Hallah Kassem is in the first year of her Masters of Science in Population and Public Health at UBC. She graduated with a Bachelors in Applied Science in Public Health and Safety from Ryerson University. She is in her first year of residence at Green College.
*This is a transcript of our conversation on January 6, 2021. It has been edited for length and clarity.
First of all, and this is kind of out of my own curiosity because I don’t get the chance to speak to many people who are studying public health or epidemiology, and I know that your research areas don’t have much to do with COVID per say, but just as someone with more experience in the field, what’s it been like to watch the pandemic happening? Do you find yourself at odds with other people or what’s been your experience?
I think everyone finds themselves at odds with someone. There’s a lot of different opinions out there right now. Actually, the pandemic unfolded while I was in an emergency management course, so it was interesting to see the emergency management tools we have in the government being put into place at the same time. But it was also interesting to see how political everything became, because you would think public health is so important and we would just do whatever is necessary to protect public health but that isn’t always the case. Politics definitely plays a huge role in how we actually put our measures into place.
I think it was also really interesting for me to see what they’re calling ‘pandemic fatigue’, which is another topic we covered. At some point people just stop caring because there’s only so much care you can give, especially with this pandemic just because it’s been so restrictive on a lot of people and has caused so many burdens. A lot of people just want their life back, to be able to see friends, go to work or to a restaurant. So, we’re seeing now, in the highest cases, in the worst of it, that people are just sick and tired so they’re not following the restrictions the way they should and you can’t really blame them at this point. It’s been a year of not being able to do so many things they love.
Throughout my undergrad in Public Health we often looked back to SARS as an example of us handling an emergency. I think it would be interesting to see what the future holds for teaching methods; I think COVID will become our go-to example. There’s going to be so many analyses and one issue in particular that we’ve had is knowledge translations. We’ve been given instructions then been told, no, don’t do that, do this instead. Even masks, at the beginning we were told not to wear masks and suddenly now you can’t go anywhere without one. That’s not the fault of anyone, it’s the nature of learning about a disease. But this pandemic has been a unique learning tool. I’m hoping that in the future we can look at how we handled COVID and see how we can translate our knowledge better, address concerns and conspiracy theories, and help reduce pandemic fatigue.
Was that surprising to you? If you knew about ‘pandemic fatigue’ beforehand was it surprising to you that people are sort of ignoring things or were you expecting that?
I expected it way earlier, I’m actually pretty shocked that it took so long. But it’s also interesting because I started in Ontario at the beginning of the pandemic and moved to B.C. in the middle of it in September. Well, hopefully the middle, we don’t really know when the end is. So it was interesting to see the differences between people following the rules here [in Ontario] versus in B.C. So here, it was way more strict and restrictive much earlier because the situation was much more dire here. Whereas when I went to B.C., I could go to the [AMS] Nest and not wear a mask. It was so bizarre. That was at the beginning and then they started implementing masks. Even still, I remember, once you’re seated at your table, so many people just weren’t wearing masks and it wasn’t even about the rules at that point it was just the general feelings of what’s necessary among students. They just didn’t think that wearing masks was that important. Whereas over here, everyone always wore it. So that was interesting, but I was more surprised that it took so long, the pandemic fatigue.
So let’s talk about the research you did during your undergraduate degree which was regarding the relationship between traditional activities and perceived mental and general health among adult Indigenous people living off-reserve in Canada. What led you to this topic? What made you interested in that question?
Throughout my undergrad, Indigenous health was a prominent topic, but I guess we didn’t go into it in much detail and I felt like there was a lot that I didn’t know. We just kind of said, this is also a marginalized group in addition to other marginalized groups, but we didn’t really go into detail about it. So I was very curious. And also, growing up my mom worked on a reserve and so I had exposure when I was younger with Indigenous health and the differences between reserves and non-reserves. My research was actually about people living off reserve, so, not really the same, but it did spark some interest.
I saw a topic that I didn’t know much about, so I did some digging and found a professor who was doing research into Indigenous health. We actually were going to start doing air quality tests and see if there are differences between health in different air monitoring regions but then the air quality data regions didn’t line up with the health data in the right ways.
Because Indigenous culture is very important to Indigenous people, obviously, like any culture, I wanted to see if there were cultural practices that could protect health. I wanted to see if people living off reserve were still partaking in traditional activities and whether or not them partaking in those activities was affecting their health.
What were the outcomes or takeaways of that research? Your hypothesis was that traditional activities are inversely proportional to self-perceptions of mental and physical health for Indigenous peoples living outside of reserves. Did you find this to be true?
I originally assumed that traditional activities would have protective effects on the health of Indigenous people. I found that it was partially true, it wasn’t completely true.
We looked at four main activities: hunting, gathering plants, making clothes, and making arts and crafts.
We found that hunting and gathering wild plants were both positively associated with good general health and that making clothes was negatively associated with general health, which was interesting because we did adjust in our analysis for age and sociodemographic covariates. Hunting was also positively associated with mental health. Though, interestingly, making clothes and footwear was significantly negatively associated with mental health, as was making arts and crafts. We thought that maybe making clothes was associated with age — the idea that people who knit or sew tend to be older — but the association was still there after adjustment. We also adjusted for income and education — with the idea that people making clothing might be doing so because it was more economical — but that also wasn’t the case. Although, there could’ve been residual confounding.
It might be that people who are less mobile or less physically active would be sitting down more to make clothing and so that inactivity is what’s really affecting their health. And same with hunting and gathering plants. Hunting is obviously an active sport, and so is going out to gather plants, so being physically active might have been what affected their health. But really, because this was a cross-sectional study we can’t make conclusions about causality.
I’m curious about the aspect of it being a traditional activity. We’re not just talking about the difference between doing something active and doing something inactive, you’re talking about the difference between doing something that is a traditional Indigneous activity versus not. Why would doing something that is a traditionally Indigenous activity be related to health?
Well, two important social determinants of health are social supports and culture. I’ve seen these affect my own mental health. For me, I know that my mental health is better when I feel more in-line with the people that I love and that it’s worse when I feel different or like an outsider. The idea is that if you feel loved and supported by the people around you and that you feel connected to your culture and safe to express your cultural practices that your mental and general health will improve. So, I hypothesized that individuals who are practicing their traditional activities feel safe and supported to do so and so would experience better health outcomes.
I love how simple it sounds when you put it like that, when you boil it down like that. It completely makes sense that doing something which surrounds you with the people you love and makes you feel included would make you happier and healthier.
Also, although this is their land, Indigenous people are a marginalized group in Canada. So, feeling like an outsider can also affect your health. I’m both Egyptian and Irish but I’m also Canadian, so it’s a mix of things and when people ask me where I’m from it’s very complicated. I know from my own experience at least, having these different pieces can make you feel like you don’t belong and that can affect your mental health. Again, like I said earlier, if you’re participating in your own traditional activities, it gives you a better sense of who you are, which helps.
At UBC, you have undertaken research in the field of environmental epidemiology, specifically researching the health effects of climate change on children in Canada. What led you to this topic from your undergraduate research? Are there any connections or commonalities?
It seems very different and it is, but actually when I was doing my undergrad research, my original thesis was related to the environment, it was environmental epidemiology. I was going to look at air pollution. Climate change has always been where I wanted to focus my research. Ultimately, I want to help prevent climate change, protect humanity from its effects, and affect policies. I want a better future.
Although the theses are quite different, I learned so much in my undergrad that can be applied to in my Masters. They’re both epidemiological studies, so I used many of the same methods in my undergrad as I will be using in my Masters.
Can you tell me a little bit more of the specifics of your Masters research? What exactly are you looking at and how are you going to be doing it?
I’m still developing it, so through the next semester I’ll be finalizing my proposal and I will actually start working on it in the summer. Generally, I’m obviously interested in the health effects of climate change, but specifically this project will be looking at extreme heat events, which are increasing due to climate change.
We’ll likely be looking at emergency healthcare utilization among children during heat waves and comparing that with temperatures from weather station meteorological data, to find the temperature at which emergency healthcare utilization is increasing. Then we’ll compare it to existing heat wave warning thresholds. Basically, what we’re trying to see is if children are affected by extreme heat differently and at different temperatures than adults. Current heat warning levels are set based on their health effects for adults, so we are trying to see if we should be adjusting that for children. They have very different physiology than adults and different activity patterns. So it is likely that they will have a different temperature at which they experience adverse effects. Based on that finding we can try to affect policy and either have two different heat warnings or one that is lower or higher based on what we find.
I’m also hoping to include an analysis comparing different communities and assessing what measures could be put in place, beyond a child-specific heat warning temperature, to protect the most affected communities. For example, children living in crowded homes or shelters may need indoor air-conditioned play spaces because they don’t have that luxury at home.
What are some of the large unknowns about your research question? Are there any significant obstacles you foresee?
Obstacles would be that using emergency healthcare data is only telling you about the kids who are seeking emergency care. So, it might not represent rural communities as well. If you are farther away from a hospital you are less likely to go. Also, going to an emergency room might be very costly for some people who don’t have healthcare coverage. Those are some things I can think of off the top of my head.
It will also be interesting to see whether the issue with my undergrad research repeats itself, I hope it doesn’t. Again, the reason why I couldn’t research air pollution and health in my undergrad was because the data for air pollution didn’t line up for the data on health. If the weather stations are far away from the emergency healthcare facilities it could affect how we’re able to interpret the data.
My next question, regarding your hopes for the real-life applications of your research, you’ve already partially answered by referring to potential policy changes in the temperature for heat warnings. Is there anything else you hope for in terms of end result for your Masters project?
Ultimately if we see a rise in emergency healthcare utilization in children at a certain temperature then policies and programs can be developed to minimize risk of illness when temperatures are at that level. Additionally, we can see what types of health issues they’re accessing services for which will advance our knowledge on the effects of extreme heat on children. We might also be able to compare health utilization in children over periods of time and if there is an upward trend that indicates that there are more children seeking emergency healthcare now, then we could also support the growing evidence that climate change is greatly affecting child health. I’m hoping that it will have some effect on how we, as a country, approach climate change.
It’s interesting to me that your undergraduate research topic dealt with a very politicized issue of the healthcare of a marginalized group in Canada and your Masters topic to a certain extent is also very political. Climate change is not simply a scientific question, it is very much a political one as well. How do you see that fitting into the future applications of your research? Have you considered the political aspects of what you’re aiming for?
That’s a really good point. I like to think when you can prove beyond reasonable doubt that something adversely affects health then policies have to change and that there’s won’t be a politician who could say ‘no I don’t want to protect human health’. But money always comes into play and politics does still play a role. I feel it’s relatively unpredictable. Although, I would hope that my research helps to reduce the political contention of how we approach climate change and health. I want to add to the knowledge that we have about how climate change affects health to build an irrefutable position that things need to change no matter the immediate financial investment.
What makes you passionate about what you study? What do you consider to be the main personal motivation behind your research?
It’s a good question and I’m not sure I have a straightforward answer. It’s something that I grew up with. I’ve always felt that public health is vitally important, why aren’t we taking it more seriously? As a five-year-old I was like, guys come on!
As a five-year-old, really?
Maybe not five, but let’s say ten.
I do remember though, in elementary school somewhere between age six and nine, having a conversation with a friend on the playground about the environment. Until that conversation I hadn’t really thought about it much. For some reason we were talking about how much we love animals and she was like ‘well if you care about animals, you should care about the earth because the earth helps the animals’ and I was like ‘yeah, I guess that is true.’ I guess that’s where I started thinking about it, started caring for it and then just never stopped caring about it.
It’s always been a pressing issue for me. There’s also a book I loved called Factfulness by Hans Rosling — highly suggest it, I’ve lent it to many friends and it comes back with a few extra dog ears every time. In the book, Rosling fact checks our misconceptions about humanity. He talks about how in almost every single way, humanity is better now than it has ever been. The effect that that book is trying to achieve is to instill hope and reduce people’s concern. Many people think there is so much war or illness or poverty, that everything is terrible. But [Rosling] uses facts to disprove our misconceptions. What he isn’t able to disprove though is the idea that climate change is getting worse; the only thing we are worse in today than ever before is climate change. Beyond all other concerns to humanity, climate change is the one area we have yet to make progress in.
by: Jane Willsie, Department of English Language and Literature, UBC; Green College Work Learn Content Writer, 2020-21