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Supporting the Efforts of Healthcare Professionals Addressing the Social Determinants of Health
Contribution from AzPHA Member Jason Zibart
The last few weeks have been tough for both healthcare and public health professionals, and it comes on top of everything we have experienced over the last two years. We have all seen the court rulings and policy shifts. We know how these shifts will likely impact the health of Americans.
Over the last few days professional societies have been voicing their concerns. One of these societies is of particular interest. The American Medical Association has endorsed voting as a social determinate of health. They have also released a roadmap for improving racial justice and advancing health equity. These recent moves were no accident. As public health professionals we should consider how we can partner with and support our healthcare professional colleagues.
As professions public health and medicine have not always had the same goals, nor have they always effectively collaborated for the greater good. Today that isn’t always true. Healthcare providers have started taking more and more interest in the social determinants of health. That interest is being driven by healthcare professionals that are tired of seeing patients that have issues beyond the ability of prescriptions and procedures to fix. That is where Dr. Alister Martin came on the scene.
If you go to the Vot-ER website https://vot-er.org/ you will find the following statement. “Dr. Alister Martin is a practicing emergency medicine physician at Massachusetts General Hospital. Like so many nurses, social workers, medical students, and doctors across America, he goes to work every day knowing he’ll meet people he can’t help through medical care alone. There aren’t prescriptions or procedures to fix homelessness, hunger, illiteracy, joblessness, or violence—the larger forces responsible for many people’s poor health and reliance on emergency rooms and community health centers.”
To try and make a difference on those social determinants of health issues Dr. Martin founded Vot-ER and the Civic Health Fellowship. Why? Because when it comes to SDOH issues, there is one simple thing healthcare providers can do to help their patients and change outcomes.
They help patients register to vote. The program does not endorse political parties or individual candidates. They just help people register to vote. To that end many Vot-ER Civic Health Fellows were involved in the AMA endorsement recognizing voting as a social determinant of health issue.
Why does all this matter to public health professionals? Because it’s our mission, right? Homelessness, hunger, illiteracy, joblessness, and violence are all within the base of the health impact pyramid. Addressing these issues through policy shifts has the best chance at making the largest impact on the health of our communities. Healthcare organizations generally have more interaction with people on a day-to-day basis than public health organizations. This puts them perfectly positioned to address an issue like voter registration.
How can we support this movement among healthcare professionals? Reach out to your contacts and introduce them to Vot-ER and the work happening all over the country. Show them that change is happening and encourage them to be part of it. Support them in an attempt to permanently bridge the divide between public health and healthcare.
Feel free to reach out to me with any questions you might have! jzibart@kent.edu
My Take: ‘Vote the Golden Rule: YES on Prop 308’
Fifteen years ago, a ballot measure passed that punishes Dreamers – kids who were brought to Arizona by their parents as a child without proper documentation. That measure, called Proposition 300, prohibits Dreamers (people in the Deferred Action for Childhood Arrivals program) from qualifying for in-state tuition at our public universities and community colleges. It also stops them from competing for scholarships funded by local or state government.
Each year about 2,000 students graduate from Arizona high schools only to run into a brick wall because of that law. Dreamers have to pay a lot more for tuition in Arizona public universities & community than their high school classmates even if they’ve been living in Arizona and went to high school here.
For example, a Dreamer graduating from an Arizona high school pays more than $326 per credit hour at a Maricopa County Community College while his or her classmate from the same high school pays only $85 per credit hour. In-state tuition at ASU is $10,978, but for an in-state Dreamer it’s $16,500 and they’re not even allowed to compete for local or state government scholarships.
On what planet is that fair?
Proposition 308 fixes that inequity by letting Dreamers who went to high school in Arizona pay in-state tuition & compete for scholarships at our universities and community colleges just like their classmates.
The simple fairness of Prop 308 will help public health and economic development too. Research shows that college graduates have a $380,000 net positive contribution to the state and graduating from a community college or university is often a fast pass out of intergenerational poverty.
Do you believe in fairness? Do you believe in the Golden Rule?
If so, you only have one choice: Vote YES on Proposition 308.
View Proposition 308
My Take: ‘Proposition 310 May Save Your Life’
We have 2 unequal emergency medical service systems in Arizona. Folks who live in cities & towns enjoy well-performing emergency medical systems that have up-to-date equipment, staff, and training.
Residents of rural Arizona (especially unincorporated areas) don’t enjoy the same level of emergency medical services as urbanites. It’s not just because of the long distances the responders travel when responding to 911 calls. It’s because rural areas simply don’t have the resources to provide the same level of service that we take for granted in urban and suburban Arizona.
Unincorporated areas need to form their own rural fire & EMS districts with money cobbled together via a special local property tax to have access to fire and emergency medical services. They don’t have a city council to go to for funding. They’re basically stuck trying to get blood out of a turnip. As a result, rural EMS care is substandard.
The major disparity in the quality of emergency medical care in unincorporated Arizona bothered me when I was the director of the state health department, but I had no way of fixing it.
Now we have a solution. Proposition 310 will supplement rural fire districts with a 0.1% sales tax collected statewide. That’s equal to an extra dime on a purchase of $100. Rural fire districts won’t be getting a free lunch though. The lion’s share of fire & EMS district funding will still come from local property taxes.
The next time you’re driving through rural Arizona ask yourself whether you think an extra dime on a $100 purchase is worth knowing that someone would help you if something bad happens. Will they have the equipment & training they need to save your life?
If Proposition 310 passes they will, so Vote YES!
My Take: ‘Keep Your Power: Vote No on Proposition 132’
Arizona has a long, proud history of direct democracy via ballot initiatives. It has served us well.
Voter initiatives are a check balance in the system – one of the only ways that we as members of the public can push back against the stranglehold that deep pocket special interests like the chamber of commerce have on the legislature.
For years, members of the state legislature proposed bills to prohibit smoking in public places like bars and restaurants. But year after year, deep pocketed, well-connected business lobbyists found ways to kill those bills using their bag of magic tricks like getting the speaker of the house or president of the senate to make sure the bills were never heard.
Finally, in 2006, a group of nonprofits and ordinary citizens took matters into their own hands and collected enough signatures to get the Smoke Free Arizona Act onto the ballot. That Initiative included a ban on smoking in public places (with exceptions) and included a 2 cent per pack tobacco tax for enforcement.
Business interests fought hard against it, even running their own weakened voter initiative. But in the end, enough people saw that the Smoke Free Arizona Act was good. It passed by a margin of 54.7% to 45.3%.
Now, the Legislature wants you to approve Proposition 132 which will require voter initiatives that include a tax or fee to pass with at least 60% of the vote. If Proposition 132 was in effect back in 2006 we might very well still have public spaces full of tobacco smoke.
Prop 132 is a bald-faced attempt to take your power away and give it to the deep-pocketed lobbyists & business interests.
Don’t let them. Please vote no on Proposition 132.
My Take: Vote for Transparency. Vote ‘YES’ On the ‘Voters Right to Know Act’
Please Vote for Transparency: Vote Yes on the Voters’ Right to Know Act
Dark money is political spending on election advertising by anonymous sources. It is called “Dark Money” because we can’t see who’s sponsoring the messages in political ads.
Under current Arizona law, rich power brokers get special treatment and unduly influence elections by secretly spending money on advertisements and promotions supporting their candidate or ballot proposition. This “Dark Money” bombards voters with negative ads, misleading information, and even outright lies.
Because we don’t know who’s paying for the advertisements, ordinary people don’t have the information they need to figure out whether it’s credible or not. It’s like my grandmother used to always say… “According to whom?” Well, with Dark Money dominating our elections, we can’t answer that question for ourselves.
The Voters Right to Know Act will fix that. It simply builds transparency into our political system by requiring ALL major contributors to identify themselves if they spend more than $5,000 for a campaign or candidate.
Elections have profound impacts on public health and policy– good and bad. Persons that get elected to public office at the federal state and local level routinely make decisions that influence public health. They appoint people for key jobs (we saw how important that was during the pandemic). They also make funding decisions that impact public health.
In short, elections have a significant impact on public health. That’s why it’s super important to have an informed electorate, so people can make informed decisions about what they decide in the ballot box- whether it’s a person running for elected office at the state, federal, or local level- or whether it’s about a voter initiative.
Cast your vote for Transparency. Vote YES on the Voters Right to Know Act.
Our Take: Vote YES On the ‘Predatory Debt Collection Protection Act’
Vote Yes on the Predatory Debt Collection Protection Act
The Arizona Public Health Association urges you to vote Yes on the Predatory Debt Collection Protection Act.
Why would a nonprofit organization dedicated to improving public health be interested in a voter initiative about debt collection?
It’s simple. Because families need to earn have a living wage and enough money and resources to provide a sturdy environment and make healthier choices. In fact, having adequate resources is the number one determinant of the health status of a family.
The Predatory Debt Collection Protection Act doesn’t give people in debt a ‘free pass’. Far from it. But it does level the playing field so people will have an opportunity to pay back their debts without spiraling into poverty.
The Predatory Debt Collection Protection Act brings Arizona more in line with the recommendations provided by the National Consumer Law Center, enabling people in debt to pay off what they owe without losing their ability to meet their daily living needs.
For example, it limits the amount of wage income that can be garnished to 10% or less of disposable earnings so that families don’t get pushed below the federal poverty level.
Right now, 25% of a person’s wages can be garnished, even if it sends them under the poverty limit. It also limits interest rates on medical debt to 3% so families don’t get trapped in an unending cycle by sky-high interest rates.
Working and middle-class families will also be protected from predatory debt collectors taking their homes and cars because it includes common-sense updates to state law that account for the rising costs of homes and cars. For example, it increases the “homestead exemption” to $400,000 so that people don’t lose their home.
Please do the right thing. Vote Yes on the Predatory Debt Collection Protection Act
You Can Send in Your Own Argument for the November Election Publicity Pamphlet
Anybody can place a statement in the Publicity Pamphlet that goes out to voters regarding the voter initiatives and ballot referrals from the legislature, but you gotta act fast. Your argument needs to be submitted to the Secretary of State’s General Election Ballot Measure Argument Portal by 11:59 P.M. on July 6th (before midnight this coming Wednesday). The submittal fee is $75.
AzPHA is turning in a ballot argument for the Predatory Debt Collection Protection Act. I separately placed arguments in the guide from myself for the Voters Right to Know Act and against Proposition 132, which would require a supermajority of voters to approve future voter initiatives that include any kind of tax.
AzPHA Special Report: Women’s Reproductive Rights in Arizona 1864-2022
Ever since the territorial days, Arizona has had a history of severely restricting women’s reproductive freedom. From territorial era laws passed in 1864 to the laws restricting both abortion and contraception passed in 1901 (called the Comstock Laws), Arizona lawmakers and governors have actively sought to restrict women’s reproductive rights.
When the U.S. Supreme Court announced their decisions in the 1960s and 1970s (Griswald v Connecticut & Roe v Wade) Arizona finally began to allow more reproductive freedom (including the right to have an abortion), but only because
the courts had forced their hand.
The recent U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization has potentially set back women’s reproductive rights to the territorial era in Arizona.
In this special report, we review historical documents to piece together the history of women’s reproductive health rights from the beginning of Arizona’s territorial era in 1864 to the present day.
Buckle your seat belt. You’re in for a bumpy ride.