A few months ago, I received a call from a reporter, asking what I thought of Maine’s increasing infant mortality rates.

Truthfully, I hadn’t been monitoring the data as closely since leaving state government in 2011, so I was shocked to learn that Maine’s rates are the only ones in the country that are increasing, i.e., worsening.

This is critical, because infant mortality – the rate at which babies die in the first year of life – is the most accurate pulse we have on the health of a society. It reflects not only the health of people at their most vulnerable time of life – that is, infancy – but also of women during and after pregnancy, and of the entire family and community, since any environmental toxin, public secondhand tobacco smoke, or other community-wide health issue often exerts their heaviest impact on infants.

I remember in the 1990s when Maine enjoyed the lowest – the best – infant mortality rates in the country, and was even on par with the lowest of any country in the world. So, I was stunned to learn that our rates have increased to the 43rd worst state in the country.

In digging into the data, I also learned not all of Maine has fared worse over the years. Compared with the 1990s, Maine’s more southern and urban infant mortality rates have stayed about the same, and in some cases even improved. For example, York County has seen a 31 percent improvement.

However, in most of Maine’s rural counties, the rim counties, rates have dramatically worsened. Some of these counties in Maine have infant mortality rates on par with Croatia, Romania, and Botswana. In other words, Maine’s worsening infant mortality rates seem mainly because of declining health of babies, families, and communities in rural Maine.

At first I thought maybe this decline was caused by one or two issues, such as the opioid addiction epidemic. So, I examined other health data, such as those for cancer, diabetes, drug addiction, heart disease, obesity and smoking, and compared county trends over the last 10-30 years. I learned that in most of these measures of health, rural Mainers are less well off than their more southern and urban counterparts, and are often worse off than several years ago. Any statewide declines in these issues over the last few years are often primarily because of worsening health of people in rural Maine.

As an example, death rates from cancer have declined across the country and state. However, mortality rates in rural Maine, which were already for the most part higher than the statewide rate, have not declined as much the last 10 years, causing an even wider gap, with rural Mainers dying from cancer at increasingly higher rates than their more urban counterparts. I also looked at childhood poverty, which is a barometer of the health of children in a community, since children living in poverty are more likely to be in poor health. Defined in 2015 by a household income less than $24,000 for a family of four (two adults and two children), poverty rates for children in Maine also vary widely by county, with rural counties faring worse and having worsened in the last 20 years. For instance, childhood poverty rates in Aroostook, Franklin, Oxford, Piscataquis, Somerset, and Washington counties are the highest in the state and have increased over the last 20 years.

By contrast, Cumberland and York counties have the lowest childhood poverty rates in Maine, and stayed about the same as 20 years ago. With the widening divide between rural and southern Maine, counties such as Piscataquis and Washington have childhood poverty rates approaching one-third of all children, and rates that are nearly three times that seen in York and Cumberland counties.

What can we do? The most critical step is to make sure Maine’s health care and public health systems across the state are sufficiently resourced to assure all Mainers have access to health care and live in healthy communities. This includes access to health care providers, health insurance (including MaineCare), public health nursing, community-based public health organizations, and governmental public health professionals at the regional and state levels. As a result, there should be readily available health care that includes drug and tobacco addiction treatments, sufficient preparedness for emergencies, and community-wide prevention on many issues such as nutrition education, cancer screening, and walkable communities. Because the economic health of a community is intrinsically related to its overall health, economic strategies that focus on rural areas are also important.

There is much beauty in rural Maine, found in its people, pristine lakes, mountains, woods and fields. However, just as we have built roads and power lines in rural Maine, we also must assure there are adequate pipelines to preserve and improve the health of those living there.