By A.M. Sheehan
NORWAY — Do you like learning how to cook healthy meals from fresh produce at the farmers’ market? How to eat healthy on a budget? Help with substance abuse prevention? Help quitting smoking? Being part of a wellness collaborative? Raising the county from least healthy in Maine? Learning how to prevent lead poisoning? Help with gambling issues?
All of these and more are brought to the community, free of charge, by Healthy Oxford Hills.
Or at least they have been.
Healthy Oxford Hills (HOH) now faces extinction because of state cuts that are aimed at eliminating Healthy Maine Partnership (HMP) organizations of which HOH is one.
In the beginning
For the past 15 years, the HMP system has provided the local public health infrastructure for the state, according to HOH Director Jim Douglas, who says the HMP system in Maine is rare and more community-based than anywhere in the country.
“It’s grassroots driven,” he says.
He tells of how HMP and HOH came to be.
“At the time of the tobacco settlement in 1999/2000,” Douglas explains, “wise people in the state knew this compensation would be coming. Maine was only one of three states that decided to devote the funds to prevention.”
Douglas explains that Maine issued a request for proposals under the Department of Health and Human Services tapping the network of healthy community coalitions. Norway was part of a community health coalition for 10 years prior to this, and only these coalitions could apply.
Douglas states that 27 were funded and they became Healthy Maine Partnerships. Based on population, the Oxford County’s HMP partners are River Valley Healthy Communities Coalition and HOH. HOH covers the southern tier of the county encompassing 13 towns.
Funding went straight to the HMPs.
Then, he continues, around 2012, the state public health distribution system came in effect and HMPs were clumped with a lead HMP for each district. In the Western Maine District, River Valley became the lead.
Although originally HMPs targeted tobacco use, over the years they added substance abuse prevention, obesity and nutrition, work-site wellness, cancer prevention and capacity building – building local coalitions.
HOH, says Douglas, is a coalition itself, partnering with hundreds of entities.
“We have created strategic partnerships for special grants,” he explains, “such as Stephens Memorial Hospital for tobacco, diabetes and walking programs; SAD 17 and New Balance to create the Riverside Trail, physical activities and programs and policy around tobacco, substance abuse, wellness and healthy eating; the Oxford County Wellness Collaborative where HOH is the ‘administrative home’ for the collaborative. This is building capacity … bringing people together.”
HMPs are so much larger than just the original tobacco-funded work, says Douglas. The other half of HOH’s funding comes from other grants, such as SNAP-ED.
“We have Kate Goldberg and Sarah Carter who split a position. Their work has put our SNAP-Ed program in the top 25 percent of the state,” he says. “They have thousands of contacts with kids and adults. They teach healthy eating on a budget in schools, Head Start, at the farmers’ market and through adult classes.”
Other grants HOH has, Douglas says, are from three different philanthropies: Maine Health Access Foundation (MeHAF), the Bingham Program and the Betterment Fund.
Douglas explains that state funding comes in five-year funding cycles that are renewed annually with supportive reporting and paperwork.
“We are mandated by CDC as to how we spend and what programs we can use the funding for. For the past 15 years,” he sighs, “each five-year cycle has seen a decrease in funding … the state receives $40 to $50 million annually in the tobacco settlement, and the HMPs get only $7 million for prevention [divided among them statewide].”
Then, without warning, everything changed. As of this year, says Douglas, instead of CDC issuing an RFP in October, “giving us time to prepare, it was issued this spring and it was completely restructured, eliminating funding for obesity, worksite wellness, school policy and cancer prevention.”
This, he says, is in spite of data showing, for example, that school districts working with HMPs showed a significant change: more kids didn’t smoke or do drugs and were eating healthier.
Instead, the state took all the funding that had supported HMPs and funnelled it into four domains: tobacco, substance abuse/opioids, youth engagement and empowerment and prevention (mass) messaging.
Further, and most damaging, says Douglas, it required that whatever organization applies for one of these four funding options must have statewide reach. Consequently, none of the HMPs are eligible to apply as the nature of an HMP is to target a regional area.
“Large organizations like MaineHealth, or UNE, which manages the SNAP-Ed program statewide, would be eligible to apply,” he says. Then, once the awards are made, he continues, subcontracts (to do the actual work) will be worked out. “We are hoping they will come to us to do the actual work.”
Further, the state changed the fiscal year for the funding from July 1 through June 30 to an Oct. 1 start, leaving HMPs with a three-month gap in funding.
Across the state, says Douglas, experienced, qualified staff are already leaving seeking other stable employment.
In the interim, Douglas says, HMPs have received a three-month funding extension to “wrap up their work.”
Further, he explains, the infrastructure piece (of the prior funding) has been retasked to a single (one-person) district-level position to coordinate each public health district.
“For us that includes Androscoggin, Oxford and Franklin counties as one district,” he says.
Douglas explains that by law, each district has a coordinating council composed of community stakeholders and in Oxford’s case that includes Androscoggin Home Care & Hospice, Community Concepts, Bates College, Central Maine Medical Center and Western Maine Community Action, among others.
“The role of the district coordinator is being developed,” explains Douglas, “but will include convening meetings, keeping minutes and working with partners on district health priorities.”
“Here at Healthy Oxford Hills,” says Douglas, “we are one of a handful of HMPs closely affiliated with a hospital. SMH is our fiscal agent. It has provided all of our fiscal and HR functions making us hospital employees. The hospital has always been very supportive of [HOH] as its outreach and prevention arm.”
“MaineHealth as a health care system has a written explicit commitment to community public health,” Douglas says hopefully. “Western Maine Health Care Corp. is an affiliate of MaineHealth so they, along with our other three funders, may be able to make up for what we are losing from the state. We are in discussions with all of them.”
Douglas says he is “cautiously optimistic.”
“The Affordable Health Care Act mandates that all nonprofit hospitals have a community health component … another reason to support us.”
HOH needs to know what its funding sources will be, if any, well before Sept. 1 in order to stay operational, Douglas says.
HOH, he says, has brought $5.5 million to this area in jobs and programming over its 15-year existence. Further, he notes, the Oxford County Wellness Collaborative, which is looked at as a very innovative social change initiative in the state, may go away if HOH goes away.