Megan Resolutions

2003- Primary Seat belt Law

ARIZONA PUBLIC HEALTH ASSOCIATION

PRIMARY SEATBELT LAW

WHEREAS, motor vehicle crashes are among Arizona’s leading causes of death, and, on average, crashes claim more than 1,000 lives each year, and

WHEREAS, in 2001 there were 6,833 Arizona children injured in crashes and 64 children who died, and

WHEREAS, seat belt usage is lower in the minority communities, contributing to an elevated injury rate among minority populations, especially Native Americans and Hispanics. The elimination of health disparities is a high priority of Healthy Arizona 2010, and

WHEREAS, elevated hospitalization rates due to crashes are seen in urban and rural areas of Arizona, and

WHEREAS, rates of injury and death can be significantly reduced by wearing safety belts, and

WHEREAS, Arizona’s current rate of seat belt usage is only 74%, and

WHEREAS, passage of a Primary Belt Enforcement Law (allowing law enforcement offices to stop vehicles in which occupants are not properly belted) will result in an 11% increa e in utilization of safety belts (to 85%), and

WHEREAS, this increased utilization will prevent 73 crash fatalities annually, prevent 1415 injuries, and avoid $104.9 million in medical, funeral, and other costs associated with injury, and

WHEREAS, passage of a Primary Belt Enforcement Law will qualify Arizona for $1 million annually in federal funds for the next five years,

THEREFORE, BE IT RESOLVED, that the Arizona Public Health Association supports the passage of a Primary Belt Enforcement Law in Arizona, AND will transmit a letter to the Arizona Governor’s Office for Highway Safety in support of such legislation.

Presented at the Annual Meeting, September 25, 2003 Action:

141~2003_(1)Primary seat belt law (public safety, legislation)

Megan Resolutions

2005- Pharmacies and Pharmacists – Duty to Fill Prescriptions

ARIZONA PUBLIC HEALTH ASSOCIATION RESOLUTION DOCUMENTATION FORM

Date Submitted: 7/7/05 Name of Submitted by: Charlotte Harrison
charrison@azfpc.org
Date Revised:

Title of Resolution: Pharmacies and Pharmacists – Duty to Fill Prescriptions

1. Statement of the Problem
This year, legislation passed in the Arizona Legislature that would have allowed pharmacists to refuse to fill prescriptions for emergency contraception based on his/her own personal religious or moral beliefs. The governor vetoed the bill, but it is not unlikely that such legislation will be introduced again. Such legislation would restrict women’s access to emergency contraception, especially in rural areas. Emergency contraception prevents an unplanned pregnancy, is approved by the FDA and is only available when prescribed by a licensed clinician.

2. Statement of Desired Action
The Arizona Public Health Association will take a public and vocal stand against restricting access to emergency contraception by allowing pharmacists not to fill a prescription unless a referral is made that would make EC immediately available.

3. Which other groups or organizations support this effort?
The Family Planning Coalition of Arizona. Membership include representatives from Arizona Family Planning Council, AzPHA, NOW, League of Women Voters, Planned Parenthood of Central and Northern Arizona, Planned Parenthood of Southern Arizona, some counties and others. The American Medical Association recently passed a resolution to require pharmacists to fill all prescriptions or provide immediate referrals.

4. Describe relationship of this issue to the current AzPHA Legislative Priorities.
AzPHA has a longstanding history of supporting access to family planning services.

5. Is this an issue for legislation?
The task will be to defeat any proposed legislation that allows pharmacists to refuse filling a legally written prescription.

6. Brief Financial and Public Health Analysis.
Emergency contraception (the morning after pill, Plan B) is a concentrated dose of oral contraception (birth control pills) that prevents a pregnancy. It is not an abortifacient, not to be confused with RU-486. Emergency contraception will not work if the woman is already pregnant. Planning and spacing pregnancies increases the chances of a healthy pregnancy and the birth of a healthy baby. Currently AHCCCS pays for 50% of all deliveries in the state, a portion of which is a result of an unplanned pregnancies.

PROPOSED AZPHA RESOLUTION

PHARMACIES AND PHARMACISTS – DUTY TO FILL PRECRIPTIONS
September 2005

In 2005, legislation passed in the Arizona Legislature that would have allowed pharmacists to refuse to fill prescriptions for emergency contraception based on his/her own personal religious or moral beliefs. The governor vetoed the bill, but it is not unlikely that such legislation will be introduced again. Such legislation would restrict women’s access to emergency contraception, especially in rural areas. Emergency contraception prevents an unplanned pregnancy, is approved by the FDA and is only available when prescribed by a licensed clinician.

Emergency contraception (the morning after pill, Plan B) is a concentrated dose of oral contraception (birth control pills) that prevents a pregnancy. It is not an abortifacient, not to be confused with RU-486. Emergency contraception will not work if the woman is already pregnant. Planning and spacing pregnancies increases the chances of a healthy pregnancy and the birth of a healthy baby. Currently AHCCCS pays for 50% of all deliveries in the state, a portion of which is a result of an unplanned pregnancies.

Refusal by a pharmacist to fill a legally written prescription for emergency contraception
 discriminates against women who are the only users of this contraceptive,
 creates additional barriers for women in rural areas where pharmacies are scarce,
 allows the personal belief of a pharmacist to override medical treatment directives of a physician and the desires of the patient.
 jeopardizes a rape victim’s ability to avoid an unwanted pregnancy.

Therefore Be It Resolved that the Arizona Public Health Association:

 Oppose any proposed legislation intended to restrict access to emergency contraception by a pharmacists unless immediate alternative access without unnecessary delay or interference is provided.

 Support any proposed legislation which requires individual pharmacists or pharmacy chains to fill legally written prescriptions or to provide immediate alternative access without unnecessary delay or interference.

142~2005_(1) Duty to Fill Prescription (medications, reproductive health, rural, healthcare)

Megan Resolutions

2005- Adolescent Access to Comprehensive, Confidential Reproductive Health Care

ARIZONA PUBLIC HEALTH ASSOCIATION RESOLUTION DOCUMENTATION FORM

Date Submitted: 8/5/05 Submitted By: Charlotte Harrison

Date Revised:

Title of Resolution: Adolescent Access to Comprehensive, Confidential Reproductive Health Care
Adapted and revised from APHA Resolution 9001, 01/01/90

Noting that adolescents tend not to seek contraception or reproductive health care until after they have 1 initiated sexual intercourse; and

Noting that sexually active and/or pregnant adolescents need informed, professional counseling and health care regardless of whether they wish to prevent a pregnancy; and

Understanding that while parental involvement in minors’ decisions may be very helpful, it can also 2 be punitive, coercive and/or abusive; and

Noting that physicians and other health care professionals have the obligation to provide care that is in the best interest of that patient; and

Emphasizing that the threat of compelled parental notification is a strong disincentive to an 3,4 adolescent’s seeking professional reproductive health care or advice; and

Noting that parental involvement laws, whether notification or consent, for adolescent3,4 reproductive health care do not appreciably discourage adolescent sexual activity; and

Further noting that adolescents are particularly vulnerable to misinformation, scare tactics, and other propaganda; therefore the Arizona Public Health Association

1. Urges that public policies and laws concerning adolescent access to reproductive health care, be designed for the primary purposes of preventing unintended pregnancy and providing sensitive, competent, professional health care to all adolescents;

2. Urges that such policies reflect the reality of adolescent sexual activity and take into consideration the demonstrably negative effect of compelled parental involvement on some adolescents’ contraceptive behavior;

3. Urges that services for adolescents include access to affordable, confidential contraceptive services;

4. Urges that a national and state policy on reproductive health care for adolescents include:
a. Confidential health services tailored to the needs of adolescents, including sexually active adolescents and those adolescents considering sexual intercourse;
b. Public policies that encourage sexually active adolescents to seek professional health care. These policies can encourage mature adult involvement (including parental involvement) but should in no way dictate or compel the specific involvement of parents or guardians in adolescent decisions regarding their reproductive health; and

5. Supports comprehensive, age appropriate and medically accurate health and sexuality education, including abstinence, in schools.

References:
1 Zabin LS, Clark SD: Institutional factors affecting teenagers’ choice and reasons for delay in attending a family planning clinic. Fam Plann Perspect 1983;15:25-29.
2 Donovan P: Judging teenagers: How minors fare when they seek court-authorized abortions. Fam Plann Perspect 1983;42:79-83.
3 Cartoof VG, Klerman LV: Parental consent for abortion: Impact of the Massachusetts law. Am J Public Health 1986;75:397-400.
4 Torres A, Forrest J, Eisman S: Telling parents: Clinic policies and adolescents’ use of family planning and abortion services. Fam Plann Perspect 1980;12:284-292.

143~2005_(1)Adolescent Access to Comprehensive, Confidential Reproductive Health Care (healthcare, reproductive health, abortion)

Megan Resolutions

2005- Hold AzPHA Meetings in Smokefree Cities

ARIZONA PUBLIC HEALTH ASSOCIATION RESOLUTION DOCUMENTATION FORM

Date Submitted: 8/2/05 Name of Submitted by: Bob England drbob@hookandassociates.com

Date Revised:

Title of Resolution: Hold AzPHA Meetings in Smokefree Cities

1. Statement of the Problem

Summary

The health hazards of environmental tobacco smoke (ETS) are well documented, and most workers take it for granted that government will protect them from unwanted ETS in the workplace. Yet workers in restaurants and bars remain unprotected across most of Arizona.

An economic incentive to enact smokefree worksite ordinances that include restaurants and bars exists. Those dedicated to protecting workers and others from ETS can deliberately take their business to cities that have already enacted smokefree ordinances. AzPHA can support its existing legislative priorities, uphold its long tradition in the area of tobacco control, support efforts by many in the community to enact further smokefree ordinances, and demonstrate true leadership by holding its major meetings only in cities which have enacted smokefree ordinances to include restaurants and bars.

Background

Numerous studies have linked ETS to heart disease, stroke, respiratory disease and lung cancer. The National Cancer Institute has projected that ETS is responsible for the early deaths of 53,000 Americans annually (NCI Monograph #10, 1999). The Public Health Service’s National Toxicology Program lists ETS as a known carcinogen (US DHHS, 2000, citing Cal. EPA, 1997). ETS is particularly hazardous to older adults, persons with cardiovascular disease, and persons with respiratory diseases. The CDC has issued a warning that anyone at risk for heart disease should avoid entering smoke-filled environments.

While a customer might arguably have the choice to avoid a smoke-filled environment, workers often do not. While many communities have smokefree workplace ordinances that exclude restaurants and bars, a great many workers are employed in these environments, and must inhale ETS as a condition of earning a living.

AzPHA has long been on record as supporting smokefree workplaces (Resolution 93-1, Smokefree Campus). Some Arizona communities have enacted ordinances extending smokefree workplaces to include restaurants and bars. Currently, Flagstaff, Tempe and Guadalupe are completely smokefree. All of Coconino County has smokefree restaurants, but bars outside of Flagstaff may allow smoking.

As other communities, and the state as a whole, debate such legislation, one argument frequently made against protecting workers from ETS is that to do so would cost businesses and city governments money, as smokers take their business elsewhere. There is no better counter to this than for those who value the protection of workers and patrons to deliberately give their business to cities that have smokefree ordinances in place.

As an organization dedicated to public health, and one which holds two major meetings each year, it is incumbent upon AzPHA to lead by example. It is time to put our money where our mouth is.
AzPHA should only hold its Annual Fall and Spring Meetings in cities that have already enacted smokefree ordinances.

2. Statement of Desired Action
AzPHA will schedule its Annual Fall Meeting and its Spring Educational Meeting only in cities that have enacted smokefree ordinances that protect all workers, including those in restaurants and bars. AzPHA will not schedule any large membership meeting in a city that has not done so.

3. Which other groups or organizations support this effort?
AzPHA was solicited to take this action by Americans for Nonsmokers’ Rights. Other organizations that have adopted this resolution include: the American Public Health Association (APHA); the National Cancer Institute, Tobacco Control Research Branch; the Centers for Disease Control and Prevention (CDC), Office on Smoking and Health; the Robert Wood Johnson Foundation, Tobacco Policy Change Program; the Colorado Public Health Association; and the National Conference on Tobacco or Health.

4. Describe relationship of this issue to the current AzPHA Legislative Priorities.
Support for a Healthy Environment is one of the three main legislative priorities. In particular, tobacco control is one of only two areas specifically mentioned within this priority.

5. Is this an issue for legislation?
No, but this supports proposed local and statewide campaigns to legislate smokefree workplaces.

6. Brief Financial and Public Health Analysis. Initially, adoption of this resolution will limit AzPHA to a choice of only a few cities within Arizona as potential sites for its Annual Fall and Spring Meetings. Currently, Flagstaff, Tempe and Guadalupe are completely smokefree. All of Coconino County has smokefree restaurants, but bars outside of Flagstaff may allow smoking.

PROPOSED AZPHA RESOLUTION
Hold AzPHA Meetings only in Cities with Smokefree Workplace Ordinances September 2005

Whereas, environmental tobacco smoke is a significant health hazard that no employee should be subject to as a condition of employment; and

Whereas, workers in restaurants and bars are no less entitled than other workers to health and safety protections; and

Whereas, some communities have passed smokefree workplace ordinances that do include restaurants and bars; and

Whereas, opponents of such ordinances cite loss of business as a rationale for opposing smokefree restaurants and bars; and

Whereas, supporters of smokefree work environments can counter this argument by taking their business to cities that have enacted smokefree workplace ordinances to include restaurants and bars; and

Whereas, the Arizona Public Health Association has long supported environmental protections, worker health and safety, and tobacco control; and

Whereas, the Arizona Public Health Association holds two large meetings each year at which it expends funds on behalf of the organization and causes individual members to expend their own funds in the city where the meeting is held;

Therefore Be It Resolved that the Arizona Public Health Association will schedule future membership meetings, including the Annual Fall Meeting and Spring Educational Meeting, only in cities that prohibit smoking in workplaces, including restaurants and bars. This resolution will become effective with the 2006 Annual Fall Meeting.

144~2006_(1)AzPHA Meetings in Smokefree Cities (tobacco, AzPHA personnel)

Megan Resolutions

2005- Fairness in Domestic Partnerships for All Arizonans

ARIZONA PUBLIC HEALTH ASSOCIATION RESOLUTION DOCUMENTATION FORM

Date Submitted _June 23,2005

Name of Submitter_ Joel S. Meister, Victoria Gaubeca

Date Revised: , 2005

Title of Resolution: Fairness in Domestic Partnerships for All Arizonans

1. Statement of the Problem
a. Summary
The Protect Marriage Arizona initiative is an attempt by a special interest group, the Center for Arizona Policy, to discriminate against any Arizonan who is or may be in a domestic partnership other than marriage, defined as the “union of one man and one woman.” Any form of domestic partnership currently recognized in any Arizona jurisdiction, other than marriage as defined by the proposed amendment, would be declared null and void. This action would deny the domestic partner benefits currently enjoyed by employees of the cities of Tucson, Phoenix, Scottsdale and Tempe and of Pima County. The Domestic Partner Registry of the City of Tucson would be declared null and void. The proposed amendment also could jeopardize domestic partner benefits currently offered to employees by private corporations in Arizona.

The proposed amendment to the Arizona Constitution “preserves marriage as only consisting of the union of one man and one woman, and prohibits the state and its political subdivisions from creating or recognizing any legal status for unmarried persons that is similar to that of marriage.” (exact wording in bold)

b. Background
For several years, various special interest groups, generally allied with fundamentalist religious organizations and so-called conservative politicians, have been promoting either federal or state constitutional amendments to prohibit the marriage of any two people other than “one man and one woman.” The effort to pass a constitutional amendment at the federal level is ongoing but not making rapid progress, while efforts at the state level have been much more effective. This appears to be integral to the strategy of the proponents. In the 2004 elections, 11 states passed such an amendment. Initiative movements are now underway in 14 other states.

Some of these amendments, such as the one now proposed in Arizona, are much more far-reaching than simply restricting marriage to one man and one woman. They would exclude not only gay and lesbian couples but any couple living together, for whatever reason, from the rights of a legal partner. For example, an elderly couple living together but unmarried for financial reasons, would be affected by the Arizona initiative.

The proposed amendment would not only outlaw domestic partnerships or civil unions of any kind, including domestic partner benefits, but also may have unintended consequences. For example, a similar amendment, passed in Ohio in 2004, resulted in an unexpected ruling related to domestic violence laws. In March 2005, charges of domestic violence against a man for assaulting his female partner were reduced by a judge because the new law no longer recognized unmarried couples.

2. Statement of desired action
a. AzPHA will join the statewide coalition, Arizona Together, which is comprised of Arizona individuals and groups representing the lesbian, gay, bisexual and transgender (LGBT), straight, human rights and faith-based communities joined together to defeat the proposed amendment that would write discrimination into the Arizona constitution.
b. AzPHA will urge all Arizonans to oppose efforts to place this initiative on the 2006 ballot by refusing to sign petitions, informing family members and friends of the dangers of this initiative, by writing letters to the editor of their newspapers, and by otherwise speaking out publicly against this initiative.

3. Which other groups or organizations support this effort?
A broad coalition, Arizona Together, is now forming to defeat this initiative. This statewide coalition currently includes:
• Arizona Human Rights Fund
• Derechos Humanos
• Wingspan
• Southern Arizona Stonewall Democrats
• Planned Parenthood of Southern Arizona
• Las Adelitas
• Tucson/Pima County Women’s Commission
• ACLU of Arizona
• Reveille Gay Men’s Chorus
• Amazon.Moms
• Arizona Leadership Institute
• City of Phoenix Gay and Lesbian Employees Association (COPGLEA)
• Echo Magazine
• Gay Mormon Fathers
• Gentle Shepherd
• Human Rights Campaign
• IONAZ
• N Touch
• National Organization for Women
• No Longer Silent
• OutFar! Lesbian and Gay Film Festival
• People for the American Way
• Planned Parenthood of Central and Northern Arizona

• PFLAG (Parents, Friends and Family of Lesbians and Gays)
• Scottsdale International Film Festival

4. Describe relationship of this issue to the current AZPHA Legislative Priorities

This issue affects access to health care, including health insurance and other health-related benefits, as well as child health and co-parent adoption rights.

5. Is this an issue for legislation? Not at this time.

6. Brief financial and public health analysis

• See #4 above. Arizonans employed by any state or local governmental entity, including school districts, whose health insurance is a domestic partner benefit, will lose that benefit should the amendment pass. Such a situation is likely to result in higher public costs for health care and poorer health status for those affected. Private employees whose health insurance is a domestic partner benefit also may be at risk.

• Children will suffer. Not every family has a married mother and father to provide. Domestic partnerships ensure that children have health care and benefits.

• Senior citizens will suffer. Seniors’ Social Security and pensions may be cut or taken away if they remarry. Many seniors live in “domestic partnerships” as a way to maintain their benefits.

• Local control will suffer. This initiative will rob towns, cities and counties of their ability to govern themselves. Currently, many local governments have already given these basic rights to their citizens and employees. Tucson has a Domestic Partner Registry that allows for hospital visitation rights – to be able to visit a loved one when he/she is sick or dying. This initiative would abolish that right.

• AzPHA traditionally supports legislation and policies that strengthen families. This amendment initiative would weaken families by excluding citizens from the benefits of marriage rather than encouraging marriage or domestic partnerships or civil unions as stabilizing institutions open to all citizens. The American Psychological Association,1 the American Psychiatric Association2 and the American Academy of Pediatrics3 all have publicly stated their support of families composed of same-sex parents.

• AzPHA traditionally supports legislation and policies that promote social justice. This amendment initiative constitutes social injustice by making discrimination and prejudice a part of our state constitution.

• General public opinion supports equity and fairness. A statewide survey in 2004 found Arizonans oppose same-sex marriage by a 3-2 ratio. However, the same poll showed 57 percent supports equal treatment and some legal recognition of same-sex couples.

ARIZONA PUBLIC HEALTH ASSOCIATION TITLE OF RESOLUTION

Fairness in Domestic Partnerships for All Arizonans

Whereas: The detrimental health and mental health effects of discrimination and prejudice based on sexual orientation are well documented1,2,3; and,

Whereas: The Protect Marriage Arizona Initiative would incorporate such discrimination and prejudice into the Arizona State Constitution; and,

Whereas: The Protect Marriage Arizona Initiative would weaken families by excluding some Arizonans from any legal recognition of their relationship4,5,6; and,

Whereas: The Protect Marriage Arizona Initiative would prohibit any form of domestic partnership or civil union; and,

Whereas: The Protect Marriage Arizona Initiative would exclude unmarried couples of any sexual orientation from access to domestic partner health care benefits; and,

Whereas: Children will suffer by losing any health care benefit based on a domestic partnership between the parents; and

Whereas: Senior citizen partners who are unmarried; e.g., for financial reasons, will lose any domestic partner benefits, including health insurance; and,

Whereas: The Protect Marriage Arizona Initiative violates the policy of AzPHA and APHA that supports access to health care for all;

Therefore be it resolved that:

The Arizona Public Health Association joins the Arizona Together coalition in its efforts to defeat the proposed amendment initiative; and,

The Arizona Public Health Association urges all Arizonans to oppose efforts to place this initiative on the 2006 ballot by:

1. Refusing to sign petitions supporting the initiative,
2. Informing colleagues, family members and friends of the dangers of this initiative,
3. Writing letters to the editor of their newspapers, and
4. Otherwise speaking out publicly against this initiative.

Citations

1 Lock, J, Kleis, BN, A Primer on Homophobia for the Child and Adolescent Psychiatrist. Journal of the American Academy of Child & Adolescent Psychiatry. 37(6):671-673, June 1998.

2 O’Hanlan, KA, et. al, Homophobia As a Health Hazard: Report of the Gay and Lesbian Medical Association

3 O’Hanlan, KA, et al., Review of the Medical Consequences of Homophobia with Suggestions for Resolution, Journal of the Gay and Lesbian Medical Association. 1(1) March 1997

4 American Psychological Association. Lesbian and Gay Parenting – A Resource for Psychologists, 1995.

“Not a single study has found children of gay or lesbian parents to be disadvantaged in any significant respect relative to heterosexual parents. Home environments provided by gay and lesbian parents are
as likely as those provided by heterosexual parents to support and enable children’s psychological growth.”

5 American Psychiatric Association. APA Fact Sheet on Gay, Lesbian and Bisexual Issues, p.4.

“Many gay men and women are parents. For example, estimates of the number of lesbian mothers range from 1-5 million, and the number of children from 6-14 million. Numerous studies have shown that the children of gay parents of gay parents are as likely to be healthy and well adjusted as children raised in heterosexual households.”

6 American Academy of Pediatrics. Policy Statement on Co-parent or Second-Parent Adoption by Same- Sex Parents.Committee on Psychosocial Aspects of Child and Family Health , February 2002.
“Children deserve to know that their relationships with both of their parents are stable and legally recognized. This applies to all children, whether their parents are of the same or opposite sex. The American Academy of Pediatrics recognizes that a considerable body of professional literature provides evidence that children with parents who are homosexual can have the same advantages and the same expectations for health, adjustment, and development as children whose parents are heterosexual.”

145~2005_(1)Fariness in Domestic Partnerships for All Arizonans (LGBTQ+)

Megan Resolutions

2005- Transportation Policies to Promote Public Health

SUPPORT FOR LAND USE AND TRANSPORTATION POLICIES TO PROMOTE PUBLIC HEALTH

September 2005

The Arizona Public Health Association (AZPHA) supports transportation and land use policies that minimize impacts on the environment, maximize public health and promote sustainable communities.

The “built environment” profoundly influences human health and productivity, according to Policy 2004- 04 of the American Public Health Association. 1 The built environment includes components of our environment which have been modified by human activity, including urban and suburban spaces, schools, housing, businesses, roads, sidewalks and transportation infrastructure. Determinants of public health which are influenced by the built environment include air quality, water quality, access to appropriate and safe physical activity, access to healthy foods and psychosocial factors. 1

During the last half century, changes in land use resulted in low density, single-use and geographically dispersed development in the Unites States and in Arizona.

Transportation became increasingly dependent on automobile travel with a decline in walking and bicycling. Residential development spreading rapidly into new areas beyond cities, called “urban sprawl,” has been accompanied by an increase in total “vehicle miles driven” and more air pollution from vehicular exhaust along roadways. These land use characteristics influence public health in a variety of ways:

Physical activity is more limited in spread-out, car-dependent communities. Public health studies link urban sprawl to decreased physical activity and increased risks of obesity, type II diabetes, cardiovascular disease, and depression . 1, 2

Asthma prevalence rates have increased 75% nationwide since the 1970’s, with a 160% increase among children under age 4. Arizona has the 4th highest prevalence in the US. 3 The burden is highest among children in some social and ethnic groups and in some inner city communities.
Components of vehicle exhaust, especially ozone and particulates, are known to exacerbate asthma. 4

Heart and lung diseases are aggravated by airborne particulate pollution, especially fine particulates. In the greater Phoenix metropolitan area, 80% of particulate pollution is caused by vehicles. 5

Motor vehicle and pedestrian fatality rates are lower in compact urban areas compared to less densely developed areas of urban sprawl. 6

Gastrointestinal illness, cancer and developmental effects such as learning disorders can be caused by contaminants in drinking water. Children are particularly sensitive to microbial contamination from sewage and livestock manures because their immune systems are less well developed than in adults. EPA has set standards for microbial, chemical and nucleotide contaminants in public drinking water systems, but data is not available for private water systems.4

Transportation options such as peripheral parking, car pooling, express bus and rail systems are underdeveloped or absent in urban areas of the state. Extending mass transit services could

reduce the number of vehicles on the roads, the number of vehicle miles driven, tailpipe emissions and motor vehicle accidents. 1, 6

Land splits and “Wildcat Subdivisions” in unincorporated areas fall outside the stringent regulations for subdivisions. People who buy property created by simple lot splits may not realize that they might have to share unregulated wells. These wells are at risk of becoming contaminated by septic tank effluent. In addition, groundwater in many areas of Arizona contains naturally-occurring arsenic and fluoride at unhealthful concentrations. 7

Land use and transportation patterns are determined by policy and funding at the federal, state and local levels, and by local and regional planning and decision-making practices. These policies and practices directly impact the mission of public health agencies at the local, state and federal level.

Therefore AZPHA supports policies that:

• Encourage transportation and land use legislation and regulatory initiatives that promote public health, and oppose measures that potentially threaten public health
• Manage growth and development statewide by requiring architecture, land use and transportation plans for long-term sustainability
• Protect and assure the supply of safe drinking water for the long-term benefit of the Arizona population
• Improve public health participation in transportation and land-use decisions and establish a process to assess the health impacts of proposed transportation and land use plans, policies and projects
• Require builders to plan for mass transit, sidewalks and bicycle paths in new residential developments
• Expand regional mass transit systems to reduce vehicle miles driven
• Require wildcat subdivisions to meet the same public health standards for wells and septic systems that are required of regulated subdivisions.

References
1. Creating Policies on Land Use and Transportation Systems that Promote Public Health. American Public Health Association Resolution 2004-4.
2. Russ Lopez. Urban Sprawl and Risk for Being Overweight or Obese. American Journal of Public Health, Vol. 94: 1574-1579. September 2004
3. Asthma: BRFSS 2002: Table L1: Self-Reported Lifetime Asthma Prevalence Rate (Percent) and Prevalence (Number) by State or Territory. US Centers for Disease Control.
www.cdc.gov/brfss/02/lifetime/tableL1.htm
4. America’s Children and the Environment: Measures of Contaminants, Body Burdens, and
Illness. Second Edition. The U.S. Environmental Protection Agency, February 2003.
5. Report of the Governor’s Air Quality Strategies Task Force. Submitted to Governor Jane Dee Hull February 17, 1998.
6. Reid Ewing, Richard A. Schieber and Charles V. Zegeer. Urban Sprawl as a Risk Factor in Motor vehicle Occupant and Pedestrian Fatalities. American Journal of Public Health, Vol. 93: 1541-1545. September 2003.
7. Bill Frank, former Chair of the AZPHA Environmental Section. Personal communication.

Submitted by Barbara Burkholder for the AZPHA Legislative Committee

146~2005_(1)Transportation policies to promote Public Health (environment, prevenative health, misc)

Megan Resolutions

2005- Promoting Public Health and Education Goals through Coordinated School Health Programs

Promoting Public Health and Education Goals through Coordinated School Health Programs

Since 1928 the Arizona Public Health Association has adopted numerous resolutions and policy statements that address public health. This position paper seeks to provide a contemporary, science-based school health program model for promoting healthy children, families and communities. This position paper models an American Public Health Association (APHA) position statement adopted by APHA membership in 2004.

I. The Role of the Education System in Promoting Public Health Goals According to Healthy People 2010, schools have more influence on the lives of young people than any other social institution except the family and provide a setting in which friendship networks develop, socialization occurs and behavioral norms are developed
1 and reinforced.

Of the 107 Healthy People 2010 objectives related to adolescents and young adults, 10 2 focus on the role of schools in improving the health of young people. Adult health 3 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 4 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 5 practice fewer health risk behaviors. Increasing the high school completion rate, a major goal of the education system, is also fittingly a health objective for the nation (objective 7.1).1

Preventable health risk behaviors that are often formed in childhood, persist into adulthood and are frequently interrelated include poor dietary choices; inadequate physical activity; behaviors that can result in violence or unintentional injuries; engaging in sexual behaviors that can cause HIV infection, other sexually transmitted diseases and unintended pregnancies; and the use of tobacco, alcohol and other harmful drugs.6 Certain risk behaviors are more likely to occur among particular subpopulations of 6 students defined by sex, race/ethnicity and grade.These behaviors can lead to serious health problems and disabilities that are costly burdens on individuals, families, and the nation.1 For example, annual hospital costs for obesity-related conditions among 7 youth aged 6 to 17 increased from $35 million to $127 million from 1979 to 2000.

Well-prepared and supported school staff can provide credible health information and direction on forming healthy attitudes, beliefs and habits. Students who participate in health education classes that use effective curricula have been found to increase their 8 health knowledge and improve their health skills and behaviors. School-based 9 programs have proven effective in significantly reducing student binge drinking, 10,11,12, 13, 14, 15 tobacco use, physical inactivity, unhealthy dietary patterns and obesity. For many young people, schools might be the only place they ever receive accurate information and guidance to prevent workplace injuries and other adult health problems.

Elementary and secondary schools are also valuable settings for the provision of public health services. The 53.8 million students and 3.6 million staff members in nearly 129,000 public and private elementary and secondary schools comprise 20 percent of 16 the U.S. population. More than 95 percent of children ages 5-6, 98 percent of children ages 7-15, and 93 percent of children ages 16-17 are enrolled in school16 and thus in easy reach of public health agencies. Schools often provide services that might not be available elsewhere. For example, schools provide most of the mental health services
17 provided to children. Many agencies work with schools to help provide critical health 18, 19 20 services, particularly for students with disabilities and those from families in
21 poverty.

II. The Central Role of Health in Promoting Education Goals
It has long been clear that education and health are inextricably intertwined.22 Schools cannot achieve national educational goals if students and staff are not healthy and fit 4, 23 physically, mentally and socially. As the U.S. Department of Education has acknowledged, “Too many of our children start school unready to meet the challenges of learning, and are adversely influenced by…drug use and alcohol abuse, random 24 violence, adolescent pregnancy, AIDS, and the rest.”

Student learning and academic achievement can be inhibited by poor nutritional 25, 26,27,28,29,30 status, poor indoor air and environmental quality, uncontrolled asthma30 and other chronic health conditions, undiagnosed and untreated oral health, vision and hearing problems, injuries, unaddressed social and mental health troubles, early 29,30 pregnancy, alcohol and drug use and other health problems.Educational institutions at all levels are coping with increasing prevalence of chronic health conditions that 31 require ongoing monitoring and care by trained health professionals. One child in four has been estimated to be at risk of failure in school because of social, emotional and 32, 30,33,34 health problems.School health programs can improve education outcomes.For example, a school health program designed to teach low-income elementary school students and their parents how to better manage asthma significantly increased effective asthma management behaviors, reduced asthma episodes and improve 35 school grades. School-based mental health services provided in partnership with community organizations can help elementary and secondary students succeed in school.33 Parents and the general public consistently demonstrate strong support for
36, 37 38 promoting health and fitness goals in schools.

III. The Coordinated School Health Program Model
The twin goals of education and health inspire the Coordinated School Health Program (CSHP) model, which is designed to purposefully integrate the efforts and resources of education, health and social service agencies to provide a full set of programs and services without fragmentation or wasteful duplication.4,30, 39 The CSHP model, which is more comprehensive than prior approaches to school health,39 provides a practical, systematic and cost-efficient30 approach to the provision of prevention education and services. Staff interviewed from schools with a coordinated approach to school health associated this approach with higher test scores, more alert students, more positive
40 attitudes, skill development, and readiness to learn.

The CSHP model involves the active coordination of the following eight components 41 such that each component reinforces the other.

1. A Healthy School Environment: School buildings and the area surrounding them are safe, secure and free of tobacco and biological and chemical agents that are detrimental to health; physical conditions including noise, lighting, temperature and air quality are conducive to learning; the psychosocial climate and culture of the school promotes academic achievement and overall well-being while preventing violence and bullying; and the school facilitates and actively promotes physical activity, healthy eating and other lifelong health habits.

2. Comprehensive Health Education: A planned, sequential, PreK-12 curriculum taught by qualified, proficient teachers addresses the physical, mental, emotional and social dimensions of health and allows students to develop and demonstrate increasingly sophisticated health-related knowledge, attitudes, skills and practices. The curriculum is consistent with the National Health Education Standards42 and
incorporates a variety of topics including personal health, oral health, family health, community health, consumer health, environmental health, sexuality education, mental and emotional health, injury prevention and safety, nutrition, prevention and control of disease, tobacco-use prevention and substance abuse prevention.

3. Physical Education: A planned, sequential PreK-12 curriculum taught by qualified, proficient teachers provides cognitive content and learning experiences in a variety of activity areas such as: basic movement skills; physical fitness; rhythms and dance; games; team, dual, and individual sports; tumbling and gymnastics; and aquatics. A quality physical education program is consistent with the National Physical Education Standards,43 promotes each student’s optimum physical, mental, emotional, and social development, and involves activities and sports that all students enjoy and can pursue throughout their lives.

4. School Health Services: Services provided for students at school or in school- linked clinics by qualified professionals such as school nurses, healthcare providers, oral health professionals, health educators, optometrists and other allied health personnel are designed to ensure access or referral to primary health care services, conduct diagnostic screening, manage chronic health conditions, provide emergency care for illness or injury, prevent and control communicable disease and other health problems and provide educational and confidential counseling opportunities.

5. School Nutrition Services: Qualified child nutrition professionals provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students and are provided in pleasant settings with adequate time to eat and socialize. All foods and beverages sold or served at school reflect the U.S. Dietary Guidelines for Americans and other criteria to assure nutrition integrity. Also included are classroom nutrition and health education to foster lifelong habits of healthy eating, and linkages with nutrition-related community services.

6. School Counseling and Psychological Services: Professionals such as certified school counselors, psychologists and social workers provide services to improve students’ mental, emotional, and social health and remove barriers to students’ academic success, through such means as individual and group assessments, interventions, referrals, tobacco cessation programs and consultation with other school staff members.

7. Health Promotion for School Staff: Opportunities are provided for school staff to improve their health status and morale through such activities as health assessments, health education, tobacco cessation and health-related fitness activities so as to reduce health care costs and motivate staff to model a healthy lifestyle to students.

8. Family and Community Involvement: The school health program is enhanced with an integrated school, family and community approach through such means as school health advisory councils, the active solicitation of parent involvement, and the engagement of health-related community resources and services such as after-school recreation programs.

The CSHP model provides an organizational framework for school districts and state education and health agencies to use in planning, coordinating and evaluating school health initiatives, synchronizing comparable public health and school health programs, and efficiently using multiple funding sources to improve the health and education of young people.2 The CSHP model also addresses the national goal of eliminating health disparities in youth by addressing unmet needs in infectious and chronic health conditions as well as mental health.

Further, it informs the professional preparation and continuing education of teachers and other school health program professionals. For example, the National Council for Accreditation of Teacher Education (NCATE), in cooperation with the American Association of Health Education (AAHE) and the National Association for Sport and
44 Physical Education (NASPE), has developed program standards for health education and physical education teacher preparation programs.

In recent years, a growing number of states including Arkansas, California, Florida, Kentucky, Maine, Maryland, Michigan, New Mexico, New York, North Carolina, Oregon, Rhode Island, Tennessee, West Virginia, and Wisconsin have adopted the CSHP model and actively promote it. Numerous scientifically rigorous, practical resources have been developed by the Division of Adolescent and School Health (DASH) within the Centers 45, 46 for Disease Control and Prevention (CDC), state education and health agencies,and 47 health and education professional organizations to guide the establishment of CSHPs.
Such resources can prove valuable to schools that already provide some of the components of the CSHP model, though perhaps with insufficient scope, quality or coordination.

IV. Recommendations for Implementing Coordinated School Health Programs AzPHA supports the implementation of effective coordinated school health programs in every public and private elementary, middle, and high school across Arizona and gives the following recommendations:
1. Establish support infrastructure: Each school and school district should adopt policies, employ a qualified school health coordinator, provide guidance and assistance, and assure adequate financial resources for the establishment of a coordinated school health program in each school that is managed by a school health team, school health advisory council or individual coordinator.
2. Conduct needs assessments: Education administrators should conduct needs assessments to identify undiagnosed health conditions or other unmet health or mental health needs that inhibit student academic success.
3. Tailor the CSHP to the local community: Every school should ensure that its school health program addresses the identified needs of students, is consistent with community values, is hospitable to the cultures and languages of the school population, and builds on community assets.
4. Establish school health advisory councils: Each school and school district should establish and support a school health advisory council (SHAC). An example of SHAC membership includes: school health program staff members, public health officials, parent representatives and members of the community to assist with the oversight, management, planning and evaluation of school health policies and programs.
5. Increase Federal & State resources: The federal and state government should expand support for school health coordinator positions in each state health and education agency to facilitate communication and coordination of programs among key players; coordinate school and state-level data-gathering and data-analysis for evaluation, public health surveillance and research; and provide technical assistance, professional development and other forms of support for the widespread implementation of CSHP.
6. Improve coordination among Federal and State agencies: The U.S. Departments of Education, Health and Human Services, Agriculture and Justice at the Federal and State level should strengthen collaboration on integrating funding streams, collecting and analyzing data, and sponsoring research on best practices to support the widespread adoption of CSHP.

7. Improve coordination among voluntary, health professional, and educational organizations in support of CSHP.

References
1
U.S. Department of Health and Human Services. Healthy People 2010: Volume I, 2nd ed. Washington,
DC: U.S. Government Printing Office. Nov 2000. Online: http://www.health.gov/healthypeople/.
2
Fisher C, Hunt P, Kann L, Kolbe L, Patterson B, Wechsler H. Building a healthier future through school health programs, in Centers for Disease Control and Prevention. Promising Practices in Chronic Disease Prevention and Control: A Public Health Framework for Action. Atlanta, GA: Department of Health and Human Services. 2003. Online: http://www.cdc.gov/nccdphp/promising_practices/school_health .
3
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.
4
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.
5
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.
6
Centers for Disease Control and Prevention. Youth risk behavior surveillance–United States, 2003.
Surveillance Summaries. MMWR May 21, 2004; 53(SS-2):1-100. Online: http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf.
7
Wang G, Dietz WH. Economic burden of obesity in youths aged 6 to 17 years: 1979-1999. Pediatrics May 2002; 109:E81-1.
8
Connell D, Turner R, Mason E. Summary of findings of the school health education evaluation: health promotion effectiveness, implementation, and costs. J School Health 1985; 55:316-321.
9
Botvin GJ, Griffin KW, Diaz T, Ifill-Williams M. Preventing binge drinking during early adolescence: one-
and two-year follow-up of a school-based preventive intervention. Psychol Addict Behav 2001; 15(4):360- 365.
10
Dent C, Sussman S, Stacy A, Craig S, Burton D, Flay B. Two year behavior outcomes of project towards no tobacco use. J Consulting Clin Psychol 1995(4); 63:676-677.
11
Flynn BS, Worden JK, Secker-Walker RH, Badger GJ, Geller BM, Costanza MC. Prevention of cigarette smoking through mass media intervention and school programs. Am J Public Health 1992; 82:827-834.
12
Botvin GJ, Baker E, Dusenbary L, Botvin E, Diaz T, Long-term follow-up results of a randomized drug
abuse prevention trial in a white middle-class population. JAMA 1995;273:1106-1112.

13
Centers for Disease Control and Prevention. Increasing physical activity: a report on recommendations
of the task force on community preventive services. MMWR 2001;50(RR18):1-16.
14
Luepker R, Perry C, McKinlay S, Perry CL, Nader PR, Parcell GS, Stone EJ, Webber LS, Elder JP, Fledman HA, Johnson CC, Kelders SH, Wu M. Outcomes of a field trial to improve children’s dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health. JAMA 1996;275:768-776.
15
Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Laird N. Reducing obesity via a school-based interdisciplinary intervention among youth. Arch Pediatr Adolesc Med 1999;153(4):409-418.
16
U.S. Census Bureau, Administrative and Customer Services Division, Statistical Compendia Branch.
2003 Statistical Abstract of the United States (online). Washington, DC: U.S. Government Printing Office. Last revised: May 21, 2004. Online: http://www.census.gov/prod/www/statistical-abstract-03.html .
17
Office of the Surgeon General of the U.S. Public Health Service, U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Washington, DC: U.S. Government Printing Office. 1999. Online: http://www.surgeongeneral.gov/ library/mentalhealth/home.html.
18
Brener ND, Burstein GR, DuShaw ML, Vernon ME, Wheeler L, Robinson J. Health services: results from the School Health Policies and Programs Study 2000. J School Health 2001;71(7):294-304.
19
National Assembly on School-Based Health Care. Creative Financing for School-Based Health Centers:
A Tool Kit. Washington, DC: National Assembly on School-Based Health Care. 1999.
20
U.S. Department of Education, Office of Special Education and Rehabilitative Services. A New Era: Revitalizing Special Education for Children and Their Families. Washington, DC: U.S. Government Printing Office. 2002.
21
Health Care Financing Administration and Department of Health and Human Services. Medicaid and School Health. Washington, DC: U.S. Government Printing Office.1997.
22
National Commission on the Role of the School and Community in Improving Adolescent Health. Code
Blue: Uniting for Healthier Youth. Alexandria, VA: National Association of State Boards of Education. 1990.
23
Novello AC, Degraw C, Kleinman D. Healthy children ready to learn: an essential collaboration between health and education. Public Health Reports. 1992;107(1):3-15.
24
U.S. Department of Education. America 2000: An Education Strategy Sourcebook. Washington, DC:
U.S. Government Printing Office. 1991:16-17.
25
Meyers AF, Sampson AE, Weitzman M, Rogers BL, Kayne H. School breakfast program and school performance. American Journal of Diseases of Children Oct 1989;143:1234-39.
26
Murphy JM, Pagano ME, Nachmani J, Sperling P, Kane S, Kleinman RE. The relationship of school
breakfast to psychosocial and academic functioning: Cross-sectional and longitudinal observations in an

inner-city school sample. Arch Pediatr Adolesc Med 1998;152:899-907. Online: http://archpedi.ama- assn.org/issues/v152n9/abs/pnu7508.html#aainfo.
27
Pollitt E, Liebel RL, Greenfield D. Brief fasting, stress, and cognition in children. Am J Clin Nutrition 1981;34:1526-33.
28
Fowler MG, Davenport MG, Garg R. School functioning of U.S. children with asthma. Pediatrics.
1992; 90 (6): 939-44.
29
Wolford-Symons C. Bridging student health risks and academic achievement through comprehensive school health programs. J School Health. 1997;67:224.
30
Kolbe LJ. Education reform and the goals of modern school health programs: How school health
programs can help students achieve success. State Education Standard. Autumn 2002;3 (4) : 4-11. Online: http://www.nasbe.org/Standard/11_Autumn2002/Education_Reform.pdf .
31
Newacheck PW, Halfon N. Prevalence, impact, and trends in childhood disability due to asthma. Arch Pediatr Adolesc Med 2000;154(3):287-93.
32
Dryfoos JG. Full Service Schools: A Revolution in Health and Social Services for Children, Youth, and Families. San Francisco: Jossey-Bass. 1994.
33
Center for Health Promotion and Prevention Research, University of Texas School of Public Health,
The University of North Carolina Center for Health Promotion and Disease Prevention, University of New Mexico Prevention Research Center. Student achievement through better health. Demonstrated Benefits of Coordinated School Health Programming. 26 September 2000. Online: http://www.learnnc.org/dpi/instserv.nsf/ID/Student_Achieveètter_Health/$file/Student_Achieveètter_Healt h.doc.
34
Murray NG, Schuler KE, Lopez SD, Low B, Kelder SH, Parcel GS. School Connections: Schools Connecting Health and Success. Houston, TX: Center for Health Promotion and Prevention Research. 2001.
35
Evans D, Clark NM, Feldman CH, Rips JL, Kaplan KL, Levison MJ, Wasilewski Y, Levin B, Mellins RB. A school asthma health education program for children aged 8-11 years. Health Edu Q. 1987;14:267-289.
36
Gallup Organization. National Telephone Survey of 1,003 Parents of Adolescents Enrolled in U.S.
Public Schools. Atlanta, GA: American Cancer Society. 1993.
37
Marzano RJ, Kendall JS, Cicchinelli LF. What Americans Believe Students Should Know: A Survey of
U.S. Adults. Aurora, CO: Mid-continent Regional Educational Laborator. Sep 1998. Online: http://www.mcrel.org/products/standards/survey.pdf.
38
American Alliance for Health, Physical Education, Recreation, and Dance. Public Attitudes Toward Physical Education. Are Schools Providing What the Public Wants? Princeton, NJ: Opinion Research Corporation International. 2000.

39
Allensworth DD, Kolbe, LJ. The comprehensive school health program: Exploring an expanded
concept. J School Health 1987;57(10):409-411.
40
Siegel M, Doner L. Marketing Public Health: Strategies to Promote Social Change. Gaithersberg, MD: Aspen Publishers. 1998:296-302.
41
Marx E, Wooley SF, Northrop D. Health Is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press. 1998.
42
American Cancer Society. Health for Success: The National Health Education Standards. Atlanta, GA:
American Cancer Society. 1995.
43
National Association for Sport and Physical Education. Moving into the Future: National Standards for Physical Education. Reston, VA: National Association for Sport and Physical Education. 1995.
44
National Council for Accreditation of Teacher Education. Standards for Health Education Programs. 2001. Online: http://www.ncate.org/standard/programstds.htm.
45
Dozens of guidance publications are listed at http://www.cdc.gov/HealthyYouth/publications/index.htm.
46
For example: School Work Group. Building Infrastructure for Coordinated School Health: California’s
Blueprint. Sacramento, CA: California Department of Education. 2000. Online: http://www.cde.ca.gov/ls/he/cs/documents/blueprintfinal.pdf; Maine School Management Association. State of Maine Guidelines for Coordinating School Health Programs. Augusta, ME: Maine School Management Association. 2002.
47
For example: Bogden JF. Fit, Health, and Ready to Learn: A School Health Policy Guide. Alexandria,
VA: National Association of State Boards of Education. 2000; Council of Chief State School Officers, CCSSO and the Association of State and Territorial Health Officials. School Health Starter Kit.
Washington, DC: Council of Chief State School Officers. 2003.

Submitted by:

Diane Cox, PhD, MSN, RN
AzPHA School Health Section Chair
On behalf of the AzPHA School Health Section March 16, 2005

149~2005_(1)Promoting Public Health and Education Goals through Coordinated School Health Programs (education, public health infrastructure)

Megan Resolutions

2006- Support Public Health Infrastructure

Arizona Public Health Association Resolution Documentation Form

Date Submitted: 7/3/06 Submitted By: Paul Mittman
Date Revised: and Barbara Burkholder

Resolution to Support Public Health Infrastructure

The Arizona Public Health Association (AZPHA) supports investment in an effective public health infrastructure that safeguards the health of the people of Arizona. Preventing and tracking epidemics, protecting against environmental hazards, promoting healthy lifestyles to decrease chronic diseases, and responding to disasters are vital to Arizona and require the State’s support both in times of economic prosperity and decline.

Background

The Arizona population grew 64.9% from 1990-2005 and is now estimated to be 6,239,482.1 Arizona is ranked 2nd in the country for population growth, behind Nevada, for the 11th year in a row. 2 Just as rapid growth increases the demand for new schools, hospitals and housing, this growth also puts new demands on public health systems. The public health infrastructure includes all governmental and nongovernmental entities engaged in providing essential public health services.

Funding for these systems has not kept pace with the new challenges. Tremendous opportunities to improve health and reduce health care costs go unaddressed. Arizona spends only $81 per capita, ranking 44th in the United States for public health purposes. 3

Arizona passed a series of permanent tax cuts in the 1990’s, leaving the state in a deficit situation with no “Rainy Day Fund” when the economy hit a decline in the early 2000’s. With the restoration of more robust state revenues in 2006, state policymakers passed a fiscal year 2007 tax cut of more than $1.1 billion per year in combined income and property tax. This is the largest tax reduction in state history. Supporters claim that cuts are a boon to the economy that will increase state revenue. However, two presidential economic experts reported recently that the government does not recover revenue lost by tax cuts.4

The fluctuations in state revenue put Arizonans at risk because of under funding and gaps in the public health infrastructure. The following statistics vividly portray the need for investment in Arizona’s Public Health system:

Access to care – over 1 million people are not covered by private or public health insurance in Arizona.5 With 17.1% of the population uninsured, the state ranks 40th in the US. 2 AZPHA’s goal is access to health care for all.

Health disparities – there are substantial inequalities in disease, health outcomes and access to care across populations in Arizona. American Indians and African Americans consistently have the poorest health status and highest rates of death. Public health agencies and partners in the private sector need to address these disparities by investing in strategies such as disease prevention, disease management, education and outreach, literacy and language services, and cultural competency training for the workforce.6

Obesity –36.6% of Arizonans are overweight compared to the Healthy People 2010 goal of 21.1%. 7 If Arizona implemented comprehensive programs to reduce obesity, we could effect substantial reductions in costs to the health system associated with diabetes, heart disease, osteoarthritis and cancer

Diabetes – 6.6% of Arizonans are diabetic resulting in approximately $50 million each year in health care costs.8, 9 By providing a comprehensive statewide program to control the onset and severity of diabetes, the Public Health system could prevent thousands of cases of eye disease, blindness, kidney failure and amputations.

Immunization Coverage – 78.6% of children age 19-35 months have received the recommended immunizations, which can reduce the risk of serious infectious disease. Arizona ranks 40th in the US.3

Motor vehicle deaths – Arizona ranks 44th in the country with 2.1 motor vehicle deaths per 100,000 miles driven.3 Implementation of injury prevention programs could prevent thousands of deaths and non-fatal injuries each year.

Tobacco smoking – 18.5% of Arizonans over 18 smoke tobacco products. The Healthy Arizona 2010 goal is to reduce smoking to 14%, which will reduce the risk of heart disease, cancer and stroke.2, 3

Sexually transmitted diseases – there were over 23,000 new STD cases reported in 2004.10 Comprehensive sex education and prevention campaigns, access to care, tracking and treatment of people with STDs could reduce the toll from these infections, including infertility and, in some cases (HIV/AIDS and syphilis), death.

Epidemic surveillance systems – influenza pandemics average 3 per century. Our last was over 30 years ago in 1968-69.11 An especially severe Avian Flu pandemic could lead to high levels of illness, death, social disruption and economic loss. A substantial percentage of the Arizona population will require medical care, potentially overwhelming healthcare resources. Adequately funded data systems, public health laboratories and surveillance can provide early detection and intervention to contain epidemics before they spread to the general population.

Licensure and assurance – state funding did not keep pace with the legal requirement to inspect and license 900 new childcare and healthcare facilities added between 2003 and 2006. Failure to investigate the growing number of complaints, up 1,137 since 2003, put vulnerable children, hospital and nursing home patients at risk for abuse or neglect.12 The state has both legal and moral obligations to assure healthy and safe care in these facilities. The Legislature finally added 22.5 FTE’s in the 2007 budget to remedy the shortfall in inspectors.

Environmental health – county health departments are responsible for assuring food safety and sanitation. Parts of Arizona exceed the federal Environmental Protection Agency’s health standards for airborne particulate and ozone pollution. Drinking water supplies in some parts of the state are contaminated with unhealthy levels of arsenic and industrial chemicals, leading to closure of some wells and investment in expensive remediation programs.13 Thirty-four businesses in the state emit hazardous air pollutants at 10-10,000 times above health-based standards, but until 2006 there were no regulations in place to require remediation.14 The state Department of Environmental Quality and several urban county public health departments monitor and enforce environmental standards. Despite the rapid growth in the state, budget and staff cuts at DEQ over the past decade have left the agency under funded and sometimes

unable to carry out some of its mandates in a timely manner. For the health and safety of the state, more resources should be allocated to this agency.

The public health workforce – public health departments face challenges in recruiting and retaining qualified and skilled employees. Salaries for nurses, epidemiologists, biostatisticians and sanitarians are higher in private businesses compared to those offered by public health departments, so public agencies face high turnover in some job categories. Many public health departments lack the funding to provide further training and continuing education opportunities for staff, which in turn can limit opportunities for promotion. Demographic trends such as the increasing number of elderly people in Arizona will require new investments in training and planning for an adequate public health workforce.15

Resolution

Therefore be it resolved that the Arizona Public Health Association:16

• Urges all elected officials to provide sufficient funding and resources to sustain Public Health infrastructure, including:

► Access to quality health services for Arizonans

► Disease and injury prevention programs

► Epidemic surveillance systems

► Environmental hazard protection

► A skilled workforce

► Effective data systems and electronic communications

• Encourages state and local policy-makers to consider other important sources of revenue beyond general tax collections, including maintenance of state estate taxes and closing tax loopholes.

• Recommends that tax cuts be considered only after the public health needs of the state have been met.

• Supports active partnership in communities among community members, health providers, public health officials, and other public and private organizations concerned with health, to build public health infrastructure.

• Recommends that all community health planning and evaluation include the use of measures of public health infrastructure capacity.

References

1. Arizona Department of Economic Security, www.azdes.gov

2. Bank One Arizona Blue Chip Economic Forecast/W.P. Carey School of Business at ASU

3. United Health foundation – America’s Health Rankings 2005.

4. “Lawmakers debate benefits, drawbacks of tax cuts,” Arizona Capital Times, June 30, 2006.

5. Arizona Population by Primary Insurance Market Segment, 2006 (In Thousands). Arizona Health Policy and Data, St. Luke’s Health Initiatives. http://www.slhi.org/policy_data/primary_insurance_market_segment_2006.shtml

6. Health Disparities in Arizona’s Racial and Ethnic Populations: Living and Dying in Arizona. Arizona Public Health Association, November 2005.

7. Arizona Diabetes Indicators Annual Report, May 2004. Arizona Department of Health Services, Diabetes Prevention and Control Program.

8. Steps to a Healthier Arizona 2010. Arizona Department of Health Services.

9. National Diabetes Fact Sheet 2003. CDC National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource.

10. Arizona Health Status and Vital Statistics 2004 report. www.azdhs.gov

11. PandemicFlu.gov. U.S. Department of Health and Human Services

12. Summary of FY 2006-2007 Division of Licensing Budget Request, Arizona Department of Health Services.

13. Arizona Department of Environmental Quality, www.azdeq.gov

14. Hazardous Air Pollutants Fact Sheet, 2006. Arizona Public Health Association

15. Boom or Bust: The Future of the Health Care Workforce in Arizona, Spring 2002. St. Luke’s Health Initiatives. http://www.slhi.org/publications/issue_briefs/pdfs/ib-02spring.pdf

16. Resolution adapted from Res. 99-15: Resolution on Public Health Infrastructure. Adopted by the National Association of County and City Health Officials on November 7, 1999. www.naccho.org

150~2006_(1)Infrastructure Resolution (preventative health, infectious disease, PH infrastructure, environment, health records)

Megan Resolutions

2007- Access to Health for the Unisured

Arizona Public Health Association RESOLUTION
ACCESS TO HEALTH FOR THE UNINSURED
September 6, 2007

Who Are the Uninsured in Arizona?
Lack of health insurance coverage is a pressing issue and the number of uninsured people in Arizona is at an all-time high, with nearly 1,072,000 people lacking public or private health insurance in 2006. The state ranks 6th among all states for the highest percentage of people with no health insurance. During the period from 2004-2005, the U.S. Census reported that 18% of Arizonans lacked health insurance compared to 15.1% for the US population.1 2

The U.S. health care system is fragmented and often confusing. For instance, most seniors 65 years and older are covered by Medicare. Medicaid, by contrast, is generally for low-income persons under 65 years. Medicare doesn’t pay for nursing home care; but Medicaid will. The people who are most likely to need nursing home care are seniors, eligible for Medicare.

Private coverage is largely employer-based, but employer-sponsored coverage is shrinking and below the national average in Arizona. Between 2000 and 2004, the percentage of non-elderly Arizonans (less than 65 years) covered by employer-sponsored insurance fell 7.3%. Nationwide, 62% of women have employee-sponsored insurance, while only 55% of Arizona women are covered, the fourth lowest among the 50 states and District of Columbia.

Additional key indicators include:

* NOTE: numbers rounded to nearest thousand.  = highest. ↓ = lowest. Rank among the 50 states and the District of Columbia. All data from Kaiser Family Foundation State Health Facts (www.statehealthfacts.org) for 2004-2005 using data from the US Census Bureau.

Low-income Arizonans with family incomes below 200% of the Federal Poverty Level (FPL) stand the greatest risk of having no insurance. There are gaps in coverage among the following groups:3
• Adults without children
• Low-wage workers employed by small businesses: 80% of the uninsured live in working families with at least one full- or part-time worker
• 19-29 year olds are the largest age group with no coverage

The Arizona Health Care Cost Containment System (AHCCCS) is the Arizona Medicaid Program. KidsCare is Arizona’s State Children’s Health Insurance Program (SCHIP), a program that covers the near poor children. Yet simply being eligible for coverage is not sufficient. “In Arizona, we face a serious challenge in terms of uninsured children. The challenge consists of finding and enrolling the estimated 130,000 uninsured children who are eligible for current health coverage such as KidsCare, not to mention retaining the 65,000 children already enrolled in KidsCare.”4

Benefits of Health Insurance Coverage
Health insurance provides access to appropriate and continuous care for people. Evidence from large medical research studies reveals that people without health insurance experience adverse health outcomes. They use fewer preventive services, delay or forgo needed care, receive fewer therapeutic services including medications, are four times more likely than insured patients to require emergency care and avoidable hospitalizations, and have higher mortality and disability rates.5

The Institute of Medicine recommends that by 2010, everyone in the United States should have health insurance. IOM provides the following set of guiding principles for reform: health care coverage should be universal, continuous and affordable to individuals and families. The insurance agency should be affordable and sustainable for society. Health insurance should enhance health and well being by promoting access to high quality care that is effective, efficient, safe, timely, patient-centered and equitable.6

Arizona’s Safety Net for People without Insurance
Arizona’s safety net consists of a patchwork of programs for primary episodic or emergency care and many of these resources are not available in rural areas of the state, such as:
• Community Health Centers: 87 community health centers provide low-cost or free primary care to 400,000 people in 13 of the 15 counties. Clients include the working poor, low-income families, immigrants, tribal members, the elderly and homeless. Funding: Federal, state, partnerships, fees.
• Healthcare Group: a state-sponsored health plan for small businesses. Nearly 27,000 members were enrolled in managed care plans by July 2007. This program could grow to 100,000 enrollees but enrollment is currently frozen.
• School-based clinics: 95 schools sites in Arizona are staffed with part-time physician assistants and nurse practitioners. Funding: partnerships in the community.
• Hospital emergency care: by law, hospitals must treat patients regardless of citizenship status or ability to pay. Asthmatics in particular receive fragmented care if they rely on emergency room care and do not get linked to an ongoing outpatient system of comprehensive care.
• Academic programs for nurses and medical residents: medical colleges, hospital-based residency training programs, and nursing schools offer a variety of primary care in clinics in urban areas.
• Medical Home Project: school nurses can refer uninsured children who do not qualify for AHCCCS or KidsCare to MD’s willing to accept $5-$10 fee as payment per visit. The American Academy of Pediatrics sponsors the program and provides free laboratory tests and medications. 850 schools and 144 physicians participate, providing over 835 primary care and specialty appointments each month for eligible children.
• Free medications: Major pharmaceutical companies offer free medications to low-income patients who meet eligibility criteria for coverage.

• County Health Departments
• ISTU/Tribal/Urban Programs
• Behavioral Health Providers

Recommendations:
Therefore, the Arizona Public Health Association, Inc. recommends the following incremental steps to improve access to health for uninsured Arizonans:
1. Support policies which promote continuous, affordable access to health care for all Arizonans
2. Improve surveillance and monitoring of health and disease and use the data to design new systems which can improve access to care
3. Support outreach efforts to increase enrollment for public insurance programs like AHCCCS and KidsCare
4. Explore strategies to increase eligibility and simplify enrollment for public insurance
5. Collaborate with partner organizations to promote “access to care initiatives” among businesses, providers, health plans, universities, public health agencies and foundations

6. Explore feasibility of adopting “best practices” that other states have developed to improve access to health insurance in Arizona

1 Arizona Population by Primary Insurance Market Segment, 2006. St. Luke’s Health Initiatives, Phoenix, AZ, www.slhi.org/policy_data/primary_insurance_market_segment_2006.shtml.
2 Income, Poverty and Health Insurance Coverage in the United States: 2004. Figure D-3. US Census Bureau, Washington DC.
3 State Health Facts. Kaiser Family Foundation. www.statehealthfacts.org
4 AHCCCS Today, August 2007, Notes from Tony Rodgers, AHCCCS Director.
5 Care Without Coverage: Too Little, Too Late. Institute of Medicine of the National Academics. 2002. www.nap.edu
6 Insuring America’s Health: Principles and Recommendations. Institute of Medicine, January 14, 2004. www.iom.edu/report.asp?id-17632

151~2007_(1)Healthcare Uninsured (public health infrastructure, insurance, disparities, healthcare )

Megan Resolutions

2009- Tax on Sugar-Sweetened Beverages (SSB)

Arizona Public Health Association (AzPHA) Resolution Form

Date Submitted: August 18, 2009
Name of Submitters(s): David A. Dubé
Address: 4041 N. Central Ave #700, Phoenix, AZ 85012
Phone: 602.506.6608 FAX: 602.506.6896 E Mail: daviddube@mail.maricopa.gov

1. a. Summary and Statement of the Problem

Tax on Sugar-Sweetened Beverages (SSB)

Centers for Disease Control and Prevention recently identified 24 recommended community strategies to use in reversing the obesity epidemic in the United States. Strategy #10 is “Communities should discourage consumption of sugar- sweetened beverages”.1

b. Background of the Issue

Approximately two thirds of U.S. Adults and one fifth of U.S. children are obese or overweight. In Arizona, 61.1% of adults and 25.9% of high school students are overweight or obese. In the Arizona WIC program, nearly a third (30.2%) of children 2-5 are at-risk of overweight or overweight.2

Americans spend $147 billion a year on medical expenditures related to obesity, with significant costs paid for with Medicare and Medicaid dollars.3 While obesity should be addressed through a wide variety of actions, one action should be to levy a tax on soft drinks to recoup some of the costs incurred by the government from the consumption of these drinks, as well as to discourage consumption.

A meta-analysis of 88 studies published in the American Journal of Public Health, found a clear association of soft drink intake with increased energy intake and body weight. Lower intakes of milk, calcium, and other nutrients along with an increased risk of several medical problems such as diabetes were also associated with higher levels of soft drink intake.4

An additional health issue with soft drink intake is dental disease. Among children, aged 1 through 5 years, consumption of sugar sweetened carbonated soft drinks was associated with an 80 – 100% increased risk of dental caries.5,6 Dental caries is the most common chronic disease of childhood and when left untreated may interfere with a child’s ability to chew, speak and smile. In Arizona, 59.4% of children, kindergarten through third grade (N = 13,138), were adversely affected by dental caries. Of these, 31.1% had untreated decay.7

Research shows that increases in taxes on cigarettes and other tobacco products is the single most effective policy approach to reducing tobacco use. While there are significant differences between tobacco and intake of sugar sweetened beverages, many state and local governments are considering taxing sugar-sweetened beverages to generate revenue, decrease intake of unhealthy beverages, and to promote public health.8

Implementing an excise tax on sugar-sweetened beverages in Arizona would have an immediate impact and generate much-needed revenue to fund health promotion and education programs targeting the obesity epidemic.

2. Statement of the Desired Action

Institute an excise tax on sugar-sweetened beverages in Arizona.

3. Which other groups, organizations support or oppose your position?

Oppose:

• Anti tax groups
• Beverage industry
• Business groups
• Schools
• Soda Retailers

Support:

Organizations Supporting Federal Sugar-Sweetened Beverage Tax:

• America Walks
• American Academy of Pediatrics District II, New York State
• American Public Health Association
• American Society of Bariatric Physicians
• Black Women’s Health Imperative
• California Center for Public Health Advocacy
• California Dental Association
• California Pan-Ethnic Health Network
• Center for Science in the Public Interest*
• Central California Regional Obesity Prevention Program
• Citizens’ Committee for Children of New York, Inc.
• Consumers Union
• Fitness Forward
• Greater Philadelphia Coalition Against Hunger
• Health Promotion Council of Southeastern Pennsylvania
Organizations Supporting Federal Sugar-Sweetened Beverage Tax (continued):

• Healthy Monday Campaign
• Mailman School of Public Health
• Columbia University
• Institute for America’s Health
• Montana Dietetic Association
• New York Coalition for Healthy School Food
• New York State Healthy Eating and Physical Activity Alliance
• Oral Health America
• Partnership for Prevention
• Physician’s Committee for Responsible Medicine
• Policy and Legislative Committee of the Public Health Association of New York City
• Prevention Institute
• Shape Up America!
• Trust for America’s Health

4. Describe the relationship of this issue to current AzPHA Legislative Priorities.

An excise tax on sugar-sweetened beverages is consistant with the Arizona Public Health Association legislative priority of:

Supporting and protecting healthy environments, including safe water, clean air, urban planning and tobacco-free lifestyles.

Depending on how the revenues from the tax were utilized, the tax could also support this Arizona Public Health Association legislative priority:

Supporting and protecting public health budgets and infrastructure to meet the needs of Arizona’s growing population.

5. Do you see this as an issue for legislation? Yes

If so, has legislation already been intiated? Not in Arizona.

By Whom? Federal level by the American Public Health Association and other organizations

If not an issue for legislation, have other groups initiated action on this subject? Forty states have small taxes on sugared beverages and snack foods. The states of Maine and New York have proposed large taxes on sugared beverages in the past year.9 The American Public Health Association and other groups have expressed support for a soft drink tax at the federal level.

6. Financial and Public Health Analysis

The Yale University Rudd Center for Food Policy and Obesity provides a calculator to use in estimating estimated revenues from taxes on sugar- sweetened beverages. The calculator was developed in collaboration with Frank
J. Chaloupka, Ph.D., Professor of Economics at the University of Illinois at Chicago and can be found at: http://www.yaleruddcenter.org/sodatax.aspx. Using the Rudd Center Calculator, an excise tax of 1-2 cents per ounce of sugar- sweetened beverages would provide between $319,853,764 and $450,755,376 annually in Arizona.

It is estimated that a penny-per-ounce excise tax could reduce consumption of sugar-sweetened beverages by more than 10%. Polls have shown support for such a proposal increases if revenues will be used to prevent childhood obesity through media campaigns, facilities and programs for physical activity, and healthier food in schools.9 Currently six states (Alabama, Arkansas, Rhode Island, Tennessee, Washington, and West Virginia) have excise taxes on sugar sweetened beverages.8

In 2009, state funding for community nutrition services in rural counties was discontinued and federal funding from the Centers for Disease Control and Prevention was not renewed for nutrition and physical activity programs. An excise tax on sugar-sweetened beverages is an important tool to assist communities in working to support healthy eating and active living.

Table 1. Estimate of yearly revenue that could be raised with a 1 cent per ounce excise tax on Sugar-Sweetened Beverages in Arizona
Drink Type Gallons Tax Revenues
Regular Soft Drinks 130,171,372 $166,619,356
Fruit Beverages 71,268,029 $91,223,077
Sports Drinks 22,716,468 $29,077,079
Ready-to-Drink Tea – Nondiet 9,153,516 $11,716,500
Flavored Water 9,424,358 $12,063,178
Energy Drinks 6,216,907 $7,957,641
Ready-to-Drink Coffee 935,104 $1,196,933
Total sugar-sweetened beverages 249,885,754 $319,853,764

Table 1. Estimate of yearly revenue that could be raised with a 2 cent per ounce excise tax on Sugar-Sweetened Beverages in Arizona
Drink Type Gallons Tax Revenues
Regular Soft Drinks 82,836,327 $212,060,997
Fruit Beverages 56,522,920 $144,698,675
Sports Drinks 15,542,847 $39,789,688
Ready-to-Drink Tea – Nondiet 7,745,283 $19,827,924
Flavored Water 6,794,305 $17,393,421
Energy Drinks 5,759,220 $14,743,603
Ready-to-Drink Coffee 875,417 $2,241,068
Total sugar-sweetened beverages 176,076,319 $450,755,376

Use of the Revenue

Earmark the revenue for new public health nutrition and physical activity initiatives.
Examples of these initiatives could include:

• statewide, comprehensive obesity prevention programs;
• subsidies of fresh fruits and vegetables in schools and communities and for food stamp recipients;
• funding for schools to meet national physical education time standards;
• programs to encourage appropriate maternal weight during pregnancy
• social marketing campaigns to counteract the marketing strategies used by food industries to advertise soft drinks and snacks to children;
• incentives to attract supermarkets to low-income neighborhoods;
• farm-to-school grants;
• fully subsidize breakfast and lunch for low-income students;
• incentive programs to improve all foods sold on school grounds;
• safe routes to schools;
• improvements to the built environment for increased physical activity.10

7. Would you and your group be willing to:
.
Write letters? Yes Prepare testimony? Yes Present testimony? Yes
Speak to other groups about this? Yes
Prepare a Position Paper for the Arizona Public Health Association for review and approval? Yes

References

1. Kahn, LK, Sobush, K, Keener, D, Goodman, Keener, D, Goodman, K, Lowry, A, Kakietek, J, Zaro, S. Recommended community strategies and measurements to prevent obesity in the United States. MMWR 2009;58(RR07);1-26.

2. Arizona Department of Health Services, Bureau of USDA Nutrition Programs. Arizona Nutrition Status Report, 2008.

3. Finkelstein, EA, Trogdon, JG, Cohen, JW, Dietz, W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs 2009;28:w822-831 (published online 27 July 2009).

4. Vartanian, LR, Schwartz, MB, Brownell, KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97:667-675.

5. Marshall, TA, Levy, SM, Broffitt, B, Warren, JJ, Eichenberger-Gilmore, JM, Bruns, TL, and Stumbo, PJ. Dental Caries And Beverage Consumption In Young Children. Pediatrics. 2003;112:e184-e191.

6. Sohn, W, Burt, BA, Sowers, MR. Carbonated soft drinks and dental caries in the primary dentition. J Dent Res 2006;85:262-266.

7. Arizona Department of Health Services, Office of Oral Health. The Oral Health of Arizona’s Children: Current Status, Trends and Disparities, 2005.

8. Chaloupka, FJ, Powell, LM, Chriqui, JF. Sugar-sweetened beverage taxes and public health. Robert Wood Johnson Foundation Research Brief, 2009.

9. Brownell, KD, Frieden, T. Ounces of prevention – the public policy case for taxes on sugared beverages. NEJM 2009;360:1805-1808.

10. Yale University, Rudd Center for food Policy and Obesity. Rudd Report – Soft Drink Taxes, A Policy Brief. May 2009.

153~2009_(1)Sugar Sweetened Beverage Tax Approved109 (prevenative health, legislation)

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