Local Columns
The Need for Public Health
By Robert G. Yandow
York Town Manager
Robert G. Yandow
While it seemed logical to me that the panel would consist of area city managers and a former county supervisor, I was somewhat surprised at the presence of the director of the Cochise County Health Department. I later learned that this was as a result of two factors. The first was that the mayor was a former deputy director for health policy for the state of New York and a former professor of public health; and the second factor was the significance and legitimacy attached to county health departments in the overall public health infrastructure in Arizona.
Being a Vermont native, the emphasis on county government was new to me as New England does not typically embrace a strong county government structure. Now that I have been back in New England for 15 months managing a town facing various health-related issues, I find myself more appreciative of the benefits of county and/or regional health organizations. Having said that, I am not an advocate for enhancing the strength of county government in Maine; rather, I am advocating for enhancement of the public health system in Maine.
The state of Maine does not have a viable public health system. In a June 2006 article in the Maine Townsman authored by Lee Burnett, Dr. Dora Mills, director of the Maine Center for Disease Control and Prevention, was quoted as saying, "We don't have a public health infrastructure and we did have one 100 years ago."
I learned this firsthand in February of 2006 when I was in search of assistance concerning the Eastern Equine Encephalitis (EEE) situation in York. My overtures to the Maine CDC were met with some congratulations for being proactive, but that was tempered by the statement that the only funds they had for mosquito-transmitted diseases was designated for surveillance and testing and that they were not in a position to offer any advice as to our proposed prevention efforts. I was essentially told that we were on our own regarding any prevention programs.
Fortunately, the voters approved an expenditure of $65,000 for a mosquito control program for fiscal 2007, the current fiscal year. For fiscal 2008 I am working with our mosquito control vendor to establish a model program that will address mosquito-borne and tick-borne diseases. This program will expand upon established mosquito control techniques to include tick-borne diseases such as Lyme disease and will include a public education component. This model program is included in a new public health line item in the proposed fiscal 2008 budget.
Torbert Macdonald Jr., in his recent letter of resignation from the Board of Selectmen, referred to "our scant public health infrastructure." There is no evidence to contradict Mr. Macdonald's assessment. The public health infrastructure in Maine consists of the Maine CDC and a scattering of local health officers (LHOs). The lone exceptions are the communities of Portland and Bangor, which have professional health departments, although Portland is the only community with a true public health department.
Some county emergency management agencies have started to address some health concerns, but the emphasis remains on the local health officers. York does not have a medical health officer and I'm told has not had one for over 15 years. Our code enforcement officer acts as our health officer as it relates to septic system and housing situations, but is not in a position to address infectious disease situations. In a June 2006 survey sent to each local community by the Maine CDC, 196 local health officers responded. Of these 196 responders, 152 indicated they worked less than five hours a month. In addition, 121 indicated they had received no local health training and 102 indicated that regional health officers should be appointed to either replace the local health officers or to assist local health officers.
The most pressing example of the absence of a viable public health system in the state is illustrated by the threat of a pandemic influenza outbreak. The Maine CDC has an excellent website concerning the flu in Maine, www.maineflu.gov/pandemic.html, which is a good resource for those that actively seek out information. Beyond that, there is not much assistance available in the practical sense. The York County Emergency Management Agency has been helpful in terms of model pandemic plans; however, they are not a public health department. There simply is no infrastructure in place to address this major threat. Communities are basically on their own for planning and response activities.
A group of us in York have been meeting for quite a few months to engage in pandemic flu planning. We are probably ahead of many communities, but not as advanced as some. Due to the absence of state and regional visibility regarding the potential pandemic, I fear that some individuals and businesses are dismissing the threat as unlikely and that, in my opinion, is a mistake. A Feb. 7 article in The Wall Street Journal states that the H5N1 avian flu virus will not be the last new influenza virus to develop. Author Peter Zimmerman states, "Even if we may have dodged the H5N1 bullet, another pandemic like the Spanish flu is inevitable and could break out into the human population so quickly that vaccines cannot be produced in time." A subsequent article in the Journal on Feb. 16 claims that there is, indeed, a vaccine available right now for the H5N1 virus but the vaccine has not been approved. The dilemma faced by the drug companies is whether to produce H5N1 vaccines at the expense of seasonal flu vaccines, given that seasonal flu kills some 36,000 people annually in the United States alone.
While the discussion takes place at the global, national and state level, the impact will be felt in every community in Maine. Most communities do not have the resources to dedicate to public health. Improvements to the state and regional infrastructure must be made to ensure the health of our citizens. This is not meant to be critical of the Maine CDC. Their resources are limited as well.
Two legislatively appointed groups are working to develop a public health system according to the June 2006 article in the Maine Townsman. One group is working on the health and human services side and the second is working on the homeland security/preparedness side. It is projected that the groups will mesh their work at some point in the future. One of the developing plans calls for hiring trained public health officials in each county at a cost upwards of $2.5 million. I look forward to the results from these study committees and any subsequent action by the legislature to improve the public health system in Maine.
