Sprague River in Chiloquin, Oregon which has a large population of Native Americans from the Klamath Tribe.
Sprague River in Chiloquin, Oregon which has a large population of Native Americans from the Klamath Tribe.

2018 RWJF Culture of Health Prize Winner

Hardworking Rural Community Taps a Deep Well of Hope

Klamath County, Oregon, dodged the worst of summer 2018’s West Coast forest fires. Even so, smoke from as far away as Redding, California, choked the skies here for several weeks in July and August.

The stubborn haze shut down outdoor activities like swimming, kept the elderly, young and asthmatic indoors, and shrouded from view the majestic mountains that give this place a rare splendor.

That hidden natural beauty serves as an apt metaphor for a place locals say is underappreciated, or at least misunderstood. Residents in this region of about 66,000 people—spread across 6,135 square miles, an area larger than the state of Connecticut—want outsiders to truly get to know them, seeing their grit, strong sense of interdependence, deep wellspring of hope, and successful efforts to improve their community.

Klamath County, Oregon

Partners come together to improve high school graduation rates, build a strong cadre of local, skilled workers, and attract new businesses.

“Klamath County was struggling, but we thought we could create something better,” says Patty Case, associate professor of family and community health at Oregon State University’s Klamath Basin Research and Extension Center in Klamath Falls, the county seat.

In the county as a whole, there have been decades of economic stagnation, precipitated by the decline since the 1970s of the area’s once-booming timber industry and worsened by the Great Recession. For the area’s Klamath Tribes, in particular, there is a long history of loss of land and rights. Steep barriers to health across the county have included inadequate transportation, high rates of substance abuse, uneven access to nutritious food, lack of law enforcement presence, low graduation rates, and limited access to health care.

In 2012, leaders in health and social services here took action, forming the Healthy Klamath coalition with the mission of creating a healthier community. Since then, the county has made progress on key outcomes, boosting graduation rates, revitalizing parts of their urban center, and reducing crime. Now, Klamath County is working to increase access to fresh produce, address transportation needs, and check teen tobacco use. The efforts have expanded as Klamath has taken steps toward creating more and better jobs and cultivating a stronger network of interconnected social, behavioral, and health care services.

Two women meeting. Valerie Franklin of Sky Lakes Medical Center and Patty Case of Oregon State University are involved in the Living Well Coalition, which aims to help people manage their chronic health conditions.

Klamath County was struggling, but we thought we could create something better.

—Patty Case,  associate professor, Oregon State University’s Klamath Basin Research and Extension Center

The area’s wealth of higher education institutions provides a critical asset for health in the county. Professors and students at Oregon Institute of Technology are using geographic information system (GIS) technology mapping to bolster new health policies and initiatives. Oregon Health & Science University is expanding its presence to introduce all sorts of health professionals, through training, to the nuances of rural life and rural health care. And OSU’s Research and Extension Center is a partner in many wellness efforts.

Winning the Culture of Health Prize is a clear signal to keep going, says County Commissioner Derrick DeGroot. “It encourages a small community like ours to keep our foot on the gas.”

A girl performing with a dance group.

Helping Every Neighbor Has Become the Mantra

When the Klamath, Modoc, and Yahooskin people—collectively known as the Klamath Tribes—lost their federally recognized sovereignty in 1954, they also lost land, culture, and a sense of identity.

Although the Tribes regained their sovereignty in 1986, the traumatic experience of having their rights swiftly terminated has had long-lasting effects on the physical and mental health of the people who went through it. That trauma extends to tribal members’ children and grandchildren.

Monica YellowOwl believes reviving the culture and telling the stories of her people is key to addressing generations of trauma. It’s also key, she says, to making Klamath County more equitable for all people.

YellowOwl, the prevention supervisor for Klamath Tribal Health and Family Services’ Youth and Family Guidance Center, has for the past four years led the staging of “Restoration of the Spirit,” an annual event to foster resilience and positive mental health through connection to each other and the past among the Tribes’ members. She has also shared how the Tribes’ history is related to current social and behavioral health, as a way of fostering awareness and empathy with external stakeholders, via training and presentations across county agencies—from the Department of Human Services to Klamath County corrections to the county’s two school districts, among other institutions.

“They reach out to say, ‘We serve a lot of your population,’” she says. “‘We don’t want to continue to be in the dark about their history.’”

YellowOwl and others in Klamath County are working to overcome the past by actively trying to build empathy between neighbors. And they’re working to overturn biases in individual attitudes and interactions as well as in broader systems and policies that have affected the Klamath Tribes and other historically marginalized populations. These include the county’s growing Hispanic population, LGBTQ people, and those living in poverty.

The county began organizing for greater equity when in 2014, Klamath County Public Health launched the Klamath Regional Health Equity Coalition with more than two dozen partners, funded by a three-year grant from Oregon Health Authority. The work toward equity has steadily progressed by heeding the insights of people from the county’s marginalized groups on the coalition’s advisory board and through additional focus groups. The county has homed in on issues of poverty, lack of opportunity, and isolation in smaller towns with majority American Indian or Hispanic populations, such as Chiloquin, Merrill, Malin, and Bonanza.

An woman and her dog standing in her fenced yard. Elodia Chavolla, 76, lives in Klamath Falls' Mills Addition neighborhood, where revitalization efforts are in progress.


A large group gathering for an outdoor community event. Members of the Klamath Tribes participate in the 32nd Annual Restoration Celebration in Chiloquin to commemorate the return of their sovereignty in 1986.

We don’t want to continue to be in the dark about their history.

—Monica YellowOwl,  prevention supervisor, Klamath Tribal Health & Family Services

Children playing on a park's wooden playground equipment. Children play at Kit Carson Park in Klamath Falls during Park and Play, a YMCA of Klamath Falls summer program that provides lunch and activities daily at parks around the city.

A social exclusion simulation in 2016—the first in the nation to focus on tribal populations—walked participants through the indignities tribal members face daily. And in a complement to YellowOwl’s work, Klamath County Public Health’s regional health equity coordinator, Valeree Lane, has over the past two years trained dozens of community members on offering safe and inclusive spaces for LGBTQ people and countering implicit bias—the unconscious way people view others through the lens of stereotype.

Marilyn Gran-Moravec, a registered nurse and clinical assistant professor at Oregon Health & Science University in Klamath Falls, has had Lane speak to her nursing students to help them find their biases. I’ve seen people saying, ‘Aha, I’ve never thought of that before.’ There’s more of an awareness” and craving, Gran-Moravec says, to learn more.  

In addition to countering long-held stereotypes and fostering inclusivity, the county is addressing persistent gaps in health outcomes for marginalized groups. Among the initiatives:

  • Klamath County Public Health is collaborating with Jackson County Public Health to create a plan for sexually transmitted infections (STI) awareness and testing in the region. One goal is to address disproportionately high STI rates among American Indian people and men who have sex with men.
  • Bilingual community health workers from Sky Lakes Medical Center are reducing the barriers to health faced by Klamath County’s growing Hispanic community by helping Spanish speakers navigate health and social services.

The county also hopes to get a jump on the factors that lead to health inequities in the first place. For example, knowing that researchers have linked living in blighted neighborhoods to a range of poor health outcomes, Klamath Falls’ city government has made improving the low-income neighborhood of Mills Addition a top priority. Each city department—public works, parks, and the police—plays a role. With nonprofit partners, they’ve reduced crime, removed abandoned vehicles and trash, and spruced up parks. And tighter vacant property codes passed by the city two years ago have helped cut down the number of boarded-up houses and unkempt lots in the neighborhood.

All these efforts contribute to an inclusive vision of a better, healthier Klamath County.

“We’re surrounded by natural beauty...and we’re still small enough that we know our neighbors,” Lane says. “Now we’re converting knowing our neighbors into seeing the beauty of our neighbors.”

A woman working her farm.

Harnessing Natural Bounty for Healthy Living

John Bellon believes parks can be a salvation. Growing up the child of a single mother in Klamath Falls, Oregon, he would head to nearby Mills-Kiwanis Park after school.

Instead of getting into trouble with his elementary school peers, Bellon got into baseball, jai alai, and kite flying. Today, he is the longtime parks manager and urban forester in Klamath Falls.

Whether pocket parks or mountain trails, family farms or vast national forests, the outdoors is a big deal in rural Klamath County. And while the county’s once-booming lumber economy may be long gone, its open-air bounty remains an important driver of health, well-being, and the economy.

“We’re really fortunate to have all these natural resources,” says Jim Chadderdon, director of Discover Klamath, the county’s tourism agency.

Though Klamath County is 6,135 square miles, the much smaller area in and around Klamath Falls is home to about two-thirds of its population of 66,000. Many others work in the city. To encourage active transportation like walking and biking in the Klamath Falls area, in 2016 the City Council approved an urban trail master plan created by the county and Oregon Department of Transportation.

“We have a lot of great trails,” Bellon says. “What we’re really lacking is the connectivity.”  That’s changing.

Kayaks in the Distance Ewauna Lake in Klamath Falls.

A protected bike lane leading downtown from one of the city’s biggest parks opened in June. In the works along Lake Ewauna is a multi-use path, geothermally heated to stay snowless in a place with long winters and about three feet of snow a year. Geothermal energy also warms downtown buildings and brings the municipal pool, where the swim team practices year-round, to a cozy 78 degrees Fahrenheit.

“It’s a renewable resource, so the carbon footprint is minimal,” says Klamath Falls City Engineer Scott Souders.

A new parks master plan for the Klamath Falls urban area will be released in January, Bellon says. It will build on the momentum of the past few years, aided in part by community organizers and local health providers Sky Lakes Medical Center and Cascade Health Alliance. They’ve helped fund several parks and playground projects, including a commons under construction downtown and a new playground at Bellon’s old stomping ground, Mills-Kiwanis, in one of the poorest neighborhoods in Oregon.

Throughout the county lie national wildlife refuges, volcanic peaks, Crater Lake National Park and other magnets to outdoor enthusiasts. Over the past decade, direct economic impact from tourism has grown from $135 million in 2009 to $154 million in 2017, and Chadderdon believes that annual number will soon hit $200 million.

“We’re bringing in people and they’re spending money,” Chadderdon says. Those dollars support jobs, wages and growth.

Another outdoor industry remains vitally important here. Farming and ranching bring in about $300 million a year. But most of the food grown in Klamath County goes elsewhere.

“I describe it as the people here don’t enjoy the fruits of their land,” says Katie Swanson, owner of Sweet Union Farm.

The past two years, Swanson and Blue Zones Project Klamath Falls, a health-promotion organization, have staged “Find Your Farmer” events. They link the county’s schools, restaurants, and grocery stores with local producers, like Flying T Salers ranch, which now provides beef to three county high school cafeterias.

Swanson also runs a website where farmers sell directly to consumers. She hopes efforts to develop a countywide food policy strategy will put more fresh, local food on residents’ plates.

When that happens, they’ll likely cook it outdoors because as Niki Sampson, executive director of Klamath-Lake Counties Food Bank, says: “In Klamath County ... if there’s six inches of snow outside, you barbecue.”

Nature Trail sign. The Sutherland Trail in Klamath Falls is named after Marilyn Sutherland, former Klamath County public health director.
2017 Culture of Health Prize Winner
A sunflower blooming on a farm.

Garrett County, Md.

In Garrett County, Maryland, everyone seems to know everyone, and neighbors band together to bridge economic, cultural and health divides.

We’re really fortunate to have all these natural resources.

—Jim Chadderdon, director, Discover Klamath

A woman standing in front of a town civic center.

Remote County Covers the Health Landscape

The town of Merrill is a stone’s throw from the California border and best known for the annual Klamath Basin Potato Festival.

Health care resources are sparse, and the one medical practice serving the town’s 830 people—as well as about 1,200 more in the even farther out towns of Malin and Bonanza—is a walk-in clinic operated by a family nurse practitioner. Driving to Sky Lakes Medical Center, Klamath County’s only hospital, takes 30 minutes or more for residents in this part of the county, and even longer if snow or ice is on the ground.

Rhonda Neighorn, a community development coordinator for Oregon Department of Human Services,  lives down the road in Malin and is active in Merrill’s Lion’s Club, which raises money for college scholarships as well as vision and hearing screenings for local children.

“We used to have a drugstore,” she says. Then the store changed hands; it’s a popular quilt shop now.

Meeting the health care needs of everyone in Klamath County while also creating the underlying conditions for health takes creativity and multipronged tactics. The challenge is formidable: How do you promote health across vast rural areas, with tiny towns like Merrill, but also a concentrated population center in Klamath Falls, the county seat? The county’s answer: consolidate some health and social services in Klamath Falls, while ensuring that efforts to improve education and employment—two critical building blocks of health—reach people across a spread out region.

A woman in an art store. Joy McInnis, executive director of Klamath Works, which helps people in need return to self-sufficiency by preparing them for work.
A man tending to a community garden. John Bellon, Klamath Falls' parks manager and urban forester, weeds at Sugarman's Corner, a park he designed in the city.
A building under construction. The construction of Holiday Market, an employee-owned grocery store in downtown Klamath Falls. The store opened in September in what had been a food desert for several years.
A man supervising a street paving project. Scott Souders, Klamath Falls' city engineer, works on a street paving project.

Even in Klamath Falls, where about two-thirds of the county’s 66,000 residents live, services have been scattered. Several new collaborative locations will help people more easily get the help they need to build healthier lives.

Sky Lakes Collaborative Health Center, slated to open in 2020, will house all of Sky Lakes Medical Center’s primary care physicians, currently spread across Klamath Falls in small practices. The physicians, behaviorists, dieticians, and physical therapists—working under one roof—will be encouraged to team up for more coordinated patient care. The health center will also be home to Oregon Health & Science University’s Campus for Rural Health, which will bring nursing, dentistry, pharmacy, and physician assistant students to the area for six- to 40-week rotations.

Over on South Sixth Street, the Klamath Works job-training program and the medical center’s community health program share space in what was once an auto dealership. The 18-acre parcel next door is being turned into a human services campus. It will include shelter for people experiencing homelessness; poverty prevention, behavioral health programs, and human services programs; and a new “sobering station” that will help people struggling with substance abuse.

The combination of services will give some of the county’s most vulnerable residents the tools and resources they need to succeed in the workforce, says Joy McInnis, executive director of Klamath Works, because employment can provide the benefits and stability that make a healthy life possible.

A boy hula hoops during a block party.

RWJF Culture of Health Prize

The Prize honors and elevates U.S. communities working at the forefront of advancing health, opportunity, and equity for all.

“There’s a whole lot more to having a job than having the money,” she says. “It enables people to support their families. It gives them self-esteem.”

Providing job training and transitional housing is part of Klamath County’s focus on upstream factors as a way of “hacking at the roots” of poor health, says Paul Stewart, president and CEO of Sky Lakes Medical Center.

To that end, the county has also focused on boosting high school graduation rates through Klamath Promise, a partnership among nonprofits, businesses, and the county’s two school districts. The partners are starting early, working to reduce chronic absenteeism in elementary school and middle school and improve third-grade reading rates.

This work is being prioritized because of the understanding that academic success and future healthier outcomes go hand in hand.

At the high school level, the school year begins with a motivational speaker who encourages seniors to stay in school. The speech launches a year-long effort to track their progress toward goals that might include filling out a FAFSA (Free Application For Federal Student Aid), meeting with a military recruiter, or applying for a job.

The year ends with a graduation parade through Klamath Falls. In 2018, the community raised $35,000 for 54 college scholarships that were given out by lottery after the parade.

The countywide promotion of student success is making a difference in Merrill and Malin, where all 22 students in 2018’s senior class at Lost River Jr./Sr. High School will pursue post-secondary education. They signed their acceptance letters at a public event cheered on by their families, neighbors, teachers, and peers.

“What we’ve been working on is altering the fabric of health in our community,” Stewart says. “Most of what we need for health is outside of the health care system.”

Welcome to Chiloquin mural. A mural in Chiloquin, where many residents are members of the Klamath Tribes.

There’s a whole lot more to having a job than having the money

Joy McInnis, executive director, Klamath Works