Somerset County adults are more likely to smoke and to be fat than adults of any other county in the state, two of the key factors that led to its dismal showing in a statewide ranking of Maine’s counties, by health.

Other counties in central Maine are healthier, with Waldo ranked 10th, Franklin eighth, and Kennebec seventh among the state’s 16 counties, according to national county rankings released Wednesday by the Robert Wood Johnson Foundation, a philanthropic organization devoted to public health.

People in Maine’s low-ranking counties are still better off than those in many other areas of the country because Maine is the ninth-healthiest state in the nation, according to the foundation.

The three healthiest counties in the state are Hancock, Cumberland and Sagadahoc, in that order. The study did not rank counties nationally, however.

Somerset County’s poor showing explains why its residents are more likely to die of a heart attack or lung cancer than anywhere else in Maine, a state expert said.

The underlying cause is poverty, experts said, with poor people more likely to be obese and smoke.

In Somerset County, more than 1 in 3 adults, or 35 percent, are obese, compared to a statewide average of 28 percent, according to the foundation.

That percentage has risen dramatically since 2004, when the county and the state averages were the same, about 24 percent.

Smoking rates are also high in Somerset County, with more than 1 in 4 adults, or 26 percent, smoking. The statewide average is 19 percent.

The number of smoking adults, however, is decreasing in Somerset County and across the state, a county health advocate said.

Obesity and tobacco use are “the biggest contributors to people being sick or dying earlier,” according to Tim Cowan, of MaineHealth, a statewide group of health care and health advocacy organizations.

About a third of cancers are linked to tobacco and a third are linked to obesity, Cowan said.

Cowan said Somerset County’s high smoking rate is why people there are more likely to die of lung cancer than anywhere else in the state.

In Somerset County, 70.5 per 100,000 people died of lung cancer, the highest rate statewide and significantly higher than the state average of 59.1 deaths per 100,000, according to the Maine Center for Disease Control’s 2012 annual cancer report.

Somerset County joins Franklin County as having the highest mortality rates because of heart attacks, according to a 2011 MaineHealth Index report.

Deadly poverty

In Somerset County, 18.6 percent of the population lives in poverty, the second-highest rate in the state, according to a 2012 report on poverty by the Margaret Chase Smith Policy Center.

That fact, more than any other, contributes to the high obesity and smoking rates, experts say.

Somerset County is just one example of many poor, rural counties with poor health, said Bill Primmerman, director at the Greater Somerset Public Health Collaborative.

“When you look at public health, the economic climate of the community has a lot to do with the health of the community,” he said, in part because people in poverty are less able to afford healthy food and less able to access exercise options.

Cowan said Somerset County smokers aren’t ignorant about the link between cigarettes and death, but they have a harder time quitting.

“It’s not as if they don’t want to quit. Most of them are trying,” he said.

More than half of Maine smokers, rich or poor, have tried to quit during the last 12 months, Cowan said, with poor smokers making the effort as often as their well-to-do counterparts.

Poor people don’t succeed as often, he said, because smoking is more widely accepted in social groups.

“If you’re trying to quit, and you’re hanging out with a group of people and some of them are smoking, it’s a lot harder,” he said.

A brighter future

Primmerman said the trend on smoking rates in Somerset County is cause for optimism.

“Smoking rates in our county have gone down from 33 percent over time,” he said.

Primmerman said a coalition of public health groups are making progress and that he expects the numbers to continue to improve over time.

“Change is definitely going to take time, which is the challenge in rural counties across our country,” he said.

The coalition has seen many successes in recent years, he said, including working with small-scale employers to improve employee health, providing public transportation to people who have access problems, and a dental health program.

The county rankings will further help direct future public health efforts.

“This is one of the ways we measure our progress and look at what we could be doing better,” he said.

Giving that perspective is the whole point of releasing health rankings, Abbey Cofsky, a senior program officer for the foundation, said.

“We rank counties because we believe there is an opportunity to change within communities,” she said. “It’s really just empowering people with the information we need.”

Cofsky said Somerset County is still better off than many counties in the country.

“Overall Maine is one of the healthier states,” Cofsky said. “Maine ranks ninth overall. That is an important piece of context.”

Cofsky said that the solution to obesity and smoking rates in a community comes from the active involvement of many different sectors of society, including schools, government, doctors, employers and individuals.

“We all have a stake in this,” she said.

Matt Hongoltz-Hetling — 861-9287
mhhetling@centralmaine.com