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Health

Maine CDC Reestablishing Health Equity Office After Pandemic Reveals Stark Racial Disparity

Nirav Shah
Robert F. Bukaty
/
AP
Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, speaks at a news conference Monday, March 16, 2020, in Augusta, Maine.

Last week, the Mills administration announced that it was establishing an Office of Population Health Equity within the Maine CDC. Its mission, according to the state, is to “identify and address health disparities” for certain populations, including women, LGBTQ communities, racial groups and people with disabilities.

For years, the office had existed at the Maine CDC under different names, such as the Office of Minority Health. But it was dissolved in 2015 by then-Gov. Paul LePage.

Some of those inequities have become particularly glaring during the coronavirus pandemic, as Black and African-American residents have been disproportionately infected by the virus: even though they make up just 2% of Maine’s population, they at one point accounted for more than 20% of the state’s confirmed coronavirus infections. That figure had fallen to less than 5% as of this week.

In some immigrant communities, advocates have attributed the higher rates of infection to the fact that many people of color live in dense housing and work in jobs such as cashiers, health care and manufacturing where it can be hard to social distance. Language and cultural barriers have also made it harder for those communities to access resources to blunt the spread of the virus.

During a news conference on Tuesday, the state’s two top health officials said that they had been planning to restart the health equity office even before the pandemic, but that the crisis has made the need for it abundantly clear.

Jeanne Lambrew, commissioner of the Maine Department of Health and Human Services, said that reestablishing the office is a step toward addressing the state's inequities: "Not the only step, but one step we could take to begin to tackle the different kinds of disparities — racial, ethnic, different types of orientations, rural Mainers. We have inequities in our system.”

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said the funding coming to Maine through the American Rescue Plan Act recently passed by Congress has allowed the state to “take the blueprints we had” for that office and “actually build them out.”

The Mills administration is now working to hire a director for the recreated office. It says that the director will “have a key leadership role at the Maine CDC,” reporting directly to Shah, and “will have the opportunity to add additional staff.”

For more on the announcement and its potential impact, Maine Public's Robbie Feinberg spoke with Lisa Sockabasin, director of Wabanaki Public Health and director of the state CDC’s office of minority health from around 2006 to 2015.

This interview has been edited for clarity.

Feinberg: So first, can you give us an overall picture of this office within the Maine CDC? What function does it serve, and what sorts of initiatives did the office lead while you were there?

Sockabasin: The office often was the office and the connector to groups that we wanted to reach out to, and that we knew, for lots of reasons, were vulnerable, and that we needed to be responsible for reaching out and building relationships with those communities. The Office of Minority Health really was focused on those relationships and making sure that we were hearing from all voices.

So this office hasn't been functional for about six years at this point. What effect do you think the absence of this office has had on the state's public health priorities and its response?

Well, what I do know, Robbie, is that having the presence of an Office of Health Equity, Office of Minority Health, whatever name that they have chosen, really is one of the key strategies for addressing systematic racism that we all know exists. And it exists and it is alive every single day. So what are the impacts? What I would say is it's been six years, racism does not take a year off, it doesn't take a month off and it doesn't take a day. Racism is in our system, and it needs to be attended to by us, it is our responsibility. So I am happy that they are moving forward to have an office. But I would say the absence and presence of those voices within systems that we know racism is inherent, there's an impact. What that impact is, I think, is a conversation that we should be having in the communities that are most impacted.

One of those conversations that really bubbled up last summer was when data showed that Maine had the largest racial disparity at the time in terms of those contracting COVID-19. Do you feel that an Office of Population Health Equity would have made a difference in terms of addressing those disparities?

Absolutely, that presence is powerful. Having an office whose sole purpose is to educate about what issues are concerning the populations who we know are the most vulnerable, for lots of different reasons, is critical in that process. Those voices could have been heard earlier, those voices could have been heard more often, and the sense of urgency would have been felt. And so, of course, it's hard to look back, but what I can say is that having an office that is focused solely on addressing these areas of systematic racism, racism that we know is within our systems, is deeply important. And an office alone, I also want to say, can't address all of it. This is one strategy of many that the state should be considering when addressing issues of longstanding generational disparities based on race, based on ethnicity, based on GLBT identification. There's lots of communities that are struggling with existing persistent health disparities that we are responsible for addressing. And this office, along with other policies and support from administration can really make an impact and I'm excited to see what they can do.

What kinds of additional supports and resources would you like to see from the state going forward in order to address these disparities and issues that you've talked about?

That's a good question. What I am curious about and what I am hopeful for, is that this position is supported. That this office that is going to be created is an office, and not an office of one but a team, a team that can tackle some of these challenges in ways that are thoughtful and that are strategic, working in collaboration with the communities most impacted. I would also say the budget matters. If the budget is just inclusive of the salary of the position, then that's not even close to being enough. Actually, it is setting that system up for a lot of frustration for that individual taking that position. So the budget associated with this office is critically important so that they can do the great work that they can do. The other thing I would say is, at what level is this position within the administration? That's also important. What capital, what connections, what voice do they have in those strategic decision conversations that happen on a daily basis? And it matters having the voice of somebody who is skilled in racial and ethnic disparities at that leadership table.