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Story Publication logo April 12, 2023

Rural Healthcare Access At Risk as Public Health Efforts Become Politicized

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Rural Rx

When it comes to health care, the gap is widening between rural America and the country’s urban and...

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Multiple Authors
Video by PBS NewsHour. United States, 2023.

The pandemic highlighted the power of local health departments and brought backlash from people who said these authorities were overreaching. In the wake of the turmoil, many were overhauled, leaving an outsized impact on rural parts of the country. With support from the Pulitzer Center and in collaboration with the Global Health Reporting Center, Dr. Alok Patel reports for our series, Rural RX.

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Read the Full Transcript

Geoff Bennett:

The COVID-19 pandemic highlighted the power of agencies like the CDC and local health departments and brought backlash from people who said those authorities were overreaching.

In the wake of this turmoil, many public health departments have been overhauled, having an outsized impact on rural parts of the country.

With support from the Pulitzer Center, and in collaboration with the Global Health Reporting Health Center, special correspondent Dr. Alok Patel has the story from Colorado.

It's part of our ongoing series, Rural Rx.

Dr. Alok Patel:

Emily Brown is busy with chores on the family farm, where they raise cattle and grow potatoes. It's a big change from her six years running the Rio Grande County Health Department.

Emily Brown, Former Director, Rio Grande County, Colorado, Health Department:

My role as a local public health director previously had been pretty low on the radar. And then COVID came along.

Dr. Alok Patel:

COVID meant long days tracking cases, announcing business closures and travel restrictions.

Emily Brown:

COVID was hard.


Dr. Alok Patel:

And then, two months into the pandemic, the county commissioners fired her.

Emily Brown:

I think it was a culmination of just a lot of different tensions that sort of maybe came to a head.

Dr. Alok Patel:

Brown was the first, but not the last. Fully half the public health directors in Colorado have quit or been fired since March of 2020, a turnover rate that is alarming to Tista Ghosh, the state's former chief medical officer.

Dr. Tista Ghosh, Former Colorado Chief Medical Officer:

I would call it a nightmare for most of the public health community. So, it's been a very difficult time, and a lot of people have left.

Dr. Alok Patel:

The controversies did not end with COVID. Until late January, Kayla Marler was public health director in Fremont County. She says her downfall came after she tried to launch a family planning program.

Kayla Marler, Former Director, Fremont County, Colorado, Public Health and Environment:

When it comes to prevention, especially when it comes to birth control, it is something that is needed.

Dr. Alok Patel:

In these small mountain towns, options are few and far between.

Kayla Marler:

And it was really disheartening, as a public health director, that I would have to tell my staff, you're going to have to let them know they're going to have to go to a neighboring county.

Dr. Alok Patel:

Marler secured a grant to start a program that would offer birth control, test for sexually transmitted infections and treat patients who needed help.

Kayla Marler:

October of this last year, brought it to the Board of Health, and it was turned down.

Dr. Alok Patel:

So, after they rejected your proposal, what happened then?

Kayla Marler:

What pretty much happened is, I was pushed out. I was pushed out of my position.

Dr. Alok Patel:

County commissioners say Marler was let go due to staff morale and financial incompetence, not family planning. But Marler denies any management problems, and showed us letters of support she got from current staffers.

And it all came down to the vote by three people.

Kayla Marler:

So I had one female and two males on my board of health. The two males voted against it, and the female voted for it. The three individuals, you also have to understand, are politicians. They are in their position because they are elected by their constituents. They had absolutely no medical background.

Dr. Tista Ghosh:

I think the debate continues now over whether public officials should be scientific experts who determine policy, or if that should be left to elected officials.

Dr. Alok Patel:

That question is playing out right now in the southwest corner of the state, where two counties that have run a joint health department for the past 75 years are going through a divorce.

Marsha Porter-Norton, Commissioner, La Plata County, Colorado:

It's just like any relationship. Whether it's a marriage or not, it takes trust.

Dr. Alok Patel:

Marsha Porter-Norton is a La Plata County commissioner who voted to stand up a new health department and end a longstanding relationship with neighboring Archuleta County.

The soon-to-be dissolved organization is San Juan Basin Public Health, where Liane Jollon has been executive director for 13 years.

Liane Jollon, Executive Director, San Juan Basin Public Health:

We do everything from restaurant inspections, to childcare inspections, to tracking exposure to lead for children.

We do things like ensure that people have access to family planning and contraception. We do breast and cervical cancer screenings. We do lots of family formation and early childhood programs. We have a water lab that tests drinking water.

Dr. Alok Patel:

When the pandemic came, San Juan Basin jumped right in.

Liane Jollon:

We went into that response mode in the first week in March, which was extraordinarily early for a local public health department.

Dr. Alok Patel:

But the response wasn't popular with everyone.


Protesters returned to the home of the executive director of the San Juan Basin Public Health Department, Liane Jollon.

Liane Jollon:

And then the cops moved them to that hillside, and now they are saying the public health director who's taking away your freedoms lives right here.

And that was difficult.

Dr. Alok Patel:

At first, it was protesters in Archuleta County who wanted to break up the department. But, ultimately, it was officials in La Plata County who pulled the plug.

Marsha Porter-Norton:

I think the pandemic laid bare a lot of differences in values. I failed to see how we were going to go forward in the future and have the kind of public health that I expect, which is what San Juan Basin is delivering now. They're delivering really good public health.

Dr. Alok Patel:

Shere Byrd is a biology professor at Fort Lewis College. She sits on the Board of Health, which recommended the split.

Shere Byrd, Vice President, San Juan Basin Public Health:

People in Archuleta County came to meetings with guns on their hips. It was just an untenable situation.

Dr. Alok Patel:

But standing up a new health department comes with a big price. A consultant hired by La Plata County released a report last month, which said this county of 56,000 people will have to find nearly a half-a-million dollars a year to maintain the same services, on top of the transition cost, nearly a million dollars.

The report also suggested staff would be cut by more than a third.

Shere Byrd:

If you're talking about 40 percent fewer people, it's going to have an impact.

Dr. Alok Patel:

Can you tell me how you felt when you first learned about the vote that San Juan Basin was going to be dissolved?

Dr. Rhonda Webb, CEO, Pagosa Springs Medical Center:

Well, we were devastated.

Dr. Alok Patel:

Dr. Rhonda Webb is chief executive at the Pagosa Springs Medical Center in Archuleta County, the only hospital for more than 50 miles around.

Dr. Rhonda Webb:

People in rural areas just don't have as good of access of health care, right? They — they just — they don't. So public health has to step in for those people and be there for them where they need to be.

Dr. Alok Patel:

Archuleta County, like much of rural Colorado, has a shortage of primary health providers. And Webb says rural counties have a lot to lose if public health funding is cut back.

Dr. Rhonda Webb:

Hospitals take care of your wellness overall. They take care of people with individual health conditions. But the public health takes care of the health of our whole community.

Sarah Flower, KDUR and KSUT Reporter:

The Centers for Disease Control and Prevention is advising that cloth-based coverings no longer …

Dr. Alok Patel:

Sarah Flower is a local radio reporter. She says the community isn't fully aware of what's at stake.

Sarah Flower:

It's like, oh, fine, masking and vaccines, but what about sewers and restaurant inspections and all air quality when there's a fire? Who's doing that? It's the public health department.

Dr. Alok Patel:

The current arrangement funds the department through December, when much of the staff might join Kayla Marler on the sidelines. Marler says that subsequent events have proven she was on the right path.

Kayla Marler:

Family planning got denied by the board of health. It was no longer than two weeks after that I get contacted by the state of Colorado, letting me know that: Kayla, we have a huge syphilis outbreak. We're needing to do something.

And I'm sitting here like, oh, yes, we need to do something, back of my mind knowing, we had a plan in place, and that was family planning.

Dr. Alok Patel:

Who or what is affected when politicians get to make these public health decisions?

Kayla Marler:

The people that are impacted are the residents. There is no room for politics to be in public health.

Dr. Alok Patel:

But with memories of the pandemic still fresh, the trend may be moving in the opposite direction.

For the "PBS NewsHour," I'm Dr. Alok Patel in rural Colorado.


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