Dr. Cassandra Crifasi, PhD in Health Policy and Management | Associate Professor at Johns Hopkins Bloomberg School of Public Health

In this episode, we discuss how Cassandra’s childhood interest in orthopedic surgery evolved into her passion for public health and injury and violence prevention, the different ways her doctoral experience at Johns Hopkins prepared her for her current work on gun violence prevention, and her take on the importance of stopping to evaluate the “so what” behind our work.

Hosted by Lois Dankwa

To connect with Cassandra and to learn more about her story, visit her page on the PHutures #100AlumniVoices Project website.

Transcript

Lois Dankwa

Hi! I'm co-host! Lois Dankwa and this is the 100 alumni voices podcast, stories that inspire, where we explore the personal and professional journeys of a diverse group of 100 doctoral alumni from Johns Hopkins University. Today, we're joined by Cassandra Crifasi, PhD in health policy and management and current associate professor at Johns Hopkins Bloomberg School of Public Health. Hi Cass.

Cassandra Crifasi 

Hi, Lois.

Lois Dankwa

How are you today?

Cassandra Crifasi 

Good! How are you?

Lois Dankwa

I'm good. I'm enjoying the day. The weather is warming, so I'm excited to dive into this chat. So I wanna first start by hearing a little bit about what made you want to pursue a PhD in health policy and management. But then also just hear a little bit more about your graduate work at Hopkins in general.

Cassandra Crifasi 

I was maybe slower to public health than some other folks who ended up pursuing a PhD in health policy and management. I actually very much wanted to be an orthopedic surgeon when I was younger. I thought it was really cool that you could help people after they were injured. I played a lot of sports as a kid, got injured a lot, and had some surgeries to repair those injuries, and just really thought it was so interesting and such a great way to help people after they'd been injured. And it wasn't until I had unsuccessfully applied to medical school that I discovered public health, and early in my public health training I realized that you could keep people from getting hurt in the first place. Like my mind was blown. It's like I didn't know that that was a thing, and that it's not just about individual behaviors, but that we can impact things at the population level through policies through other sort of sets of expectations and that is a tool to help people be safer to keep them from getting hurt in the first place, and that really changed my trajectory. I also had the benefit of learning about the program at Hopkins in particular, from one of my mentors in my master's program and just realized that if I wanted to have much bigger impacts than I ever thought possible, that policy was the tool that I wanted to learn more about to think about how we could keep people and communities safer.

Lois Dankwa

Wow! I love that. I love that for a couple of reasons, cause I can certainly identify with a lot of parts of your experience. I think if we switch out orthopedic surgeon for neurosurgeon it's more consistent with what my experience was. So, I certainly understand that. I'm curious then, since you are someone that shifted from wanting to be someone that practiced medicine to then zooming out to kind of this, seeing how all the pieces work together, but then also influencing through policy, how did that influence then while you were in your doctoral program, how you thought about things and did things and thought you wanted to use your degree after you were done?

Cassandra Crifasi 

So, when I started my doctoral training, I had thought that I would study some kind of occupational injury related to the health care setting. So, I had worked for a very short time as an EMT and then as a nurse's aide for several years before going back to school, and had seen colleagues get injured, had experienced injuries myself, and had realized again that the way we craft policy, the way we think about programming in various institutions can serve as a tool for injury prevention, and that's really what I came into Hopkins thinking that I would do. Through the course of my training, I got exposed to other forms of injury and violence prevention, and really had my perspective broadened about the the ways that policy might impact multiple forms of injuries or multiple forms of violence. So, then once I sort of got a little bit further into my training, I realized that if I really wanted to make the impact that I was thinking about in terms of healthy and safe communities, then I needed to be thinking about other forms of violence and not just violence in the workplace which is still something I think about but also taking a step back and thinking about the various places in which people might be exposed to violence, and thinking about taking the tools of policy to understand homicide, suicide, unintentional injuries, largely thinking about this in the context of firearms. But how can we take what might otherwise be thought of as an individual action or an individual behavior and really take that step back and think about, how can we influence access? How can we think about availability, the types of firearms, how they're stored, how people are using them, and really think about the the big P policy laws, regulations, but also little p policy programs, training, safety courses, the kinds of things we might want to have people engage with or learn more about to try to impact that health and well-being and safety of our communities through this policy tool?

Lois Dankwa

Yeah, that's it's really interesting to hear as someone that also does health policy and management work, it's interesting to hear a similar trajectory, but then also very different interest in it. But noticing how it's through the lens of kind of preventing injury and harm in the first place, and I'm curious how, so what's funny when I think about my own experience, I noticed how, what I thought I wanted, or how I described my interest when I was in undergrad basically describe what I'm doing now. And I mean, sometimes it can be hard to place how things are similar and different. But I'm curious if you notice how kind of your original conception of how you wanted to exist professionally like is fitting into what you're doing now, and what pieces stuck, and what pieces didn’t, and how you're like, how you manage the stuff that didn't stick and if you find ways to push them in in some way, shape, or form?

Cassandra Crifasi 

That's such an interesting question. And I was thinking about this the other day, totally unrelated to this. But some was asking me about teaching, and my interest in teaching, and and I was reflecting on sort of what I wanted to achieve like if I if I had my life goal had gone the way I wanted it to go at the time and I'd become an orthopedic surgeon. I wanted to be at a university affiliated hospital because I wanted to help train the next generation of folks who would be helping people recover from their injuries. And so it's it's really interesting to reflect back on that and realize, well, I'm still sort of helping to train the next generation of people who are going to be using policy as a tool to help improve safety and well-being and help us to understand and mitigate issues that might come along with various policy solutions, and so that teaching part really stuck. I've always loved teaching. I've been a snowboard instructor and a martial arts instructor in addition to sort of the more formal teaching that I do now. And so really thinking about how we can equip people with the tools and skills that they need, whatever the context, to achieve their goals is something that I've always been really passionate about. So, doing it here at Hopkins in the school of public health, it's really thinking about how I can pay it forward? How can I help folks who are as passionate about injury and violence prevention as I am? Understand how policy can be used as a tool at the population level to really impact our health and wellbeing.

Lois Dankwa

Yeah, it's I love the piece about kind of understanding how to use the understanding of things in general just as tools to help kind of move things forward. So, I'm curious, then, about your time at Hopkins, while you are in the program, kind of what things motivated you towards your next step. And did you always know that you wanted to be a faculty member? I know you said you were interested in teaching, but what did your like 2hat was your first role post-PhD, like, and yeah, how did you get to this moment?

Cassandra Crifasi 

So, one of the early experiences I had in my PhD training program was in January 2013, the university, the school hosted a summit Reducing Gun Violence in America: Evidence for Change in the wake of the Sandy Hook School, shooting that had occurred in December 2012, and I was a long-time gun owner. Still, I'm a gun owner, and was really shook by that event. Many people were, and really was expecting something to change, State and Federal policy to change as a result of that of that incident, and seeing Hopkins and all of the amazing faculty, bring together researchers from across the country from across the globe to talk about what policies we have strong evidence on, what the public support is for this various policies, seeing people put this all of this work together, writing the book, getting into the hands of all of the policymakers, and seeing that as still a relatively young student, and thinking, Wow! This is this is amazing. This is what you can activate when people really care deeply about a particular topic, and then to see nothing really happen at the Federal level. We saw a lot of great movement at the state level, but to see nothing happen nationally at the Federal level in the wake of that, it was really really challenging, and I was questioning for myself, is this really the space that I want to spend my life working on? It seems so hyperbolic; it seems so polarized. You hear it talked about in the media and it was so discouraging. But I had fantastic mentors who said, Cass, if if we stop fighting, then we absolutely have lost. If we give up, then we're never going to make progress, and we need to have hope and we need to have optimism. But hope is not a strategy, one of my colleagues, Josh Horowitz, says that all the time. Hope is not a strategy, so we take that hope, and we pair it with effective strategies that have broad public support, and we keep working until we achieve the things that we know need to happen to make our community safer, our families and our friends safer. And so that was a real tipping point for me early on this again early 2013 and into 2014 as I was wrapping up my PhD program, that was a real time of reflection. Is this how I want to spend my time? And I'm so glad that I had these great mentors who continued to support me to stay in this space, because now, 10 years later, it's we're making an impact. We saw in June the first major Federal legislation pass in 30 years related to gun violence prevention, and it can take time, and it can take more effort than sometimes we feel like we can give. But if we if we keep putting in the hours, keep putting in the time, and we don't give up, we pair our hope with effective strategies, then we really can make a difference.

Lois Dankwa

Yeah, I love that you mentioned and you kind of shared how a mentor really helped you through a moment where you were feeling a bit discouraged after seeing kind of response to current events. And it makes me think that for a lot of us in doctoral programs, whether it is in health policy and management, or it's in something else, the role of current events can change a lot can change how we feel about the work that we're doing, knowing that it might change the topic or the specific lens that we're placing on our topic or method of interest or something like that. And I'm curious for you how you've kind of, I mean, you just told a story that kind of touches on this, but perhaps expanding on how, in your experience, you've managed with the fact that current events might change the specific thing you're focusing on or how you have to message about the work that you're doing recognizing that it's still is important and still has value?

Cassandra Crifasi 

It's something we struggle a lot with, particularly, not just broadly in public health, but particularly when we're thinking about gun violence prevention and safety. Far too often conversations around preventing gun violence are sort of coalescing around a mass, shooting, and mass shootings are terrible and tragic events, and we should absolutely be thinking about how we can solve them, how we can address these issues. But it also minimizes the much broader issue we have of gun violence in the US. At this point we have nearly 50,000 people dying from gun-related injuries in each year. So, most of those, around half or so, more than half, are suicide. Large majority of the remainder are homicide, and in that there is a proportion that are mass shootings, but for a long time a mass shooting would happen, we would inevitably get a media request, and people would say, okay, great. You have these policies that might work on homicide overall. But you don't know that they work on mass shootings, so we don't have any solutions, and we heard that enough times that we said, well, I guess we really need to go out and get some answers to this, because we can't keep saying we think it might work, but we don't know. And so, some of our colleagues got together, and we answered some of these questions. What are some policies that are effective at reducing the incidence of mass shootings, or at lowering the number of people who are injured if I'm mass shooting does occur? And oh, by the way, it will also help us reduce the likelihood of overall firearm homicide, intimate partner homicide, firearm suicide, all of these other issues, and being able to address the the current topic sort of the current issue that might be happening, but then also being able to complement that with and here's what we know about how it affects violence more broadly. And oh, by the way, it's supported by the majority of US adults. We've really worked hard to be able to answer some of these questions in the most holistic way possible, because, depending on the audience you're speaking with whether it's policymakers at the Federal level or the State level, whether it's advocates or decision makers or regulators, whoever it might be, folks are going to have different questions. They're going to have different priorities and different perspectives on how they are coming to a potential solution. And as researchers, as public health practitioners, if we can come equipped with the most robust data, then we're more likely to be able to answer the question that's of interest to the particular group, and then we can hopefully move, move the issue forward, and being able to ground people back down to, yes, this terrible tragedy happened. But let's look at how prolific and how horrific these incidents are on a daily basis in the US. And here are some robust tools that are evidence-based and broadly supported that can help us address these issues. 

Lois Dankwa

Right, having evidence that goes far and wide, is able to then cover the kind of the different priorities and perspectives that people are holding.

Cassandra Crifasi 

Exactly.

Lois Dankwa

I'm curious, then what what are like common myths that people think about when they're thinking about your field?

Cassandra Crifasi 

Well, the the primary myth is that anybody who is promoting or advocating any kind of reasonable gun policy to reduce violence just wants to take everyone's guns away, and that can be very frustrating because we have a lot of evidence to the contrary. We have States and the Federal Government that have had many laws on the books that are effective for a very long time, and there hasn't been any kind of mass confiscation. The other really frustrating piece is, we will hear there isn't anything that works. We don't know what works. People are still going to gain access to guns. And so, you're just impacting law-abiding citizens’ ability to defend themselves and bad guys are going to get guns anyway, which is also false. We know that there are really strong sales, firearm sales laws that can keep guns out of the hands of people who are prohibited from having them, which can also then reduce multiple forms of violence. And the other maybe frustrating thing is one of many frustrating things is when you hear people talk about support for these laws, they're often talking about polls that say, do you want gun laws to be stronger or weaker? Or do you think we should have more or less gun control?  And as a policy reached researcher, I find that question so frustrating, because if I said to you, Lois, 100% of your constituents want more laws, what are you supposed to do with that? What actionable information do you have to figure out which laws to pass? Any old laws? Are their particular kinds of laws that are better? And so, we have gotten really specific on our public opinion polling data so that we can then say, here are the types of policies that we know are effective and here's the public support for them. And so, having conversations around this nebulous thing of gun control, and that people don't support gun control, it’s a) incorrect and b) not really helpful for us to advance the conversation and advanced life-saving policies. So, those are some of the frustrating things that are unique to my particular field in gun violence prevention, but are more broadly issues around public health and how we're messaging, and what evidence we have available to us.

Lois Dankwa

Yeah, it's about just right. It's well, my brain is just thinking about how I I really appreciate how people from kind of at your level, where you've gone through the PhD process, and you're now kind of working on the topic in a very full way, but you're responding to like the community and culture and all of those pieces in your work. And I'm curious about how your experience in your PhD kind of prepared you for this ability to be able to have such command over the topic and how you talk about it, recognizing that people have there are myths about your field, but then, like, yeah, how have you, how did your program prepare you to be able to have such command over the topic?

Cassandra Crifasi 

So absolutely the training, the classroom training, that I received was remarkable, right. Sort of thinking about understanding research methods, being able to design my own research studies to be able to answer these really important and compelling questions, but also the ability to then do that work while in the PhD program, being able to work with some of the top researchers in the field in the entire country and learning from them and working with them, hearing them talk about the work was really impactful and it really informed the way I think about this. I also had the opportunity to take a course on health advocacy and thinking about what is the “so what”? All the time I'm talking with students, and they they'll say, well, this is the thing that I want to do or this is the information that I found in my research question, Ok, great. But so what? What are people supposed to do with that? How do we take it the next step? Don't just tell me what. What is the so what? And so that's something that really, I embodied. I really sort of took that into myself as I was thinking about how to do this work, moving forward, because it's not enough when we're thinking about the violence that is impacting our communities across the US, when we're thinking about firearm homicide that tends to concentrate in our minoritized communities, when we're thinking about suicide that tends to impact older white adults. What is the so what and how do we make this information meaningful to people whose lives, their families, their communities, are forever impacted, forever changed when an incident of gun violence occurs? We have to keep the people in our minds when we're doing this work and really being surrounded by people who live that, who do that every day with their research was so powerful.

Lois Dankwa

Right. It's certainly just just being in the space and learning from the people who have experienced all of the stuff longer than you just is a great way to absorb. So, I'm curious then what advice would you have and give to someone who might be interested in your career that looks like yours?

Cassandra Crifasi 

I'm a big proponent of trying most opportunities that come your way, even if it doesn't even if it's not exactly what you want to do for the rest of your life, it can help you figure out what you don't want to do. And so I’m a big fan of trying new things, trying internships, trying field placements, trying different opportunities to really get a sense of what is the thing that's going to get you excited every day. And my my personal mantra is passion gives you purpose, but planning makes progress. So, find something that you are passionate about, something that makes you want to get up every day and do the work. But then you have to be really mindful about setting out a plan so that you can achieve that goal, so that you can get into the PhD program, finish your dissertation, publish your papers, whatever it might be, but that planning is so important, and providing yourself with a structure, the mentors, whatever you need to help you put that plan together is so important. Every interaction is an opportunity to learn and grow and find out something new about yourself. And really don't shy away from hard topics. Don't shy away from trying something that might put you out of your comfort zone. Some of the most best learning experiences I've ever had in my entire life were times where I was really uncomfortable because I didn't know what to expect. I didn't know what was going to happen, or maybe I was in a room with folks that I was so intimidated by I wasn't sure that I was even going to open my mouth, but being in those spaces, pushing ourselves, getting comfortable with being uncomfortable is the best way for us to learn.

Lois Dankwa

Yeah, I love that. Also, I love an alliteration. And you can you just repeat passion gives purpose. 

Cassandra Crifasi 

Passion gives you purpose. Planning makes progress. 

Lois Dankwa

I love that. I'm gonna have to write that down later, because love an alliteration, love a mantra. So that certainly inspired me, and as my last question, I am curious what inspires you right now?

Cassandra Crifasi 

Oh, so many things inspire me, but I think the one thing that is, I'm really sort of holding close to myself right now is I have 2 high school students, a sophomore and a junior, and the thing that inspires me right now, the thing that I'm working toward is a world that is as free from violence as possible for my kids that are going to be adults in the not-too-distant future. How can we use policy as a tool to create a community, a world, a school, a workplace, playgrounds, whatever it might be, that are going to allow my kids and their families to have the safest, happiest, most productive lives possible. That's what I'm holding close right now.

Lois Dankwa

I love that right, right, just working towards a better future, I guess.

Cassandra Crifasi 

Absolutely.

Lois Dankwa

Well, Cass, it's been so wonderful to chat with you today, hear a little bit about your work, your perspective, your experience. Thank you so much for joining today.

Cassandra Crifasi 

Thanks so much for having me.