Written by Andrew Coburn, PhD, Research Professor Emeritus, Muskie School, University of Southern Maine and Deborah Deatrick, MPH, Public Health Consultant
With funding from the Maine Health Access Foundation, we have recently completed a report that calls for a rural, community-based demonstration to test better ways of aligning funding and services to address health-related social needs (HRSNs). We believe that despite the state’s economic and demographic challenges (exacerbated by the pandemic), Maine is at a positive tipping point to move “upstream” to develop and test a regional approach to improve individual and community health that builds on and amplifies local energy, resources, and experience.
HRSNs are a subset of the Social Determinants of Health that have come to be recognized as major contributors to poor health outcomes among patients and excess costs in the health care system. Nowhere have the effects of HRSNs been more evident than in rural communities in Maine where individual factors such as race and ethnicity, age, income, education, and chronic disease are compounded by social and environmental factors to produce significant health disparities. As one of the most rural states in the U.S., with almost two-thirds of our residents living in rural areas, we Mainers know what makes us healthy – or not. Yes, we want a hospital or health clinic within a reasonable distance when we need it, but it’s the social and economic needs that challenge the health of rural people and communities. The lack of affordable, safe housing. Food deserts. Limited or nonexistent public transportation. Widespread substance use with few accessible treatment options. Contaminated drinking water in our wells. These and other social, economic, and environmental needs are responsible for the vast majority (80%) of factors that contribute to our individual and community health.
Maine has many resources and assets that could form the foundation needed to demonstrate new community-level approaches to address HRSNs. Strong community partnerships in many communities, innovative Medicaid policy reforms, prior investments by philanthropy to build community health coalition capacity, workforce innovations (Community Paramedicine, community health workers, care management), a functional statewide Health Information Exchange, and more than a decade of experience with the Maine Shared Community Health Needs Assessment all provide experience and a platform for building more effective community-level systems of care.
COVID 19, the addiction epidemic, and other public health crises have highlighted the impact of individual and community-level social needs on the health of Maine people. They have also revealed and exacerbated long-standing inequities in access to health and social services among vulnerable and often marginalized populations in the state. Although these problems are not new and have long been acknowledged by both health care providers and community-based organizations (CBOs) in rural Maine, what IS new is a growing interest in addressing the underlying causes and systems. Throughout Maine and elsewhere, health care, public health, social service, and other CBOs are working to build an infrastructure of collaboration and service coordination and integration to address HRSNs that impede equitable access to health care and contribute to poor health outcomes.
The influx of substantial new Federal resources to strengthen our public health capacity and respond to long-standing inequities in Maine, combined with robust local community-based partnerships, make this a perfect time to demonstrate new, system-building strategies to better align funding and services to address HRSNs. Experience and insights gained from such a demonstration will not only improve the health of rural Mainers but will provide a valuable roadmap to system transformation.