Shelby Disease Control, Public Health, Public Health Law

Ducey & Christ Again Use Their Emergency Power Authority for Harmful Purposes

IT’S TIME TO END THE PUBLIC HEALTH EMERGENCY DECLARATION BECAUSE THEY ARE NOW CONSISTENTLY MISUSING THEIR EMERGENCY AUTHORITY

The purpose of declaring a public health emergency is that it gives governors and health directors authority to do things that they normally can’t… allowing them to conduct interventions to help mitigate the public health crisis using authority that they don’t normally have.

The governor declared the current public health emergency on March 11, 2020. That declaration gave Governor Ducey broad emergency powers under ARS 26-303 and Director Christ sweeping public health powers under ARS 36-787.

In the first weeks of the pandemic, they used their emergency authority for mostly good things like the original stay at home order, a moratorium on evictions, enhanced public health surveillance, and operational and reporting directives to hospitals.

Once May, 2020 arrived, they resisted using their authority for good things. They refused to use their emergency authority to implement an enforceable statewide mask mandate even after the evidence was compelling that it was the most effective intervention that we had at the time. They also refused to do any meaningful enforcement of mitigation measures in bars, restaurants and nightclubs (except during the summer “pause”). The list goes on.

They even began using their authority for bad things, like preventing locals from putting in place mask mandates (they finally allowed that at the very end of June – but a revoked it again a couple of months ago). They are also prohibiting businesses from inquiring about a person’s vaccine status (EO 2021-09). They have been micromanaging the K-12 system in a variety of ways for harmful purposes.

Yesterday, they used their ARS 26-303 and ARS 36-787 emergency authority to prevent the universities and community colleges from implementing reasonable mitigation measures this fall (see E.O. 2021-15).

ASU had designed a mitigation plan for this fall that was thoughtful, calibrated and evidence based. The policy recognized the risk difference between vaccinated and unvaccinated students and managed those risks appropriately by requiring unvaccinated students to undergo periodic testing and to wear a mask on campus. Ducey & Christ’s Executive Order micromanages the universities and community colleges by dictating that they can’t have a policy that distinguishes between vaccinated and unvaccinated students.

Remember, the value of declaring a Public Health Emergency is that it allows them to conduct helpful interventions. So the question becomes, are Ducey and Christ using their emergency authority for anything helpful at this point?

I just scoured all the executive orders, and I’d say that the only helpful thing that Ducey and Christ are using their emergency authority for right now is to require COVID-19 surveillance reporting (e.g. COVID-19 case and hospital capacity reporting), which helps track the trajectory of the epidemic and provide hospital capacity data.  The E.O.’s with those requirements have been extended several times during the pandemic (every 60 days). The latest extension is E.O. 2021-14, which extends the reporting requirements until the end of July.

However, the ADHS has existing non-emergency rulemaking authority that could have and should have used long ago to make COVID-19 a new reportable illness. Astonishingly, Director Christ has not yet made COVID-19 reportable (see the Communicable Disease Reporting Rules).

At this point, it is clear that Governor Ducey and Director Christ are far more interested in using their ARS 26-303 and ARS 36-787 public health emergency authority for harmful rather than helpful purposes. Yesterday’s executive order micromanaging the universities and community colleges and preventing them from implementing reasonable and calibrated plans for this fall clearly demonstrates that, from this point forward, they will only be using their authority to harm rather than help the response.

The only remaining helpful Order requires laboratories and doctors to report COVID-19 cases, something that they are accustomed to doing by now and would likely continue to do if they were to lift the emergency declaration. Additionally, it is nonfeasance on the part of Director Christ that she has not made COVID-19 illness reportable by now (15+ months into the public health emergency).

However, Governor Ducey & Director Christ will not be lifting the emergency declaration anytime soon because they are clearly enjoying the authority that the public health emergency declaration gives them to micromanage cities, counties, businesses, the K-12 system and now universities and community colleges.

Shelby Disease Control

Data Are Rolling In Regarding the Effectiveness of Mitigation in Schools

WHAT ARE THE RESULTS?

A CDC MMWR released last week found that mitigation measures like masks and distancing were quite effective at slowing the spread of COVID-19 in schools. A new MMWR entitled Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools found that rates of COVID-19 were 37% lower in elementary schools that required teachers and staff to use masks, and 39% lower in schools that took steps to improve ventilation.

In schools that improved ventilation alone (e.g. open windows, fans), COVID-19 incidence was 35% lower. Schools that combined opening windows with filtration had a 48% reduction.

Another article in the journal Science entitled Household COVID-19 risk and in-person schooling found even more striking results.

Researchers found that school-based mitigation measures (when done properly and in tandem) reduce the spread of COVID-19 so much that it is statistically the same as going to distance learning. Here’s an excerpt from the article:

School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extracurricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures are reported, a significant relationship is no longer observed.

Teachers working in schools had an increased risk of COVID-19, but in schools implementing effective interventions, the risk was similar to that in other in-person occupations (e.g., health care or office work). Although in-person schooling was associated with household COVID-19 risk, the risk can likely be controlled with properly implemented school-based mitigation measures.

The most important school interventions were daily symptom checks, teacher masking, and closure of extracurricular activities.

This and future research regarding the effectiveness of school-based mitigation measures provides valuable information for school districts and parents this fall, especially for grades K-5 (right now the Pfizer vaccine is only authorized for kids 12 years old and up). The evidence in these articles suggest that implementing and adhering to targeted interventions can allow schools to safely stay in-person.

Shelby Uncategorized

June 2021 Arizona Screenings and Panel Discussion ERNIE & JOE: CRISIS COPS

Diverting community members away from jail and into mental health treatment, one 911 call at a time. That’s the focus of the Emmy-award winning documentary Ernie & Joe: Crisis Cops.

Vitalyst Health Foundation, The David & Lura Lovell Foundation, and The NARBHA Institute have partnered to bring this powerful film back to Arizona in June for a series of screenings.

Leaders and individuals from law enforcement, the fire service, emergency medical services, emergency dispatch, behavioral health services, and community members are invited to register now for a free regional screening.

HBO has captured the San Antonio Police Department’s pioneering crisis intervention approach in an Emmy Award-winning documentary, and Vitalyst is pleased to be offering free virtual screenings.

By region, the Zoom-based “Ernie & Joe Crisis Cops” events will span the month of June, starting with Maricopa County’s screening on June 3. The screenings are open to leaders and individuals from law enforcement, the fire service, emergency medical services, emergency dispatch, and behavioral health services. The abridged, 35-minute screening will be followed by a live panel Q&A.

As communities reckon with the behavioral health impacts of the pandemic and more, the work modeled by Ernie and Joe in this documentary is more important than ever. All Arizonans are encouraged to view the full documentary via HBO, and our first responders are urged to click here to register today for their free regional screening events. See below for more information about the upcoming screenings and to register:

Contact: [email protected] with any questions.

Shelby Behavioral Health, Opioids, Prevention, Public Health

Syringe Services & Fentanyl Test Strips Finally Legalized

The opioid epidemic is one of the greatest public health crises of our time. The causes of are deep and the public health interventions needed to ease the crisis are many. Those interventions include changes to prescribing practices, distribution of naloxone, more robust treatment options including Medically Assisted Treatment, and harm reduction and engagement strategies like Syringe Services.

We need all those tools working together to mount an effective response. Arizona’s Opioid Epidemic Act was an important law that is addressed many of those factors- but not all. Things that weren’t included in the Act (despite strident advocacy by numerous organizations including AzPHA) include decriminalizing syringe service programs and legalizing fentanyl testing strips.

As this 2019 report by Stephanie Innes in the Arizona Republic shows, needle exchange efforts in Arizona have been impaired because some of the things that syringe service programs do had been felonies under state law.

Syringe services programs are community-based prevention efforts that offer a range of interventions. They provide access to and disposal of sterile syringes and injection equipment, linkage to substance use disorder treatment, and naloxone distribution. People who use syringe service programs gain access to other vital services including vaccination, testing, and linkage to care and treatment for infectious diseases including viral hepatitis and HIV.

Nearly 30 years of research shows that comprehensive syringe service programs are safe, effective, and reduce overall health costs. They play an important role in reducing the transmission of viral hepatitis, HIV, and other infections and are a major component of the Ending the HIV Epidemic: A Plan for America initiative.

The U.S. Surgeon General determined that syringe service programs don’t increase the illegal use of drugs by injection. Studies also show that they protect the public and first responders by providing safe needle disposal.

Sadly, syringe service and fentanyl test strips have been considered drug paraphernalia under Arizona law (a class 6 felony). While arrests, indictments and convictions of workers that operate syringe service programs have been rare, the fact that syringe service programs are illegal has had a chilling effect on the ability of organizations and individuals to operate and fund these important programs.

After all- it’s pretty hard to get a grant award if you need to disclose to the funder that you intend to commit felonies with the money! A cohort of public health organizations led by Sonoran Prevention Works have been trying for the last 4 years to simply decriminalize syringe service programs & legalize fentanyl test strips.

This year those efforts were finally successful.

The governor signed SB1250 overdose prevention which makes it legal for cities, towns, counties, and NGOs to implement a syringe service programs. While the state still can’t technically operate a syringe exchange program, there’s no restriction on the state funding syringe service programs with the copious money on the way from the American Rescue Act Plan.

The governor also signed SB1486 drug paraphernalia, testing equipment sponsored by Senator Marsh. This bill (once it becomes law 90 days after the end of session) will make it possible for folks to buy fentanyl test strips to make sure that any drug they have is free from fentanyl. Fentanyl has become the dominant cause of opioid deaths in the last few years and is rapidly increasing (see Figure 14 in our landmark (opioid epidemiology report).

NEW OPPORTUNITIES

Making syringe service and fentanyl test strips legal provides a big opportunity for AHCCCS, ADHS and the county health departments to fund syringe service and fentanyl test strip programs.

Because of the American Rescue Plan Act, there are more resources than ever to implement these programs. SAHMSA’s Community Mental Health Services Block Grant Program and Substance Abuse Prevention and Treatment Block Grant Program will be dispersing $1.5B to states in the next 2 years.

These supplemental funding awards are in addition to the usual $2.5B award. Here’s a press release and information on the supplemental awards. Arizona’s share of the pie is about $80M!

Back in the day, these SAHMSA substance abuse funds were managed by the ADHS. These days they’re managed by AHCCCS’ Substance Abuse Prevention and Treatment Block Grant.: FY 2021 Substance Abuse Prevention and Treatment Block Grant Program American Rescue Plan Supplemental Awards.

The combination of the passage of these important new laws and the substantial increase in funding from the American Rescue Plan Act provide a terrific opportunity to implement both of these evidence based best practices in a big way.

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

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

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

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

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

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

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

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

If your health department has not already, contact Dr. Cecilia Rosales at [email protected] and her team will work with you to get the mobile health units out to your county quickly!

Shelby Public Health, Return on Investment, Suicide Prevention

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Shelby Community Health Workers

An Open Letter from AzPHA’s Community Health Justice Committee

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

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

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

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

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

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

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

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

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

Learn more here.

– AzPHA’s Community Health Justice Committee

fosemckay Current Priorities

PROPOSITION 449

AZPHA RECOMMENDS A YES VOTE ON PROPOSITION 449

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

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

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

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

That extended system of health care consists of:

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

  • The Arizona Burn Center;

  • Three behavioral health centers;

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

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

  • The Arizona Children’s Center.

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

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

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

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

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

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

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

fosemckay Current Priorities

PROPOSITION 208

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

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

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

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

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

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

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

  • Largest class sizes in the nation

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

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

  • Enough nurses to serve only one-third of schools

Invest in Ed Initiative

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

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

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

  • 10% for teacher mentoring and teacher retention

  • 12% for Career and Technical Education vocational training programs

  • 3% for the Arizona Teachers Academy for scholarships

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

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

References:

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

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

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

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

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

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

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

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

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

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

fosemckay Current Priorities

PROPOSITION 207

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

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

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

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

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

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

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

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

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

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

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

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

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