All through the COVID-19 pandemic, different public well being challenges raged on. Substance use in Maine surged and weight problems charges continued to tick upward. Deadly drug overdoses within the state set data in 2020 and 2021, and are on monitor to take action once more.
Smoking charges have fallen however Maine nonetheless has increased charges than the nationwide common. Vaping skyrocketed earlier than the pandemic and general tobacco use has elevated amongst youth.
Youth charges of smoking, ingesting and vaping all declined in the course of the pandemic. However public well being specialists cautioned that these adjustments could possibly be momentary, as a result of lack of entry to substances throughout COVID-19 orders to remain at house.
In sum, many indicators of well being in Maine worsened throughout Gov. Janet Mills’ time period, however got here as she and leaders internationally handled the worst public well being disaster in a century — a worldwide pandemic that claimed greater than 2,600 lives in Maine and greater than 1,000,000 nationally. And, information exhibits, lots of the identical indicators additionally worsened beneath her lead challenger, Republican Paul LePage, who was governor from 2011-19.
Now, as Maine enters its third pandemic winter, public well being specialists are struggling to evaluate and handle the opposite well being challenges that proceed alongside the cussed struggles with COVID-19.
Beneath Mills, the Maine Heart for Illness Management and Prevention is restructuring its method to prevention work round weight problems, tobacco and substance use. Prevention funds will circulate on to the eight public well being districts slightly than statewide organizations like MaineHealth.
The transfer will create extra native management and is meant to bolster the native public well being infrastructure in a state uncommon for its lack of county public well being departments.
Public well being specialists mentioned this transformation has been within the works for some time and is a step in the correct route, however extra work must be achieved to construct up native public well being.
The numbers
Opioid use in Maine elevated beneath each the LePage and Mills administrations.
After climbing for years, deadly opioid overdoses dipped to 354 in 2018 earlier than ticking up once more. Then in 2020, the primary 12 months of the pandemic, drug deaths elevated 33% over the earlier 12 months to 504.
The current surge of opioid deaths could possibly be partially attributed to the psychological well being disaster spurred by the pandemic and an increase in fentanyl. Graph courtesy the U.S. CDC.
This 12 months, deadly overdoses are on track to surpass final 12 months’s report quantity. There have been almost 800 extra overdoses — deadly and nonfatal — as of August in contrast with the identical interval final 12 months, in line with the monthly overdose report funded by the Maine Workplace of the Lawyer Common and the Workplace of Behavioral Well being.
The current surge could possibly be attributed, at the least partially, to the psychological well being disaster spurred by the pandemic and an increase in fentanyl, which was concerned in an estimated 77% of Maine drug deaths.
Tobacco use amongst youth elevated from about 11% in 2019 to twenty% final 12 months, in line with the Maine Built-in Youth Well being Survey. This could possibly be as a result of the query in 2019 didn’t embody digital cigarettes, which was on the rise earlier than the pandemic. Youth vaping almost doubled between 2017 and 2019.
Youth ingesting has declined for years beneath each governors. In 2011, when LePage took workplace, 28% of Maine highschool college students reported presently ingesting alcohol. That dropped to about 23% by the point Mills took workplace in 2019. Final 12 months the speed was 19%.
Whereas vaping skyrocketed within the years resulting in the pandemic, conventional cigarette smoking dropped in Maine from 23% in 2011 to lower than 16% final 12 months.
Lowered smoking charges can attributed to Maine’s success with therapy, prevention and coverage. Graph courtesy U.S. CDC.
Deborah Deatrick, retired senior vice chairman for neighborhood well being enhancements at MaineHealth, attributed the lowered smoking charges to Maine’s success with therapy, prevention and coverage. She pointed to legal guidelines requiring smoke-free eating places and indoor areas, tighter vaping restrictions, and higher entry to therapy strategies like nicotine substitute remedy and counseling.
“By way of tobacco and weight problems, we all know what to do. We all know what works. We have now some insurance policies and packages and methods that we all know have borne outcomes,” Deatrick mentioned. “It’s actually a matter of conserving our pedal to the steel and conserving on with what we’re doing collectively in the private and non-private sector.”
Nonetheless, weight problems has continued to show difficult. The variety of grownup overweight Mainers elevated threefold for the reason that early Nineteen Nineties, mentioned Rebecca Boulos, govt director of the Maine Public Well being Affiliation.
Final 12 months, almost 32% of Mainers have been overweight, in line with the U.S. CDC. The nationwide fee of weight problems final 12 months was 33.9%.
When LePage took workplace in 2011, Maine’s weight problems fee was 27.8%. When Mills took workplace in 2019, it was 31.7%.
The variety of grownup overweight Mainers elevated threefold for the reason that early Nineteen Nineties, in line with the Maine Public Well being Affiliation. Graph courtesy U.S. CDC.
People who find themselves decrease earnings, have much less schooling, are racial and ethnic minorities, or dwell in rural areas are at increased threat of weight problems, Boulos mentioned. Many threat elements are shared with tobacco and substance use.
“Weight problems is a really advanced persistent illness,” Boulos mentioned. “It’s a constellation of things. The determinants of weight problems must do with genetics and entry to protected locations to recreate, and reasonably priced wholesome meals.”
Social and bodily environments, organic and genetic elements, psychological well being, private views, medical health insurance protection, socioeconomic standing, and product accessibility, availability and worth all make prevention work advanced, mentioned Robert Lengthy, spokesman for the Maine CDC.
“Maine CDC is dedicated to persevering with to work with companions throughout the state to handle these points as a part of an ongoing and collaborative effort to enhance the well being and well-being of Maine residents,” Lengthy mentioned.
Straight to native companies
A method the Maine CDC is making an attempt to handle well being issues is to restructure the general public well being forms and put prevention cash instantly within the arms of native companies.
The Maine CDC will distribute funds by way of the state’s eight public well being districts to contract with native teams offering substance use, tobacco use and weight problems prevention work.
It will “permit extra funding to go instantly towards prevention providers,” Lengthy mentioned. Maine CDC will work with awarded bidders to create a plan based mostly on the priorities recognized in conversations with native stakeholders and neighborhood members.
Beforehand the Maine CDC distributed funds to a bigger contractor, just like the College of New England or MaineHealth, which then distributed the funds to subcontractors in native communities.
The change may create a extra “regional method” to the prevention work in a rural state that doesn’t have county-level public well being departments, mentioned Bridget Rauscher, who manages prevention packages for tobacco, weight problems and substance use for the Portland Public Well being Division.
“I feel the aim is to deal with the area that you just’re serving so it’s extra centralized, so on-the-ground work might be extra impactful for the neighborhood,” Rauscher mentioned. “The best way it’s damaged into public well being areas aligns with infrastructure on the state stage, and may permit areas to tailor work to the wants of the neighborhood.”
Rauscher mentioned she is optimistic the outcomes will enhance as a result of the prevention measures will higher replicate the neighborhood being served. For instance, she mentioned, some components of the state could not want Portland’s stage of funding for well being fairness methods round language boundaries, whereas Portland could face fewer transportation boundaries than extra rural communities.
Rauscher works with faculties and early childhood schooling to show expertise that construct resilience and confidence.
“We’re educating children to face up for themselves, to suppose critically and independently, and construct shallowness,” Rauscher mentioned. “We’re not simply saying, ‘Don’t smoke. Don’t use medication.’ It’s skill-building. Lifelong skill-building.”
Boulos, with Maine Public Well being Affiliation, mentioned the change brings extra deal with prevention. Prevention doesn’t at all times get as a lot consideration or focus as therapy as a result of it’s onerous to quantify. However one estimate, from Trust for America’s Health, discovered that for each greenback spent in persistent illness prevention packages in Maine, the state will get a $7.50 return on its funding inside 5 years.
This new method will construct on current relationships and neighborhood partnerships, no matter who’s governor subsequent 12 months, Boulos mentioned.
“These (partnerships) transcend administrations,” she mentioned. “They’ve been constructing for many years and can proceed to construct previous the following 4 years..”
Deatrick, who retired from MaineHealth and is now a public well being marketing consultant, mentioned traditionally there haven’t been sufficient teams on the bottom doing outreach or funding for the work.
“The idea is a extremely good one. It’s one thing public well being has been speaking about for many years, which is constructing native or regional public well being infrastructure, which for essentially the most half we don’t have in Maine,” Deatrick mentioned. “From a normal standpoint I feel it’s nice that Maine CDC is constructing native regional public well being infrastructure.”
However there’s nonetheless a spot for public well being and personal well being organizations to work collectively, Deatrick mentioned. The method going ahead ought to be a partnership between private and non-private.
For instance, the cash distributed by Maine CDC for tobacco prevention comes from state and federal funding however it helps work achieved within the personal sector, Deatrick mentioned.
“It’s symbiotic. You scratch my again and I scratch yours. You want each. The general public sector can solely achieve this a lot,” Deatrick mentioned. “What the Maine CDC is making an attempt to do now could be go a step additional in bridging that hole between the federal government and native areas of the state by placing some cash into constructing some native infrastructure.”
Mills vs. LePage
As governors, Mills and LePage had totally different philosophies on public well being. Beneath LePage, the variety of stuffed positions within the Maine CDC shrunk from 418 to 333 in January 2019. Beneath Mills, 404 positions are stuffed right now, in line with Scott Ogden, spokesman for the Mills reelection marketing campaign.
Specifically, the general public well being nursing program shrunk under LePage from greater than 50 positions to fewer than 20 at one level. Public well being nurses with the Maine CDC are accountable for house visits with expectant mothers and new infants, and function a neighborhood supply of well being info of their neighborhood.
LePage previously told The Maine Monitor in March that the general public well being nurse program wanted extra oversight and a greater reporting construction. He promised on the time to fill all vacant positions and absolutely fund this system if reelected.
“I’m a giant believer that if you happen to’re going to rent folks, they must be efficient and so they must optimize their talent stage to assist society,” LePage mentioned on the time. “These are public well being nurses being paid by the general public and the general public has a want to get the right providers.”
He mentioned he needs to eradicate poverty, home violence and opioid habit by way of packages that assist folks assist themselves, not by “giving them all the pieces and letting them go to their very own gadgets.”
A spokesman for LePage didn’t present responses from the previous governor for this story.
LePage beforehand has supported some funding into opioid therapy in addition to advocated for a cleansing middle, however he vetoed laws that expanded entry to naloxone, the lifesaving narcotic that may reverse an overdose. He wrote in his veto message that “Naloxone doesn’t actually save lives; it merely extends them till the following overdose.”
LePage additionally has criticized Mills’ mandate that every one healthcare staff get vaccinated in opposition to COVID-19.
LePage’s perspective towards public well being appeared to indicate that “it isn’t all that essential and we’ll let the neighborhood maintain this,” Deatrick mentioned.
In response to shrinking public well being positions beneath LePage, the personal healthcare sector began funding its personal public well being packages, mentioned Deatrick, who was with MaineHealth for 20 years.
Deatrick mentioned most individuals in public well being appear to share her considerations about LePage.
“You could discover any individual who says (LePage) did an awesome job with X, however I couldn’t consider a public well being situation the place I might give him a constructive grade,” Deatrick mentioned.
In response to the substance use disaster, Mills expanded prevention, therapy and restoration packages, with plans to proceed increasing, Ogden mentioned. He added that Mills expanded Medicaid, which resulted in additional than 22,000 Mainers receiving substance use dysfunction therapy.
Mills additionally signed a legislation banning vaping and tobacco merchandise on college grounds and buses, supported $7 million in tobacco use funds within the current finances, applied free college meals, permitting WIC for use at native farmers markets and delivering meals help to low-income households in the course of the pandemic, Ogden mentioned.
“Extra broadly, the Maine CDC’s effort to rebuild a regional method to public well being — which was dismantled beneath the LePage administration — will permit us to focus on funding towards community-based organizations that, in flip, will permit them to deploy options that work finest for his or her communities to enhance well being outcomes. It’s one other instance of the governor’s continued dedication to enhancing Maine’s public well being system,” Ogden mentioned.
Joanne Pleasure, senior program supervisor of prevention for Wholesome Communities of the Capital Space, mentioned she was involved when Mills got here into workplace that prevention didn’t look like a precedence and it took some time to refill positions on the Maine CDC. There appeared to be extra emphasis on healthcare than prevention, Pleasure mentioned.
However general the Mills administration has a broader view of conserving folks wholesome, mentioned Pleasure, who has labored on weight problems, tobacco use and substance prevention since 2001.
“My concern with a LePage administration is simply his historical past,” Pleasure mentioned. “His historical past was that the Maine CDC didn’t apply for each federal grant that they have been certified for. … It goes together with the philosophy of smaller authorities. When there’s smaller authorities, there’s smaller public well being.”
Whereas some well being statistics continued to worsen beneath Mills, Pleasure mentioned it’s unimaginable to check the final couple years in the course of the pandemic to the LePage years.
“It’s unimaginable to say ‘setting apart COVID,’ as a result of COVID permeated well being, psychological well being, substance use. It simply permeated all of it. It simply modified all of it,” she mentioned.
“It’s not apples to apples in any respect. It’s COVID and COVID and COVID.”
Rose Lundy covers healthcare for The Maine Monitor. Attain her by electronic mail with different story concepts: rose@themainemonitor.org.
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