Alan Pruhs: Compassion, Community, and the Cost of Care

 Join host Dr. Cougar Hall as he sits down with Alan Pruhs, Executive Director of the Association for Utah Community Health, for a powerful and heartfelt conversation about what it really means to make healthcare accessible for all. 

From the rural clinics of Bicknell to the streets of Salt Lake City, Alan shares inspiring stories from Utah’s community and migrant health centers—where compassion, cultural humility, and collaboration drive the mission. 

Hear how Utah’s “community health” model tackles social determinants of health, why affordable care matters to everyone (insured or not), and how we can take the politics out of health to focus on people. 

This episode is a reminder that health is not a privilege—it’s a shared responsibility. 

Recorded, Edited & Produced by Christy Gonzalez, Harper Xinyu Zhang, Madison McArthur, Kailey Hopkins, and Tanya Gale

Transcript

Cougar: [00:00:00] Welcome to Y Health, a podcast brought to you by the BYU Public Health Department. I'm Dr. Cougar Hall, a professor here at Brigham Young University where you are a student. Parent or BYU fan. This podcast will help you navigate the world of public health. Our podcast strives to help individuals receive accurate information regarding public health, so whether it's global or local, we will discuss how it pertains to you. 

Just kick back and relax as we talk about Y Health. Alan Pruhs welcome to the Y Health Podcast. Thank you. Great to be here. And we've just met, yeah, so we've been chatting offline as they've been doing soundcheck, but I can't wait for this. Dito, will you just take a minute? You've introduced yourself just a little bit to me, but if you'll introduce yourself to our audience, that'd be great. 

Alan: Yeah, absolutely. Alan Pruhs, I'm the Executive Director of the [00:01:00] Association for Utah Community Health. We're sort of. Federally recognized in the state of Utah as the primary care association, and our main role and responsibility is to provide training and technical assistance and supports to Utah's community migrant and homeless health centers. 

We support 14 community health centers throughout the state of Utah organizations. Those 14 organizations operate approximately 65 clinic locations from Cash County. Down to southwest, Utah, St. George area and southeastern Utah. We have urban, rural, and frontier locations, including even two tribal organizations that we work with. 

But they support access to care for about 175,000 unique patients that, um, have over 600,000 visits annually. Our approach is in a comprehensive manner, so it's access to primary and preventive medical. Dental, behavioral health, substance use disorder services, pharmacy services, and then what we like to call supportive services, [00:02:00] or the term that we report on is enabling. 

I just don't like that word enabling, but it's supportive services, so we recognize. Transportation translation services, there are barriers to care that might impede an individual's ability to lead the healthiest life possible. And we, so we wanna make sure that we address those social drivers to ensure that they can be healthy and lead that life that we all wanna live. 

Cougar: Yeah, well you're doing the real work. I mean, you're talking to a public health guy where, you know, we truly believe that health is a right and that everyone has a right to to care. Of course, we focus on prevention and population, so we're trying to get the biggest bang for our buck and reach people before they have a chronic illness or disease. 

Yeah, but kindred spirits. Yeah. This is where the rubber hits the road, especially in our rural communities, our underserved communities, where access is limited. So thank you and thanks for joining us today. 

Alan: Yeah, my pleasure. I get to represent the people that actually do that work. Yeah. So I [00:03:00] don't take the credit for it, but I appreciate the acknowledgement and I'm gonna give it right back to them. 

'cause they do that work every day and it's not always easy. They're sometimes tasked with. Doing the most with the least, and oftentimes with very complex patients because of the circumstances in their lives. And so I'm always proud to serve them and I felt fortunate for 21 years now to work with such tremendous people. 

Cougar: Yeah, no, I can only imagine that they care providers in these clinics. They're the salt of the earth, 

Alan: so to speak. Yeah, they really are. They're doing a lot. And they're giving up a lot. 'cause they could go work mainstream and probably make a lot more money and actually see maybe less complex patients, but their hearts are in the right place and we're lucky to have an incredibly talented staff from management down to clinician to support staff. 

Cougar: Yeah. Oh, amen. It has to be very humbling to work with such fine people and to provide care. For such wonderful people who for whatever reason have been on the outside looking in when it comes to health insurance and 

Alan: Absolutely. [00:04:00] So that's one of those areas like this program was developed on, is to address those barriers, right? 

Yeah. Health insurance being primary as we've moved to an insurance based system. We still have a lot of folks that either can't afford insurance or maybe not eligible for insurance. And so this has always been a way to, to provide that access to care to keep you healthy. It's a limited set of benefits, right? 

We're not just specialty care or hospitalizations, but we work with great organizations such as Intermountain, who allow us to access that and partner to address those needs beyond our four walls. And so I think we're fortunate to have good partners in a state like Utah as well, to be able to address that broader scope of health. 

Cougar: Yeah. And the need is great. Let's just jump right to it. 'cause as we're talking about providing care to those who are uninsured or to those who are, for whatever reason, have been on the outside, as I said, looking in what are the funding mechanisms, how are things adjusted? So, so that someone can actually access care. 

That's a great question. How much do they pay? Is it a sliding system? [00:05:00] All of that would be fascinating. Absolutely. Great question to understand the nuts and bolts and the 

Alan: finances. So I think that the thing to think about with community health centers is we're designed to provide access to care in areas where you wouldn't normally see that. 

So I like to talk in terms of. Medically underserved populations and medically underserved areas. So if we define that in sort of thinking about a medically underserved area, we have a lot of rural and frontier locations across the state of Utah that they're probably not advantageous for a system or a private practice to go in and set up shop. 

Right. But their population centers such as Bicknell, Utah, we have Wayne Community Health Center serving Bicknell. By the way, I would love to live in Bignell. Can I just tell you, I, every time I go down there, it's, it's one of my favorite places in the world. And you realize when you're down there, there are people that live here. 

And if. A community health center isn't here. They gotta travel a hundred miles over a mountain pass into Richfield to get there. Right, exactly. So we look at those underserved areas and you're able to establish a community health center. And a health center receives a federal base grant. We're [00:06:00] not fully federally funded. 

I think sometimes that's a misunderstanding when, when they understand the program. The Federal base grant is actually about, in Utah, about only 20% of total operating revenue. Oh, okay. Across the. The country, it ranges anywhere from 3% to maybe 25%. And so those medically underserved areas, we have a community health center that's there to serve everybody in that community regardless of their situation. 

So if they're on Medicare, we see 'em, we take Medicare. If they're commercially insured, we work with the commercial insurance companies. We accept commercial insurance payments. If they're on Medicaid, we accept Medicaid, gladly, willingly, and we serve that population as well. And if you're uninsured, we offer sliding fee scale services to individuals who live below 200%. 

Of federal poverty guidelines. Okay, so there's a limit in terms of the H household income in which the sliding fee is enacted. Interestingly, the sliding fee is not set by the federal [00:07:00] government. We certainly wouldn't want people in the Beltway mm-hmm. Determining what the right fee would be in central Utah. 

Right. The fees are actually set by the boards of directors of those community health centers, which are 51% consumer majority. 51% of the board of directors have to be actual patients receiving services. So you really truly have like patient directed care. Yeah. Right. And they understand, you know, what's going on in their community. 

They understand the difficulties people may have accessing and they put all that into play when they're determining those slides. If you're below a hundred percent of federal poverty level and uninsured. We provide access at a nominal fee. Again, that nominal fee is set by the board, and those can be anywhere from seven to $10 to $20. 

Now, that's not very nominal in my book when you're at a hundred percent or below a federal poverty guidelines. Mm-hmm. But we also don't limit access to care based on one's [00:08:00] inability to pay. So really it's not a free clinic. There are skin in the game, as we like to say, and people actually appreciate that they feel better about contributing towards their healthcare, but we don't make that a barrier if it is an inability to pay. 

Cougar: Okay, so that would be. You, as you were explaining, there's a population, but then there's a region, so, so we talked about area. Yeah. And let's talk about population. And Utah is so unique, as you said, with our, absolutely. With our frontier towns. And they're beautiful. But you drive through and you're like, yeah, if I were a for-profit business, I don't know. 

Right. I don't have, don't have the 

Alan: volume here. Right. I don't have the necessary, you just don't have the 

Cougar: numbers. Right, right. Now let's talk about the population that you said. Yeah. 

Alan: Because there are those in need everywhere. Yeah. I mean, Utah's a unique state, right? Highly urbanized. 80% of our population lives on 20% of our landmass. 

Mm-hmm. The Wasatch front, and nobody could say that the Wasatch front was medically underserved. There's clinics, there's hospitals, there's everything around us, but there are populations, [00:09:00] right? Living on the Wasatch front who have limited access. And that's when we start to see a little bit more of, you know. 

Higher rates for uninsured low income households. There's limited access. If you don't have insurance, there's good access, but not as great access if you have Medicaid compared to a commercially insured individual. Okay. Or a Medicare individual. So you start to see sort of capacity issues and limitations for the uninsured. 

You also mix into that too. And some of our medically underserved populations might be from communities of color who have different sets of needs or different sets of circumstances that need to be addressed. Could be language barriers, could be cultural issues. Right? And you have to be culturally humble in order to understand how do we best serve that population? 

I need to understand that culture and work with them. Not tell them what to do, but work with them to help understand if you have diabetes, how do we address it from your cultural point of view? Let's talk about, you know, your diet and let's [00:10:00] talk about diabetes related to that. So there's always that approach and how you address those populations. 

Cougar: I can see how your clinicians really need to be miracle workers and to be culturally humble and to be responsive and to understand contextual factors and clues and cues, and we could go on and on. And yeah, so much of that is what we're trying to help our students and prepare our students. So the next generation of public health workers really understands these social and cultural determinants of health. 

But easier said than done, it is, yeah. Yeah, go ahead. Sorry. Well, we used to 

Alan: talk about cultural competencies. Mm-hmm. And, and I don't get caught up too much in words, but I think we've adjusted that to be more culturally humble. 

Cougar: Yeah. 

Alan: Cultural humility. Right. We may have some competencies related to certain cultures. 

It could be language. Yeah. It doesn't mean that we're competent in understanding all aspects. And so I think being. Humble and sort of working with the patients to better understand their [00:11:00] situations, their life, their culture, and how do we adjust that towards our understanding of medicine? And I wanna help you address diabetes. 

And it's really interesting too when you start to work in tribal communities and we see some traditional healing. That takes place along with Western medicine and one alone doesn't always work, but when you combine those two, you see great results. We work with a system called Utah Navajo Health System in the Blanding, Montezuma Creek, monument Valley, Navajo Mountain Area, and I've worked with their traditional healer and had great conversations and better understanding about the work he does to supplement. 

The work that the clinicians, the physicians do, right? Yeah. Understanding even medication and how that ties in culturally, and every time I had a chance to talk with him, I learned so much about the role he plays and how he advances the world of science by mixing it with the culture. 

Cougar: I love it. I can imagine that that level of [00:12:00] inclusion really increases patient adherence Absolutely. 

To protocols and just a desire to access what you're. Community health clinics are providing, working with people, not against them. Right. Oh, I love it. I love the cultural humility. I think you're right. I think whoever we are, wherever we work, to approach things as like, I want to be the learner. Mm-hmm. 

And I wanna learn from you and man, that is the way to go. Yeah. So what are some of the challenges? And I don't want this to turn into a negative, but the reality is we have tremendous challenges. We're talking here in the summer of 2025, and we're all paying more for food. Mm-hmm. There are now fewer and fewer people who are accessing some of these federal programs. 

Not to get too political, but I mean, we can't ignore or deny that things are changing at a federal level as far as where money's going and what services are gonna continue to be provided. So what are some of the challenges that we're facing? 

Alan: We've had a lot of [00:13:00] challenges throughout. Our existence. Right? 

Yeah. And we've gotten over some of them and then now they're resurfacing. Right? And one of them is just like coverage, right? Insurance coverage. That's the key to health in the US You have to have insurance. That's the key to get in the door. Mm-hmm. We worked after the passage of the Affordable Care Act. 

Utah was a state that chose not to expand Medicaid. We had to work for a number of years and put it to a ballot initiative in order to get Medicaid expansion. And once we have it, I thought even the policy makers were like, this actually. Works well. We're getting more lives covered. Mm-hmm. We're seeing less uncompensated care. 

'cause that still rolls into higher fees and higher insurance premiums. Yes. Right. They, they have to make up for uncompensated care. So it balances out for everybody. But we gained a couple of steps forward and then with the passage of the reconciliation bill, the one big beautiful bill by Medicaid, I think we're, we're placing some more maybe administrative burdens on a population that already. 

Has some challenges and struggles and so we're naturally going to see more [00:14:00] people probably lose coverage or coming in and out of coverage, so. In addition to that, we're we're concerned about the marketplace, the a CA marketplace, and the expiration of the Biden administration tax enhancements, right? 

People were able to get insurance on the marketplace, lower income households at a much lower rate. Those tax will expire at the end of this year. So as people go to purchase insurance on the marketplace, and Utah has, I think it's over 12% of the population in Utah, get their coverage through the marketplace. 

They're going to see their prices, their premiums increase. Again, I think some of them are going to have to make difficult financial decisions. Yeah, and probably forego insurance. So two steps forward, one step back, one step forward, two steps back, I'm not quite sure yet. But we do expect to see a rise in the number of uninsured, and that's difficult for us from the Utah Community Health Centers. 

Our patient population primarily consists [00:15:00] of about 9% are Medicare users. About 26% are commercially insured, okay? 20% are Medicaid, and about 45 to 48% are uninsured. And so we already see twice the number of uninsured in our health centers compared to our colleagues nationally. And so when we're asked to see more uninsured, it creates a fiscal challenge. 

We've already been. Fiscally challenged. You're already stretched thin out. We are stretched so thin and this is what one of the things we're so proud of our health centers is they do so much with a dollar, right? They stretch that dollar. Mm-hmm. They do the work that they can and still drive good quality care. 

'cause that's, at the end of the day, providing care is great. If it's not good quality care, then you haven't done much for that patient and that family. So we really strive to ensure that the quality of care is on par or above average of what we see across [00:16:00] the systems. Mm-hmm. And so that's always a focus of our better care, higher quality care. 

But now you're challenged with doing it with with less. Yeah. 

Cougar: Wow. So there are some challenges as far as funding. 

Alan: Yeah. There will be those funding challenges. Yes. And there, and 

Cougar: there's gonna be people who are, are currently able to gain insurance through the marketplace that are gonna find themselves, I like the way you said it. 

They're gonna have, I mean, they're gonna have some decisions to make. Yeah. The cost of housing is at an all time high, at least from my perspective. Absolutely. As someone who has children who are trying to afford homes or town homes or apartments, I don't think it's too political. Okay. I 

Alan: mean, I think it's just the reality. 

I think you're absolutely correct. Yeah. Yeah. 

Cougar: Again, Alan, I'm not a real political person, but my background is education. I didn't know when I became a teacher how politically divisive education, education, funding, what we teach to whom we teach, all those. I'd had no idea what I was walking into. And then I think as I transitioned to public health, boy, [00:17:00] yeah, you just realize that. 

All this is inherently political. Yeah. And even how we see health, which it feels like this should be this universal truth where we are compassionate and we provide care and we recognize, I mean, what was our charge as Christians to feed the hungry, to clothe the naked, to care for the sick and the afflicted. 

Right. And yet, even though we have this charge, boy, there's 17 million ways to look at that. Mm-hmm. And to execute it. And of course. Many, many ways to try to fund it or not fund it or rationalize it or, so it's just, I don't wanna step on a landmine, but I feel like you are literally, you're on the battlefield and you have to be, I can only imagine so calculated. 

You can't create enemies, but you have to be able to push and pull and to. Use the powers of persuasion and to collaborate and to be strategic in so many ways. [00:18:00] How are you navigating this space, especially between federal government and state government and trying to keep the lights on, so to speak? Yeah, and 

Alan: that, I mean, that's been an area we've always had to address. 

At times. It maybe been easier and certain times more difficult, and we kind of go through those ebbs and flows and ups and downs. You just learn to try and like we've always tried to find sort of common ground, right? Ideology is strong. Mm-hmm. And I try not to get into ideological debates or conversations, but I try to like. 

Formulate our conversations to address the ideology and sort of gain a better understanding from one another about what we're trying to provide and the impacts of that healthier populations and more a population able to contribute more to society. Mm-hmm. Right. It's less expenses that other people might have to pick up in terms of uncompensated care or other areas. 

So as we try to address that. Scope of health. One thing we've always tried to address from the origins of this program is sort of the, you know, those [00:19:00] social drivers of health. Yeah. And one thing we saw during the pandemic, which was no surprise to some of us, but to others, it was quite shocking. Like the need for food, shelter, basic sort of life. 

Issues. Right. We're sort of exacerbated during the pandemic. Yeah. And we did a lot of work with the state in terms of providing um, options for those individuals. The state, I think was kudos to them, to the public health system was well-informed that yeah. Folks who are going to maybe get COVID and they're going to need to isolate as we did early on right. 

May not have that ability to isolate. And if they're going to be in isolation for two weeks back at the height of this, what happens to their job? Um, how do they afford food? Now, if there's no. Paycheck coming in during those two weeks. How do they afford rents? How do we make sure that we don't end up with more people displaced and on the streets than what we had prior to this? 

So we began to address those issues and this [00:20:00] system. Community health centers have always addressed those systems from its origins. We've recognized that in order to be healthy, there's only so much that you can do within the four walls of a clinic. Most of what happens in terms of a person's health, I'd say 80, 90% is outside of those clinic walls. 

Where do you live? What access to good, healthy food do you have? The air you breathe, the water you drink. So thinking through those factors has always been a big part of this. How do we address those? What do we do? And now. We're at a time when we're going to be challenged again. I think we'll rise to the occasion and I think there's a lot of great people not only in this state, but in the country who will step up and we're gonna figure out a way to get through this moment and we take another two steps forward again, or will there be another step back? 

We're prepared to handle that. Mm-hmm. I think we're just worried about the unintentional. Consequences of sort of policy at this moment. And then how do we address that? How do we first advocate for good public policy? [00:21:00] How do we band together as community health, public health, other sectors, and how do we present good solid policy that doesn't get too political? 

Mm-hmm. That just sort of meets that middle ground about sort of needs and why. Right. We need a healthy population. Right. That's good for the economy. So addressing those areas. And you mentioned earlier, yeah, food. I mean, we heard that from people who voted. The economy, it's the price of food. I mean, it was the price of eggs for a long time. 

Well, they haven't gone down. Yeah. And so things continue to rise. You mentioned housing, huge issue. Right. And health centers, we, we always see sort of generically community health centers, but there are three other types of health centers designated. So one is homeless health centers, and a lot of people in Utah are familiar with the fourth street clinic in downtown Salt Lake, that's specifically a homeless health center organization. 

Serving the unsheltered. Right. But we have two other homeless health centers that folks aren't really aware of. One right here in Provo that Mountain Lands operates called the East Bay Clinic. They've [00:22:00] partnered with the Food and Care Coalition, established a clinic in that location to better serve. 

Those individuals who are struggling with homelessness at this time. Midtown Community Health Center in Ogden also has a homeless health center as part of their profile PO or portfolio, I should say. Right. They o operate a number of community health centers and each have a homeless health center as well. 

Cougar: Yeah. 

Alan: All of our health centers actually serve individuals who are unsheltered and maybe homeless at this time, and sometimes chronically. In addition, we have community and homeless health centers. We also have agricultural worker health centers. We have a clinic up in the Brigham City area that's been largely serving migrant and seasonal farm workers for over 30 years now. 

They're incredibly important to our country and our economy, right? That's where we get a lot of our food, and Utah has plenty of 'em. So that was established as well to make sure that those individuals were healthy, that they were getting immunizations, that we might be treating illnesses that could be spread through that area, and just ensuring that they have health while they're [00:23:00] here doing the work. 

You know, quite honestly to support our living. Mm-hmm. Uh, and then we have public housing, health centers. Utah doesn't have any of those. But when you think back to the days when you had large public housing areas in the East coast mm-hmm. You might have two, 3000 people living in a square block in public housing, all low income. 

What a better place to put a community health center. Right, right. Than at a base of one of those to create that access. Right. Keeping people healthy, allowing them to stay employed, be gainfully employed, and continue to sort of move up that ladder. Health is everything. Yeah. Right. If you don't have your health. 

Doesn't matter. There's nothing else that matters. Correct. Yeah. Right. You can't work, you can't do these things. So I think health is at that just root of keeping the communities going, the population working, and folks contributing to society. 

Cougar: You are making the best case for public health I've ever heard. 

It's so true. This is in invest in health. Yeah. And then you can have a productive workforce. 

Alan: Absolutely. And we talked a little [00:24:00] bit like public health and community health are. Kindred spirits. Yeah. We're so aligned, right? Yeah. And I just think public health has got a much bigger scope. We do our part, we partner with public health. 

Public health has that broader position, but one without the other doesn't work. No, exactly. I think they work really well together. 

Cougar: Yeah. We walk hand in hand. We're really focused on populations and prevention and we recognize in public health just the bang for the buck. $1 invested in prevention, what that does as far as preventing costly care down the road, but you're providing that care and you just remove the costly Yep. 

From that equation, just providing care. Yeah. No matter what the challenge is, no matter who the patient is. We're not gonna turn people away. We're gonna work with the politics and the systems and the different policies, some of which we like, and some of which are really frustrating. And yeah. And it's interesting 'cause you've done this long enough, you've seen the pendulum swing back and forth, and I love the way you said two [00:25:00] steps forward and sometimes one step back, sometimes three steps back. 

Mm-hmm. And then we have to regroup and we've had our nose bloodied and just try to help people understand this doesn't need to be a political Yeah. Be divisive. Right. These are things we can all agree upon. Yep. I mean. 

Alan: If you didn't have health centers, like right now, there are over about 1800 health center organizations in the country with over 10,000 clinic locations. 

There's a health center in every state and almost every county in the country, they serve about 32 million people annually. Wow. It's a big system of care. Nationally, about 20% of our patient population are uninsured. As I mentioned, in Utah at our health centers, it's about 46%. You think about that population, you take 20% of 32 million or 46% of the 175,000 people we see. 

Mm-hmm. Imagine if those individuals sought care in an emergency room for a primary care sensitive condition. 

Cougar: I can imagine 

Alan: you've seen, think of that ripple effect, right? Yeah. That [00:26:00] visit on average is $2,500. Yeah. We can serve a patient in for an entire year in a comprehensive matter, for far less than that, actually about 1200 to $1,500. 

And that's dental, medical, as we talked about before, right? Yeah. So oftentimes too, that individual who is uninsured and low income, they're not gonna be able to pay that hospital bill if that's their only point of access. So that visit now goes uncompensated. The hospital's forced to either write that off as bad debt or that individual gets sent to collections in some of the for-profit systems. 

But either way, it's written off as bad debt. Eventually the hospital has to make up for that uncompensated care. Now that comes through higher fees that's passed along to insurance companies. So then therefore your premiums will go up as well. So it's a systemic issue. Yeah. We think, ah, I'm insured. I don't have to worry about. 

The uninsured. Well, you do because your insurance is gonna continue. You're paying for it to increase, you are paying for it. It's that hidden tax we've talked about for years, almost a [00:27:00] decade now, and here we go again with potentially the, the increase in uninsured. We're gonna see people are gonna fill it regardless of their situation. 

Some worse than others who are gonna lose coverage. Others who have coverage are gonna say, gosh, my, you know, here we go again. My premiums going up, my fees structures are going up. Mm-hmm. I'm gonna feel the pain of this. Oh, so everyone 

Cougar: has an interest in 

Alan: this? I think so. You think about it broadly? Yeah. 

Yeah. 

Cougar: And if I'm honest, at least from where I'm sitting, I have a financial interest, but I also have a, a very real, tangible human interest as I've been taught that we're all brothers and sisters. Couldn't agree more. So just to have a little bit of compassion. How about we have a lot of compassion and recognize. 

We can do better. Yeah, we can. We can do better. 

Alan: Yeah. I think so. I feel fortunate to live in Utah. I've grown up here. I've had opportunities to leave here. I, I can't seem to leave here. I mean, it's just an [00:28:00] incredible, you're not the only one out if you've been on I 15. Yeah. It's an amazing state. Right. I love the geography of Utah. 

Yeah. The fact that I have world class skiing and hiking and all of this in my backyard, an amazing desert south of me, like it's an amazing state, but I think the people also make this an amazing state. I expect us to rise up at this moment again and to begin to address sort of maybe what we're experiencing and, and sort of what the maybe unintended or intended consequences of policy changes are gonna be. 

Right. I think it's a challenge to Utah and, and I think. I have to hold out, hope that Utah will step up and that we'll begin to address those needs in a different way. And we like to say in our state, in the Utah way, right? Yeah. And so I do believe that we have that opportunity and I think we'll rise to the occasion. 

Cougar: I love your optimism and your hope, and I have no other choice other than the optimistic. I'm hopeful I'm right there with you have to stay hopeful. Yeah. Yeah. I mean, recognize that. Utah's always done it. Its own [00:29:00] way and maybe as there are fewer federal dollars and there are policies that are making it more difficult and stretching you thinner, as we've said that Utah does some unique problem solving. 

Yeah. And we come together and we work in different ways and yeah. Are there things. Speaking to that, and maybe this is how we wrap things up out, and I've taken a lot of your time. I could talk to you for hours. We haven't even talked about college football, but what are, what are things that people can do? 

Alan: Well, I think that stay active, be aware of what's happening. You can support community health centers, but I think we don't go out and fundraise actively. We raise our fees on patient services. We work with, as we mentioned before, all forms of insurance, and we serve individuals regardless of where they're at. 

But stay informed. As I mentioned, you know, we have community boards. People can get engaged with their local community health centers in terms of their boards if they're interested in that area. Go to a community health center. You really [00:30:00] want to get good access to good primary preventive care, and you want to have a, what we refer to as a medical home. 

And you wanna maintain that medical home regardless of the circumstances in your life. You're insured today, you're uninsured tomorrow. Mm-hmm. That community health center is gonna be there. So I think sometimes people think of them based on our target populations and who we strive to create access for that it's not for them. 

And I think you're wrong. Yeah. It is for you, it's for the entire community. Be involved in that. You know, there's probably a number of other ways that I can't think of at the moment in terms of how to get involved, but be informed about what's happening. I think for me it's unfortunate that it is. We talked about education. 

I have a daughter who's a fourth grade teacher in Title one school. It's been her life calling to be a teacher. Mm-hmm. And it's been fascinating as a father to watch her from the age five, pretending to be a teacher, to now be a great teacher. Isn't that great? But to recognize and she's now being like, wow. 

Just like you mentioned earlier, the politics in this. It's in everything I said. And unfortunately, I [00:31:00] think there are things that there shouldn't be. But let's just stay informed about what those politics are. Let's keep human beings in mind, our fellow brothers and sisters, how this impacts them and how this impacts our community. 

Yeah. We're all together here, right? So I think that's a big thing that I would just stretch and stress, I should say, for individuals. Stay informed. Don't become too politicized about the issue. Take the politics out of it and think about the situation and the individuals that are impacted by this. I think. 

We'll do better together as a society and individuals if we think that way. 

Cougar: Yeah, thank you. I should just say amen. But of course I'll try to add my spin to that, Alan, but that is just so perfect to take the politics out, focus on people. I just think so much, and I've already kind of hit the compassion word a couple of times, but I mean, you're looking at me here. 

You know the listeners can't see me thankfully. 'cause I'm not much to look at. Like I say, I have a face for radio or podcast two of us. But. [00:32:00] I'm the portrait of privilege in this country, and I'm three months away from being homeless. If there was some life changing event, lose my job, have a terminal illness to a child or to a spouse, I mean, it's more fragile for all of us. 

Well, for 85% of us, absolutely. We're way more fragile. Even with generational wealth. Yeah, we're more fragile, and so if we can just have. An increase of empathy, of understanding, of compassion, and recognize, well, there are individual determinants of health. You should take care of yourself. You should strive to move more, to maybe eat a little less and to manage stress and to get your preventative care. 

And I'm a huge fan of that. I've been promoting that for almost 30 years in my career. Individual determinants matter, but they fail. They shrink in comparison. When you look at the social determinants or the social drivers of health, and so to [00:33:00] recognize, man, we are all way more fragile. We need a system. 

We need that support. We need access to education, access to finance, to banking, to employment, to the clean air and clean water, and like go through all the social determinants of health. They're important for all of us. And we don't live just as individuals. We are communities. And so I just wanna say amen to everything you said and just add just a little more public health and a little more understanding. 

It's so easy to judge. It's so easy to point a finger. It's so easy to talk about, you know, pull yourself up by your bootstraps. Well, you need to be accountable. Well, you need to be more self-reliant and that's great. Yeah, I agree. Yeah. And. Do we really believe in mercy? Do we really believe in taking upon us one another's burdens and thus fulfilling the law of Christ? 

Alan: I think it's great perspective. I always think of that like who am I right to look at that and make a judgment? I don't know what their [00:34:00] situation's been, and I'm not here to do that. We're here to make sure that we can address the situation they're in, which gets back to kind of what we talked about. 

It's not just enough to address a person's diabetes. If you don't understand the other drivers that are affecting that. Yeah. Right. So we have to think beyond sort of, here's a prescription and eat better when maybe they don't have the means to eat better. It's expensive to eat healthy, right. It's a lot less expensive. 

To eat package, produce foods that are high in sugars and other area harmful. So again, I think that's a great perspective and that's what we wanna just share with folks. We're all pretty close to being on that edge, and I hope that it never happens to me and you, right? But if it does, I hope that there are people and systems out there that are going to approach us. 

With that lack of judgment and that ability to say you're a fellow human being. Yeah. Who needs some assistance? Healthcare might be one of 'em at this moment, and we're gonna address that. 'cause you're gonna get out of this situation. We've heard that pull yourself up by the bootstraps and sometimes the [00:35:00] response in my office is, that's great, but we know a lot of people who don't have any boots, don't have boots to pull those boots straps up. 

So how do we even address that? Basic area, let's get 'em a pair of boots. Now they can pull themselves up by it. So that's a big part of that community health center model is addressing that whole person and addressing what they need beyond the clinic walls to be healthy. 

Cougar: Probably two or three years ago, I had a clinician from a community health center come and speak to my class. 

It was my first introduction to federally qualified health centers. I just realized, I sat there and I listened as this woman was presenting to my students, and I thought she embodies everything that I read in the New Testament. Everything I read in the Sermon on the Mount, this woman embodies that. 

There was no judgment in the way that she was speaking, talking about her patience, it was compassion, it was understanding, it was her hippocratic oath [00:36:00] to care to provide care, and it's, it's one of those. And I'm gonna get emotional, but it was one of those times where I was so inspired, like I can be a better person in my realm. 

I'm not a clinician, but in my spaces and in areas where I do have an opportunity to influence, I can just be better. Mm-hmm. And we all have those moments where we're inspired by something we've seen or heard or someone we've observed and we realize, oh, now I see my potential. Now I see who I can be. And I think we also experienced that on a community level, on an aggregate. 

Like wow, we could in Utah really experience like a hashtag life elevated, right? Like we really, we have that potential. Yeah. So I just want to say thank you. I'm sorry that I got a little emotional and that's great and I'm all over the place. Oh. But I wanna say thank you. Fighting the good fight and doing the work, and please continue. 

Thank you for sharing your time and your talents, your experiences with us. [00:37:00] Absolutely. On the Y Health Podcast. Good stuff. I 

Alan: appreciate being here. And you know, as I mentioned before, I've enjoyed my relationship with BYU, even as a U of U alum. I think highly of this school and I think highly of your public health department. 

I've had a number of years now of involvement at times and for the listeners, from the students to others, think about a career in community health. Yeah. We have a lot of folks that have come from this school that are working in health centers, and I've had great relationships and experiences, and I think as you work and think about your future in public health. 

Think broadly. Community health, as we mentioned, is an area where I think a lot of students can think about moving into and if they want to be sort of on the ground in the trenches doing that work, there's a lot of opportunities within the administrative side and supportive sides and clinical. If you continue to move on and advance your degrees and wanna be a clinician, we are really happy to support the workforce of the future and to partner together and bring more of the public health students into our world, and I think they'll help make it better.[00:38:00] 

Yeah. 

Cougar: We need to have you back 'cause we should talk about the future here at BYU as we're just laying the groundwork for a medical school. It feels like there's tons of opportunities Absolutely. Here. Exciting. The U has a proud tradition and has the state has been blessed. Yeah. By the University of Utah. 

And hopefully BYU can make a contribution. 

Alan: Absolutely. And we look forward to working with the new schools. 

Cougar: Yeah. 

Alan: We wanna provide opportunities for medical students to do. Rotations, we wanna see some residencies developed where we actually wanna build that. And I think it's sort of in alignment with what I've read about the new medical school. 

I think those missions align well between what we do and what the medical school is being set up and established to do. So having that opportunity for those students to actually. Serve the populations we're targeting. It presents a good opportunity for the future, and I'd love to come back anytime. Yeah, 

Cougar: let's do that. 

Alan, thanks so much, bro. Thank you. Appreciate it. 

Alan: Okay. 

Cougar: Thank you for joining us today. Catch us on our next episode, and don't forget to [00:39:00] subscribe to Future Y Health Episodes.