Improving Health Equity with Epidemiology: An Interview with Dr. Tabassum Insaf
April 18, 2023
On the night of December 2, 1984, an accident at a factory owned by the Union Carbide Corporation unleashed the toxic gas methyl isocyanate on the city of Bhopal, India, killing at least 2,259 people immediately and injuring over half a million. Estimates of the true magnitude of the disaster vary, but researchers have suggested that approximately 8,000 more deaths occurred within the first two weeks of the accident, and another 8,000 have died since.
Dr. Tabassum Insaf of the Department of Epidemiology and Biostatistics grew up in Bhopal in the aftermath of this event, and it has given her unique insight into the relationship between public health and environmental justice. “Though I was fairly young at the time of the disaster, I became acutely aware of the long-term health effects when I started my medical training,” says Dr. Insaf. “The Union Carbide factory was situated in a densely populated, impoverished community, and we saw hundreds of patients with chronic systemic issues over a decade after the tragedy.”
Bearing witness to the legacy of the Bhopal disaster gave Dr. Insaf the motivation to pursue a career in medicine and later, epidemiology: “I realized the importance of focusing on communities versus individuals in order to drive systemic change in healthcare. The tragedy of Bhopal is that generations continue to suffer because any efforts at research and data analysis were stifled. I believe that if we are to make a difference in the health of the people we serve, we need to be able to analyze and interpret data and create an evidence base for future policy.”
Although Dr. Insaf has researched a diverse range of public health topics, the common thread running through her work is a focus on health disparities and social determinants.
“It is unfortunate that where we live, work and play still plays a role in determining health," she says. "Our environment contributes to our susceptibility to infectious disease and to our access to quality health care. Climate change will be a huge challenge in the coming years, and we will have to work hard to ensure that our efforts at mitigation and adaptation are equitable.”
To combat complex health issues of our times, Dr. Insaf is passionate about using new technologies and innovations, and her collaborations and research have led to tangible changes to public health policy. She explains, “Our collaboration with NASA and the National Weather Service led to lowering of heat warning thresholds in the state, and our team’s collaboration with Syracuse University and CDC led to development of a statewide wastewater surveillance network.”
Although technology can be a powerful tool for public health, Dr. Insaf also believes that more basic solutions, like improving access to care, are fundamental to solving the biggest public health challenges we face today.
“We are seeing increased centralization of care for complex health procedures such as for high risk cancer surgery in an attempt to improve patient outcomes, but we need to ensure that this model does not contribute to increasing disparities. Access to care cannot be characterized only through geographic proximity—insurance coverage, availability to take time off as a patient or care-giver, health beliefs, and trust in the system all play a role in whether those who need the care are able to utilize it as intended.”
Dr. Insaf also believes that taking on the challenges of the twenty-first century requires a new way of looking at health: “If we can learn one thing from disasters like Bhopal or the COVID-19 pandemic, it is that we must stop compartmentalizing health issues as infectious, chronic, or environmental. People with chronic co-morbidities are at the highest risk of complications with infectious disease agents such as SARS-CoV-2 and we saw the highest burden of disease and mortality where chronic disease outcomes were the most prevalent. Similarly, our built environment and increased global connectivity contributed to making what could have been a local outbreak of a novel virus to a devastating pandemic. We need to focus on the driving factors of disease and keep an eye on the trends in risks such as smoking, obesity, climate change and environmental exposures that continue to contribute to a broad spectrum of human illness.”