Finding your cat story: Perspectives from the founding director of the health policy research scholars program

I was delighted when I received word in 2015 that I had been selected to serve as principal investigator and director of the Health Policy Research Scholars (HPRS) program.1 The Robert Wood Johnson Foundation (RWJF) had recently restructured its portfolio of “human capital” grant programs. As part of the restructuring, the foundation ended some programs, such as the New Connections, reimagined other programs, such as the Clinical Scholars Program, and created new programs, such as Interdisciplinary Research Leaders, and Culture of Health Leaders. But the new program that I was most interested in was Health Policy Research Scholars, which was designed to develop the next generation of health equity scholars, an awesomely important task that I would share with my partners Drs. Harolyn Belcher and Lydia Isaac. The primary purpose of the HPRS program was to form a multi-disciplinary cadre of scholars who would use their discipline-based skills to create new knowledge about policy solutions to health inequities. As stewards of this new program, our task was to help the scholars develop the leadership and advocacy skills necessary to be effective in the health policy arena. This was a dream opportunity for me. I had been a faculty member at the Johns Hopkins Bloomberg School of Public Health for more than two decades, working to increase the ranks of health policy researchers who were focused on health inequity. And now RWJF was actually going to provide the resources to train 40 scholars per year from universities across the country. There was no template for such a program, so we would have to create one. And the foundation insisted that we do it fast. We received word that we were selected to lead the program in the fall of 2015. And we were expected to select the scholars by the spring of 2016. We had to, metaphorically, build the airplane while flying it, or perhaps more like writing the user's manual while taxiing down the runway. In some ways determining the curriculum was the easy part. The scholars needed to know how to write and deliver testimony, write decision memos, learn the organization and structure of government, be familiar with key theories and frameworks in health policy. However, we needed much more than just a curriculum. The program needed to attend to the social and developmental aspect of the scholars as well. Many of the scholars were first-generation college students, many of them were from families or communities that faced economic and social challenges that could impact their ability to focus on their studies. Some scholars sent a portion of the monthly stipend the program provided home to help support their families, others had the daunting challenge of navigating the complexity of not having legal status within the United States, and some were even providing housing for younger siblings in their apartment at school. The challenges some of the HPRS scholars faced were numerous and complex and we set up structures to try to support them. The HPRS scholars were working on research to address health inequities, but sometimes there were not faculty members at their institution that had the appropriate expertise to support their research interests. In some cases, the topics they wanted to research were not viewed as important in their academic departments. This left some of the scholars working in a vacuum without the support and mentorship that other students in their doctoral program enjoyed. The HPRS program supplemented the scholar's mentorship network to fill the vacuum with someone from outside of their home institution that could provide the needed mentorship. We sought to make HPRS a national network of peers that would help to address the isolation that students of color and first-generation students can sometimes feel in the academic world. One unique aspect of the program was our atypical approach to selecting the scholars from the large number of highly qualified applicants. We chose 40 candidates who were newly admitted PhD students at universities across the country. The scholars came from diverse academic fields, ranging from statistics to film studies, from botany to history, from architecture to demography. Unconvinced that undergraduate GPA or GRE scores were indicators of leadership potential, we looked for indicators of curiosity, creativity, leadership, and the commitment to enact change, rather than merely selecting the applicants with the highest GPA or GRE score. We sought to create a space where the scholars would feel comfortable sharing their successes and challenges with each other and with program staff. Through that process we learned the extent to which impostor syndrome affected many of them. Impostor syndrome refers to that self-negating inferiority complex when talented and accomplished people feel that they do not deserve their accomplishments. This is the defeating idea that they somehow “fooled everybody” and are merely experiencing the trappings of success, but not the true substance of success. Impostor syndrome can affect anyone but especially affects people of color and women. But, even though some of them did not seem to know it, the HPRS scholars were selected because they were the best of the best. We found every way we could imagine to remind them as often as we could. In fact, I view the HPRS scholars as important national assets with the potential to influence the creation of a more equitable and inclusive society. Never have I been more convinced than I am today that they will make major contributions. The incredible breadth of the scholarship in this special issue of HSR gives me confidence that we were right. Within the doctoral programs they were completing, they would learn to communicate within the tradition of their academic disciplines. Our task was to train them to also be effective advocates for addressing health inequity within the policy arena. Academics are trained to present evidence in a nuanced way that sometimes can come across as equivocal. “Well Senator, one study found this was true, but on the other hand another study found it was not true, so let me explain to you the various details of each study.” Unfortunately, this does not work well in public policy. Policymakers need to make decisions, the best decisions that they can, using the best information that's available. I was at the Maryland State Capitol to testify in support of a bill related to health inequities. While awaiting my turn I listened in on others who were testifying before me. One academic after the other talked about their research and in many cases went into detail about their data analysis. Statistics and facts ruled. I saw the collective glazing over committee members' eyes. The last thing they needed was another long-winded presentation with fancy words and statistics that did not give definitive recommendations. One speaker took a very different tack. She told a story. Honestly, I do not recall the details of the story, but it was something about a cat that had climbed an electrical pole. The police had to get involved. The committee members perked up and listened as this master storyteller regaled them with her cat story. She related her story to her opposition to the legislation that I and most of the other academics were there to support. From the tone of the questions and comments from the committee members, it was evident that the women and her cat story were going to win the day. That was the lightbulb moment! Explaining scientific findings via a story was much more effective than pummeling people with facts and expecting them to see things your way. Story trumps data. Clarity trumps equivocation. We built the cat story into the design of the program. Teaching the HPRS scholars to use the power of story to create connection and relatability and convey a call to action. The point of a cat story is to use metaphor to illustrate the argument that was supported by the data. Over the course of my 3 years standing up and running the program, the scholars were taught the importance of having a good cat story to function more effectively in the practical world of public health policy and communicating science to the public. But, perhaps my most important goal as founding director was for the HPRS scholars to become a national network that would support each other's success. I left the program in 2018. The rigors of a deanship at a leading school of public health were incompatible with running the program. The program was on a solid footing, yet still relatively new and fragile. I hoped that the network would continue to strengthen. My hopes recently became a reality when I saw on social media a photograph that assured me that we had succeeded. Six HPRS scholars from the first cohort posted a picture reuniting for lunch while attending a national conference. Almost a decade later, they have lasting bonds and continue to help each other succeed. The initial cohorts of HPRS scholars used to joke about the cat story concept. We even created a cat story t-shirt as an unofficial symbol of the program. Although they were not wearing those t-shirts at that lunch, they—and all the graduates of the HPRS program—are creating their own cat stories and making a difference in advancing health equity. And I am immensely proud to have been a part of it. No funding to report.