Imagine a handful of small communities in a state are home to people who smoke at double the rate of the rest of the population; have rates of obesity, diabetes and heavy drinking that are at least 60 percent higher than the rest of the state’s; and live shorter lives than everyone else.
In a state where those in power actually make it a priority to turn around those statistics and improve the health of residents, these statistics would be a cause for concern. They would be reason enough to devote the resources necessary to determine what’s wrong and what can be done to improve the health of those who live in these communities. The statistics would make the case for some sort of intervention that helps these communities lead the charge to change their trajectory.
The first part of the description is a reality in Maine. Under Gov. Paul LePage’s administration, the latter part is a fantasy.
A recent health assessment of the more than 10,000 members of the four federally recognized Native American tribes in Maine — the Penobscot Indian Nation, Passamaquoddy Tribe, Houlton Band of Maliseets and Aroostook Band of Micmacs — paints the picture of a population with unique health challenges that require attention. But the LePage administration this summer cut off its last remaining direct ties with the tribes in the area of public health.
The state’s infrastructure for combating public health problems is a shell of its former self under the LePage administration after years of budget cuts and structural changes that have hollowed out the resources local communities have to mount campaigns to improve their residents’ health. But the state retains a presence in all but one of its nine, legally established public health districts.
The public health district with which the state has severed all of its direct ties is the tribal public health district, with four of the state’s five tribal communities in rural and economically struggling Aroostook and Washington counties. The end of those ties comes six years after lawmakers and the LePage administration recognized the need to incorporate the four tribes into the state’s network of public health services — to the point of writing the partnership into state law — and including them in other health-oriented initiatives.
But the relationship has gradually unraveled in recent years. Meanwhile, tribal members are more likely than Maine’s population as a whole to be living with diabetes, high blood pressure, asthma, depression and anxiety. They’re less likely to have access to nutritious diets and services they need to manage those conditions. Now, the public health district that includes them is the only one without any state investment in the form of a paid staff member to coordinate local public health improvement efforts.
Before the state cut off that modest investment at the start of July, the tribal public health district, under the leadership of its one staff member, was working on plans to start a tribal addiction treatment center and on alternatives for expanding addiction and mental health treatment services in tribal communities. Now, no one is dedicated to carrying out that critical and urgent work.
If it doesn’t even try to proactively address health problems in Maine, the state can’t expect to move the needle on smoking rates, nutrition, chronic disease management, substance use prevention and a whole host of other health-related challenges.
The state can’t expect a return on the investment it’s made for six years in tribal communities when it suddenly cuts off public health ties with the tribes.
And when it comes to improving a temperamental relationship with the four tribes, the state can’t expect much when it keeps going back on its word.