March 2019 – AZ Public Health Association

March 24, 2019May 5, 2021

Will Humble Public Health Law, State Legislature, Wills Blog

Legislative Update

It was a busy week especially in the House with the various bills that were advocating for and against (mostly for). Here’s a run down on this week’s action and a forecast for next week. Lots of bills still need to go to the Rules Committee before being released to a floor vote. Here’s our weekly spreadsheet with all the bill updates.

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Bills that have passed one chamber and received a do pass committee recommendation in the sister chamber:

SB 1040 Maternal Mortality Report (Brophy-McGee) – AzPHA Position: YES

Passed the Senate 30-0. Bill Passed the House Health Committee 9-0.

SB 1085 Association Health Plans- AzPHA Position- Opposed

Passed the Senate 24-6. Passed the House Health and Human Services Committee 6-2-1. Rules Committee Next.

SB 1088 Dental Care During Pregnancy (Carter) – AzPHA Position: YES

Passed the Senate 27-3. Passed the House Health & Human Services Committee 8-1. Passed House Appropriations 7-4. Rules Committee Next. Will still need to get into the final budget.

SB 1089 Telemedicine Insurance Coverage (Carter) – AzPHA Position: Yes

Passed Senate 30-0. Passed the House Health & Human Services Committee 9-0.

SB 1109 Short Term Limited Health Plans- extension – AzPHA Position: Opposed

This bill has passed both chambers and has been signed by the Governor. It authorizes the sale of short- term limited health plans in Arizona for terms up to 3 years. The previous limit was 1 year. These plans don’t cover pre-existing conditions and have limited consumer protection because they aren’t required to cover the essential health services under the ACA and can drop enrollees. We urged a not vote because of the poor consumer protections.

SB 1165 Texting and Driving Prohibition (Brophy McGee) – AzPHA Position: YES

Passed Senate 20-10. Passed the House Transportation Committee 5-1-1. Rules Committee Next.

SB 1174 Tribal Area Health Education Center – AzPHA Position: Yes

Passed Senate 30-0. Passed the Senate Education Committee 13-0. Rules Committee Next.

SB 1211 Intermediate Care Facilities (Carter) AzPHA Position: Yes

Passed the Senate 30-0. Passed the House Health & Human Services Committee 9-0.

SB 1247 Residential Care Institutions (Brophy McGee) AzPHA Position: Yes

Passed the Senate 30-0. Bill passed the House Health Committee 9-0.

SB 1245 Vital Records- Death Certificates (Brophy McGee) AzPHA Position: Yes

Passed the Senate 30-0. Passed through all House Committees- ready for a Floor Vote.

SB 1354 Graduate Medical Information & Student Loan Repayment (Carter) AzPHA Position: Yes

Passed Senate 28-2. Passed Hiouse Appropriations Committee 10-1, HHS Committee Next.

HB 2125 Child Care Subsidies (Udall) – AzPHA Position: YES

Passed House 46-13. Passed the Senate Health and Human Services Committee 7-0-1. Rules Committee Next.

HB 2488 Veteran Suicide Annual Report (Lawrence) AzPHA Position: Yes

Passed House 60-0. Passed the Senate Health and Human Services Committee 7-0-1. Rules Committee Next.

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On this Week’s Agenda:

House Health & Human Services: Thursday 03/28/19 at 8:30 AM, House Rm. 4

SB 1009 Electronic Cigarettes, Tobacco Sales (Carter) – AzPHA Position: YES

Passed the Senate 30-0. Assigned to the House Health and Human Services Committee.

SB 1355 Native American Dental Care – AzPHA Position: Yes

Passed Senate 25-5. Assigned to House Health & Human Services Committee.

SB 1456 Vision Screening- AzPHA Position: Yes

Passed Senate 29-0. Assigned to Senate Education Committee.

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Bills that passed one chamber and have been assigned to a committee but have not yet been put on an agenda yet include:

SB 1060 (Strike-all Amendment) Electronic Cigarettes. Smoke Free Arizona Act (Carter) – AzPHA Position: YES

Passed the Senate 28-0. Assigned to the House Health and Human Services Committee.

March 24, 2019May 5, 2021

Will Humble Oral Health, Prevention, Wills Blog

Arizona’s New Oral Health Plan Published

The Arizona State Oral Health Action Plan 2019-2020 Workgroup released the Arizona 2019-2022 Oral Health Action Plan this week. The report articulates goals, delivers recommendations, and identifies strategies to improve the oral health of all Arizonans. It incorporates strategies gathered over three years of collaboration with health care stakeholders, state and regional oral health coalitions, educational institutions, professional associations, and grassroots organizations. This plan offers solutions to address the tremendous burden of preventable oral diseases that affect individuals across the lifespan by collaboratively creating a new blueprint to improve oral health and overall health.

The goals and objectives address four cross-cutting systems of care: Policy, Care, Community, and Financing. The goal and objectives for each category begin on page 18 of the Report. Recommendations include:

Policy—using data and stories to educate, advocating for Medicaid dental coverage for pregnant women, increasing the number of Arizonans with optimally fluoridated water, and establishing a state oral health surveillance plan;

Care —ensuring an adequate, diverse, and culturally competent workforce, incorporating oral health as an essential component of overall health and well-being through integrated inter-professional systems, and encouraging, supporting, and tracking inter-professional educational models of care;

Community—maintaining a statewide network of champions and leaders for oral health advocacy and planning, supporting evidence-based prevention and early detection programs, and implementing and disseminating consistent and uniform messaging; and

Financing—financing oral health as an important component of overall health, funding and expanding oral health prevention, and sustaining financial support to improve health outcomes.

As is the case with any plan- the real key is translating the plan goals and objectives into public policy via administrative advocacy (policy interventions by state agencies), legislative advocacy (policy interventions like SB 1088 which would provide preventative oral health care for pregnant Medicaid members), by working with systems of care to improve inter-professional collaboration and by influencing policies by payors to drive better outcomes (e.g. teledentistry).

March 19, 2019May 5, 2021

Will Humble Maternal Health, Oral Health, Wills Blog

Extending Preventative Oral Health Coverage to Pregnant Medicaid Members will Save Money & Improve Birth Outcomes

Good oral health is more than just a nice smile. Having good oral health improves a person’s ability to speak, smile, smell, taste, touch, chew and eat. Untreated tooth decay leads to needless pain and suffering; difficulty in speaking, chewing, and swallowing; and missed school days. Evidence also suggests that poor oral hygiene and health increases the risk of other health problems like diabetes, stroke, heart disease and bad pregnancy outcomes.

Physical and nutritional changes that occur during pregnancy often lead to an increased risk of dental and gum problems from increased inflammatory response, loosened ligaments and increased acidity in the mouth. In addition, several studies have found a link between gum infection and poor birth outcomes, such as pre-term deliveries, lower birth weight and high blood pressure, which can lead to serious complications for both mom and the baby.

Many studies have found a relationship between periodontal disease and worse birth outcomes- but until now there hasn’t been a systematic overview of systematic reviews. Now there is. This new systematic overview found a clear relationship between periodontal disease and pre-term birth, low birth weight and preeclampsia (potentially dangerous high blood pressure during delivery). The researchers reviewed 23 systematic reviews (including between 3 and 45 studies) and found an association between periodontal disease and preterm birth (relative risk, 1.6), low birth weight (LBW; relative risk, 1.7), preeclampsia (odds ratio, 2.2), and preterm low birth weight (relative risk 3.4).

The implications of the study are profound. The estimated population-attributable fractions for periodontal disease has a mid-point of 16%, 18% for low birth weight, and 22% for preeclampsia. Let’s look at what that means here in AZ.

In 2015, 7.2% of AZ live births were low birthweight (less than 2.5 kg). With about 80,000 births (5,760 low birthweight births a year), that means periodontal disease is potentially contributing to 1,036 low birthweight weight babies each year in AZ.

About half of AZ births are paid for by our Medicaid program- meaning periodontal disease may be contributing to 520 low birth weight babies among Medicaid members every year. Let’s look at what that might be costing.

An analysis by Truven Health Analytics a few years ago found that the average health care cost for a low birth weight baby during the first year of life is $55,393 compared with $5,085 for a non-low birth weight baby.

Putting the two estimates together suggests that the 520 pre-term babies potentially attributable to periodontal disease (and paid for by Medicaid) would cost about $29M for the first year of life compared with only $2.6M for a similar number of non pre-term births, a savings to the state that is much greater than the estimated cost of the benefit (less than $200K in the first year).

Let’s do whatever we can to get comprehensive oral health coverage for pregnant Medicaid members SB 1088 over the line this year and improve birth outcomes while reducing health care costs! It’s being heard in the House Appropriations Committee Wednesday, March 20 starting at 2 pm. We’re signed up in support of the initiative and I’ll be speaking briefly at the hearing.

You can help by contact the House Appropriations Committee members with the contact info at the end of this email and letting them know that investing in better oral health for pregnant Medicaid members will improve birth outcomes and reduce healthcare costs. The piece below is also posted on our website at: https://azpha.org/wills-blog

Member & email address

Regina E. Cobb rcobb@azleg.gov

Diego Espinoza despinoza@azleg.gov

Charlene R. Fernandez cfernandez@azleg.gov

John Fillmore jfillmore@azleg.gov

Randall Friese rfriese@azleg.gov

John Kavanagh jkavanaugh@azleg.gov

Anthony T. Kern akern@azleg.gov

Aaron Lieberman alieberman@azleg.gov

Bret Roberts broberts@azleg.gov

Ben Toma btoma@azleg.gov

Michelle Udall mudall@azleg.gov

March 18, 2019May 5, 2021

Will Humble Medical Marijuana, Wills Blog

Arizona Supreme Court to Hear Important Medical Marijuana Edibles Case Tuesday

The AZ Supreme Court will be hearing the State v Jones Case (CR-18-0370-PR) on Tuesday, March, 19 2019 at 10 am at the ASU College of Law (111 E Taylor St., Phoenix). The public can attend the hearing but if you go you better come a little early.

Back in 2013 a medical marijuana patient (who had a valid ADHS Medical Marijuana Card) was arrested for possession of a small amount of hashing (a preparation of marijuana) in Yavapai County. Even though he had a valid card, he was convicted by a jury of a class 6 felony and spent nearly a year in jail.

Mr. Jones appealed his conviction (State v. Jones). Over the Summer, the AZ Court of Appeals in the case upheld the conviction, maintaining that the hashish that he possessed did not meet the definition of mixtures or preparations of marijuana as defined in the Arizona Medical Marijuana Act. The hearing on Tuesday is the oral arguments in the appeal to the Arizona Supreme Court (the Court agreed to hear the case a few weeks ago).

The Arizona Medical Marijuana Act provides qualified patients and dispensaries a number of legal protections under the voter approved Act. The Arizona Medical Marijuana Act definition of “Marijuana” in A.R.S. § 36-2801(8) differs from the Arizona Criminal Code’s definition of “Marijuana” in A.R.S. § 13-3401(19). In addition, the Arizona Medical Marijuana Act makes a distinction between “Marijuana” and “Usable Marijuana” A.R.S. § 36-2801(8) and (15). The basics of the case consists of a profound difference of opinion between the prosecutor, who believes that edibles are not included in the definition of Marijuana in AMMA, and the defense, who makes the common sense argument that edibles are included.

If Mr. Jones’ appeal is successful, Arizona’s medical marijuana program will stand as is. If it is unsuccessful, it’s reasonable to expect ADHS to completely overhaul their medical marijuana regulations and to impose a completely new regulatory scheme that would exclude extracts, resins, and edibles. Dispensaries and patients would no longer have access to these mixtures and preparations of the Cannabis plant, and dispensaries would be required to discard the instruments and equipment needed under the current regulatory scheme and overhaul their business models to one that focuses exclusively on marijuana flowers.

I filed a Declaration in the case on behalf of Mr. Jones (CR-18-0370-PR). My Brief basically argues that hashish and other mixtures or preparations of marijuana are indeed covered under the voter approved statutory language and the regulations that we developed at the ADHS while I was Director. I filed the Amicus as the former ADHS Director, not in my capacity as the Executive Director of AzPHA.

March 18, 2019May 5, 2021

Will Humble Public Health, Wills Blog

Global Life Expectancy Improvements: You Can Thank Public Health

Life expectancy has increased rapidly in the last 200 years. In 1800, life expectancy was around 30 years in all regions of the world. In the early 19th century, life expectancy began to increase in industrializing countries while it stayed low in the rest of the world.

Since 1900 the global average life expectancy has more than doubled and is now approaching 70 years. Today, no country in the world has a lower life expectancy than the countries with the highest life expectancy in 1800.

We can thank public health and improvements in then social determinants of health for most of the improvements. Deaths from infectious diseases declined drastically in the US during the 20th century, mostly (but not exclusively) because of the development of vaccines and mass vaccination programs. The development of antibiotics and improvements in housing and sanitation (environmental engineering) were also big factors.

Public health interventions contributed to a sharp drop in infant and child mortality and a corresponding 30-year increase in life expectancy. For example, in 1900 30% of all deaths occurred among kids less than 5. In 1900, the three leading causes of death were diphteria, pneumonia, tuberculosis, and diarrhea and enteritis.

The big drivers reducing childhood deaths were universal vaccination programs, improvements in sanitation and hygiene, and antibiotics. Public Health professionals played a major role in each of these areas and our public health programs today rest on their shoulders.

The CDC wrote a really good MMRW a few years ago called the 10 great public health achievements of the 20th century 10 Great Public Health Achievements of the 20th Century that identified the following public health interventions as the drivers of the increases in life expectancy and health outcomes. They are:

For a super interesting read about the improvements in global life expectancy visit the Our World In Data website.

March 18, 2019May 5, 2021

Will Humble Injury Prevention, Wills Blog

Distracted Driving: A Clear and Present Danger

Distracted driving kills people just like impaired (drunk) driving does. Thousands of people each year are killed by distracted drivers.

There are a lot of ways people can be distracted while driving… it happens anytime you take your eyes off the road. Any non-driving activity is a distraction that increases your chances of crashing and hurting or killing yourself, your passengers or other drivers.

Let’s face the facts. Our cell phones are an increasing part of our lives whether we want to admit it or not. It seems perfectly natural to pick up your smart phone and check email or texts or other social media, like twitter. Sometimes we do it while driving, like at a stop light – when the main problem is not seeing that the light has turned green and the driver behind you honks at you to get going. You make it through the light but the guy behind you doesn’t. That’s a harmless irritation.

But sometimes people check their phones while they’re driving- and that’s what’s lethal. Sending or reading a text or checking or social media takes your eyes off the road for at least 5 seconds. At 55 mph, that’s like driving the length of an entire football field, blindfolded.

The Data

A study published in the New England Journal of Medicine found the risk of crashes increases significantly when: dialing a cell phone (odds ratio 8); reaching for a cell phone (odds ratio 7); sending or receiving text messages (odds ratio 3.9); reaching for an object other than a cell phone (odds ratio 8), and eating (odds ratio 3). In other words, a person dialing a cell phone while driving is at an 800% increased risk of crashing.

Does that sound safe to you? Of course not, but chances are you’ve done it. It’s super dangerous, but most of us don’t recognize how dangerous it is.

The National Traffic and Highway Safety Administration (NTHSA) tracks data regarding distracted driving… allowing elected officials to have some data with which to make public policy regarding texting or social media and driving.

So, we know that distracted driving is a clear and present danger. The question is what should we do about it in terms of public policy? Many states have made public policy decisions to reduce distracted driving from cell use- but AZ (as a state) has not been one of them so far.

Cell Use Laws

Currently, 46 states ban text messaging for all drivers. Forty-one of those even have primary enforcement, meaning that law enforcement folks can pull you over for violating the distracted driving law.

Of the 4 states without an all driver texting ban (Arizona is one of those 4), 2 at least prohibit texting by novice drivers. In Arizona, the only restriction applies to school bus drivers and people under 18 in the first 6 months of their learner’s permit. Montana doesn’t even prohibit school bus drivers from texting. NTHSA tracks what the state laws are that address distracted driving. You can visit their State Laws page to what the laws are in the various states.

Over the years Arizona lawmakers have introduced bills that tried to put a little muscle into distracted driving laws, to no avail. This year there’s increasing optimism that AZ might actually be able to pass a law that deals with distracted driving because of the makeup of the new legislature.

SB 1165

There have been a few cell-use bills proposed this year. We’re supporting SB 1165, sponsored by Senator Kate Brophy McGee because it’s the most comprehensive of the bills. It’s progressing nicely- passing through the Senate by a vote of 20-10. It basically prohibits using a hand-held cell phone while driving with some common-sense exemptions (for example if the person is using it hands free etc).

Violations are a civil money penalty (no driving points) with the first offense being between $75- $150 and the 2nd offense between $150 and $250. The bill would provide a state overlay so the cell phone use laws would no longer be different from jurisdiction to jurisdiction. Warnings would be given between now and January 1, 2020- with the citations coming after that.

Interested in adding your voice and learning more about how you can make a difference? You could always join AZPHA and participate in our Public Policy Committee which continually tracks and advocates for bills like these that enhance public health in Arizona.

Interested in learning more about distracted driving generally? Check our NTHSA’s website on distracted driving.

March 18, 2019May 5, 2021

Will Humble State Legislature, Wills Blog

March 17 Legislative Update

Legislative Update

It was a busy week especially in the House with the various bills that were advocating for and against (mostly for). Here’s a run down on this week’s action and a forecast for next week.