Will Humble Community Health Workers, Wills Blog

How to Get Your CHW Training Program Certified

Is your organization ready for CHW Voluntary Certification? One way to prepare is to get your training program approved by AzCHOW. The training program approval process ensures that CHW training programs prepare CHWs to understand the 10 Core Competencies and work to the fullest extent of their skills and abilities. You can read more about training program approval using the resources on the AzCHOW website:

Technical aid is available. They can meet with your organization to provide support and recommendations to prepare for CHW training program for approval. You can schedule a first meeting with Katy Tucker at kmtucker@arizona.edu.

Will Humble Community Health Workers, Wills Blog

Report: Building Community Health Workers Into the Continuum of Care

For a picture of how CHWs can fit into a continuum of care, take a look at this report from the NAU Center for Health Equity Research in collaboration with the UA Prevention Research Center (AzPRC) which provides insight into innovative strategies for integrating, sustaining and scaling of the CHW workforce within Medicaid (AHCCCS).

The Center for Health Equity Research at NAU through funding from the ADHS and in collaboration with the UA Prevention Research Center (AzPRC) wrote a report which provides insight into innovative strategies for integrating, sustaining and scaling of the CHW workforce within AHCCCS.

The report provides direct insight to this pathway via conversations with health plan leadership including topics on:

  • Current and Projected Utilization
  • Roles, Competencies and Skills
  • Recruitment and Training
  • Financing and Payment Models
  • Healthcare and Workforce Policy

The report found that Arizona health plan leaders recognize that Community Health Workers can play a significant role in improving patient outcomes and reducing system costs for health care. Many health plan leaders already actively support their contracted provider networks to better integrate and finance CHWs to meet HEDIS measures.

The research team found that health plan leadership expects that the new Arizona Complete Care Contracts will fundamentally expand the need for CHWs and the core competencies, roles and skills as plans expand their services and seek creative approaches to meeting membership medical and non-medical needs.

The report sheds light on important next steps toward building CHWs into the care network. Congratulations and thanks to AzPHA member Dr. Samantha Sabo, Louisa O’Meara, and Katie Castro for their work on this important roadmap document.

Will Humble Community Health Workers, Medicaid, Wills Blog

The Tumblers Click: Community Health Workers Entering Arizona’s Care Network at Scale

Community Health Workers are frontline public health workers who have a trusted relationship with the community and facilitate access to a variety of services and resources for community members. Building CHWs into the continuum of care has been proven to both improve health outcomes and reduce healthcare costs… especially when it comes to preventing and self-managing chronic diseases.  

The evidence that Community Health Workers cut healthcare costs and improve outcomes was clear several years ago- but it’s been a multi-year process to put together the infrastructure to build them into Arizona’s healthcare network. Education and training the workforce was critical of course – but we also needed a process to credential CHWs so they could be reimbursed for their work through health insurance and Medicaid claims.

We also needed training sites that could supply the curriculum that builds the knowledge and skills. Finally, AHCCCS needs to embrace the use of Community Health Workers and authorize their reimbursement via claims and encounters.

That’s a lot of work… work that took several years requiring community groups working in tandem with state and county government, community colleges and academia to make it all happen. Luckily, we had the Arizona Community Health Workers Association (AzCHOW) to help provide that grassroots community input to help drive the process and facilitate development of the workforce.

Credentialing

How was AzCHOW able to do it? They got a big boost back in 2017 when the 2017 the Vitalyst Health Foundation provided AzCHOW with a $123K Innovation and Medical Assistance Grant.

We can save money and lives with community health workers | Heather Carter

AzCHOW’s work paid off with a big victory in May 2018 when then Representative Heather Carter worked super-hard to pass HB2324, charging ADHS with developing a voluntary certification process for CHWs. Sadly, that relatively simple rule package wasn’t a priority for then Director Christ and the responsibility for developing the rules languished for 4 years before the department established the certification process.

Last Summer ADHS’ rule package was finally approved by the Governor’s Regulatory Review Council and the voluntary certification process will officially be in place on November 7, 2022.  

The ADHS rules prescribe the CHW scope of practice and core competencies; qualifications; standards for education and training programs; continuing education requirements, and criteria for granting, denying, suspending, and revoking a certificate; and set up and collect nonrefundable fees for certification as a community health worker. See the final regulations here.

Curriculum Development & Training

As AzCHOW and the rest of the system waited patiently for ADHS to finally get their certification rules finished AzCHOW continued to work with Central Arizona College and Scottsdale Community College to set up curricula to prepare the workforce for certification. For example, SCC started their 1st cohort of scholars in their Community Health Worker Program this fall. They even partnered with Mercy Care to provide $1,000 Scholarships.

Community Health Worker Program at Scottsdale Community College

For more information, fill out this online form or contact Pooja Paode, Program Director: pooja.paode@scottsdalecc.edu.

Reimbursement

The prep work is just about done to really plug CHW’s into the care network – where they can begin reducing improving health outcomes and reducing costs at scale. ADHS finally finished their credentialing work and have promised to open the portal to apply for certification on November 8. Scottsdale Community College & Central Arizona College have training programs in place and AzCHOW has been prepping the workforce.

The next big step is to build a funding pipeline so CHWs can get reimbursed for their work. There are many CHWs and CHRs already working in the field – but they’re mostly being paid with administrative funds from AHCCCS’ contracted Managed Care Organizations. The real workforce scale-up will happen once AHCCCS contracted MCOs can start sending claims and encounters to AHCCCS for their work.

19 of the 22 tribes in Arizona employ CHRs. CHRs have traditionally been funded through the IHS system. CHRs currently make up roughly 30% of the CHW workforce in Arizona.

Fortunately, current AHCCCS totally gets the importance of building the CHW reimbursement pipeline and is working hard to make that happen. The first step is to amend their State Plan Amendment with the Centers for Medicare and Medicaid Services. At a very informative webinar last Friday, AHCCCS committed to turning in a State Plan Amendment before the end of 2022 and expect to get CMS approval by March of 2023. See the AHCCCS PowerPoint.

The SPA language is succinct: “Certified Community Health Workers (CHW) acting within their scope of practice as defined in state law may provide AHCCCS-covered patient education and preventive services.” Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each billed in 30 minutes increments.

    • 98960- patient education & training for 1 patient for 30 minutes.
    • 98961- for a group of two to four patients.
    • 98962- or a group of five to eight patients.
Summary

It has taken many long years to build the infrastructure to use the skills of Community Health Workers at scale within Arizona’s healthcare network. Kudos to the network of hard-working and tenacious folks that have been working toward this goal over the last several years!

Will Humble Nutrition, Wills Blog

FDA Proposes New Criteria for When Foods Can Be Labeled “Healthy”

Last week the FDA proposed updated criteria for when foods can be labeled with the nutrient content claim “healthy” on their packaging. This proposed rule would align the definition of the “healthy” claim with current nutrition science, the updated Nutrition Facts label and the current Dietary Guidelines for Americans. 

The proposed rule would update the “healthy” claim definition to better account for how all the nutrients in various food groups contribute and may work synergistically to create healthy dietary patterns and improve health.

Under the proposed definition for the updated “healthy” claim, which is based on current nutrition science, more foods that are part of a healthy dietary pattern and recommended by the Dietary Guidelines would be eligible to use the claim on their labeling, including nuts and seeds, higher fat fish (such as salmon), certain oils and water. 

To be labeled with the “healthy” claim on food packaging, the products would need to: 

  • Contain a certain meaningful amount of food from at least one of the food groups or subgroups (e.g., fruit, vegetable, dairy, etc.) recommended by the Dietary Guidelines.  
  • Adhere to specific limits for certain nutrients, such as saturated fat, sodium and added sugars. The threshold for the limits is based on a percent of the Daily Value (DV) for the nutrient and varies depending on the food and food group. The limit for sodium is 10% of the DV per serving (230 milligrams per serving).

For example, a cereal would need to contain ¾ ounces of whole grains and contain no more than 1 gram of saturated fat, 230 milligrams of sodium and 2.5 grams of added sugars. 

FDA is also developing a symbol or icon that manufacturers could use to show that their product meets the “healthy” claim criteria. This will be a front-of-package (FOP) labeling system to quickly and more easily communicate nutrition information to empower consumers to make healthy decisions.

Proposed Rule: Food Labeling: Nutrient Content Claims; Definition of Term “Healthy”

Will Humble Public Health, State Legislature, Wills Blog

It’s Opening Day for Early Voting: AzPHA Officially Takes Positions on Ballot Propositions

AzPHA Recommends YES on Props 209, 211, 308 & 310
Urges NO on Prop 128

AzPHA’s 501(c)3 nonprofit status prohibits us from taking positions on the candidates- but we can take positions on policy issues and the ballot propositions. We’ve taken a deep dive into the public health implications (direct & indirect) of all 10 ballot propositions and have taken positions on 5 of them.

AZPHA Recommends YES Votes on the Following Propositions
PROP 209: Predatory Debt Collection Protection Act

Summary: The measure makes multiple changes to state statutes on wage garnishment debt collection. It limits the interest rate on medical debt to 3%. It would protect more equity in homes, vehicles, household goods and bank accounts from being taken by creditors. It also limits the amount that can be garnished from wages to pay off debts.

Arguments for it: Medical debt causes many Arizonans to fall into bankruptcy. The standards for wage garnishment and asset collection are outdated. People shouldn’t lose their homes or vehicles because of predatory debt.

AzPHA’s Take: Vote YES On the ‘Predatory Debt Collection Protection Act’

Who’s backing it: Arizona Public Health Association, Healthcare Rising Arizona (which receives support from the SEIU-United Healthcare Workers West), Arizona Students’ Association, Phoenix Workers Alliance, Neighbors Forward AZ, Democrats of Casa Grande

Who’s opposing it: Goldwater Institute, Arizona Chamber of Commerce & Industry, Arizona Free Enterprise Club, Tucson Metro Chamber, Greater Phoenix Chamber, Arizona Bankers Association

PROP 211: Voters’ Right to Know Act

Summary: Prop 211 would change state law to require political groups and people spending more than $50,000 to influence the outcome of an election to disclose the original donor of contributions over $5,000. It would also require real-time reporting of significant campaign spending and allow the Arizona Citizens Clean Elections Commission to enforce the provisions of Prop 211. Allows civil penalties for violations. 

Arguments for it: “Dark money” is a corrupting influence on our democratic system and Arizona voters deserve to know who is funding political campaigns. Prop 211 will bring transparency and accountability to campaign messaging because voters will know who is paying for those ads. And it’ll stop regulated utility companies like Arizona Public Service from secretly funding the campaigns of their own regulators, as has happened in past elections.

AzPHA’s Take: Vote for Transparency. Vote ‘YES’ On the ‘Voters Right to Know Act’

Who’s backing it: Arizona Public Health Association, League of Women Voters of Arizona, former Phoenix mayors Paul Johnson and Terry Goddard

Who’s opposing it: Arizona Free Enterprise Club, Center for Arizona Policy Action

PROP 308: Tuition; Post-secondary Education

Summary: Prop 308 would change state law to allow all Arizona students, regardless of immigration status, to be eligible for financial aid and in-state tuition at Arizona universities and community colleges. Students must have graduated from an Arizona high school and been enrolled for two years.  It would ask voters to repeal Prop 300 from 2006, which passed overwhelmingly at the time and barred non-citizens from receiving in-state tuition. 

Arguments for it: Arizona students should be able to attend Arizona universities, regardless of immigration status. Undocumented students and Dreamers are a vital part of our economy. It’s good for business and it’s the right thing to do.

AzPHA’s Take: ‘Vote the Golden Rule: YES on Prop 308’

Who’s backing it: Arizona Public Health Association, Arizona Chamber of Commerce and Industry, Southern Arizona Leadership Council, Arizona Education Association, Aliento Education Fund, Valley Interfaith Council, Stand for Children, Local First Arizona

Who’s opposing it: Former Senate President Russell Pearce, the Arizona Republican Party, RidersUSA

PROP 310: Fire districts; Sales tax

Summary: Prop 310 would increase sales taxes by a tenth of a penny on the dollar to fund rural fire districts. 

Arguments for it: Fire districts serve 1.5 million Arizonans and handle not only fighting fires but providing emergency medical services in car crashes along major parts of Arizona’s highway system. Fire districts are strapped for labor, equipment and resources, and 911 calls often take upwards of 30 minutes for a response.

AzPHA’s Take: Proposition 310 May Save Your Life Vote YES

Who’s backing it: Professional Fire Fighters of Arizona, Arizona Fire Chiefs Association, rural fire districts

Who’s opposing it: Arizona Free Enterprise Club, Arizona Republican Party

 

AZPHA Urges NO Vote on Prop 132
PROP 132: Initiatives; Supermajority vote

Summary: Prop 132 would amend the state Constitution to require a 60% vote to increase taxes at the ballot. 

Who’s for it: Arizona Chamber of Commerce and Industry, The Goldwater Institute, Doug Ducey, Arizona Tax Research Association

Arguments against it:  Lawmakers already need a two-thirds majority vote to pass any increases on taxes or to roll back tax credits and exemptions, and that supermajority requirement has hindered lawmakers’ ability to pass even common-sense tax increases. Bottom line: this proposition is designed to limit the voice of voters.

AzPHA’s Take: ‘Keep Your Power: Vote No on Proposition 132’

Who’s against it: Arizona Public Health Association, League of Women Voters of Arizona, Arizona Center for Economic Progress, Arizona Education Association

____________

AZPHA is Not Taking an Official Position on Props 128, 129 & 309 but Our Executive Director Urges NO Votes
PROP 128: Voter Protection Act; Court Determinations

Summary: Prop 128 is a constitutional amendment that would allow lawmakers to bypass the Voter Protection Act to amend or repeal any ballot measure with any ‘illegal’ or unconstitutional language. (Currently, the Voter Protection Act bars lawmakers from repealing voter-approved laws, or from amending them, unless lawmakers can muster a three-fourths majority in both chambers and the changes “further the intent” of the voter-approved law.) 

Who’s backing it: Arizona Free Enterprise Club, Arizona Chamber of Commerce and Industry, Center for Arizona Policy, Home Builders Association of Central Arizona

Argument against it: One single sentence or word in an initiative might be found unconstitutional or ‘illegal’, and the courts can already nullify just the unconstitutional or ‘illegal’ part and leave the rest. But if Prop 128 passes, lawmakers could then throw out the entire law, even though most of it is perfectly constitutional, which would shift power from the voters to the Legislature.

While the word ‘unconstitutional’ in the statutory language has a clear meaning, the word ‘illegal’ does not. The very purpose of a voter initiative is to change laws. For example, if Proposition 128 passes and there is a voter initiative in 2024 that constitutionally legalizes abortion could the courts decide the initiative is ‘illegal’ because it contradicts existing law?

Who’s opposing it: League of Women Voters of Arizona, One Arizona, Living United for Change in Arizona (LUCHA), Save our Schools Arizona, Sierra Club Grand Canyon Chapter, Will Humble

PROP 129: Initiatives; Single Subject

Summary: Prop 129 would limit initiatives to a single subject and require each provision be represented in the title. While lawmakers are barred from loading multiple subjects into a single bill, citizens writing initiatives are not, the Arizona Supreme Court has ruled.

Who’s backing it: Arizona Free Enterprise Club, Arizona Chamber of Commerce & Industry, Center for Arizona Policy Action

Arguments against it: It would eliminate initiative backers’ ability to combine forces for good-governance initiatives that touch on several aspects of the law. It would give the courts yet another technicality to use to ignore the will of the people. And the same rules shouldn’t apply to initiatives as lawmakers because passing a bill is a lawmaker’s job, but it costs citizens a lot of time and money to pass their own laws via initiative. 

Who’s opposing it: Arizona Education Association, One Arizona, League of Women Voters of Arizona, Will Humble

PROP 309: Voter Identification; Affidavit

Summary: Prop 309 would change state statutes to require voters who vote in person to show a photo ID, instead of multiple pieces of certain mail, like bank statements. For voters without a photo ID, the state would issue a free non-operating license for voting purposes. If receive a ballot by mail, you would have to write your birthdate, ID number and signature on a “concealed early ballot affidavit” before mailing it back or dropping it off at a polling place.

Who’s backing it: Heritage Action for America, Arizonans for Voter ID, Arizona Free Enterprise Club, Arizona Republican Party, Goldwater Institute, Arizona Women of Action, Election Transparency Initiative, America First Policy Institute

Arguments against it: It will impede people’s ability to vote by adding burdens and creating confusion. It will invade people’s privacy. 

Who’s opposing it: Arizona County Recorders, Prescott Indivisible, League of Women Voters of Arizona, One Arizona, Defend Arizona Rights, Opportunity Arizona, Arizona Education Association, Living United for Change in Arizona (LUCHA), Chispa Arizona, Our Voice Our Vote Arizona, Mi Familia Vota, Will Humble

Will Humble Social Determinants, Wills Blog

President Promises to Use Executive Authority to Overhaul Marijuana Enforcement & Convictions

Asks DEA to Look into Rescheduling Marijuana’s Classification Under the Controlled Substances Act

Last week President Biden promised to use his executive authority to overhaul the way the federal government enforces marijuana possession laws and promised to pardon folks who have been previously convicted of possession of small amounts of marijuana under federal law.

The most immediate action appears to be pardoning prior federal offenses of simple marijuana possession.  While most marijuana possession convictions are under state law, there are about 6,500 people with prior federal convictions for marijuana possession between 1992 and 2021 who may be denied housing, employment, or educational opportunities as a result.

This pardon will help relieve those collateral consequences. Biden asked his Attorney General Garland to develop the administrative process to issue the certificates of pardon.

The vast majority of marijuana convictions are at the state level. See: Expunging Cannabis Possession Convictions Made Easier in AZ

The president also asked the Drug Enforcement Administration to investigate rescheduling marijuana under the Controlled Substances Act.  Congress passed the Controlled Substances Act decades ago – but left most of the details to the DEA, Justice Department, and HHS.

Those agencies have classified marijuana under ‘Schedule 1’ – the most restrictive category along with heroin and LSD. Marijuana is even classed higher than fentanyl, methamphetamine, and cocaine – drugs that do more public health damage than marijuana.

Schedule 1 and 2 drugs face the strictest regulations because they are considered to have no medical use. Schedule 1 drugs are effectively illegal for anything outside of research, and schedule 2 drugs can be used for limited medical purposes with the DEA’s approval because they are still considered to have a ‘high potential for abuse’. At Schedule 3 and beyond, both the FDA and DEA play a role in regulating the drug.

Here’s how the reclassification process will work. The Drug Enforcement Administration will officially ask HHS to review the medical and scientific evidence about marijuana’s scheduling. HHS will evaluate the drug based on 8 factors including its potential for abuse, the scientific evidence for a drug’s pharmacological effects, and the scientific evidence for a drug’s medical use.

HHS will then make a recommendation to the DEA, who will make the decision about whether and how to change the scheduling of marijuana.

Let’s imagine that DEA ends up changing marijuana to Schedule 2 or 3, and the FDA begins to have some authority to regulate marijuana. You might thing that rescheduling marijuana would have a big impact on enforcement of marijuana laws – either nationally or at the state level…  but you’d be wrong because FDA approval or lack thereof has no bearing on the administration’s enforcement discretion.

Rescheduling would make it much easier to do research on marijuana, but rescheduling would really have little to no impact on enforcement of existing marijuana possession or trafficking laws at either the state or federal level and would have little effect on state regulation of medical or retail marijuana.

For a deeper dive visit: Clearing Up Misconceptions about Marijuana Rescheduling

Some examples of the drugs that are on each schedule:

  • Schedule 1: marijuana, heroin, LSD, ecstasy, and magic mushrooms
  • Schedule 2: cocaine, meth, oxycodone, Adderall, Ritalin, and Vicodin
  • Schedule 3: Tylenol with codeine, ketamine, anabolic steroids
  • Schedule 4: Xanax, Soma, Darvocet, Valium, and Ambien
  • Schedule 5: Robitussin AC, Lomotil, Motofen, Lyrica, and Parepectolin
Will Humble Maternal Health, Reproductive Health, Wills Blog

Doula Care Reduces C-sections, Pre-term Birth & Cuts Birthing Costs by a Net $1,000

AHCCCS Actively Working Toward Incorporating Doula Care as a Covered Service but ADHS Still Hasn’t Developed the Certification Regulations

Those of you that attended the health equity conference last week were treated to a terrific late morning panel discussing a range of reproductive health topics including: 1) maternal mortality interventions; 2) local health policies that promote access to care for birthing people and infants; 3) overcoming barriers to care for birthing people and infants in Arizona, and 4) opportunities for cross-sector collaborations.

Several of the speakers (DeShawn Taylor, MD, Jennifer Piatt, JD, Zaida Dedolph Piecoro,, Sara Salek, MD, and Jacqueline Badine) mentioned the role that Doula care can play in improving birth outcomes (especially Ms. Badine). Their discussions inspired me to take a deeper dive into Doula care this week, so here goes.

A doula is a trained professional who provides physical, emotional, and informational support to a woman throughout her pregnancy, childbirth, and postpartum period. Doulas act as a facilitator between the laboring women and her physician by ensuring that the mother gets the required information to make informed decisions.

Several studies have shown that moms who have doula services during their pregnancy and delivery have fewer cesarean sections and epidurals, reduced premature births, higher rates and a longer duration of breastfeeding, while substantially reducing birthing costs

In March 2014, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal medicine issued a consensus statement which explicitly stated that published data has indicated better labor and delivery outcomes when continuous support personnel such as doulas are used. In addition to improving birth outcomes, doula care has a high return on investment.

Doula care reduces healthcare costs by lowering the rate of pre-term and C-section deliveries to the tune of about $1,000 per doula-supported birth

Fortunately, the word that doula care improves health outcomes while reducing healthcare costs has struck a chord- and Arizona policy is slowly moving toward integrating doula care into the network, including AHCCCS coverage.

The strategy for building doula care into the network is much like the model we used for Community Health Workers…  build a professional certification process, followed by amending AHCCCS’ waiver with CMS to provide for reimbursement for the services.

Back in 2021, the legislature passed, and the governor signed a new law [ARS 36-766.01-09] charging the ADHS with developing rules to certify doulas including a scope of practice, qualifications, standards for education and training programs and compliance criteria. The law gave ADHS ‘exempt’ rulemaking authority- which is essentially the diamond lane for writing rules (there’s no excuse for slow-walking them).

While ADHS hasn’t made any tangible progress on that rulemaking yet, they’ve at least published a ‘Notice of Public Information‘ with the Secretary of State.

The slow pace of the rulemaking shows that finishing the rule isn’t a priority for the current ADHS director, but it might be a higher priority for whoever is appointed to that post a few months from now.

At the Health Equity Conference last week, AHCCCS’ Chief Medical Officer (Dr. Sara Salek) mentioned that the agency is in the process of preparing an amendment to their state plan to incorporate doula care as a covered service. Hopefully the next ADHS director will get on the stick and finalize the doula certification rules in time for certification to be available by the time AHCCCS is able to complete their paperwork with CMS. 

Also See:  Doula Coverage to Help Minimize Arizona’s Birth Woes

Will Humble Professional Development, Wills Blog

Message from AzPHA Member Dr. Leonard Kirschner: Nine Big Lies & One Big Truth

Ken Burns gripping documentary, “The U.S. and the Holocaust” brought back memories of my own family. My four grandparents immigrated from eastern Europe in the 1890’s and settled in New York. My parents were born in New York, met, married and had two children in the city. My father and his sister were orphaned and raised by cousins. My father got his college degree from City College, his Master’s in Business from NYU, and became the Chief Operating Officer of an international textile corporation with headquarters in New York.

My aunt moved to Paris in the 1920’s to study at the Sorbonne. When the war started, she joined the OSS (the precursor to the CIA). She served in North Africa and Europe. A true immigrant story. At the end of the war, my aunt returned to Europe to search for the cousins she had met in her years living in Paris. They had all perished in the Holocaust. My own history makes me reflect on big lies that have had horrific consequences.

The Big Lie #1. When Adolph Hitler rose to power in 1933, he propagated the big lie that the Jews of Germany had caused the country to lose World War 1. He added to that lie by saying the Jewish population was the cause of all the problems the country faced in the Great Depression. Joseph Goebbels, his Minister of Propaganda, said it well: “A lie once told remains a lie, but a lie told 1000 times becomes the truth.” My dear friend Sue was born in Stuttgart, Germany, in 1937, into a family that had lived in the country for centuries. Her father served in the German Army in World War 1 but that did not matter because he was a Jew. They escaped to the United States in 1938. I met Sue when we were in high school. Those big lies led to the death of millions of innocent people.

The Big Lie #2. For hundreds of years witchcraft was believed to exist. There are estimates that tens of thousands of people (mostly women) were convicted of witchcraft and hung, drowned or burned at the stake. The American colonies were not immune to this big lie with the most infamous being the Salem witch trials of 1692-1693 in which 19 individuals were executed. This event has been described as a case of mass hysteria. In the 1950’s, the Massachusetts Legislature passed legislation exonerating the people who had been executed.

The Big Lie #3. Joseph McCarthy was a United States Senator from Wisconsin, serving from 1947 to 1957. He propagated the big lie that the United States was the target of widespread communist subversion. He claimed to have lists of communists in the State Department, the administration of President Truman, the U.S. Army and other government agencies as well as in Hollywood. There were no lists. Eventually Senator Margaret Chase Smith called him out and the Senate censured McCarthy. Today the term, “McCarthyism” stands for a demagogue who makes reckless and unsubstantiated accusations.

The Big Lie #4. “Separate but Equal” was a legal doctrine employed in the years after the Civil War. It included segregation in housing, education, health care, transportation and many other services. The fact is that these services were separate but definitely not equal. The Supreme Court decision in Brown v. Board of Education in 1954 started the dismantling of this noxious practice. The passage of the Civil Rights Act of 1964 was historic. In 1963, I was a newly commissioned USAF Captain stationed at Gunter AFB in Mongomery, Alabama. I was living in a motel in the city when I heard the screech of tires. I went out in the street to find a man who had been hit by a hit and run driver. I gave first aid and called for an ambulance. When the driver arrived, he looked at the injured Africa-American and said we had called the wrong ambulance. We needed to call the “Black Ambulance.”

The Big Lie #5. American Indian boarding schools were established in the United States to “civilize” Native American children. One of the largest schools was in Phoenix, and we still drive on Indian School Road.  The schools were usually harsh as the children were forcibly removed from their families, had their hair cut and were not allowed to speak their native language. Many of the children died, and we are still finding evidence of unmarked graves. Eventually, through court action and legislative victories, the system was shut down.

The Big Lie #6. Following the Japanese attack on Pearl Harbor, President Roosevelt issued Executive Order 9066, that led to the incarceration of some 120,000 people of Japanese ancestry in concentration camps in the western part of the country. That included camps in Arizona. Some two thirds of those incarcerated were United States citizens. The big lie was that they were a threat to the country. That was false. Many volunteered to serve in the military and their units were among the highest decorated combat units in the war. In 1988, President Reagan signed the “Civil Liberties Act” which apologized for the incarceration. My friend Judy was born in Los Angeles in 1938, to Japanese parents. In 1942, she and her entire family were deported to the Poston War Relocation Center on the Colorado River Indian Reservation. At its height, the camp had 17,000 inhabitants and was the third largest city in Arizona. When Judy and family were released in 1945, they returned to Los Angeles but had lost their home and business.

The Big Lie #7. In 1964, the United States and North Vietnam were engaged in a limited confrontation in Southeast Asia. On August 4, 1964, the USS Maddox, an American destroyer, was patrolling in the Gulf of Tonkin between China and North Vietnam. The commander of the Maddox reported that the ship was being attacked by North Vietnamese boats. Later evidence proved that there were no hostile ships in the area. The outcome of this error was the passage of the “Gulf of Tonkin Resolution.” That gave President Johnson the authority to deploy US troops to South Vietnam and commencement of open warfare against North Vietnam. Marines were deployed to DaNang in early 1965, and I arrived there on Labor Day of that year.

The Big Lie #8. Immigration has been a contentious political issue for centuries and remains so today. The term was coined in the 17th century referring to non-warlike population movement. It has been a constant in our country since the landing of the passengers on the Mayflower. They were immigrants fleeing religious intolerance. We, however, have spent time and resources limiting new immigrants. In 1882, Congress passed the first of many immigration laws; “The Chinese Exclusion Act.” In the 1920’s, Congress passed several laws that put quotas on immigration from certain countries. Ken Burns chronicles how those quotas kept scores of people from escaping Nazi Germany death camps. The last comprehensive immigration law was signed by Ronald Regan in 1986. There are any number of big lies concerning immigrants. They won’t assimilate. FALSE! They don’t pay taxes. FALSE!  They are here to get government benefits and won’t work. FALSE!  Today we have a border wall, DACA immigrants, transport to northern cities and other political issues. It is time for Congress to perform its function and act.    

The Big Lie #9. November will be the third anniversary of the start of the Covid pandemic in Wuhan, China. Since then, the disease has ravaged the world with over one million deaths in the United States. One of the great scientific efforts has been the development of vaccines that are safe and effective. That has also led to an avalanche of big lies concerning the vaccines. Let me mention a few. When you get the shot, you will have a microchip injected into your arm, FALSE! The vaccine is made with fetal tissue. FALSE! The shot will alter your DNA. FALSE! The vaccine will make you unable to have children. FALSE! And more big lies.

The Big Truth #1. Joseph Robinette Biden Jr. won the 2020 presidential election.

Will Humble Reproductive Health, Social Determinants, Wills Blog

An Evidence Review: Does Outlawing Abortion Care Harm Public Health?

In a Word, Yes. Here’s How

Laws regulating abortion care in Arizona are very close to fully settled now that Pima County Superior Court Judge Kellie Johnson the lifted the injunction in the Nelson v. PP case. In her decision she dismissed the relevance of the new law limiting abortions to those at less than 15 weeks of gestation because the state legislature included in the session law that the 15-week gestation age limitation does not “… repeal by implication or otherwise Section 13-3603 or any other applicable state law regulating or restricting abortion.”

Women’s Reproductive Rights in Arizona: 1864–2022

Planned Parenthood of Arizona has appealed but given the makeup of the AZ Appellate & Supreme Courts, there is little chance of being overturned. Abortion care will be illegal in Arizona through at least December of 2024, when a voter initiative may change the landscape, repealing ARS 13-3603 and substituting it with alternative regulations.

Abortion Care Now Largely Illegal in Arizona

Pregnant persons of means will be able to travel to clinics in Las Vegas and Southern California for abortion care…  (see this clinic locator) but many with fewer resources will not be able to… begging the question:

What will the public health impact be from the ending of abortion care in Arizona?

The most comprehensive analysis done to date is the ‘The Turnaway Study’ which is a longitudinal study examining the effects of unwanted pregnancy on women’s lives.

The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having or Being Denied an Abortion

The major aim of the study is to describe the mental health, physical health, and socioeconomic consequences of receiving an abortion compared to carrying an unwanted pregnancy to term. Among the study’s top-level findings is that receiving an abortion does not harm the health and wellbeing of women, however, being denied an abortion results in worse financial, health and family outcomes.

The Turnaway Study found serious consequences are more likely to occur when women are denied a wanted abortion including a 400% increased risk of living below the Federal Poverty Level, which causes a cascade of bad health outcomes and intergenerational poverty.

Beyond a 400% increase in the risk of living in poverty, the Study found that women denied an abortion also are:

  • More likely to experience serious complications from the end of pregnancy;
  • More likely to stay tethered to abusive partners;
  • Less likely to have aspirational life plans for the coming year; and
  • More likely to experience poor physical health for years after the pregnancy.

The study also finds that being denied abortion has serious implications for the children born of unwanted pregnancy, as well as for the existing children in the family.

The study also found that many of the common claims about the detrimental effects on women’s health of having an abortion are not supported by evidence. 

For example, women who have an abortion are not more likely than those denied the procedure to have depression, anxiety, or suicidal ideation. Their findings suggest that 95% of women report that having the abortion was the right decision for them over five years after the procedure.

Here are some resources that make the results of the Turnaway Study more digestible:

Issue briefs on the mental health and socioeconomic consequences of having an abortion versus carrying an unwanted pregnancy to term are also available.

More than fifty scientific papers in peer-reviewed journals have used the findings of the Turnaway Study. Here’s a bibliography that provides a complete list of publications. 

For a deep dive into the Turnaway Study including the study’s design, methods, analysis, results, and conclusions visit The Turnaway Study | ANSIRH (Advancing New Standards in Reproductive Health).

Will Humble Professional Development, Wills Blog

Register Today! AzPHA’s Annual Awards Event: Thursday, October 27, 2022

AzPHA’s 2022 Annual Awards Event

Celebrating Excellence & Integrity In Arizona’s Public Health System


Join us for AzPHA’s annual award event as we recognize public health leaders with integrity & who support evidence-based public health policy!
Thursday, October 27, 2022
5:00pm – 8:30pm
Outdoor Courtyard at the Maricopa Medical Society
326 E Coronado Rd #101, Phoenix, AZ 85004

Tickets only $60 and includes a full taco bar from Senor Taco with taco fillings, beans, rice, guacamole, chips, tortillas & additional pre-rolled tacos. Open Hosted Bar service by Top Shelf Bartenders includes wine, beer & soft drinks

View Our Program Brochure

Register Today!

2022 Awardees

Senator Andy Nichols Award

Doug Campos Outcalt, DO – UArizona

Policy Maker of the Year

Laura Conover – Pima County Attorney 

Pete Wertheim Public Health Leadership Award

Loni Anderson – Pima County Health Department

Cele Cohen Nursing Award

Tascha Spears, RN – Pinal County Public Health Service District

Elsie Eyer Commitment to Underserved People Award

Andy Shanks – Southern Arizona Hospital Alliance

Harold B Woodward Award

Allan Williams, PhD – University of Minnesota

Health Education Award

Maricopa County Dept of Public Health – Ryan White Program

Public Health Research Award

Frank LoVecchio, MD, MPH – Valleywise Health

Corporate Public Health Service Award

Salt River Project for the Implementation of their COVID Management Plan

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