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Jul 07, 2019

Decades of Health Gains Lost After Cutbacks in Low-Income, Rural Maine

Study suggests continued health programming is needed to reduce health disparities in low-income communities.

Since taking away valuable resources and programming in a rural Maine county, improvements in smoking and mortality rates have disappeared, based on a recent study published in JAMA Network Open. According to authors, findings highlight the need for continued health promotion programming to improve outcomes, particularly in low-income areas.

Conducted by researchers at the MaineGeneral Medical Center, this study tracked health outcomes among individuals living in Franklin County, Maine. Franklin County is a low-income, rural area that was identified as having poorer health than other communities in the state back in the 1960s. At that time, it received significant support to improve health care quality and access, which resulted in the creation of a community action agency, nonprofit medical group practice and a community hospital. The added resources had significant benefits on public health.

According to a 2015 report, these efforts helped reduce rates of smoking, high blood pressure and high cholesterol—all of which can lead to heart disease. Mortality rates and hospitalizations also declined, helping close the gap between outcomes in Franklin and other counties in Maine.

These benefits didn’t last forever, however, once funding was cut. Based on the recent analysis published in JAMA Network Open, the gains once achieved in Franklin County have dwindled following changes in leadership and resources.

The analysis compared smoking and mortality rates in Franklin County with other Maine counties from 1971 and 2015. Data came from a number of sources, including the U.S. Census Bureau American Community Survey and the Centers for Disease Control and Prevention’s mortality files and Behavioral Risk Factor Surveillance System.

The new study included an extra five years of data, since the last review was published in 2015. With this update, researchers found that the gains achieved from 1986–2005 had disappeared by 2006–2015.

What that means, according to authors, is that the benefits of public health interventions don’t last forever. Efforts to enhance quality and access to health care helped improve outcomes while they were implemented in the low-income county of Franklin. However, these benefits declined once programming was stopped, based on study findings.

For this reason, experts highlight the need for continued programming in rural, low-income areas like Franklin County. Education about a healthy lifestyle and access to quality health care are critical to promoting better health. Based on findings, these efforts must be sustained to help close the gap on health disparities in underserved, low-income communities.

Questions for You to Consider

  • What are health disparities?
  • Health disparities refer to differences in health outcomes or burdens of disease between groups of people. Health disparities can exist between different populations of race, sex, income, or even geographic location. In health care, the goal is to eliminate these differences so all individuals have the same ability to achieve good health.

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