Measuring and Fixing the Disturbingly Strong Link between Health and Economic Status in Maine Counties

Measuring and Fixing the Disturbingly Strong Link between Health and Economic Status in Maine Counties

Dan Onion, MD, MPH

Mt. Vernon/Vienna Health Officer


September, 2017

My mission as town health officer is to promote the health of all town residents. That can be done in several different ways: educate individuals about how to better care for themselves, find and evaluate environmental risks in town, and promote ways the health care infrastructure can be improved. The last can get a little political, because it involves state-wide public policies. But it is important for all of us to appreciate those policy impacts. One policy issue with the greatest impact on health is insurance. I think it’s important for voters, as they are asked to vote on proposals to improve health disparities, to understand the powerful correlations between county populations' health and their socio-economic status (SES) in Maine and elsewhere.

The data to estimate the effect of household economics on health come from two principle sources. The US Census Bureau collects most socioeconomic status (SES) data by county, with the same methodology, throughout the nation. In our state, like most, the Maine Center for Disease Control (CDC) collects health data and passes them on to the national CDC. A county’s socioeconomic status correlates tightly with its good or bad health outcome differences, including death rates.

Research using these data shows that the poorer a county’s socioeconomic status, measured any number of ways, the worse the county’s health, also measured in any of a number of ways (see table). I include a graph below the table showing this correlation using the first row examples above.

Maine County SES vs Outcome measures

SocioEconomic Factors

Health Outcomes

Household income

Age-adjusted mortality

% of people living below Federal Poverty Level

Years of premature (<age 75) life lost

% of children receiving free school lunches

Hospitalization rates/1000 people/year


Over the last 50 years, the link between economic status and health statistics appears stronger than ever. In the 1960s, only 15% of the variation among Maine county mortality rates was explained by income variation. By 2010, that percentage had risen to 80% as shown by the R2 value of .81. This makes sense to me from the patients I see. Poorer patients have higher rates of smoking, lower levels of exercise, and poorer diets, as well as much more difficult access to health care when they are sick because of no or very spotty health insurance. They also have less reliable transportation, and inadequate funds to pay for prescriptions after heat, food and car expenses.

Our studies in Franklin County have shown that improving access to health care and to programs that reduce risk factors, can compensate for lower economic resources. Improved access and reduced risk factors can improve outcomes of those county populations back to or even better than those of the more affluent counties. Sadly, our most recent data show that Franklin, after 45 years of being better than average, has now regressed back to average for a county with its socioeconomic status. We held a conference in Farmington last week to analyze the possible reasons why. Diminished leadership in these areas and a failure to monitor the success of existing programs to guide improvements were major reasons cited there.

When possible, our communities should strive to affect these powerful factors, by encouraging healthy behaviors and improving access to regular medical care for all. The local Neighbors Driving Neighbors transportation project is one example. Another way to help would be by expanding MaineCare, as allowed by the Affordable Care Act, to include the working near-poor. I know from our local research and my medical practice, that such a program gets everybody on the same level playing field to do the best they can with their lives, both adults and especially kids. Right now half the children in Maine are living in impoverished households. Last year I supported MaineCare expansion by gathering signatures on election day in Vienna. That referendum was approved and will now be on the ballot in November and would be a powerful improvement for a group of people needing better health care access.

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