Building Public Health in Maine
One hour away from the home of HSPH lecturer Paul Campbell in Massachusetts is a bridge to Maine--and another world. The northern-most state in New England contrasts with its urban southern neighbor in more ways than its rarefied beauty.
Massachusetts ranks as the third highest state in the union in per capita income. Maine is 36th. Massachusetts has four graduate schools offering degree programs in public health. Maine has zero. Massachusetts has a well-developed and funded public health infrastructure. Maine had virtually none, until now, thanks to policymakers, scientists, and public health advocates in Maine and an organization that Campbell heads.
Campbell is president of the Maine Center for Public Health (MCPH), a non-profit organization established by the state's legislature in 1996 to improve the health of the state's citizens. Since its establishment, the center has undertaken several initiatives, including growing collaborations between MCPH and HSPH. The partnership also includes the state's Bureau of Health directed by Dora Mills, HSPH alumna and Maine's health officer.
Maine is a state with a split personality of sorts. Along the scenic coastline, enclaves of fabulously wealthy people have erected large summer homes overlooking the Atlantic. Tourists patronize charming shops. The siren call of the wild lures Odyssean campers and hikers.
But there is another Maine better known to many of the 1.3 million residents, described Campbell, one that is sparsely populated, starkly pretty, rural, and poor. These residents look out for their neighbors, he said, but shy away from more formal, state-sponsored interventions. Their primary sources of information about public health are the state's Bureau of Public Health, television, and newspapers.
In the past, Maine has suffered from the highest rates of tobacco addiction in the nation by certain groups, including school-age children and young adults. The state has climbed out of that most negative ranking in recent years, but the issue remains a serious concern.
The state also has the worst indicators in the region for levels of exercise and nutrition, said Campbell. Three-quarters of the residents die from four major chronic illnesses--cancer, cardiovascular disease, lung disease, or diabetes--and many of those deaths are premature, according to the MCPH. Campbell said that prevention strategies are needed to impact behavior risk factors and reduce the premature deaths and disability due to chronic disease.
"Maine is a beautiful place with lots of natural resources," said Campbell. "Recently state political leaders have decided that they want to reverse historical trends and have the population's health match the strength of their natural resources."
The leaders' decision was fed by a serendipitous confluence of organizational efforts and a monetary windfall.
In
the past few years, Maine's public health advocates have become more organized.
MCPH and the state's Bureau of Health developed an intensive planning
project called Turning Point to develop recommendations for improving
the public health system. Funded by the Robert Wood Johnson Foundation,
the project helped establish 30 health districts in the state. In these
districts, coalitions of public and private organizations unite, said
Campbell. Initially they will address preventable chronic disease, but
eventually they will tackle a broad array of public health issues.
Nearly at the same time, the state was infused with new funding sources thanks to the Big Tobacco settlement. The money has allowed the state to pay for public health projects.
Campbell saw an opportunity to bridge his work at HSPH with his presidency of MCPH, forming budding collaborations between the school and the center. He approached Steven Gortmaker and Charles Deutsch, both in the Department of Health and Social Behavior, who direct Harvard’s Prevention Research Center. Theirs is one of 23 such centers funded by the Centers for Disease Control and Prevention (CDC) across the country. Traditionally, Harvard’s project has focused its efforts on Massachusetts in general and on Boston in particular.
But with the support of Gortmaker, Deutsch and Maine’s Bureau of Public Health, Campbell convinced the CDC to do something it had never done before—extend the purview of Harvard’s center to Maine, with the state’s Bureau of Health matching the CDC’s funds dollar for dollar. The money will be largely used for applied research, creating a scientifically rigorous, long-term program to improve nutrition, increase physical activity, and reduce obesity in Maine.
“We want to link these research initiatives to action and policy change,” said Campbell. “There is a real need to test and measure the effectiveness of programs and then to share that information with groups across the state.”
MCPH has also launched a five-year effort with HSPH and the Maine Bureau of Health to train a new group of public health professionals.
Campbell said training and education, as well as applied research activities, respond directly to a report issued by the Institute of Medicine in 1989 that served as a wake-up call of sorts for schools of public health.
The
report, The Future of Public Health, challenged schools of public
health to descend from their ivory towers and ground themselves in communities.
HSPH’s Division of Public Health Practice resulted from that call.
Now two of its leaders—Deborah Prothrow-Stith
and Leonard Marcus—are set to help strengthen Maine’s training
program. What started as a project to better the health of Maine’s
residents has quickly evolved into a fruitful partnership between HSPH
and MCPH.
“The collaborations are a two-way street,” said James Ware, dean for academic affairs. “They give us the opportunity to help Paul in his efforts to build a public health infrastructure in Maine, and they also give the school’s students and faculty a chance to engage in the practice of public health.”
MCPH and Maine’s Bureau of Public Health have made progress in the past year and a half--and just in time. Declines in income tax revenues and sales during the current fiscal year, along with increases in expenses, have led to a $200 million deficit in the state. To help close that gap, Maine’s governor recently proposed decreasing Tobacco Settlement funding for some of the prevention programs that just got underway.
In telling testament to what Campbell and his colleagues are accomplishing in Maine, public health advocates from across the state contacted their legislators and packed meetings of legislative committees to protest the proposed cuts. In response, both the state’s Health and Appropriations Committees have voted over the past week to reject the Governor’s proposals.
“That probably wouldn’t have happened a year ago,” said Camp-bell.
What is most important, he concluded, is that the state’s public
health infrastructure strengthens and that ultimately the people of Maine
get measurably healthier.
| Paul Campbell invites HSPH students and faculty interested in learning more about public health in Maine and MCPH to visit the center's website at www.mcph.org. Students interested in internships or other work through the center should contact MCPH Program Director Karen O'Rourke through the center's website. |
