Megan Resolutions

1994- Public Health in Care Reform

RESOLUTION 94-2

ARIZONA PUBLIC HEALTH ASSOCIATION RESOLUTION:PUBLIC HEALTH IN HEALTH CARE REFORM

WHEREAS: The inaccessibility of health care coverage for millions of Americans is requiring that an increasing portion of public health dollars be spent on providing personal medical care to those who otherwise would be without; and

WHEREAS: Personal medical services are effective only in the context of healthy communities and environments; and

WHEREAS: The basic functions of public health include engagement of community health status (including personal and environmental health), quality and range of health services, community concerns, and resources ; policy development using the data gathered from assessments and geared toward improving and protecting the health of the community; and assurance that necessary and high quality health services are available to all; and

WHEREAS: Public health programs should provide public health, health promotion, disease prevention and environmental health services,
encourage or provide population-based health services, maintain the capacity to respond to emergencies, administer quality assurance programs, recruit and train health care professionals; and

WHEREAS: Comprehensive health care reform should insure that individuals receive needed individual medical care through the personal care delivery system, thereby freeing the public health system to concentrate on public health functions;

THEREFORE BE IT RESOLVED THAT: The Arizona Public Health Association calls for health care reform legislation that acknowledges basic public health functions, requires that states carry out these functions, and that states provide and receive adequate, dedicated funding for the activities related to public health functions.

Passed by Board of Directors
8/19/94

Passed by Membership Annual Meeting 9/15/94

ARIZONA PUBLIC HEALTH ASSOCIATION RESOLUTION DOCUMENTATION FORM

DATE SUBMITTED 3-18-94
DATE REVISED 8-19-94

NAME OF SUBMITTER:

PUBLIC HEALTH IN HEALTH CARE REFORM
KATHLEEN JOHNSON
MEDICAL CARE SECTION

1. Statement of the problem

a. Summary

The 1988 Institute of Medicine study on The Future of Public Health said “Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.” A reformed health care system must recognize public health, its mission, and the activities necessary for fulfilling the mission, as well as personal and family medical care. Adequate and dedicated funding for recognized core public health functions is an essential part of any health care reform legislation.

b. Background

“Safeguarding America’s public health has been the province of our public health agencies since the early days of the 20th century.

But in recent years, these agencies have been unable to fully carry out their mandate of prevention and education. While the nation’s health care crisis was worsening and private health care costs increasing, more and more people were becoming unable to use the private health care system and seeking help from the public sector. Consequently, official public health agencies have had fewer resources with which to perform their core community disease prevention and health promotion services.”

In a universal, comprehensive health care system (which AzPHA endorses as a legislative priority), the vast majority of individuals should receive their personal/family medical care from private practitioners. This should relieve the strain on the public health system.

“Freed from the burden of providing individual medical care, official public health agencies can fulfill their traditional mission of promoting and protecting the nation’s health.

“To keep communities healthy, public health agencies must have the resources to perform their three Core Functions:

“Assessment – Public health agencies must assess community health needs and the resources for handling disease, injury, and environmental dangers. Public health agencies must assess personal health, environmental health, community concerns and resources and data on the quality, range, and use of public and private medical services.

“Policy development – Public health agencies must develop policy in response to specific community and national health needs. Public health agencies must develop comprehensive public health policies to improve health conditions, incorporating scientific information and data from assessments; ensure that policies are politically and organizationally feasible and that they respect community values; devise measurable objectives and implementation strategies; and identify resources needed to implement the health policies developed.

“Assurance – Public health agencies must assure that conditions contributing to good health, including high-quality services, are available to all. Public health agencies must provide essential public health and environmental health services; respond to personal and environmental health emergencies, such as outbreaks of disease and spills of toxic chemicals; administer quality assurance programs, such as enforcing health standards and laws, and licensing health professionals and facilities; and guarantee care for those unserved after health care reform.”

Health care reform legislation should acknowledge these core public health functions, require that state and local public health agencies fulfill these functions, recognize the responsibility of these agencies, and ensure adequate and dedicated funding for the activities. The American Public Health Association has suggested that legislation specify an allocation of 3-6% of total national health expenditures for public health. The source of this money could be a portion of health insurance premiums or excise or “sin” taxes, an income tax check off and/or general revenues.

2. Statement of the desired action

The Arizona Public Health Association proposes that health care reform legislation acknowledge the core public health functions and requires that states carry out all of these functions and that they receive adequate, dedicated funding for the activities related to those functions.

3. Which other groups. organizations support this effort?

The American Public Health Association strongly supports the inclusion of and adequate funding for public health core functions and programs in any national health care reform legislation.

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

Not only is this issue directly related to the legislative priority of Universal Access to Health Care, but is also directly related to the future of public health activities in both Arizona and the nation. The public health issues that comprise the other legislative priorities depend on public policy and legislation that recognizes the importance of 1) public health activities in protecting and
improving the health of our nation, and 2) adequate funding to effectively carry out these activities.

5. Is this an issue for legislation?

This issue is an integral part of the current debate and legislative proposals regarding health care reform at the federal level and may, at a future date, be a part of state efforts at health care reform.

6. Financial and public health analysis.

The resolution has no impact on the financial status of AzPHA. It does, however, imply that dedicated funding as a part of federal health care expenditures be identified, leading to improved funding of public health activities.

129~1994_(1)Public health in health care reform (public health infrastructure, legislation)

Megan Resolutions

1995- Arizona Health Education Centers

ARIZONA PUBLIC HEALTH ASSOCIATION RESOLUTION: ARIZONA HEALTH EDUCATION CENTERS
RESOLUTION NO. 95-1

WHEREAS, There is a continuing need in Arizona to improve access to health care in rural and medically underserved areas through education and training;

WHEREAS, The education and training mission of Arizona’s AHECs is fulfilled primarily through an emphasis on recruitment and retention of health providers emphasizing primary care in rural and other medically underserved areas;

WHEREAS, There is a critical need for on-site continuing education (based on local demand) and the provision of computer and library support services for health care providers in Arizona’s communities however remote their location;

WHEREAS, Seven national evaluations of AHECs have demonstrated these programs to be cost effective means of assuring the improved minority repre­sentation and availability of health care professions in rural and medically underserved areas;

WHEREAS, The Arizona AHEC System has been nationally recognized as one of the best programs in the country; and

WHEREAS, The Arizona Public Health Association previously passed at its Annual Meeting of September 17, 1987, Resolution 87-:-3, titled 11 Arizona Health Education Centers;

NOW, THEREFORE,
The Arizona Public Health Association fully supports and endorses the restoration of state appropriated support to continue the programs and services of Arizona’s AHEC System as has been accomplished in other states of this country.

Passed by Membership
AzPHA Annual Meeting 9/14/95

Pat.Zurick, .Executive.Secretary

95-1

130~1995_(1) Arizona health education centers (education, disparity, PH infrastructure )

Megan Resolutions

1997- Environmental Health

97-1

Arizona Public Health Association Annual Meeting September 10, 1997

RESOLUTION ON ENVIRONMENTAL HEALTH

WHEREAS, Pollution and degradation of the natural environment have the potential to cause adverse health effects, and

WHEREAS, Prevention is the most cost effective and efficient way to promote environmental health and pollution control, and

WHEREAS, Indoor and outdoor air quality standards have a direct effect on the level of protection that will safeguard wlnerable populations, including individuals and communities; and

WHEREAS, Public policy efforts to ensure the safety of drinking water and the viability of Arizona’s water systems are vital to protecting the public against waterborne diseases caused by dangerous chemicals and microbial contaminants, and

WHEREAS, Cleanup of previously polluted natural resources is critical to assure public health and environmental protection, and

WHEREAS, By the year 2000, the United States is expected to generate 193 million tons of solid waste a year, with increasing amounts annually; and public health professionals have a large role to play in managing waste and designing solutions to potential hazardous situations, and

WHEREAS, Environmental pollution has an impact on all communities, and solutions require the expenditure of public and private funds,

THEREFORE, BE IT RESOLVED THAT:

The Arizona Public Health Association supports local, state and national efforts to prevent, control and remedy environmental pollution in order to insure public health protection. These efforts are best accomplished by an open process that ensures equity, accountability, community awareness and public participation.
Resolution Passed September 10, 1997

131~1997_(1) Environmental health (environement, public safety)

Megan Resolutions

1998- Domestic Violence

98-1

ARIZONA PUBLIC HEALTH ASSOCIATION
Proposed Resolution 9/98

TITLE: DOMESTIC VIOLENCE

WHEREAS: Domestic violence is a serious and widespread problem that affects all economic, educational, social, geographic, racial, ethnic and regional group;

WHEREAS: Domestic violence has been called by former Surgeon General C. Everett Koop one of the major public health problems in America today, as much a public health issue as communicable disease control had been during the last two centuries;

WHEREAS: Domestic violence is an act, or series of acts, that lead to physical, emotional, or other injury to another individual. These acts may be overt, covert or threats of harm. They include acts of physical, sexual and emotional abuse, incest and neglect;

WHEREAS: Domestic violence can involve spouse/partner abuse, child abuse or elder abuse;

WHEREAS: Domestic violence in one generation can lead to repetition of violence in the next generation;

WHEREAS: Domestic violence has become an increasingly public issue in Arizona;

BE IT RESOLVED THAT: The members of Arizona Public Health Association support activities undertaken as an organization, in coalitions or individually to reduce the incidence of domestic violence. These activities may involve strategies to improve prevention and education, legal judicial reform, service delivery and/or research.

PASSED BY MEMBERSHIP ANNUAL MEETING 9/16/98

Pat Zurick Executive Secretary

132~1998_(1) Domestic violence (violence, public safety)

Megan Resolutions

1998- Abuse of Antibiotics

98-2

ARIZONA PUBLIC HEALTH ASSOCIATION
Proposed Resolution 9/98

TITLE: ABUSE OF ANTIBIOTICS

WHEREAS: Antibiotic prescriptions have increased steadily since the 1980s WHEREAS: As much as 50% of all antibiotic use is unnecessary WHEREAS: Antibiotics are effective only against bacterial infections
WHEREAS: Antibiotics are NOT effective (misused) as a treatment for viruses

WHEREAS: Antibiotic misuse (abuse) has created bacterial strains now resistant to many antibiotics

WHEREAS: Antibiotic Resistance is rising at an alarming rate

WHEREAS: The Arizona Public Health Association considers this a public health crisis

BE IT RESOLVED THAT: Antibiotics be used only to treat bacterial infections

BE IT RESOLVED THAT: When prescribed, antibiotics should be taken as prescribed (complete the course)

BE IT RESOLVED THAT: This information will be shared as widely as possible, by all Public Health Professionals, with providers, patients, and the public in general.

PASSED BY MEMBERSHIP ANNUAL MEETING 9/16/98

Pat Zurick Executive Secretary

133~1998_(1)Abuse of antibiotics (healthcare, medication)

Megan Resolutions

1999- Folic Acid and the Prevention ofNeutral Tube Defects

Arizona Public Health Association Resolution
Folic Acid and the Prevention ofNeutral Tube Defects

The Arizona Public Health Association, referencing the American Public Health Association resolution number 9914; and

Recognizing that neural tube defects (NTDs) are among the most serious birth defects in the United States and that approximately 4,000 pregnancies are affected by NTDs each year; and

Noting that of approximately 60 million women of childbearing age in the United States, nearly 4 million will have a baby in a given year, and that half of these pregnancies are unintended; and

Citing that the Centers for Disease Control and Prevention estimates that up to 70 percent of NTD cases could be prevented if women consumed 400 micrograms of folic acid daily for at least one month prior to conception and during the first trimester of pregnancy, and

Citing the US Public Health Service 1992 recommendation that all women capable of becoming pregnant consume 400 micrograms of folic acid to reduce NTD risk, and

Citing the Institute of Medicine Food and Nutrition Board 1998 recommendation that to reduce NTD risk, women capable of becoming pregnant should take 400 micrograms of synthetic folic acid from fortified foods, vitamin supplements, or a combination of both, in addition to consuming a varied diet, and

Recognizing the evidence that consumption of folic acid taken before conception and during early pregnancy can reduce the incidence of NTDs; and

Recognizing that facial clefts and congenital anomalies (including cardiovascular, urinary tract and limb defects) may be reduced through daily consumption of folic acid which may also improve poor pregnancy outcomes such as prematurity, low birthweight, placental abruption, spontaneous abortion, and stillbirths, and Noting that in 1998 only one in four women of childbearing age reported that she had heard about the

US Public Health Service’s recommendation, and
Seeking to promote the health of women of childbearing age and to prevent their children from being born with NTDs;

therefore Arizona Public Health Association
1. Supports public health campaigns that include public health education to inculcate the importance of folic acid for the health of women and infants, and professional education to encourage health care providers to recommend that female patients of childbearing potential consume a well balanced diet that includes both food and a daily multivitamin with folic acid;
2. Urges the Arizona State Government and Legislature to support such campaigns .

134~1999_(1)Folic acid and prevention of neural tube defects (maternal and child health, preventaitve health)

Megan Resolutions

1999- Abolition of the Death Penalty

Arizona Public Health Association Resolution
Abolition of the Death Penalty

The Arizona Public Health Association, referencing the American Public Health Association resolution number 86 I 1; and

Understanding that there is no method for terminating human life which is assuredly instantaneous or painless. and asserting that an interest in the health and well-being of the American public legitimately extends to the human condition of society’s condemned; and

Believing capital punishment is cruel and produces severe psychological terror in those condemned to death and has a negative influence on the psychological health of the public; and

Recognizing that adequate alternatives are available to punish offenders such as institutionalizing offenders for life in prison without provision for parole; and

Recognizing that empirical studies fail to establish capital punishment as a deterrent to crime, and Believing that absent a deterrent effect, the death penalty is mere vengeance and that the State cannot sanction the deliberate execution of individuals to accomplish revenge consistent with the underlying principles of the Bill of Rights to preserve and protect human dignity; and

Observing that executions are arbitrary moral judgments guided by passions and prejudice, and are not rationally related to the heinousness of the crime or the culpability of the criminal; and

Noting further that capital punishment has impacted discriminatorily on minorities and the poor; and Concluding that procedural safeguards and legal due process standards cannot eliminate arbitrary and capricious imposition of the death sentence and cannot redress the fundamental human rights violations;

therefore Arizona Public Health Association
1. Calls upon the state legislature to abolish capital punishment;
2. Urges executive officials to use their power to prevent the imposition or execution of the death sentence; and
3. Encourages its members and other professional organizations of health workers to work for the abolition of capital punishment.

135~1999_(1) Abolition of the death penalty (justice, misc)

Megan Resolutions

1999- Childhood Asthma

Arizona Public Health Association Resolution
Childhood Asthma

The Arizona Public Health Association, understanding that asthma is an ambulatory care sensitive condition that is responsive to appropriate care and management; and

Recognizing that asthma is the most prevalent chronic illness among Arizona children;

Recognizing that asthma disproportionately affects minority populations and those living in poverty;

Realizing that untreated, or inadequately treated, childhood asthma can result in remodeling of the airways such that permanent damage is sustained;

Realizing that untreated, or inadequately treated, childhood asthma is one of the leading causes of school absenteeism;

Recognizing that environmental conditions can trigger acute asthma episodes but that many of these conditions are readily controllable;
Noting that Donna Shalala, Secretary of the United States Department of Health and Human Services has called for a special initiative by that agency to combat the asthma epidemic in our country;

Recognizing that knowledge to successfully manage asthma in most patients can readily be found in the National Institutes ofHealth (NIH), National Heart, Lung, and Blood Institute’s National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma (Guidelines); and

Understanding that the appropriate care of childhood asthma requires a partnership between health care providers, administrators of schools and child care programs, private enterprise and families.

Therefore, the Arizona Public Health Association:
1. Strongly encourages AHCCCS, KidsCare and private health insurers to adopt the standards of asthma care found in the NIH/NAEPP Guidelines and other publications, and require their providers to create an asthma action plan for each child with asthma to improve diagnosis, treatment and referral;
2. Strongly encourages AHCCCS, KidsCare and private health insurers to provide all children with asthma peak flow meters, spacers and other equipment necessary to achieve self-efficacy in asthma management;
3. Strongly encourages the Arizona Department of Education and all local school districts to adopt the Environmental Protection Agency policies and procedures described in Tools for Schools to develop and maintain environmental conditions on school grounds that are safe for children with asthma;
4. Strongly encourages the Arizona Department of Education and all local school districts to develop policies and procedures which enable children with asthma to self­ medicate based on the documented observation and approval of nursing staff who are trained in educating children on preventive and acute asthma care;
5. Supports community organizations such as the Arizona Asthma Coalition, the Maricopa Allies Against Asthma Coalition and the Asthma Care Alliance of Southern Arizona in their efforts to develop local solutions for children with asthma and their families.
6. Strongly encourages private enterprise to join in the campaign to raise awareness that ASTHMA CAN BE CONTROLLED by providing employees with information about diagnosing and managing asthma in their children and grandchildren and by requiring health insurers to provide the equipment and education needed to manage asthma.

136~1999_(1)Childhood asthma (children, healthcare, insurance, education)

Megan Resolutions

1999- First Oral Health Assessment

Arizona Public Health Association Resolution
First Oral Health Assessment

The Arizona Public Health Association, referencing the American Public Health Association resolution number 9903; and

Understanding the importance of oral health throughout the lifespan, and cognizant of the influence oral health has on overall health, wellness, and quality of life; and

Recognizing the need for oral health assessments, anticipatory guidance, prevention, and early intervention among infants and young children;

Believing that oral health of children is best assured through preventive measures that begin during infancy; and

Recognizing that dental caries (a multi-factorial, diet dependent infectious disease with significant behavioral components) can begin in infancy if primary preventive measures are not undertaken and can progress to advanced stages without early diagnosis and treatment; and

Realizing that the seriousness and societal costs of childhood caries are enormous in light of estimates indicating that five to ten percent of preschool-age children have early childhood caries nationally, and this rate is even higher among families with low incomes and among some racial and ethnic minorities, and that thirty-seven percent of Arizona children between the ages of two and four years have experience tooth decay; and

Noting that survey results show twenty percent of children from families with low incomes and forty percent of children in some American Indian populations have early childhood caries; and

Recognizing that early childhood caries have significant implications on overall child health, often requiring extensive restorative treatment and extraction of teeth at an early age, resulting in considerable cost and increased risk; and substantially contributing to pain, personal suffering, speech, learning and eating problems, as well as poor child nutrition, low body weight and potential risk to overall child health; and

Recognizing that transmission of dental disease causing bacteria occurs early in life, primarily from mother to infant; and
Noting that the Surgeon General of the United States released a report entitled Oral Health in America: A Report of the Surgeon General in May 2000, which indicates that while advances in the nations oral health have occurred over the past half century, these advances are not shared by all Americans including children who loose more than 51 million school hours each year due to dental­ related illnesses; and

Realizing that infection with the mutans streptococci organisms associated with most cases of early childhood caries has been shown to occur in children as young as nine months of age; and
Noting that in a study of3,003 children in the Women, Infants, and Children (WIC) Nutrition Program, over forty percent of all preschool caries experienced had occurred before the age of three; and

Observing that in the first and second years of life, a majority of affected children in these WIC programs had early-stage dental caries confined to enamel that were potentially remineralizable through dietary and fluoride interventions and dental plaque control; and

Recognizing that there is evidence that change can be achieved in dietary and health behaviors for infants and young children at risk of developing early childhood caries, significantly reducing the risk of such disease through reinforcement of simple interventions and instructions involving fluorides, diet, and dental plaque control; and

Recognizing that early visits to may health professionals provide an opportunity to promote feasible and affordable primary prevention measures for oral health; and

Understanding that the prevention of early childhood oral diseases requires an interdisciplinary approach, given the present low rate of dental attendance in early childhood, and that such prevention should commence in the health care networks that already serve children; and

Recognizing that many health professionals and some dental professionals have had little or no training or experience in providing oral health assessments, oral preventive care, or anticipatory guidance (counseling about oral development and home care at various development stages) for infants and young children; and

Noting that many dental organizations such as the American Academy of Pediatric Dentistry, the American Dental Association, the American Dental Hygienist’s Association, and the American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, as well as many state Medicaid programs, recommend age one for the first oral health evaluation;

therefore Arizona Public Health Association
1. Recommends that primary care organizations and early childhood health and education programs, such as WIC, Title V (MCH), and Early Start, promote age one as the appropriate age for a first oral health assessment to institute primary preventive measures and anticipatory guidance by all child health practitioners, thus impacting the Arizona epidemic of early childhood caries; and
2. Strongly encourages AHCCCS and KidsCare, other child health and dental insurance programs, and managed care organizations to include oral examinations by a dental • professional beginning as early as age one as a reimbursable preventive dental service;
and
3. Urges the agencies to include in their programs promotion of oral health of infants and children as an integral component of general health assessment and health promotion, and to provide specific information, training, and technical assistance on oral health assessment procedures and anticipatory guidance messages; and
4. Recommends that state and local health departments and community health centers incorporate oral health in interdisciplinary ways into their programs for infants and children, and that faculty organize training programs for health professional students’ in association with these programs; and
5. Strongly encourages AHCCCS and other health and dental insurance programs and managed care organizations to include oral health services for pregnant women and women of childbearing age.

137~1999_(1)1st oral health assessment (oral health, education)

Megan Resolutions

1999- Injury and Violence Prevention & Control Programs in State & Local Health Departments

Arizona Public Health Association Resolution
Injury and Violence Prevention and Control Programs
in the State and Local Health Departments

The Arizona Public Health Association (AzPHA), referencing the American Public Health Association resolution number 9927; and
Observing that deaths from unintentional and intentional injury are the leading cause of death for Americans aged 1-34 years, and are the leading cause of years oflife lost prior to age 75; and

Realizing that the societal cost of injury-related morbidity and mortality were estimated at $260 billion in FY 1995; and

Noting that the systematic federal, state, and local public health response to motor vehicle safety issues resulted in a substantial reduction in deaths attributed to motor vehicle crashes in the US; and
Acknowledging that injury rates from specific causes vary substantially among states and within regions of states; and
Recognizing that state and local injury surveillance is needed to better reflect details of local conditions and to assist in establishing program priorities and evaluating the impact of interventions; and

Recognizing the importance of state and local injury and violence prevention and control intervention implementation and evaluation; and
Observing that Ariz;ona does not have a core injury and violence prevention program; and Acknowledging that the Institute ofMedicine recommends strengthening state infrastructure by development of core injury prevention programs in each state’s department of health; and Observing that the Institute of Medicine recommends that support for strengthening state infrastructure in injury prevention should be provided by the National Center for Injury Prevention and Control in collaboration with state and local governments; and

Noting that the National Center for Injury Prevention and Control’s Advisory Committee recommends a level of core funding for injury and violence prevention;

therefore Arizona Public Health Association

1. Urges collaboration with the State and Territorial Injury Prevention Directors’ Association and the American Public Health Association Injury Control and Emergency Health Services Section, to develop information that will be useful in educating governors and state legislators about the problem of injury and the importance of state based interventions;
2. Urges collaboration with National Council of State Legislatures and the National Governor’s Association to bring the issue of injury forward on the legislative and programmatic agendas of the states;
3. Advocates for increased funding for the National Center for Injury Control and Prevention that is targeted toward the establishment and maintenance of state-based initiatives in injury control;
4. Urges the governor and state legislator to direct the state and local health departments to establish injury and violence prevention and control programs that focus on surveillance; program design, implementation and evaluation; coordination and collaboration; technical support and training; and public policy;
5. Encourages the governor and state legislature to allocate additional appropriations to state and local health departments for injury and violence prevention and control;
6. Encourages schools of public health, medicine, dentistry, optometry, engineering, and other appropriate schools to establish or expand research and training programs in injury and violence prevention and control, and urges federal and state governments to allocate funding for such programs; and
7. Supports the Centers for Disease Control and Prevention and the Health Resources and Services Administration in its work with state and local health agencies to further the development of injury and violence prevention and control programs through expanding available resources including core funding and technical assistance.
8. Supports Arizona 2010 injury /violence prevention efforts.

138~1999_(1)Injury Violence Prevention & Control Programs in State & Local Health Departments (violence, public safety, legislation)

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