Half a dozen of the state’s most prominent health organizations — including the American Cancer Society, American Heart Association and American Lung Association — have withdrawn their support for the upcoming State Health Improvement Plan.
In a letter sent to the Maine Center for Disease Control and Prevention this week, the organizations said they could not support the state plan because it put ideology before public health.
“We don’t want an official document, the State Health Improvement Plan, going forward without the science behind it. It makes us look silly. It erodes all of our credibility,” said Angela Westhoff, executive director of the Maine Osteopathic Association and president of the Maine Public Health Association, two of the six groups that signed the letter. “And I don’t think that we need to politicize health, that’s my personal statement.”
A spokesman for the Maine Department of Health and Human Services, which oversees the CDC, said the state health plan had not yet been finalized, but he acknowledged that health recommendations may have been dropped from it during the process.
“It is important to recognize that we value the contributions of our public health partners and the collaborative process,” John Martins wrote in an email. “As is the case with any collaboration, all suggestions and recommendations are considered and evaluated, but in the end, not all are adopted and included in the final product.”
The state plan serves as a road map for Maine and includes strategies for improving the health of its citizens. The Maine CDC is seeking accreditation through the Public Health Accreditation Board and a state health plan is required as part of that. Accreditation generally defines standards of high quality and currently is not mandated for such agencies.
Work groups — which included state health officials, health care professionals, and representatives from state and national health organizations — crafted the state plan between last May and August.
But the six groups said they were told last August that the Maine Department of Health and Human Services might not approve the state health plan as written because DHHS leadership was not comfortable with three of the strategies meant to decrease obesity and smoking in Maine.
The groups said they heard nothing more about it until early February, when they received from the state what they believed to be the plan’s final version. They discovered the three questioned strategies were missing, as were two others. Those were:
* Enact an excise tax on sugar-sweetened beverages and use that new revenue to pay for programs that treat or prevent obesity.
* Promote tobacco treatment benefits for MaineCare recipients.
* Increase the tobacco tax to raise the price of cigarettes by 15 percent. Ensure all tobacco products are taxed at the same level.
* Increase access to insurance coverage for nicotine dependency.
* Increase state tobacco funding to 75 percent of the federal CDC’s Best Practice State Spending Recommendations.
“Kind of the nonsense part of it for me is that these are all national CDC best practices,” Westhoff said. “These aren’t things that somebody picked from the sky and said, ‘Oh, well, wouldn’t it be nice if we tried this?’ These are things that our federal CDC has endorsed.”
One strategy was added. It sought to discourage the consumption of sugar-sweetened beverages by seeking a waiver from the federal government to prohibit Supplemental Nutrition Assistance Program (formerly food stamps) recipients from using that money to buy such beverages.
“They took out multiple things that were evidence-based and they added something that wasn’t evidence-based,” said Tina Pettingill, executive director of the Maine Public Health Association.
The Legislature in June 2013 rejected a bill proposed by Gov. Paul LePage that would have sought a similar SNAP ban on sugary drinks.
“The federal government has never given a waiver for that,” Pettingill said. “They’re not going to get a federal waiver.”
The six groups told the CDC they were not only upset with the plan’s outcome but also with the process that created it. Although the work groups collaborated well, they said, they believe DHHS and the CDC weren’t as transparent in their final decisions as they should have been.
“It’s just one more cloud, and that’s unfortunate because I think there are many, many good people at the CDC who are working exceptionally hard to have a positive impact for Mainers’ health,” Westhoff said.
Although the groups believe the 83-page document they saw in February was the final version of the plan, spokesman Martins said Friday that the plan had not been published or finalized. He believes it will be completed within the next month.
“We are confident that the final plan has taken into consideration the viable suggestions made by our partners, reflects the administration’s public health priorities and will help Maine achieve public health accreditation,” he said.
In their letter, the groups asked that the plan include a “prominently placed disclaimer” that makes clear the original draft was changed without the work groups’ permission and that, as a result, some of those involved removed their support.
“We did not want to see our name on a document that was significantly changed in the last review which I would describe as largely a political process when, in fact, the state health plan is supposed to be a non-political document to advance the strategies for improving the health of Mainers,” said Gordon Smith, executive vice president of the Maine Medical Association.
Martins said DHHS and the CDC are evaluating their next step, but they do expect to include language that recognizes that some groups withdrew their support.
Martins believes the withdrawal of support will have no impact on the CDC’s attempt at accreditation.
“As previously stated, we very much appreciate the collaborative process and believe that as we move forward, strong working relationships will continue,” he said.