EP77 Aging, Disasters and Resilience with Dr. Alexis Merdjanoff

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I AM GPH EP77 Aging, Disasters and Resilience with Dr. Alexis Merdjanoff
EP77 Aging, Disasters and Resilience with Dr. Alexis Merdjanoff

Alexandra Arriaga:    Hello everyone and welcome to another episode of I AM GPH. My name is Alexandra Arriaga, and today we have our very own Dr. Alexis Merdjanoff, who is a clinical assistant professor in the social and behavioral sciences at New York University's College of Global Public Health. She is a public health sociologist who explores how population health is affected by exposure to natural hazards, including hurricanes, floods, extreme heat and wildfires. Dr. Merdjanoff is particularly interested in how social inequalities shape the impact of hazards on health recovery and resilience for vulnerable populations. She's also the director of research for the Population Impact Recovery and Resilience research program, and she's currently working on several studies including the Longitudinal Katrina@10 program, the Sandy Child and Family Health study, TiE ScaleUp East Boston to answer questions related to improving the health and well-being of populations exposed to disasters and climate change. She will also be teaching a study abroad course based in NYU Florence. This course will contrast U.S. and international approaches to aging, health and natural hazards. That course will cover theories and principles of aging and the life course related to these topics. With the goal of understanding how environmental risk factors shape the aging process, the course will also have the students consider how Italian approaches to aging and health, including those of policymakers and local stakeholders differ from the U.S. model. This course also serves as an elective requirement for the advanced certificate in public health disaster science policy and practice at GPH. If you would like to learn more about Dr. Merdjanoff's work or the course you'll be teaching in Florence, please stay tuned. Hello, Dr. Merdjanoff, how are you doing today?

Alexis Merdjanoff:    I'm doing well. How are you?

Alexandra Arriaga:    Great. Thanks for asking and thank you so much for joining us. First I would like to begin by asking you about your story. So you did your undergrad at NYU, then you did grad school at Rutgers, and now you're back. So how do you find your way to being a professor here at NYU?

Alexis Merdjanoff:    It is a long and winding road. I wanted to come to NYU as an undergrad for as long as I could remember. I wanted to be a journalist, so I came here to study journalism and oftentimes funny things happen when you take electives. And I took an elective in the sociology department here and it completely changed the way that I thought about the world. And I think that it fit my personality better than journalism, because it gave me the ability to dive deeply into issues that I really cared about. Issues around inequality is. So I became a sociology major and really as soon as I completed my undergraduate thesis, I knew that I wanted to get my PhD and I had two fantastic mentors. I think mentoring is so important for establishing your career trajectories and I'm really fortunate that I had two great mentors here. And they said, 'You should take some time and make sure that that's what you want to do." Because it is a very difficult and challenging journey to get a PhD and you want to be sure that that's what you want to do. So I took their advice to heart and I went and did something totally different. And I worked in Broadway advertising and at this film studio for about three years and did a lot of really cool stuff, met celebrities and worked on Project Runway. And I had this fantastic life as a 22-23 year old.

Alexandra Arriaga:    You worked on Project Runway?

Alexis Merdjanoff:    I did.

Alexandra Arriaga:    I used to watch that show so much.

Alexis Merdjanoff:    It was a big deal.

Alexandra Arriaga:    What did you do there?

Alexis Merdjanoff:    Well, you remember how the challenges would always have some sort of product integrated into it?

Alexandra Arriaga:    Yes.

Alexis Merdjanoff:    So I was part of the department at this film studio that would identify partners and then the creative people would use that sponsorship to come up with the challenges.

Alexandra Arriaga:    That is so unexpected. Wow. I would have never imagined that. Wow.

Alexis Merdjanoff:    Yeah. So I did that for a while and then I remember I was just sitting there one day and realized that I wasn't really fulfilled doing that and I needed something more and it felt like the right time to go back to school. So I went to Rutgers to do my PhD in sociology and I went there because I was actually really interested in issues related to gender and sexuality and they have a really strong program in that. Again, not thinking I was going to do work in disasters, but Hurricane Katrina happened and there was all this incredible research happening around this event that completely upended people's lives and played out in ways that very much relate to gender, race, ethnicity, socioeconomic status, and how those factors can really influence what happens after an event like that. And that's kind of how I got into doing disaster research was that this really traumatic event happened and it fit really well with my larger interests. Then Hurricane Sandy happened and since then it has been, feels like one right after another. And it was through my work on Hurricane Sandy and Hurricane Katrina that I met David Abramson, who is a faculty member here. And David was working at the National Center for Disaster Preparedness. He was the deputy director there and I started working there and we've been working together for about six years now. And so when he came here, I was still actually working on my dissertation, but I came to NYU GPH with him and we have been working on disaster and climate related events since then.

Alexandra Arriaga:    So you kind of got recruited almost.

Alexis Merdjanoff:    Yeah, well David got recruited and I was the fortunate one who came with him. He asked me to come with him and the timing worked really well with where I was with my dissertation. I actually didn't think that I was going to end up as a faculty member. I really wanted to do research and I was really focused on that and I ended up teaching here qualitative, the qualitative MPH class. And one thing led to another. And that's kind of how I ended up as a faculty member here.

Alexandra Arriaga:    So fun fact for our listeners. I'm actually taking that class this semester so.

Alexis Merdjanoff:    You get an A.

Alexandra Arriaga:    Thank you. Perfect. So something that I found really interesting about your class is that you are opening up our minds about qualitative research. And I feel like in sciences we always thought everything has to have data behind it, numbers, statistics, this and that. They make us take biostats in epidemiology. Everything is based on math on this, you know, what they call hard science. So why do you think that qualitative research is so important?

Alexis Merdjanoff:    Where do I begin? It's important for a lot of different reasons. And it's actually interesting where qualitative fits within the realm of public health as a discipline. Because I was asked to teach this class because there was nobody else here who could teach it. And that just speaks to the evolution of the field because a lot of the people who were... This was about five years ago. The faculty who were here were trained in the 80s, early 90s and qualitative was not part of the public health curriculum. And because qualitative is a huge component of being a sociologist, we do both qualitative and quantitative. I was able to teach that class and I completely agree that public health is very focused on really epidemiology as the gold standard, but I come from a perspective that all of these areas of focus and all of these methods can bring something different to the table, and we need these different types of ways of answering questions. So qualitative allows you to really dive deeply into an issue of concern. It allows you to understand processes and why and how certain health problems occur in the way that they do and how they might vary amongst different populations and different subgroups. And I think it's a really powerful way to understand public health problems. It's not instead of, but I think it's in addition to, and side by side with what we can learn from quantitative.

Alexandra Arriaga:    Can you think of an example of a time in which your qualitative research was able to answer a question that ended up being extremely pivotal for the research you were doing or let's say more elucidating than maybe any of the data that you could have gathered otherwise?

Alexis Merdjanoff:    Absolutely. We were doing a study on Hurricane Sandy in New Jersey on the nine most effected counties in New Jersey. And we had this really interesting finding that children who lived in houses that had minor damage actually had worse mental health than children who lived in houses that were either completely damaged or destroyed. And we couldn't really wrap our heads around why that was happening. And we had some thoughts, but they were really just hypotheses as to why we were getting these results with our quantitative data. It's a very powerful data set. It's a representative. It's a random sample of people living in this disaster footprint that we call. And so we did focus groups and interviews with mothers and their children who had experienced this type of housing damage. And what we found out was that children who are living in houses that had minor damage, they oftentimes didn't feel heard. And this was because just the way that damage can play out in a community, especially minor damage, means that there may be some houses on a block that are damaged and they may not, they're probably not destroyed, but maybe the kitchen is gone or the whole lower level is gone. It needs to be replaced. And so people don't see that you're living in a damaged house. And if you think about going to school, and maybe a majority of the students at the school don't have damage and only a handful of them are living in houses that have minor damage. The school also is not as focused in providing services for those children as opposed to communities that are completely wiped out, oftentimes schools will put programs in place to address the needs of children. And so these children often felt forgotten as if people didn't realize that they and their families were going through a recovery from the storm. And so that was of those instances where the data just told us part of the story, the quantitative data, and that we needed the qualitative piece to fill in the picture to help us understand why we were seeing the results in our statistics that we were.

Alexandra Arriaga:    That's extremely interesting. So going back to the hurricanes and all the work that you've done, it seems like most of it lives at the intersection of climate change and public health. And I'm wondering, can you explain to us how climate change is already impacting public health, or how will it impact its future?

Alexis Merdjanoff:    So this is really what I feel like is my area of focus right now is increasing the interest amongst public health professionals and researchers to be at the forefront of this issue of the climate emergency. Because right now we're not, and it's a matter of how our work is funded. It's a matter of that we're not really thinking holistically in how to approach this problem even though we know that climate change affects health. So, for instance, I recently read in a paper that by 2090 the projected cost of health from climate change will be $168 billion. And that actually slots in to the top 10 public health problems, the costs of those top 10 public health problems right in between cigarettes and arthritis. So it will become a major public health problem if nothing is done to mitigate, adapt, make the changes that we need to make. And I come into this area because I've been doing research on disasters for a while now and disasters and climate change are kind of seen as interchangeable, I think by the larger public. But there are differences. So a disaster is an event that occurs and it's within a confined time period. And climate changes is this slow burn, literally a slow burn. And yet climate change can also exacerbate the disaster event itself. It can make it stronger. We're seeing some weird weather patterns with storms like Hurricane Harvey that will sit over land for days at a time and dump a couple of feet of rain. And so we're really, we need to bring these areas together, the people who are doing disaster research, the people who are doing climate research and public health. And when I go to conferences about disasters and climate change, there are not a lot of public health professionals there. And so I feel like, especially with the history of this profession and how public health researchers and practitioners have done such a good job of doing interdisciplinary work and learning to have a holistic take of any kind of a problem like cigarette smoking or the HIV/AIDS crisis, that we know how to bring multiple people together and these kinds of complex problems really require that kind of thinking. So I very much believe that public health needs to have a seat at the table because we have been here before and we understand how to address these complex problems, and we understand how things like climate change can affect health at multiple levels. Not just asthma, but maybe whether or not you have a flood insurance and how that might impact your mental health or your physical health. And so really we, I feel like we can bring a much broader perspective to the table.

Alexandra Arriaga:    Yeah. Like it needs to be a more holistic collaboration.

Alexis Merdjanoff:    Absolutely.

Alexandra Arriaga:    I agree. And so the disasters you study are obviously terrible tragic events, but if there was a positive side to this story, we might call that resilience or maybe the ability to bounce back from a disaster. Why is resilience so interesting to you?

Alexis Merdjanoff:    So I think the goal with any disaster is at a population level to at a minimum bring people back to where they were before the event occurred. And this is challenging because there are often circumstances in which people were not in a good place before a disaster happened. And is that really our goal is to bring them back to that not so good place? Look at an event as a way to elevate people to an even higher standard of living. So to me, the recovery piece of a disaster is really interesting because it plays out over many, many years. And one of the questions that we've been focused on, especially with our work on Hurricane Katrina and which happened now 14 years ago, is what allows some people to bounce back and other people to never recover, and some people to actually thrive after an event? And those are really interesting questions because it oftentimes is not totally innate to an individual. There are some people who are just better equipped to handle an adverse event, but what we tend to see is that it's people who have social cohesion, people who have support from others in their community and their family and friends who are able to bounce back. And so that's actually something that we can instill in a community before an event occurs. It's hard, but we're actually at a period of time where we've seen a decrease in the investment that we put in social infrastructure. So we put a lot into physical infrastructure, seawalls and addressing risk communication and even the models of how to predict a storm. Right? We've put a lot of money and time and effort, a lot of smart people to think about how to best do the pre-event. And part of that though has to also include how do we create an atmosphere that builds a connection across multiple types of people, so that people can leverage that and when an event happens. So to me, we have to invest in things like libraries and community centers and ways for people to feel like when something bad happens, they know where they could go to get some help. And we tend to see that that's the factor that really allows people to be resilient in the face of an adverse event.

Alexandra Arriaga:    That's really interesting. I'm now I'm wondering, can you teach someone how to be resilient?

Alexis Merdjanoff:    We're trying. We have a really interesting project right now in East Boston with a neighborhood housing group called NOAH and NOAH is really interested in building this type of social cohesion within their community. East Boston is at increasing risk of facing the effects of climate change from either a flooding or even heat affects, heatwaves. And they're really interested in this social side of they have this great community and how can we start to leverage and build people together? And so we've done a couple of things so far and we're in the middle of the project, but we've done a residential survey to see what the knowledge level is like amongst community members. Are you aware that these changes are happening in your community and your environment that you live in? Do you have a preparedness plan? Do you know who you would call in the event of emergency? So we're doing that within the neighborhood of East Boston itself and we're also doing a network mapping exercise, where we're trying to figure out how our different institutions and leaders in the community connected and can we build those connections further, so when an event occurs that those relationships are already in place and people can leverage them. And we're going to be trying to do that. Once we have the network map, we're going to actually try to build those connections through an assembly in East Boston that we're hoping a couple hundred people will attend. So we're in progress and we'll see how it works out.

Alexandra Arriaga:    Awesome. I hope you keep us posted. So talking about your research again, as you've gone deeper into it, has your understanding of disasters evolved over time? If so, what do you understand now that you didn't in the past?

Alexis Merdjanoff:    So I used to think that disasters were unique events and I think that that was the mindset when Katrina rolled around that it was different from Hurricane Andrew and it would be different from any future storm. And through our work, I have found that there are certainly patterns that emerge after recovery patterns that emerge around mental health and housing instability like different exposures and recovery. And those are things that we've seen in Hurricane Sandy and even though I haven't worked on Hurricane Maria or Hurricane Harvey, I see that there are similar patterns that emerge after those events and this is really a challenge to the people who do this type of work, is that we need to have data that demonstrates that there are these common patterns that emerge and that we can generalize across storms. Because that'll allow us to create better recovery programs. It allows us to create better preparedness efforts. And so that was, that's definitely something that has evolved from you over time, but it really speaks to this need for pre event and post event data and for us to start using very similar measurements and scales across our studies, even if it's different researchers so that we can start to generalize across these events that will occur with greater frequency.

Alexandra Arriaga:    Switching to happier topics.

Alexis Merdjanoff:    Yes please.

Alexandra Arriaga:    In the spring, you're going to be in Florence.

Alexis Merdjanoff:    Yes.

Alexandra Arriaga:    Everyone here is jealous and you're going to be teaching a course about aging, environment and health. Can you tell us about that course and why should students be excited about it?

Alexis Merdjanoff:    Well, they should be excited because it's in Florence and I'm teaching it.

Alexandra Arriaga:    Of course.

Alexis Merdjanoff:    Besides that, I think they should be excited for a couple of different reasons. Aging is a really important issue that is going to come to the forefront of our policies and especially health-related policies by 2040. 2040, the population of older adults is expected to double and we are woefully under prepared for that. And when you combine that with what's happening with our environment and where older adults like to live, which they tend to live in coastal areas, that's where people like to retire. And older adults also like to age in place. They don't want to go to any kind of institutionalized setting or a nursing home. They want to age in their own homes. So this to me is the merging of two very challenging aspects of where our world is going. So, the course in Florence is going to compare and contrast different approaches to aging and environment in Italy and the United States. Italy has the highest percentage of older adults in all of Europe. It also has an aging infrastructure prone to earthquakes, flooding, climate change. And we're going to take an overnight trip to Venice and try to understand how Venice is dealing with climate change and there's also this aspect of successful aging. If our life expectancy is increasing, how can we do that well? What kind of resources do people need? And that goes from at the individual level to maybe institutional level, to even what do governments and policymakers need to do to allow people to successfully age where they want to.

Alexandra Arriaga:    Are people in Italy successfully aging?

Alexis Merdjanoff:    They live longer and they also tend to have higher rates of happiness.

Alexandra Arriaga:    They have gelato and wine.

Alexis Merdjanoff:    And cheese.

Alexandra Arriaga:    And pasta.

Alexis Merdjanoff:    And good olive oil.

Alexandra Arriaga:    What else do they need?

Alexis Merdjanoff:    That's it. That's actually what we're going to find out at the end of the class. Is that to age successfully, that's all you need.

Alexandra Arriaga:    Yes.

Alexis Merdjanoff:    So we'll just import all of that.

Alexandra Arriaga:    Basically. I think so. We've just basically found the solution to this. Going back to what you said, you say that in the U.S. we are under-prepared for the aging population. What does that mean?

Alexis Merdjanoff:    Well, they're going to need more resources in terms of healthcare. We are not really prepared. A lot of my work is around housing and we are not really prepared for older adults to live independently. And so a good example of this is, let's say you buy your house when you're in your 30s or 40s and a lot of people will like to just live there forever. You probably were not thinking, can I climb stairs when I'm 75-years-old? Is there easy access to hospitals? Do I live close to friends and family? Right? And I think that's also a really important piece of people tend to retire and move to other areas is those networks that I talked about being so important for the recovery of disasters are often weaker or maybe not there or are evolving. So I think on multiple levels we are under-prepared and it's going to take a lot of funding, and thinking differently about even how we treat older adults. Because we tend to view older adults culturally here as if there's nothing that they can really add to society. And to me in my work, I've found that older adults are often the most resilient to disasters and this despite them being framed as a vulnerable population. And so they tend to bounce back a lot faster than younger people.

Alexandra Arriaga:    Why do you think that is?

Alexis Merdjanoff:    I think that it's because once you get to a certain age, you have experienced a lot of life. And I've actually, I'm working on a project right now in coastal Louisiana, looking at aging in these high risk coastal areas. And I've had older adults say to me, "Once I reached 75 I just realized that fewer things mattered. What matters are my relationships and yeah, I need a roof over my head, but it doesn't need to be this roof and I'll be fine wherever."

Alexandra Arriaga:    Wow.

Alexis Merdjanoff:    And I think that as you get older, generally fewer things start to matter and so they're able to bounce back and put things in perspective. So to me, we can actually learn a lot from older adults and learn how to harness these feelings of resilience and what does it take to bounce back. And one of my goals is to try to identify what those traits and characteristics are, and instill them in younger generations.

Alexandra Arriaga:    That's fantastic. And speaking about younger generations now, I'm going to give you a chance to be everyone's advisor and mentor for a second.

Alexis Merdjanoff:    Sure, I would love to do that. 

Alexandra Arriaga:    Yes. So for all the MPH students that are listening and they're considering doing a PhD, they're like, "Ah, I don't know if that's the route for me." What do you think is the best advice that you can give them in terms of next steps in their career?

Alexis Merdjanoff:    So similar to what I went through, as you know in my early 20s you have to make sure that it's a road that you really want to venture down, which means that you have to be driven by a certain question or interest area and driven so much to understand it in incredible detail. And that's what motivates you because a lot of this profession is internally motivated and you set your own goals and agenda every day. You create your own structure. And so that in and of itself is really challenging and you have to center that structure and drive around something. And for me it's around these issues related to disasters, climate change and social vulnerabilities. And I know that the world is changing and that things will continue to... There'll be new questions that have to be answered. And I'm really driven by that. And so I think that that's something that if you're thinking about a PhD, that that's a really good gut check. Is this really something that I want to focus on for, at minimum, the next seven to 10 years?

Alexandra Arriaga:    That's a lot.

Alexis Merdjanoff:    It's a lot.

Alexandra Arriaga:    Yeah.

Alexis Merdjanoff:    And that that means you have to be really, really passionate about what you're doing.

Alexandra Arriaga:    So basically you have to have a passion before you embark on the PhD route. It's not like you can start and then figure it out. You should go in with a clear view.

Alexis Merdjanoff:    I think you should go in with a passion for curiosity and a passion for understanding a particular issue in great detail. You don't have to know what that is right away. And I think it's very healthy for people to go into a PhD program and say, "I'm interested in this, but maybe I also want to take a class in something totally different." Because that type of experience will actually help you focus your original research and think about it differently. And so I think you shouldn't go in and just with blinders on, but you should absolutely be able to say to yourself, "I want to understand something in such great detail that I'm willing to read endlessly about it and go to conferences and talk to other people and try to stay at the forefront of an issue. And shape the knowledge that shared with other people." So yeah, it's also a very long, long road with lots of challenges.

Alexandra Arriaga:    That's what we've heard. And last but not least, when it comes to grading papers, meeting with students, going to conferences, lecturing about public health late into the evening, like our class. Where does your motivation come from to put in the hours and do this work, both inside the classroom and in the community?

Alexis Merdjanoff:    That's such a good question. I care very deeply about a couple of things. I care very deeply for my students and their ability to learn and that learning and that's really where my passion comes is that I constantly want to be learning and I feel like I learned from my students and they learn from me. And that drives me very much. And then I think also just this passion for getting voices heard that maybe we wouldn't hear from otherwise. So when I talk about older adults and how they're often forgotten about in our society, getting their voices out and what they need in order to live successfully and age successfully is really important to me. So I care very deeply about that. And I think if it wasn't personal to me, then I wouldn't care as much. But because I feel so deeply about engaging with these communities and engaging with students, and making GPH the best place for people to come and learn about public health. That is what drives me even when I'm sitting there with a to do list that spans an entire page and I don't know where to start. You have to have that passion and it also brings you a sense of balance and calm, but it's all for a reason.

Alexandra Arriaga:    Absolutely. Well, and for all of those listening, if you get the chance to take a class with Dr. Alexis Merdjanoff, I highly recommend it.

Alexis Merdjanoff:    Oh good.

Alexandra Arriaga:    Yes. She will make you learn. She is strict but very, very passionate. So thank you so much.

Alexis Merdjanoff:    Thank you. Thank you for having me.