Defining Value in Population Health: Evaluating Program Impact and Outcomes; How Artificial Sweeteners Became Normal: A Sociotechnical Look at Aspartame

While my capstone project with UVA Health Population Health and my STS research on the aspartame controversy appear unrelated, both topics address the problem of understanding the true impacts of health interventions, whether in patient care programs or dietary regulations, due to technical and societal factors. With multiple variables at play, it is difficult to study the causal relationship between a health intervention and the impact on society (Yuan et al., 2024). Both topics focus on the difficulty of measuring and interpreting health outcomes in ways that truly reflect public benefit (or lack thereof). Additionally, both projects approach their research question from a systems perspective, incorporating different stakeholders’ perspectives to gain a comprehensive understanding of the situation. My technical project centers around evaluating the UVA Health Population Health Department’s Interactive Home Monitoring program, which provides follow-up care for patients discharged from the UVA Medical Center through remote patient monitoring protocols, proactive care coordination strategies, and patient engagement practices. My group utilized a mixed-methods approach to identify and quantify the dimensions of program value through currently collected metrics (e.g. readmissions, emergency department visits, length of stay) and qualitative content analysis to understand multiple stakeholder perspectives (patients, health professionals, UVA Health system). Ultimately, my group’s findings aim to establish a framework for defining and assessing value in population health programs, aligning stakeholder priorities with program outcomes. My STS research investigates the ongoing public debate over aspartame, the first Federal Drug Administration (FDA) approved artificial sweetener in 1974 (Program, 2024) . Using Actor-Network Theory (ANT), I explore how relationships among regulatory agencies, scientists, food companies, the media, and consumers have shaped the normalization of aspartame and other artificial sweeteners in the United States, despite persistent controversy. For example, in 2023, the FDA and World Health Organization (WHO) disagreed on the safety of aspartame, with the FDA maintaining that the additive is safe, while WHO claimed it to be possibly carcinogenic (Kimball, 2023). My research frames aspartame’s widespread acceptance as a result of systemic interactions in which no actor can effectively place checks and balances on the others. This networked dynamic has not only contributed to public confusion around aspartame’s safety but has also paved the way for the approval and normalization of five additional artificial sweeteners in U.S foods. Working on both my technical and STS research projects simultaneously has helped me look at problems from a systems perspective, zooming out on the actors at play. Too often, key stakeholder perspectives are overlooked, which can shift both the understanding of the problem and solution developed to address it. These projects have shown me the importance of carefully addressing and incorporating all relevant actors and their perspectives. In other words, nothing should ever be studied in silos because the world operates as a dynamic system of systems. In the future, I will apply ANT to my work, always striving to take a comprehensive systems approach.