It takes a partnership to prevent chronic diseases

By Robin Mayo, R.N.

    The Healthy Maine Partnerships are proposed to be eliminated by Gov. Paul LePage’s budget proposal. As a fellow Republican and a registered nurse I am extremely disappointed in the Governor’s proposal to dismantle the historically successful public health infrastructure that has proven successes in combating the three major risk factors associated with preventing chronic disease. This has been accomplished by utilizing evidence-based strategies to improve nutrition, increase physical activity, and decrease tobacco use (all of which are preventable risk factors for chronic disease).

    Without health promotion and disease prevention efforts chronic disease will continue to grow and health care costs will continue to rise. Healthy families are the key to a healthy economy. When people are healthy, children do better in school, workers are more productive, families have more money in their wallets, and businesses can add jobs because their health costs are lower.
    I recall working at St. Joseph Hospital in Bangor in the mid-1980s and talking with a seasoned intensive care registered nurse who said to me “I’d be out of a job if people quit smoking.” A majority of those people being treated in the Intensive Care Unit at that time was the result of long-term tobacco use. The Healthy Maine Partnerships since 2001 have decreased youth smoking rates by 48% and decreased adult smoking rates by 24%. This means big savings because cigarette smoking costs $811 million annually in direct health care costs.
    I first became involved in prevention after some years working with hospitalized patients who had multiple chronic conditions and the only recourse was to treat their symptoms with little time to provide time for counseling sessions to quit smoking or improve their nutrition or to provide increased opportunities for physical activity. I think we have an opportunity to decrease the costly impact of these preventable chronic conditions by altering individuals’ behaviors and we have a trained public health workforce that is working diligently with limited funding to do just that.
    There is a role to play within the various health care settings and to assume any one entity can be the “be all, get all for health care needs” is not wise. The hospitals and primary care provide a role, but without health promotion and disease prevention efforts hospital and primary care costs will continue to rise and individuals with multiple chronic conditions will require more healthcare dollars to treat their combining chronic symptoms.
    Forcing a choice between disease prevention and primary health care is creating a false dilemma for policymakers. Investing in primary care to treat illness is important, but it should not be at the expense of community public health systems that help prevent tobacco use and substance abuse, support physical activity, and healthy eating, provide education and health promotion programs, and encourage local policy and environmental change.
    It’s not realistic or accurate to suggest that Maine’s primary care doctors can or will deliver the full range of critical disease prevention and health promotion programs currently being provided through Maine’s public health system. It’s irresponsible and unfair to ask primary care providers to take on functions best performed by community health networks. They must co-exist to be effective and efficient.
    I think of Maine’s public health infrastructure as an effective tool to “teach people to fish” to meet their health care needs. “Give a man a fish feed him for a day; teach a man to fish and you feed him for a lifetime.” This proverb can be applied to individual health care “Treat a person’s symptoms make them feel better for a moment; teach a person positive healthy behaviors and implement long-term public health policy and environmental changes and keep them healthy for a lifetime.”
    The value added to our local communities by the Healthy Maine Partnership (HMP) system is difficult to measure all their successes. HMPs provide responsible beverage seller server trainings and responsible tobacco sales training to employers and their employees. Parents Who Host Lose the Most campaigns and getting youth engaged in Sticker Shock programs create awareness to the importance of preventing underage drinking. Drug Take Back initiatives have removed hundreds of pounds of prescription drugs annually from our communities that could easily end up in the hands of our youth and residents. HMPs work with local health care providers to engage them in the Prescription Monitoring Program, to help them better monitor prescription drug use of their patients, provide nutrition education to low-income families, work closely with schools and worksites to improve nutrition and physical activity policy and environmental changes within the school and work environments.
    Keeping the Fund for a Healthy Maine working to prevent disease and promote good health is our best opportunity to support healthy families, lower costs for businesses, and help young people stay in Maine. We don’t have to choose among keeping Maine’s public health infrastructure intact, helping kids resist tobacco use, and supporting primary healthcare. We can and must do all three. Success is only possible through a comprehensive effort which includes prevention, early detection and treatment to improve public health and reduce health care costs. Keep the Fund for a Healthy Maine working as it was intended – helping smokers quit, giving kids a healthy start, supporting new parents, helping families get active, teaching students about healthy choices, and delivering community public health in every community in Maine. We need to continue to utilize our HMPs to make the healthy choice the easy choice in Maine.
    Robin Mayo, RN of Milo is the Penquis Public Health District representative to Maine’s Public Health State Coordinating Council.