Tough Questions

What does it take to solve societal problems that have no easy answers?

> From health care to homelessness, from climate change to political polarization, we asked alumni with expertise and leadership experience in a range of areas to walk us through potential solutions for pressing challenges we face today. > These are problems that resist silver bullets and often demand uncomfortable trade-offs. They’re also urgent: They affect millions of people right now. > Driven by personal experience, professional expertise, and a stubborn refusal to accept the status quo, these Lewis & Clark alumni share the ways we can meaningfully address some of the country’s—and the world’s—biggest challenges.

 

  [ 1.]

Why is rural health care in crisis, and
how can we begin to turn it around?

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In many ways, the numbers alone tell the story: Some 20 percent of the U.S. population lives in rural areas, but just 11 percent of physicians practice in them.

What makes that yawning gap even more troubling is that rural areas are exactly where physicians are needed most. On the whole, rural residents are both older and sicker than their urban counterparts. “Health care, in general, is limping along at best,” says Lisa Dodson BA ’81, founding dean emerita of the Medical College of Wisconsin–Central Wisconsin. “And rural health has always fared worse.”

Dodson herself has had a front-row seat to these challenges. As a young doctor, she spent seven years practicing in the tiny town of John Day in Eastern Oregon.

While she loved the wide scope of her responsibilities—her charge was to care for patients from cradle to grave, many of whom she saw in her day-to-day life—the role had its downsides, including long hours and few true days off. “I conducted a lot of medical care in the grocery aisles,” she says wryly.

The reality is that the challenges facing rural health care are as varied as rural America itself. A farming community 20 minutes from a regional hospital faces a different challenge than an isolated mountain town three hours from the nearest emergency room. Many rural hospitals, a large share of which were built in the 1940s and ’50s under the Hill-Burton Act, are now crumbling or closing outright; 136 were shuttered between 2010 and 2021. Medicare reimbursement rates, adjusted for inflation, have fallen nearly 30 percent since 2001, squeezing the already-thin margins of rural practices.

But amid these structural headwinds, Dodson sees at least one structural solution: place-based education. The idea is straightforward—recruit students from rural communities and train them in or near those communities, since research consistently shows that physicians are more likely to practice where they train. Then, make the medical school path faster and less expensive.

In 2014, after working for years as an associate professor of family medicine at Oregon Health & Science University in Portland, Dodson landed the role of founding dean of the Medical College of Wisconsin–Central Wisconsin, where she could put her experience and ideas to use to train a generation of students eager to fill those gaps and make a difference as physicians in the places they called home.

The approach she developed for the school, adapted from common wartime practices and honed with the help of a growing number of rural physician training tracks at institutions nationwide, focuses on three main prongs.

The idea is straightforward—recruit students from  rural communities and train them in or near those communities.

The first is to attract students who are already from rural areas. “Many students are placebound—they’re helping out with the family farm or they’re caring for Grandma,” she says. Some simply have an affinity for activities, like hunting and fishing, that are easiest to do in rural areas. “They know how to engage in their community, and they’re willing to work hard.”

The second is to help students build strong community ties in rural areas from the beginning. “From day one, we want students to meet people in the community and solve problems in the community,” she says. “We wanted to move away from the idea that problems are solved by experts in cities.”

And the third is to methodically build a curriculum that allows the vast majority of students to graduate in three years instead of four—with a corresponding decrease in tuition costs. Those lower costs can make the idea of medical school seem far more possible for more students while allowing them to begin their residencies and practice an entire year earlier.

The approach has worked in central Wisconsin: The program graduated 113 students between 2019 and 2025, and 80 percent of them ultimately went on to practice in rural or nonurban areas of the state. It’s a result that can have an impact on tens or hundreds of thousands of people over the course of these physicians’ careers. “If I get one doctor to go to Medford or Amery [Wisconsin towns of fewer than 5,000 residents], they can have an impact there for 20 or 30 years.”

It’s a model that’s become increasingly common. In 2000, only 5 schools offered immersive rural training options for physicians; by 2024, there were 71 rural-focused medical school programs across the United States.

It’s one of the trends that Dodson finds especially encouraging. “This work can be really hard, but I’m optimistic that we will be able to do this,” she says. “It’s not an impossible hill to climb.”

  [ 2.]

What approaches to reducing pollution and
minimizing climate change can get real results?

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The stakes of ever-rising greenhouse gas emissions and global warming are often framed in existential terms: Without change, how much worse off will our society and quality of life be a century from now?

But the effects are also devastatingly immediate. Nearly 14 million Americans are at increased cancer risk from toxic air pollution; millions more develop asthma from pollutants in the air.

For Dan West BA ’07, the stakes of protecting the environment feel personal. He grew up among the mountains and rivers of western Montana. During his college search, he was drawn in after learning that the college was within an hour’s drive of more than 100 rivers. “I always naturally gravitated to the outdoors,” he says.

If you really want to do something about climate change, go to Washington, D.C., because the policy is decades behind the science.

So perhaps it also made sense that he would go on to major in physics (“the ultimate observation of nature”), and later become a geophysical field researcher, where he traveled to Greenland to study glaciers.

It was there in Greenland, stuck in a tent on an ice sheet, that one of his advisors said something that changed the course of his life. “If you really want to do something about climate change, go to Washington, D.C., because the policy is decades behind the science,” he told West.

So that’s what West did. He pivoted to get a master’s degree in public policy and management from Carnegie Mellon University and went to D.C., where he spent more than a decade working in a range of policy roles on Capitol Hill and at NASA, the Natural Resources Defense Council, Audubon, and Rivian. Today, he is the senior western policy manager at the nonpartisan Clean Air Task Force and based in Seattle.

What his work has taught him is that the challenge of transitioning to clean energy—though undoubtedly complicated—is not unsolvable. With targeted investment, political will, and a spirit of innovation and open-mindedness, real change could be just around the corner.

One simple policy change with big impact would be reallocating fossil fuel subsidies. “These subsidies are on the order of hundreds of billions of dollars per year,” he says. Oil companies, as one example, get billions in tax credits for exploratory drilling—even if the work never produces a drop of oil. “We could give that subsidy to, say, the geothermal industry to do exploratory drilling, build clean power plants on those hot spots, and connect them to the grid. Mature industries should not need subsidies, anyway” he says.

A technology-agnostic approach—a perspective he credits in part to his professors in the Lewis & Clark physics department—could also make a major difference. While renewable energy like wind and solar continue to offer vast opportunities, accelerating demand for energy means that we’ll need to consider all potential alternatives, including revisiting existing options. “Should we add nuclear to our mix?” West asks. “Right now, there’s a real generational divide. Older generations tend to be anti-nuclear. Younger generations tend to be pro-nuclear.”

And the third is to be willing to make small changes to our fossil fuel–dependent lifestyles. According to West, switching to an electric vehicle is the most impactful thing an average American household can do to reduce its carbon footprint without changing its lifestyle. West has been driving an EV between Seattle and Missoula for several years now and still gets there in the same amount of time, even in winter. He says the overall driving and ownership experience is more affordable and enjoyable, too.

West says he considers himself more pragmatic and apolitical nowadays in the pursuit for climate solutions—eager to work with both Democrats and Republicans who are willing to seek meaningful solutions. The real test, he says, is straightforward: “How willing are you to work with someone on something that you may disagree with on something else?” The solutions, he believes, exist—the question is whether we’ll choose them.

  [ 3.]

What strategies can communities use to support people experiencing homelessness as funding shrinks?

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For more than two decades, Brandy Westerman BA ’96 worked in international humanitarian response—the kind of career that took her to displacement crises in several countries, where she helped coordinate shelter and services for people who had lost everything.

Then, a few years ago, she used that experience to make a surprising career pivot to become Portland’s emergency humanitarian operations director. In her current role, she applies the same frameworks she once used overseas to address a growing crisis on American soil: homelessness.

There’s no question that the challenge in Portland and surrounding areas is significant. Some 17,000 individuals experienced homelessness in 2025, according to Multnomah County estimates, a number that has been climbing steadily for years.

Part of that increase may be a reflection of new strategies for data collection, but many factors contributing to the rise—high housing costs, low housing stock, and stagnant or dwindling local and federal resources—have been mounting for years. And while Portland’s traditional shelter model is well designed with extensive wraparound services, it was also becoming unsustainable. “Some of the established ways of working with people experiencing homelessness are very effective in small numbers, but we’re no longer in a world where we have small numbers,” Westerman says.

And it’s why her humanitarian operations mindset—to save lives now and improve services as time goes on—has proven particularly valuable. One example of this approach was Portland’s recent decision to put up very basic shelter fast—activating 1,500 beds in about a year. “It’s not as nice as some options,” Westerman says. “But it is a warm, safe space with staff who are there to ensure people’s safety and care.”

In that sense, it’s worked well: While this type of emergency shelter was once tight, today, “anybody who wants a bed now can have one,” she says.

An asset-based model flips the question: What does a community already have that could be used more effectively? 

Westerman’s work with refugee populations has also helped the city zero in on creative solutions through an asset-based approach. While conversations about homelessness often center on deficits—not enough housing, not enough treatment, not enough support for rental assistance—an asset-based model flips the question: What does a community already have that could be used more effectively?

Portland, for example, has underutilized housing stock that could potentially be maximized through home sharing and roommate matching, approaches the city is beginning to explore. Research also points to the potential of direct funding—money that goes straight to a recipient’s bank account—as a way to unlock creative housing solutions. “An individual with $1,000 is going to have much higher purchasing power than a government making decisions about how to spend that $1,000,” Westerman says, noting that a recipient might rent a room from a friend or negotiate informal arrangements. Any savings they pocket, she says, would likely go to food, medicine, and other essentials as they get back on their feet. The theory, says Westerman, “is less about Let’s give the person what we think they need, and more about Let’s give the person the economic power to make their own buying decisions.”

Despite the challenges Portland faces, Westerman finds hope in individual stories—like the woman who arrived at a Portland shelter two years ago, pregnant and deep in addiction, who went through treatment, stabilized, and now works at that same shelter as a single mom, serving as a role model for those who are now where she once was. “These are the stories where you’re like, Yes, more of that,” she says. “We’re never going to get to 100 percent housed. But every person matters.”

  [ 4.]

At a moment of geopolitical uncertainty, what’s the best way to plan for the future?

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If you feel like the trajectory of the world is more uncertain than ever, you’re not alone. Tariffs are upending long economic partnerships, AI is scrambling our understanding of the role of entire industries, and geopolitical alliances that once seemed unshakable are fracturing in real time. Measures from the World Uncertainty Index, a country-level measure of economic and political uncertainty, are at some of their highest levels in nearly two decades.

You might feel paralyzed by the headlines—or want to stick your head in the proverbial sand. But there are better ways for individuals and organizations to think about living in tenuous times, says Dawson Law BA ’05, founder of the London-based geopolitical risk advisory firm Conseil Global Advisors and a former U.S. diplomat and U.S. Treasury official.

If there’s anyone who should know, it’s Law, who got an early lesson in the disorienting power of global events. On September 11, 2001, the Montana native was living in Switzerland as a 16-year-old foreign exchange student. In an instant, the world changed—and he found himself processing the terrorist attacks through dual lenses, both as an American citizen and as someone living outside the country’s borders. “It was a moment of cataclysmic change in world politics,” he says, and he knew he would pursue a career linked to international relations. Today, as he advises companies and investors on how to navigate turbulent international waters, he continues to bring multiple perspectives to complex problems.

The first step is to see the world more clearly and less emotionally, which often means looking past the headlines.

The first step is to see the world more clearly and less emotionally, which often means looking past the headlines. In an era of minute-by-minute news cycles and algorithmic outrage, he pushes clients to focus on actions over words, and to resist the pull of reactive decision-making.

For example, Law points to a recurring pattern in global politics: rhetoric often outpaces reality. Even when governments announce sweeping tariffs, export controls, or industrial policies, implementation tends to be phased, negotiated, or diluted over time as economic costs and political constraints set in.

Likewise, while security relationships—particularly within alliances like NATO—are under visible strain, core commitments have proven more resilient than headlines suggest, with defense spending increases and new forms of burden sharing emerging across Europe. “The rhetoric can be dramatic, and the risks are real,” Law says. “But when you focus on what’s actually happening—how policies are implemented, how institutions respond—the picture is often more measured. Understanding the gap between words and actions is how better decisions get made.”

But seeing clearly is only the first step. The next is planning differently. “The most effective response isn’t trying to predict the future more precisely, but preparing to operate across several plausible futures,” says Law.

He encourages organizations to build scenarios, stress-test their strategies against different political and economic conditions, and trade some efficiency for resilience—diversified suppliers, financial cushions, and shorter planning cycles. “The organizations that do best aren’t the ones that guess right,” he says, “they’re the ones that adapt.”

And the final lesson, Law emphasizes, is not to wait for others to fix the problem but to use the power you do have. Too many companies and individuals, he says, are waiting for a rescue that will never come. “I’ve met with companies who say, ‘When’s the government going to fix this?’ or ‘When are we going back to normal?’ ” he says. (The answer might just be “never.”)

For individuals and organizations, that might mean speaking up to elected officials or administrators. It might also mean recognizing that uncertainty will remain, so it’s time to build the right networks—through relationships, systems, credibility, and trust—to see the moment through.

Understanding our individual agency, he says, might be one of the most powerful levers of all. “We are all stakeholders in our world, our politics, and geopolitical upheaval,” he says. “We all have a role to play.”

  [ 5.]

How can we help students reengage in school?

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Nearly 40 percent of high school students in the United States don’t feel connected to others at school, according to CDC data, and the consequences of that disconnection can be crushing. A sense of disconnection has been correlated with everything from poor mental health to higher absenteeism.

Cari Zall MAT ’05, assistant professor of teacher education at L&C’s Graduate School of Education and Counseling, knows that this disconnection can be counterproductive to the very aim of school itself. “Kids can’t learn and be creative and analyze and synthesize material if they feel a complete sense of exclusion from the space that they’re in,” she says.

The research is also clear on what happens when students feel connected: Their school attendance is more consistent, they perform better academically, and they are less likely to experience depression or drop out.

Each year, a new cohort of teachers enters classrooms trained to build belonging from day one. 

For Zall, creating that sense of connection requires teachers to foster environments and use teaching methods that encourage collaboration, self-management, self-awareness, curiosity, and relationship-building. These skills, known broadly as social emotional learning (SEL), are ones Zall is particularly passionate about.

This type of student-centered work can happen through redesigned lessons that teach content and human skills at the same time, like a geography lesson where students work together to create an island nation, assigning roles and solving problems together as a way to foster effective collaboration. “We’re not trying to teach students to do anything that’s outside the realm of actually learning a given subject,” Zall says. “We’re just showing them how to do it in ways that will expand their ability to associate and relate to other people and themselves.”

Connection can also grow through longer-term classroom culture building. “Everything grows out of a teacher’s relationships with their students,” Zall says. A classroom that knows how to be together is one that can face almost anything, whether that’s a failed experiment or a hard conversation about something happening in the community or the world.

Most important, says Zall, is for this work not to fall exclusively on the shoulders of a handful of motivated teachers but for it to be built systematically. At Lewis & Clark, the teacher education program embeds SEL into every facet of the work, teaching students how to include it as they write lesson plans, manage classrooms, and even think about the role itself.

Even broader than that, Oregon has made SEL a legislative priority, creating standards for K–12 education and teacher education designed with the kind of rigor one might expect for content-area standards in math or science.

Oregon is ahead of the curve nationally when it comes to integrating these standards, and Zall is optimistic about the current momentum. Each year, a new cohort of teachers enters classrooms trained to build belonging from day one. “They are bringing with them these ideas and these motivations to help kids grow themselves along with their knowledge,” she says. “Our goal is to create independent learners who want to continue to learn even after they walk out of the classroom.”

  [6.]

How do we effectively govern the use of AI as the technology advances?

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In 2020, the Jackson, Mississippi, city council passed an ordinance that banned facial recognition technology in its policing. The council’s rationale wasn’t just that the AI-infused technology was biased and often inaccurate (though it was). It was also that its use fueled deeper concerns about government overreach, surveillance, and its chilling effect on free speech and democratic participation, says AI researcher and former Amazon software engineer Andrea Dean BA ’17.

Yet five years later, the city council rolled back the ban, citing the improved accuracy of the technology and signing a multiyear contract with the company that provided it. “They were no longer talking about questions of democracy and surveillance,” Dean says. “It appeared to be a decision based solely on technical performance.” Through her research as an academic fellow with the Kapor Foundation, Dean identified a troubling trend: Policymakers are substituting rigorous debates about human rights with narrow evaluations of technical optimization.

As AI’s capabilities have accelerated, the questions of its use and governance have become more urgent.

Dean brings a unique, interdisciplinary lens to these questions. As a math and computer science major who had worked on AI-based projects with Associate Professor and Chair of Computer Science Peter Drake, she brought deep knowledge to the technology itself. And her classes on history and social change helped her see the ways that technology, power, and politics were inseparable. She later deepened her perspective on the evolving field of AI through working in the technology industry and earning a master of law and technology from Georgetown University Law Center. She has worked as a researcher with the Algorithmic Justice League and the Knight-Georgetown Institute and is a board member of hackNY, an organization empowering responsible technology leaders.

In high-stakes scenarios, our decisions about AI’s use and misuse, says Dean, should stem not from specific metrics like accuracy and bias scores but from more bedrock values and rights, like democracy, mercy, and equality.

Consider judicial sentencing. Some might argue for a performance standard—that is, once AI’s capabilities have reached a critical threshold, we might reasonably use it to inform sentencing decisions. But a principles-based approach law scholars have used is to push back on the premise entirely, arguing that mercy cannot be automated. “One way to frame it is, ‘Is it good enough to use yet?’ ” says Dean. “But the better question might be, ‘Should we use it at all in this scenario? What’s at stake here?’ ”

The important work ahead is thoughtfully defining which high-stakes decision can be responsibly automated, and which must remain fundamentally human. 

Dean points to our use of paper ballots in elections as a model of this more principled restraint. Despite their low-tech simplicity, paper ballots remain the gold standard in election system design because of a concept called “software independence,” where no software flaw can determine an election outcome in an undetectable way. Drawing from this, Dean proposes a framework of “AI independence” for high-stakes domains. “Democracy and trust in election outcomes is so important that we’re willing to forego efficiency gains that we might get by using more software,” Dean says. AI might still be used effectively in that context, like scanning and recording paper ballots, but cannot change the final outcome. It operates under strict, system-level constraints.

Dean hopes communities recognize their agency in shaping AI governance, rather than viewing technological integration as an inevitable, predetermined path. The important work ahead is intentionally designing these systems—thoughtfully defining which high-stakes decisions can be responsibly automated, and which must remain fundamentally human.

  [7.]

How do we rebuild trust in our civic institutions—and in one another?

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A2025 Pew study found that just 17 percent of Americans trust the federal government all or most of the time, a precipitous drop from its high of 73 percent in 1958.

It’s not easy to be an optimist in today’s political climate.

And that erosion of trust extends beyond politics into our personal lives. A survey of college students found that 71 percent of Democrats and 31 percent of Republicans would not date someone who voted for the opposing presidential candidate.

The only thing we can seem to agree on—to the tune of 80 percent—is that Americans are divided on the most important values.

It’s a profound frustration that Landon Mascareñaz BA ’05, CEO of Courageous Colorado, has seen up close. As part of his work with the organization, which works to reduce partisan divides and build community-driven political reform, he’s traveled to more than 20 sites statewide to hear from residents about the challenges they face in engaging with politics. “The exhaustion I’ve seen in our communities about politics is off the charts,” he says. “There’s so much dissatisfaction.”

But his work has taught him that there are a handful of pathways that can help restore our faith in the government and in each other.

The most important step is to recognize there is no single fix for the country, or even individual states—even though plenty of organizations like to promise one. “The philanthropic community really over-dials on their ability to prescribe solutions,” he says. “What we need is a solution set. And then a community can choose what makes sense for them.”

What we need is a solution set. And then a community can choose what makes sense for them.

For example, when he and his team facilitated community conversations about what citizens thought would drive more open and representative democracies, Courageous Colorado offered up a list of more than two dozen options, ranging from ranked-choice voting to campaign finance reform to term limits.

The most promising solutions looked different in every community. Mascareñaz says that when communities take ownership of the solutions they choose and work methodically to implement them, the process fuels a sense of optimism and possibility.

In fact, when participants were asked to imagine a future in their community if their ideas were implemented, the answers were strikingly similar—no matter how different the solutions themselves. “They were saying things like: ‘It’s going to reduce polarization.’ ‘We’re going to solve the hardest things in front of our community.’ ‘Our campaigns are going to be different,’ ” he says. “It was so inspiring.”

For Mascareñaz, the work of his nonprofit has shown that the very act of getting together in community to talk about solutions and move toward them has made a difference. “There’s not ‘one thing’ that will solve what ails our democracy,” he says. “It will be a multitude of solutions combined with the time, talent, and treasure of our community members coming together to build it.”