Will Humble Injury Prevention, Wills Blog

Arizona Motor Vehicle Driving & Conditions Among the Most Dangerous in the U.S.

The National Highway Traffic Safety Administration tracks injuries and deaths from motor vehicle crashes in the US through its Fatality and Injury Reporting System Tool and provides access to the data for policymakers at the local and state level. The data provides info for policymakers to analyze trends, identify high-risk areas, and develop strategies to enhance road safety.

Fatality and Injury Reporting System Tool (FIRST)

Arizona stands out in NHTSA’s most recent data update and not in a good way.

According to recent data, Arizona ranks 2nd in the US in pedestrian and bicyclist deaths at 4.6 per 100,000 persons (in 2022), second only to Louisiana. This alarming statistic underscores the necessity for interventions and enhanced safety measures to better protect pedestrians and cyclists with improvements in the built environment (mostly at the city level). Part of why AZ ranks so poorly in pedestrian deaths is due to the driving behavior of Arizonans – which is the 5th worst in the country (as measured by a constellation of injury and death criteria). Not sure what interventions are there though.

Building Momentum for a Safe System Approach to Reduce Road Traffic Injuries in the United States | American Journal of Public Health | Vol. 114 Issue 6

Another concern in the most recent NHTSA data is Interstate 17 between Phoenix & Flag.  I-17 was identified as the 9th deadliest stretch of highway in the US… highlighting the critical need for improvements along I-17 to reduce traffic-related fatalities and make it safer for all road users. Fortunately, ADOT is in the middle of a multi-year process to improve safety and congestion on I-17 (see ADOT’s I-17 Project Area Website).

More info, summary data available at States With the Best & Worst Drivers 

& NHTSA’s: Fatality and Injury Reporting System Tool

Will Humble Professional Development, Wills Blog

APHA Webinar: Public Health Service Loan Forgiveness Program

Jun 11, 2024 12:00 PM in Arizona

Webinar Registration – Zoom

Join Public Service Promise for a FREE expert-led webinar with Susan Polan, Associate Executive Director for Public Affairs and Advocacy, American Public Health Association. The webinar, for APHA members and anyone in the public health field, will explain how to obtain student loan relief from the Public Service Loan Forgiveness Program.

Betsy Mayotte, an expert on student loans and President of The Institute of Student Loan Advisors, will walk through the requirements of qualifying for the program and will answer general questions about how to navigate the application process.

The PSLF program is administered by the U.S. Department of Education and is designed to forgive the student loan balances of those employed by a government or non-profit organization.

Public Service Promise is a new non-profit that works with unions, along with non-profit and government entities, to educate public servants about the process for obtaining student loan forgiveness through the PSLF. Public Service Promise does not provide individualized financial counseling or legal advice.

Will Humble Air Quality, Climate Change, Public Health, Wills Blog

The Arizona Corporation Commission & Public Health: Part IV – Air Quality

At first glance, the Arizona Corporation Commission might seem like it has pretty much nothing to do with public health. But when you scratch the surface just a little, you’ll discover that the Commission does in fact influence public health.

This week we cover how the Commission’s decisions can have a direct impact on the air we breathe.

First things first, what is the ACC? They are the elected officials and staff who are tasked with regulating electricity, gas, water, and telecommunications. While that might sound pretty dry, the choices they make ripple out into our daily lives, especially when it comes to our health and air quality.

The type of energy the ACC promotes via their policy decisions can either help improve air quality or make it worse.  When the commissioners make decisions to incentivize renewable energy sources like solar and wind, they’re doing us all a huge favor. These clean energy sources don’t spew out harmful pollutants. That means no soot, no smog – just pure, clean air.

But…  when commissioners have the backs of the utilities that they’re supposed to be regulating rather than voters and ratepayers, they lead us down the path toward worse air quality. Legacy energy sources favored by many utilities like coal and natural gas are major polluters. They emit nasty stuff like carbon dioxide, sulfur dioxide, and nitrogen oxides. These pollutants can lead to smoggy skies and a host of health issues, from asthma to heart disease. 

Continued reliance on fossil fuels means more pollutants in the air, more health problems, and higher healthcare costs. It’s like a domino effect – poor energy choices lead to poor air quality, which leads to poor health.

But, when the ACC pushes utilities to include more renewable sources of electricity by scrutinizing their sources and provide them financial and regulatory incentives to shift solar farms, rooftop solar, or wind turbines, they’re cutting down on these harmful emissions. This shift not only helps fight climate change but also means cleaner, healthier air for all of us.

It’s not just about clean air. The ACC’s decisions also have a direct impact on public health. Cleaner air means fewer respiratory issues, less heart disease, and a lower risk of some cancers. It means fewer sick days and hospital visits, and more people living healthier, happier lives.

So, the next time you hear about the ACC making a decision, remember it’s not just bureaucratic mumbo-jumbo. It’s about our health and the quality of the air we breathe.

Let’s keep an eye on their decisions and support the candidates who promote clean energy and a healthier future for Arizonans, our topic in Part V.

Will Humble Public Health Law, Wills Blog

AZPHA Ballot Proposition Arguments Filed

Every cycle the Arizona Secretary of State generates a publicity pamphlet to help educate voters ahead of the general election. The pamphlet includes arguments in support of and against citizens’ initiatives and legislative referrals. It’s a feature of the Clean Elections voter initiative from several years ago. The publicity pamphlet is a key educational resource for voters to use before voting.

As Arizona’s independent voice for public health, we’ve played a key role i5n helping voters to understand the public health implications of the various ballot measures. One way we do that is to send arguments for and against ballot propositions focusing on the good and bad public health impacts. Last cycle AZPHA placed arguments for or against 5 of the 10 ballot propositions.

This cycle the window for getting arguments filed is May 20th – June 20th. The arguments are posted in order they are received so it’s a good idea to get arguments early so voters see our stuff first.

There are already 6 ballot measures set for the 2024 ballot (not including the upcoming voter-driven Arizonans for Abortion Access). Three have direct impacts to public health / public health policy and a 4th will the AZ for Abortion Access initiative. The Open Primaries initiative also connects with public health by engaging more independent voters.

AzPHA Presentation: 2024 Ballot Measures

Last week our AZPHA Board of Directors approved our Public Health Policy Committee’s recommendation to take a position on 5 of the ballot measures. Our ballot arguments have been completed and filed with the Secretary of State.

Here are links to our Arguments:

Anybody can turn in an argument. Simply write up an argument (300-word limit) and submit it to the General Election Ballot Measure Argument Portal along with the $75 fee. Portal is open through July 3.

Will Humble Reproductive Health, Wills Blog

Hobbs Sparks Review of Arizona’s ‘Essential Health Benefits’ for Reproductive Health

One of the primary features of the Affordable Care Act was the establishment of marketplace health insurance plans that folks can buy – with most qualifying for subsidies scaled to income to make the plans affordable.

While the math for the subsidies was set by the feds, the coverage those plans offer in each state were a hybrid of criteria set by the feds (the 10 essential health benefits). Governors have some influence too, as they get to select a ‘benchmark plan’ that defines minimum benefits in each essential health benefit category.

Back in 2014, Governor Brewer picked the AZ State Employee ‘EPO’ Plan as the benchmark for Arizona’s Marketplace plans. Ever since then, Marketplace plans have needed to cover (at a minimum) the same benefits as the state employee plan.

Other commercially available plans need to be “substantially equal” to the state employee benchmark plan in scope, limitations, and exclusions (e.g. visit limits).

At the time, I opined on my ADHS Blog that the choice was a good one because it had a robust behavioral health component with fewer limitations, restrictions and exclusions than most other options- and already covers behavioral health services at parity (meaning behavioral health has the same level of coverage as physical health).

To my knowledge, the Ducey administration never made any changes to that benchmark plan.

Hobbs Proposing Changes

Last week Governor Hobbs issued an Executive Order that makes over-the-counter birth control options available at no cost to State employees, ordering an analysis of the costs & benefits of requiring expanded contraception coverage for other health insurance plans, and requiring AHCCCS to consider ways it can expand access to contraception for its members.

See: Katie Hobbs issues executive order expanding access to contraception

Buried in the Executive Order, but getting little fanfare, was a provision that directs ADOA and the Department of Insurance & Financial Institutions to examine the benchmark plan established in 2014 and look at the benefits & feasibility of setting a new benchmark plan that would mandate provision of additional reproductive healthcare benefits among commercial and marketplace insurance plans in AZ.

AHCCCS has been tasked with a similar charge – to examine benefits and feasibility of expanding Medicaid benefits among a host of reproductive health criteria (by June 30, 2024).

Hobbs issues executive order expanding access to birth control for state government workers • Arizona Mirror

Because the ACA is federal legislation and the law gives governors the authority to set minimum coverages by establishing a benchmark plan, her action won’t need legislative approval. AHCCCS would need approval from CMS to extend reproductive health benefits. 

Note: The Order is limited to examining Arizona’s essential health benefits through the lens of reproductive health.

Will Humble Professional Development, Wills Blog

Public Health Journalism this Week

Families demand action against midwife after multiple deaths | 12news.com & 1016132 (youtube.com)

How marijuana reclassification could impact Arizona dispensaries – Axios Phoenix

Kris Mayes to investigate Steward Health Care’s bankruptcy (azcentral.com)

Here’s what Arizonans need to know about the FLiRT COVID-19 variants. (azcentral.com)

Fake drug and alcohol treatment centers cause a big scandal in Arizona : NPR

Arizona facing third wrongful death lawsuit related to Medicaid fraud (azcentral.com)

 

Former ADHS director recalls scope of practice changes for midwives

See: Families demand action against midwife after multiple deaths | 12news.com

Will Humble was the state’s health director when the scope of practice for midwifery was expanded. Midwives used to be prohibited from conducting VBAC births, or vaginal birth after cesarean delivery, in Arizona.

There was a strong push to change that. Humble recalls it wasn’t an easy decision.

“We had the home birth enthusiasts and the midwives pushing for an expanded scope of practice to include VBAC. And on the other side, we had OBGYNs who had spent years in medical school and then a residency practicing how to manage births, including VBACs,” Humble recalled. “And they thought it was just outrageous that midwives, who had almost no medical training, really hadn’t been a medical school, that they would be allowed to do this practice.”

Ultimately, after extensive research, Humble said the state sided with midwives. They did, however, add additional criteria and limitations for VBACs to try to minimize risk.

“If the midwife doesn’t follow those criteria, the risks go from manageable to extreme. Same goes for the agency. If the state agency isn’t doing a good job overseeing the midwives, those risks go from manageable to really, really bad,” Humble said.

Humble said transparency from the health department is critical to ensure parents are making the best and safest decision for their family.

“The health department has two-fold responsibility. Number one, to hold the midwives to the letter of their regulations and to ensure that there’s disciplinary action when those criteria aren’t being met. The second piece is to make that information known,” Humble said.

Will Humble Oral Health, Wills Blog

Biden Administration to Allow States to Include Adult Dental Services as an Essential Health Benefit

Last week HHS finalized a new rule allowing states to include adult dental services in the list of designated essential health benefits required to be covered by most health plans under the Affordable Care Act.

States that add adult dental to their benchmark plan would also guarantee coverage for people on the state’s Medicaid program.

When the ACA was passed in 2010, children’s oral health services were included in the statutory language within the ten categories of services that were required to be considered…  but adult oral health services were excluded. The new HHS rule removes that long-standing prohibition and allows states to include adult oral health services as a standard benefit.

If states take the option presented in this new rule and update their benchmark plans to include adult dental services, all qualified health plans will be required to incorporate adult dental services either within the medical plan or via a contract with a standalone dental plan issuer. States that wish to add dental coverage will have to go through the process of updating their benchmark plan to specify the inclusion of adult dental services as an essential health benefit.

Governor Hobbs’ executive order last week around Arizona’s essential health benefits around reproductive health didn’t mention anything about oral health…  but this new rule provides a fresh opportunity to advocate for adult oral health to be incorporated as a benchmark essential health benefit.

 

Note: Back in 2014, Governor Brewer picked the AZ State Employee ‘EPO’ Plan as the benchmark for Arizona’s Marketplace plans. Ever since then, Marketplace plans have needed to cover (at a minimum) the same benefits as the state employee plan. Other commercially available plans need to be “substantially equal” to the state employee benchmark plan in scope, limitations, and exclusions (e.g. visit limits).

At the time, I opined on my ADHS Blog that the choice was a good one because it had a robust behavioral health component with fewer limitations, restrictions and exclusions than most other options- and already covers behavioral health services at parity (meaning behavioral health has the same level of coverage as physical health). To my knowledge, the Ducey administration never made any changes to that benchmark plan.

Will Humble Maternal Health, Wills Blog

AHCCCS Preparing Reimburse for Doula Services: Comment Thru June 10

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 epidural, reduced preterm birth and higher rates and longer duration of breastfeeding.

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

Good news!

AHCCCS has filed a State Plan Amendment that will add coverage and payment for doula services effective October 1, 2024!  Comments are being accepted publicinput@azahcccs.gov through June 10, 2024.

We encourage you to send comments to AHCCCS in support of this evidence-based initiative that both improves birth outcomes and reduces delivery costs.

Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery – PubMed

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

Leveraging Doulas to Improve Birth Outcomes

Doula Services Improve Maternal and Child Health Outcomes

Who’s a Doula?

Will Humble Environmental Health, Wills Blog

Is H5N1’s Jump to Cattle a Big Deal? (Updated May 24)

I’m sure you’ve heard that the H5N1 avian influenza strain has been recently discovered to have jumped to cattle and has been detected (by PCR) in raw milk in at least 59 cattle herds among 9 states. No herds are known to have been infected in Arizona as of yet (that we know of).  What are the public health implications and what’s being done to investigate and intervene?

Background

Let’s start with a quick history of how the H5N1 avian influenza virus got started.

In 2020 it appears that there was some reassortment (aka gene-swapping) between dually infected domestic poultry and wild bird influenza viruses that resulted in the new ‘HPAI’ H5N1 influenza virus.

In February 2022 the USDA discovered this new version of the influenza virus rifled through a US commercial turkey facility, marking the first known commercial outbreak of the virus in the US.

The H5N1 avian virus is shed in the saliva, mucous, and feces of infected birds. It spreads rapidly through poultry flocks and among wild birds and is quite lethal for poultry.  An estimated half a billion farmed birds have been slaughtered in efforts to contain the virus.

For the most part the virus has just been making birds sick – but there have been detections of the virus in all kinds of mammals as well – ranging from sea lions to mink to polar bears.

New Regulations after Some Cattle Became Infected

Last month, the USDA found that the virus had begun to infect domestic cattle…  although the symptoms and virulence in cattle is much lower than in birds. While infected cattle had some symptoms, they haven’t been serious nor lethal (in contrast with the effect of the virus on birds).

The USDA is the regulatory authority for the testing, investigation, and control measures for both the birds and the cattle. USDA has several new regulatory measures already in place that you can see here: aphis-requirements-recommendations-hpai-livestock.pdf (usda.gov). 

Virus Surveillance & Investigations

So far all of USDA’s testing in actual meat from cattle is clear of the virus, but it’s showing up in high concentrations in the milk of infected dairy cows.

The vast majority of milk on the shelf is pasteurized and not a threat at all because if the virus is in the milk, the heat of pasteurization kills it. Raw milk (legal in Arizona) of course is a theoretical risk for humans but is unlikely to cause severe illness unless the virus changes dramatically from where it is today.

Note: It’s legal to sell raw milk that’s not pasteurized but it must meet specific standards in ARS 3-606. The Arizona Department of Agriculture (ADA) is the regulatory authority (not ADHS). Raw milk producers need to get a separate license from the ADA and comply with detailed regulations that cover sanitation, handling, and labeling. Raw milk must be specifically labeled indicating that it’s not pasteurized and summarizing the potential health threats from consuming raw milk.

Workers close to infected cows and birds haven’t been becoming sick – except for a couple cases of ‘pink eye’ where workers got an eye infection from splashes while milking cows.

The meat that has been tested at retail sites in the 9 states that have found infected dairy cows has so far all been negative. USDA is testing meat at licensed slaughterhouses (using PCR), but the results aren’t out yet.

A hamburger study is underway at the slaughterhouses too. No results yet – but there will likely be results by next week.

Here are the results so far: Updates on H5N1 Beef Safety Studies | Animal and Plant Health Inspection Service 

USDA still doesn’t know exactly how the cows are getting it from the birds – but that’s under investigation. My bet is that it’s because some farmers feed dairy cattle chicken feces (they call it litter), which could be infecting the cows.

Bird flu outbreak: Arizona farms haven’t detected any cases

If that turns out to be the case the intervention is simple – order farmers to stop feeding chicken feces to cows. Whether they’d comply is another matter.

Future Implications

As for the H5N1 virus mutating in cows and jumping to people in a much more virulent form…  yeah it’s theoretically possible but has never been observed before.

The normal pathway for new virulent influenza virus (pandemics) is birds > pigs > humans. That’s the long-term pattern including H1N1 back in 2009. Why? Because believe it or not pigs are close to humans on the biological tree and have similar respiratory receptors.

New strains almost always come from China because in rural China humans, pigs and birds (usually geese) all live together.  Cattle are far from humans on the mammal tree so it’s unlikely the H5N1 virus would mutate and become a virulent human strain in a bovine.

May 23, 2024 Update:

USDA’s Food Safety and Inspection Service collected 30 samples of ground beef from retail outlets in the states with dairy cattle herds that had tested positive for the H5N1 influenza virus at the time of sample collection. The samples were sent to APHIS’ National Veterinary Services Laboratories (NVSL) for PCR testing. NVSL reported that all samples tested negative for H5N1.

USDA’s FSIS, APHIS, and Agricultural Research Service (ARS) are working on three separate beef safety studies related to avian influenza in meat from dairy cattle.

  1. Samples of ground beef obtained at retail in the affected States test negative: Samples were collected at retail outlets in the States in which dairy cattle herds have tested positive for H5N1 influenza virus. The samples were analyzed by APHIS using polymerase chain reaction (PCR), to indicate whether any viral particles were present. No virus particles were found to be present.
  2. Beef muscle sampling of dairy cows at select FSIS-inspected slaughter facilities: FSIS has completed collection of muscle samples at from cull dairy cattle that have been condemned for systemic pathologies. The samples are currently being analyzed by APHIS using PCR to determine presence of viral particles. The results are forthcoming and will be posted as soon as they become available.
  3. Ground beef cooking study: ARS inoculated a very high level of a HPAI virus surrogate into 300 grams ground beef patties (burger patties are usually 113 grams) to determine whether FSIS recommended cooking temperatures are effective in inactivating H5N1 virus The burger patties were cooked to three different temperatures (120-, 145-, & 160-degrees Fahrenheit), and virus presence was measured after cooking. There was no virus present in the burgers cooked to 145 (medium) or 160 (well done) degrees. Even cooking burgers to 120 (rare) degrees, which is well below the recommended temperature, substantially inactivated the virus.
Will Humble Professional Development, Public Health, Wills Blog

Kelli Donley Williams Named Deputy Director of Maricopa County Department of Public Health

Good news for Arizona’s public health system folks. Our Immediate Past President Kelli Donley Williams announced at our last Board meeting that she’ll be beginning a new job as the Deputy Director for the Maricopa County Department of Public Health in late June.

For the last few years Kelli has been serving as the director of human services at the Maricopa Association of Governments.

Her primary responsibility at MCDPH will be assisting Director Fowler with planning and management of the operations of the department. This includes oversight of three divisions: Health Outreach, Partnership and Equity; Child and Maternal Health; and Organizational Support and Community Operations. 

In addition to serving several years on the AZPHA board including terms As Vice President, President Elect, President and now Immediate Past President, Kelli is a proud UArizona Mel & Enid Zuckerman College of Public Health graduate. She found her passion for public health while volunteering with the Peace Corps in Africa in 2000.

Kelli is a native Arizonan and the author of four novels, Under the Same Moon, Basket Baby, Counting Coup, Desert Divide.

Kelli lives with her husband Jason, animals, and unruly vegetable garden in Mesa, Arizona. She blogs at: www.africankelli.com.

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