Welcome to Buffalo HealthCast

Vennela Damarla: 0:02

Hello there. Welcome to Buffalo HealthCast, the official podcast of the University at Buffalo's School of Public Health and Health Professions. Join us as we delve into the latest research from Dr. Yohane and uncover how factors like environment, chemicals, psychosocial stressors can shape the earliest days of child life. Whether you are a parent or a health care professional or simply curious about the intersection of environment and health, this podcast will guide you in understanding how we can nurture healthier future from the very beginning. I'm Vennela Damarla, MPH student and also production assistant for Buffalo HealthCast. Today we have Dr. Yohane Phiri with us, who is a post doctoral research associate in the Department of Epidemiology and Environmental Health. It is so wonderful having you here, Dr. Yohane, let's start with some introduction. Dr. Yohane, can you tell us a bit about yourself and your work.

Dr. Yohane Phiri: 1:02

Yeah, thanks so much for having me on this podcast. So as I've already said, my name is Dr. Yohane Phiri. I'm currently postdoctoral research in the Department of Epidemiology and Environmental Health. I work under this provision of the Chair of the School Professor Pauline Mendola. It is an honor when you invited me to join you in on this podcast, to share a number of experiences that I have developed through my endeavor and understanding environmental exposures and specifically focusing on perinatal and periodic Health to health epidemiologists whose research focuses on environmental exposures, I specifically examine what type of environmental characteristics used to be, the air pollution affect perinatal and pediatric health. I have the skills now by I'm able to integrate a number of large data sets in the US that includes data from Medicare, Medicaid and the birth registry data. I link these with air pollution and our environmental pollutants, so this allows us to examine the effects of various developmental exposures and maternal and neonatal health outcomes. These include preterm births, low birth weight status and issued within our NATO Intensive Care Unit admissions. And I'm also involved in other projects, prospective projects, one of which is trying to employ secondary data from a completed project that was funded by the NIH, started project that was conducting Birmingham and University of Alabama, and we try to investigate asthma control status in women during pregnancy. These projects are vital because they generate insights that both theoretical, but also in the reward decision making, because if we understand the role that environmental exposures have in worsening, in our gravitating the conditions of pregnant women themselves, but also their offsprings and the long life risks, the wrong life impact of these exposures, this will be very important in the design of policies which would help in deducing or which would help in controlling some of these major health determinants. So to epidemiologist, outwork with someone who is doing dental medicine, I'll work with a nutrition epidemiologist. Together, collectively, we have that ability to develop or come up with policies or research that could be used to address some of the major challenges that our communities are facing. We should understand that public health is a complex issue, and there are a number of complex ways, the number of ways that we can bind to deal with such type of challenges. So in general, I think I use both qualitative and quantitative research methodologies in most of the projects that are taken. Thank you.

Vennela Damarla: 4:19

That's wonderful. Dr. Yohane, what made you interested in the topics you study?

Dr. Yohane Phiri: 4:24

Yeah, so thank you very much for this wonderful question. Um, first of all, I'm not originally from the US. I'm a Malawi. Malawi is located in the south eastern part of Africa. My journey into studying about mental health exposures, I think, began in the year 2003 when I joined the University of Malawi in those days. Now it's called Malawi University of Business and Applied Sciences (MUBUS), where I majored in our mental health at that time, I specifically majored into looking at a. Occupational Health. And in Malawi, there's a region known as Mulanje, people grow tea, and there were a number of increasing instances of people reporting injuries, a number of operational exposures in their work environment. So my undergraduate degree program really focused on trying to find factors that were associated with the prevalence of this disease, I mean, these instances amongst the typical workers in Mulanje. But through the course of doing that research, I noticed that it wasn't all about the occupation hazards that were exposed to, but also to do with the living environment of the people at that time, I'm not sure of this status. Now that some of the changes are being made, there have been policies that have been revised to address these issues. But then a number of living involvement factors were associated with a number of outcomes that the tea picking workers, the people that picked tea or plant tea in the estates were exposed to so from there, my attention kind of shifted, and I initially grew interest to understand a number of factors associated with our living environment. This curiosity led me to go and apply for funding and do my master's degree in environmental Mental Health And Urban Studies, which I did in Kojaheri, investor in Turkey. And I also did an internship in sustainability science with investor of one in Germany. The purpose of all this was just to try to see how our living involvement shapes most of the things that determine our health. And through that curiosity, I ended up pursuing a PhD program, which I did in Taiwan, Taipei Medical University. And I finished my PhD studies in 2023 and in Taiwan, that's where I think I kind of deeply developed a passion to understand, to say, I focused on women specifically because I worked on a project and there were a number of interesting findings that that project is called the longitudinal examination across prenatal and postnatal health in Taiwan. It is one of the most wonderful projects that I wave awake on, and it drives my interest in understanding the role of environmental exposures and outcomes in pregnant women and children. So from there, then I think I specifically focused on understanding environmental pollutants, that's indoor air quality, indoor air pollution and also health in both the pregnant women and the children. That's how my journey to today has been built.

Vennela Damarla: 7:50

That's a really insightful journey. Dr. Yohane, I appreciate how you have detailed that. I mean, a lot of people are not aware of the environmental factors are causing a lot of issues. People mostly focus on occupational exposures, but they neglect the environmental factors. So it's really insightful to know how environmental factors can influence a lot of health conditions. So what are the most common environmental factors that could lead to prenatal health conditions?

Dr. Yohane Phiri: 8:20

Thank you so much for that wonderful question. Vennela, drawing from my own experience and from my own research, the most notable factors that we have explored and I have got scientific evidence or scientific data on, include air pollution. So exposure to air pollutants, such as particulate matter of less than 2.5 micro diameter, nitrogen dioxide, sulfur dioxide, and many other these have been linked to prenatal outcomes. A number of studies, including some that I have done in the US and also that I did in Taiwan, they have provided evidence that factors like pretend birth, low birth weight, status and developmental delays in the neonates or in the offsprings of parents, or in the children that are born from mothers associated with air pollution and air pollution can affect a number of factors, including the fetal growth, the blend by brain development, and this may lead to long term health most of the time we ignore environmental exposures or air pollution as something which is very small, but Most of the effects of air pollution. As far as there are those that we call acute and immediate effects, there are also those that we call a long term effects. We may not be able to know that preterm death, for example, a low birthweight baby was born just because of exposure to air pollutants. Points another interesting thing in countries, I'll give this a specific example, like in countries like Taiwan, where the region is very hot and it's very humid, indoor air quality plays a significant role. So the number of issues, for example, allergens in indoors, indoor environment, in terms of ventilation, in terms of issues with how many times do you clean your household? All these factors are also a significant environmental exposure that could lead to a number of outcomes associated with prenatal health, again, in a modern world whereby we use a number of chemical exposures, also a very, very important thing. Of recent you see that, due to improved scientific findings, a number of companies that produce chemicals, they are enforced, or they are given a mandate to make sure that they provide what we call a safety data sheet for every chemical. This is to make sure that us as consumers, before we use these chemicals, we should know what are the dangers of its exposure. It is important to know that sometime there are a number of exposures of chemicals that have got negative impact. For example, when I was working in a project in Taiwan where we did find that some pest sites that are used to specifically in summer to control the number of, let's say bugs or house flies indoors, were associated with elevated levels of development of asthma in children that were under five. Remember, children are the most at risk from developing such type of conditions when they live in an environment, an indo environment, where there are a number of there's a combination, or there's an integration of a number of mental exposures, so chemicals specifically are another important element. And in most recent years now, like when I've come to the US, I've worked on projects that are focusing on old go systematic racism. Now this goes to socio economic factors. You should understand that there are communities out there that are exposed to environmental factors more because of where they are located or they are based. There is evidence that people from poor socioeconomic background are more likely to be exposed to a number of environmental factors that I did mention of a on like air pollution, they will have poor indoor air quality because they live in dilapidated houses. There's a higher level of into allergens and etc. And one interesting thing is we also have a environmental wildlife, for example, noise, environmental noise, this often keeps to be ignored. It is very interesting that in countries like the US, we have the power we can regulate the amount of noise we are exposed to in our living environment by calling of authorities to enforce these laws. But I come from a developing country whereby most of these wars, they may be there, but they are not enforced, and the number of studies, or the number of scientific research that has been done to explore some of these variables and association with perinatal outcomes has not been thoroughly been established. So the chance that I have here to work on understanding some of these environmental exposures as also with prenatal outcomes, I think it's one of those experiences that are always cherished. So we know there's an impact to do with climate change. Just few days ago, we had a tornado in Buffalo. This is something that has never happened before. Buffalo has never expressed a tornado. So what are some of the impact of these changes in the climate that will impact the NATO outcomes? This may not be in the short term effect, but it could come later on in life with aggregated with other environmental exposures that were exposed daily living environment so, so in short, that's what I think.

Vennela Damarla: 14:31

Well, the climate change is another big topic, though. So Dr. Yohane, you have mentioned about the environmental exposures, such as air pollution, prenatal exposure, socio economic factors, noise pollution, they influence the birth outcome and childhood development. So how do you think these factors influence all those outcomes and development in child?

Dr. Yohane Phiri: 14:54

Remember that environmental exposures play a significant role in a number of outcomes. Not only prenatal outcomes, but when you low birth outcomes or child development, there is a number of ways or mechanisms that these developmental exposures could influence such type of outcomes. For example, pollutants, like air pollution, has been linked to a number of outcomes, and air pollutants can affect fetal development by posing the placenta barrier and leading to a number of what we call inflammation and oxidative stress. Inflammation and oxidative stress, this will end up having an impact on the way the fetus is developing while still in the womb of the mother. This is even before they have come out. So air pollution has that ability to affect the development stages of the fetus while still in the home. A number of our projects that I'm doing now, I've worked on a paper that we examined a neonatal intensive care admission in the US, and we found that of the national data that we use, that's the best certificates data in the US, linked with a number of environmental air pollution exposure we found that about 8.1% of children that are born in the US that are admitted in senior intensive care units, and these are because of a number of issues. And in this research, we try to explore like, what are some of those in terms of environmental exposures? And we're especially focusing on air pollution. And we found there is that significant association with air pollution exposure a month before birth, neonatal health outcomes such as preterm birth and low birth weight. So as I'm saying, We, as far as we cannot trace that actual causal Association, but we are able to think of what, what are some of these factors that are associated with infant development or influences on the birth outcomes in terms of household and outdoor environmental exposures. So these often, like, for example, allergens, they exacerbates respiratory conditions such as asthma in children, and sometimes poor indoor air quality, which may be characterized by higher indoor levels of air pollutants may be associated the development of a number of allergic diseases, but also respiratory issues in children. Remember, when babies are born, their development process was in the mother's womb, then coming out. They need to develop skills to be able to cope up with the outside development and if we have got a number of environmental potents that are being exposed to the environmental potents who tend to affect the natural acclimatization process to be able to breathe well and to grow and remember, they did not have that sufficient immunity at birth. So all that exposure, if you've got a number of these developmental exposures in our living environment, we end up affecting the development the child and the number of early life living environmental exposures that we could be talking of. But in brief, they have an intermediate effect on the development. That's both when the infants are still in the mother's womb, but also when they have come out. So air pollution can affect or environmental exposures can affect both of these stages, and that's where the danger is. Thank you,

Vennela Damarla: 18:36

Well you have explained how indoor air pollution was linked to acute respiratory infection in children under five in your study. So were there any specific pollutant that were found to have the most significant impact?

Dr. Yohane Phiri: 18:50

Thank you. I think in this case, now you are referring to a project that I did in Taiwan, the long examination across prenatal and postnatal health in Taiwan. Yes, there are a number of important factors that we focused on, specifically in terms of indoor air quality and also the ambient air pollution. So we did find that within the household development there were a number of factors that played a significant role. For example, purchase of new furniture was linked to higher instances of respiratory issues. This is likely due to when we buy new furniture. Often, they are coated with chemicals that will probably that for decorative purposes. Some are for the protection of the furniture, and these chemicals produce higher levels of for example, VOCs. These VOCs have an ability to enter into our systems, and in children, such has been associated with elevated levels of presenting with a number of allergic outcomes. For example, as. Ma and also rhinitis. Additionally, for that, in that project, you know, as I already indicated before, Taiwan is a humid country, and also it is kind of hot. So because of this, in houses which have got poor ventilation, you find that you have modes that will grow in the households, and we did find in one of our studies that we did in Taiwan that most smell in the children bedroom were associated with the higher risk of respiratory infections, indicating that the presence of mold not only makes our living environment and comfortable, but also as the power to produce what cause pores and allergens in the air. And these allergens in the air, if in health, will result into poor respirator outcomes and a number of other atopic diseases. So amongst the specific potent we did notice also that allergen levels in the children's bedroom, that's like dust mites, had a considerable impact on health. Our habits. Cleaning habits are really very important, because if we don't clean our living garments that frequently, we leave surfaces that will end up accumulating allergens and dust mites, we may end up developing a number of outcomes. So I think, in essence, my study simply underscored the importance of at least maintaining a clean environment, a well ventilated home that's to minimize indoor airports, which in turn may help to reduce the risk of acute respiratory infections, specifically in young children.

Vennela Damarla: 21:50

So Dr. Yohane, do you think the combined effect of indoor air pollution as well as the smoking habits of family members are associated with higher rates of acute respiratory infection symptoms in rural children.

Dr. Yohane Phiri: 22:06

So smoking habits of family members have been proven to be strong, associated with higher rates of acute respiratory infection when you smoke that Smoke does not only affect you, but it is more hazardous to people that don't smoke. In modern science, we have environmental tobacco smoke. We also have what we call secondary smoking. These are more hazardous than primarily smoking. And for environment tobacco smoke, you find that after you've smoked some of the particles of the smoke will tend to remain attached to surfaces within your environment. So if you're a parent that smokes lives in a rural area or lives but your economically poor background, it is like you're tripping the levels of exposure, because, as I already indicated earlier on, socio economic status is one of the determinant of health. So imagine you're living in an economically disadvantaged community. These details are probably you've got poor access to water, your living environment are already not good. You've got exposure to a number of allergies because you don't clean or because of inability to take care of some of the roles that you have or responsibilities you have. You expose young children, for example, in your living environment, to a number of exposures, adding smoking on, it simply worsens the condition. So the other issues to do with social economic are disadvantaged, you find that their houses probably are not well inflated, and exposure to pollutants in environments that are not well inflated results into a number of heavy outcomes. So the interaction of social demographic factors such as low socio economic status and limited access to health care and education. Disparities, this indeed further complicate the situation. And remember, if you live in a disadvantage community, you are exposing your household to a number of environmental exposures already, and if you smoke, it means you're worsening the condition. Yes, combination of these really worsens outcomes, that's both prenatal outcomes, but also infant health outcomes. So in brief, I think that's what I would say.

Vennela Damarla: 24:38

As a dentist, I know how smoking can drastically affect a person's health, and second hand smoking is something that actually affects more than the person being smoked. So yeah, the smoking habits are definitely are associated with higher rates of acute respiratory infections in children. So there is an article that's. says, the presence of pets, potted plants or living near parks or roads is associated with indoor microbial levels. How do you think these factors influence the indoor environmental quality?

Dr. Yohane Phiri: 25:12

That's a great question, Vennela. So one of the papers that has explored indoor air quality that's endomicrobial and allergen levels association with a number of environmental factors, is a project that I did. I know there are other projects that have been published and have been shared in the academic circles, but in my in our project, we did realize that we did find that having pets and potted plants and also living near parks or roads has got a significant influence on endomicrobial allergy levels and the overall environmental quality of value of your household. So pets, for example, if you have a pet, we often go out with pets, take walks outside, and these have got a direct contact with a number of surfaces, which have got also microbes and pets in so doing, when we bring them into our homes, they may come in with what we call microbes. This may include bacteria and fungi from the outdoor So while some of these microbes, yes, they may be beneficial, others may be might contribute to increase in Indo allergens. And remember, exposure to indo allergens, such as house dust mites, etc, may end up resulting into a number of outcomes. And since my research focuses so much on children and pregnant women's health, there have been studies that are have shown that households that have pets were more likely to have their children with poor respiratory conditions. I know there are some that have proven otherwise, but in a paper that I did, we did find that a household pets, having a pet in a household was more associated with poor respiratory outcomes in children. Potted plants are another important household thing or exposure that is discussed amongst scientists, especially those that focus on government exposures, so household poly plants may have both positive and negative effects, so they can improve air quality. You know, we talk of the photosynthetic processes, they will be able to clean our environment if it has higher levels of carbon dioxide, because we understand our survivors humans is totally dependent on plants. But at the same time, they also may provide large surface areas for harboring moths, because, you know, the leaf surfaces provide a very nice environment for moths to grow on. So if it is advisable to clean these into potted plants frequently and make sure we check them if they do not have any moths that are growing on them, because if there are these moths that can grow on them, these moths can release spores into the air, and those moths have a potential to exacerbate origins and also respiratory conditions. Living near parks, it is very important to live near Park because parks provide an environment whereby we could take a walk and kind of refresh ourselves, but we should remember that proximity to parks can also have a disadvantage. Remember, parks have got different types of plants that are grown there. There are some plants that produce allergens they produce and and this is, suppose, the diversity of these or these airborne microbes that come from those plants may enter, probably our homes, if we have got a home close to a park, and we may get exposed. Remember, each and every human being have got different levels of atopy. That's the way they react to different types of environmental exposures. So leading to parks can have can quite a double edged saw in that we may have some microbes that you get exposed to in parks that you walk, that are beneficial for our everyday, everyday life, but also some that may trigger a number of heavy outcomes. So when we come comes to population that I focus on as perinatal pediatric health for children and for pregnant women, often times, exposure to such type of environments may lead to poor healthier. Outcomes, and because, if you are living close to these parks, you may end up getting a higher levels of specific types of probably alleges, or, let's say, spores or pollen. And these will tend to exert to worsen the conditions, some of the conditions that come due to pregnancy. You know, I always call or in science, we call pregnancy and inflammatory stage, whereby you've got a number of changes that are ongoing in you, and this will have an effect on your immune system. Your immune system already gets weaker because of the pregnancy stage. So exposure to more of these new allergens, or more spores or more pollen, due to proximity to parts, may result in poor, healthier outcomes. So as far, it is a double EXO I would advise during this time, exposure to such type of environments could really be reduced so that we avoid such type of poor heavy outcomes.

Vennela Damarla: 31:10

Well, this is something new I got to learn today. So imagine having a pet and then just to know that the indoor microbial levels are increasing just because of the pets. I mean, it's sad to know that, because I have always wanted a dog in my home. So moving on to the next question, how do socio economic factors and prenatal mental health influence the relationship between environmental exposures and child health outcomes? 

Dr. Yohane Phiri: 31:39

So thank you so much for that, for that question. Vennela, let me start this question. Say, having a pet is not a problem, just going back to your comment, but it is important to be informed of some of the exposures that we may get from our pets. We take care of our pets, at least take them to the to the to the vets for checkup. You need to clean them. You need to have places where you can keep them, and within our environment, if you're taking a dog for a walk, I've seen a number of people that will probably have a specific designed covers for the feet, a number of ways to make sure that when the dog comes in an indoor environment does not bring does not bring in a number of some of these plausible environmental potents that we're talking about. Now let's go back to the question that I asked me, and you talking of this psychosocial influences of probably parental health or mental health and children health. So we talked a lot about the physical environment, but parental mental health is also one of the most important issues, one of the most important factor that is associated with child health. So when parents experience stress and desirable depression, this may have an effect on how they manage their home environment. That's the first thing, not only that, but depression, anxiety and also stress, may have an impact on how the immune system works. So for example, a pregnant woman who is depressed or has got anxiety or have got, has got stress, they are too likely, possible outcomes that will impact how they clean their home environment, leading to increased indoor allergen levels. It may affect their cleaning habits that may result into household environmental factors. There are some that will even go to the extent of probably nudging in risk behavior, such as drinking and smoking and all these will have an impact on the unborn baby. Depression, stress and anxiety has gone an influence on our immune system and how it works. If you are depressed, if you are stressed, you will be likely to end up not having a balanced diet. You are more likely probably not to eat if you are pregnant, that's even very bad for the devolving child. So these are some of the factors that when we are exploring the association between environmental exposures and neonatal heavy outcomes or prenatal health, we also try to understand that such psychosocial factors may be mediators of our association. Between environmental exposures and health. I worked on a project in Taiwan, and in that project, we're trying to look at the outcomes allergic rhinitis, conjunctivitis and also asthma. And we wanted to see whether parental mental health status, that's depression and anxiety were associated with the likelihood of their offsprings or their children developing asthma, conjunctivitis, rhinitis and also eczema. And we did find that a number of kids in that study whose parents had depression had three to four times a higher likelihood of developing eczema. So it tells you this parental mental health or psychosocial factors, I significant factor that may affect a child health, that's both when they still in the developmental stages during pregnancy, but also if they are already born and they are growing up, because, as I already indicated, psychosocial factors are really significant in Determining what could behavior of the people that have watched stress, depression or, let's say, anxiety. So the combination of socioeconomic challenges and parental mental health simply can amplify the negative effects of your mental exposures on children's health. So and this highlights the need for a whole for holistic approaches in addressing child health. So when you addressing child health, you should also make sure that we take into account not only their physical environment, as I do focus on environmental exposures, but we also try to see whether their mental health or emotional well being or emotional being with the entire family is also at play in some of the outcomes that we assess.

Vennela Damarla: 37:07

Thank you, Dr. Yohane for breaking down it so clearly. And I also believe that depression is one of the most suppressing issues worldwide. Moving on to our next question, how can your research finding be used to develop public health strategies and target innovations which are more effective.

Dr. Yohane Phiri: 37:27

I'm just one of the people that probably focuses on environmental exposures and in number of different types of outcomes, interdisciplinary research helps in addressing a number of these factors. But in terms of policy research and practical recommendations, I think the research that I'm doing now provides valuable insights into a number of factors which can significantly enhance public health strategies and intervention specifically for all the work that I have done in epidemiology and environmental health highlights a number of factors. First of all, it leaves us to with the responsibility to identify at risk populations. So most of the research that I've done has been pointed like which populations are most vulnerable to specific research. For instance, in my studies, I did review that there were certain communities in probably in Taiwan, that way more plausible, more prone to environmental hazards. And therefore, what should we do in order to avoid that, but also in terms of informing policy development by providing this evidence that I've just spoken of, it is we provide the link that exists between environmental factors and heavy outcomes, and These findings can inform policy makers about the need for regulations or changes in environmental standards. For example, some of my research has found association between Neonatal Intensive Care Unit emissions and also air pollution. We policy makers could try to work with these findings and see how they would manage to control both stringent rules and regressions in the management or regulation of air quality standards, but also we talk of designing interventions that are targeted to specific populations that could also work. We were talking of he has in prevention programs. So as I already said, some of the environmental exposure that I specific around specific communities, they wouldn't need a whole city or a whole region to change. Change their policies. They deal with issues to do with hygiene, keeping our environments clean. My research provides the basis for knowing that probably, if we target this population and probably gave them health education on issues to do with keeping their household clean, ensuring that they have got proper ventilation. A number of factors affect associated with the environmental living environment, we could probably change the direction of some of the outcomes that I have I've spoken about

Vennela Damarla: 40:40

Those are actually the excellent strategies in order to target the interventions more effectively. So what are some actionable recommendation for policy makers to reduce the impact of environmental pollutants on prenatal and pediatric health?

Dr. Yohane Phiri: 40:56

Thank you so much. I think one of the most interesting thing is that being someone has started in a number of countries and seeing how in different countries, like duration, dealing with air quality issue to do with environmental exposure works, I should applaud the US for taking a very Good initiative in making sure that there is a controlled way of making sure that the have got they have strengthened air quality regulations, so one of the findings or recommendations around to give is to further strengthen these Air Quality regressions of interest in the US. I think from the literature that I've read, there has been a significant improvement in terms of levels of air pollutants. There's also issues to do with enhanced monitorings, so there's to be increased funding for even mental health available systems to track, probably pollution levels and the impact on vulnerable populations. So I understand as far as the number of tools that have been used, number of regulations draw to regulate air pollution, one of the important factors is also to focus on promoting multiple green spaces. So in most of our urban planning, most of the poor air quality occurs, largely in cities. This is because cities have got probably a number of high high levels of traffic, and also like production factories, etc. So investing in promoting green spaces could also really help in reducing these environmental exposures. But also we have to focus on strategies that focus on reducing exposure to indoor air pollution, or indoor air pollutants, so families can immunize this. This goes to individual families by making sure that they use methods of cleaning indoor air, potions. They avoid smoking indoors. They choose non toxic cleaning products, and also making sure that they regularly make sure they live in environmental Well, inflated and also most importantly is out say, promotion of a healthy lifestyle. I think part of our immune system, as far as environmental exposures are concerned, most of our part of our health system also depends on our lifestyle, so encouraging practices such as consuming organic produce when possible, reducing the use of plastics to minimize exposures to harm of chemicals, issues to do with making sure that our lifestyle is health frequent exercise, this would also help in probably reducing a number of the effects of mental exposures that affect pregnant health. Think that's all I would say. In summary,

Vennela Damarla: 44:14

I would completely agree with you. Dr. Yohane, lifestyle changes and staying hygiene are the most important things in order to mitigate the most of the environmental risk. So how can families and healthcare providers use the findings from your research to make informed decisions in eliminating the environmental risks?

Dr. Yohane Phiri: 44:36

So when talk of healthcare providers think we're looking at now integration of environmental health into routine care, so Heather providers to basically focus on routinely assessing environmental exposures in prenatal and pediatric healthy settings. This includes about both the home and also the Community Environmental Research and provide. Guidance on how this could be mitigated. Uh, secondly, I think we could focus on advocating for regular health screening. So we have to promote regular screening for conditions that may worsen, that may be worsened by environmental exposures, such as asthma, allergies and developmental disorders, if these are screened regularly and we notice that there are some precursors to their currency, we would start to figure out, probably it could be because of their living environment of that specific community end up being addressed, but also we have to educate and empower our communities. So we have to provide our committees with up to date information on how environmental potents can affect health and offer practical advice on reducing exposures. One of interesting factors that in the developed country, like the US, I've noticed that we are able to find information of, for example, air pod levels that are in Buffalo because we've put a number of monitoring stations that are around us. This goes back to communities. It is our responsibility to stay informed of a number of exposures that we're exposed to. As far as the government is taking part in ensuring that they regulate and control the levels of air pollutants, but we also have to stay informed some of these changes in local level air pollution is not directly impacted affected by the activities of our local governments, etc. These are some of these our local, localized or personal air pollution exposure are affected by the activity that we do within our living environments. So we should be aware of the changes that are having an environment and how these may affect the levels of environmental process that we are exposed to in so doing, who help to prevent exposure to higher levels of mental pollutants that may impact our health.

Vennela Damarla: 47:16

Thank you. Dr. Yohane, what final advice would you give to your listeners about protecting their families from environmental hazards?

Dr. Yohane Phiri: 47:25

Thank you so much for this opportunity. First of all, I think to me, all I would say is, let's stay informed, stay educated. Let's educate ourselves about some of the common developmental hazards in your area, or whether they are air or water quality issues or exposure to harm, chemicals or risks from climate change. Let's always stay informed. Understand this research. Understanding these risks may help us to take proactive measures, for example, reporting if we see that within our environment there's a leakage which is probably causing chemical exposure, or if there's a fire which is resulting into higher levels of pollutants from burning or from fire, we could report this, and our local government probably will take responsibility in trying to avert or correct some of these effects. And another thing is to, let's ensure that we improve our indoor air quality so regularly. Check and maintain if you've got air filters at home, maintain them if you smoke, which I would encourage you to do. As an environmental epidemiologist, I would, at all costs, advise you to avoid smoking, but if you do, make sure that you avoid smoking in indoor environment and also for cleaning, make sure that when you buy a cleaning product, reach the material safety data sheets that are always some of them are always attached on the bottles, or you've got a link on the bottles or the packaging of the chemicals, read about them and see whether It's non toxic and will have no impact if you are exposed to them. And also importantly, let's ensure that our houses are well inflated and make sure that we continue to promote personal hygiene and our living government hygiene, because these are also significant precursors to higher levels of indoor environmental potents, and also it means that's a precursor to indoor air quality. If our indoor environments are not well cleaned, we've got higher levels of air pollutants, poor indoor air quality, and finally, health. Habits, let's encourage each other to have heavy habits such as washing hands, regularly, practicing food safety hygiene and food safety handling, but also making sure that we eat where we can eat organic food or we can eat food that has not been processed with a number of chemicals, because that would also improve our health. So in short, I think these are the most important recommendations that I would share with you. Thank you so much.

Vennela Damarla: 50:34

Thank you so much for your time. Dr. Yohane, your points have sparked a lot of thoughts. Stay tuned for another episode on Buffalo HealthCast. Thank you.

Nada Fox  00:00

Greetings, public health enthusiast, and welcome to another episode of the Buffalo HealthCast podcast. My name is Nada Fox, and I'm going to be your host. And I'm beyond thrilled today to have a distinguished guest with us someone whose experience and expertise spans the vast landscape of Social Work and Health Research. Dr. Elizabeth Bowen, thank you for taking the time to speak with us today.

Dr Elizabeth Bowen  00:23

Thanks so much. I'm excited to do this.

Nada Fox  00:26

Can you tell our listeners a little bit about your background and your experience,

Dr Elizabeth Bowen  00:31

Of course, this is a big part of why I do the research that I do. But so my name is Elizabeth Bowen. I'm currently an associate professor in the School of Social Work here at UB. But my background, before I went the research route, my background was in social work practice. So after I got my master's degree, I was working as a social worker in Chicago, and happened to find a job working in supportive housing programs. So these were programs that helped people experiencing homelessness get into stable, affordable housing with supportive services. And a lot of the clients that I worked with had a history of addiction and substance use problems along with other kinds of physical health problems, sometimes mental health issues, lots of trauma, so a lot of  co-occurring issues. But in any case, in this work, what I saw was that, it seemed like my clients were getting this message that if they were unable to manage their substance use problems. And if they were not succeeding in recovery, it was kind of their fault. So they had often been in and out of various treatment systems. And they had gotten this message that, you know, if they were motivated, it would work. So if they were struggling in recovery, it was because they didn't want it bad enough, or they weren't motivated. And so people, I heard that from my clients in many different ways over time. And often people internalize this message. And it caused a lot of shame, it caused people to feel bad about themselves when they struggled with recovery. But from my perspective, coming into this, I didn't see it that way. It felt to me like it wasn't that they weren't motivated. It was more that they lacked stable housing, they lacked basic resources, it was just nothing in their life was really set up to be conducive to recovery. And so that felt really unfair to me that they're getting this message that it was their problem that they weren't motivated, rather than looking at the environment and looking at how things could be better set up to support them for recovery, including that really vital thing of having stable housing. So I know that's a long answer. But that's the clinical practice experience that always stuck with me. So then years later, when I decided I was interested in doing research, this was one of the things that remained interesting to me and kind of stuck out in my head was that disconnect between the messages that people get about recovery, and just the realities of the kinds of challenges that people struggle with. And then I came across this idea, this theory of recovery capital. So it's not my theory, it was developed by two other researchers, William Cloud and Robert Grandfield. But once I started reading about recovery capital, it really clicked with me because I thought this is exactly what I was observing as a practitioner. So from the get go, I was interested in doing some research related to recovery capital. And that kind of brings me I guess, to where we are today that I've had the chance to dive into that topic further and continue to do research on it. And ultimately, I'm really interested in using recovery capital to shift the lens that we use to look at addiction, especially for people that are homeless people that don't have a lot of income, people that are marginalized or otherwise lacking in resources.

Nada Fox  03:49

Thank you so much. So you've highlighted the intersection of homelessness, homelessness, excuse me, and health issues such as addiction recovery, could you delve into how stable housing plays a role in supporting individuals with substance use disorders on their path to recovery? 

Dr Elizabeth Bowen  04:08

Absolutely. So I think there's first of all, I think sometimes there's a stereotype that if people are homeless and struggling with an addiction issue, that that addiction is the cause of their homelessness. And while it could be a contributing factor for some people, that's not always the case. And fundamentally, homelessness is really about a lack of affordable housing in this country. And being homeless is very traumatic for a lot of people. So often substance use is a way to cope with that for a lot of people with the trauma that comes with losing one's home and everything that goes along with that. So that's just to point out that it's often not as simple as somebody having an addiction issue and that leading to them becoming homeless. So that said, there is a lot of co-occurring between these problems between Homelessness and substance use problems with regard to all kinds of different substances. But to me, the kind of key takeaway here is just that it's so difficult to address a substance use problem without addressing the housing piece. And historically, that's kind of what we asked people to do. So housing, services and services for people experiencing homelessness, traditionally, were set up that people really had to kind of prove themselves to get into housing. So people had to first go into a shelter system, then establish sobriety worked towards various goals and kind of prove they were, quote, unquote, ready for housing. And then finally, they could be rewarded with getting access to some kind of affordable housing program. So that's like the, the history here of a lot of homeless services. And some programs still do operate that way. But there has been a paradigm shift in the past couple of decades in the United States and in other places toward this idea of housing first, and that was the kind of program that I worked for, in my social work practice experience. So Housing First is exactly what the name sounds like, it flips that idea of having to prove that you're ready for housing, and tries to get people into housing as soon as possible with the idea that once somebody has housing, then they have that foundation of stability from which you can work on other things. And often these issues are all tied up together. So it's not just addressing somebody's substance use problem, but it's also addressing other kinds of health issues that might also being doing treatment for mental health issues for underlying trauma, linking people to employment resources, or education, all these things affect one another. But it's hard to work on any of them without stable housing. So that's what the housing first model does is get people into housing more quickly, so that you can connect people with resources and start to work on their goals with regard to recovery, or however they define addiction recovery, as well as any other goals that they might have.

Nada Fox  07:04

I think it's very interesting, because it's kind of dealing with the issue in a Maslow's sort of way like we have to deal with well, you know, the very first bottom of the pyramid, their physical safety those needs stable shelter and housing in order to even think about the next steps. 

Dr Elizabeth Bowen  07:19

Yeah, exactly. 

Nada Fox  07:20

It's interesting that you bring up that that wasn't always the case, because we kind of put the burden on the individual for a long time then, and expected them to be able to solve all of these problems prior to addressing that most basic, basic right. So thank you so much for putting that into perspective for us. Now, you talked about housing first and working in those types of groups. And you've collaborated a lot with local service providers, like the homeless alliance of Western New York, and it's just a practical application of your research. So how do these partnerships contribute to addressing addiction and substance use disorders within this community?

Dr Elizabeth Bowen  08:02

Yeah, there's a lot of I think, really great services in Western New York, and a lot of excellent providers that are trying to do exactly that. But the whole idea with Housing First is that it's really individualized, depending on the individual persons goals. And so there's not you know, one way that programs, address addiction and help to facilitate recovery, it really depends on you know, the individual client and what they want to work toward. And that was the same way with the program that I used to work in, in my social work practice experience. So housing first programs tend to take I'm sure there's some variations, but most take a harm reduction perspective, meaning that people don't necessarily have to define their recovery as being abstinent from whatever substance they were using. When you take a harm reduction perspective, you can work with people on whatever goals they have. So sometimes that is abstinence. It certainly doesn't preclude that. But sometimes their goal might be, you know, to switch from using one substance that's particularly risky, in various ways to a substance that might be safer and might have to do with using or drinking less it might have to do with the situations in which a person uses a substance that might have to do with the effects on their health or on their life, and how can they, you know, reduce those negative effects but not necessarily commit abstinence, if that's not where they're at or what they're ready for. So that's my I think biggest thing that I've observed about various programs here, as well as just with housing first, in general, is I think, programs often do a really good job of trying to honor that and work with people to meet them where they're at and to let people define the recovery way that they wanted to find it and then connect people with resources based on their specific goals.

Nada Fox  09:59

Thank you so much. I think it's so interesting that you've kind of defined like a harm reduction approach to it, and how recovering might not necessarily be a linear thing. It ebbs and flows, and people are trying, and we're all people. And sometimes we trip and make mistakes. But that doesn't mean. So I know you're you lead this big NIH study, and you came up with the multi dimensional inventory of recovery capital. Can you tell our audience a little bit about what this is? And how does this measure specifically address the needs of diverse populations?

Dr Elizabeth Bowen  10:09

 Absolutely.  Yes. I would love to. So I will back up a little bit and talk about what recovery capital is first, and then tell you about this measure. So as I said earlier, when I moved from practice into becoming a researcher, I happen to come across this great article on this theory of recovery capital, and I hadn't heard of it before. But when I read it, it really resonated with me right away. So developed by a William cloud, and Robert Greenfield. And Robert Greenfield is here at UB, by the way. So that was kind of a happy accident for me, when I started at UB was that I realized, Oh, I'll get to, you know, work with the developer of recovery capital. So in any case, they had done this study, looking at people who recovered from substance use problems without formal treatment. And so that's often called natural recovery or unassisted recovery. So meaning people that don't go to inpatient or outpatient treatment, often don't even go to AAA or NA or other 12 step meetings, just people that on their own, recognize they have a substance use problem, and are able to address it and recover. And this is actually a lot more common. I don't know the specific statistics off the top of my head, but it's more common than a lot of people think so not everybody that recovers necessarily goes through formal treatment, or through 12 steps. Um, so in any case, cloud and Greenfield, recognize that and we're interested in looking at, okay, so if people are able to recover without treatment, how do they do it? Like, what are their strategies? So they did a really nice qualitative research study where they interviewed various people, I think this was in Colorado, where they both were working at the time. And so they found people that had recovered in this way, and interviewed them about like, how did you do it? What strategies to use. And then based on that, analyzing those interviews, what they found was that people talked a lot about things like their social networks. So needing to change if they hung out with a lot of friends that were drinking or using, they had to change their social network, they talked about tapping into other kinds of social support. So maybe they weren't in treatment, but they just had a good friend or family members, who understood them and supported their goals and doing that. People talked about kind of their own knowledge, learning about addiction, being able to understand it better themselves, we use that they develop their own coping strategies, people talked about hobbies and other things that they were able to tap into in their lives instead of the substance use problem. And so through analyzing all of that thought, and Grandfield, came up with this idea of recovery capital. And so what that means is, it's just a term for the different resources that people have that can support their recovery from addiction. And there's four major categories to ID. So it's social capital. So that's the social connection, social support, your social network, a human capital, those are the characteristics of a person. So like your knowledge, your education, spirituality, just things about you personal characteristics that can help in recovery, physical capital, that refers to things like housing, like we were talking about earlier. So like those tangible resources, housing, employment, transportation, income, health insurance, just those basic resources that are really critical for Foundation for Recovery. And then the last one is cultural capital. And so this has to do with feeling like you can connect to a culture that support your recovery. And sometimes that might be something like a 12 step group, or some other kind of sober recreation group, or it might also just be connecting to however you define your own culture, and finding elements within that culture that support or affirm your recovery. So that's cultural capital. So those are the four categories. So again, I just read about that as a theory and thought, that's really cool. I'd like to do some research on this. And then I kind of dove into it deeper over the years. And one thing I got interested in was, how do you measure this? So this idea of recovery capital, I think is pretty popular at this point. In a lot of people research it, it's pretty popular in practice settings to like people are, are interested in this idea. And there are different ways to measure it. So other people have already made surveys to measure recovery capital, but I took a really close look at some of them, and found there often were some issues with them. So one problem was they sometimes deviate from this theory of recovery capital. So for example, recovery, capital doesn't say anything about abstinence, you can define recovery, however you want, and still talk about recovery capital. But then when I looked closely at some of these measures, and you look at the actual items they have on them, some of them would have items that would ask that would say things about, you know, abstaining, or not using, and I thought that doesn't exactly, you know, fit with the theory. So that was one thing. And then I also looked at a diverse population. So as a social worker, and given my practice background, I know that, you know, sometimes there's a tendency to assume that something that's tested mainly with white people, mainly with middle class people, sometimes mainly with men, so lack of gender diversity, there can be this assumption to assume that like, it's going to work for everybody, when we know, that's not often the case. And so I was interested in how were these measures developed, were they tested with diverse audiences, and I found that often they weren't, often they were usually a some gender diversity, but it was often mostly white people, mostly middle class people. So I thought, we don't even know if these are really, you know, reliable and valid for more diverse audiences or populations. So that's what ultimately led me to propose this grant and was fortunate to get funding to make a new Ultra Measure recovery capital. And I think the part I got most excited about is that we really got to do it from the bottom up. So that was another thing that often researchers just come up with the items that go on these tools, and then they test it out. But it's often the researchers coming up with it. And I wanted to really involve people with lived experience. So people who are in recovery themselves or people working in the recovery field, to get their perspective on what should we actually ask on this? And how should we phrase the questions because it gets, I know, that seems like a small thing. But that becomes really important, because we know words are important. And the way that you say something, can sometimes you know, just one or can make a difference with how people interpret it. So me and my team put a lot of thought into, we did come up with some initial like starting points of like, Should we ask about this. But then we did a lot of focus groups and interviews with people in recovery, mainly people in recovery, some people working in the service system, as well. And of course, there's sometimes some overlap between those two groups. So we got really great feedback from people about what we should ask what we shouldn't ask how to ask it. And then based on that, we were able to make a draft version of this measure called the multi dimensional inventory of recovery capital, I call it the Merck or mIRC, for short. And we did other testing, so then we gave it to a much larger group of people, but still with a lot of attention to diversity. So when we did test it, we were able to do it with an audience that was economically diverse, racially diverse, gender diverse. And it's not perfect, I think no research is but we were able to get a pretty broad group of people to fill this out. I should also say diverse with regard to recovery experience. So we had people that had been through treatment. And then we also have folks that would be in that natural recovery category who had not been through treatment. So we were able to get those perspectives represented as well. So after lots of work to test this, and then make some changes and refine it, we were able to finalize the measure last spring it and make it publicly available. So it is out there now for anybody who would like to use it. It's on we have a website through the UB school social work. So if you Google UB school, social work, recovery capital or Merck mIRC, it should come up and there's a little bit background on it. And then you can download the tool there. So it's out there. And my hope is that people, both researchers, and people in practice or somebody in recovery, that might be interested in using this tool for themselves. My hope is that people will use it and find it informative.

Nada Fox  19:19

Well, it's definitely informative. I went through and kind of did it on my own, just kind of do a self assessment, you know, which I think is kind of interesting and gives you a different perspective, and, and just yourself and what you're doing now. So as an educator, you teach courses on substance use and addiction. How do you approach these subjects in your teaching? And what insights do you aim to impart on future social workers in the field of addiction?

Dr Elizabeth Bowen  19:50

Yeah, thanks for asking about that. I think the way that I teach about addiction is very much in line with the way that we've been talking about it here. So I've tried to just emphasize this, there's not one definition of recovery that people can define that in a lot of different ways I do teach about recovery capital. So I do think that it's important for social workers and other people working in the recovery field, to know about that, and to have the sense that it's not just about what's internal to someone, not just about their motivation, but really about the resources. And that's a very social work view. We talk a lot in social work about people within their environments, and I tried to really drive that home, specifically in addiction practice and with recover. So we talked about the need for housing, we talked about how would you look at other forms of recovery capital that a person either has, so we can emphasize those strengths, as well as looking at where they might be struggling a bit, and how we can address those issues. And I talk a lot about equity issues as well when I teach about addiction. So, you know, I think you can't really talk about these issues without talking about drug policy, without talking about how that has been implemented in really racist and classist ways in the United States and looking at those, addressing those core systemic issues. Because ultimately, it's, it's not enough to just treat, I think the people in front of us that clinical practice is important. But I also want any students that I interact with to come across with that systemic lens, so that we're also looking at not just helping individual people, but thinking about changing the whole system. So that's at least what I shoot for. And then I also tried to go in with an open mind myself and to learn from my students, because that is something I found that I really do. Learn from people every time I teach, even when I teach the same class over multiple years, because the students are always different. And they bring different perspectives, different lenses, I often have some students in recovery in my classes, and who sometimes aren't open, you know, don't want to be that public about it. But then sometimes I have students that are very comfortable sharing about their own recovery backgrounds. So I always learn from that. And I always try to go in with that mindset, to hear from different people and to have my own perspectives challenged and expanded by what I learned.

Nada Fox  22:18

It's interesting because you talk about overviewing it from a systemic point, kind of looking at the big picture. And this is kind of the synergy between public health and social work, right? Like we're all trying to look at things from the big picture addressing the inequities talking about it. What do we need to do? How do we change this? How do we make this more equitable? Right? 

Dr Elizabeth Bowen  22:40

I think there is a lot of overlap. A lot of synergy. Yeah. With Social Work and public health, for sure. Absolutely.

Nada Fox  22:45

And I think what people that like are kind of unfamiliar with public health, like it's always easier to explain it like it's very broad, big picture, I feel. Yeah. We're not treating an individual. But these anecdotal things lead to, you know, the evidence for what's going on in our in our communities in our state or however macro we want to get. So earlier today, you talked about your, you know, trauma informed care, and that sort of stuff. And you highlighted the how you use this in your framework. So I was hoping that you could answer this question, how does your policy analysis framework is based on trauma informed care? How does this approach contribute to addressing substance use disorders within the homeless population? And what policy changes do you believe could make a significant impact going forward?

Dr Elizabeth Bowen  23:47

Yeah, that's a great question. I love thinking about policy and talking about that. Um, so to just explain about this framework. So several years ago, a colleague, Shanta Murshid, and I developed this framework for trauma informed policy analysis that was then published in the American Journal of Public Health. And what we were trying to do with that was take this idea of trauma informed care, which is something we talk about a lot in social work. And that's basically the idea that for any kind of services, so mental health treatment, addiction, treatment, housing, whatever it may be, that it's important to think about delivering those services in a way that's trauma informed meaning that recognizes a lot of people that seek services have been through different kinds of trauma, like I talked about with populations experiencing homelessness, and sometimes people can be re traumatized in the process of seeking services. So how can we try to help people feel safe and recognize what they've been through, recognize how that might be affecting whatever problems or issues they present with. And then also try to prevent retraumatization from happening while people are getting services. So that's the whole idea of trauma. informed care. And the UB School of Social Work has been a big leader in that we have some great resources on that, and on how to do that. But my colleague Shunta Murshid, and I had gotten to talking about kind of taking the next step of taking it to that more macro level. So we just had started talking about what if we weren't, you know, just trauma informed in our services, but we tried to have policy that was more trauma informed I, with the aim of really trying to prevent trauma from occurring in the first place. Because if you think about traumas that happen in so many communities, they are systemic, and get they are potentially preventable. So that's how we got to talking about how you would implement principles like safety, and choice and empowerment, those are core principles of trauma informed care. So this paper that we wrote was about what those policies are, what those principles would look like in policy. So in laws and other kinds of high level policies. And so to answer your question about what that look like for people experiencing homelessness and addiction issues, to meet the most fundamental policy change, there would be expanding access to affordable housing. And I mean, the type of housing programs I was talking about, so Housing First, specifically, but also just affordable housing in general, because while a lot of people do need, those kinds of services that come along with Housing First there are, there are many people that experience homelessness, really, just as an economic issue, they might be in some kind of short term financial crisis or something like that. And some kind of just financial assistance, rental assistance, not even necessarily a huge amount of money, but at the right time, and being able to access that in a timely way that could prevent homelessness entirely for a segment of the population. So we really need more affordable housing across the board. And one thing I always try to communicate to people is that, you know, in the United States, we've never made housing and entitlement benefit. So meaning certain programs like Medicaid, or SNAP, which is what people sometimes called food stamps, those are entitlements, meaning if people are eligible for them, and they apply, they're entitled to get it. So the government can't say, like, oh, we ran out of money for that this year, you're eligible, but we're not going to give it to you. So we don't do that for certain programs. But that's not what we've done with housing. So housing has always worked the opposite way where people can be eligible and apply. And they have to wait years, sometimes, you hear about weightless for supportive housing, or for other affordable housing, that are years long, and of course, expecting people to wait years for something as basic as housing. What are people supposed to do in the meantime, it doesn't make sense. So that, to me, would be the most, the biggest trauma informed change we can make would simply be expanding access to housing, and that would take a big investment in various kinds of affordable housing. But it is something I think that's doable. And it's a policy choice that so far in this country, we've chosen not to do it. So that is the biggest change that I can think of.

Nada Fox  28:19

Thank you so much. We'll just continue along that and I think this kind of you might have already answered this. But what changes do you hope to see in public health and the social work landscape in the future? And it seems like a housing first policy, and affordable housing, is there anything else that you would like to you would hope to see in the landscape of public health and social work in the future? 

Dr Elizabeth Bowen  28:43

Yeah, good question. So in addition to expanding access to housing through an increase in funding for affordable housing, I'm over a lot I would like and help to see just programs to move toward greater accessibility. And so I just think about specifically with addiction recovery services. Currently, I think there are some barriers that don't necessarily need to be there. And that do prevent people from getting help. And by that, I mean both financial barriers, so if people want various kinds of treatment, but can't afford them, but then also things like I have a colleague that does some research on methadone maintenance treatment, and how, you know, because of current policies that people have to go to a clinic generally to get methadone if they're getting that for their recovery from an opioid problem. And it's hard to get take home doses. And then obviously, it's hugely inconvenient to people to have to go somewhere every day, or almost every day to pick up this dose of medication and take it on site. A lot of people find those processes to be dehumanizing as well. So I look at things like that. And I think about how could we be trauma informed and how could we just increase recovery capital by make Seeing all kinds of various treatments more accessible to people. And so I think of my colleague who, you know, kind of put that issue on my radar. But I think about things like that. So if methadone and other kinds of medications for addiction treatment, for example, were more accessible to people so easier to get, if you could get it, you know, in your home, I think that would increase choice that for a lot of people would increase dignity and privacy as well as just making it more accessible in a practical manner. So that's one example. But in general, that's something I think about with policy change the intersects across social work and public health. Just how can we make treatment and recovery services more accessible to more people, as well as more trauma informed?

Nada Fox  30:49

People experiencing homelessness isn't an a population that's kind of popular or the most sought after in these sorts of discussions. And it's important that we highlight this community and they're not so hidden. And yes, they're at the forefront. 

Dr Elizabeth Bowen  31:06

Well, right. And I saw the you know, with your theme being about addiction, exactly. People, when people are talking about addiction and recovery issues, they're not always thinking necessarily of a really marginalized population like that, like people that don't have stable housing. So I'm happy that I can kind of bring that perspective into the conversation. Yeah.

Nada Fox  31:25

And it's, and it's nice, because I think, not on purpose, but people tend to do this. It's their fault, sort of lens on this community. And that's, that's not fair to this community. It's, you know, it's not so thank you so much for, you know, giving the audience that sort of perspective. Last question for you. It's not too horrible. What is what if you could have one thing for our listeners to walk away with from this discussion today? What would that be?

Dr Elizabeth Bowen  32:01

Good question. If I had to say one thing for listeners to walk away with from today, I guess it would be just to think about recovery holistically. And to think about both addiction and homelessness as societal problems more than personal problems. So to look at how all of the different policy choices that we make, as a society, contribute to these issues, or access to treatment and recovery resources, and I just think it's so critical to shift the thinking from looking at these problems as individual failings, to looking at them more as a byproduct of policy failures and of choices that we've made as a society. So to bring that lens and specifically to be a lot more holistic in the way that we think about addiction recovery and have conversations about it. And recovery capital has been a big part of how I think about that. And I hope that that can be a useful tool that other people will think about and learn more about too.