By Amy Harris 

Abdulkerim Said, Director of Health Equity Partnerships at the Maine CDC’s Office of Population Health Equity (OPHE), is convening a series of community forums around the state to discuss the social determinants of health (SODH).

His goal is to hear from stakeholders what his office can do better to serve the needs of four identified groups: 1) refugees and immigrants, 2) the BIPOC community, 3) the LGBTQ+ community, and 4) people with disabilities.

Said plans to hold regular stakeholder gatherings in Portland, Lewiston, Augusta, Bangor, and Brunswick, areas chosen because of their concentration of refugees and immigrants, Black and Brown people, LGBTQ+people, and people with disabilities.

Social determinants of health are at the front of mind for most people working in public health or healthcare in the U.S. today, and include racism and discrimination, and uncertain access to housing and citizenship status.

According to the U.S. Centers for Disease Control, SODH are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Representatives from the following organizations and offices attended the inaugural meeting for the Portland region: Maine Inside Out, Portland Department of Public Health, Gateway Community Services, MaineHealth, Catholic Charities Maine’s Office of Maine Refugee Services, Volunteers of America, New England Arab American Association, Preble Street, and the Greater Portland Immigrant Welcome Center.

The Office of Population Health Equity was reinstated with federal funding during the COVID-19 pandemic after having been eliminated under the administration of former Maine Gov. Paul LePage.  Newly-hired staff such as Abdulkerim Said are tasked with addressing Maine’s disparities in health that COVID-19 so brutally revealed. This involves bringing members of the hardest-hit communities to the table.

Said sees his role and these forums as a way to “flip the power – give power to the people so that they can tell [the CDC] what is wrong and how to fix it, because the most powerful people, the ones sitting at the table, don’t always give their money or design their programs based on community feedback.”

Abdulkerim Said

But shortages of time and money, and the slow pace with which the wheels of government turn, are not only impeding progress, but risk thwarting it. The OPHE team and the community-based organizations (CBOs) they plan to empower are on the precipice of what many forum attendees described as a “financial cliff.” The $32 million grant that the Maine CDC received as part of the federal government’s COVID-19 response in November 2021 came with an expiration date, and OPHE and CBOs need to use all of this money by May 2024, or they will lose it with “no extensions or exceptions,” according to Said.

Community leaders such as Nélida Burke, Minority Health Program Coordinator for the Portland Department of Public Health, and Claude Rwaganje, Founder and Executive Director of ProsperityME, expressed frustration with the process. They reported that their organizations did not receive any money until almost halfway through the two-year grant timeline due to multiple delays. As Rwaganje observed: “You are asking the impossible. We won’t be able to achieve the grant goals or spend the money. The money will be gone, but the challenges or problems won’t be.”

Many of the greater Portland CBO representatives at the forum expressed similar disappointment. The amount of paperwork and data-collection required by OPHE to apply for the grants, the cost and labor involved in hiring additional staff or designing new programming –  for such a short funding window, with no guarantees that funding will continue after May 2024 – is frustrating. Burke pointed out that the grant from OPHE to the Portland Department of Public Health barely covers the salary of one half-time community health worker (CHW) for one year.

Burke’s and Rwaganje’s frustrations stirred suggestions from other attendees about ways to put the federal money to work on such a short timeline. Barbara Ginley, MaineHealth’s Director of Community Health for Portland, said, “You need to have a plan B for what to do if it is looking like you might be leaving federal dollars on the table.” 

MaineInsideOut is an organization that helps disenfranchised youth through the arts. Executive Director Bruce King shared how his organization put funds towards capacity-building initiatives, such as updating their computer software and hiring a philanthropy lead to identify future funding sources for when the federal disparity grant money disappears.

King also described MaineInsideOut’s shift to political advocacy as a necessary part of empowering community voices. Attendees strategized how they could better combine their limited resources (staff time and political capital) to lobby state and federal policymakers about Maine’s social determinants of health.

All agreed that greater Portland’s lack of affordable housing is the most significant barrier to achieving health equity. CBO leaders at the forum called upon Said and his staff to elevate the state’s housing crisis to the level of a public health crisis like COVID-19. Rosie Dibello, Project Manager at Preble Street, reminded OPHE staff that housing instability both creates health problems and exacerbates existing ones.

As the forum drew to a close after nearly two hours, attendees agreed to continue these challenging conversations, to “be present in the room,” as Barbara Ginley of MaineHealth put it. Although frustrated by the slow pace of fund dispersal, the short timeline, and the work involved in administering the funding grants, CBO leaders pledged to work collaboratively to assist the Maine CDC’s response to widening health disparities in Maine. They also agreed to encourage more of their communities to attend ongoing OPHE forums. 

“The people I wanted to come to the meeting aren’t here yet,” Said told the gathering. “I want community members, not the organization leaders … the parents, the teachers, the community health workers, the religious leaders.” Anyone interested in attending OPHE’s upcoming Regional Community Health Forums can email Abdulkerim Said at [email protected] or Eden Silverthorne at [email protected].