Lewiston and all of Maine share our emotions of grief and sorrow

 Dora Anne Mills, MD, MPH

The View from Maine

October 27, 2023

Lewiston, Maine

So many friends from around the country and world have kindly reached out that I thought I would share a bit what things are like in Maine, from my personal perspective.

We find ourselves in such an unimaginable situation that many of us are struggling to figure out what to write, what to say, and what to do. The mixture of conflicting feelings - from shock, anger, numbness, to grief - complicates the situation.

Unlike most states, Maine is one big small town. With only just over one million people in the entire state, we’re a close-knit community. We’re the most rural state in the nation, with about 61% of our population living in rural communities, versus 19% nationally. Our largest city, Portland, only has 68,000, which would be considered a town in many other places. We often say that the “six degrees of separation” is about a half degree in Maine. We still only have one area code, 207, which is a part of our identity, along with lobsters, lighthouses, and pine trees.

Maine is a lot like Cheers, a place where everybody knows your name, where they’re always glad you came. And like Cheers, Maine communities have many gathering spots, like bowling alleys with leagues, and bars with corn hole, pool, and dart tournaments.

Indeed, on Wednesday evening (October 25), a Lewiston bowling alley was hosting its weekly youth night with a number of older mentors sharing their love for the game. And a bar and grill a few miles away was holding its regular corn hole tournament, including one with the Deaf and Hard of Hearing community.

Then, that life and those lives were shattered.

As the names of the victims emerge, there are many of us and/or our family members, coworkers, and friends who know them or know their loved ones. Maine communities are like a tightly-woven blanket, with threads that are inextricably linked. Below is a site with brief biographies on the victims the Portland Press Herald is posting, updating, and making freely available. Even in these brief summaries, one can sense the various ways in which these community members’ lives were threaded across the community of Maine. And how as these 18 threads become unraveled, our blanket is left with gaping and bloodstained holes.

Compounding the situation is that as I write this, the alleged shooter/mass murderer was not yet found. Tens of thousands live in areas that were in lockdown, which covers a two-county area about three-quarters the size of Rhode Island. Even in areas a couple of hours from Lewiston, schools, daycares, and many businesses are closed. Grocery stores are closed in the lockdown and adjacent communities. LL Bean, which is famous for being open 24x7 every day of the year, is closed for the second day in a row. Some aspects of life are eerily quiet. And in that quiet, there is tension, since life the way we have known has been shattered.

Many felt Maine was immune from much of the gun violence seen in other states. After all, Maine has been being ranked by the FBI as the safest state in the nation. On average, Maine sees about 20 homicides per year, representing some of the lowest rates in the country. This is despite Maine having high gun ownership rates, with an estimated 45% of households with guns (2016 data). But after Wednesday evening’s horrific rampage, it is clearer to everyone that we are not immune.

Indeed, if mass murder gun violence can happen in Maine, it can happen anywhere in the United States.

Friday Night Addendum: We are relieved to know that the killer's body was found this evening. We can move around freely again, knowing he is no longer a threat. But the shock of losing so many wonderful people is just sinking In.

Resources:

States rurality:

https://www.americashealthrankings.org/.../pct_rural/ME

Portland Press Herald Lewiston victims' biographies:

https://www.pressherald.com/.../lives-lost-in-lewiston.../.

US News state rankings on crime:

https://www.usnews.com/.../10-safest-states-in-america

US CDC state homicide data:

https://www.cdc.gov/.../homicide_mortality/homicide.htm

Gun ownership estimates by states 1980-2016:

https://www.rand.org/pubs/tools/TL354.htmlhe

Maine Gun Safety Coalition: https://www.mainegunsafety.org/

The Maine Gun Safety Coalition grieves with the families and friends who lost loved ones in the mass shooting in Lewiston, Maine. We watched in horror as the tragedy in Lewiston happened before our eyes – the result of our state's weak gun laws. We call on our elected officials tonight to stop bowing to the gun lobby and look squarely at the face of what has happened in Maine’s second largest city. At a minimum, the Maine Gun Safety Coalition believes an assault weapons ban is necessary to try to prevent more such tragedies in our state.  From Camilla Shannon, Board Chair.

Maine rising infant mortality rates point to problems in northern Maine

Statement by Dr. Dora Mills

Dr. Dora Anne Mills of the University of New England was the Maine State Health Director from 1996 to 2011.

"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.