The Atrómitos Way
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The Atrómitos Way
#035: Here We Have Idaho: The Consequences of Small Government
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Getting to know another team member of Atrómitos, Amanda Rodgers, MPH, shares her journey into public health and how her experiences in Idaho's challenging political and healthcare landscape have shaped her understanding of the field. Despite working in a system that often hampers progress, Amanda chose to stay in Idaho, driven by a passion to make a difference in her home state. Amanda discusses the pressing public health issues in Idaho, including the lack of resources in rural areas, the impact of conservative policies, and the erosion of trust in government.
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So we have a lot of anti-trans bills that have gone through. HB 71 banned all gender-affirming medical care for minors in Idaho. And that makes it illegal for a health care provider to provide those services. I just have to say, like, I understand that there are arguments on whether or not to do something with someone who's a minor, but that's where a medical professional should decide and give counsel to the family in the minor, not our government. Our government shouldn't be deciding how families choose to live.
SPEAKER_01Welcome to the Adromatus Way Podcast, where we have meaningful discussions on the challenges in healthcare and the solutions behind them. I am your host and producer, Liz Church. Each episode we dive into the complexities of our health and social system, gaining the experiences and insights of the guests that shape our lives and our communities. And today, ladies and gentlemen, I have the great opportunity to introduce another member of the Adromatus team to sit with me here on the Adromatus Way. Amanda Rogers. Amanda Rogers is a dedicated public health professional with a deep commitment to making a difference in her home state of Idaho. And today's conversation will allow the audience to get to know her personally and then know her professionally following her journey into healthcare to navigating the intricate and challenging landscape of public health in Idaho. So, without further ado. Hi Amanda. Hi. Welcome to the podcast. So before we dive into your background, I do this, I don't want to call it torture, but it kind of is torture to my team. Uh, ask you some fun questions so the audience can get to know you better. So, first one I've got for you. Would you say that you are more an introvert or extrovert?
SPEAKER_00So this is highly debated. And I consider myself an ambivert, or I call myself an outgoing introvert. So it's debated because my introvert friends are like, you are not an introvert, you do not get to claim this. You are way too outgoing, and people know you. And then my extrovert friends often find that I'm like, yeah, I need to go be alone now, you know. So I'm just solidly in the middle, I think.
SPEAKER_01That is really I can't imagine that. Maybe it was because I I'm very introverted and I can't imagine a middle ground, but it's crazy. I didn't even think about it being an actual thing.
SPEAKER_00I love presenting. I do have the weird thing where I actually do like being in front of a crowd. I do get energized from that. I know.
SPEAKER_01I don't know how to do that.
unknownI know.
SPEAKER_00And and I think part of it has to do with like a background in teaching and just getting comfortable with being in front of everyone. And but then, yeah, I just have to go be alone. Sometimes I'll turn off my phone and I'm gonna go hike for two hours, and I don't want to say a single word. I don't want to hear a single word, and I'll just be gone. And one way it was described to me though was if you go to a party, where do you find yourself? Do you find yourself in a corner talking to two or three people, or are you circulating the room? And I do both, but Mike, at the end of the day, I actually love it when I find people I like, and then I'm like, okay, I don't have to talk to everyone anymore. I'm just gonna talk to you in the corner.
SPEAKER_01You have a very interesting background, and we're gonna just talk about part of it real quick. So your first degree was in English, uh, which tells me you're an avid reader. So, do you have a favorite book that you could share with the audience and explain why it's your favorite?
SPEAKER_00Yeah, you know that you know this question was like pure torture, right? Like to even answer a single one. So you know that I can follow rules. Of course. Like, I won't give you categories. Um, no, I'll make it brief. I will say, because I'm in Idaho, I have to give a couple shout-outs to Idaho authors. So Tony Dore, All the Light We Cannot See. I mean, that's now becoming a TV series. Um, Alan Heathcock, he was one of my professors in college, and he has a great book called Vault. So, and another one called 40, but check out those. And then when it comes to nonfiction, David Sederis, 100% satire satire satireist, what can I say that word? Essayist, satirist, whatever. He's sardonic and hilarious. Um, fiction, I like Neil Guiman or Gaiman. I never know how to say that correctly.
SPEAKER_01Yeah, I don't either. I think it's Gaiman. I don't know.
SPEAKER_00Yeah, Cormac McCarthy and Barbara King Solver. And then if I have to say like the book, I will say Barbara Kingsolver Poison, the Poison Wood Bible. And the reason I'm saying that's my favorite is it's one that I've it's huge and I've legitimately read it three times like multiple times. Like I've gone back to it through multiple life stages. I read it in high school and then which did not have the capacity to comprehend it then. Read it again in college, and then I read it again in my 20s and like later in my 20s, and it evolved for me in meaning every time. And it's this amazing story that follows these daughters and this wife, whose husband decides to pick up their life from southern US and move to Africa to be a missionary, and he had no idea what he was doing, and it's following his family and this life that they've been thrown into, following their dad/slash husband, who was on an interesting journey of his own. And I don't want to spoil it. It is a darker book, but it's it's amazing. It has an amazing look at colonizing and our ways of which we consider ourselves in the world and how we consider ourselves to do good for the world. And also, I mean, just mentionings of how the patriarchy plays throughout that. I don't think that Barbara King Solver says that, but I'm gonna say that. You're not speaking for her, but this is your I'm not speaking for her, but those are the term, those are the things that I've come to understand as I've I'm now sitting here, you know. But over time, it's seeped in over many years.
SPEAKER_01I wonder what your interpretation will be, if it'll be the same and maybe in 10 years if you pick it up again. Try to wait a decade and see which how you feel and see what you've things you recognize, things that change. I don't know. Idea. You don't have to, just throwing it out there.
unknownI probably will.
SPEAKER_01So then going into the last question I've got for you. So you went from an English major to obtaining your master in public health. So can you give us a deep maybe not too much of a deep dive? Because you and I spent like an hour talking about your deep dive, and I was looking at you like, holy crap. I mean, we're not gonna do the explicitives that I and the faces I was making, but we're gonna let's talk about what prompted you to make that switch to the healthcare sphere.
SPEAKER_00Yeah, so like any good story, it was a twist of fate, and truly not something that I initially had decided to do at all and kind of found myself doing. So, like any good millennial, I graduated into a recession, was living in a state that had one of the lowest unemployment rates in the US at the time, or highest unemployment rates, lowest employment rate, you know what I'm saying? And I basically I had a Spanish minor and I spoke Spanish, and I'm gonna get out of here for a while while um I'm gonna leave the US while it's going through this. So I joined Peace Corps, or I applied to join for Peace Corps, which is an a US agency that works in lower income countries that have invited them in to work on their skilled workforce, which is problematic in its own terms. You know, they did they do send a lot of 20-year-olds who don't know what they're doing places, but and I was one of them. So being an English major, I assumed I was gonna be sent to go teach English somewhere, and I actually was originally lined up to go do that. I was going to go somewhere in the Caribbean and teach English, and my paperwork sat somewhere on someone's desk too long, and I missed my opportunity to go. Like it didn't, it didn't end up that I could go for that that line of service. So they re-looked at my resume. They were like, Well, you didn't make it into that one. And this is like a year-long process, right? So they're like, it's gonna be like another six months before we can find something for you, but let's try and see what else you have going on in there. Um, looks like you used to be a camp counselor in high school. And so in high school and early college, I had participated in something called the Idaho Drug-Free Youth Summit, and I was a counselor, and it's exactly what it sounds like. It promotes drug-free lifestyle. They basically were like, cool, youth development, that's what you're gonna do. So I got sent instead to Peru, where I worked in youth development, and one of the top goals was helping promote a healthy lifestyle, and they essentially trained us for two and a half months, two-ish months, on public health. So they trained us on how to do a community needs assessment and how to go in and work with stakeholders and do key informant interviews and surveys and SWOT analysis and all the things, and then sent us out and told us that our first three months of service, we were only allowed to do that. And so I ended up in this rural community in Peru that I lived in for two years and made a lot of amazing relationships, had a life-changing experience. And my primary goal ended up being, after doing my community needs assessment, teaching sex education in high school with the local OBGYN. And so it was the most amazing project I had. I had other projects, but it was my absolute favorite. And then I was like, Can you do this in the US? Like, do people do this? And there were other volunteers who were public health volunteers. And I was just like, wait a second, there's a whole line of work that I missed here because I was an English major, creative writing major. I was sitting alone in a room writing essays and not out doing community-driven work. And so I came back to the US and basically was like, how do I do that? I don't think I could ever do anything again that doesn't serve the well-being of everyone. And I just did everything I could to try and get into public health, but you know, I didn't have the degree in it, so no one wanted me. So I worked at a hospital as a patient registrar. I was working in triage in an ER and in the call center, and just doing everything I could to make my way where I could in quote unquote healthcare. And I had a friend from Peace Corps who had gone back to college, gone, gotten into a fellowship program at the University of Arizona in Tucson called the Peace Corps Coverdale Fellows. And basically, it's a fellowship that's offered for returned Peace Corps volunteers to pay for their entire graduate program and it in in exchange for volunteer work and service work in the US. And um yeah, I then started studying for the GRE at my job at the hospital. I took all of my books and studied on all of my shifts and got into got into the University of Arizona magically in a in a college of public health and a line of work I had not really done except for Peace Corps, and um and then begged, I'm not joking, the director of the fellowship to accept me. Um, I sent a Hail Mary message about six weeks before school started. And I noticed that you haven't told me no yet to this fellowship. So maybe there's still a yes in there, and I will blow my life up. And I was living in Washington at the time, Washington State. I was like, I will blow my life up and pack my car, and I will be in Tucson starting classes if you say yes. And then later that week she said yes. So I literally a few days before moving to Tucson, didn't even have a place to live, packed my car. This inevitably was like also leaving a relationship. It was just something I felt so called to do that I was truly willing to blow up my life to do it. And at as another turn of fate, I ended up being able to live with my friend who I did Peace Corps with, who told me about the fellowship. So I yeah, and that and that's when I got in, and the University of Arizona was great. I had an amazing experience there. The Peace Corps covered up fellows, shout out to Georgia. Um, just I I've told her many times that she changed my life. So here's another thing, it changed my life. And I actually started studying first and foremost sexual violence prevention because I got placed with magically a mentor who's one of the top researchers in the in the United States, Dr. Coss, Dr. Mary Coss. So I just had this very serendipitous, magical experience of everything working out in my favor in so many steps along the way and leading me into public health. And yeah, and then eventually I realized that I hadn't lived in Idaho. I'm from Idaho, I hadn't lived here for about nine years. And I realized I just wanted to come home. I had this very stark moment. I had gone into a doctoral program. I was actually getting a DRPH, a doctorate of public health. And I just had this moment of realizing academia wasn't the route I wanted to take. I wanted to work directly with communities. I didn't want to just be doing, I didn't want to be spending three to five years in research and then potentially staying in academia. Even though DRPH is more a practic, practice-based title and degree rather than a PhD, which is more research. I just tended to gravitate towards more research. And yeah, and I just kind of realized this isn't, this isn't the route I want to go. I want to go to where the community, maybe not the community level, but above the community level, to where I can help decipher policy and and budgets and and the funding that comes through to help filter that out to communities. And so I I truly just did a Google search of public health jobs in in Idaho, and an evaluation specialist position came up in the Idaho Department of Health and Welfare, and I'm 100% qualified because of all the research I've been doing. And evaluators and researchers are very hand in hand. And so yeah, it was just, it was my chance to come home. I had to do some really hard things and say goodbye to people at the university and turn down my my doctorate program. It was a huge decision, but not one I took lightly at all. And it it just was, I just felt like it was time. It was time to make a different change.
SPEAKER_01So speaking of Idaho, we have a lot to talk about Idaho.
SPEAKER_00Yeah, we do.
SPEAKER_01Um let's see what's what's been going on in Idaho, but let's start with your professional experience. How has your understanding of public health evolved through your experiences, especially considering Idaho's current political and healthcare landscape?
SPEAKER_00As I was leaving my doctoral program, clearly I gotta go to the top. I gotta go and to the top as best as I could in this quote unquote system, right? I wasn't going to the CDC, but I was like on a state level, the top is the Department of Health. I thought, yeah, if I go there, then I helped determine through research, through best practices, how how money should be spent and what how that should be spent with communities and making sure that communities are getting the money that they need. And I when I was working for the Department of Health and Welfare, which I did for six years, I often saw myself as a liaison for community organizations and nonprofits and universities as like a person to help break down the bureaucratic barrier barriers and to get them the funding that they needed, which was you know given to us through the feds and sorry, the federal government and state government. And um, and yeah, I thought that's the best way I can help people. And then over time, as um our quote-unquote small government, which means policy, became pretty heavy policy in how public health runs, pretty, pretty heavy, as it started to get more and more like that, and I was able to help communities less and less. I was I I keep my coworkers or my former coworkers and I, I speak to my former colleagues a lot still. We use the word hamstrung or hamstring, a common term. They're just hamstringing us or this, that, you know, and that was the feeling. It was this feeling of we are we have so much capacity to provide, and we're being prevented from doing our jobs, we're being prevented from actually serving in public health. And and that's when I realized that actually grassroots levels, grassroots level efforts, a lot of times can get more done. And it it was very hard to come to the realization that the system I was working in, which should have been the system that served people the best, that should have been the system that created the most opportunity, was not. And and I will throw in there my own personal thoughts being that as long as we live in a society that runs off of capitalism, that runs off of the haves and the haves nots, and someone needing to be above someone and someone needing to be below, we're we're never going to truly promote public health on a system-wide level, like a full system-wide level, because it doesn't make enough money. It doesn't make enough money for for our communities to be that well and healthy. It doesn't seem human at all. It isn't, it isn't, and also like that in the context of Idaho, there's more going on there than just that. You know, there is a lot more going on. And but it is something that consistently I've seen that the grassroot level efforts are where people can actually mobilize, they can do it quickly, they can what quickly being the key term, because that's not something you can do in the government. And in fact, a lot of people who are trying to, I think, impede public health intentionally, they do that by making it slower. They do that by making it more ineffective. And it's it's a terrible thing to be part of an organization or an agency that cares so deeply and wants so much to provide and is so incapable of meeting people where they where they are when they need it. And because of policy and bureaucracy that maybe initially was instituted in order to provide equity and well, a bad word now, equity.
SPEAKER_01I don't know. We'll get more than that.
unknownI know, right?
SPEAKER_00And to making sure that things are transparent and done above board. Like that, that is definitely where some policy and bureaucracy comes from, is that it was all about checks and balances. But but then it go went into a new realm where it was no longer about checks and balances, it was about preventing things from happening. And yeah, I was gonna talk about this in a little bit, but I might as well say right here the Idaho government has been, our legislators and our leaders, they've been moving away from federal funding and moving away from working with federal government. And first of all, federal funding is one of the number one sources of funding for every state in the US. Like it is how we work, it's our taxes coming back to us, it's it's it's how we address needs on a nationwide level. And Idaho is systematically starting to eliminate federal involvement. And that we can suppose could be part of trying to become sovereign and to no longer be beholden to federal agencies and requirements. Some of it, I can't tell if it's a misunderstanding or it's just this is the cloak they're putting it under. There's this idea that, oh, if we return federal funds, it'll go back towards our deficit. But that's not how it works. If we return federal funds that were, that are allocated to states to work on different health initiatives, it just goes back to that health initiative bucket and gets redistributed to other states. It doesn't go towards any federal deficit. It doesn't help us be less in debt as a nation. And it doesn't better our communities. But it on the division of public health level within the Department of Health and Health and Welfare, there has been a larger look at federal grants and seeing them as a regulatory burden. And at one point, one grant that I know of in that was COVID COVID relief funds was $11 million and it was turned away by the state from the federal government. And that's just one of the grants that it could measure up to more than. I mean, I don't know the exact number, like estimated maybe around $30 million. So that's money that our communities didn't get in in addressing this emergent pandemic need. And all the other states got it. And there's no reason why we shouldn't have gotten it, other than we didn't, our government decided it didn't want to be involved with that regulatory burden or with the being beholden, quote unquote, to the federal government. And I mean, we we have seen data that shows that more Republican states fared worse during COVID.
SPEAKER_01Oh yeah. Oh yeah. It was it was kind of one of those situations where you didn't want to laugh because so many people suffered, but you had to just hang your head because it's like, why did you let all these people have all these problems? Why did you let your citizens suffer? Why it was the meaning of that?
SPEAKER_00And conservative politics is really in Idaho is really, like I said, working towards that. Sovereignty, working towards what they consider freedom from socialism. And so working in having freedoms, that's and being independent, being sovereign, and having quote unquote rights. They're their sovereign rights. However, a lot of it ends up actually being rights for some and not for all.
SPEAKER_01Do you have the ability to talk about, you know, given the complex and dangerous government climate restricting progress and growth for Idaho? Why did you decide to stay in Idaho despite the challenges?
SPEAKER_00It's home. It's home. It's home. And also when I was in grad school, there was this moment where many of us were wondering where to go next, right? Like where do we go from here? We've just gotten this education. We're now ready to go be professionals. We know about different programs that are running all over. We know about different states that are more likely to support different programming, which means, in turn, a better area for us to be a workforce. That's where we would want to work, right? You want to work where there are jobs. And a couple of my friends uh came from red states. And, you know, I'm also clearly from Red State group, grew up in one of the most rural and remote communities in Idaho, in an isolated remote community that didn't even have a hospital. And we we kind of talked about how sure we could go and work on these cool projects in these states that already have these really deep, profound years and advanced projects that have been going on. Or we could go home and help. Like we could actually be part of the help that that could make our state great or make our state healthier and bring our education and our knowledge back to the to the communities that we came from. And that's that's definitely something that I felt when I was at the Department of Health and Welfare. It was really interesting to be from such a rural and remote community. I'm from a community that's designated frontier, which means it has less than seven people per square mile. And my community that I'm from is less than it varies depending on the local climate with work, but workforce, but it usually hovers under a thousand. And I grew up in a community that really cared about each other. And I know that things have shifted and changed over time, and that was a different era, but I grew up feeling like I was being taken care of by my community and that everyone put in their effort. I have a mom who is a philanthropist, and I I watched her most of my life volunteer for various things around the community when she later became the president of a nonprofit that helped with emerging needs for community members, whether it be emergency food boxes or utility bills and services, and just being at home, even visiting now. My mom is answering calls from people in the community and directly on her phone line and then going and helping. And that's the community I grew up in. And so when I went and worked at the Department of Health and Welfare, I realized that there is a disconnect. Like Idaho is so rural and frontier, and then it has some major urban centers. And I'm living in Boise and working in Boise. So I would recognize when certain projects were being done that people wanted a rural voice or they wanted an understanding of different practices in rural communities to roll out these projects, and they were just struggling. And and then I recognize I'm like, oh, it's because you're not used to how things work there. And yeah, they're not gonna trust you whatsoever. You're you you represent the government in a system that's from outside of their community, they're not gonna just adopt that instantly, you know, and so I ended up becoming someone in conversations that would speak to my my experience growing up in my hometown and understanding the culture of a small town and a community that is built on rugged individualism, who needs to be independent and and feel independent. And they're homesteaders, they're ranchers, they're people who are really making it on their own and but still need these services, like really need them. And uh and like how to make that accept accessible and acceptable in a community level, because asking for help and getting help is also a huge tenant that is difficult to have when you're in that rugged individualist mindset and eco that.
SPEAKER_01Yeah, yeah. And I think it's it seems foreign to me because where I am, there's I think they did the census. We're the smallest county is in like a size of the way that the border's cut out, but we have like a hundred thousand and some change. I think it's like twice that now.
SPEAKER_00Oh yeah, the county I come from is the largest in size with the least amount of people. It is truly just land for it's just yeah, you can drive for an hour, not and like maybe see a few houses. And it's very remote. I don't have cell service sometimes, most of the time in my parents' house where I grew up. I don't have cell service there. Still, you have to have, if you're going to the community where I'm from, it's smart to have like a Garmin in Reach, like which is a GPS system to help get messages out if you're spending any time in the woods around or just like out recreating in the area. Also, to have a life light membership, because that is the way you're gonna get emergency care. Because there is a volunteer EMS in the community and a rural clinic that is has limited hours and doesn't have consistent staffing with a doctor. So, and yeah, so that's that's those are two things that are pretty, and that's not just my community, right? Like that's pretty well representative of a lot of Idaho.
SPEAKER_01When I think about this, and one of the things that you had mentioned when we were talking is like that sense of community and people not realizing that they need it. And I feel like with a lot of the things that are happening in Idaho, it's kind of like it's trying to break apart it being the government, it's trying to break apart that grassroots, that community to keep it so it's strong. Does that make sense?
SPEAKER_00It yes, and you know, it is like often the irony is a lot of conservative policies end up hurting conservative small communities the most, right? But I mean, I will say I do still see a lot of community cohesion in these communities. It's not that there isn't communic co community cohesion, it's that they don't want anyone outside of the community to come in. It's kind of it's a joke, and I feel I can I can kind of make the joke. I I sometimes am not recognized in my own hometown since I have left. And so people do have a little bit of a wall up initially when I come back home and and then they see me with my mom and totally melt, and it's it's no longer that wall's no longer there. I look quote unquote city. And but you know, I don't know if you ever watched South Park growing up, but you know, there's like the joke where like, we don't take kindly to your kind around here. That's kind of the like everyone is very kind, I will say though. People are nice, people will will be kind to you as you're passing through. But when it comes to like, oh, I want to come to this community and make change, people are gonna be like, whoa, whoa, whoa, who are you? Who are your ancestors? How do you have roots here? No one's averse to having things that help them, it's just the package in which it comes in, right?
SPEAKER_01Yeah, and we can totally expand and go on and on about your life in Idaho with these fun things. I mean, I just really encourage everybody, just read up on the news, see, and you will have stuff that's coming out in the next couple months about things, certain things in Idaho.
SPEAKER_00Do you want me to speak to some of those things more specifically? You can. Yeah, I'll I'll go ahead and say our Idaho's government has made pretty much a tax on education, autonomy, and health, like across the board. If we look at just the top things you'll see in the news, the Idaho Library Bill, which was HB 710, made it so basically it was a mandate that for Idaho public libraries and schools, that any materials that were considered quote unquote harmful to minors needed to be redacted and taken to areas that only adults could access. And any adult could make a complaint about a book, deeming it adult material. And a lot of times that ends up being content that talks about sexuality, gender identity, concepts that are quote unquote worldly, are arguably not things that should be taken out of the grasp of someone who's a minor who's could 15, 16, 17, 18, you know. And this is including in books in school. So basically, it gives a concerned parent or adult access to basically get rid of any book that they decide from a library and removing access from a minor to it. And and that includes fines if the library can't comply, which I I mean, we all know how well funded libraries are. They just have all that money and all that time. And this honestly has hurt smaller communities the worst. So rural communities are getting hit the hardest with this bill because rural communities have small libraries where they can't separate content. Like some libraries are maybe a thousand square feet. So, yeah, so we have a rural remote community in Idaho that had to basically make it so no children could come in their library. And because they could not decipher out what was an adult content and what was children content, because it was all in the same room. They that library also had a lot of after-school programming that was really consistent that brought in money and that gave the community access to programs for their children. And now they're trying to find workarounds with it. They have to get parent permission and working with things so that they can still come there and use it and have selected books for them to access from the library. But it just creates a huge burden and a barrier to communities having access to books and like and education and content and honestly, like autonomy, right? And how they choose to educate themselves. You know, moving on, continuing to talk about autonomy. So we have a lot of anti-trans bills that have gone through. Um, HB 71 banned all gender-affirming medical care for minors in Idaho, and that makes it illegal for a health care provider to provide those services. I just have to say, I understand that there are arguments on whether or not to do something with someone who's a minor, but that's where a medical professional should decide and give counsel to the family and child in the minor. Not the not our government. Our government shouldn't be deciding how families choose to live. It should be that the medical professionals that they work with can help them make an educated decision based on what's best for them. And then we also had House Bill 421, which makes it so that sex and gender definitions have been amended, and meaning that there is a only a binary and you're either female or male, and it is what you were born as. So that is now required, and you cannot self-identify. That that's very detrimental to our trans community. And I, as we've had professionals on here come and talk about all of the ways in which that hurts our youth and our communities who are already honestly a disparate situation with their own mental health needs and their health care. So yeah, that yeah. So, and then of course, we can't go without talking about our near-total abortion ban. The near-total abortion ban was a trigger law that was waiting for Roe v. Wade to fall and basically came down the second that Roe v. Wade was overturned. And that makes it illegal for any provider to provide an abortion unless the mother is about to die. So a provider literally has to wait for someone's vitals to fall to critical points in order to provide care. And it also makes it illegal for any adult to take a minor over state lines to get an abortion outside of state. But this has been, of course, been wrapped up in the Supreme Court with Mtala, the Emergency Medical Treatment and Labor Act, because you're going against the fact that we need to provide emergency services because many women were being flown out. Well, women were being flown out of state. We had a senator who lied point blank to the Supreme Court saying that that wasn't happening. And it in fact was, and we had health systems stand up and go, we don't know where Senator Labrador is getting his information, but here's how many people we've had to fly out of state for emergency abortions. Our neighboring states are now taking on a lot heavier burden with having people go over state lines to get medical treatment in their communities. Even places like Utah, who has a 12-week ban, there's a huge increase of people going over to Utah, which we know not everyone has the ability to travel for an abortion. And it just puts so much strain on a woman's health on in any instance, whether she's intentionally pregnant or not, to have to go through these means in order to get her health care met. This this whole abortion ban did create backlash within the medical provider community. So we lost pretty quickly almost a quarter of our providers, and specifically in the OBGYN and maternal health sector. And that caused an entire hospital in northern Idaho to close. It was a labor and delivery for sure that closed. And so that made it so every community had to reallocate where they were going to get their maternal health services and labor and delivery services, which meant that some people were traveling 40 miles just to see a provider. And then in locally, I've also in the Treasure Valley, we've had another labor and delivery hospital clinic close. It's just, yeah, lack of providers. They can't keep it open with providers leaving and OBGYNs who wanted to stay in and work in the state, they they just couldn't bring themselves to because that's their livelihood. They are supposed to be taking care of their patients. They've taken an oath and emergency abortions and helping people make those choices, whether it's an emergency or not, is part of their oath and helping someone have health care. And they were basically put on the chopping block as being felons if they were to do their job. So for themselves and for their for their own livelihoods, they had to choose to leave. And that has created trickle down with other providers, you know. Sometimes providers are married to other providers, so then you're losing other providers. And just knowing in general for for those providers that their license and their livelihood and everything is at risk just by practicing, they choose not to practice here. So yeah, we were already at a provider shortage, and even more so now. But there's all these other things beyond that that, and I could go on forever about the abortion ban. You'll see something that I've written in the future that does go on a little bit lengthier, but there are other policies and things that have happened that aren't as like in the news and as big that do trickle down and hurt communities. So they repealed the Needle Exchange Act. So our harm reduction program was closed down. The we have the opportunity to fund pre-K in the state. Pre-K is known to just increase basically everyone's health and wellness across the board. It's known to everyone when someone has gone to pre-K, they're less likely to use social services and they're more likely to join the workforce and to go through higher education. It also increases the ability for parents to take care of themselves and their families and join the workforce. Pre-K helps the community all around. And um it was highly debated because once again, this is one of those mistrust of the government thing. Essentially, people don't want the quote-unquote state raising their children. And they believe that that should be a family's job, even if that means that that prevents that family from actually having the full access to all the things that they could do to increase their livelihood, like having childcare so that they can go to work, and having free child care so that they're not paying essentially an entire year's wage for that child to go. So we chose to not do that. And instead, everyone got a little, hey, we had a surplus, you got some money back. So I think all of a every resident got $600 in the mail, and which made, I mean, I understand that some people thrive off of getting that money and need money more intensely, but I personally would have liked my $600 to go towards funding our community's wellness. We also let this has been since amended, but there were a couple of years there where they let the maternal mortality work group, the review group, lapse. And this is what actually reviews like why women have died within their span of time in the birthing process, whether it be before or within certain months afterwards. So our legislators let that group lapse. And so we weren't having any surveillance on it. I mean, there is surveillance on death records, et cetera, but no work group to review practices and like ways in which that could have been prevented, which by the way, every other state has this group group. It has since been reinstated in the most recent legislative act, and they're going to be reallocating it to a different sector than the public health, and they're going to put it in the medical sector, which is great, as long as it exists. You know, we legislators basically put so much pressure on the State Department of Education and schools for having what is called the Idaho Youth Risk Behavior Survey. And this is the youth risk behavior survey is a national survey that is done through the CDC. The CDC pays for it to happen. Basically, it's it's a given. Every state does this, and it's the number one way to understand for kids, and I'm trying to remember if it's like seventh grade through 12th grade or middle junior, junior, senior high age, to understand their behaviors and their patterns and like in ways where we say, has anyone ever like touched you inappropriately? And understanding it's one of the only indicators for knowing if anyone under the age of 18 has had any sort of sexual mistreatment or abuse, which by the way, about what is it, 85% of sexual assaults are underneath the age of 18. So it was the only way that we could have tracked that, but it wasn't just tracking that. It was also tracking if they used tobacco and if they drank alcohol and if they were physically active and how many vegetables they ate a week. And that got basically completely removed because it mentioned sex. And it wasn't a direct thing where this mentioned sex, take it out. It was that legislators caused so much pressure on it that the State Department of Ed was like, we're not doing this anymore. This is getting too hard. And so Idaho is now the only state that doesn't do that. And it completely removes any way for public health professionals to know how to provide programs for this for young people who, you know, we basically need to know what's going on with them in order to help what's happening with adults, right? Like this is upstream. And then inevitably, sex education was also removed as a requirement. It's no longer mandated. So each school can decide if they're gonna do sex education. And I believe that it's abstinence only is now like the only ways to do that. And so that basically got rid of the adolescent pregnancy prevention program, a state level. Yeah, I'm like, really, we're really cueing people up really well for an abortion ban by not educating them at all, right? Like not allowing them to have any access, not acknowledging their humanity, not acknowledging their right to have any sort of education. We also, this last year, every year they have to approve of things like the summer EBT program. The summer EBT program is a program that gives people who are on EBT benefits additional money for their children who have now come back from school for the summer. And that did not pass. So just so many children who are now at home without that consistent meal at school don't have that, like those families don't have those extra benefits. That was literally just like a little bit more money added to a program they were already saving money on. And a legislator actually made a comment about how she thinks that children should be doing something to demonstrate that they've earned that.
SPEAKER_01Oh, I remember that. Yeah, I remember seeing that, and I was like, is that good? I mean, there's a lot of explicitive that I could have said, but uh-uh. No, ma'am.
SPEAKER_00Yeah, because children should work to have food, not not that their families and their caregivers are in a position where they're trying their best to get them food, you know.
SPEAKER_01And don't you understand? They're trying to protect the children.
SPEAKER_00Yeah, right. They're trying to protect them from being on welfare programs, which are considered a negative. And in general, we're basically anything that says health equity, health disparities, so Determinants of health, you know, diversity, equity, and inclusion, any DI thing that is being attacked on a statewide level from our government, from our legislators, and public health professionals are not, even though, like, this is a key component to what work is, which is just addressing that certain individuals and certain groups have worse outcomes in different areas, right? Like that's just how it is. We can't acknowledge that. We can acknowledge that there is a difference and it could be based on race. We can't acknowledge that there is a difference and it could be based on socioeconomic status. So that's basically completely torn apart any equity-driven work that's been on the state level. And it really, once again, that word hamstrings any ability to put forward any progressive, and when I say progressive, I'm not saying progressive in the liberal sense. I'm saying progressive as in like we are going after this in a preventative, upstream way. Like we are going to be not being responsive and reactive. We are going to get ahead of the game progressive and try to help people before it becomes an emergency. And or we're going to try to address something that has gotten far out of alignment, like out of alignment and gotten heavy in one way and not in the other, you know, et cetera, and try to bring it more into balance. And then there are just smaller ways in which, like I mentioned earlier that it feels like, well, it doesn't feel like it is government impeding on how public health works in order to kind of prevent it from doing its full thing. And one of that is, you know, they they passed a Senate bill, it was like 1455, and it was by the finance committee. And it created essentially this level of bureaucracy that makes it incredibly difficult for the division of public health within the Department of Health and Welfare to apply for grants. So it's it's a new requirement. Once again, I'm sure in the name of transparency and checks and balances, that they essentially send any grant that they want to apply for all the way up to chain, all the way up to the chain, like to the top for to the finance committee for the entire state. And there within the division of public health and within the Department of Health and Welfare, there are people in these roles that that work to help with approving that you can apply for a grant. Because you're looking at the the statewide budget, right? Like there are things to take into consideration then there. Like, what are we as a state applying for? What are we trying to manage budgetarily? Like that's very common. But to create this extra step of sending it up just makes it incredibly difficult, if not impossible, for them to be competitive with responding to grants in time. Because I, if anyone has worked on a grant, whether it be from federal grant or state grant, sometimes you get a month, sometimes you get two months. And when you have to get together a team, you have to work with stakeholders, you're doing everything you can to do your best effort to say, we want to apply for this, we want to make sure it's going to the right way, to the right places, and we want to demonstrate that we can do this well. I mean, it takes time to create those committees, to work with people, to make sure you're have all of your boots on the ground and then also back in the office who are helping run everything from behind the scenes. And a lot of times there's already a lot of internal review processes to do those checks and balances that limit the amount of time you have to write. So then to then have to wait to get approval from this very high top-tier portion of the state government that doesn't have any involvement in public health and and actually isn't in the public health department whatsoever, they get to determine if you applied for this or not. It's it's totally negating the professionals and their expertise. It's negating any sort of work that they've been hired to do or to understanding the breadth of how this can be rolled out. It's just it's just seeing it as a line item. And as I mentioned, they're trying to reduce their regulatory burden with federal grants. So they could just decide, no, we don't we don't want to manage that much money for this federal grant for this program. And that program could be anything from maternal and child health to diabetes and heart disease to environmental health, uh, tobacco control, anything.
SPEAKER_01I feel like I'm lost in a lot of these things. So, like you're talking you're talking about just Idaho, and I'm seeing all the states, all the 50 states, and the glorious things that are coming out of certain states. And you know, that term could be turned into two different ways. There's the repression, and then there's good laws that are being done, like in Minnesota and Michigan, and then you see what's happening in Texas and Idaho, and you're just like, why don't you want to help people? I'm just so lost on that.
SPEAKER_00And it's just it's you can you have to like uh here's what I gotta say it's it's not even it's like a culture thing. It's so hard because part of me wants to be defensive, even though I'm sitting here saying all these things. I'm like, here's all the ways in which our government is literally making it so we can't help people. All the brainwashing that's happening about you know, quote unquote socialism, blah, blah, blah. But I'm wanting to be defensive and be like, but I know this goes back to like, why am I here? I know these communities want everyone to be well and healthy. I know that people truly want their neighbor to be doing well and they want others to be doing well. And it's there's but there is a disconnect on how we all see that that to be effective and how to do that, you know, because some people think, leave me alone, that's how I'll do well.
SPEAKER_01My diabetes by myself, thank you.
SPEAKER_00Right, or they see the system that's managing diabetes as actually not being on their side. At the end of the day, it's like maybe they have diabetes and they want it to be managed and they want it to be well and healthy themselves, but they don't trust the people who are rolling it out. And you know, and I I get that because we do have we we within healthcare also have some very corrupt aspects. Like it's we're not like the superheroes and we're not the saviors either. There are aspects of healthcare, like big pharma, whatever it's like all the things, and the fact that hospital administration is now like one of the largest income earners in the state, it's like people are making money off of people being unwell, and so there's mistrust there. And for public health, the whole goal is to try and gain trust in order to better help everyone. Like you can't you but you can't start at a place where you're like, this is supposed to help you, why don't you do it? You know, and you I can do that.
unknownI know.
SPEAKER_00Darn it, take your medicine, and you have to see it as like, well, there are also communities who have been forgotten for a really long time. There are communities that have had to do this on their own for a really long time, and they're not about to accept anyone's help that comes in saying they're gonna help when they're like, Oh, what strings are attached here?
SPEAKER_01No, thank you. Yeah, yeah, yeah. And I'm sure we can name a few communities that unfortunately have that mindset. But one thing I do, and this is the perfect way to close the entire conversation. I find myself really hanging on the dread and the feeling of that impending doom, like there's no hope left. So, what keeps you motivated and hopeful about improving public health given all the things that's happening in Idaho right now?
SPEAKER_00Honestly, it's the people I know who are working in it. I I have a, I would say, a pretty strong group of people in my network in in Idaho who are the people who care a lot. Like a lot, a lot, and who are the people who are, I mean, amazing for the job. I don't know if it's because of the work that I do or whatever, but I seem to be surrounded by nonprofit executive directors who are doing amazing work in the community. I have incredible friends in public health that were my colleagues at the Department of Health and Welfare. And even if we're in all in different places now, some are still there, some have moved on to other locations. I mean some of the most dedicated, determined, smart, thoughtful, caring people I've ever met in my entire life. And they have some of them been doing this a lot longer than I have. And they show up every day just passionate and trying to think of more ways to to work and and help people. And and there have definitely been times where I have lost hope and lost motivation, and I've been like, you know what, get me out of public health. I'm done with this. I don't want to do this. Yeah, get me out of here. Who's gonna hire me now? I don't know. But but yeah, I uh there have been times when I just was like, this is this is the wild goose chase, basically. And I've been tricked into thinking that I could help people and I can't. And but the people that I'm surrounded by, I mean, I'm still very close to that friend who I did Peace Corps with, who I lived with in grad school. She works in Tucson still, and she's doing amazing work. And we we talk almost every day about the work that we do. And so my sister-in-law is in public health, my other sister-in-law is in in health insurance. Like, I have a brother who's a dietitian, my boyfriend's a psychiatrist. I my my whole network is like everyone top-down in health care and in community care, like in community grassroot levels that just care about the well-being of our communities and our society. And I think that's what community is, right? Is that it's like there are times when you don't have the strength, but everyone else does. Or there's times when all of you are just completely downtrodden and cannot think of any reason to move forward. And then you like sit in that together and then you keep moving forward. So as long as I am in Idaho, and even if I, for whatever reason, may leave Idaho someday, I I have people here that are just like anchors, just absolute anchors in the community and in in working towards basically a better community for everybody in everywhere sense that they can, that it makes me want to be here and it makes me want to be part of that, and it makes me want to do right by them and by my community, and just keep keep going.
SPEAKER_01The Adromatus Way is produced by me, Liz Church. Editorial assistance for this episode was by my fantastic team at Adromeda's. I would like to express our heartfelt appreciation to our guests who've shared their expertise, stories, and insights with us on the podcast. And finally, a big thank you to our listeners. Your support and engagement have meant the world to us at Adromatas. We're a boutique consulting firm with the imperative mission of creating healthier, more resilient, more equitable communities. I encourage you to connect with us. Let's continue these conversations and work together towards positive change. You can listen to all of our previous episodes on our website, adromatasconsulting.com slash adromatus dash way. That's A-R-T-O-M-I-T-O-S. We can also be found on Apple Podcasts, Spotify, Amazon Music, or wherever you get your podcasts. We'll see you next time.
