Community Context 

Oxford County, which shares its Western border with New Hampshire, is an area with a rich natural landscape of lakes, rivers, forests, and mountains. The population is nearly 58,000 as of 2020, and the county’s population is majority White.  As a rural community, Oxford County faces a decline in economic opportunities, an aging population, and rising poverty levels. 

There are varying levels of wealth and poverty within the 35 towns that make up Oxford County. Since the late 19th century, pulp and papermills were the economic engine of the county. Manufacturing remains one of the top industries in Oxford County, along with health care and social assistance industries, as well as retail trade. There has been a shift toward tourism (e.g., Sunday River Ski Resort) as many mills and factories have closed their doors over the past three decades.

Maine and Oxford County remain mixed in terms of political party affiliations, with political leanings generally shifting from one election to another. In 2018, Democrat Janet Mills was elected governor of Maine, although the majority of Oxford County residents voted for her Republican opponent. In addition, in recent years, county commissioners have tended to be Republican and Independents. 

In 2017, Maine voters approved a Medicaid expansion ballot initiative, but it was blocked by the governor throughout 2018. On the first day of her tenure as governor, Janet Mills signed an executive order to expand Medicaid. Oxford County’s rate of uninsured individuals decreased from 11.6 percent in 2011 to 8.8 percent in 2019. 

Despite improvements in access to health insurance, Oxford County residents continue to face significant barriers to achieving optimal health and well-being. For example, there is a lack of public transportation and no major highways that run through the County—which has exacerbated isolation as well as limited access to health services and economic opportunities. 

Residents of Oxford County have historically experienced high rates of obesity, mental health issues, and increasing substance use, which have persisted over the past five years. Recently, the community has been experiencing growing rates of teen vaping. However, Oxford County has made notable progress to address chronic diseases, such as cancer.

Oxford County’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, Oxford County still faces notable shortages in its capacity to address health and well-being.

However, a core group of dedicated individuals continue to promote public health, wellness, and apply a social determinants of health framework on a broad scale with the help of external funding. Over the past five years, the community has focused on implementing new initiatives that address high-priority areas, including substance abuse, ACEs, and mental health. With deeply entrenched rural poverty, social isolation, and a loss of employment opportunities compelled Oxford County to tackle structural barriers to health and well-being. It started to use a social determinants of health lens to address the root causes of poor health outcomes—both mental and physical. Oxford County’s attempts to address health equity over the past five years have largely remained stagnant, but there are signs of broader conversations around equity that are laying the groundwork for potential systems change beyond not only economic and education equity, but health equity as well.

Lessons Learned: Where is Oxford County Five Years Later?

While conversations around health equity are largely still taking place within the health sector, there is an opening to that dialogue that has evolved over the past five years. Views have changed from thinking about whether individuals have access to health insurance or are managing their chronic conditions only, and there is a stronger emphasis on social determinants of health and root causes more broadly. 

Health leaders in the community have been considering collaboration differently as well, such as increasing efforts to incorporate community voice in health decision-making. 

Oxford County recognizes the importance that health actions extend beyond the few individuals currently involved. The county is bringing non-health organizations to the table, but it will be important to understand the organizations’ motivations so as to sustain long-term momentum. 

Other communities facing similar challenges as Oxford County with respect to an individualistic mindset, stigma around seeking support, and considerable concerns about economic inequity will benefit from reviewing how Oxford County is actively addressing those issues and working to expand the discussion of health and well-being.

Oxford County is supported by a committed group of individuals working to tackle the community’s long-term health issues and build its growing capacity for health data, but it also faces staffing shortages and burnout from individuals who have been working to influence health over the years. 

Facilitators

  • A small number of committed community members have built strong connections across health-focused organizations 

  • Significant strides have been made in the development of health data capacity 

  • Young people have become more engaged in community-centered work

Barriers

  • The socioeconomic composition of the community is highly stratified 

  • Stigma around asking for help and a mindset of self-sufficiency impedes the community’s ability to help those in need 

  • Having a small group of people focused on health can lead to burnout and staff shortages