New AZPHA Resolution – Structural Racism is a Public Health Crisis: Opportunities for Intervention

AZPHA Resolution: Structural Racism is a Public Health Crisiis: Opportunities for Policy Interventions

Many of AzPHA’s public health priorities are driven by Resolutions that are approved by our members.  AzPHA has dozens of Resolutions in place dating back to the 1930s. They are all available on our website: AzPHA Resolutions

Early resolutions focused on the importance of food safety regulations, tuberculosis control, family planning, and other public health issues. More recent Resolutions have focused on support for addressing the opioid epidemic, certifying community health workers, and addressing electronic cigarettes. Our Resolutions are important to us because they set our public health advocacy priorities.

AzPHA Resolutions stay in place until and unless the Members vote to remove or update a Resolution. Resolutions are developed by AzPHA Members and are forwarded to the Board for review. Members must approve all Resolutions.

We are pleased to announce the approval of a 2023 AzPHA Resolution:

Structural Racism is a Public Health Crisis: Opportunities for Policy Interventions

This resolution has been in the works for years (some have been asking for such a statement for decades!). A special note of thanks to the team who instigated this process over the past several months, to get it to where we could review and vote on it as a community. The Membership and Board of Directors of the Arizona Public Health Association thanks the members of AZPHA’s Community Health Justice Committee for their long hours of work developing this important policy statement.  We also recognize the assistance and mentorship of the American Public Health Association in the development of this Resolution.

Primary Authors:

Zeruiah Buchanan, MPH; Carly Camplain, PhD;  Satya Sarma, MD; RJ Shannon, BA; Jannah Scott, MPH; and Vivian Huang, MD: (2022-23  AzPHA Community Health Justice Committee)

Assistance from:

Lily Cardenas, MSW; Mac McCullough, PhD; Aimee Sitzler, MSW; Marcus Johnson, MPH; Lauriane Bellot-Hanson, M.Adm; Penny Allee-Taylor, BS


Structural racism creates variations in population health outcomes. Structural racism operates through economic, educational, criminal justice, environmental and health policy levers to create a legacy of inequities that can have long lasting impacts, even after the policies themselves are changed. Policies and procedures that perpetuate racial inequities continue to exacerbate existing poor health outcomes and worsen quality of life for people belonging to marginalized racial and ethnic groups. The current research goes as far as to point to a physiological basis for health disparities related to increased and sustained stress termed “weathering.”

Arizona is home to Native Americans, Latinos and Latinas, Asian American & Native Hawaiian Pacific Islanders, Black/African-Americans, people who are refugees, immigrant, and migrant workers (RIM) and other people of color who have historically suffered the health impacts of structural racism. By acknowledging this ongoing injustice, we begin the work of promoting equity within our education, criminal justice, housing, and health systems.

Arizona Republic Develops Database Tracking Resident-on-Resident Harm at Assisted Living Facilities

From AZCentral: “Few public records exist that track resident-on-resident harm in Arizona’s senior living industry.

Assisted living facilities, which are state regulated, don’t have to report all resident injuries to their licensing agency, the Arizona Department of Health Services. Nursing homes, which are federally regulated, have to report injuries to the Health Department, but little attention is paid to altercations between residents, which researchers say are often the result of neglect or poor care.

The Arizona Republic built a first-of-its-kind database that chronicles incidents in which residents hurt other residents or staff in senior living facilities across the state.”

Senior Living in Arizona:
Query AZ Republic’s Database of Incidents of Residents Hurting Each Other

“Reporters requested police call histories from every Arizona nursing home and assisted living facility that serves more than 10 people. Reporters then requested incident reports for those calls stemming from assault, domestic violence, fight, sex offense and abuse calls, including variations of those keywords.

The database reflects incidents The Republic found from either police or state reports that documented alleged or substantiated physical contact between residents or between residents and facility employees. Reporters contacted more than 50 facilities and companies that own these facilities to get their reactions to the incidents included in the database. Only a handful responded.”

Arizona Republic Article Prompts Hobbs to Direct DHS & APS to Investigate Regulation of Assisted Living Facilities AZ

AZ Republic Article Prompts Hobbs to Direct DHS & APS to Investigate Regulation of Assisted Living Facilities
Announces Health Care Facility Licensing Legislative Priorities

The critical value of investigative journalism was on full display this week. After the Arizona Republic’s Caitlin McGlade published her latest investigative piece about the regulation (or rather lack of regulation) of assisted living facilities in Arizona, Governor Hobbs announced she’s directing ADHS & ADES’ Adult Protective Services to do a comprehensive investigation into the response to complaints at Heritage Village and where the State fell short.

Arizona Gov. Hobbs wants closer look at response to Mesa care center

Additionally, she announced her administration’s priorities in the upcoming legislative session to strengthen accountability for health care institutions, including assisted living facilities. For several months the administration has been working diligently to develop comprehensive reforms that crack down on bad actors, protect patient care, and strengthens accountability, including:

  • Allow ADHS to increase fees and fines based on the severity of an infraction;
  • Increase ADHS regulatory powers, including cracking down on license hopping, and empower the agency to revoke licenses for cause;
  • Close inspection loopholes for facilities that are licensed by accreditation or have a previous deficiency free inspection;
  • Implement robust licensure requirements for assisted living facilities;
  • Invest in additional employees and legal support for ADHS;
  • Increase regulation and certification of facilities advertising Alzheimer’s, memory, and dementia care; and
  • Create a new, transparent quality rating system available to the general public for residential and nursing care institutions and which includes skilled nursing, assisted living, and long-term care facilities, within the AZ Care Check system.
Need help about what kind of long-term care is right for you or someone in your family? Check out this resource from
  What to Know About Nursing Homes –

Assisted living facilities need real accountability, Gov. Hobbs
Why is a Mesa assisted living center with 150 citations still open?
Assisted living facilities need real accountability, Gov. Hobbs

Editorial Note: It would have made a lot more sense for the Governor to have asked the legislature to call on the Arizona Auditor General to investigate the regulation of assisted living facilities rather than ordering the agencies ‘investigate’ themselves. Laurie Roberts also pointed that out in this opinion piece.

Delightful AZPHA Awards Event

AZPHA held our annual awards event last Thursday at the University Club of Phoenix. It was a delightful evening with terrific weather and engaged awardees & attendees. We recognized four outstanding folks for their contribution to public health – each in their own distinct way.

Dr. Theresa Cullen was recognized with our Senator Andy Nichols Honor Award for her outstanding contributions to public health throughout her career including during her tenure at Pima County.

Dr. Cullen personifies the exceptional public health leader worthy of this award, demonstrating outstanding commitment to advancing health equity in Pima County, Arizona, nationally, and globally.

Her distinguished career has spanned three decades as a family physician, clinical director and national health IT expert and advocate, working with Tribal Nations, the Indian Health Service and the Veteran’s Administration in the US Public Health Service.

Dr. Cullen’s advocacy has improved health systems, access to services and influenced equitable policies. Dr. Cullen’s tireless commitment to protect and promote the health of our communities, especially those most at risk for severe outcomes, was evident through the COVID-19 pandemic. COVID-19 was the third leading cause of death in Pima County in 2021, compared to being the leading cause of death for the State.

Under her leadership, PCHD pursued and recently achieved reaccreditation from the Public Health Accreditation Board. Her establishment of an office focused on health equity, policy and community engagement and her recent hiring of a tribal liaison reporting directly to her is a testament to her commitment to systems change and advancing equity.

Dr. Cullen, like many public health leaders across the country, weathered many personal attacks through the pandemic and during her short-lived nomination to be become Director of ADHS. During the toughest of times, she serves with fortitude, tireless energy, and grace.

I believe she is the ideal candidate to receive the 2023 Senator Andy Nichols Honor Award.

Lindsey Perry was recognized for the terrific work her team at the Arizona Auditor General’s Office has done in recent years holding state agencies accountable – including uncovering ADHS’ misconduct ignoring nursing home complaints during the Ducey Administration (corrective actions is now underway under the new administration).

State government is responsible for ensuring the health and safety of Arizonans in so many ways. Ensuring state agencies are effective at their various missions protecting the public is dependent on agencies doing their job, which requires agencies to be held accountable for meeting their mission. Ideally, that accountability comes from governor’s office oversight of agencies. Sadly, some administrations make agency oversight a low priority.

Luckily, Arizona has a lead Auditor General (Lindsey Perry, CPA, CFE) who has built a robust team of professionals who do hold agencies accountable. The accountability Ms. Perry’s team brings to the table is critical to ensuring the health and safety of Arizonans.

In 2019, Auditor Perry’s team published a report disclosing that the ADHS’ Licensing Division had not been properly investigating complaints at AZ Nursing homes.

That report’s findings alerted the legislature, the media and stakeholders to address the agency’s shortcomings – who then pressed the agency to correct the problem. The Auditor’s 30 month follow up report found the agency reclassified nearly all high-risk complaints at nursing homes as low risk as a means of deceiving the public into thinking the problems had been corrected.

That watershed report led to legislative hearings and additional funding for the agency. It was also a major factor in compelling licensing division leadership changes at the agency. Those changes are now leading to positive reform and better protection for seniors.

Haley Coles received our Rising Public Health Star award for her amazing work with Sonoran Prevention Works with harm reduction and saving lives. From one of her nominations:

Haley Coles burst on the Arizona public health scene a few years ago with compelling advocacy to change Arizona laws (e.g., Good Samaritan Law, legalizing needle exchange programs and fentanyl test strips). In terms of public health programming, she’s been the driving force behind Sonoran Prevention Works – who has established themselves as a leader in public health operational work in harm reduction and Narcan distribution. Her organization has saved countless lives in Arizona amid the opioid/fentanyl crisis.

Senator Theresa Hatathlie was recognized with our Policymaker of the Year award for her heroic efforts “… shining the light on the harms being done to vulnerable people, persisting in her advocacy which is leading to real changes for the better” – Senator Mitzi Epstein. From one of her nominations:

Senator Hatathlie is the first public official to highlight the tragic human tracking in Arizona – holding early Senate hearings and bills highlighting this public health disaster. She was the first official to publicly disclose this human trafficking and Medicaid fraud disaster in which to people were picked up in white vans and driven to the Phoenix area from places as far away as the sprawling Navajo Nation. In some cases, the people allegedly didn’t even know the location of the homes where they were staying. We later learned in announcements by Governor Hobbs & Attorney General Mayes that hundreds of millions of dollars in fraud were also involved.

Senator Hatathlie was also a major player in the development of Operation Rainbow Bridge, an effort to find and get needed services to hundreds of tribal members that were victims of the trafficking, that affected as many as 7,000 Native Americans recruited to illegitimate sober living homes in recent years.


Nonprofit Grant Opportunities

Nonprofits have a unique ability to engage in developing meaningful public policy that builds healthier communities. This can range from sharing of information to conducting research to grassroots or direct lobbying.

Regardless of the tactics, public policy must be responsive to community needs, and community-based nonprofits play an invaluable role in ensuring these needs are reflected in meaningful public policy.

Vitalyst offers technical assistance to nonprofits focused on any of the Elements of a Healthy Community, and financial assistance may be offered to those working to advance issues included in Vitalyst’s Public Policy Agenda.

Grant Process

  1. Vitalyst Discovery intake form. *Be sure to click “Advocacy and Public Policy Capacity Building” when identifying your interests;
  2. Advocacy and Public Policy Selfie. Upon submission, you’ll receive a confirmation email prompting you to complete the final step;
  3. Schedule a consultation with Vitalyst Staff to discuss the recommended next steps.

Learn more here: Advocacy and Public Policy Capacity Building

Public Health Careers Clearinghouse

Public Health Careers Clearinghouse

Did you know you can learn about key high-demand public health professions and positions at The site has numerpous video profiles of public health professions and a nationwide public health job search portal.

  • Infectious/communicable disease control
  • Chronic disease & injury prevention
  • Environmental public health
  • Maternal, child, family health
  • Access to & linkages with clinical care, including public health nursing and nutrition sciences
  • Laboratory sciences
  • Program administration, grants management and finance, and executive leadership

I especially liked the FAQ part of the portal – especially for early career professionals and new graduates: FAQs | Public Health

Heat Deaths Set Record in Maricopa County

Maricopa County Department of Public Health’s heat associated death weekly report this week reported that there have been 425 heat deaths confirmed so far in 2023, with 200 additional deaths still under investigation.

This large public health problem and threat isn’t just due to the record-breaking heat we had in July. It’s also because of the continuing regional affordable housing & homelessness problem. In fact, nearly half of the heat related deaths were among folks experiencing homelessness (44%) – making homelessness far and away the number one risk factor for heat related death.

The 2023 Point in Time homelessness county estimated there are 4,900 unsheltered people experiencing homelessness (the denominator).

See MCDPH’s October 2023 Heat Report

One hundred eight (108) of the heat associated deaths were indoor. Of those 81 had a nonfunctioning air-conditioner. An air-conditioner was present but not being used in 11 deaths, and another 11 deaths had no air-conditioner. There were two deaths where there was no electricity.

There has been a new record set every year since 2016. 2022’s record of 425 was 25% higher than the previous record set in 2021. Based on preliminary data, 2023 will set another record, though MCDPH expects it’ll be several months before all investigations are completed and data are finalized.

For their part, MCDPH will continue its work with partners to reduce heat-associated deaths by:

  • Analyzing data from its recent cooling center survey to understand how people find out about them and what can be done to increase usage
  • Hiring a Cooling Center Coordinator position to implement strategies learned from the cooling center survey to increase access to cooling centers in Maricopa County
  • Working with stakeholders to find additional funding and partnerships to enhance heat-relief strategies in Maricopa County
  • Hosting planning meetings with community, government, and faith-based partners to update Maricopa County’s Climate and Health Strategic Plan

Of course, the solution to this increasing public health threat is multi-sectoral since the primary determinant (homelessness) is a multi-sector problem requiring zoning and other policy changes and resource interventions at the state & local level.

2023 sees 425 confirmed heat-associated deaths in Maricopa County (

News Flash • Maricopa County, AZ • CivicEngage

AZPHA Welcomes Barbara Lang as New Cochise County Health Director

Some welcome news out of Cochise County this week: Barb Lang has been selected as the new Health Director of Cochise County (Called Cochise County Health and Social Services). Cochise County has been a longstanding Organizational Member of AZPHA.

Barb will be an asset to the people of Cochise County and to Arizona’s public health system. She is a proven good decision-maker and has substantial depth in public & behavioral health.

Lang has more than two decades of wide-ranging experience in public health and healthcare administration & behavioral health. She worked at ADHS for several years as our head of Behavioral Health Licensing.

She also served as AHCCCS’ Behavioral Health and Intergovernmental Administrator and Chief of Behavioral Health Licensing at the Arizona Department of Health. For the last few years she’s been the Chief of Standards and Compliance and Chief Privacy Officer for Community Bridges.

Barb’s depth in behavioral health will be a welcome experience addition to the cohort of county health officers.

From Cochise County’s news media release: “Throughout my work, I have always ensured that rural communities have not only a seat at the table, but also a voice. I believe establishing comprehensive plans that consider the diversity and individualized needs of unique geographical regions in Arizona is integral.” 

Congratulations Barb – we look forward to working with you and your team at Cochise County!