I was amused to read earlier this month that Gov. Paul LePage spoke in his radio address of the importance of preventive medicine and public health efforts to keep people healthy and save health care dollars. This comes at the same time that he and his administration have been quietly dismantling Maine’s public health structure.

Dozens of positions at the Maine CDC, our state public health division, have been left unfilled for years and then eliminated in the 2016-2017 budget — professionals such as public health nurses, epidemiologists, lab scientists, and public health educators. Ironically, 24 of those 44 positions were federally funded; no state budget savings there.

Large amounts of federal prevention funds have been declined or left on the table. The administration declined a $500,000 per year, five-year grant already awarded to Maine for education and screening of colorectal cancers. Opportunities for funding in sodium reduction (a collaborative effort with hospitals and other institutions), lead poisoning prevention, home visiting, and testing of wells for arsenic were also declined, just to name a few.

The governor tried hard to redirect the millions of tobacco settlement dollars, held in the Fund for Healthy Maine for prevention-related programs, into paying for medical services in Medicaid and nursing homes. The Legislature sidestepped those moves, but less visible efforts to move settlement funds from prevention to specific areas of medical care have been successful over the years.

Healthy Maine Partnerships — the 27 community-based coalitions and organizations funded through settlement dollars to address such health issues as smoking prevention, obesity prevention, and physical activity — are essentially being eliminated with a new Maine CDC contracting process.

Classic prevention successes such as oral health, family planning, and home visiting have been severely diminished by budget cuts and workforce reductions.

Why does this matter? Aren’t we just right-sizing government and shifting priorities? Who needs all that federal funding anyway?

We do. Maine ranks quite low among the states in state funds committed to public health and prevention (ranked 33rd). To provide reasonable levels of protections for our citizens, Maine CDC became adept (ranked 11th) at securing federal funds for state prevention programs.

That’s also why advocates have been vigilant in trying to protect the Fund for Healthy Maine for public health purposes—because there is so little state money for prevention.

Moreover, Maine is unusual among states for its lack of local or county public health departments (other than Portland and Bangor). We do have an archaic collection of nearly 600 town health officers that are essentially voluntary — you know, those people in your town budgets that make about $100 per year and are sometimes also the animal control officer or the code enforcement officer. I was one for about 25 years. Although attempts have been made to improve their skills and connectedness to other public health efforts, it is hardly a “system.”

In response, Maine CDC spent years building up local public health resources through the Healthy Maine Partnerships and district health liaisons (state employees placed in nine public health districts). But apparently now, the administration wants to ditch the partnerships in favor of strengthening the roles of district liaisons.

I believe in the district liaisons and their important role. In fact, I sponsored the legislation that helped create them back in 2009. I believe that state health employees need to get out of Augusta and work in local and regional venues.

Healthy Maine Partnerships are not the only health resources in the regions — there are health care providers, school systems, social service agencies, first responders and others.

But the partnerships provide so many more “boots on the ground” to address community challenges like lead poisoning, substance abuse, lyme disease, or smoking. The district liaisons are a thinly staffed system that will coordinate fewer and fewer locally based prevention efforts.

There is a new view in Maine CDC that prevention is best done by the health care system— in primary care offices and hospitals. There’s no question that medical care providers have always been key players in a state with few public health resources. But can we really cram more preventive counseling into the day for clinicians who, under productivity pressures, are expected to see a patient every 15 minutes? And hospitals are already constrained by budget shortfalls from the failure to expand Medicaid — where are their discretionary funds for public health programs?

I recognize the need for Maine CDC to shift priorities and respond to emerging health threats, like the opioid crisis. We all want Maine to respond well to that challenge. But we should not permit our state health agency to allow other critical health needs to wither with scant staffing and funding. I fear that we are in a cycle of slashing government to demonstrate that it doesn’t work, so that we may slash it further.

Lisa Miller, of Somerville, is a former legislator who served on the Health and Human Services and Appropriations and Financial Affairs committees.

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