Solutions to fight decline in life expectancy eyed

The cycle of poverty is a classic vicious circle. Unemployment leads to poor living conditions: inability to access educational opportunities, poor housing, the lack of choice that makes people feel they have little control over their lives, and substandard health care. Saying that Washington County is the economically poorest county in Maine is merely a label. When statistics speak, the poorest people know they do not lie.

A federal report titled "The Reversal of Fortunes: Trends in County Mortality and Cross-Country Mortality Disparities in the United States" was published in April 2008. Since then, directors of several local health care institutions have seized this report to promote an attack on the cycle of poverty. The third meeting in a series titled "Health Disparities in Washington County" will be held at the CareerCenter at 15 Prescott Drive in Machias on Friday, September 12, at 10 a.m.

Washington County is the only county in the Northeast that has shown increased mortality over the 40 years studied (1960-2000). This decline has been dramatic for women, particularly Native American women. To use local data and a recent World Health Organization report on world-wide disparities for contrast, a Passamaquoddy woman living in Indian Township has only a six year longer life expectancy than a woman in Botswana, which was ranked lowest in the WHO study at 43 years of age. On average, a woman in Japan lives 43 years longer than a woman in Botswana. The average longevity for women across the U.S. is 79. The WHO report was the result of a three-year study by the Commission on Social Determinants of Health.

While statistics in Washington County are influenced by the disparity between Native Americans and Hispanics on the one hand and white people on the other, the disparity between rich and poor in the county is not specifically along ethnic lines. Deficiencies in health services, housing, education and employment opportunities affect all citizens.

The first meeting in the county-wide series was held at Indian Township in July. The second, organized by Pleasant Point Health Center Director Sandra Yarmal, took place in the tribal offices on August 26. At that meeting, State Senator Kevin Raye asked if there were disparities in the county as a whole and was told by a member of the group that had met in July that the group and Dr. Dora Anne Mills, director of the Maine Bureau of Health, were endeavoring to find out.

Elizabeth Neptune, consultant for Indian Health Service for all the tribes east of the Mississippi, responded, "The data on state levels is very poor. Native Americans, who make up one percent of the population, are lumped in with others. Pooling all the statistics from all the tribes in Maine could be done if we decide what to look for."

Rep. Anne Perry, nurse practitioner on the staff at the Calais Regional Hospital, said she "went into the U.S. Center for Disease Control site and found that Maine is considered a white state. There is absolutely no information on minorities in Maine."

"We have to team up with Washington County," said Donald Soctomah, tribal representative to the state legislature. "Where there is no stable economy, we need to get the right type of services before the Health and Human Services Committee of the state legislature."

Recruiting doctors is another economic problem that has consequences for public health. Wayne Dodwell, president and CEO of Down East Health System (DEHS) in Machias, listed some recruiting difficulties: the isolation of rural life, especially for those who are single; competition (for example, $300,000 salaries in Massachusetts); and low economic support from government. Yet, he said, "I don't know if the hospitals would be here if they didn't have that support."

Rep. Perry noted that primary care, which is rated low as a specialty, is the greatest need. She cited "300 open physicians' positions in the state."

Dodwell noted the limitations of some of the remedies DEHS resorts to for hiring. "We use the J-1 visa program. They move on unless they have acclimated. We will also take somebody of any specialty who may have 'defects' in their background."

At the August meeting, much of the discussion devolved to health professionals seeking medical solutions. The meeting on September 12 is intended to bring together representatives from the health facilities in Washington County with representatives from state agencies that deal with economic development, employment, and human services.

In the words of Rep. Perry, "We need a healthy work force, but we need employment to get people health care. All of the counties in the U.S. that have the same problem, they're all in the rural South."

She went on to cite a documentary film, Unnatural Causes, and referred anecdotally to several cases of women aged 35-45 who did not have health coverage "at the time [they are most likely to] encounter health problems." Dodwell pointed out that good health arises from prevention, and said the axiom is: "Catch early, treat well."

Nakia Dana, assistant director of the Indian Township Health Center, asserted that one aspect of prevention was to perceive "the need for economic possibility." Diane Raymond, chief nursing officer at Down East Community Hospital, mentioned a community benefit: "51% of the people [in the county] received income from the government."

Rep. Perry asked for agenda items for the September 12 meeting and urged the group to set lines of communication with the state people who would attend so that plans carry forth. Neptune asked for a reporting from the state that would break out the statistics for the tribe and analyze the general economy, with special attention to health.

Also attending the August meeting were Andrea Driscoll, RN, quality manager for Calais Regional Medical Services, and Kirk Altvater, assistant director of the Pleasant Point Health Center.