A major outbreak of whooping cough was bad news for many Mainers in 2012, but it might have come with a silver lining: a dramatic increase in the percentage of Maine children being immunized.

The pertussis outbreak and immunization increase are among more than 50 measures included in America’s Health Rankings 2013, a widely cited annual state-by-state report released Wednesday. While Maine had some areas of improvement, and some areas that slipped, the report downgraded Maine’s overall ranking from 15th to 16th healthiest in the nation.

Despite its relatively high ranking, Maine continues to face health challenges, including rates of binge drinking, cancer deaths and smoking that are among the highest in the U.S., as well as an increasing obesity rate.

The state’s immunization rates for diseases such as tetanus, diphtheria, pertussis, measles and mumps show significant improvement. The percentage of children ages 19 months to 35 months who were fully immunized increased from 69 to nearly 73, raising Maine’s ranking from 21st to 12th.

The immunization rate among children ages 13 to 17 increased from nearly 60 percent to 65 percent, pushing the state from 24th to 20th.

It’s hard-won improvement, said Dr. Jonathan Fanburg, who practices at South Portland Pediatrics, a MaineHealth affiliate. Fanburg credits a recent multifaceted effort by health care professionals and state officials to increase children’s vaccination rates and boost the “herd immunity” for all Mainers.


“It’s a struggle – a battle at times – to stamp out the misinformation that’s out there and provide accurate information for parents,” Fanburg said.

Despite persistent concerns about vaccines’ safety, Fanburg said he assures parents that “they’re safe, they’re effective and they’re much less expensive than the disease.”

Crystal Davis of Hollis knows a few mothers who oppose immunization or question the safety or need for it. She and her husband, Chad, trust the recommendations of health officials and the doctors at South Portland Pediatrics. Their children Nolan, 11, and Paige, 6, are up to date on their immunizations.

“I’m relying on research rather than rumor,” Crystal Davis said. “We do it to try to prevent any kind of illness down the road.”

Fanburg noted that Maine recently adopted a universal childhood vaccine program, which provides vaccines to health care professionals at reduced cost because the state buys them in bulk from the U.S. Centers for Disease Control and Prevention. As a result, all Mainers can be immunized regardless of their health insurance or ability to pay.

Last year’s whooping cough outbreak likely encouraged Mainers to get immunized, Fanburg said. The number of reported pertussis cases increased from 202 in 2011 to 737 in 2012, reflecting a national trend in the worst year of pertussis infection in more than 50 years.


“We get lax because we don’t see these diseases every day,” Fanburg said. “That’s very often the benefit of immunization, but you can’t stop it.”

This year, the Maine Center for Disease Control and Prevention reported 196 cases of pertussis from January through July 26, compared with 333 in the same period in 2012. Data for the last several months was unavailable Tuesday, said John Martins, spokesman for the Maine Department of Health and Human Services.


Started in 1990, America’s Health Rankings is a yearly report based on data from various sources, including the CDC, the American Medical Association and the FBI. Its goal is to raise public awareness, influence public policy and improve public health. This year, Hawaii was ranked the healthiest state, while Mississippi was ranked the unhealthiest. Lower numbers indicate healthier rankings.

Maine’s 2012 ranking was adjusted, along with all states, to reflect changes in health measures that were made to produce more accurate rankings in the 2013 report but still allow year-to-year comparisons. The adjustment moved Maine’s 2012 ranking from ninth to 15th.

The rankings are published by the United Health Foundation, an independent nonprofit established by UnitedHealth Group, a Minneapolis-based health insurance and service company. The report is produced by an independent market research firm and directed by a scientific advisory committee that’s administered by the Gillings School of Global Public Health at the University of North Carolina.


The advisory committee includes Andy Coburn, a professor and assistant dean of public health at the Muskie School of Public Service at the University of Southern Maine.

“Maine is a relatively healthy state overall,” Coburn said, “but there are areas where we should be focusing our attention.”


Maine’s obesity rate continued to climb, from 27.8 percent to 28.3 percent of adults, lowering the state’s ranking from 25th to 28th. Meanwhile, its diabetes rate held steady at nearly 10 percent of adults, about 110,000 of Maine’s 1.3 million people.

Sometimes, healthier behaviors in other states affect Maine’s rankings.

Its ranking for physical inactivity fell from 13th to 15th, even though the proportion of adults who reported no physical activity declined from 23 percent in 2011 to 21 percent in 2012.


And Maine’s ranking for binge drinking fell from 18th to 33rd, even though its proportion of adults who reported having four or more drinks (women) or five or more drinks (men) on one occasion held steady at 17 percent.

“Most other states have seen a rather dramatic drop in binge drinking, so Maine is just going along without much change in that area,” said Tom Eckstein, a principal of Arundel Street Consulting, the independent market research firm that developed and produces America’s Health Rankings.

Some rankings reflect Maine’s reputation as “the way life should be.” Maine has ranked lowest in violent crime since 2007 (123 offenses per 100,000 people) and its air pollution ranking improved from 12th to 10th.

Meanwhile, Maine’s rankings for cardiovascular deaths (from 239 to 223 per 100,000 people) and high school graduation rate (80 percent to 83 percent) both improved from 17th to 13th, and the ranking for children living in poverty (17.7 percent to 16.2 percent) improved from 19th to 17th.

Some areas improved but have a long way to go. Maine’s ranking for the number of dentists (from 49 to 51 per 100,000 people) improved from 37th to 35th, but is far below top-ranked Massachusetts, with more than 85 dentists per 100,000 people.

As healthy as Mainers are, the state spends relatively little on public health – $86 per person compared with $225 for top-ranked Hawaii. The difference puts Maine at No. 21 for public health funding.


Maine ranks 29th for the relatively new measure of “disparity in health status.” That means that the proportion of Mainers who report having very good or excellent health is 30 percentage points higher among high school graduates than non-graduates, Eckstein said.

“It’s one of the better indicators of quality of health life in the report,” he said.


MaineHealth, the parent organization of Maine Medical Center in Portland, uses America’s Health Rankings to develop its annual Maine Health Index Report. The report, also released Wednesday, identifies goals and strategies to improve Maine’s individual rankings and overall health.

“We’re trying to improve the prevalence rates for all Mainers,” said Deborah Deatrick, MaineHealth’s senior vice president of community health.

For instance, while Maine’s ranking for smoking improved from 33rd to 29th, the smoking rate of 20 percent of adults isn’t much lower than it was in the early 2000s, according to the MaineHealth report. The report recommends increasing Medicaid coverage for tobacco cessation medications.


Maine’s ranking for cancer deaths fell from 37th to 39th, reflecting a rate increase from 201.7 to 203.5 deaths per 100,000 people. MaineHealth’s report calls for continued efforts to reduce tobacco dependence, increase cancer screenings and improve care standards.

MaineHealth’s report also notes a significant increase in the number of preventable hospitalizations among Medicare patients. Maine’s ranking fell from 20th to 26th as its preventable hospitalization rate increased from 59.3 to 62.4 per 1,000 patients.

The report recommends steps to improve the diagnosis of chronic conditions such as asthma and chronic obstructive pulmonary disease, and to better manage patients’ medications and outpatient care.

Kelley Bouchard can be reached at 791-6328 or at:

[email protected]

Twitter: @KelleyBouchard

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