The Life or Death Stakes of Inclusion

By Elizabeth Labiner

Sana Khan is a self-described “Wildcat for Life,” raised in Arizona and in the process of earning her third degree here. Khan grew up in Kingman, a town in northwestern Arizona with a population smaller than the undergraduate population of UArizona. “I was really into reading and hanging out with my siblings because there wasn’t much else to do in Kingman,” she reminisces. 

When it came time for college, Khan left Kingman for the comparatively big city of Tucson, first earning undergraduate degrees in Physiology and Psychology before continuing on to a Master of Public Health. After a short break, she returned to the Mel and Enid Zuckerman College of Public Health (MEZCOPH) to pursue a doctoral degree in Epidemiology. Her academic career here has helped her define her interests and find her calling, advancing from a general desire to help others to fighting for social justice by balancing inequalities in health and healthcare. Khan explains, 

I wasn’t sure what I wanted to do when I started my MPH. I knew what my interests were broadly. I was interested in helping people and in reducing health disparities. I also started my graduate degree around 2016 and was feeling pretty hopeless about the state of things in America. Getting my MPH gave me a concrete way to accomplish these goals. The projects conducted at MEZCOPH allowed me to work within my community, and I felt as though the values of the faculty closely aligned with my own.

The professional and personal values of the faculty were crucial to her decision to return to graduate school and pursue a PhD at UArizona. Khan works with Dr. Kate Ellingson, Dr. Kacey Ernst, Dr. Beth Jacobs, and Dr. Kristen Pogreba-Brown, all of whom impact her view of her career and life goals: 

While my mentors are (of course) impressive professionally, I chose to stay at the UA for my PhD because of how they practice their values in their roles as researchers and faculty. They are outspoken about improving public health and in their social justice efforts. I feel incredibly grateful to learn from these women, and I hope I can do as much good as they have in their careers and personal lives.

Khan is well on her way to that goal. Her research interests emphasize the intersection of women’s health, health disparities, and infectious disease epidemiology. Khan’s dissertation is primarily focused on antibacterial resistance and how it occurs. This is a critical area of medical research, because when bacteria evolve in response to antibiotics, it renders our typical treatment methods ineffective. Antimicrobial resistance occurs in part due to the misuse and over-prescription of drugs, creating resistant bacteria known colloquially as “superbugs” that lead to deadly infections. “I’m interested in learning what knowledge, behaviors and attitudes lead to antibiotic misuse and how these behaviors can be improved using an effective public health intervention,” Khan explains. She continues, “I’m also interested in exploring how COVID-19 has changed how people use and prescribe antibiotics, and if this will lead to greater antibiotic resistance in the future.” 

Khan’s work has taken on a new urgency in the current climate; she finds greater recognition and reception for her research among nonspecialists. “It is definitely weird to be an infectious disease epidemiology student at the moment,” she muses, noting that she no longer has to refer to movies to give a frame of reference or illustrate her work. Since the onset of the COVID-19 pandemic, Khan has also been involved in creating a new cohort study with the aims of investigating both the short- and long-term effects of COVID-19 in a diverse population. The study is enrolling both people who have and have not had COVID-19. Anyone interested in joining may learn more and sign up for the CoVHORT study by visiting https://covhort.arizona.edu/join/. 

Khan’s assessment of the impact of the pandemic here in the United States highlights both the abysmal response and the deep divisions it revealed: 

The current pandemic has demonstrated how many of our systems in the US are broken. Our response was late and messy and resulted in so much unnecessary death. Our healthcare system was pushed to its limit in March and April and still has yet to recover to full capacity. The lack of available testing and personal resistance to mask-use has also exacerbated an already horrible situation. The most effective public health response would have been to shut down for several weeks in conjunction with a detailed contact tracing effort. We tried to shut down, but we did not provide accurate resources to make this happen, outside of a one-time stimulus check. We also know that not everyone was afforded the luxury to “work from home.” Essential workers, such as healthcare workers, farm workers, factory workers, transportation workers, and grocery store workers were not afforded this luxury. Many people had to make the difficult choice to continue to work to earn a living while get exposed to the virus or face the uncertainty that comes with unemployment.

Further, she points out that the virus is not impacting all racial and ethnic groups in the same way. Black and Latinx people are more likely to be hospitalized and die from COVID-19. Khan notes that social determinants of health have long predicted negative health outcomes for minority groups over time: 

This is just yet another example where we have failed to prioritize ‘all lives.’ Minorities are more likely to experience discrimination in housing, healthcare, and from the police. Minority groups also comprise a higher percentage of the workforce that we deem “essential.” Poor communities were less likely to have access to testing and were more likely to have a COVID-19 exposure. These issues are not new, but the pandemic has highlighted how deep health disparities run in America. I hope this can serve as a motivation to change these systems. 

Khan concludes, 

We needlessly lost over 200,000 lives. I am infuriated by this. We still have the opportunity to correct our response and mitigate some of the damage caused by COVID-19, but we will never get there until we are all on the same page, use masks, believe in science, continue to social distance and comply with contact tracing efforts.

Looking ahead, Khan isn’t sure whether her career will take her into teaching, research, a public health position in an organization such as the Centers for Disease Control and Prevention, or some combination of all three. While her specific plan is yet to be determined, she does know one thing beyond a shadow of doubt. She’s committed to improving the health system for those it currently fails: 

Wherever I end up, I hope to continue to lessen health disparities and be an advocate for others. I hope the attention the US has received for its botched COVID response is enough for us to want to invest in public health and make lasting, effective changes to our healthcare and public health systems. I hope I can be part of this change.