May 23, 2018
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A promising step from the LePage administration to improve Maine’s health

Courtesy of DHHS
Courtesy of DHHS
Acting Commissioner Ricker Hamilton oversees the largest agency in state government, the Maine Department of Health and Human Services.

Gov. Paul LePage’s administration has spent much of the past seven years dismantling the state’s capacity to respond to public health emergencies and proactively tackle other statewide health problems such as obesity and persistently high smoking rates. So it’s encouraging to see the state start to rebuild its workforce of public health nurses.

Before the LePage administration decimated their ranks, Maine’s public health nurses were a critical component of the state’s efforts to prevent infant deaths and ensure that infants got off to a healthy start in life. They played a major role in state efforts to contain the spread of highly contagious tuberculosis. And they were a crucial part of the state’s response to public health emergencies such as the 2009 H1N1 influenza outbreak and a 2002 cluster of botulism cases in northern Maine.

At the start of the LePage administration, the state employed about 50 public health nurses across the state as well as a handful of supervisors and program leaders. As of September 2017, a Maine Center for Disease Control organizational chart showed a staff of 17 public health nurses. The program was so short-staffed last year that nurses from Aroostook County regularly had to travel to Lewiston and Portland to staff clinics for patients with latent tuberculosis. The CDC has also dispatched Bangor- and Augusta-based nurses to Washington County and put them up in hotel rooms for temporary assignments.

Public health nurses didn’t disappear as the result of cuts in a tight budget environment. Legislators made a point of funding their positions. The LePage administration, however, simply refused to fill most vacancies as they came up, and members of former Commissioner Mary Mayhew’s staff prevented the program from properly functioning — for example, by not allowing a former program director to email his staff without approval from staffers in Mayhew’s office and by requiring that the program withdraw its informational brochures from circulation at health care facilities and other public places.

It took an act of the Legislature, but the Maine Department of Health and Human Services, under newly confirmed Commissioner Ricker Hamilton and a new CDC director, is finally restoring the ranks of public health nurses. The department says it’s moving to fill vacant public health nursing positions as lawmakers required in legislation that passed last year over LePage’s objections.

In a December report to the Legislature’s Health and Human Services Committee, Hamilton told lawmakers the department made seven public health nursing hires between Sept. 1 and Dec. 15. The department has posted job openings and circulated them. It launched radio ads last month promoting the job openings, according to Hamilton’s report.

We’re encouraged by the movement to restore a crucial part of the state’s public health infrastructure. The amount of work that remains to be done to tackle some of the state’s pressing health problems is also daunting.

In addition to undermining public health nursing, the LePage administration over the past seven years has also cut funding to regional coalitions formed to tackle local public health challenges; dissolved those coalitions; cut most funding to the committees the administration set up to replace those coalitions; and has drastically cut the portion of funds Maine receives each year from a legal settlement with tobacco companies that actually fund anti-tobacco and other public health efforts. LePage administration policies have left fewer low-income people with access to health insurance, food assistance and small sums of cash assistance — all of which contribute to the health of the people who depend on those services.

With stubbornly high smoking rates, the continuing toll of opioid addiction, the highest rate in New England of adults lacking health insurance, and growing rates of deep poverty among children, Maine’s standing in the annual America’s Health Rankings dropped to its lowest level yet last year — 23rd, after peaking at eighth in the nation in 2010.

Restoring the state’s corps of public health nurses is an important step in changing this picture. But DHHS can’t stop there.

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