Residents of Jackman who want mental health counseling or hospice care have to go somewhere else to find it.
And doctors to provide those services aren’t flocking to Jackman — or any of rural Somerset County’s other communities.
Anyone who lives there knows it, and now the numbers support it.
Somerset County, in the northwest-central part of the state, has the least number of physicians, dentists and mental health professionals per capita in the state, and it also has the highest rates of smoking and obesity, according to a study released Wednesday by the Robert Wood Johnson Foundation, a nonprofit organization dedicated to public health. The study ranks every county in the United States on a variety of health care factors, including quality of life, health behavior and clinical care.
Hancock County tops the state’s 16 counties with the best overall health, while Piscataquis was last. Kennebec County ranked fifth and Franklin County, eighth.
Among states in the U.S., Maine ranks 16th.
According to the rankings, Somerset County has 1 primary care physician per 1,858 residents and 1 dentist per 5,263 residents. The state average is 1 primary care physicians per 935 people, and 1 dentist per 1,862 people.
A new category in the rankings this year, the number of mental health care providers, also does not reflect well on Somerset County, which has a ratio of 1 mental health care professional per 1,196 residents. The state average is 1 per 351.
Somerset County’s characteristics are similar to those of other rural areas in the U.S., said Bridget Catlin, director of county health rankings and a senior scientist at the University of Wisconsin Population Health Institute, which collaborates with the foundation to put out the rankings.
“Rural counties in general are not as healthy as people usually expect. People have this image of clean air and good living, but unfortunately rural areas can struggle with some of the factors that most influence health, things like education, income and jobs,” said Catlin.
In Somerset County, 18.2 percent of the population lives in poverty, about 5 percentage points more than the state average of 13.3 percent, according to the U.S. Census Bureau. The number of children living in poverty also has increased since 2010, the first year the rankings were done, from 22 percent to 26 percent.
In general, the new 2013 data show little change from the 2012 rankings by the foundation, but that’s because changes in health care can be slow to implement and require time, according to Bill Primmerman, project director for Somerset Public Health, a countywide task force that looks to implement policy and environmental changes in the health care of communities.
“Our socio-economic conditions and access to care are two major factors that play into the health of our citizens. They are also two things that it takes a lot to address and overcome,” Primmerman said.
State data that predate the rankings show there have been some long-term improvements in health, although the county is still behind most of the state. For example, the teen birth rate in 1999 was far higher than what it is today. According to data from the state Department of Health and Human Services, there were 80 births by mothers ages 15-19 per 1,000 females in 1999. In 2013, that number dropped to 37, although it remains higher than the state average and has not changed since 2012.
Somerset County also has the highest rates of adults who smoke and who are overweight in the state. According to the rankings, 26 percent of adults smoke and 33 percent are overweight.
Most health resources in the county are concentrated in the southern part, where the larger communities of Skowhegan, Fairfield and Norridgewock are.
Geographically, it’s the third-largest county in the state, stretching north and west from just past Waterville to the border with Quebec.
Access particularly to mental health care becomes more difficult the farther north in the county a person lives,according to Lynn Duby, the CEO of Crisis and Counseling Centers, a nonprofit organization that responds to the health and substance abuse problems of residents in Somerset and Kennebec counties.
The problem is often an economic one for health care providers, for whom it can be expensive to send professionals to remote parts of the state to provide services, she said.
Most health care agencies are reimbursed for their services, either through insurance or MaineCare, which pays for each hour of counseling provided, but would not reimburse a health care professional for time spent traveling.
“If you have to put a health care professional in a car and have them drive two hours to where they are going to see a patient, you’ve lost two hours of billable time on the way there and two hours coming back,” Duby said. There are also few locations for out-of-town professionals to provide services and not enough of a critical mass to sustain the services of a permanent professional.
“It’s very difficult to recruit people to that area and expensive to have them there, given the limited number of people. Yet it’s badly needed,” said Dawn Cook, chief practice officer for Penobscot Community Health Care, a network of health care providers that oversees the Jackman Health Center.
One place in the county that’s shown improvement is in Jackman, population 700, one of the county’s northernmost communities.
In December, the Jackman Health Center got a grant of $450,000, establishing it as a federally qualified health center. Federally qualified health centers, which exist around the country, get yearly funding to maintain primary care services in underserved areas. The program is administered by the U.S. Department of Health and Human Services.
The grant has made it possible for the Jackman Community Health Center to expand hours and add walk-in care.
On Monday, it also added dental service, the first in the town.
Two days a month a team consisting of a dental hygenist and a dental assistant travel from Bangor and set up in the local school for cleanings, Cook said.
“It’s been helpful to people and a very positive move. There is a lot of energy in the community around bringing a full-time dentist there, and it’s something we would consider in the future,” Cook said.
Bingham, south of Jackman on U.S. Route 201, opened a dental clinic in late 2012. The town’s dentist, Tamara Diamond — the only one in the area — previously had conducted her practice in a single room in the back of the Bingham Health Center. It took the town 10 years to raise the money for the separate dental area.
In Jackman, the health center also is working on getting mental health and hospice services, Cook said.
One emerging solution countywide when it comes to access to mental health care is providing services via electronic media, which are becoming increasingly common in rural areas, Crisis and Counseling’s Duby said.
Setting up interactive television either in a home or in a health center can make it possible for patients in rural areas to communicate via television or computer to professionals in other locations, she said.
“It’s easier with some services than others, but I think the whole health care services system is starting to do more of that as a way of providing a level of service to rural areas where there’s so much distance and there isn’t a critical mass,” Duby said.
The goal of the rankings released Wednesday is to inspire action on how to make communities healthier and reduce numbers of intensive health problems.
An additional factor that is used in calculating the rankings is the number of uninsured people, which Catlin said those who put the study together hope will decline with the implementation of the Affordable Care Act, although it will take more than health insurance to improve how people feel day to day.
March 31 marks deadline for most people to sign up for the act before fines kick in. So far in Maine, 25,412 people have signed up, according to the U.S. Department of Health and Human Services.
“Preventative care is one of the big pieces of the Affordable Care Act that is provided at no cost to people. It doesn’t change the need to get to a primary care physician, but it will hopefully make a difference in the number of higher-risk health issues that need to be seen,” Primmerman said.
Rachel Ohm — 612-2368 firstname.lastname@example.org