Arizona Public Health in 2022: The Good, the Bad & the Ugly

Public health policy & operations were in a 2022 whirlwind. We started off with the Omicron surge amid disappointing COVID-19 vaccination rates, no statewide interventions and executive orders preempting local jurisdictions from doing anything – leading to a surge in hospitalizations (albeit with far fewer deaths that in January 2021).

Spring brought shocking revelations that the Arizona Department of Health Services (under the leadership of Cara Christ and Colby Bower) failed to investigate thousands of high-risk complaints at AZ nursing homes and covering up the nonfeasance by reclassifying 98% of their high-risk complaints as low, giving them a year to follow up rather than a week and jeopardizing the health and safety of nursing home residents (can you say criminal misconduct?).

Summer was a whipsaw, with the US Supreme Court overturning Roe v. Wade upending and throwing up in the air how Arizona is supposed to regulate abortion care (which won’t be resolved until sometime in 2023). But the summer also brought us the first bipartisan state budget in 14 years. With it came substantial new investments in public health and education.

Fall brought us an early influenza season, a historic RSV epidemic, and a predictable late fall COVID wave. A national assessment of COVID vaccination rates showed AZ has the lowest percentage of boosted nursing home residents (ADHS is the regulatory authority for nursing homes and did not use their authority to compel vaccination efforts among licensees).

As we closed out 2022, we learned Arizona has had the highest overall per-capital death rate from COVID-19 (no surprise given the policy decisions made by Doug Ducey, Cara Christ and Don Herrington). However, we closed out 2022 with optimism that the leadership decisions and operational integrity of state government and ADHS will improve when Dr. Theresa Cullen takes the reins of the ADHS in February 2023.

Here’s our 10-point summary of the good, the bad, and the ugly for public health in 2022:

  • January- Omicron in full swing with practically no interventions in place by the state (except vaccine distribution) resulting in an enormous amplification of infections. Hospitals were stressed (30% of beds occupied by COVID patients) but less so than the complete disaster of January 2021 (when there were also no interventions in place by the state) when 70% of beds were occupied by COVID patients:  Arizona Has the 2nd Highest COVID-19 Death Rate Per Capita During the First 2 Years of the Pandemic
  • March – Governor Ducey finally ends the state public health emergency. Decision has little impact on public health because the public health emergency authority was only being used to preempt local jurisdictions and schools from implementing interventions: Ducey Finally Ends the Public Health Emergency (And with It his Harmful Micromanagement of Political Subdivisions & Others)
  • April – Follow-up from the 2019 Auditor General’s report finds ADHS had continued to fail to follow up on thousands of care complaints at nursing homes. Instead of fixing the shortcomings found in the 2019 report, the April 2022 report found ADHS (under former Director Christ’s leadership) simply reclassified 98% of all high-risk complaints as low risk (giving them a full year to investigate high risk complaints that should have been done within a week). Auditors also discovered that ADHS (under Interim Director Herrington’s leadership) never used more than $1M in appropriations from the previous year to improve nursing home inspections and complaint investigations: Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era
  • April – May: Governor Ducey signs several bills that preempt local and county jurisdictions from using public health authority. Mr. Ducey also signs SB1009 restricting his successors public health emergency authority to 120 days (Mr. Ducey enjoyed more than 600 days of public health emergency authority): Dozens of New Laws Take Effect this Weekend… Some Good & Some Bad – Our Summary and see preemption bills PowerPoint 2022.pptx
  • JuneBipartisan budget passes with several investments in public health (Maternal health, access to care, behavioral health, human services [e.g., APS, housing, and water]: Legislature Passes a Bipartisan Budget for 1st Time in 14 Years: Here’s A Summary Top Line Health & Human Service Line Items
  • June-July U.S. Supreme Court overturns Roe v Wade upending reproductive/abortion care in Arizona: AzPHA Special Report: Women’s Reproductive Rights in Arizona 1864-2022. Later in 2022 courts would stay the territorial era law prohibiting nearly all abortions but a final resolution of how AZ will regulate abortion won’t be resolved until 2023.
  • September – Omicron booster becomes available but would remain among the states with the lowest uptake of the booster. Indeed, AZ nursing homes rank dead last in booster shot uptake.
  • October – Record year for RSV infections – stressing pediatric care. Influenza arrives much earlier than normal with a large spike. COVID cases also increase in late fall, but only 9% of hospital admissions are due to the illness.
  • November Voters elect Katie Hobbs Governor & Kris Mayes as Attorney General– decisions that will likely profoundly impact public health decision-making over the next 4 years. New state public health leadership is expected, staffing changes have not yet been announced.
  • December – Arizona overtakes Mississippi as the state with the highest per capita death rate from COVID-19. AZ also has the dubious distinction of having the largest increase in all-cause mortality among all states. Arizona now has the highest COVID-19 death rate of any state
  • Year End: Governor-elect Hobbs names Dr. Theresa Cullen as the next Director of the Arizona Department of Health Services, finally bringing talented leadership back to ADHS. Dr. Cullen most recently served as Director of the Pima County Public Health Department. Prior to that, Dr. Cullen served 25 years in the U.S. Public Health Service, rising to the rank of Assistant Surgeon General.  Dr. Cullen received her M.D. from the University of Arizona, College of Medicine and M.S. in Administrative Medicine/Population Health from the University of Wisconsin, Madison.

Final Call for Presentations: AzPHA Annual Conference

Call for Presentations: AZPHA Annual Conference
Addressing Health Disparities:
Building Infrastructure & Engaging the Next Generation of Public Health Leaders

AzPHA will be holding our annual conference on Thursday, February 23, 2023 at the Desert Willow Conference Center in Phoenix, AZ. In preparation for the conference, AZPHA is conducting an open call for abstracts for persons wishing to present at the conference.

We invite you to propose any presentation related to our theme of Addressing Health Disparities: Building Infrastructure & Engaging the Next Generation of Public Health Leaders and especially proposals regarding:

  • The CDC Workforce Infrastructure Grants
  • Work/Plans Related to Opioid Settlement Activities – (especially related to health disparities)
  • The CDC Health Disparities Grant
  • Addressing the Unique Challenges to Public Health in Rural & Tribal Communities

Presentations are scheduled to be held in person. Depending on your selection, you may be asked to present twice. You may propose your work as a solo presenter or as a team. The breakout sessions will be 45 minutes, there will be a morning and an afternoon session.

Presenting teams: All presenters must register for the full event. Please identify the primary presenter for your team presentation. This individual will communicate conference-related information with the rest of the team.

If you are submitting this proposal as part of a team, please confirm the following before applying:

  • Proposed speakers have agreed to participate
  • Proposed speakers will be available on Thursday, 2/23/23
  • Deadline for submission is December 23, 2022

We look forward to reviewing your proposal for the 2023 AZPHA Annual Conference!

Please submit your proposal to present by 12/23/22 using our call for proposals form
You can also propose to present a poster at the conference. Use our poster presentation proposal form
 

Learn How the Arizona State Legislature Works by Listening to this Consumable Podcast During the Break

The Arizona State Legislature will convene on Monday, January 9, 2023. Many legislators will hit the ground running with bills that they already have in the hopper. That means we need to be ready to fight for good bills, fight against bad bills, and be prepared to advocate for adjustments for bills somewhere in the middle right out of the box.

You can prepare your advocacy chops before the legislative session starts by listening to the Arizona Common Ground podcast, an eight-episode educational podcast series that gives a behind the scenes glimpse of the state legislative system and learn how bills can become laws. The Consumable Podcast Series is Available as:

ARIZONA COMMON GROUND on Apple Podcasts

ARIZONA COMMON GROUND | Podcast on Spotify

Krista Romero-Cardenas, MPH, a former senior instructional specialist for the Western Region Public Health Training Center and alumna of the Mel and Enid Zuckerman College of Public Health is the creator and host of the Arizona Common Ground podcast – an eight-episode educational podcast series that will take you through the process of how bills are passed in Arizona.

This is a must-listen to podcast for anybody interested in learning how the Arizona State Legislature makes the sausage!

ARIZONA COMMON GROUND

By AzPHA Member Krista R. Cardenas, MPH

The podcast series is available as ARIZONA COMMON GROUND on Apple Podcasts
ARIZONA COMMON GROUND | Podcast on Spotify

AzPHA Annual Members Meeting: January 11, 2023

AzPHA Annual Members Meeting:
January 11, 2023
11:00am – 1:00pm (Zoom)
Register Here

Agenda

  • Welcome & Introductions
  • Approval of 2021 Business Meeting Minutes
  • Treasurer’s Report
  • Public Health Policy Committee Report
  • Professional Development Committee Report
  • Membership Committee Report
  • Community Health Justice Committee Report
  • Executive Director’s Report
  • Recognize Outgoing Board Members
  • Recognize New Incoming Board Members
  • Passing the Gavel & Remarks by Incoming President
Register Here

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Call for Presentations: AZPHA Annual Conference

Call for Presentations: AZPHA Annual Conference
Addressing Health Disparities:
Building Infrastructure & Engaging the Next Generation of Public Health Leaders

AzPHA will be holding our annual conference on Thursday, February 23, 2023 at the Desert Willow Conference Center on Phoenix, AZ. In preparation for the conference, AZPHA is conducting an open call for abstracts for persons wishing to present at the conference.

Presentations are scheduled to be held in person. A virtual option has yet to be confirmed but is being considered. Please select which format you prefer to present, and we will do our best to honor your preference based on what is available.

Depending on your selection, you may be asked to present twice. You may propose your work as a solo presenter or as a team. The breakout sessions will be 45 minutes, there will be a morning and an afternoon session.

Presenting teams: All presenters must register for the full event. Please identify the primary presenter for your team presentation. This individual will communicate conference-related information with the rest of the team.

If you are submitting this proposal as part of a team, please confirm the following before applying:

  • Proposed speakers have agreed to participate.
  • Proposed speakers will be available on Thursday, 2/23/23
  • Deadline for submission is December 23, 2022.

We look forward to reviewing your proposal for the 2023 AZPHA Annual Conference!

Please submit your proposal to present by 12/23/22 using our call for proposals form
You can also propose to present a poster at the conference. Use our poster presentation proposal form

Coming in February: AzPHA Firearm Epidemiology Surveillance Report w/ Policy Intervention Evidence Review

The AZPHA Board of Directors met in early 2022 for a strategic planning session. One of the outcomes from the session was to set longer term public health policy priorities for AZPHA to work on. 

Among those priorities was a focus on prevention of deaths from firearm injuries and deaths. Our workplan for that priority started with pulling together a public health surveillance report of firearm injuries and deaths in Arizona and a literature review of evidence-based interventions (no such surveillance report has been produced by ADHS during the Ducey administration – leaving an 8-year gap in surveillance evidence).

We expect our report to be published in February. In the meantime, we will be presenting snippets from the report in these weekly policy updates.

A huge shout out to our authors for the report, Julia Jackman & Allan Williams, who have put in countless hours preparing our report!

Turnover in the AZ State Legislature Upsetting the Lobbyist Apple Cart

In part, because of redistricting, there is a ton of turnover at the Arizona State Legislature coming. Thise changes will have big implications for the movers and shakers down at the Capitol because so much of lobbyist’s influence is due to relationships. With so many new faces – they’ll need to build new relationships – and a lot of them.

I started writing a piece earlier this week to explain what it all means- but then the Arizona Agenda came out with an explainer last week. There’s no way I can explain it better than Rachel Leingang & Hank Stephenson did in their piece last week…  so, I’m providing it for you here (with attribution).

If you’re not a subscriber to the Arizona Agenda I encourage you to become one. A terrific well-written and consumable email like the one below will come to your in-box every weekday morning for only $120 per year. Here’s where to subscribe: Welcome to the Arizona Agenda (substack.com)

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With Democrats freshly in control of nearly every statewide office and massive turnover in the Legislature, the power dynamics at the Capitol are rapidly changing.

Many of the old power brokers are on the outs, and a new class of influencers will have an opportunity to prove they can enact policy in the newly purple state. Holding the Republican caucus together is no longer the go-to play. The mandate from the Governor’s Office is a bipartisan policy agenda, and in a split government, building a coalition is key.

Sure, the Legislature is still full of MAGA warriors. Warren Petersen is leading the state Senate, and Sen. Wendy Rogers and her ilk mostly run the Legislature’s most powerful committees. But if you’re a lobbyist looking to pass bills at the Capitol next year, you’re probably not asking “Freedom Caucus” leader Rep. Jake Hoffman to sponsor them.

The Republican firebrands who have largely set the tone and direction of the state Legislature are on the outs, as are their friends in the lobbying class.

Instead, Capitol lobbyists say they’re looking at moderate Republicans and, for the first time in more than a decade, Democrats, to help push their policy priorities through the legislative process.

The same politicians who were preparing for four years on the back bench under a Kari Lake governorship are now seeing their political fortunes skyrocket. A month ago, for example, Republican Sen. T.J. Shope was blocked on Twitter by the potential next governor. Today, he’s almost universally considered one of the Capitol’s most influential leaders, several lobbyists said.

“T.J. Shope will have to run all the bills,” one lobbyist joked. 

The ranks of moderate Republicans have been decimated in recent years. But we may for the first time see the “moderate caucus” grow, or at least see an increasing number of Republican lawmakers crossing the aisle to work with Democrats to pass shared priorities out of necessity or self-preservation. 

Keep an eye on Republican lawmakers from swing districts¹, like Reps. Justin Wilmeth and Matt Gress, and Sens. Steve Kaiser, Shope and J.D. Mesnard. Political insiders also point to a handful of Republicans with independent streaks, like Reps. Ken Bennett and David Cook and Sen. Sine Kerr, or a willingness to cut deals, like Sen. David Gowan, as the type that will thrive in a divided government.   

And legislative Democrats, with their former colleague now on the Ninth Floor, are a more powerful force than they have been in more than a decade. While individual Democrats are sure to shine under a Democratic governorship, the Democratic leaders in both caucuses will now wield nearly as much power as their Republican counterparts. Senate Democratic Leader Raquel Terán and House Democratic Leader Andrés Cano, working with the Governor’s Office, will likely drive the state budget process, for example, not Republicans. 

But it’s not just the politicians whose influences are waxing or waning. The lobbying class will change as well. While many of the old-timers were savvy enough to not make personal enemies with either candidate, others put all their eggs in the Lake basket.

Those in the lobbying and consulting corps who offered their full-throated backing of losing America First candidates could see their fortunes flop, like their candidates. Lobbyists like Spencer Kamps of the Homebuilders’ Association of Central Arizona, Bas Aja of the Cattlemen’s Association, Danny Seiden of the Arizona Chamber of Commerce and Industry and Patrick Bray of the Arizona Farm and Ranch Group were all major Lake supporters who were rumored to be among possible picks for her administration.

Instead, the political power center of Arizona is now built around centrist Democrats like lobbyist Mike Haener, the co-chair of her transition team who has been a staple in state government and policy since the Janet Napolitano administration; Chad Campbell of Strategies 360, a former lawmaker and longtime Hobbs friend and ally; and Joe Wolf, Hobbs’ top campaign adviser, as well as a few Republicans who stuck by Hobbs through the campaign.

Perhaps the biggest question is where Arizona’s progressive infrastructure fits into the Hobbs machine. What kind of influence groups like LUCHA, Progress Arizona and unions that supported Hobbs will have on the governor’s agenda, and will they ultimately work as friend or foe to her generally center-left administration? On that front, one lobbyist warned that while progressives will certainly have their best opportunity for wins in years, similar to far-right Republicans, progressives focused on controversial issues should stay sober about what’s possible, even under a Democratic governor.

Governor-elect Hobbs Begins to Hire Executive Staff

Last Friday Governor-Elect Katie Hobbs announced who will be filling senior posts in her upcoming administration. A couple of weeks ago she named Allie Bones as her Chief of Staff. Here are some of the folks that will be on the 9th floor 22 days from now (source: Governor-Elect Katie Hobbs Announces Key Senior Roles In Administration)

Tracy Lopes – Director of Policy Tracy Lopes | LinkedIn
Tracy Lopes received her law degree from the University of Massachusetts at Dartmouth. After graduating law school, she spent many years as an Assistant District Attorney, mainly in the Abuse Crimes Unit.

While on a leave of absence, she was a Legal Intern for the International Criminal Tribunal for the Former Yugoslavia. While there, she was awarded a Certificate in International Humanitarian Rights by the International Committee of the Red Cross.

Tracy has been a Law Professor and was an Administrative Law Judge with the Department of Economic Security. She received her MS in Forensic Psychology from Arizona State University and is currently working on her MSW degree from the same.

Most recently, Ms. Lopes has served as the Chief of Staff for the Democratic Caucus of the Arizona House of Representatives. In that role she became very familiar with public health policy. We expect Tracy to be a friend of public health in the incoming administration.

Will Gaona – Director of Public Affairs Will Gaona | LinkedIn
Will Gaona served as the legislative affairs director for the Arizona Secretary of State from 2019-2022. He has previously worked in municipal government and the nonprofit sector, including stints at Protect Democracy, the ACLU of Arizona, and the Arizona Coalition to End Sexual and Domestic Violence. Will graduated from the Sandra Day O’Connor College of Law in 2012 and from the University of Arizona in 2009.

Ben Henderson – Director of Operations Ben Henderson | LinkedIn
Ben Henderson is a public servant and technocrat who has spent his career helping the government use data, technology, and continuous improvement to be a force for good. He has served as Director of Operations as well as Deputy Budget Director for Colorado Governor Polis, Chief Operating Officer for the AZ Department of Education under Superintendent Hoffman, and in Economic Development for the City of Phoenix.

Murphy Hebert – Director of Communications Murphy Hebert / Twitter
C. Murphy Hebert has made Arizona her home for nearly 30 years. Most recently, she served as the communications director in the Office of the Secretary of State, prior to that she worked at the Maricopa County Recorder’s Office and the Arizona State Legislature. She is a proud Sun Devil, who graduated from ASU with a bachelor’s degree in Journalism. She also earned a master’s degree in Political Science from American University.

Sarah Brown – Office of Strategic Planning & Budgeting Director
S
arah Brown currently serves as Chief Financial Officer and Human Resources Director at the Arizona Secretary of State’s Office, where she has worked since February 2019.

Before joining the Secretary of State’s Office, she worked in the Maricopa County Recorder’s Office from 2013-2019 and, prior to that, in corporate finance. Sarah holds a bachelor’s degree in accounting, a certificate in diversity and inclusion, and is the chair of the Bring Change to Mind Arizona Council of Advisors.

Ariel Morin – Diversity Equity & Inclusion Director
Ariel Morin has worked for the State of Arizona for 11+ years, serving in positions at DES, DLLC, ADOA, and most recently as the HR Manager with the Secretary of State. Her primary focus is on HR principles, AMS, and Diversity, Equity, and Inclusion (DEI).

She possesses certifications in DEI and Conflict Management. Born and raised in Maryvale, Ariel’s love for her community inspired her to pursue her education in Public Administration and Intercultural Communication.

AzPHA Annual Members Meeting: January 11, 2023

Wednesday, January 11, 11:00am – 1:00pm (Zoom)
Register Here

Agenda

  • Welcome & Introductions
  • Approval of 2021 Business Meeting Minutes
  • Treasurer’s Report
  • Public Health Policy Committee Report
  • Professional Development Committee Report
  • Membership Committee Report
  • Community Health Justice Committee Report
  • Executive Director’s Report
  • Recognize Outgoing Board Members
  • Recognize New Incoming Board Members
  • Passing the Gavel & Remarks by Incoming President
Register Here

AzPHA Firearm Injury & Mortality Surveillance Report Coming in January: Report to Include a Policy Intervention Evidence Review

The AZPHA Board of Directors met in early 2022 for a strategic planning session. One of the outcomes from the session was to set longer term public health policy priorities for AZPHA to work on. 

Among those priorities was a focus on prevention of deaths from firearm injuries and deaths. Our workplan for that priority started with pulling together a public health surveillance report of firearm injuries and deaths in Arizona and a literature review of evidence-based interventions (no such surveillance report has been produced by ADHS during the Ducey administration – leaving an 8-year gap in surveillance evidence).

We expect our report to be published in mid-January. In the meantime, we will be presenting snippets from the report in these weekly policy updates.

A huge shout out to our authors for the report, Julia Jackman & Allan Williams, who have put in countless hours preparing our report!