Shelby Community Health Workers, Medicaid, Prevention, Social Determinants, Vaccination

UA Mobile Health Units Provide Great Partnering Opportunity for County Health Departments

The UA’s Mel & Enid Zuckerman College of Public Health has Primary Prevention Mobile Health Units that have been administering vaccine and doing preventive health screenings in rural & underserved Arizona communities in partnership with local health departments and organizations.

The mobile health units have served Arizona communities since 2016 and maintain close relationships with local communities. They’re  currently collaborating with Cochise, Santa Cruz, and Maricopa County health departments, Sunlife, and Chicanos por la Causa to distribute COVID-19 vaccine and are enthusiastic to expand partnerships to additional local health departments, FQHCs, other community based organizations.

Their teams are flexible, bilingual, and driven by local health department and community priorities. The units can arrive at a site anytime – e.g. early in the morning, weekends, evenings. Team members are trained to address vaccine hesitancy by tailoring conversations to address individual concerns.

The Team collaborates with health department and community partners to host mobile vaccine events in farming communities, senior housing complexes, community centers, schools, long-term care facilities, and other locations.

The teams are comprised of health sciences staff, students and volunteers with faculty oversight. Many staff, students and volunteers have strong ties to rural communities and are eager to work in partnership with their local health departments to expand vaccine access throughout rural Arizona.

There’s no cost to the county health department. This is a major win for health departments in the continued critical effort to get our most vulnerable vaccinated!

If your health department has not already, contact Dr. Cecilia Rosales at crosales@arizona.edu and her team will work with you to get the mobile health units out to your county quickly!

Shelby Public Health, Return on Investment, Suicide Prevention

Governor Vetoes $15M in Funding for Research & Public Health Prevention

INVESTMENTS WOULD HAVE COME FROM EXCESS MONEY IN THE MEDICAL MARIJUANA FUND

Actions speak volumes, don’t they? Well, the Governor showed his true colors when it comes to investing in public health when he vetoed more than $15M in public health prevention programs for things like suicide prevention, health issues and communities affected by drug addiction and incarceration, and medical student loans with a focus on psychiatry.

All of the money would have come from excess funds in the Medical Marijuana Fund that are there because of my mistake.

When the Arizona Medical Marijuana Act passed back in 2010 I set the card fee at $150/year ($75/year for folks that qualify for SNAP) which turned out to be way too high. I anticipated that we’d have about 40,000 card holders, not hundreds of thousands. As a result, the Medical Marijuana Fund now has almost $100,000,000 in it, far more than is needed to administer the program.

The governor’s veto of SB1408 stopped more than $15M from going to various public health and research programs. Governor Ducey’s veto scuttled a golden opportunity to use some of the excess money in the fund for worthy causes. Instead, the Fund will continue to lie dormant and important public health interventions unaddressed.

The bill would have required ADHS to provide grant monies from the Fund for a host of good causes, including:

  • $5,000,000 to the county public health departments to address public health issues related to drug addiction and incarceration;

  • $2,000,000 to the Institute for Mental Health Research for research to improve mental health services, research and education;

  • $2,000,000 to the Primary Care Provider Loan Repayment Program & the Rural Private Primary Care Provider Loan Repayment Program (prioritizing providers in behavioral health);

  • $2,000,000 to the Board of Medical Student Loans with a focus on psychiatry or other areas of practice;

  • $1,250,000 to ADHS for suicide prevention;

  • $1,250,000 to the AHCCCS for suicide prevention;

  • $1,000,000 for the health care directives registry; and

  • $250,000 to the ADHS’ Arizona Biomedical Research Commission for research the correlation between marijuana use and mental illness.

Sadly, none of these research and intervention opportunities will be happening now that the governor vetoed the bill.

Shelby Community Health Workers

An Open Letter from AzPHA’s Community Health Justice Committee

The JAMA podcast and its aftermath raise questions of the knowledge and attitude of physicians, public health practitioners and institutions regarding health disparities and racism in healthcare. Being unaware or ignoring the social, political and historical factors that impact health outcomes today is malefic to improving health equity.

In advertising the podcast, JAMA’s former editor said, “No physician is racist, so how can there be structural racism in healthcare?” This uninformed and biased viewpoint negates the lived experiences of many consumers of healthcare.

JAMA’s podcast (now removed from the site) further suggested that pointing to systemic racism as the root cause of health disparities is divisive. This ignores the scientific basis laid out in the body of research on health disparities.

Furthermore, to maintain that mentioning the role of racism in health disparities could be disruptive or divisive is bound to stifle the speech of those working in public health who strive to highlight the scientific knowledge and advocate for justice.

Comprehending systemic racism as a root cause of health disparities is a rich paradigm that can lead to more integrated public policy solutions. Policy solutions should be evidence-based, culturally responsive and rely on the existing research.

We call upon all health institutions and personnel, especially those who serve marginalized communities, to:

  1. Educate themselves and their staff comprehensively on the issue of structural racism and health disparities,

  2. Ensure their staff can discuss the evidence basis openly and without fear of reprisals, and

  3. Institute cultural humility advocacy learning beyond cultural competency and unconscious bias training.

Learn more here.

– AzPHA’s Community Health Justice Committee

fosemckay Current Priorities

PROPOSITION 449

AZPHA RECOMMENDS A YES VOTE ON PROPOSITION 449

Maricopa County voters are being asked to continue the property tax levy for the Maricopa County Special Health Care District. The assessment is due to expire in 2024 when its 20-year life span comes to its conclusion. The tax levy represents about 12% of the District’s revenue which is approximately $81.9M and is crucial to maintaining Valleywise Health’s mission.

Valleywise Health (formerly known as Maricopa Integrated Health System) is Arizona’s only public teaching health system and serves the needs of anyone who comes through its doors. Its mission is to “provide exceptional care, without exception, to every patient, every time.”

More than 65% of Valleywise patients are uninsured, underinsured, or covered by AHCCCS, Arizona’s Medicaid program, or Federal Emergency Services. Annually, Valleywise serves nearly 400,000 patients with its staff of nearly 3,700 medical and healthcare professionals.

Valleywise Health was established in 1877 as a place to care for the sick in the one of the fastest growing areas in our country and is governed by an elected Board of Directors. Today, Valleywise is a growing presence for health care services in Maricopa County.

That extended system of health care consists of:

  • Valleywise Health Medical Center, the only hospital in Maricopa County verified by the American College of Surgeons to provide adult (Level I) and pediatric (Level II) trauma care;

  • The Arizona Burn Center;

  • Three behavioral health centers;

  • 12 Community Health Centers – Federally Qualified Health Centers throughout the Valley;

  • The McDowell Healthcare Center, the largest provider of HIV primary care in Arizona, women’s and pediatric refugee health services;

  • The Arizona Children’s Center.

Valleywise has been working hard to keep Arizonans safe from Covid-19 and has acquired an advanced testing technology that can detect the virus in 45 minutes or less. It has conducted community education projects across the county in ten languages.

Valleywise is also home to the Arizona Burn Center, widely regarded as the finest in the US for emergency treatment and burn survivorship. First responders across the Valley routinely express their wishes to be taken to Valleywise for treatment if injured on the job.

Valleywise has expanded behavioral health services across Maricopa County, including the creation of the Valleywise Behavioral Health Center in Maryvale where medical care and behavioral health care services are administered together, at the bedside.

The First Episode Center in Tolleson serves patients and their families experiencing their first episode of psychosis. Valleywise is also the largest provider of court-ordered behavioral health testing and care in Maricopa County.

Valleywise is addressing a nationwide doctor shortage through a partnership with Creighton University Medical School, District Medical Group, Dignity Health and St. Joseph’s Medical Center. Its goal is to grow the number of new doctors, nurses and medical professionals in Arizona, which currently ranks near the bottom of all states in the number of practicing physicians per capita.

Residencies at Valleywise continue to be some of the most sought-after in the nation. As an example, each year there are 14 ED (emergency department) residencies available at Valleywise. The hospital receives 1600 applications for those 14 spots.

The Arizona Public Health Association strongly recommends a YES vote on Proposition 449.

fosemckay Current Priorities

PROPOSITION 208

AZPHA RECOMMENDS A YES VOTE ON PROPOSITION 208: INVEST IN ED

FACT SHEET: ARIZONA’S EDUCATION SYSTEM IS CRITICAL IN PROMOTING PUBLIC HEALTH GOALS

According to the CDC, the direct contact and amount of time schools have with 95% of our nation’s children and youth make them critical in promoting student health and safety and helping them to establish lifelong health patterns. The National Longitudinal Study of Adolescent Health found that student connection to adults at school is strongly positively correlated with reductions in violence, substance-use, emotional distress and pregnancy.

Adult health status is directly associated with higher educational levels, regardless of income. Children who do not learn to read in the first few grades, who read poorly, or who are retained in grade more than once are more likely than their peers to be drawn into a pattern of risky behaviors. People who acquire more education not only are healthier and practice fewer health risk behaviors, but their children also are healthier and practice fewer health risk behaviors.

According to 2020 U.S. Census data, Arizona spent $8,239 per pupil in FY2018 (federal, state and local sources) as compared to the U.S. average of $12,612. The chart below displays the trend in Arizona public education funding over the past two decades (all sources, in 2007 dollars).  Total funding has recently begun to approach levels in the early years of the recession but has not reached the funding level of 2007. 

One of the greatest impacts of inadequate funding is inadequate pay for teachers and Arizona ranks 48th in the nation for elementary teacher pay and 49th for secondary teacher pay.  Chronic underfunding and inadequate pay for staff translate into underserved students:

  • 1800 unfilled teacher vacancies (Arizona School Personnel Administrators Association, December 2019)

  • Largest class sizes in the nation

  • Over 3000 teachers not meeting standard requirements, for example, not certified

  • Highest student to counselor ratio in the nation with 903 to 1

  • Enough nurses to serve only one-third of schools

Invest in Ed Initiative

The Invest in Ed Initiative, supported by education, health, small businesses, faith and civic groups, and now AzPHA raises revenue for K-12 education by creating a dedicated, voter-protected fund.  Funds raised must be spent according to the following requirements:

  • 50% for hiring and pay increases for teachers and classroom support personnel including counselors and nurses

  • 25% for hiring and pay increases for student support services personnel, including classroom aides, school safety and student transportation

  • 10% for teacher mentoring and teacher retention

  • 12% for Career and Technical Education vocational training programs

  • 3% for the Arizona Teachers Academy for scholarships

The Initiative generates necessary revenue through a 3.5% surcharge on earnings over $250,000 for single filers or on earnings over $500,000 for married filers. The surcharge is applied only after deductions, on taxable income. The vast majority of Arizonans (99%) including the average small business owner, lawyer, doctor and dentist will not pay this surcharge. Only the top 1% of earners will contribute.

The federal tax cuts of 2017 saved these highest earners over $47,000 on average. This method of revenue generation avoids further negative impact on low wage earners, who pay a higher portion of their income in state and local taxes.

References:

About CDC Health Schools. U.S. Department of Health and Human Services, 2019., https://www.cdc.gov/healthyschools/about.htm

Blum, Robert. “Forward.”  Prevention Science in School Settings, edited by Kris Bosworth, Springer, 2015, p. v.

National Center for Education Statistics, Office of Educational Research and Improvement, U.S. Department of Education. The Condition of Education 2002. NCES 2002–025, Washington, DC: U.S. Government Printing Office. May 31, 2002. Online: http://nces.ed.gov/pubs2002/2002025.pdf.

Tyson H. Kappan special report–A load off the teachers’ backs: Coordinated school health programs. Phi Delta Kappan. Jan 1999:K-1. Online: http://www.pdkintl.org/kappan/ktys9901.htm.

Lowry R, Kann L, Collins J, Kolbe L. The effect of socioeconomic status on chronic disease risk behaviors among U.S. adolescents. JAMA 1996;276:792-97.

Arizona Interfaith Network. “Education in Arizona.” Education Civic Academy, 2020, Phoenix AZ.

Teacher Pay. Expect More Arizona, 2020, https://www.expectmorearizona.org/progress/teacher_pay/

School District Employee Report, Arizona Department of Education, 2020, http://www.ade.az.gov/sder/PublicReports.asp

Where Will the Money Go? Invest in Education, 2020, https://investined.com/get-the-facts/where-will-the-money-go/

Arizona Interfaith Network. “Education in Arizona.” Education Civic Academy, 2020, Phoenix AZ.

fosemckay Current Priorities

PROPOSITION 207

PROPOSITION 207 (SMART AND SAFE ARIZONA ACT) POSES BOTH PUBLIC HEALTH RISKS AND BENEFITS

AZPHA IS NOT TAKING A POSITION ON PROPOSITION 207 BECAUSE OF THE NUANCED PUBLIC HEALTH RISKS AND BENEFITS

AzPHA is neutral on Proposition 207 aka the Smart and Safe Arizona Act. It would legalize the possession and use of up to 1 ounce of marijuana (for people 21 and over) and set up licensed retail stores where up to 1 ounce of Cannabis can be sold to adults 21 and over. It would also offer expungement of some previous convictions for marijuana convictions. Here’s a link to the statutory language.

AzPHA has an existing Resolution regarding the legalization and retail sale of marijuana (it’s posted on our members only website) but the Resolution doesn’t specifically address the Initiative that will likely be before Arizona voters this fall.

There are public health risks and benefits with the Initiative. One public health risk is that it will likely increase access to marijuana for adolescents (it is clearly harmful to them). It will likely cause increases in ED visits from edible overdoses and may increase impaired driving and it’s consequences.

On the benefit side, everybody with convictions of less than an ounce can apply for expungement of their conviction, which will help their ability to make a living and improve the social determinants of health for themselves and their families.

Another big benefit is the criminal justice reform parts of the law. Adults will no longer be charged with nor convicted of possession of less than an ounce, with benefits to social determinants of health in my opinion (currently, possession of even very small amounts of marijuana are a Class 6 felony unless the person has an Arizona Medical Marijuana Certification).

Also, people of color are disproportionately charged with and convicted of marijuana possession even though they don’t disproportionately use the substance.

We had some interns do an analysis of the risks and benefits… here are their reports:

In short, the AzPHA Board of Directors elected to not take a position on Proposition 207 because there are both clear public health benefits and risks.

We also encourage Arizona voters to read the reports from our interns and think through whether they believe the public health benefits of the criminal justice reform portions of the law as well as the increased funds that would become available for public purposes outweigh the public health risks from increased access to Cannabis.

We believe that individual voters should carefully examine those benefits and threats before deciding how to vote on Proposition 207.

Shelby Behavioral Health

Ducey Whimsically Vetoes Important Governance Bills

In other irresponsible actions, the governor also vetoed two bills that would have helped governance of important state government functions. Both bills are low profile but important. Both got unanimous support from the legislature.

Vetoed: Better Oversight at the Arizona State Hospital

SB1716 would have provided for some badly needed additional oversight at the Arizona State Hospital (ASH). The ADHS both runs and regulates ASH. That lack of check and balance creates a ‘fox watching the henhouse’ situation in which the ADHS Director can send the message to her or his licensing team to ‘go easy’ on ASH or send in rookie inspectors that are unlikely to find deficiencies or substantiate complaints.

The bill that he vetoed would have made some modest reform that would have helped with oversight some (although far less reform than is needed).

The bill would have required the ADHS to add information in their reports about certain patient information and information on admission by civil commitment.  It would have also forced the ADHS to buy a surveillance system at ASH that has audio and visual capability and adequate storage.

The original bill would have created a badly needed independent Governing Board, but pressure from the ADHS resulted in an amendment that removed that provision.

I think Director Christ and Governor Ducey like things just the way they are…  a status quo scenario in which there is little accountability because the ADHS both runs and ‘regulates’ ASH.

Vetoed: Needed Reform of the Psychiatric Security Review Board

For the last 25 years persons that have been determined by the courts to be ‘guilty except insane’ (GEI) of a crime are placed under the jurisdiction of the Psychiatric Security Review Board housed at the ADHS. The PSRB maintains jurisdiction for the length of their presumptive sentence while they are committed at the Arizona State Hospital’s Forensic Unit (operated by the Arizona Department of Health Services).

The PSRB decides whether to release any person determined to be GEI person from ASH to the community if the they meets statutory release criteria (A.R.S. § 13-502). A big problem has been that the PSRB doesn’t have nearly enough resources to properly carry out their function and as a result due process suffers.

SB 1030 (which the governor vetoed last week) would have moved the PSRB responsibilities to the superior court in 2023, which is in a MUCH better position to make these decisions. The bill also makes important reforms of practices and the procedures of the PSRB.

This is a complex issue and many people spent countless hours working out the details of how to provide better governance of GEI system. The bill passed with unanimous support.

Nevertheless, the bill fell victim to a whimsical governor who is more interested in posturing than good public policy.

Shelby Marijuana, Social Determinants

Ground Rules for “Social Equity” Adult Use Marijuana Stores Set

SEE OUR POWERPOINT SUMMARIZING THE FINAL REGULATIONS

The authors of the Smart and Safe Arizona Act (aka Adult Use Marijuana) included an opportunity for persons “ from communities disproportionately impacted by the enforcement of previous marijuana laws” to be able to compete for 26 new licenses to own and operate a “marijuana establishment”.

Today the ADHS released the final criteria that they’ll use to decide who qualifies to apply for these new coveted licenses. In a nutshell, the new rules require that applicants meet 3 of the 4 following criteria in order to apply for one of these potentially lucrative licenses:

  1. Had a household income of less than 400% of the federal (HHS) poverty level in 3 of the last 5 years;

  2. Convicted of and eligible for expungement of eligible for possession of marijuana under A.R.S 36-2862 (less than 2.5 oz of Cannabis);

  3. Have a spouse, surviving spouse, parent, child, sibling or legal guardian who was convicted of a violation of federal or state laws related to marijuana or marijuana paraphernalia;

  4. Have lived in a “community that has been disproportionately affected by the enforcement of Arizona’s previous marijuana laws” in 3 of the last 5 years. (These criteria have yet to be developed and will be added in a subsequent iteration of the rules).

Principal officers & board member applicants cannot have an “A.R.S. § 36-2801 felony offense (with some exceptions – see the PowerPoint).

Applications would be accepted during the first 2 weeks of this December and would be awarded by the end of the year.

In addition to complying with all other requirements for operating a marijuana establishment, social equity licensees must show how they’ll help communities disproportionately affected by Arizona’s marijuana laws through either specific hiring or interning practices or by donating some of their profits to community organizations that focus on social or health inequities in the community.

The Marijuana Industry Trade Association will be holding a webinar this Friday from 3-5pm to explain the latest draft regulations. It’s free and you can join here.

SEE OUR POWERPOINT SUMMARIZING THE FINAL REGULATIONS

Editorial Note: Many states have attempted to put together social equity license programs as part of adult use marijuana laws. Most attempts have been largely unsuccessful and subject to intense criticism by the very communities that were supposed to be helping. Many of those programs were overly complex and relied on subjective qualifying criteria.

In my opinion, the ADHS rules have a decent chance at being successful where other programs have failed. The selection criteria are thoughtful, relevant, objective and verifiable. Well done in my opinion. It’s important to give credit where credit is due.

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