EPA & NHTSA Preempt State Fuel Efficiency Standards

This week the EPA filed a Final Rule that stops states from setting their own fuel efficiency fleet standards. California and 13 other states have more slightly aggressive fuel efficiency standards than the current EPA standards (AZ does not).  If today’ final rule withstands certain challenges it’ll prevent those states from having enhanced standards.

That’s important because the EPA is about to roll back the current federal fleet emission standards.  More on that in a bit. 

Under the existing national regulations, new cars, trucks, and SUVs fleets need to average about 50 miles per gallon by 2025. But back in 2018 the EPA & NHTSA proposed a roll back of the existing national vehicle fleet fuel efficiency standards (the current CA standard is basically the same as the current federal standard).

If the CA standard and the current national standard are the same, then what’s the big deal?

It’s a big deal because the Administration has proposed (but not yet finalized) a Rule that will roll back the current standards by stopping the progression of standards in 2021.  Rather than requiring a fleet average of 50 mpg by 2025, the proposed new federal standard would stop at 38 mpg (last year, the average fleet fuel efficiency was about 25 mpg),

So basically, the EPA this week set the stage for preventing CA and 13 other states from keeping the current standard of 50 mpg by 2025 when the EPA officially rolls back the standard (probably in the coming weeks).

Fuel efficiency standards are an important driver that pushes vehicle manufacturers to discover new ways of improving fuel efficiency and are an important strategy toward reducing greenhouse gas emissions.  The transportation sector is the largest contributor to atmospheric CO2 emissions.

You Can Be a Part of Increasing the Transparency of Arizona Elections

Elections have profound impacts on public health – good and bad.  Persons that get elected to public office at the federal state and local level routinely make decisions that influence public health.  Elected officials at the federal, state and local level make funding decisions about important agencies that impact public health and pass or fail to pass important national public health policy laws. 

Elected officials also make important appointments at state and federal agencies (like CDC, HHS, HRSA, CMS & EPA at the federal level and ADHS, AHCCCS, ADEQ etc. at the state level).  The persons in those positions set agency priorities, have wide latitude to make important decisions and who to hire.  They also have broad Rulemaking authority and establish or don’t establish public health policy that can has a profound impact on public health.

In short, elections have a big impact on public health. That’s why it’s super important to have an informed electorate, so people can make informed decisions about what they decide in the ballot box- whether it’s a person running for elected office at the state, federal, or local level- or whether it’s about a voter initiative.

Sadly, voters aren’t as informed as they could be about the decisions they make at the ballot box because it’s legal in the US and in Arizona to spend money to influence elections and not disclose whose money it is or why they’re spending it.  Sometimes you might hear this being called “Dirty Money” or “Dark Money” – referring to political spending when the original source remains secret.  All sorts of organizations, corporations, and wealthy individuals spend large sums of money to advertise and otherwise influence elections while the source of those funds remains hidden from the voters.

Since 2010, more political advertising has been secretly funded in Arizona as a percentage of total campaign spending than in any other state.  In part that’s because Arizona law has essentially no requirement that folks disclose political spending.

That’s where the Outlaw Dirty Money voter initiative comes in.  It’s a voter initiative that has been filed with the Secretary of State to change the state constitution that, if passed by the voters, will mean that at least Arizona voters will have a right to know who is spending money to influence elections.  You can read the text here.  Here are the elements of the Initiative:

  • Organizations spending more than $20,000 in state races or $10,000 in local races would be required to report the original source of their funding;

  • Organizations would be required to disclose all original contributors who gave $5,000 or more in an election cycle, removing the existing practice of creating a maze of organizations to hide the original source;

  • The Citizens Clean Election Commission would write and enforce the regulations to implement the Outlaw Dirty Money Constitutional Amendment;

  • Voters can file a complaint directly with the Clean Elections Commission to report violations; and

  • Local governments can pass more stringent requirements than those set forth in this Amendment.

You Can Play a Part

It will take the signatures of 357,000 Arizona voters to put the Outlaw Dirty Money Initiative on the November 2020 ballot.  That’s a lot of signatures.  This is a grassroots effort, so the signature gathering is being done by volunteers- meaning that many people need to be involved in the signature gathering effort.

Terry Goddard, the Chairperson for the Initiative, recently paid a visit to an AzPHA Board Meeting and described the Initiative and provided me with several initiative petitions.  I am already busy gathering signatures for the Initiative, and I’m hoping that you will gather some signatures as well.

Simply contact me at willhumble@azpha.org and I will get you some petitions and describe what you need to do.

AzPHA Annual Report

At the end of each Fiscal Year (July 1 to June 30) the AzPHA publishes an Annual Report summarizing the activities of the previous year including a discussion of our activities, membership update and a summary of our financial position.  We just completed this year’s Annual Report and posted it in the Members Only portion of our website.  You can get to the Report and a host of other financial information here. Here’s a quick summary:

The Arizona Public Health Association continued to make progress in all facets of our mission, including advocacy, professional development and networking.  We’ve increased our membership 27% in the last two year (632 at the end of FY-2019 compared with 496 members in FY-2017) and grown the number of sustaining Organizational Members.

In FY-19 we provided our members with timely policy updates (50 Public Health Policy Updates in FY 2019), targeted Action Alerts, and multiple comments on state public health matters (e.g. agency actions and legislative debates), and federal rulemakings (e.g. Title X, methane rule, public charge). We took public positions and testified in committee on many bills during the last legislative session.

We also continued to improve our website including our calendar of statewide public health events and blog content.  These improvements are also increasing our visibility on search engines.

AzPHA continued to diversify our revenue sources and improve our financial position (operating reserves), built new relationships with key partners, and enhanced our professional development and networking options. 

Feel free to view the full Annual Report when you get a chance.  We are a member organization In short, AzPHA is poised for another successful year.  Our progress toward improving our administrative and operational infrastructure positions us well for the coming year. 

Our enhanced individual and organizational membership, more aggressive and engaged advocacy work and our and fiscal diversification leave us in a strong position financially as we look toward the future of AzPHA and our Vision of Healthy Communities for Arizona.

Dispensary Owners File Retail Marijuana Voter Initiative 2.0

A group of Medical Marijuana Dispensary operators refiled a new proposed retail marijuana voter initiative this week. The revised language is largely the same as the language they submitted the first time around- but there are a few changes.

The first version said that the ADHS (who would regulate the program if it passes) sets standards for edible potency by=ut that they can’t set standards lower than 10mg of THC.  The revised version makes it clear that they can’t set standards above 10mg (a much better decision).  The new version also allows for an additional 26 retail marijuana store licenses (the former language would have basically limited licenses to the existing medical dispensaries. The new version also increases the criminal record expungement limit to possession of 2.5 ounces (in the first version it was 1 ounce.

Here’s an old blog post with my initial thoughts about the Initiative.

We’ll continue to review the language and evaluate whether basic public health principles related to our Retail Marijuana Resolution before taking any position.


AzPHA Member Vote on Updated Firearm Violence Prevention Resolution

Please Vote by October 4, 2019

In 2018, AzPHA members approved 3 new Resolutions including one entitled Resolution to Prevent Firearm Violence in Schools

This year we are proposing an update of last year’s firearm violence resolution. The updated version is entitled Resolution to Preventing Firearm Violence in the Community and Schools.

Our AzPHA Public Health Policy Committee developed the updated Resolution. The Board of Directors reviewed the Resolution at their September 20 meeting and have asked me facilitate an electronic vote of our members.

Accordingly, please review the updated Resolution and cast your vote at this link by close of business on Friday, October 4, 2019. We will announce the results in an October Public Health Policy Update and at the 2019 Annual Meeting on October 29, 2019.

Arizona Sexually Transmitted Infection Action Plan in the Works

The Arizona Department of Health Services is developing a Sexually Transmitted Infections Action Plan as part of something state government calls a “Goal Council Action”.  I’m not 100% sure what a Goal Council exactly is, but an initial “STD Action Plan” was presented to and approved by the “Goal Council” last week.

The Plan includes numerous actionable interventions (below) – although there’s no recommendation to decriminalize syringe service programs- which is a key evidence-based best practice to reducing the spread of some sexually transmitted infections. Below are the action items in the elements in the Plan. 

  • Promote policies that allow providers to prescribe treatment for partners.

  • Improve access to screening and treatment in rural Arizona by implementing standing orders for chlamydia, gonorrhea, and syphilis.

  • Identify ways to encourage expectant mothers to access prenatal care and receive syphilis screening and promote healthy pregnancies.

  • Utilize perinatal caseworkers to better understand the barriers to accessing care and link women to prenatal care and other social services to prevent reinfection and promote healthy pregnancies.

  • Expand partnerships with correctional facilities, home visiting programs, and groups that work with current and recovering drug users to address root causes of STD transmission.

  • On-board additional laboratories to electronic laboratory reporting via HL7 messaging or spreadsheet reporting. Initiate the enhancement of ADHS IT infrastructure to accept electronic case reports (eCR) from providers.

  • Expand multi-site resistance screening in Maricopa County.

  • Develop a plan to respond to emerging STDs like LGV and Chancroid.

The agency will be scheduling follow-up meetings with stakeholder subcommittees to discuss the action plan in more detail and establish next steps for implementation.

The Network for Public Health Law Launches Harm Reduction Legal Project

Individuals and communities across the United States are struggling with an epidemic of drug-related harm. Many states, including Arizona are hindered by laws and policies that reflect an outdated, punitive-focused approach to drugs and individuals who use them Like the fact that syringe service programs in Arizona are still technically committing felonies.

the Network for Public Health Law has launched the Harm Reduction Legal Project to address the legal and policy barriers that impair the implementation of evidence-based harm reduction measures. 

The Harm Reduction Legal Project provides direct guidance  to address legal and policy barriers to the creation, operation, and scale-up of harm reduction policies and programs.

Entities and individuals requesting assistance in navigating the often extremely confusing maze of existing laws and regulations that hamper harm reduction initiatives will have access to subject matter experts who can provide research, legal analysis, and strategic guidance as well as referrals to other knowledgeable experts and leading institutions. 

The Harm Reduction Legal Project provides real-time support to help organizations to successfully operate within existing law and policy while providing information to advocates who seek to modify existing legal restrictions on harm reduction initiatives.

To learn more or inquire about assistance from the Harm Reduction Legal Project, contact harmreduction@networkforphl.org or visit networkforphl.org/harmreduction

Some States Implementing Interventions to make Insulin more Affordable

Folks living with Type 1 diabetes and some people with Type 2 diabetes require daily insulin injections as part of their treatment. The cost of insulin per patient has nearly doubled in the last couple of years with an astonishing average annual cost of $5,700 per patient.

In fact, one in four individuals with diabetes (both those with and without health insurance) have said they have rationed or skipped taking insulin due to cost…  which can cause medical complications and be life-threatening.

The federal government hasn’t done much to make it more affordable.  They (FDA) did announced a new policies to increase competition in the insulin market, but that hasn’t done much. 

Some state legislatures have moved forward to make it more affordable.  For example, Colorado recently enacted H.B. 19-1216, which will cap the co-pay for a 30-day supply of insulin at $100 effective Jan. 1, 2020.

Oregon enacted SB 9 which will allow pharmacists to prescribe and dispense emergency refills of insulin to people with a previous prescription.

A New York bill, introduced this week would allow pharmacists to dispense emergency insulin and related supplies in a similar manner.

The Florida, Illinois, Michigan, New York, Pennsylvania, Rhode Island, and Wisconsin legislatures have introduced similar bills each of which would cap the out-of-pocket cost for a 30-day supply of insulin at $100 (none have yet been enacted as far as I can tell though).

Will Arizona be the next state to implement interventions to make insulin more affordable?

Federal Public Health Budget Progress (FY20)

Last week the Senate released the FY20 Labor, Health and Human Services, and Education appropriation bill.  The draft bill includes $178.3 billion discretionary funding, which is an approximate 1% increase over FY19.

Click here for the bill text, report language, and full summary.  document.  It’s unclear how Congress will proceed with funding the federal government when the fiscal year ends on Sept. 30. Given current tension among various members of Congress and the differences between the House and Senate Labor, Health and Human Services, and Education bills, a short-term continuing resolution through November or early December seems likely.

Below is a high-level summary of the Senate bill. The bill is just a proposal, and the differences between the House and Senate bills will need to be resolved in conference.

At first glance, it appears that most public health programs are level funded when compared to the previous year’s funding levels. Notable public health provisions include:


The total proposed funding level for CDC is $7.5 billion, an approximate $180.5 million increase from FY19. The funding includes:

  • $140 million in new funding to support first year activities associated with ending the HIV epidemic.

  • $10 million, or a $5 million increase, to address infectious disease and the opioid epidemic.

  • $5 million to better inform how Adverse Childhood Experiences increase the risk of future substance use disorders, suicide, mental health conditions, and other chronic illnesses.

  • $10 million for a suicide prevention initiative to utilize data and evaluation to inform efforts to prevent suicide, especially among vulnerable populations.

  • A $100 million increase in funding to continue global health security efforts to accelerate capacity to prevent, detect, and respond to infectious disease outbreaks.

  • Level funding for ASTHO priority programs, including the Public Health Emergency Preparedness cooperative agreement at $675 million and the Preventive Health and Health Services Block Grant at $160 million.


  • $1.5 billion for the state opioid response grant, which is level with FY19 funding.


  • $50 million base funding for community health centers to increase outreach, testing, care coordination, and HIV prevention services, including the use of PrEP in high-need counties and states.

  • $677 million for the Title V Maternal and Child Health Services Block Grant, which is level with FY19 funding.

  • $25 million for the HIV/AIDS Bureau Special Projects of National Significance Program. This program supports the development, evaluation, and dissemination of innovative models of HIV care to improve the retention and health outcomes of Ryan White HIV/AIDS Program clients.

Office of the Assistant Secretary for Preparedness and Response

  • $11 million for the National Ebola Training and Education Center.

  • $275.5 million for the Hospital Preparedness Program. (Note: It is unclear from the report language text if this is an increase or level funding with FY19.)

AzPHA Members Voting on Updated Firearm Violence Prevention Resolution 

In 2018, AzPHA members approved 3 new Resolutions including one entitled Resolution to Prevent Firearm Violence in Schools

This year we are proposing an update of last year’s firearm violence resolution. The updated version is entitled Resolution to Preventing Firearm Violence in the Community and Schools.

Our AzPHA Public Health Policy Committee developed the updated Resolution. The Board of Directors reviewed the Resolution at their September 20 meeting and have asked me facilitate an electronic vote of our members.

Accordingly, please review the updated Resolution and cast your vote at this link by close of business on Friday, October 4, 2019. We will announce the results in an October Public Health Policy Update and at the 2019 Annual Meeting on October 29, 2019.

Background about AzPHA Resolutions

Many of AzPHA’s  public health priorities are driven by Resolutions that are approved by our members.  AzPHA has dozens of Resolutions in place dating back to the 1930s.  They are all available on our Members Only site

Early resolutions focused on the importance of food safety regulations, tuberculosis control, family planning, and other contemporary public health issues.

More recent Resolutions have focused on support for addressing the Opioid epidemic, certifying community health workers, and addressing electronic cigarettes.  Our Resolutions are important to us because they set our public health advocacy priorities.

AzPHA Resolutions stay in place until and unless the Members vote to remove or update a Resolution. There is a process for developing new Resolutions.  Resolutions are developed by AzPHA Members and are forwarded to the Board for review. 

The Board reviews the Resolution and votes whether to forward the Resolution to the Members for approval.  Proposed Resolutions can be voted on electronically before the Annual Meeting or they can be voted on in-person at the Annual Meeting.  After approval of the resolutions, final copies are posted on the members only portion of our website