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Health

Here's how Maine is trying to tackle health disparities highlighted by the COVID-19 pandemic

The COVID-19 pandemic highlighted some of the social disparities in health care and risk among the nation's various demographics.

In Maine, the CDC has been working to address some of those disparities during the pandemic, but it's hoping to make a bigger impact with its new Office of Population Health Equity.

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Ian Yaffe (manomaine.org photo)

It's led by Ian Yaffe, who spent years working on behalf of farm laborers and migrants who support Maine's agricultural industries such as blueberries Down East.

Maine Public's Jennifer Mitchell spoke with Yaffe about his new role and what's on his agenda.

This transcript has been lightly edited for clarity.

Mitchell: So Ian, the Office of Population Health Equity, what's the idea behind that, and is it the first time we've done this or not?

Yaffe: So at the core, the Office of Population Health Equity is built around the idea that the health care system is designed around the needs of the majority. And this can produce disparities within specific communities, intentional or unintentional. This office used to exist in Maine CDC and was called the Office of Minority Health. And so establishing the office again, as the Office of Population Health Equity means that we'll be focusing on a broader set of concerns and disparities and working with community leaders, including racial and ethnic populations, but also women LGBTQIA+ individuals, individuals with disabilities, and really any other group of people that we see disparities in health outcomes for.

So did the pandemic just make these disparities more obvious to more people? Are there any lessons from the pandemic that can inform the work going forward?

So some of the things that we've learned are that COVID-19-related health disparities are inextricably linked to complex and widespread health and social inequities that put many communities, including racial and ethnic groups, and people living in rural communities, at higher risk of infection, exposure, hospitalization and mortality from COVID. And so at the very basic level, we believe that we have to strive for the highest possible standard of health for all people, and make sure that there's special attention to the needs of those who are at greatest risk of poor health based on social conditions.

How are you going to go about setting priorities for the office? It's a wide number of demographics that you're wanting to serve and look into — do you even know what the priorities are yet?

Our goal here is really to center communities that are directly affected. So whatever it is that we're alternately working on here, it's not about what my vision is, or what I see the needs are, there isn't going to be one set way of doing this, mostly because we know that communities are unique. Relying on there to be one strategy is one of the things that helps produce disparities in the first place, because it ignores the unique needs that community members face.

So lots of stakeholder participation. And you'd also told me earlier that a website is planned as well so that individuals can also participate. What about the barriers? What are some of the barriers that are perhaps keeping some populations at a disadvantage? How did we get here?

There are a ton of reasons how we get where we are right now. I think, at a very basic level, our goal through this office is to examine more of the impact of policies, rather than focusing on the intent. And so we know that sometimes in policy and in systems design, there may be unintended consequences, there may be disparate impacts that were not intended, and that are unique to specific communities. And so through that lens, we might need to look at filling gaps. Our most important priority is to look at those root causes, especially those root causes that are related to race, class, ethnicity, and gender, and to prevent gaps from occurring in the future.

What about climate and the environment? You know, one of the emerging discussions across the country seems to be about the role that environment and climate are playing in these issues of disparity and demographics and health. Is that likely to be part of the discussion at all?

I imagine that will be something that comes up in our conversations with community leaders. We know that there are both longstanding impacts of environmental-related emergencies among the communities that we're talking about, particularly with people of color. I would expect that that would come up because all of these things connect together. You can't really look at health care, separate from environment, separate from social conditions, separate from race, class, ethnicity and gender. And so our goal is to be able to have that conversation in a way that is much more proactive than anything that we've done before.