Sit down at the counter in one of Maine’s smoke-free diners and talk to the typical Mainer next to you about healthier living, and more specifically smoking.

Odds are you’ll be talking to someone around 44 years old. Compared to his fellow Americans, he will be more likely to die from smoking, including cancer related to tobacco use, especially lung cancer. There’s just under a two-in-three chance he’ll have a weight issue, including a 29 percent chance he’ll be obese. He’ll be more likely to binge drink and, sadly, more likely to commit suicide.

“Do you think smoking remains a big problem here?”

In between big bites of bacon and eggs, with a side of pancakes no doubt, you might get a response that goes something like this: “It’s not nearly as bad as it used to be. I mean, I quit two years ago. Well, for a while, anyway. So, nah, not so big a problem anymore.”

And that typical Mainer would be half right. We have made progress on reducing tobacco use in Maine over the past decade and a half. The best known of Maine’s public health initiatives brought higher tobacco taxes, smoking bans in most workplaces and later such bans in all public settings. It also brought some very effective tobacco cessation efforts funded with money from a state settlement with the Big Tobacco companies. As a result, smoking rates in Maine have declined from about 25 percent of adults and 38 percent of youths in 1995 to about 19 percent of adults in 2014 and 10 percent of youths in 2015 (use of any tobacco products among youths was 16 percent). Over the past three years, about six in 10 adult Maine smokers quit for at least one day. That’s progress, but a close look at that typical Mainer tells us it’s not nearly good enough.

When we look at the investments we’ve made in recent years to prevent youth from using tobacco products and to help tobacco users become free of their dependence on nicotine, and then we compare those to the costs tobacco use still imposes in Maine’s communities, we get a picture of a modest investment yielding modest results. Unfortunately, this holds true for many of our efforts at improving public health. Yes, many good, smart and dedicated people are working very hard through innovative and effective programs to help us change our habits to be healthier, but those hard-won successes often represent humble progress against daunting challenges. We can and should do more.

I’m proud to be part of an organization that has as its vision, “Working together so our communities are the healthiest in America.” As part of that, MaineHealth provides the very best care it can as close to home as possible through our member hospitals, physician practices and outpatient facilities. However, we also help fund and manage programs and partner with others in efforts aimed at improving public health. For instance, the MaineHealth Center for Tobacco Independence runs the statewide tobacco treatment programing on behalf of the Partnership For a Tobacco-Free Maine – including providing free assistance with quitting through the Maine Tobacco Helpline. MaineHealth’s member organizations have helped lead the successful implementation and expansion of Let’s Go 5-2-1-0, which aims to increase physical activity and reduce obesity among youth in many of Maine’s communities. Our member hospitals are also doing a variety of outreach and programming aimed at making healthier communities.

But a healthier Maine cannot be achieved by our organization, or any organization, working alone. This takes real collaboration. All levels of government need to contribute with both funding and policies proven effective through scientific studies. Businesses, large and small, need to understand that investing in the health of their employees helps the bottom line. And schools, nonprofits, philanthropists, foundations and families and individuals all have a role. By working together and enhancing each other’s capacity, we will have the greatest impact.

This is a good time to be discussing the health of the people who live here. A unique statewide collaboration among Maine’s larger healthcare organizations and the state Center for Disease Control and Prevention has recently completed a report called the Community Health Needs Assessment. This document is a report card that grades our public health results in Maine.

The report provides data by county and for the state as a whole and can be viewed at www.mechna.com.

It paints that picture of the typical Mainer outlined above and also identifies challenges such as poverty, mental illness, substance abuse and addiction and access to healthcare coverage. These factors contribute to higher healthcare costs. They also make our lives shorter, less healthy and less happy.

The data show, among other things, that smoking remains a big problem here. Lung cancer alone claims around 50 lives per 100,000 each year, and smoking-related deaths from all causes add up to about 100 out of every 100,000 people each year.

This doesn’t mean we shouldn’t be alarmed about obesity, mental health, drug and alcohol abuse and other factors that can erode our quality of life and contribute to premature death. We should be. But we should still be alarmed that tobacco use continues to kill so many, and we shouldn’t be satisfied with the progress we’ve made thus far.

The financial return on better health for Mainers is huge, but other than efforts targeted at specific employee groups, those returns tend to be diffuse and don’t collect as a single revenue stream. This makes funding health improvement tricky. Yet, higher worker productivity, lower utilization of expensive medical care and better quality of life have real value, making health improvement a smart financial investment.

Health improvement requires the attention of many stakeholders. It has been easy historically for any one of them to step back on the hope that others will pick up the slack. We’ve seen this in recent years as the Fund for a Healthy Maine, which was created by the state to fund health improvement activities with tobacco settlement monies, has been eroded to help balance the state budget.

Many large businesses, meanwhile, have stepped up with innovative and substantial employee wellness initiatives and have achieved impressive results, but many others have lagged. Meanwhile, small business owners – stretched for time and resources – struggle with strategies to motivate employees to pursue healthier habits.

And by no means have we in health care done all that we could or should, but we are focused on getting better. To that end, the consortium that undertook the health needs assessment – which calls itself the Shared Health Needs Assessment Planning Process – is coordinating with hospitals and other stakeholders to gather public input on our health status and the problems that need to be addressed.

In coming months there will be forums in every Maine county to get feedback that will be used by local hospitals to develop community health programing. For more information, contact your local hospital or go to www.meshnapp.com.

I look forward to someday stepping into that diner and sitting down next to a fit fellow enjoying some nonfat yogurt and fruit or maybe some oatmeal. He’ll have just come from a long walk along a new path built with the help of his local town and committed community volunteers. He will be proudly smoke free, a moderate drinker and happy to be living in such a beautiful place. When I ask him if tobacco use remains a concern, he won’t hesitate.

“We’ve got to keep at it,” he will say. “There are too many lives at stake.”

Timothy Cowan is an epidemiologist and director, health index initiative with MaineHealth, the state’s largest health care provider with member and affiliate hospitals throughout southern, western and central Maine as well as Carroll County, New Hampshire.

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