Faculty Feature: Saba Rouhani on Racial Equity and Drug Policy Reform
Meet Saba Rouhani
Introduction
Saba Rouhani, PhD, ’18, reflects on leveraging the power of multidisciplinary scholarship, bridging policy and public health, and fostering racial equity through drug policy reform.
- Role: Assistant scientist
- Years with HBS: 2021 – present
- Fun fact: "I was on a few episodes of Sesame Street as child!"
Background
Interested in exploring the intersections of criminal legal reform, drug policy reform, public health, and harm reduction, Saba Rouhani, PhD, ’18, joined the Department of Health, Behavior and Society as a faculty member in 2021.
As an undergraduate at Scotland’s University of Edinburgh, Rouhani majored in medical microbiology, studying the political and logistical implications of integrating different infectious disease prevention programs in Sub-Saharan Africa.
After graduation, Rouhani pursued a master’s degree in control of infectious diseases from the London School of Hygiene and Tropical Medicine, where she built her foundation in epidemiology and population health. During that time, she furthered her work to leverage existing structures to deliver primary health care in Sub-Saharan Africa. In particular, she assessed the impact of utilizing local school systems to support health care, especially in rural areas where schools often outnumber health clinics. After completing her master’s thesis, Rouhani moved to Mali, where she worked and lived in the community while managing a large, randomized control trial of school-based malaria prevention and control.
Rouhani’s formative public health experience in Mali inspired her to pursue a PhD in public health. She joined the Department of International Health’s doctoral program in Global Disease Epidemiology and Control, earning her PhD in 2018. Her doctoral dissertation, based in the Amazon in Peru, focused on the role of the gut microbiotia in driving the cycle of undernutrition and infection in young children.
During her doctoral studies, Rouhani began shifting her focus to public health to issues facing her community here in the U.S. She completed a post-doctoral fellowship that allowed her to pursue her interests policing and substance use, working closely with HBS professor and harm-reduction expert, Susan Sherman, PhD. Now an assistant scientist with HBS, Rouhani researches connections between drug policy reform and public health, including efforts to promote racial equity through drug policy reform.
Public Health Journey
What sparked your interest in public health?
Growing up, my family were dispersed all over, and so I did a lot of traveling back to my home country of Iran and also other countries around the world. I was really fascinated by the different health systems that I was seeing and how health access shaped other facets of society.
Even though I began studying politics and social sciences, I was also interested in biology and health sciences. And then I realized I didn't have to choose between the fields since public health is the intersection of all of those things.
Path to HBS and BSPH
What led you to the Bloomberg School?
I realized that if I wanted to keep working in this field, I would need to get a PhD. I applied to come to Hopkins and I got into International Health’s doctoral program in global disease epidemiology and control.
I came to Hopkins in 2013, and I very much had my exploratory hat on. I joined an eight-country consortium based in Peru that studies maternal and child health, and specifically, the interaction between undernutrition and compromised immunity in early life. The less nourished you are as a small child, the more susceptible to infectious disease you are. But then the more infectious diseases you get, the less nourished you are, in part because a lot of those infectious diseases are gastrointestinal; they interrupt your absorption of nutrients and your ability to gain weight healthfully, etc.
I did my doctoral dissertation based in the Amazon in Peru. I studied biomarkers of very young children’s gut composition to see if we could identify targets for therapies to improve their intestinal immunity and promote healthy growth.
What led you to shift your focus from international health to public health systems in the U.S.?
While I loved living and working around the world, doing my PhD here in Baltimore City got me interested in local issues. It was my first time living in the United States as an adult (I left when I was 17 and lived abroad for 10 years), so it was my first real exposure to the health crises that we face here at home.
I became involved in some local social and racial justice movements right around the time that Freddie Gray was killed. The city was reckoning with the impact of state violence on low-income communities and communities of color. Specifically, I became very interested in how drug policy and substance use issues fit into the wider architecture of structural racism I was seeing around me.
So, I pursued a post-doctoral fellowship through the National Institute of Health and the National Institute on Drug Abuse that would translate my existing skills to the fields of substance use policy. I sought out Dr. Susan Sherman, a harm-reduction champion whose work in that area has been formative. I worked under her mentorship to pivot to social epidemiology and substance use research.
While at the Bloomberg School, you’ve been a student, postdoc, and faculty member. What has it been like to transition between different roles and Departments?
Yes, my PhD was in International Health, and my postdoc was housed in the Department of Mental Health. Now I’m faculty in HBS. This is my third Department since joining Hopkins! It has been a really interesting experience to absorb the different cultures and learn new methodologies in each one.
I think it has given me a breadth of knowledge to apply when I think about a public health problem or gap. It’s been really valuable learning how different schools of thought might approach the same scientific question, and wonderful to collaborate with people in each of these Departments.
My transition to faculty has also been very exciting. I still have some impostor syndrome, having joined Hopkins as a student. But I was happily surprised that my faculty role does feel truly distinct from the ones I’ve held before. It’s exciting to pitch my independent ideas and collaborate with people I used to study under.
Research Interests
What are some of your current research interests and projects?
My own research agenda is exploring how the policing of substance use has contributed to the current overdose and incarceration crises and driven deep disparities in health and social wellness in our society.
There’s an increasing appreciation of how drug war policies, how prohibition of all illicit drugs and the treatment of drug use as criminal, is causing individuals and their broader communities a lot of harm. Going in and out of the carceral system is associated with more overdoses, more substance use, etc. That literature is now out there. It is a really exciting time because there are now policies being adopted, or at least considered, to try to reverse this criminalization approach. In some settings, decriminalization is being enacted through prosecutorial discretion and prosecutorial reforms, and Dr. Sherman and I have been working to evaluate and inform some of these new policies.
Racial Equity and Drug Policy Reform
You received a Pilot Research Award from the Bloomberg School for your project titled “Promoting Racial Equity Through Drug Policy Reform: Examining Implications of Drug Decriminalization for Racial Disparities in the Criminal Legal System.” How did the project begin?
We had the opportunity to work with the State Attorney's Office on the early evaluation of a decriminalization policy in Baltimore. The State's Attorney announced that she would stop prosecuting a suite of low-level crimes, including drug possession. Through that opportunity to evaluate that work, I saw a need to really think critically about how these policies may or may not help address the racial inequities that we've seen arise from drug war policies.
Using the Pilot Research Award, our project aims to look at ways that structural racism impacts health and whether and how that can be reversed through drug policy change. We are speaking with policymakers around the country who are at different stages of designing or implementing changes to the punitive, criminalized approach to drug possession, to understand whether and how racial equity measures are integrated into their policy process. We’re also conducting some quantitative analyses to measure whether policy benefits are equitably distributed.
What new insights do you hope the project will provide around racial equity and drug policy reform?
I think it's really important to actually conduct rigorous research on this because other policy reforms in the recent past have promised to address these racial equity issues and come up short. Many hoped that if cannabis were legalized or decriminalized, it would help address some of the racial disparities in the prison population. That has not borne out in a lot of settings. We're seeing that people of color are still being disproportionately arrested, but just for a different charge. And there’s such existing disparity in criminal histories and economic access that in settings where cannabis is now very, very profitable. Communities of color are often unable to participate in that economy.
So, I think it’s critical to not just assume reversal of some of these policies is going to be a magical cure to the deep inequities that we see along racial lines. That’s what motivated us to conduct the study. We hope to devise a toolkit or some actionable recommendations for different jurisdictions who really want to act on this.
Would you share more about the scope of the project and your team’s research approaches?
We are looking at cities around the country that are exploring or adopting ways to move drug possession out of the courts, and speaking with policymakers in those settings to explore motivators, challenges, and successes with these reform attempts. We are also specifically working to understand which pieces of the policy are explicitly designed to address racial inequities, and if there are measures in place for effective evaluation and accountability pertaining to that objective. We’re also speaking with national drug policy reform advocates to understand the merits of different approaches to decriminalization — namely, the legislative route versus the prosecutorial discretion route — and their implications for things like racial equity, sustainability, and downstream health outcomes.
We are complementing that with some quantitative research, looking a little bit more closely at cities like Baltimore, that have already been bold and adopted some of these reforms. In these settings, we’re measuring whether arrests have decreased for drug-related charges, whether reductions in criminal justice involvement are racially equitable, and trying to identify where inequities are persisting. To do this, we’re looking at reductions in arrest by race at the individual level, but we're also looking at neighborhoods where arrests are persisting. What is the racial and social makeup of those neighborhoods? What about factors like gentrification or history of redlining? These are the kinds of community-level indicators of structural racism that we would like to explore.
What are some of the other research initiatives you’re pursuing?
Dr. Sherman and I are really trying to build out more work in this area of the intersection of decriminalization and harm reduction. We have a couple of different projects in the works in that regard.
Besides my pilot award, we've been collaborating with colleagues in the Department of Health Policy and Management to look at nationally representative polling data and understand, more broadly, how Americans are feeling about decriminalizing drug possession and reinvesting resources from aggressive enforcement of drug policies to other services. It’s an exciting time because different models of decriminalization are gaining some traction here, in a way that I wasn't sure they would in the U.S. setting.
Beyond that, I have had the opportunity to continue work on a number of Dr. Sherman’s projects related to drug checking. We’ve been working hard to validate and scale up access to drug checking resources which can potentially help people who use drugs navigate the illicit drug market more safely. A volatile and unregulated drug supply is one of the key ways that drug prohibition can increase overdose risk.
Finally, as faculty I have been able to get experience doing some applied work collaborating with the Maryland Department of Health, conducting evaluations of statewide impacts of different models of investing in harm reduction. Maryland’s Department of Health has a dedicated division called the Center for Harm Reduction Services, and it has been really rewarding to work with that group as they design and roll out programs to meet the needs of people who use drugs statewide.
Public Health and Policy
What do you find most meaningful about working at the intersection of public health and policy?
This is really the crux of what I'm interested in: how do laws and social policies either potentiate public health or act as a direct obstacle to it?
Often, unfortunately, providing evidence-based resources to promote the health of people who use drugs and their wider communities is directly at odds with the prevailing policy environment. We see this with laws limiting access to services like syringe exchange programs, overdose prevention sites, etc. And I personally think many of these laws are rooted in ideas about morality, or in agendas related to consolidating political power, instead of in evidence or commitment to healthcare as a human right. So, I do find it meaningful to work in this area and try to move the needle among decision makers, to urge them to consider the actual evidence of what works and doesn’t work in restoring the health and dignity in communities which have been historically harmed by our approach to drugs.
The projects I've worked on in public health had been really different from each other, but the overarching goal was always to work with communities that have been systematically excluded or disinvested in, to reduce broader health and socioeconomic disparities. Whether internationally or here in Baltimore, that’s what I’d like to keep learning—how to do better. Right now, working on drug policy reform seems like a high-impact way to do this work.
This interview has been edited and compressed. Views expressed are the subject's own.