Community Context

Located in the northeast corner of Idaho in the Upper Snake River Valley in Madison County, Rexburg is known to residents as “America’s family community.” 

The city’s population—which is predominantly White and almost exclusively comprised of members of the Church of Jesus Christ of Latter-Day Saints (LDS or Mormon Church)—increased by over 55 percent between 2010 and 2020. BYU–Idaho is Rexburg’s top employer and the university make up a large percentage of the local population. 

Rexburg, much like most of Idaho, is politically, socially, and fiscally conservative: Republicans have historically led at state, county, and local levels. A primary demographic group are young families with low incomes. 

Rexburg residents often seek out opportunities to be physically active, especially outdoors during the summer months and at indoor recreational facilities during the community’s long winter. But Rexburg is not immune to social, economic, and health issues. While Medicaid was expanded in Idaho via ballot initiative in 2020, residents still report issues with access to care due to a lack of sufficient healthcare providers to meet the needs of the growing population. 

Concerns with mental and behavioral health have consistently topped the list of local health issues. This is driven by the needs of the local student population and concerns that the widespread influence of the LDS Church may lead to anxiety and depression for those who feel like they do not fit in with its teachings. 

COVID-19 also led to an increase in mental health needs in the community. In terms of the direct impact of COVID-19, Madison County had some of the highest cases per capita of any county in Idaho, and was once a national COVID-19 hotspot, though hospitalization and death rates were relatively low due to the county’s young population.

Community Actions

Rexburg’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, Rexburg’s capacity to address health and well-being has been driven by the regional public health department and county hospital, which expanded its capacity for mental health services over the past five years.

Nonprofits, educational institutions, and city departments also support efforts to promote well-being. The LDS Church is highly influential over the local culture, including health practices. While organizations often partner with one another, there are no formal and sustained cross-sector collaborations focused on health in the community.

The LDS Church has played a key role in guiding the local health narrative, placing value on self-reliance, making healthy choices, and increasingly joining other community leaders in discussing the role of mental health in overall well-being.

Issues of equity are mostly discussed as volunteer support for people who need it, while simultaneously opposing policy efforts or government investments intended to address the root causes of those needs. There is growing recognition of diversity—especially with respect to LGBTQ+ populations—in the community once thought to be very homogenous.

Lessons Learned: Where is Rexburg Five Years Later?

While Rexburg is unique as a deeply religious college town, it also reflects a dynamic present in many American communities. Over the last five years, the community’s large student population continued to present with needs for economic and social support. Mental health challenges received increasing attention from diverse stakeholders, while community members remained largely opposed to government intervention. Despite these beliefs, community capacity to address health challenges increased—led by the local hospital and a long-standing school-based program. Interest in additional recreational opportunities and economic development also grew, supported by new infrastructure and planning efforts. 

The community is heavily reliant on committed residents and grassroots efforts to help to fill gaps in the safety net; and the community will likely continue to be challenged by a prevailing mindset that individuals are responsible for their own health. Small-scale discussions of health equity have not permeated the local narrative, but generational shifts and a national focus on these topics are expected to have some impact. Rexburg’s journey may be informative to other communities who have been challenged by limited public funding and a resistance to government intervention in health.

Rexburg benefits from religious values related to living a healthy life and contributing to the community, and community level efforts have been supported with external funding. Younger generations are beginning to push on issues related to mental health and equity. However, factors within the homogenous and self-reliant community also hinder efforts to promote health. Leadership for health has limited capacity; community members resist government intervention and support; and collaborations are rarely sustained.

Facilitators:

  • Shared values of health and social support within the LDS community

  • Extensive coordination between major institutions

  • External funding used to catalyze activity around health using a bottom-up approach

  • Strong focus on younger generations

Barriers:

  • Services provided by regional health district remain relatively basic 

  • Lack of sustained collaboration for health 

  • Largely homogenous community masks needs of underrepresented groups

  • Members of the community resistant or skeptical of government intervention