We Mainers like to explain our state as a series of dichotomies. Whether it’s physical geography – mountains vs. the sea – or social geography – bustling small cities vs. a rolling rural countryside – we can never quite let go of the idea of “two Maines.” As is often the case with such platitudes, there is an element of truth to this view, and that is certainly the case when it comes to the health status of Maine people.

The latest national County Health Rankings report, released this week by the University of Wisconsin, shows that where Mainers are doing well economically, they are among the healthiest people in the nation, and where Maine people struggle, their health is poor.

In 2017, Washington, Aroostook, Piscataquis, Androscoggin and Somerset counties are at the bottom of the rankings, while Cumberland, Sagadahoc, Knox and York rank at the top. The lowest-ranked counties are poorer, less educated and have more behavioral and environmental challenges than their top-ranked counterparts.

In addition to large disparities among counties, the data tell us that Maine’s health status overall is worsening. In December, the America’s Health Rankings report, which has ranked the health of all U.S. states for 25 years using similar measures to those in the county report, said that Maine slipped from the 15th healthiest state in 2015 to 22nd in 2016. Among a number of troubling findings, data from the U.S. Centers for Disease Control and Prevention show that Maine’s infant mortality rate, an especially sensitive measure of the health of states and countries, is rising despite declines between 2005 and 2010.

The continuing economic deterioration of many of Maine’s poorest counties is perhaps the single most important contributor to these trends. Without adequate incomes, many Mainers struggle to find basic economic security, housing, a good education, healthy food and access to good health care.

Health rankings are a call to action, not a prescription for solutions. For example, in 2009, publication of the America’s Health Rankings report prompted Maine’s largest health care system, MaineHealth, to act. System leaders recognized that achieving their lofty vision of “Working together so our communities are the healthiest in America” was not possible without identifying and addressing problems.

MaineHealth selected six leading health problems with a large impact on health, including low childhood immunization rates, tobacco use, obesity, preventable hospitalizations, cancer deaths and cardiovascular disease deaths – and called for an annual report to track progress on these priorities over time. A seventh priority (opiates and prescription drug abuse) was added in 2012.

MaineHealth’s own Health Index report (also released this week at mainehealthindex.org), was conceived as a way for MaineHealth and its community partners to hold themselves accountable. And through programs such as Let’s Go!, which targets childhood obesity, real progress has been made. Let’s Go! is now being implemented in all 16 Maine counties and has produced both behavior and environmental changes that appear to be having an impact on stabilizing child obesity rates.

Unfortunately, as Maine’s health has deteriorated, the state has stepped away from programs and policies that could help people make better choices. Such disinvestment includes significant reductions in public health nursing in many of our most vulnerable communities and a budget that eliminates funding for obesity and tobacco prevention.

Moreover, according to a recent report, the state has explicitly chosen not to pursue federal grant opportunities to address colorectal cancer screening rates, to improve water testing for arsenic and lead and to address other critical public health problems and needs.

Meanwhile, Maine’s decision not to expand health coverage through the Medicaid expansion option in the Affordable Care Act has left over 30,000 low-income citizens without access to health insurance

Although we cannot immediately change our economy or our social demography, we are not powerless to improve our health. Vermont, New Hampshire and other rural states have seen their health rankings far surpass our own.

Let’s use these rankings not as an indictment, but a call to action. We must first recognize we have a serious problem and acknowledge that poor health will undermine the state’s future economic growth. Then we need a realistic, practical plan that borrows the best ideas from other states.

For all the talk of “two Maines,” only together can we create a thriving state where each community is among the healthiest in America.