an advocacy group called RESPND-MI, or Rapid Epidemiologic Study of Prevalence, Network, and Demographics of Monkeypox Infection. The project began, according to Goedel, as “a ragtag team” of advocates and scientists watching with concern as monkeypox spread seemingly unabated.

On August 30, 2022 the group launched a community-led survey of monkeypox symptoms and networks among queer and trans people in New York City. The project holds weekly meetings and has evolved into a unique consortium of 19 co-investigators, with expertise in activism, network science, biostatistics, clinical medicine, virology, marketing, communications, and health policy.

In partnership with that group, Goedel has been modeling projections of monkeypox transmission that can be used to inform behavior change communications, and vaccine coverage. “What has been clear about monkeypox and is unique to our time, is that our health department capacity is even more limited than pre-pandemic,” he explains. “They can’t possibly collect all the data, so there need to be alternative methods of supplementing that to reach those most at risk.

“We don’t have the luxury of choosing whether to be a scholar or an activist,” Goedel says firmly. “I believe that my job is to be a footnote to the movement work. So I’ve asked myself, what does a movement actor need to make the case? My answer is that the data I provide must support the work, has to be easily translatable, and it needs to be good, clear, and relevant.”

The sequential public health emergencies of COVID-19, and now monkeypox, are doing their part to change the face of both public health and academia across the country. At the Brown University School of Public Health, rigor is balanced with the needs of local communities and on-the-ground public health realities. Investigators are encouraged to use the data they collect to improve the lives of those who have been marginalized or overlooked.

More academics, like Nunn and Goedel, are choosing to bypass traditional academic outputs for a more applied, and impactful, role in the community. They’re not ignoring research. Rather, they’re using it as a launchpad for social change and direct public health action in the communities that need it most.

Nunn believes that the image of the university scientist as detached from the real world is already changing. “Academia needs a cultural shift. It does not traditionally reward service, and we need to change this,” she says. When asked about the tradeoffs she’s had to make, she says there are some: for example, she does less committee and research work. “It can be lonely,” she says, but then she pauses, and smiles. “But I think we’ve proven our worth.”