Insist, Resist, Enlist, Persist: Dr Julie Smith reflects on a lifetime of research impact
1. What’s your key take-home message for achieving research impact?
Being ‘an academic’ should not mean your life‘s work cannot be to change the world. Universities are increasingly places where research is expected to provide new knowledge and understanding that is valued for being relevant and useful for improving people‘s lives. The changed focus partly reflects a growing presence of female scholars who prioritise real-world impact over ‘esoteric excellence’.
2. Tell us a little bit about the research impact.
Since coming to the Research School of Population Health in the 1990s as a casual research assistant then a Visiting Fellow, my research has;
- Informed Australia’s national dietary guidelines on the economic benefits and cost savings from enabling women to breastfeed, by protecting, supporting and promoting it
- Been used by international experts advising the French President to illustrate how poorly GDP [Gross Domestic Product] measures the economy and distorts policy and economic growth patterns
- Drawn attention to how economic and commercial factors shape women’s breastfeeding decisions – by being kept ‘too busy to breastfeed’, mothers are pressured to buy commercial baby foods
- Helped shape Australia’s National Breastfeeding Strategy, led US Congress members to include breastfeeding support initiatives in Obamacare by showing it contributes to affordable health care
- Put ‘Breastfeeding Economics’ on the research agenda for the World Health Organization, the US Surgeon General’s Office, the World Bank, and the Gates Foundation.
3. What have you learnt―that others could benefit from―about how to achieve research impact?
Firstly, insist that the unthinkable can be achievable. For example, who would have thought that two Nobel prize winners 1 would use my work 2 to exemplify how badly GDP measures genuine economic progress. Or that pioneering feminist economist Marilyn Waring would use my estimates of the economic value of human milk in her influential books and high-profile international lectures.3 Speaking the language of national accountants, helped get them to listen. Research can provide compelling evidence to create public awareness, and create an appetite for something to be done. Economics is the language of policymakers, so showing the health system costs and benefits in dollar terms, even for something as intangible as breastfeeding, gets attention. When I briefed Congressional staffers on my estimates of the Australian hospital system costs of low breastfeeding rates,4 US Congressional members quickly spotted an opportunity to include ‘breastfeeding promotion’ measures in the Affordable Care Act (“Obamacare”). Thousands more US women were helped to breastfeed as a result of the new law.5
Secondly, resist pressures to be conventional. Be brave, and wear a flak jacket. Powerful opposing interests will of course use their influence, for example, Big Formula [infant formula manufacturers] aims to maximise market size and growth. As tobacco control researchers have done, be aware of industry interests, and understand and expose their opposing perspectives and strategies for marketing and policy interference.6,7 Show the consequences of doing nothing 6 and publicise it 8-10. Help show what needs to be done.11
Thirdly, enlist others with similar commitment and passion, and engage deeply with those travelling in the same direction. Having worked as a volunteer with breastfeeding support and advocacy organisations internationally and nationally since the early 2000s, I was able to pull together top level research teams from these networks at very short notice to do commissioned work for the World Health Organization and the Department of Health on commercial baby food marketing,12 and breastfeeding support strategies.13 Stepping up as a volunteer can influence policy at various levels. For example, preparing a national breastfeeding leadership plan as a volunteer for the Australian Breastfeeding Association14 informed its influential public health advocacy, then triggered and informed a Parliamentary Inquiry in 2007,15-17 which generated a national breastfeeding strategy.18 As an academic, your expert contributions to such government inquiries and consultations can be influential, and the media values new ideas on current issues. Keep in touch with policymakers and parliamentary processes. Practice ten second grabs.
Finally, persist. Be generous in sharing ideas on what needs to be done, even if it means it takes until the next generation of researchers for it to be funded! A major study in The Lancet on ‘Investing in Breastfeeding’ in 2016 estimated the national economic productivity effects of cognitive losses from low breastfeeding rates in countries like Australia.19 I had advocated such research including through the International Baby Food Action Network after being scathingly criticized and denied Australian Research Council funding for this in 2006. Networking and discussion with participants at a non-governmental organisation event made it happen. You can get the research done and achieve your goals without getting funding. Consider leaving Australia to get quicker results.
1. Stiglitz JE, Sen A, Fitoussi JP. The measurement of economic performance and social progress revisited; Reflections and overview. Paris: French Observatory of Economic Conditions - Economics Research Center 2009 December
2. Smith JP, Ingham LH. Mothers' milk and measures of economic output. Feminist Economics 2005;11:41-62.
3. Waring M. Still Counting: Wellbeing, Women's Work and Policy-making: Bridget Williams Books; 2018.
4. Smith JP, Thompson JF, Ellwood DA. Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory. Australian and New Zealand Journal of Public Health 2002;26:543-51.
5. Kapinos KA, Bullinger L, Gurley-Calvez T. The Affordable Care Act, Breastfeeding, and Breast Pump Health Insurance Coverage. JAMA Pediatr 2018;172:1002-4.
6. Smith J, Blake M. Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950-2010. Aust N Z J Public Health 2013;37:337-44.
7. Smith JP, Iellamo A, Baker P, eds. Child health is on the line as Codex deliberates food standards https://croakey.org/child-health-is-on-the-line-as-codex-deliberates-food-standards/2018.
8. Baker P, Smith J, Salmon L, et al. Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway? Public Health Nutr 2016;19:2540-50.
9. Smith JP. Baby care needs nurturing. The Canberra Times 2014 23-24 March.
10. Salmon L, Smith JP, Heads J. Marketing of milks for infants and young children: Effective regulation is urgent. Crikey2013.
11. World Health Organization (WHO). Guidance on ending the inappropriate promotion of foods for infants and young children Geneva: World Health Organization (WHO),; 2018
12. Smith JP, Sargent GM, Mehta K, et al. A rapid evidence assessment: Does marketing of commercially available complementary foods affect infant and young child feeding? . Geneva: Commissioned by the World Health Organization; 2015 May
13. Smith JP, Cattaneo A, Iellamo A, et al. Review of effective strategies to promote breastfeeding: an Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Australian Department of Health 2018.
14. Breastfeeding Leadership Plan. 2004. (Accessed 10 July 2015, at https://www.breastfeeding.asn.au/system/files/030804abastrategy.pdf.)
15. House of Representatives Standing Committee on Health and Aging. The best start. Report on the inquiry into the health benefits of breastfeeding. Canberra: Commonwealth of Australia; 2007.
16. Smith JP, Harvey P. Submission to Parliamentary Inquiry into Health Benefits of Breastfeeding; Chronic disease risk and infant feeding. Parliamentary Inquiry into Health Benefits of Breastfeeding. Canberra2007.
17. Smith JP. Submission to Parliamentary Inquiry into Health Benefits of Breastfeeding; Economics of Breastfeeding. Parliamentary Inquiry into Health Benefits of Breastfeeding. Canberra2007.
18. Commonwealth of Australia. Australian National Breastfeeding Strategy 2010-2015. Canberra2010.
19. Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding practices? 2016:491-504, 2016 Jan 30.