رونوشت کامل Nothing About Us Without us: Queer Healthcare in Rural America

00:04:31.199 And a lot of this stuff is very recently changed. 00:04:31.279 --> 00:04:39.600 And so, you know, you had where homosexuality was by the medical establishment viewed as a mental health condition that can be treated. 00:04:39.839 --> 00:04:48.079 And we've seen the effects of things like conversion therapy, which is harmful and doesn't, you know, you can't change that part of who you are, right? 00:04:48.160 --> 00:04:58.560 And so I think in many ways, healthcare institutions are a reflection of the broader society that really prioritizes heterosexual people or for queer people. 00:04:58.959 --> 00:05:02.639 That makes me think of when people say, oh, the gay agenda. 00:05:02.879 --> 00:05:03.439 Yeah, right. 00:05:04.879 --> 00:05:12.800 Because you are a researcher in this space who is wanting to promote uh better health equity for the queer community. 00:05:13.040 --> 00:05:17.120 And we're seeing the impacts of the current policy changes in clinics. 00:05:17.279 --> 00:05:24.079 So, for example, I'm from the sexual health care space and we're seeing uh cuts in funding at a national level. 00:05:24.399 --> 00:05:33.040 For the work that you're doing, are you trying to educate about the importance of resource access for people in queer communities? 00:05:33.279 --> 00:05:40.000 So when you were using the word pathologize, I would love to hear what your definition of that is in like a healthcare setting. 00:05:40.399 --> 00:05:55.439 I think in the context of research and also the delivery of healthcare services, the way that providers treat patients, right, there's interpersonal prejudice that people may have as providers based on the backgrounds that they have. 00:05:55.680 --> 00:05:58.720 And there's also those institutional prejudices. 00:05:58.800 --> 00:06:12.879 And so hospital systems or other healthcare facilities may have policies in place that are maybe preventing same gender couples from receiving reproductive care, for example. 00:06:13.120 --> 00:06:17.920 There could be gender-affirming care restrictions in some facilities. 00:06:18.160 --> 00:06:32.399 And what's interesting is that when we look at there's these four domains of healthcare that I'm particularly interested in, which is healthcare access, which is whether or not you can actually go to a doctor when you need to. 00:06:32.560 --> 00:06:40.079 There's healthcare utilization, which is your ability to access different types of services and how frequently you're able to go. 00:06:40.319 --> 00:06:50.399 And so, you know, for chronic conditions like diabetes management, you might have to go more frequently, versus if you get an injury or the common cold, maybe you go once and you don't have to go again. 00:06:50.560 --> 00:06:56.160 And the other two things that are really important to understand are facilitators and barriers. 00:06:56.319 --> 00:07:04.399 And so, in the context of queer rural people, there are these really pronounced barriers of distance. 00:07:04.560 --> 00:07:11.839 And so we see this in rural communities, and obviously this varies by region, where in some parts of the United States there's greater distances. 00:07:11.920 --> 00:07:21.439 So, for example, in the western United States, where there's just larger land masses between towns and cities, that plays a key role in whether or not someone can go to the doctor. 00:07:21.519 --> 00:07:30.240 If you have to drive an hour, two hours, three hours just to go for a checkup, that's a really big barrier that also has a cost associated with it. 00:07:30.399 --> 00:07:32.879 Because unfortunately, gasoline's not free. 00:07:32.959 --> 00:07:36.480 And so you if you got to fuel up your car just to go to the doctor. 00:07:36.639 --> 00:07:55.040 And the other key part there when we talk about facilitators is usually driven by resources in the terms of both income that people have, so having money to afford co-pays to go to the doctor, and also health insurance is another really big facilitator. 00:07:55.120 --> 00:07:58.720 And so in the United States context, often this is tied to our employment. 00:07:59.199 --> 00:08:07.519 And so for people who are living in rural communities where their employment maybe they're self-employed, they may not have health insurance. 00:08:07.680 --> 00:08:13.920 And so that really makes a really tricky situation to go to the doctor for a simple cold. 00:08:14.160 --> 00:08:17.759 And anyone listening to this, I've had personal experience with that. 00:08:17.920 --> 00:08:20.240 I know a lot of people that I know have had personal experience. 00:08:20.319 --> 00:08:25.600 And then this is just kind of the reality that we're living in in healthcare in America, is that we have all these barriers. 00:08:25.680 --> 00:08:32.639 So I can't even imagine also living in a rural area of how much more that would impact your ability to get care. 00:08:33.039 --> 00:08:37.360 So with rural healthcare, people are geographically isolated, right? 00:08:37.440 --> 00:08:40.639 And which is a huge impact on their ability to get health care. 00:08:41.039 --> 00:08:53.279 But do you feel like we see reflections of these rural healthcare situations, even in areas where there is a lot of hospitals and there is so, what are the intersections with all those factors? 00:08:53.360 --> 00:08:56.879 I know there's a lot of them, but how do you kind of break those down in your research? 00:08:57.200 --> 00:08:58.159 That's a great question. 00:08:58.320 --> 00:09:02.720 That has a lot to do with a concept in public health called structural urbanism. 00:09:02.960 --> 00:09:11.519 And so structural urbanism is this idea that we have provided provision of health care where there's the greatest profit motive. 00:09:11.759 --> 00:09:19.679 Unfortunately, sometimes with that is the case where if people don't have those other resources, I was talking about health insurance, right? 00:09:19.759 --> 00:09:20.720 That's a big one.

00:09:20.879 --> 00:09:25.200 Just because you live in an urban area doesn't mean you necessarily have health insurance. 00:09:25.519 --> 00:09:29.279 The other key facilitator, again, is your income. 00:09:29.440 --> 00:09:31.679 Are you able to afford to go to the doctor? 00:09:31.919 --> 00:09:44.159 And what's interesting with the rural and urban comparison for health services is that people who live in urban areas may have greater proximity to healthcare facilities and clinics. 00:09:44.399 --> 00:09:46.720 That being said, so does everybody else. 00:09:47.039 --> 00:09:57.360 So if you have a population, say, of two million people living in an urban area and there's three hospitals, well, there's many people who are going to come to those hospital doors. 00:09:57.519 --> 00:10:01.600 And so you will find that there's almost a greater competition, right? 00:10:01.759 --> 00:10:03.360 To access those services. 00:10:03.600 --> 00:10:07.919 And the people who are able to pay for the services are the ones who are going to receive them. 00:10:08.240 --> 00:10:15.600 And I think a lot of this is a reflection of these core social structures in our society that shapes that, right? 00:10:15.679 --> 00:10:24.240 We live in a capitalist society, and that plays a big role in everything to do with our healthcare system because it prioritizes profit over equitable care. 00:10:24.480 --> 00:10:24.799 Right. 00:10:25.039 --> 00:10:26.559 And that is sad. 00:10:26.720 --> 00:10:26.879 Yes. 00:10:27.120 --> 00:10:28.320 Let's just call it what it is. 00:10:28.399 --> 00:10:28.960 That is tragic. 00:10:29.679 --> 00:10:30.000 Yes. 00:10:30.320 --> 00:10:33.600 If only we would care more about the people getting the care. 00:10:33.759 --> 00:10:44.639 Because, you know, when you think about it, I think it's crazy that this is still a controversial issue because healthcare is the same as access to water or food. 00:10:44.879 --> 00:10:50.240 It's something that is vital to your life and being able to have a life. 00:10:50.480 --> 00:10:58.720 And what I'm hearing from you is that there's also this added complexity with access to care for the queer community because of their identity. 00:10:58.960 --> 00:11:08.879 And I was wondering if you could talk about that relationship some more of this need to access vital resources, but then also having that barrier of one's identity. 00:11:08.960 --> 00:11:14.480 Do you have any personal experience with that or have you observed that in the systems that you work in? 00:11:14.799 --> 00:11:15.759 Yeah, absolutely. 00:11:15.919 --> 00:11:31.039 I think that on a personal level, and this is really kind of what led me down this path of inquiry was going to the doctor as a young 20-something and wanting to understand what my options were for HIV prevention. 00:11:31.200 --> 00:11:37.360 You know, going to the family clinic, I didn't know if I could talk to that person about HIV prevention. 00:11:37.840 --> 00:11:45.840 That

really shaped me and my health because I was afraid to talk about what my health needs were. 00:11:46.000 --> 00:11:57.279 And so I think that when we think about social identity in the context of institutions, those identities are in relationship to other identities in society. 00:11:57.360 --> 00:11:57.600 Yes. 00:11:57.759 --> 00:12:02.720 They're also in relationship to the institution themselves, and those are in relationship to history. 00:12:02.960 --> 00:12:05.919 And so I consider myself a queer theorist. 00:12:06.000 --> 00:12:24.720 And so looking at this problem through a queer theory lens, I think is helpful because we're able to challenge the status quo with queer theory, look at non-normative structures to understand wait, maybe the way that that functions isn't working, it's actually reproducing inequality in people. 00:12:30.960 --> 00:12:35.759 When you say queer theory, what is that lens? 00:12:36.080 --> 00:12:40.799 I know it's a very broad question that's tied to a lot of you know historical context. 00:12:40.960 --> 00:12:41.200 Yes. 00:12:41.360 --> 00:12:44.480 But for example, in the queer community, like we can't help using that lens, right? 00:12:44.559 --> 00:12:46.879 Because of our own personal experience. 00:12:47.120 --> 00:12:52.399 But for other people that might not identify with that, can you just break down what that is? 00:12:52.720 --> 00:13:02.320 Queer theory, I conceptualize as a very powerful analytical tool to understand how social hierarchy manifests in society. 00:13:02.559 --> 00:13:02.879 Okay. 00:13:03.120 --> 00:13:08.320 And so when we think about being queer, there's, I mean, it's such a core thing, right? 00:13:08.399 --> 00:13:11.360 Of like this is just about who you love, who you want to have sex with. 00:13:11.440 --> 00:13:11.759 Yeah. 00:13:11.919 --> 00:13:14.720 And something that pretty much everybody does, right? 00:13:15.039 --> 00:13:18.480 So it's something that's so fundamentally a part of who we are as humans. 00:13:18.639 --> 00:13:28.240 But what queer theory does is shows us because we've had to live on the margins, we have had to shrink ourselves, change who we are throughout the life course. 00:13:28.320 --> 00:13:32.879 It gives us a different understanding of what a normative life looks like. 00:13:33.039 --> 00:13:39.440 So when we think about the American dream, for example, and sort of what that means, right? 00:13:39.759 --> 00:13:50.000 Typically, what you're probably going to think about is, you know, the white picket fence, the 2.5 kids, the golden retriever, and it's probably a mom and a dad, right? 00:13:50.159 --> 00:13:57.440 And so that right there is a good example of how we reinforce what a normative life looks like. 00:13:57.600 --> 00:14:00.240 And there's a term for this cultural hegemony. 00:14:00.320 --> 00:14:00.480 Yep. 00:14:00.639 --> 00:14:06.960 And that means basically that this is what is normal and this is what everyone is expected to do in society. 00:14:07.200 --> 00:14:12.799 And so when we say, well, that's normal, that's how it's supposed to function, no, actually it's not, right? 00:14:12.879 --> 00:14:17.120 That there's other experiences that are outside of what's considered quote unquote normal. 00:14:17.279 --> 00:14:22.879 And those are things for us to explore, understand, and figure out how does it all just fit together? 00:14:22.960 --> 00:14:31.759 Because at the end of the day, it really doesn't matter if somebody has a mom, dad, 2.5 kids, a golden retriever, or it's a dad and a dad, 2.5 kids, right? 00:14:31.840 --> 00:14:32.639 It doesn't matter. 00:14:32.799 --> 00:14:38.720 And so it's this thing that's artificially imposed on us as a society, and it's dangerous. 00:14:39.039 --> 00:14:42.480 I think that's so key that what you just said, it is artificial. 00:14:42.720 --> 00:14:52.159 The nuclear family structure, it's not supported by objectivity and data that that is what is the healthiest situation for all people. 00:14:52.320 --> 00:14:52.480 Right. 00:14:52.639 --> 00:15:08.799 And I think especially right now in our year 2025, we're seeing this pressure that this is what is healthy and normal when this box that is being imposed onto people is not what is healthy and normal for most people. 00:15:09.039 --> 00:15:09.279 Right. 00:15:09.519 --> 00:15:12.399 It doesn't reflect the society that we live in. 00:15:12.639 --> 00:15:13.360 Absolutely. 00:15:13.679 --> 00:15:23.039 So I think that's really interesting how we have these institutions, but they don't actually represent the people that they study, which is why you're studying them, right? 00:15:23.360 --> 00:15:24.559 Exactly, right, exactly. 00:15:24.639 --> 00:15:38.000 Yes, that's exactly what led me here is wanting to know how do we disentangle these really complicated ideas and concepts around who we are, just as such a human level of like love and sex. 00:15:38.159 --> 00:15:43.440 Like, I mean, it's one of the building blocks, I feel like, of civilization is love and sex. 00:15:43.600 --> 00:15:53.679 You know, so it's like if we can understand all the depth and breadth of what that could possibly be, you know, I intentionally use the term queer in my research. 00:15:54.000 --> 00:15:57.679 And there's all different ways that people talk about this population. 00:15:58.000 --> 00:16:06.000 And so, you know, people will say LGBTQ, people will say sexual minority, there's all these different terms that we use. 00:16:06.159 --> 00:16:13.440 And I like using the term queer because I think it represents pushing the margin even further, right? 00:16:13.519 --> 00:16:18.080 That there's all these things that we understand about sexuality and gender is always changing. 00:16:18.240 --> 00:16:20.480 It's something that isn't static. 00:16:20.639 --> 00:16:29.679 And so the way that we talk about homosexuality today is different from how society talked about it 20 years ago, 50 years ago, 100 years ago.

00:16:29.919 --> 00:16:38.320 And so I like the term queer to kind of keep our eye on that moving target that this is always in flux, it's always changing, and our understanding of it changes. 00:16:38.480 --> 00:16:44.559 I mean, there's terms that I've learned in my lifetime that nobody was using 50 years ago. 00:16:44.720 --> 00:16:54.879 And that's one of the great things is that sexuality and gender is really kind of this infinite institution that is always gonna change along with other structures in society. 00:16:55.120 --> 00:16:56.320 And that sounds beautiful. 00:16:56.960 --> 00:16:59.200 The way you describe that as beautiful. 00:16:59.679 --> 00:17:08.079 Do you feel like this whole spectrum, this whole unknown about because you know, sexuality it really is human identity, right? 00:17:08.240 --> 00:17:10.960 Which there's a lot of fear and a lot of repression. 00:17:11.119 --> 00:17:11.359 Yeah. 00:17:11.599 --> 00:17:23.200 And do you feel like that maybe has relation to what we're seeing right now, where people have this reaction of like, oh, let's be afraid and let's repress that part of ourselves because it's so vast and infinite. 00:17:23.440 --> 00:17:25.759 Do you feel like that's resonant with what's going on? 00:17:26.079 --> 00:17:41.359 Yeah, I think that people are uncomfortable with maybe their own sexualities because there's these forces in society, this sort of domination that we have because of cis heteropatriarchy. 00:17:41.759 --> 00:17:42.160 Oh wow. 00:17:42.640 --> 00:17:43.279 That's a big word. 00:17:43.440 --> 00:17:45.440 Yeah, the$5 word thrown out there. 00:17:45.599 --> 00:17:47.119 So we have patriarchy. 00:17:47.279 --> 00:18:00.160 Yeah, so we have cis heteropatriarchy, which it reinforces those things we were talking about a moment ago with the cultural hegemony of the 2.5 kids, the man and the woman, the dog, the white picket fence. 00:18:00.319 --> 00:18:04.960 And so I think that people are because those forces are so strong, right? 00:18:05.039 --> 00:18:17.599 Like there's such a societal pressure that you're supposed to fit into that and to step outside of those forces of domination can be very scary for people, especially depending on where they are. 00:18:17.759 --> 00:18:20.000 Because they're systems of control, exactly, right? 00:18:20.079 --> 00:18:22.319 They're ways of enforcing control, right? 00:18:22.480 --> 00:18:33.839 Because when a again, correct me if I'm wrong, but I believe historically when societies are more uniform and that term cultural hegemony, hegemony, thank you, that makes a population easier to control, right? 00:18:34.079 --> 00:18:34.400 Right. 00:18:34.640 --> 00:18:44.240 Another core part of my work is so we have examining capitalism because of living in a capitalist society, a for-profit healthcare system. 00:18:44.480 --> 00:18:54.319 There's then on this idea of control, there's these two other core social structures of colonialism, which is the way that we understand borders and land. 00:18:54.640 --> 00:19:04.079 And then there's also imperialism, which is the way that policy is made to enforce control of those borders in that land. 00:19:04.160 --> 00:19:15.599 And we see that now, where the current administration is using a militarized police force essentially to harm certain members of the population, right? 00:19:16.079 --> 00:19:23.200 So I think control over our bodies is a really important part of capitalism, imperialism, and colonialism. 00:19:23.519 --> 00:19:27.119 And with that, a part of our bodies is our health. 00:19:27.359 --> 00:19:38.640 And so I think it becomes the perfect lens to understand control over bodies and how that can take the form of both military force, it can take the form of policy making. 00:19:38.880 --> 00:19:52.559 And I saw a statistic where last year there was 112 legislative legislation put forward across the United States that was anti-LGBTQ healthcare specific. 00:19:53.200 --> 00:19:54.319 So they're being very productive. 00:19:54.400 --> 00:19:57.440 I'm sure it's even higher now this year than it was last year. 00:19:57.599 --> 00:20:05.359 So it's this national debate about who can have healthcare and who can't, what type of healthcare they can have. 00:20:05.680 --> 00:20:10.559 And I think that that then becomes reflected in other parts of society. 00:20:10.640 --> 00:20:18.160 So as it becomes normalized, that people say, well, if there's, you know, say a change of like how people feel about trans people, for example, right? 00:20:18.319 --> 00:20:26.559 There's a concerted effort to further marginalize trans people more than they already are by certain people in Washington and across the United States. 00:20:26.880 --> 00:20:32.720 You know, we hear this rhetoric around how they're dangerous and they can't be in sports with people, right? 00:20:32.799 --> 00:20:35.839 And it's like just this outrageous stuff that they're saying. 00:20:36.160 --> 00:20:37.279 About a minority, right? 00:20:37.519 --> 00:20:42.799 A minority that is what less than, especially for trans people in sports, like what is it, less than two percent? 00:20:42.960 --> 00:20:45.039 Yes, one percent of the population. 00:20:45.200 --> 00:20:46.079 Yeah, it's crazy. 00:20:46.400 --> 00:20:52.319 They're making it sound like there's just this dangerous group of people that many trans people, none of whom are dangerous, right? 00:20:52.400 --> 00:20:54.400 And it's just like it's so outrageous. 00:20:54.480 --> 00:21:16.160 But what that does is that it changes people's mental models of how they feel about that population, because being one to two percent of the population, it could be the case that people may never meet a trans person, depending on where they are, who they are, what kind of social circles they're in, or they may never meet an out trans person at the very least, because people may be afraid to be out. 00:21:16.400 --> 00:21:23.920 But what happens when there's

those changes in mental models, it results in people then embracing that. 00:21:24.160 --> 00:21:35.200 And maybe someone's doctor is a doctor, and they embrace those beliefs, and then that further causes harm and makes it so that trans folks can't access healthcare. 00:21:35.519 --> 00:21:35.680 Yeah. 00:21:35.839 --> 00:21:41.680 So by mental models, you mean this stigma that people have towards each other. 00:21:42.160 --> 00:21:59.759 And that's honestly really the goal of what I really hope this podcast does, and at least maybe one way, or in a small way, is because I feel like when you truly talk to someone just as a person, just like as a human being, it often makes you really question your. 00:22:00.160 --> 00:22:03.039 Own ideas and perceptions of the world. 00:22:03.279 --> 00:22:16.480 Even you talking to me right now about rural healthcare in the queer community, you know, an area that I don't know a lot about, that's making me think a lot about everything going on and just like how we can better represent and be there for the community. 00:22:16.720 --> 00:22:30.559 So a lot of the people that are pushing this hatred and disproportionate fear of a small group of people, oftentimes they haven't even met or spoken with these people that they're talking about. 00:22:30.799 --> 00:22:48.640 And I saw this video, it was this news article the other day, which was a very anti-LGBTQ man apologizing to the community because he actually spoke to one of the people that were on the other side. 00:22:48.720 --> 00:22:52.319 And it suddenly made him realize like, hey, these are people just like me. 00:22:52.480 --> 00:22:55.599 Like these are people that are just advocating for affordable health care. 00:22:55.759 --> 00:22:59.200 And you know, like I think it's really interesting with all the issues that we're facing. 00:22:59.359 --> 00:23:05.599 Like, if you really look at it, we are all kind of wanting the same things, like whether on the left or the right. 00:23:05.759 --> 00:23:12.319 And again, on this podcast, we try to just bring you the most objective knowledge and have you make your own decisions. 00:23:12.559 --> 00:23:18.079 But whether you identify it on the left or the right, we all agree that we need affordable health care. 00:23:18.400 --> 00:23:18.720 Right. 00:23:18.960 --> 00:23:19.359 Absolutely. 00:23:19.599 --> 00:23:20.640 Like who can argue with that? 00:23:20.799 --> 00:23:28.160 Affordable health care, clean air, clean water, these are all things that are essential to being alive. 00:23:28.480 --> 00:23:32.480 So why would we be against our own health and life? 00:23:32.799 --> 00:23:33.039 Right. 00:23:33.119 --> 00:23:34.160 It doesn't make any sense. 00:23:34.240 --> 00:23:53.680 And no, I think what's interesting is that you have a vocal minority of people which are pushing a narrative that queer people and trans people are dangerous when they're not, and that they're trying to dehumanize this population in order to

achieve their political objectives. 00:23:54.000 --> 00:24:09.200 And there's a really interesting organization here in Arizona called the Center for the Future of Arizona, and they do all this wonderful public opinion polling to really understand where is their consensus among people across different political beliefs. 00:24:09.359 --> 00:24:18.400 And what they find is exactly what you just said that there is a high level of consensus that everybody wants healthcare for themselves and for others. 00:24:18.640 --> 00:24:29.440 And so there are ways that people agree on many, many issues, and some of these other issues that it would seem like people don't agree on, but there really isn't a whole lot of division there. 00:24:29.680 --> 00:24:36.480 It's just division that's pushed by a very loud group of people that have political objectives. 00:24:36.559 --> 00:24:43.839 And so most everyday folks that you encounter, though, view healthcare positively for everybody, including queer people. 00:24:44.160 --> 00:24:44.400 Right. 00:24:44.559 --> 00:25:02.720 And maybe more on the darker side, maybe another layer of this issue is that we might all want healthcare and a high quality of life, but there's people that might only want that for themselves and people that are like them, even though there's resources available for everyone to have that. 00:25:02.880 --> 00:25:05.279 They want it only for themselves, but not for others. 00:25:05.519 --> 00:25:05.759 Right. 00:25:05.920 --> 00:25:06.160 Right. 00:25:06.319 --> 00:25:09.039 Maybe we have to also acknowledge that, you know? 00:25:09.440 --> 00:25:09.920 Yeah. 00:25:10.240 --> 00:25:19.119 A lot of that I think is so core to this system in which we're almost in competition for resources always, right? 00:25:19.279 --> 00:25:41.759 That there's this artificial scarcity around resources because they say they can't build enough healthcare facilities, however, they have money for other things like militarizing the police, you know, and so there's ways in which I think policymaking could be used to provide more health services so people aren't in competition. 00:25:41.920 --> 00:25:55.039 So I understand that if someone goes to a hospital and they see a big line of people, and it's people that don't look like them, people who are different from them, they may think to themselves, well, all these people are taking up my slice of the health care. 00:25:55.519 --> 00:26:02.480 But if there was an abundance of healthcare and not so limited in terms of like even in the urban areas, right? 00:26:02.559 --> 00:26:08.319 Like there's only so many doctors, there's only so many nurses to care for a growing population. 00:26:08.559 --> 00:26:12.079 So if people are not in competition, I think a lot of that would change. 00:26:12.319 --> 00:26:13.839 Yeah, absolutely. 00:26:18.400 --> 00:26:32.240 To circle back around to rural healthcare, would you say that healthcare access, based on everything that we just talked about, do you think this has been used as a tool for oppression and colonialism? 00:26:32.640 --> 00:26:33.920 Yes, absolutely. 00:26:34.160 --> 00:26:40.640 And I think what's interesting in the context of rural healthcare is that we see the effects of colonialism that persist to this day. 00:26:40.799 --> 00:26:47.839 So when we look at rural parts of the state of Arizona, for example, this is where a lot of Native American communities live, right? 00:26:48.000 --> 00:26:56.880 Some of our largest Native American communities are in rural areas where they have the least access to resources, including healthcare infrastructure. 00:26:57.039 --> 00:27:03.039 So I think it certainly is reflective of the colonial past and present of the United States. 00:27:03.200 --> 00:27:14.240 And it's something that until there's major changes in the way that we think about land and the distribution of resources across land, I think uh definitely persists. 00:27:14.559 --> 00:27:26.160 And even though the rural areas throughout the United States have a lot less access to hospitals, clinics, providers, they have the majority of the burden of disease. 00:27:26.400 --> 00:27:26.640 Right. 00:27:26.799 --> 00:27:27.200 Is that right? 00:27:27.279 --> 00:27:27.440 Yes. 00:27:28.079 --> 00:27:29.359 Can you explain why that is? 00:27:29.759 --> 00:27:33.359 I think a lot of it would have to do with those financial factors. 00:27:33.519 --> 00:27:39.119 And so people who live in rural communities typically have lower levels of educational attainment. 00:27:39.279 --> 00:27:45.519 They typically have lower income levels and lower rates of health insurance. 00:27:45.599 --> 00:27:54.720 And so those are really the key facilitators in any context of healthcare that's gonna make it so whether or not you can access services or not. 00:27:54.960 --> 00:28:13.680 And so because people are not able to access services due to those barriers, it creates where there's a higher likelihood of chronic disease, oftentimes in rural areas too, which is distinct, is that there's more distance between everything, not just between where you live and where your doctor is. 00:28:13.839 --> 00:28:20.160 And this creates where we're a really car-centered society in the United States, especially in rural areas. 00:28:20.240 --> 00:28:22.799 It's really the only way to get around, oftentimes. 00:28:23.119 --> 00:28:31.759 And so things like motor vehicle accidents are higher in rural areas as well, because there's just more of a chance that you would be driving a longer distance. 00:28:31.839 --> 00:28:32.799 And I did not know that. 00:28:32.880 --> 00:28:36.640 Yeah, you would think it wouldn't, you would think of even more urban areas, right? 00:28:36.960 --> 00:28:37.279 Yes. 00:28:37.599 --> 00:28:38.640 That is really interesting. 00:28:38.880 --> 00:28:45.839 Yeah, so I think it's it's those factors of that there's these financial factors that prevent people from accessing health

services. 00:28:46.079 --> 00:28:56.000 There's obviously the geographic distance between accessing health services and where you live, and then there's those other factors like being more car-centered, so there's more motor vehicle accidents. 00:28:56.160 --> 00:29:02.079 People in rural areas also typically will work in professions that maybe are a little more dangerous. 00:29:02.240 --> 00:29:07.519 So working like in farming or ranching, where you may be run over by a tractor, right? 00:29:07.839 --> 00:29:12.400 So those kind of effects definitely have an effect on our health. 00:29:12.559 --> 00:29:22.559 And the last thing I would say is that in terms of resources, it's not just that there's limited healthcare provision in rural areas, that there's also limited access to food. 00:29:23.119 --> 00:29:30.160 And so when you drive into a rural area and you see that there's a dollar general, well, where's the safeway? 00:29:30.480 --> 00:29:32.960 Where's a grocery store that has fresh food? 00:29:33.279 --> 00:29:35.119 And that plays a big role. 00:29:35.200 --> 00:29:42.480 And so if people don't have access to healthy food, we know that there's a strong association with uh increased chronic disease. 00:29:42.799 --> 00:29:44.400 Yeah, that's a huge factor. 00:29:44.559 --> 00:29:48.480 And we even see those food deserts in urban areas, right? 00:29:48.640 --> 00:29:52.000 So it seems like it's a widespread problem wherever you are. 00:29:52.559 --> 00:29:52.720 Right. 00:29:53.119 --> 00:29:55.599 And a lot of this comes down to resources, right? 00:29:55.759 --> 00:30:00.720 So if there are, I guess they're artificially uh limited, right? 00:30:00.880 --> 00:30:10.960 That there's so much wealth in the United States, and sometimes that wealth doesn't always find its way to the population in a way that's going to create thriving. 00:30:11.119 --> 00:30:21.200 So if we don't have grocery stores in urban or rural areas, or we don't have hospitals in rural rural or urban areas, it really just makes it so people can't flourish. 00:30:21.519 --> 00:30:29.680 In your expertise, and you're soon to be a PhD, that's or you are a PhD candidate, so it's very exciting. 00:30:29.920 --> 00:30:57.200 So in your expertise, would you say it's impossible to examine health care critically without looking at all of these layers of like cultural hegemony, all these societal, because it seems like when you really, you know, you're you're very eloquent and you have all these terminology, and it seems like you really see everything as this interconnected web with healthcare in there, but it's always, I feel like in your mind, connected to all these other issues. 00:30:57.279 --> 00:31:04.079 So you would you say it's impossible to examine it without also going into all these complicated issues, right? 00:31:04.400 --> 00:31:08.640 Yeah, I think it is very complicated to break it out from those. 00:31:08.880 --> 00:31:16.720 And I think the reason why is because

those structures are so core to every aspect of society. 00:31:16.880 --> 00:31:21.119 No matter the institution, I think you could take the same approach and replicate it. 00:31:21.279 --> 00:31:22.400 And people do, right? 00:31:22.559 --> 00:31:32.240 This is work that's rooted in social conflict theory, and that is the predominant sociological theory for understanding inequality in society. 00:31:32.319 --> 00:31:44.720 And so at the core of it, the way in which resources have been distributed across society, across individuals, across institutions inherently creates a hierarchy. 00:31:45.200 --> 00:31:53.279 Those with greater number of resources have greater outcomes in life, and those with fewer resources have worse outcomes. 00:31:53.440 --> 00:32:07.519 And so you could look at that in the context of education and the students who have greater access to resources, the schools that are more well resourced, we see higher levels of academic achievement. 00:32:07.759 --> 00:32:12.400 And that then translates into whether or not a student will go into post-secondary education. 00:32:12.559 --> 00:32:21.119 So that relates to educational attainment, and your income level is also positively correlated with higher levels of educational attainment. 00:32:21.279 --> 00:32:29.119 So I think you could really replicate this across any institution and across any outcome and would see the same thing. 00:32:29.200 --> 00:32:36.640 So that's why I think it's so important to look at this through the lens of how resources are allocated and why. 00:32:36.799 --> 00:32:58.000 And a lot of that I think has to do with how we understand our relationship to the land and how we understand other people's relationship to the land and creating borders around certain areas of land and using military and other policy making to determine who gets to be in that land and who doesn't. 00:32:58.240 --> 00:33:00.400 Yeah, I feel like that is really key. 00:33:00.480 --> 00:33:05.039 And just to what you said before, this really does create the system of competition, right? 00:33:05.200 --> 00:33:10.400 Where it's only this meritocracy where it's like, it's not a question of you should have healthcare. 00:33:10.480 --> 00:33:12.400 It's oh, do you deserve healthcare? 00:33:12.720 --> 00:33:12.960 Yes. 00:33:13.119 --> 00:33:24.160 You know, based on some very small, narrow boxes of if you fit into those boxes and those definitions, because yeah, it's like we have the resources available. 00:33:24.319 --> 00:33:28.400 It's like it's just a meritocracy the way we the way everything works. 00:33:28.480 --> 00:33:40.079 And it's like we all operate in this meritocracy where it's like even we're all biased in that sense where there's that constant pressure of just like having to compete for being able to pay rent, being able to afford groceries, you know. 00:33:40.160 --> 00:33:45.359 And it's like, I mean, from my perspective, I don't really believe in like there's good people and bad people. 00:33:45.440 --> 00:33:48.880 I just feel like we are all products of our environment, right? 00:33:49.039 --> 00:33:49.440 Right. 00:33:49.680 --> 00:33:54.000 And like we can make decisions and transform these environments. 00:33:54.079 --> 00:34:01.039 But at the end of the day, we're really bound to if we can eat or drink or you know, get care. 00:34:01.599 --> 00:34:03.119 So there's a lot. 00:34:03.839 --> 00:34:04.799 There's a lot going on. 00:34:05.119 --> 00:34:06.400 Yes, there's so much going on. 00:34:06.559 --> 00:34:10.880 And I think that I think of all these great unknowns in our world. 00:34:10.960 --> 00:34:14.880 And so there's a great unknown about the ocean, right? 00:34:14.960 --> 00:34:17.840 There's so much stuff in the ocean that we don't even know that's in there. 00:34:18.159 --> 00:34:25.840 And oceanographers are doing amazing research to figure out what is in the ocean, and we have people who are exploring space, right? 00:34:26.000 --> 00:34:32.239 There's this vast solar system that we're a part of, and we have astronauts who are figuring that out. 00:34:32.559 --> 00:34:36.159 And another great unknown is our social world. 00:34:36.480 --> 00:34:41.599 And part of that is something I said earlier around how these things are changing. 00:34:42.079 --> 00:34:49.199 These are not static understandings or static experiences of gender or sexuality or race, ethnicity, right? 00:34:49.280 --> 00:35:01.360 You could really look at any of these things, and it changes throughout history because of our relationships to each other, our relationships to institutions, and our relationship to history itself. 00:35:01.679 --> 00:35:07.840 And so, as there's what, eight plus billion people, I don't know what number we're at now. 00:35:07.920 --> 00:35:09.840 There's a lot of people on this planet. 00:35:10.079 --> 00:35:23.679 And so, across all of our societies around the globe, there's really an infinite number of experiences that people could have in the social world because there's different cultural understandings of gender and sexuality, for example. 00:35:23.840 --> 00:35:24.079 Right. 00:35:24.320 --> 00:35:35.840 And so what we may understand about gender and sexuality in the context of the United States is very different from how they understand it in parts of Asia or parts of Africa or parts of Europe, right? 00:35:36.000 --> 00:35:47.440 So that place and space plays such a big role in shaping who we are and how we then interface with people around us and society more broadly. 00:35:47.760 --> 00:35:48.880 That is also beautiful. 00:35:49.440 --> 00:35:49.679 Thank you. 00:35:51.360 --> 00:36:05.360 Because honestly, when you say that there's so many infinite possibilities and infinite relationships that we have with the world and with each other, I feel like, especially right now when a lot of people are feeling, you know, despair or hopelessness, right? 00:36:05.599 --> 00:36:06.559 Things can

change. 00:36:06.719 --> 00:36:06.960 Absolutely. 00:36:07.199 --> 00:36:22.639 You know, because I feel like the only constant in the universe, honestly, is that things will change and things are changing and things will not be staying the same because it's impossible, you know, because time and space and you know, just all that fun stuff. 00:36:23.039 --> 00:36:27.119 And I think that we can learn a lot from how things have changed. 00:36:27.280 --> 00:36:40.800 And that's why I find myself using queer theory as a lens to understand our current situation in healthcare because it's been able to be used to understand other things that have happened throughout history. 00:36:40.960 --> 00:36:57.119 So thinking about, say, for example, the HIV epidemic of the 80s, when you had really a lot of queer organizing for liberation in the urban cores of New York, Chicago, San Francisco. 00:36:57.599 --> 00:37:06.239 And this really created a movement for people who were feeling like the government was failing them. 00:37:06.400 --> 00:37:06.639 Yeah. 00:37:06.800 --> 00:37:14.000 There was this reluctance at best by the government to talk about what was happening with HIV in the 80s. 00:37:14.159 --> 00:37:17.599 People were afraid of touching HIV patients, right? 00:37:17.679 --> 00:37:21.920 There was so much stigma around what they called a gay disease, a gay cancer. 00:37:22.239 --> 00:37:22.719 Which it's not. 00:37:23.039 --> 00:37:23.519 Right, exactly. 00:37:23.679 --> 00:37:25.199 It's not right in the gay community. 00:37:25.440 --> 00:37:25.679 Exactly. 00:37:25.760 --> 00:37:26.559 It affects us all. 00:37:26.719 --> 00:37:26.960 Yeah. 00:37:27.199 --> 00:37:42.000 And it's through that that there was these organizations like Act Up who started raising awareness that the government is not supporting queer people as they're being disproportionately affected by this virus. 00:37:42.639 --> 00:37:54.960 And so sending a strong message to lawmakers and to also the American public, changing those mental models that people have about what this quote unquote gay disease really is. 00:37:55.119 --> 00:38:00.880 And then when people found out, wait a minute, this doesn't just affect gay people, this affects anybody. 00:38:01.199 --> 00:38:06.159 And that really had a tremendous effect on how people then view HIV. 00:38:06.320 --> 00:38:09.920 Now, things could still have a long way to go still when it comes to HIV. 00:38:10.000 --> 00:38:11.440 There's still a lot of stigma there. 00:38:11.599 --> 00:38:15.360 But I think we've made leaps and bounds since the 80s, right? 00:38:15.519 --> 00:38:21.039 So I think there's a lot of optimism in seeing that kind of change just happened in the space of HIV. 00:38:21.119 --> 00:38:21.440 Yeah. 00:38:21.679 --> 00:38:28.880 And, you know, there's other social movements that then were born out of the HIV epidemic. 00:38:28.960 --> 00:38:31.920 And so when you had ACT Up, they didn't just stop there. 00:38:32.159

--> 00:38:38.079 They also were calling attention to the way in which the police were treating LGBTQ people. 00:38:38.159 --> 00:38:38.320 Yeah. 00:38:38.480 --> 00:38:43.360 They're calling attention to how LGBTQ people couldn't serve in the military. 00:38:43.519 --> 00:38:53.519 It called attention to really, again, looking at all these institutions across society and how people were able to interface with it or not. 00:38:53.920 --> 00:39:02.400 And so I think that it can be a really powerful thing when we have these movements arise out of bad situations, right? 00:39:03.280 --> 00:39:04.159 And we're seeing that now. 00:39:04.320 --> 00:39:04.480 Right. 00:39:04.800 --> 00:39:10.719 People are organizing, people are getting together, you know, to fight for our identities and our freedom. 00:39:11.039 --> 00:39:11.599 Absolutely. 00:39:11.760 --> 00:39:17.199 And I think that's really a core of what we need more now than ever is unity. 00:39:17.360 --> 00:39:19.119 We need community with people. 00:39:19.519 --> 00:39:23.519 And when people come together, we're really strong together, you know? 00:39:23.920 --> 00:39:24.239 Yeah. 00:39:24.480 --> 00:39:27.280 And we live in individualistic society. 00:39:27.519 --> 00:39:30.559 Through that, there's isolationism that occurs. 00:39:30.719 --> 00:39:36.239 And when people are more disconnected from others, well, A, it has an effect on their health. 00:39:36.320 --> 00:39:36.639 Yeah. 00:39:36.960 --> 00:39:39.599 And B, it also has an effect on our society. 00:39:39.679 --> 00:39:45.840 So if people are not coming together for a common cause, it really can have the opposite effect, right? 00:39:45.920 --> 00:39:49.599 If people are not connected, they they find themselves terrorism like that. 00:39:49.760 --> 00:39:50.239 Yeah, lost. 00:39:50.480 --> 00:39:55.679 Lost adrift at sea, you know, which is not fun. 00:39:56.000 --> 00:39:56.880 No, not at all. 00:39:56.960 --> 00:40:07.199 And through this work, I also wanted to make sure that people see that the limitations that queer people face for healthcare in rural areas isn't just a dumb problem. 00:40:07.440 --> 00:40:17.760 It's an all of us problem because it's looking at what are those barriers, facilitators that people experience to access healthcare. 00:40:17.840 --> 00:40:20.719 And those are things that are present, like we've talked about today. 00:40:20.880 --> 00:40:27.840 They're present in urban areas, and they're also present for people that are maybe living in a rural community, but they're not queer, right? 00:40:28.000 --> 00:40:31.760 And so I have three comparison groups in my research. 00:40:31.840 --> 00:40:42.639 And so there's rural people who are not queer, there's rural people who are queer, and there is queer people who live in urban areas. 00:40:42.880 --> 00:40:43.119 Okay. 00:40:43.360 --> 00:40:55.199 And so the reason I compare across these three is that then we can see that there are these same barriers that exist for people, no matter where they are or who they are. 00:40:55.360 --> 00:41:02.639 So for example, in rural communities, lack of transportation to access healthcare affects everybody. 00:41:02.800 --> 00:41:03.119 Yeah. 00:41:03.440 --> 00:41:17.440 And it's more pronounced among queer people because when we look at the urban population for queer people, they also have challenges around access and utilization that their heterosexual counterparts do not have in urban areas. 00:41:17.519 --> 00:41:17.679 Yeah. 00:41:17.840 --> 00:41:28.159 So it's kind of a way of understanding how do these factors compound and intersect with each other in a way that produces distinct outcomes in the population. 00:41:28.400 --> 00:41:34.719 But really, it's calling attention to things that are affecting people no matter who they are or where they live. 00:41:35.039 --> 00:41:36.639 I feel like that's a big deal. 00:41:37.119 --> 00:41:41.360 You know, like, yeah, these things affect us no matter who we are or where we live. 00:41:41.519 --> 00:41:41.840 Yeah. 00:41:42.079 --> 00:41:42.320 Right. 00:41:42.400 --> 00:41:56.719 So it's like that connection, I feel like, where I haven't really grown up in a rural area, but it's like, wow, the things that I experience with healthcare, they're probably also experiencing in a very similar way, but with the added geography distance, right? 00:41:57.039 --> 00:41:57.360 Yeah. 00:41:57.599 --> 00:42:02.000 And a key takeaway is that healthcare disparities are not accidents. 00:42:02.159 --> 00:42:02.559 Yeah. 00:42:02.800 --> 00:42:07.039 They are a product of systemic forces. 00:42:07.519 --> 00:42:12.239 And so those are forces that, you know, people contain multitudes. 00:42:12.400 --> 00:42:14.239 They have many aspects of who they are. 00:42:14.400 --> 00:42:14.719 Yeah. 00:42:14.960 --> 00:42:18.159 So in my research, I control for all those factors. 00:42:18.400 --> 00:42:28.639 And so things like socioeconomic status, things like race and ethnicity, immigration status obviously plays a big role too, especially in the current climate. 00:42:28.880 --> 00:42:33.760 That really shapes people's experiences and institutions, their sexuality, their gender. 00:42:33.920 --> 00:42:53.280 But even there's some really interesting research that's been done for how people who are more queer presenting, I guess you could say, people who are challenging gender expression maybe in different ways, they experience worse health outcomes than people who are more normative. 00:42:53.519 --> 00:43:05.360 So if someone walks into a clinic, for example, and they're a man who has a more feminine gender expression, they're more likely to receive worse care and have worse health outcomes, right? 00:43:05.679 --> 00:43:21.599 And that's supported by research that's been done on this, and it's really interesting to think about the role that that plays and how those then effects are more pronounced in certain areas where maybe there's

higher levels of stigma or maybe there's different cultural beliefs. 00:43:21.840 --> 00:43:26.800 And again, this is pronounced in rural areas, but rural areas vary a lot. 00:43:27.039 --> 00:43:36.559 The question of rurality is a really tricky one, but I think it's interesting in the context of the United States because when we think about what is the United States, right? 00:43:36.639 --> 00:43:40.239 Like there's always like the Iowa caucus plays such a big role. 00:43:40.480 --> 00:43:49.519 And so there's these states that for a long time people said they were flyover states, that there was these, you know, lots of rural population there. 00:43:49.679 --> 00:43:49.920 Yeah. 00:43:50.079 --> 00:43:51.679 But it's a big part of the United States. 00:43:51.760 --> 00:43:56.480 Like most of the United States, I think it's like 76% of the United States is considered rural. 00:43:56.639 --> 00:43:59.760 Now, most of the population doesn't live in a rural area, obviously. 00:44:00.159 --> 00:44:02.880 Because that's the whole way the urbanization works. 00:44:02.960 --> 00:44:07.519 And so people live in these urban concentrations. 00:44:07.760 --> 00:44:13.760 That gives us a lot to work with, though, that there's a ton of the population still that lives in rural areas. 00:44:13.840 --> 00:44:19.599 And actually, fun fact about when I started doing this research, people were like, do gay people even live in rural areas? 00:44:20.000 --> 00:44:20.639 Right. 00:44:21.039 --> 00:44:22.480 And actually, I was wondering about that. 00:44:22.559 --> 00:44:22.719 Yeah. 00:44:23.599 --> 00:44:24.239 Great question, right? 00:44:24.400 --> 00:44:31.840 And so there is actually another interesting concept from queer theory that describes that, and it's called queer metronormativity. 00:44:32.079 --> 00:44:37.599 So queer metronormativity is this concept that gay people only live in urban areas, right? 00:44:37.840 --> 00:44:39.599 That that's where they live. 00:44:39.840 --> 00:44:46.559 But actually, 20% of the LGBTQ plus population in the United States lives in a rural area. 00:44:46.800 --> 00:44:47.199 What? 00:44:47.519 --> 00:44:47.679 Yeah. 00:44:47.840 --> 00:44:51.039 So it's it's it's a significant number. 00:44:51.280 --> 00:44:52.079 That is, yeah. 00:44:52.400 --> 00:44:55.119 And I think what would that be 20% would that be? 00:44:55.199 --> 00:44:56.480 Like how of what number? 00:44:57.199 --> 00:44:58.000 About three million people. 00:44:58.239 --> 00:44:58.800 Three million. 00:44:59.039 --> 00:44:59.360 Wow. 00:44:59.519 --> 00:44:59.599 Yeah. 00:44:59.760 --> 00:44:59.920 Okay. 00:45:00.159 --> 00:45:01.119 Three million people is a lot. 00:45:01.199 --> 00:45:03.039 That's like the size of a city, you know. 00:45:03.199 --> 00:45:05.199 And then what is defined as rural? 00:45:05.280 --> 00:45:06.639 Like what's a rural town? 00:45:06.719 --> 00:45:08.320 Like how many people would that be? 00:45:08.639 --> 00:45:11.280 That is a question of a lot of debate. 00:45:12.880 --> 00:45:18.159 So as I started to disentangle what rural and urban means, uh-huh. 00:45:18.719 --> 00:45:27.679 Some people in the rural sociology space conceptualize it as a gradient where you have the urban center with the greatest population. 00:45:27.920 --> 00:45:28.159 Okay. 00:45:28.400 --> 00:45:31.039 And then there's a gradient that goes out to suburban. 00:45:31.280 --> 00:45:36.079 And then the further you get away from that urban core, the more rural it becomes. 00:45:36.320 --> 00:45:39.440 Now, that being said, there's many different definitions. 00:45:39.599 --> 00:45:48.480 So some government agencies, like the US Census Bureau, uses one definition for understanding rurality. 00:45:48.719 --> 00:45:55.840 In the context of healthcare, we have government agencies like Health and Human Services that use a different way of understanding rural. 00:45:55.920 --> 00:46:03.679 So there's really not one way of that there's, you know, if there's 15,000 people in an area, is that a rural town? 00:46:03.920 --> 00:46:04.480 Maybe. 00:46:04.719 --> 00:46:14.559 And I say maybe because there could be, for example, a place that has 15,000 people, but 20 minutes down the road, there's a town of 500,000, right? 00:46:14.639 --> 00:46:14.880 Yeah. 00:46:15.119 --> 00:46:16.559 So it depends a lot. 00:46:16.719 --> 00:46:24.480 And so I conceptualize rurality as the greatest distance from the urban core. 00:46:24.800 --> 00:46:25.119 Okay. 00:46:25.440 --> 00:46:28.559 So it means different things in the context of regions too. 00:46:28.719 --> 00:46:41.119 So in the western United States, where we have greater geographic distances from urban cores versus in the northeast, where we have a lot smaller distances, right? 00:46:41.280 --> 00:46:45.440 Like the states in the northeast themselves are smaller. 00:46:45.840 --> 00:46:51.679 Versus in the west, states like Texas, California, Arizona are really big states. 00:46:51.760 --> 00:46:58.239 It takes, you know, 12 plus hours to drive across the state of Arizona versus in Massachusetts. 00:46:58.400 --> 00:47:01.360 You can probably drive across multiple states in 12 hours. 00:47:01.519 --> 00:47:02.639 So I think that plays a big role. 00:47:02.800 --> 00:47:05.760 So regionally, rurality differs. 00:47:06.159 --> 00:47:13.840 And going back to some of those core concepts of the social structures of colonialism, that is where colonialism began, right? 00:47:13.920 --> 00:47:14.800 In the United States. 00:47:14.880 --> 00:47:22.800 And so it's a reflection of the way in which land has changed over time and who is using that land. 00:47:28.880 --> 00:47:35.920 Do you feel like colonialism has impacted outreach efforts to rural areas? 00:47:36.320 --> 00:47:37.599 Yeah, I think so. 00:47:37.840 --> 00:47:42.800 I think that colonialism has really shaped everything that's happening in the United States, right? 00:47:43.039 --> 00:47:43.599 Definitely,

yeah. 00:47:43.760 --> 00:47:44.000 Yes. 00:47:48.159 --> 00:48:02.559 And, you know, in terms of outreach, yeah, we see where the parts of the population that have some of the most pronounced health outcomes that are negative are Native Americans. 00:48:02.880 --> 00:48:07.039 And a lot of that is through colonial practices, right? 00:48:07.199 --> 00:48:14.559 Where there's a course that I've taught and it explores the colonialism of health. 00:48:14.880 --> 00:48:34.000 And one key part of it is that there was obviously violence, which is one of our public health measures, but there's also the spread of infectious disease that occurred during colonization that had a tremendous effect on the indigenous population. 00:48:34.480 --> 00:48:45.280 And that resulted in both widespread loss of life, lots of highly rates of mortality, but it also had effects on food systems. 00:48:45.599 --> 00:49:01.119 So when there was parts of the population dying off because of infectious diseases that were new pathogens that were being brought by settlers, then there was people who were in charge of the crops who died in the process. 00:49:01.199 --> 00:49:04.000 And so now the population can't eat, right? 00:49:04.239 --> 00:49:08.159 Those are things that are reflected in our contemporary society as well. 00:49:08.480 --> 00:49:10.800 Where, and we see examples of this, right? 00:49:10.960 --> 00:49:21.119 During the COVID-19 pandemic, there was those rural communities and Native American communities had a very different response to the pandemic relative to urban areas. 00:49:21.199 --> 00:49:24.320 And a lot of it was because there was limited resources. 00:49:24.480 --> 00:49:29.199 So getting PPE out to Native American communities was really tricky. 00:49:29.280 --> 00:49:35.440 And so they used other mitigation efforts to try to prevent the spread of the virus. 00:49:35.599 --> 00:49:44.639 So having stricter quarantine or stricter regulations around movement, which kind of goes along with uh colonialism, right? 00:49:44.719 --> 00:49:49.199 That there's restrictions around who can move and a lot of it has to do with resources. 00:49:49.440 --> 00:49:51.599 Yeah, or not wanting to take the vaccine. 00:49:51.840 --> 00:49:51.920 Right. 00:49:52.800 --> 00:49:53.119 Yep. 00:49:53.360 --> 00:49:53.920 Absolutely. 00:49:54.480 --> 00:50:05.199 Which, when you look at all the things that you just mentioned, you know, it makes sense why you would mistrust the government and someone that's saying from a different state, different very far away from you, it's like, hey, take this. 00:50:05.360 --> 00:50:05.599 Yeah. 00:50:05.920 --> 00:50:07.599 Because why would you trust that? 00:50:08.000 --> 00:50:09.599 That's a good point that you bring up. 00:50:09.679 --> 00:50:13.440 I uh was a part of a project called the Arizona Youth Identity Project. 00:50:13.599 --> 00:50:16.239 This was during 2020, so lots of stuff to uncover. 00:50:16.400 --> 00:50:20.880 And it was trying to understand how young people felt about society. 00:50:21.360 --> 00:50:32.960 And so that was people from the ages of 18 to 26, and they were interviewed on a variety of topics, some of which included the COVID-19 pandemic. 00:50:33.119 --> 00:50:43.119 And out of that, we were able to publish numerous articles that were exploring themes around vaccine hesitancy or acceptability or refusal. 00:50:43.440 --> 00:50:57.519 And what we found in our research was that there was a distrust of government because of these long-standing reasons that I think are, you know, in many ways justified. 00:50:57.840 --> 00:50:58.480 Yeah, that makes sense. 00:50:58.800 --> 00:50:59.360 Yeah, right. 00:50:59.519 --> 00:51:11.440 That you know, people say, for example, in Native American communities, felt distrust because generally speaking, these institutions hadn't looked out for Native American communities. 00:51:11.519 --> 00:51:14.719 They've been kind of left to fend for themselves in many ways. 00:51:14.960 --> 00:51:18.639 But even more so is that there's been active harm done. 00:51:18.800 --> 00:51:23.920 So one example of that is the Havasupai people. 00:51:24.239 --> 00:51:37.119 They had an experiment conducted by some researchers at one of our state institutions that they collected blood samples from without their consent of what they were going to do with the blood samples. 00:51:37.440 --> 00:51:42.239 And for that tribe, blood is a sacred thing to them. 00:51:42.400 --> 00:51:50.480 And so it was it was a betrayal, and then that shaped how that community felt about medical researchers. 00:51:50.719 --> 00:52:06.719 And while the medical researchers had the best of intentions to try to study why there was higher prevalence of certain diseases in this community, they did it in a way that didn't involve the community as equal decision makers and what they would do to achieve their health. 00:52:07.199 --> 00:52:08.960 Nothing about us without us. 00:52:09.280 --> 00:52:10.639 That's a really good one. 00:52:11.119 --> 00:52:19.840 In your research, what would you say are some successful models of community interventions for healthcare, specifically for rural healthcare? 00:52:20.239 --> 00:52:20.800 Great question. 00:52:20.960 --> 00:52:29.679 So there is a study I was a part of through the ASU Global Center for Applied Health Research called Parenting in Two Worlds. 00:52:29.840 --> 00:52:30.159 Okay. 00:52:30.400 --> 00:52:42.000 And this is an intervention study designed to help parents who are Native American navigate complex topics with their children. 00:52:42.239 --> 00:52:46.960 One of the studies we did was on sexual health among Native American teens. 00:52:47.119 --> 00:52:58.000 And so across Arizona, many Native American communities have higher rates of teenage pregnancy and they also have higher rates of sexually transmitted infections. 00:52:58.320 --> 00:53:12.480 And so understanding that the importance of parents being

a part of their child's health and talking to them about it, how do you blend those elements of living in two worlds, really, right? 00:53:12.639 --> 00:53:16.719 So there's the indigenous knowledge that people have that's really important. 00:53:16.960 --> 00:53:21.920 The ways in which Native American people think about family are really important. 00:53:22.320 --> 00:53:29.599 So we wanted to make sure that the intervention we were designing was something that A would actually be implemented and B would be effective. 00:53:29.840 --> 00:53:33.679 So we worked with the community to develop that intervention. 00:53:33.840 --> 00:53:51.760 And so working with the Phoenix Indian Center, we developed a program where parents would come in to learn different strategies of how do you talk to your teenage daughter about preventing pregnancy, for example. 00:53:52.079 --> 00:53:55.519 And how do you do it in a way that's culturally responsive? 00:53:55.840 --> 00:54:01.039 And for Native American people, welcoming a baby into the world is a wonderful thing. 00:54:01.599 --> 00:54:10.639 And so making sure that we're keeping that in mind when we're, you know, maybe we're not going to say like, well, there's always abortion or something, right? 00:54:10.880 --> 00:54:19.360 So, so really being culturally responsive and thinking along with the community of what does that intervention look like, what's going to be effective. 00:54:19.519 --> 00:54:27.440 And we found a lot of success with it, where parents were able to better navigate those conversations with their kids about sexual health. 00:54:27.760 --> 00:54:32.719 And it saw a decrease in unwanted teenage pregnancies. 00:54:33.360 --> 00:54:35.920 And also sexually transmitted infections. 00:54:36.000 --> 00:54:50.320 And so there were outcomes there that really backed up that involving the community, making sure that it's culturally tailored and reflects their beliefs, and it's something that they would actually feel comfortable talking to their kids about, for example. 00:54:50.559 --> 00:54:58.800 So did you find that there were similar taboos about discussing sexual health or any sort of like shame or embarrassment? 00:54:59.440 --> 00:55:00.239 Absolutely, yes. 00:55:00.559 --> 00:55:10.239 And I think that really speaks to the title of the intervention parenting in two worlds, because they really are parenting these two worlds, right? 00:55:10.320 --> 00:55:25.280 Where there's the traditions that they have as Native American people that are really important and that they live in this contemporary society that has all these pressures for young people to that couldn't make them end up pregnant. 00:55:26.880 --> 00:55:35.920 So it's a lot of tensions to navigate, and I think it's just as uncomfortable for most people to talk about sex with their parents, but it's really important. 00:55:36.239 --> 00:55:41.920 And finding a way of doing it that's culturally responsive definitely shows positive results. 00:55:42.239 --> 00:55:48.559 That's amazing that you were able to successfully implement that because I feel like that's such a complicated thing to help people navigate. 00:55:48.719 --> 00:55:48.880 Yeah. 00:55:49.039 --> 00:55:49.840 So kudos to you. 00:55:50.079 --> 00:55:50.320 Thank you. 00:55:50.400 --> 00:55:50.559 Yeah. 00:55:50.639 --> 00:55:57.519 And I a lot of it is a lot of it's thanks to the community for being a part of it and helping guide it. 00:55:57.599 --> 00:56:05.519 And I think researchers serve as an important catalyst for changing different dynamics in communities. 00:56:05.840 --> 00:56:08.159 And that can be positive or negative. 00:56:08.639 --> 00:56:21.360 So as long as you're again going back to nothing about us without us, that really is the way to go to make sure that you're doing right by the community and implementing something that's really going to make a positive impact. 00:56:21.679 --> 00:56:21.920 Yeah. 00:56:22.079 --> 00:56:23.199 Representation, right? 00:56:23.440 --> 00:56:23.760 It does. 00:56:23.920 --> 00:56:24.400 It matters. 00:56:24.960 --> 00:56:25.840 Transparency. 00:56:26.079 --> 00:56:27.280 Yes, absolutely. 00:56:27.519 --> 00:56:49.599 And I think that's a a lot of what could be done differently in research, whether it's in the context of healthcare or biomedical research, is that transparency, operating within integrity, these are really important things that will go a long way, especially if we're trying to address disparities in communities who have been excluded from these conversations. 00:56:49.840 --> 00:56:53.599 We have to be open about it, let them into the process. 00:56:53.840 --> 00:56:58.400 And people don't need to be a researcher to know what their experiences are, right? 00:56:58.800 --> 00:56:59.039 Exactly. 00:56:59.199 --> 00:57:02.719 Yeah, people are the best authorities on their experiences out there. 00:57:02.960 --> 00:57:07.599 So we're just the people who come in and quantify it or qualify it with data. 00:57:07.840 --> 00:57:14.079 And then hopefully that data translates into something that can be designed as an intervention. 00:57:14.400 --> 00:57:20.800 That is really cool that you shared that because it makes me feel like it's possible to change those relationships. 00:57:21.039 --> 00:57:21.360 Yeah. 00:57:21.599 --> 00:57:21.840 Right. 00:57:22.000 --> 00:57:27.119 Like there are ways to address these systemic issues that we're seeing. 00:57:27.360 --> 00:57:27.599 Right. 00:57:27.760 --> 00:57:27.920 Right. 00:57:28.000 --> 00:57:28.960 And that gives me a lot of hope. 00:57:29.039 --> 00:57:29.760 So I know. 00:57:31.199 --> 00:57:31.519 Yes. 00:57:31.679 --> 00:57:33.760 I think that we need some good news. 00:57:33.840 --> 00:57:43.360 You know, there's a lot of things happening every single day, some of which are alarming and hard to grasp how society has been shaped in such a way. 00:57:43.599 --> 00:57:47.440 But I think we have a

wonderful tool to change it, and that's each other. 00:57:47.519 --> 00:57:56.400 You know, if we rely on each other, create cohesion in our communities, and really work on those issues that are ones we can all agree on. 00:57:56.639 --> 00:58:02.079 If most people in Arizona believe that healthcare is something that everybody should have, that's what we should focus on, right? 00:58:02.400 --> 00:58:05.920 Rather than these kind of fringe sort of issues. 00:58:06.559 --> 00:58:07.199 Yeah, exactly. 00:58:07.360 --> 00:58:07.599 Right. 00:58:07.760 --> 00:58:18.400 And so it's like through changing these other outcomes around healthcare, education, our environment, our really justice system, right? 00:58:18.480 --> 00:58:19.360 The list goes on. 00:58:19.440 --> 00:58:22.719 Like I think there's a lot of commonality we could come together on. 00:58:22.960 --> 00:58:31.599 And if we focus on those things, a lot of these sort of divisive issues, people will probably be like, oh, I guess that actually isn't such a big deal after all, you know. 00:58:32.400 --> 00:58:33.119 Let's calm down. 00:58:33.360 --> 00:58:34.239 Yeah, exactly. 00:58:34.400 --> 00:58:38.000 Like, like focus on the big stuff, you know, and and healthcare is such a big thing. 00:58:38.079 --> 00:58:43.440 It's been a debate for as long as I've been alive in the United States, you know, like the United States has been ongoing. 00:58:43.679 --> 00:58:50.400 And since the Affordable Care Act, there really hasn't been a whole lot of meaningful healthcare legislation that's come forward. 00:58:50.639 --> 00:59:01.280 And in many ways, I feel like we've had the opposite happening where there's all these advances that have been rolled back with, you know, the decision over Roe versus Wade. 00:59:01.679 --> 00:59:05.599 You know, there's trans health being debated at the Supreme Court. 00:59:05.679 --> 00:59:08.159 I mean, these things are huge, right? 00:59:08.320 --> 00:59:11.920 That we're not seeing any movement though in the legislature, at least. 00:59:12.079 --> 00:59:17.519 In the judicial system, it moves a lot, it seems like, but in the legislative system, not as much. 00:59:22.239 --> 00:59:28.079 On a personal level, I sometimes struggle to find ways to get out there and advocate. 00:59:28.159 --> 00:59:32.960 Because you know, a lot of the times I feel like we're put in this position of learned helplessness. 00:59:33.119 --> 00:59:33.280 Right. 00:59:33.440 --> 00:59:33.920 You know what I mean? 00:59:34.000 --> 00:59:37.119 Where we're just like, oh my God, there's so much going on that it's so overwhelming. 00:59:37.199 --> 00:59:44.480 Like you're constantly bombarded by information, but there are practical ways to get out there and create community, right? 00:59:44.559 --> 00:59:45.599 And seek those connections. 00:59:45.760 --> 00:59:52.320 So do you have just for anybody listening, like any practical steps that you've taken besides being on a podcast, you know? 00:59:54.079 --> 00:59:57.440 Some of the most important things are recognizing that you can't do it all. 00:59:57.599 --> 01:00:04.159 And so focus on where your strengths are, focus on what you really can do well to make a difference. 01:00:04.320 --> 01:00:07.519 And so for me, I found this voice in research. 01:00:07.599 --> 01:00:11.280 And I was like, okay, I think there's something here that I can work with. 01:00:11.679 --> 01:00:18.559 And that has then informed other parts of my life to create community, create cohesion. 01:00:18.639 --> 01:00:24.559 And so I think that A, finding what you're really good at and running with it is a really good first step. 01:00:24.719 --> 01:00:28.880 And then I think having conversations with people in your community is really important. 01:00:29.039 --> 01:00:37.679 Get to know your neighbors, get to know your colleagues, get to know people that you see on a daily basis and build those connections with them. 01:00:38.000 --> 01:00:38.880 That are not AI. 01:00:39.039 --> 01:00:39.440 Exactly. 01:00:39.519 --> 01:00:40.960 Yes, that are not AI. 01:00:41.920 --> 01:00:42.960 Get to know real people. 01:00:44.239 --> 01:00:44.880 Yes, exactly. 01:00:45.119 --> 01:00:46.400 Touch grass, get out there. 01:00:46.480 --> 01:00:51.519 And like, you know, something that we talked about was this isolationism. 01:00:51.599 --> 01:00:55.119 And when we talk about health too, there's another epidemic going on right now. 01:00:55.199 --> 01:00:57.119 It's a loneliness epidemic. 01:00:57.360 --> 01:01:04.000 And it's just such a sad thing to think about that people are experiencing loneliness when there's so many people on the planet. 01:01:04.239 --> 01:01:12.239 And so make connections, meet people, do things that will make it so you meet people you wouldn't meet otherwise. 01:01:12.559 --> 01:01:16.000 We are losing our third spaces in society. 01:01:16.159 --> 01:01:21.519 There's less places that we can go and make connections, but the ones that we do have, go there. 01:01:21.760 --> 01:01:22.480 Go to there. 01:01:22.639 --> 01:01:24.480 Find find where that is. 01:01:24.880 --> 01:01:25.440 Yes. 01:01:25.679 --> 01:01:31.440 There's wonderful programs that happen at our public libraries that I think are underutilized. 01:01:31.599 --> 01:01:35.119 There's places you can meet people at coffee shops and at bars, even. 01:01:35.199 --> 01:01:39.440 I think that there's ways of building connections really wherever you are. 01:01:39.599 --> 01:01:41.920 And so find places that you like being. 01:01:42.159 --> 01:01:46.880 And I think you'll naturally meet people there that think like you do. 01:01:47.199 --> 01:01:48.559 And if you do that, you know what? 01:01:48.639 --> 01:01:50.880 That is literally revolutionary behavior. 01:01:51.199 --> 01:01:51.599 Exactly. 01:01:51.679 --> 01:01:51.840 Right. 01:01:52.639 --> 01:01:57.920 Systems of power benefit from us being alone and keeping ourselves isolated.

01:01:58.159 --> 01:02:00.400 So I guess we're just revolutionaries. 01:02:00.719 --> 01:02:01.039 That's right. 01:02:01.119 --> 01:02:01.440 We are. 01:02:01.519 --> 01:02:02.639 Yeah, exactly. 01:02:02.960 --> 01:02:06.480 It really is revolutionary to be connected, right? 01:02:06.639 --> 01:02:11.280 And to find community because when we come together, we're very powerful. 01:02:11.440 --> 01:02:11.679 Yeah. 01:02:11.840 --> 01:02:13.679 We're very, very powerful when we come together. 01:02:13.840 --> 01:02:17.519 I mean, there's millions of people that think this way too. 01:02:17.679 --> 01:02:21.360 And so I think it's finding those people, building those connections. 01:02:21.440 --> 01:02:23.360 And I'm interested to see where it goes. 01:02:23.599 --> 01:02:27.920 And I think that we are in the midst of a cultural revolution. 01:02:28.000 --> 01:02:29.440 I think things are changing. 01:02:29.840 --> 01:02:38.480 I think that the last five years, like just using COVID as kind of like a starting point for all these catalytic events that have happened in society. 01:02:38.639 --> 01:02:44.400 We saw the COVID-19 pandemic, we saw the Black Lives Matter movement that same year, right? 01:02:44.559 --> 01:02:44.800 Yeah. 01:02:45.039 --> 01:02:54.400 And since then, especially with the current administration, there's all these other counter movements, and these are things that really inspire a lot of change in society. 01:02:54.719 --> 01:02:57.760 So I think that it's happening right before our very eyes. 01:02:57.840 --> 01:02:59.519 And these things take time, you know? 01:02:59.599 --> 01:03:05.280 It's like there's not been any sort of cultural revolution that's occurred overnight. 01:03:05.519 --> 01:03:10.400 And so throughout history, we've seen it change many, many times. 01:03:10.639 --> 01:03:12.639 And I think we're all a part of that change. 01:03:12.880 --> 01:03:13.199 Yeah. 01:03:13.440 --> 01:03:17.519 And that always is so inspiring because I feel like we're just so resilient. 01:03:17.679 --> 01:03:18.079 Yes. 01:03:18.239 --> 01:03:21.119 You know, and it's like sometimes it doesn't feel that way, obviously. 01:03:21.280 --> 01:03:25.679 But I feel like just from how far society has come, we truly are resilient. 01:03:25.760 --> 01:03:30.320 Like we found these ways to be resilient in the face of unimaginable horrors. 01:03:30.559 --> 01:03:31.280 Absolutely. 01:03:31.519 --> 01:03:33.360 Which is so so good. 01:03:33.679 --> 01:03:34.639 Yeah, I agree. 01:03:34.800 --> 01:03:35.119 Yes. 01:03:35.280 --> 01:03:54.800 And I think I'm glad you brought up resiliency because that's such a protective factor for queer people, both rural and urban, to have the ability, despite the circumstances, despite the structural barriers that exist, people are still able to find health and wellness. 01:03:54.880 --> 01:03:57.840 They're still able to get by in society. 01:03:58.000 --> 01:04:03.920 So how do we make sure that everybody doesn't need to rely on resiliency in order to get by? 01:04:04.079 --> 01:04:11.599 And so I think that addressing these structural factors will really transform people's lives in a positive way. 01:04:11.679 --> 01:04:17.760 And it makes me feel very optimistic knowing that there's there's changes coming and there's changes happening right now. 01:04:18.000 --> 01:04:26.079 It's like we can hold the two truths that yes, things are dark right now, but there truly are real reasons to be optimistic. 01:04:26.159 --> 01:04:26.400 Yeah. 01:04:26.719 --> 01:04:28.639 And actually have some things to look forward to. 01:04:28.800 --> 01:04:31.760 And it's I feel like so important to find those things, you know. 01:04:32.079 --> 01:04:32.639 Yeah. 01:04:32.960 --> 01:04:39.760 You said something and made me think about how these systems rely on us not doing anything. 01:04:40.000 --> 01:04:40.320 Exactly. 01:04:40.719 --> 01:04:41.679 Not making community. 01:04:41.760 --> 01:04:50.719 And if we're isolated and we're not with people, then we're not talking about these things and we're not like I look, we're on a podcast right now talking about these very topics. 01:04:50.800 --> 01:04:58.800 And I think that's really important to spread that message and let people know that what their experiences is what other people are experiencing as well. 01:04:59.280 --> 01:05:02.480 And being able to relate and be like, hey, like I'm also going through that. 01:05:02.559 --> 01:05:07.679 And you know, I feel like part of fear is also the freeze response, which is what causes inaction. 01:05:07.840 --> 01:05:16.719 So I don't want us, like by saying this, for anyone to feel bad or guilty of being in a freeze response where you feel like you literally can't do anything, like you can't move. 01:05:16.880 --> 01:05:19.519 And like, you know, there's resources out there for that. 01:05:19.760 --> 01:05:23.760 And I'm gonna link these in the description below. 01:05:24.079 --> 01:05:30.159 So if anyone needs mental health resources or healthcare resources, definitely check those out. 01:05:30.400 --> 01:05:35.280 I also want to thank the sponsor of this episode, Vitalist Health Foundation. 01:05:35.440 --> 01:05:39.599 They made all of this possible with their very generous contribution. 01:05:39.920 --> 01:05:43.199 And finally, Kyle, thank you so much for being here. 01:05:43.360 --> 01:05:48.559 We really appreciate having you on the Lavender Lounge and just bringing such a wealth of knowledge and expertise. 01:05:48.880 --> 01:05:51.599 And it really made a beautiful episode. 01:05:51.679 --> 01:05:52.159 So thank you. 01:05:52.480 --> 01:05:53.360 Well, thank you for having me. 01:05:53.519 --> 01:05:54.559 This has been a great experience. 01:05:54.639 --> 01:05:58.239 It's good to be here and always happy to be a part of these conversations. 01:05:58.480 --> 01:05:58.719 Yeah. 01:05:58.800 --> 01:06:01.679 If you want to read Kyle's work directly. 01:06:01.840 --> 01:06:05.280 I will link the articles to his work below as well. 01:06:05.440 --> 01:06:07.119 So definitely go check those out. 01:06:07.280 --> 01:06:08.559 And thank you.