"I made a lot of mistakes," says Stephen Luby, professor of infectious diseases at Stanford, about his work as a scientist working to tackle big social problems like reducing pneumonia infections among millions of children. Another take: this kind of humility, combined with a commitment to learn with others and continually adapt over many years is exactly what it takes for a scientist to solve problems that affect millions of people's lives.
In a presentation to our Impact Lab Design Fellows—faculty who have funding and professional support from Stanford Impact Labs to build new research-practice partnerships to make progress on social issues—Luby shared his experience working in Bangladesh first at the U.S. Centers for Disease Control to reduce child pneumonia, and today as part of a team of scientists, Bangladesh-based brick manufacturers, and energy technology advisors working to change how bricks are made to save lives, improve living standards, and combat climate change. Their team has $500,000 in start-up lab funding from Stanford Impact Labs to accelerate their work.
Luby reflected on 15 years of work in Bangladesh as a series of pivots, describing the moments and interactions that changed his understanding of the problem, approach, and potential for solutions to make a public impact. In it, he captured five important lessons for anyone working to put research to work for society:
Lesson 1: Where you start is not where you may go
Luby and his family moved to Bangladesh in 2004. He was head of the U.S. Centers for Disease Control (CDC) agency in the country, working to reduce infectious disease in Bangladesh and around the world. Luby describes his work as a medical epidemiologist as a physician that “focuses on patterns of diseases across whole populations and looks for strategies to reduce that burden of disease.”
Pneumonia is the leading cause of death for children in Bangladesh and globally. Luby and his CDC colleagues set up a surveillance system in a low-income neighborhood in Dhaka to collect samples from children they suspected had pneumonia to identify the pathogen responsible for the infection. This pathogen-specific surveillance, Luby says, is what allows epidemiologists to design the right interventions to prevent the spread of infections.
Luby’s colleague, Pavani Ram, encouraged the team to also hang air quality monitors inside homes to see how air pollutants might also contribute to pneumonia infections. UC Berkeley had modified smoke detectors the team could use as inexpensive sensors to detect particles small enough to get into childrens’ lungs. Over a year, Luby and his team could see children breathing contaminated air were at higher risk for pneumonia. The surprise, Luby says, was that the strongest predictor of indoor air pollution wasn’t what was happening inside the home. Rather, the strongest predictor of indoor air pollution was outdoor air pollution.
"Children breathing contaminated air were at higher risk for pneumonia. The surprise was that the strongest predictor of indoor air pollution wasn’t what was happening inside the home. Rather, the strongest predictor of indoor air pollution was outdoor air pollution."
When they looked for the major causes of outdoor air pollution in Dhaka, twenty years of Atomic Energy Center analysis in Dhaka pointed to one source above all others: brick kilns. Brick kiln manufacturing accounted for more than 90 percent of black carbon in the air, and in wintertime produced more than 40 percent of the small particulate matter in the air. The impact, according to an analysis by Dr. Sarath Guttikunda, was an estimated 5000 additional premature adult deaths. Dr. Emily Gurley also showed increased risk of child pneumonia.
What started as an effort to look at the pathogens driving pneumonia turned into a new question: what leads brick manufacturers to make bricks in ways that generate so much pollution and contribute to thousands of deaths each year?
Lesson 2: Listening and learning with those closest to the problem and solutions is imperative (and may require professional facilitation)
To better understand how bricks were made in Bangladesh and the incentives and experiences of those involved, Debashish Biswas, anthropologist and assistant scientist at Bangladesh-based health research institute icddr, b, led in-depth interviews with soil sellers, large brick manufacturers, brick kiln owners, and members of the Department of the Environment. They produced a report that they hoped would help them get additional input from the Bangladesh Brick Manufacturing Owners Association, Department of Energy, large construction firms, the World Bank, environmental NGOs, and scientists.
Luby and his team hired professional facilitators for the meeting, knowing the long history of stakeholder meetings with similar—and sometimes the same—groups that had gone awry. Even so, several people invited were reluctant to come. Members of the brick manufacturing owners association explained nothing productive had come out of prior experience and worse, they had been pilloried in the press when they participated. Members of the Department of Environment were concerned about mentions of corruption in the report and wanted them removed or said they might not join the conversation either.
Biswas and Luby and their team persuaded invitees that their interest was in substantive discussion, not press, and that they would not alter the content of the report. “As scientists,” Luby said, “all we could offer was our best understanding of the current situation and we needed feedback on that.” The day of the meeting, they welcomed two members from the Department of the Environment and eight members of the Bangladesh Brick Owners Association.
Luby, Biswas, and their colleagues designed the meeting to get feedback on their effort to reframe air pollution as a public health problem, rather than industrial development or environmental concerns. They wanted participants to tell them whether they had properly understood the incentives of brick manufacturers. Did they get it right? Was there more to the story? And they wanted to brainstorm a way forward together.
When the January 2013 meeting began, Dr. Emily Gurley shared their evidence about the association of air pollution and increased risk of child pneumonia, using a photograph of the brown cloud that forms during wintertime over homes in Dhaka. As she spoke, Jamil Hussain, vice president of Bangladesh's national brick manufacturing association, asked to address the group. Luby worried this could be the start of major disagreements or the moment the meeting could go off the rails.
Instead, Hussain said “We don’t dispute anything you just said. Brick kilns do damage the environment and human health. What I’m asking for is your help in solving this problem.” He said part of the challenge was that the government policy prescription would not be effective.
Luby was “stunned.” At that moment, his whole idea of the problem—and solution—was upended. He thought they needed to persuade brick kiln owners and manufacturers that brick kilns harm health. Instead, he says, “We had misframed the problem. The problem wasn’t that they didn’t understand the health consequences. The problem was that the solutions were difficult to implement.”
"We had misframed the problem. The problem wasn’t that they didn’t understand the health consequences. The problem was that the solutions were difficult to implement."
Luby and his colleagues were already listening to and learning from brick manufacturers and others when they produced the report. But the in-person interaction—aided by professional facilitators and sensitive to participants’ prior experiences and concerns—created an a-hah moment. It changed the dynamic from one of researchers looking for stakeholder reactions, to an opportunity to work closely together on solutions.
That moment also helped build trusted relationships needed to identify, test, and learn from possible solutions together. Today, Luby, Biswas, the Bangladesh Brick Manufacturing Owners Association, and Greentech Knowledge Solutions are part of the Build a Better Brick lab, one of eleven public impact labs that have start-up funding from Stanford Impact Labs to accelerate and share their progress.
Lesson 3: Ideas and insights from other disciplines expands the spotlight on the problem and potential solutions
Relatively small suggestions and ideas from colleagues with different experiences and expertise reframed Luby and his colleagues’ understanding of what contributed to pneumonia among children in Bangladesh—and pointed to an entirely new set of potential solutions. They also used inexpensive technology innovations—the converted smoke detectors to monitor air pollution—from colleagues at UC Berkeley who had designed them to monitor air quality and pollution, not pneumonia infections.
In their book Decisive, Chip and Dan Heath describe “the spotlight effect” where researchers—and all of us—tend to focus too narrowly on a limited set of choices in our immediate frame. Luby and his team expanded the spotlight when they added the air monitors to their work and again when they posed ideas and directly engaged brick manufacturers and others. Each time, it pointed them to a new set of people to work with and learn from, and towards new potential solutions to curb childhood pneumonia infections.
"Debashish Biswas says the opportunity to 'build strong links between researchers, implementation partners, academics, regulatory bodies, entrepreneurs, and policymakers working to decrease emissions' means they can expect 'bigger changes in the brick kiln industries' and more potential to expand their work in other parts of South Asia and beyond."
Greentech Knowledge Solutions’ Sameer Maithel says “the most exciting part is getting an opportunity to work with a multi-disciplinary and multi-country team of public health specialists, social scientists, engineers, brick kiln owners and workers.” Biswas, at icddr, b, says the opportunity to "build strong links between researchers, implementation partners, academics, regulatory bodies, entrepreneurs, and policymakers working to decrease emissions” means they can expect “bigger changes in the brick kiln industries” and more potential to expand their work in other parts of South Asia and beyond.
Lesson 4: Frame problems and solutions from others' perspectives
The team started to look at technology solutions. They focused first on high-income country examples, including electrostatic precipitators that can filter and scrub pollutants. Dennis Grahn in biological sciences at Stanford, had developed a particulate afterburner to reduce the harmful airborne particles from wood stoves used in the Pacific Northwest by 99.7 percent. They wondered if they could adapt something similar for brick kilns in Bangladesh.
On paper, it looked plausible. Afterburners would cost $5,000 per unit and last for years, they weren’t difficult to manufacture, and you could see whether they were being used and working. An engineer made site visits to assess adaptability and local manufacturing. A team of international policy masters students explored whether there might be a larger market for them in India and China. But two big questions lingered: why would a brick kiln owner pay money to install an afterburner and continue to run it? And would enough brick kiln owners be willing to do it to bring the price down and impact air quality?
Luby says the more they talked to brick kiln owners, the answer to those questions was clear: no. It would be low cost, society would benefit, but not enough kiln owners would adopt it to make a difference. So they pivoted again. They focused on interventions compatible with incentives of people who make the bricks.
Colleagues at New Delhi-based Greentech Knowledge Solutions proposed natural zig-zag kilns—kilns with larger chimneys that pull more air through the kiln through a zig-zag pattern of bricks so it improves oxygenation and combustion efficiency. The process burns coal more completely which means brick owners use less coal and save money. Coal is the largest expense for brick manufacturers and the team estimated it would reduce coal consumption by 25 percent per brick and that the savings on coal in the first year alone would exceed the cost of converting kilns. And the intervention reduces black carbon emissions—the ones contributing to pneumonia in adults and children and global warming—by 85 percent.
"It’s one thing to have very bright people at Stanford and people on our study team come up with ideas, but we really need to test all of these ideas against all of the folks that are acting in the field. It requires deep listening to people with a different perspective."
Luby says a major reason the top-down technocratic approaches to improve brick manufacturing in South Asia over the last 40 years haven’t worked is that the groups involved haven’t really listened to the people who make the bricks. “It’s one thing to have very bright people at Stanford and people on our study team come up with ideas, but we really need to test all of these ideas against all of the folks that are acting in the field. It requires deep listening to people with a different perspective." The lesson, he says, is to think about how to get something to work in a way that is compatible with someone else’s world view and their perspective.
Lesson 5: Impact isn't instant—it takes time to adapt, learn, repeat
Luby’s engagement with Bangladesh began in 2004. In seventeen years, the questions, understanding of the problem, and approach changed in significant ways. What started as a focus on pathogen tracing led to brick manufacturing as a major source of air pollution contributing to pneumonia infections and deaths. A report intended to make the case that brick manufacturing is a public health issue led to a collaborative effort among researchers, brick makers, and technologists to work together on solutions. Technology solutions that looked right on paper didn’t work for brick makers, but pointed to something else that did.
At every step, the team gathered new ideas and insights that helped reframe questions, test something new, learn, and adapt. And it took time to build personal, trusted relationships between researchers, brick makers, technologists, and government partners. The start-up funding from Stanford Impact Labs will help Luby and his Stanford colleagues continue to work with Debashish Biswas from Bangladesh-based research institute icddr, b, Sameer Maithel at Greentech Knowledge Solutions in New Delhi, and the Bangladesh Brick Manufacturing Owners Association to implement and evaluate solutions together.
Luby’s story shows what happens when teams use insights from across disciplines, listen with empathy to people with different perspectives, and connect different kinds of knowledge and experiences. It expanded their understanding of the problem—what contributes to childhood pneumonia—and led them to new practical solutions that have potential to save lives, improve living standards, and combat climate change.
Stanford Impact Labs’ fellowships and start-up impact lab funding kick-start joint work, learning, and progress like Luby and his colleagues experienced. And a growing network of partners and affiliated labs—like the Better Brick Lab—are sharing what they are learning while they are doing the work so others can benefit and find their own ways to put science to work for society.
More about the Better Brick Lab:
Brick manufacturing is a substantial part of the economy and employment opportunities in Bangladesh. Kilns used to make bricks also generate enormous pollution. Estimates suggest the brick kiln sector may be responsible for up to half of all particulate matter in Bangladesh’s capital, Dhaka. The problem is a matter of global significance: each year the global gasses from brick kilns in South Asia are equivalent to the climate impact generated from the entire U.S. passenger car fleet. Brick manufacturing demonstrates complex tradeoffs between growth and the environment and demands a new approach. Efforts in the past thirty years focused on constructing capital intensive modern kilns or relied on government regulations and enforcement. High costs and inability to enforce regulations means progress has been slow. The Better Brick Lab is working with civic organizations and environmental advisory firms to generate scientific evidence on how to increase adoption and use of new technologies that can drive profits up and pollution down.