The 46th Legislative District saw one of the most competitive primary election races of 2022. State Sen. David Frockt announced his retirement, causing Rep. Javier Valdez to run for the vacancy, opening a vacuum that five progressive women candidates attempted to fill.
Dr. Lelach Rave, who will compete against Disability Rights Washington Policy Director Darya Farivar in November, said that she decided to enter the race after consulting with Frockt. Rave is a pediatrician who felt frustrated with the number of times that a patient would come into her office with a problem that her “doctor’s bag of tricks could do nothing about.”
“There are just lots of systems-levels things that families were dealing with that required systems-levels answers, and that wasn’t this toolkit that I had,” Rave said.
So, she entered the world of advocacy, pushing for policies at the state level that could improve health outcomes, such as the move to increase the minimum age to buy tobacco products to 21.
Now, Rave wants to go from pushing policymakers from the outside to working with them on the inside, using her background as a clinician to advance legislation to improve Washingtonians’ well-being.
This interview has been edited for length and clarity.
RC: Why do you want to represent the 46th Legislative District?
LR: it really comes from my background, being a doctor, being a pediatrician. And the thing that got me into doing advocacy work in general was finding that as I was working with families and patients —and I had a kid in front of me and a parent, and we have a shared goal of ultimate health and well-being for this young person — but there are often things that were standing between us and our goal that my doctor's bag of tricks could do nothing about. So despite lots of years of training with medical school and residency and everything else ... There are just lots of systems-levels things that families were dealing with that required systems levels answers, and that wasn't this toolkit that I had. And so about a dozen years ago, [I] started working really extensively with the American Academy of Pediatrics and their legislative team to try and address that whole other set of issues, which honestly has more to do with well-being than the issues that I was often able to deal with as a physician.
And I really have been working in parallel for the last dozen years, doing my clinical day job and then as a citizen advocate, really working on what are the systems and the policy issues that can help. And so doing that for a dozen years now, this open seat came up. And so I quite literally turned to David Frockt, who was our retiring senator and whom I've worked with on numerous policy things over that time period, and said, okay, David, you know, I've dabbled in this. What do you think? And he said, I think you should run. We have not had that science voice, that clinical voice in the legislature in a really long time, and it could be something unique and special to add.
I was reading an article earlier today that was positing, what if doctors could prescribe adequate housing? And it feels like this is almost the flip side of that other scenario.
I remember years ago, we used to have these huge prescription pads where we would prescribe, like, "go outside and play for an hour a day," things that were so obvious but often are not happening for people and are really integral to their well-being. So, some of it's the easy stuff, like go outside and play as opposed to being sitting on your game console. But some of it is stuff like, could we prescribe housing? Could we prescribe when you go to the store like buy a fruit and a vegetable in addition to whatever else? Things that perhaps seem really basic, but there really is this huge intersection between what we know with science and health and what we know about human behavior and habits and all the social determinants of health, the things that push us to walk down different paths, and how can we influence those?
What makes you better for this job than your opponent?
We literally have hundreds of lobbyists and activists in Olympia. We literally have zero doctors. So I think it's something that's a voice that is missing, and that could really help us create better policy.
You mentioned that we have lots of lobbyists: You have lobbied and Olympia. Where do you see the distinction there? And what about that experience informs your approach walking into Olympia? How will that translate into effective leadership?
I would say I've been an advocate and maybe distinguish that from a lobbyist, because I don't have any of the official lobbying paperwork, etc, etc. I would say that that advocacy work has really helped me, one, become familiar with how the sausage is made, what those processes are like. And I've been able — through the advocacy work that I've done with the American Academy of Pediatrics — to be involved in every step along the way. So sometimes I've been involved with conceiving and writing legislation. Other times been involved with testifying in front of committees and explaining and advocating for legislation during the process of having it be passed. And sometimes been really involved with the implementation side of: Okay, we've gotten this law passed. How do we actually roll it out and make sure that it has the impact that we expected and hoped for it to have in the community?
So I've been involved throughout that whole process and in that have also developed relationships with some individuals, some of whom are the Democrats that you might think would be completely on board with some of the things that we'll talk about, I'm sure, but also with some Republicans.
And so [I've] had the opportunity to work with people with very, very different perspectives and life experiences. And I think that's where being a doctor and using my clinical skills has kind of transferred over, because often when I'm in exam rooms with patients, I don't get to choose who comes in. And sometimes there are people who are very significantly from me in terms of belief systems, and the task is always to figure out where that common ground is and how do we work forward together?
What are the biggest issues facing the 46th, and how are they unique from statewide issues?
Often when I'm at the door, I'll ask people what's on their minds, and the response is, "Where to start?" But I would say, consistently, the things that I hear about most are affordability and the unhoused population.
... I think it probably plays out distinctly in different areas, but I don't believe that it is distinct. I believe it is actually a very widespread issue throughout, certainly our metro area and beyond as well.
Who or what organizations do you take ideas and inspiration from? Who's going to be your "kitchen cabinet" when you go into the legislature?
I would say that one of the places that I have gotten a lot of information from is actually the professional organization: the American Academy of Pediatrics. That might sound very narrow, and you might be surprised that the lead article in the pediatrics magazine last month was all about poverty and Child Protective Services and very much social determinants of health. So, I do have my professional home that I come from, and that certainly is a basis of trusted information for me. But I would say, beyond that, my experience with all the families — and there literally are thousands of them that I've worked with through the years — and the places where those relationships lead me is really where I go. So the stories that every family brings in terms of what their lived experience is, and then they often share with me as they're sharing those stories.
Are there any community organizations within your district or folks that you work with directly?
Many of them I've actually really connected with even through this process. So some of the different neighborhood organizations — Lake City has its own neighborhood association, Wedgwood has its own neighborhood association — and I've actually gotten to go to some of those meetings and interact with those individuals. It's been really enlightening because things that I drive by every day and they're like, "Yeah, that lot over there, we're actually planning X, Y or Z for it," and [I] never would have known that just going through.
Gov. [Jay] Inslee said that abortion is safe in Washington, but there are plenty of Republicans who would vote otherwise. How would you protect that in the legislature?
That's a huge one, and it's a huge one for me, personally, just because it's a lot of work that I have done over the years is working with young people in terms of accessing and helping them access reproductive health care. And there are lots of levels of challenge for that, even with our current laws on the book.
So to specifically talk about the question in terms of keeping it "more durable than an election cycle," I think that it is worth considering a constitutional amendment. I do not know if we have the votes for that, quite honestly, just because I haven't done that research, and constitutional amendments are not necessarily easy to have happen. But that certainly is the most permanent, long term way to make sure that it remains enshrined in law. I would also say that, for me, a big, big priority is making sure that reproductive health care services are accessible, that it is important that it is more than just on paper, but that people can actually realize and utilize the services.
And so in King County, for example, the only place that one can get a hospital-based abortion is the University of Washington. And that's because all the other health care systems have merged with religiously based organizations that do not offer those services. And there's implications beyond reproductive health care. Those organizations are also not discussing end of life care and death with dignity, and there are repercussions, for sure, with that. It's super important in my mind that we make sure that it's not just available on paper, but that people actually can reach these services. And especially as we're going to become a sanctuary state and have increased demand because people are coming in from Idaho, or even across the country, to utilize the services here, it's going to become even more and more essential that we have actual access.
And so, some of that is perhaps legal. That's not the word that I want. This is where not being a lawyer and being a medical person comes in. But my understanding is there's perhaps legal implications that the legislature can help protect both providers and family members.
What is your position on the recent police reforms that have passed in Olympia? What is your position on the Blake decision and the legislature's moved to recriminalize possession? Next year that law expires, so what would replace it?
I have never been a "defund the police" person. I am a person who really believes that we need to fund the institution to create the institution that we want it to be. And that means that it takes more funding to do the trainings that people will need for anti-bias work and deescalation training. All of that actually requires that you fund them more, in my opinion.
I also really understand that many police officers are feeling like they are being asked to do jobs for which they are not trained and for which they really are not the most appropriate individuals to do that particular work. And so the work of bringing alongside someone who has the mental health training — the social worker, the navigator, all of the other pieces that we know so many individuals need — I think is crucial. In my mind, this goes to a bigger issue of where we are with mental health in our community, and we need to make sure that we have enough people to bring in and supplement the law enforcement force so that we can give the services that we need. And at the moment, that whole mental [health] workforce is really depleted, and we do not have those people there that we need.
And it's become this interesting cycle because we actually now have a police force which is very depleted as we're down several hundred officers in the city of Seattle. So, we don't have anyone that we need to have. We don't have the people who we actually want to bring in if there's a dangerous situation and we need safety, and we don't have the people that we want to bring in if we have a situation that best supported through mental health and other services.
In this case we're really looking at the police reforms that recently passed that, frankly, police unions have been complaining about. And so there is an attempt to bring some of those back. What are your opinions on those reforms and these calls to change them?
Creating stops for really minor issues like license plate tabs and things like that, and tail lights: ridiculous and obviously cause a lot of harm.
The pursuits are, my understanding, were pretty curtailed already by many police forces… I think it makes sense to have a uniform policy of: There really need to be incredibly limited times when we use high-speed pursuit, because we know that can be dangerous and dangerous not only to the individuals who are being pursued and to the officers, but also to the whole, wider bystander community. I think there needs to be some very specific direction about when that risk-benefit ratio comes out in favor of taking that risk.
In terms of the Blake decision ... I think, again, we have a scenario where many things were criminalized that are not served best in the criminal justice system, and we also know that the impact of that was very disproportionate along racial lines. And so, the idea of calling that back I think makes a lot of sense.
And that goes back, for me at least, to the idea that mental health and addiction are actual diagnoses. Those are actual things that the medical system has what to say about. And the way to treat that is an actual medical treatment model. . And we know that people are not adequately getting that sort of treatment when they are embedded in the criminal justice system. Really switching our perspective on that to "this is a medical diagnosis, and how do we give a medical treatment," I think, is much more effective in terms of reaching the long term outcome that we're all hoping for.
Where do you stand on the current push for social equity licenses in cannabis?
My understanding is we've created this new industry that has a significant financial ... it's an economically robust industry, and we want to make sure that, again, there is equitable access to that... the fruits of that new economic sector are open and accessible to everyone, especially with the history going back to the previous question of who was criminalized most often for things such as possession. It's an amazing opportunity to turn that on its head.
Homelessness is a growing issue in Washington state. So talk to me about how people become homeless here, why they stay homeless here and what are the effective policies that the legislature specifically can do to change that?
The unhoused population — as you guys well know — is not a monolith, right? We have a lot of groups within that. So for families, the most common cause of being without housing is actually domestic violence. And so that is a whole set of programs and supports and issues that one needs to deal with. There are others who end up in a situation of not being housed, which are folks who, let's say, are graduating from the foster care system, and we know that those kids do not receive adequate supports, are not set up for success upon exiting that system. Whole different set of issues, perhaps, there. I think a lot of the folks that I hear about at the doors are the people who are living under [Interstate] 5 or have tents up on sidewalks. And for the chronically homeless, there are a whole other set of issues, often dealing with mental health and drug addiction.
And like I said earlier, in my mind, those are very much medical diagnoses. And so my big picture approach is that being without housing is your symptom, and the diagnosis is underneath. And how you deal with that symptom is going to depend on what your underlying diagnosis is. In terms of some of the things that take people with that underlying diagnosis and leave them without housing specifically — because there are lots of different challenges that people with all these diagnoses would face.
We have a huge lack of housing in our community and our state and we have a big affordability issue. And so we need to build a whole heck of a lot of housing. And some of that comes through the Housing Trust Fund, some of it comes through different grant programs that are given to nonprofits in different areas. There are lots of different ways that people are working to create more housing, some of it short term — tiny homes, things like that — some of it more long-term supportive housing. We probably need to say yes to all of it, because we have such a great need that if you can shelter someone, the answer has to be yes.
In terms of affordability, we need to put more money into people's pockets. And I know we're going to talk about taxes, but certainly for some of the families and other entities who perhaps are not struggling as much with mental health and addiction, if you have an unexpected illness and you don't have adequate health insurance and suddenly you have big bills and things sort of cascade. The idea of putting more money into people's pockets hopefully makes that less of a housing-threatening situation.
I think one definite area that I'd like to see us think about is the rebates that we give to families. Right now I believe — and you can correct me if my numbers are wrong here — that families up to 200 percent of poverty receive rebates from the state level to funnel back to them some of the regressive taxes that they are paying in terms of sales tax. Do we have to stop at 200 percent of poverty? My guess is that there's a whole big section of folks who are making above that who are really struggling too.
And when you go back to the mental health and the addiction piece, you need to have more treatment services, and we need to invest robustly in our mental health system. I see that in the clinical setting where I just want to send a kid to a therapist and there's no one all the way to: I have a child who needs an impatient psychiatric bed and there's no place to take them. And, in my mind, there's a really big issue there with our workforce. We have inpatient psychiatric beds in our state that are not filled because we don't have the staff to actually put people in them.
When we talk about more housing, the 46th is, I believe, predominantly single family homes. Do you see pushback from your own potential constituents about trying to put more housing into some of these places that have traditionally not supported multifamily housing?
Yeah, some people who are all over it and think absolutely, it needs to be done and some people there's pushback. So I think it is going to be an important conversation for the community to have, and it might be a tough one. But I do also think that those same people see the issue, see the problem and realize that something needs to be done.
What is your opinion on our current tax code? And if it was negative, how would you see it changed?
We all know that we have a really regressive tax code, and that is really unjust. I'm super excited to see what comes out of [Rep.] Noel Frame's tax work group. I am excited about the idea of a wealth tax. If there's a way that they have found to thread the needle and make that work constitutionally in our state, I think that would be tremendous. I think that there is a huge role to be played for closing tax loopholes as well. I think that there are probably many places that we are leaving money on the table, but we do not need to be doing that.
And then specifically around the income tax, my understanding is that we need to create a constitutional amendment to make that happen. And so in my mind, what I have understood is that we do not have the votes in the legislature right now to make that happen, and so it feels a little counterproductive to spend a lot of time talking about that if it's not going to happen.
What's your favorite place in your district?
I did choose a spot that's pretty close to my house. I really love the Ravenna-Cowen Park, and I try and run through there as often as I can because I feel like I have my little reset, retouch point in nature going through that wooded area. And every summer, they also have barred owls there that have nests and young, and it's so cool because I don't think I've ever seen... Are they called owlets? I don't remember what they're called. The little ones. I've never seen them as close as I do every summer going through there. It's just amazing.
Read more of the Oct. 12-18, 2022 issue.