Will Humble Family Planning, Public Health, Public Health Law, Vaccination, Wills Blog

The Dangers of Implementing Project 2025′ Public Health Proposals

The Heritage Foundation’s Project 2025 has published a report that is essentially a blueprint for what they urge the incoming Trump administration to accomplish. While the report itself distances itself from Mr. Trump, the narrative pursued by their leadership over the last year suggests the team at the Heritage foundation has been collaborating closely with the persons that would be expected to have power shortly.

The report proposes extensive changes to the U.S. Department of Health and Human Services including CDC, FDA, HRSA, CMS and the NIH. While framed as cost-cutting and efficiency measures in the report, the reforms risk eroding critical public health infrastructure and reducing agency effectiveness.

Project 2025: Heritage Foundation’s Blueprint for Undermining the US Department of Health and Human Services

Here’s a breakdown of the potentially damaging public health impacts if these recommendations were implemented:

  • Weakened Regulatory Oversight on Health
    The plan suggests reducing the regulatory role of agencies like the FDA & CDC. If these changes were adopted, oversight over drug and food safety, disease prevention, and vaccine efficacy could weaken, potentially increasing public exposure to unsafe products and preventable diseases.
  • Diminished Support for Vulnerable Populations
    Project 2025 proposes scaling back initiatives that serve at-risk groups, including those that support low-income families, the elderly, and individuals with disabilities. Rolling back programs such as Medicaid expansion and the Supplemental Nutrition Assistance Program (SNAP) could exacerbate health disparities and worsen health outcomes among these populations.
  • Restricting Reproductive and Preventative Health Services
    The Heritage Foundation’s report emphasizes defunding programs focused on reproductive health, including contraception access and abortion services, which play critical roles in preventative health. Reduced access to reproductive services would likely result in adverse health outcomes, particularly among low-income individuals and those in rural areas.
  • Reduced Scope of Infectious Disease Monitoring
    The report calls for a diminished focus on infectious disease tracking and control, suggesting that this should be a state rather than federal responsibility. This shift could result in delayed responses to emerging diseases, as states lack the resources and coordinated infrastructure to address national and global health threats alone.
  • Decreased Preparedness for Climate-Related Health Impacts
    Project 2025 suggests deprioritizing climate-related health initiatives, despite growing evidence that extreme weather events are increasing in frequency and severity, posing serious health risks. By ignoring climate-related health impacts, the reforms could leave communities vulnerable to respiratory illnesses, heat-related deaths, and vector-borne diseases.
  • Potentially Politicized Health Guidance
    By advocating for more politically aligned leadership within HHS, Project 2025 risks allowing political agendas to overshadow scientific guidance in public health decisions. This approach could weaken public trust and lead to inconsistent or biased health guidance.
  • Undermining Evidence-Based Practices
    Project 2025 advocates for reducing federal agencies’ reliance on current scientific guidelines and best practices, arguing they lead to “mission creep.” However, weakening evidence-based measures could undermine HHS’s ability to respond to public health crises effectively and allow political bias to influence decisions traditionally grounded in science.

Implementing the recommendations from Project 2025 may lead to a fragmented, underfunded HHS, significantly weakening the nation’s ability to support and protect public health. Instead of enhancing efficiency, these reforms may compromise public safety, worsen health inequities, and hinder the government’s ability to respond to health crises.

RFK Jr. as HHS Secretary? Why It Could Mean the End of Evidence-Based Public Health Policy – AZ Public Health Association
Will Humble Disease Control, Healthcare, Public Health, Wills Blog

RFK Jr. as HHS Secretary? Why It Could Mean the End of Evidence-Based Public Health Policy

If you’re reading this, you’ve no doubt heard the word on the street that Robert F. Kennedy Jr. will be appointed the Secretary of Health and Human Services if Donald Trump wins the presidency. HHS is a super-agency which includes CDC, CMS, FDA, HRSA, NIH and other agencies. The very agencies who oversee protecting public health and the most vulnerable persons in the country.

What would a Kennedy-run HHS look like? Given Kennedy’s longstanding skepticism of evidence-based health policy, his leadership of HHS would likely prioritize his personal beliefs over solid science.

Kennedy’s vocal stance on vaccines provides a glimpse into his priorities. For years, he’s argued that vaccines are neither safe nor effective, claiming, without evidence, that they’re tied to a laundry list of health issues, including autism, autoimmune disorders, infertility, and obesity. His assertions have been widely debunked by researchers and public health agencies, but Kennedy has doubled down, continuing to spread misinformation that contributes to vaccine hesitancy and compromises public health.

His leadership at HHS, including the numerous core health and health care agencies, would shift resources and policies away from promoting vaccines—an essential tool in fighting preventable diseases—and instead, focus on unsubstantiated hunches that will put lives at risk. In addition to his anti-vax positions, Kennedy has pushed other unproven therapies, including ivermectin, hydroxychloroquine, and chelation therapy – none of which are supported by scientific evidence for the uses he promotes. During the COVID-19 pandemic, Kennedy advocated for these treatments, despite a lack of credible data backing their effectiveness.

If appointed to HHS, his influence could result in funding for these non-evidence-based treatments and sidelining effective, science-backed interventions. Under Kennedy’s leadership, we might see the federal government actively endorsing and funding unproven therapies, wasting taxpayer dollars and eroding trust in the department.

Another alarming aspect of Kennedy’s approach is his disdain for agencies like the CDC and FDA, both essential parts of the HHS. He’s called for “slashing” their budgets and has even suggested that current leadership within these agencies should be investigated and potentially jailed, accusing them of engaging in conspiracies and misinformation.

This rhetoric is not only unfounded but is deeply damaging to public trust in institutions meant to safeguard health. Should Kennedy gain control of these agencies, it’s likely he would try to implement his agenda by weakening their funding and influence, leaving FDA and CDC ill-equipped to regulate food and drug safety, and provide reliable guidance.

Kennedy’s leadership would likely align with Project 2025, a right-wing policy blueprint that proposes drastic rollbacks of federal public health initiatives. This project, which Trump has vowed to implement if re-elected, calls for shrinking the federal government’s role in health policy, reducing the power of public health agencies, and limiting their ability to issue health recommendations.

The Dangers of Implementing Project 2025s’ Public Health Proposals – AZ Public Health Association

The HHS and the various subagencies (FDA, CMS, HRSA, NIH etc.) under Kennedy could very well fast-track these proposals, potentially dismantling key public health protections. For instance, Project 2025 advocates for removing the CDC’s authority to issue public health guidelines, a move that would be disastrous during health emergencies and diminish the role of science in policy decisions.

Kennedy’s approach to health policy is often rooted in personal beliefs rather than evidence, a dangerous quality for the head of agencies responsible for regulating food, drugs, public health guidance, and the efficient operation of Medicare and Medicaid.

Public health leaders are tasked with protecting and improving lives through science, not ideology. If Kennedy’s history is any indication, his appointment would mean prioritizing fringe theories over established science, appointing persons to lead CDC, CMS, FDA, HRSA and NIH that share his zeal for believing in things that aren’t evidence-based and weakening the agencies that Americans rely on to keep them safe.

At a time when public health faces multiple challenges, from pandemics to chronic disease, having an HHS Secretary who dismisses scientific consensus could be catastrophic. Health policy requires leaders who understand and respect evidence; Robert F. Kennedy Jr. has shown time and again that he does not.

Vote carefully my friend.

Will Humble Reproductive Health, Social Determinants, Wills Blog

Biden Administration’s New Family Planning  Rule: What It Would Mean for Public Health

The Biden Administration is proposing a new regulation, led by the Departments of Health and Human Services, Treasury, and Labor, to require health plans to cover over-the-counter contraception without any copays.

This initiative, part of broader efforts to expand reproductive health access post-Dobbs v. Jackson, builds on the Affordable Care Act, which mandates coverage for preventive services.

The new rule (when finished) would include a wide range of FDA-approved contraceptives such as oral pills, patches, rings, and emergency contraception like Plan B, without the need for a prescription or copay.

To review or comment on the proposed rules during the 60-day public comment period, visit the Federal Register. To review the draft rule, visit CMS.gov.

The statutory authority for this rulemaking comes from the ACA, which provides the statutory framework for comprehensive preventive healthcare services.

By removing financial barriers to contraception with zero copay, this proposal would improve access to birth control and other preventive measures for millions of Americans, particularly women who face cost-related challenges.

Family planning has long been recognized as a critical part of public health. Access to contraception is vital not only for preventing unintended pregnancies but also for improving maternal and child health outcomes, reducing abortion rates, and supporting women’s educational and economic advancement.

Overview of Family Planning in the United States – A Review of the HHS Family Planning Program

Family planning services also lower the risk of preterm births, infant mortality, and complications related to pregnancy and childbirth.

According to the CDC family planning is one of the 10 great public health achievements of the twentieth century, on a par with accomplishments like vaccination and advances in motor vehicle safety.

Ten Great Public Health Achievements — United States, 1900-1999 (my favorite MMWR)

The move is a key step in ensuring fair access to healthcare and expanding family planning services, which, in turn, improve broader public health indicators.

Editorial Note: This Rulemaking will take many months to work through the regulatory process. If Mr. Trump wins the upcoming election there is a very good chance that the new administration would cancel this important rulemaking.

Will Humble Health Insurance, Healthcare, Wills Blog

Quality Health Care is Top of Mind for Arizona Voters, Candidates Should Take Notice

The election is well underway, as you’ve no doubt noticed. The campaign messages are unavoidable, filling our mailboxes and commercial breaks. And don’t get me started on the spam texts …

One surprise, however, has been the relatively light candidate focus on an issue that will affect every single one of us sooner or later: health care.

Past elections were dominated by talk of Medicare, the Affordable Care Act and other health programs. This cycle … not so much. It’s all the more baffling in light of the COVID-19 pandemic – which revealed system-wide inequities in terms of health care availability, and continues to sicken and kill far too many Americans.

Consider, also, that health care remains top of mind among voters. A Pew survey this year found that health care affordability is the 3rd biggest concern overall.

In fact, issues related to health care affordability make up five of the top six concerns cited by voters over the age of 50, according to a 2024 survey by the University of Michigan Institute for Healthcare Policy & Innovation.

I mention all of this because, though candidate and campaign priorities may change, our focus as the Arizona Public Health Association remains consistent. For nearly 100 years, APHA has been committed to health care access and affordability, infectious disease, reproductive health, nutrition and the environment.

Availability of quality health care remains the cornerstone of everything we do – whether government-led Medicaid and Medicare, a robust private insurance marketplace or the successful public-private model of Medicare Advantage, where 33 million Americans and a majority of Arizona seniors receive their care.

Program innovations like care coordination and telehealth should be protected, because they expand access to care in underserved communities and help older Arizonans maintain their health and independence.

Arizonans deserve to hear from candidates about what they intend to do to promote quality health care for everyone in our state.

Thank you for being a member of AZPHA and the work we do – today and long after this election has passed – to advocate for public health and hold elected officials accountable.

Will Humble Behavioral Health, Wills Blog

Helping Loved Ones Get the Care they Need – Secure Residential Treatment: A Crucial (and Scarce) Resource for Supporting Mental Health Treatment (Part III of III)

One of the biggest barriers to providing effective treatment for persons with a serious mental illness who need court ordered treatment in Arizona is the lack of secure residential facilities that can provide secure court-ordered care.

These specialized facilities are key for ensuring people with an SMI get the care they need in a safe, structured environment. Secure facilities provide a controlled atmosphere where patients can receive individualized therapy, medication management, and life skills training, which are critical components for recovery.

Research suggests secure residential facilities are highly effective at stabilizing individuals with an SMI, reducing the likelihood of relapse, and preventing unnecessary hospitalizations, underscoring that treatment in secure environments can be a game-changer for people who require intensive care but aren’t suited for traditional outpatient or voluntary inpatient settings.

AHCCCS plays a key role in ensuring access to these essential services. For AHCCCS to fulfill its mission of supporting individuals with SMI, there needs to be an adequate supply of more secure treatment facilities.

Sadly, Arizona is falling short in that regard… even before the closure of St. Luke’s Hospital.

St. Luke’s lays off employees after license suspension
Arizona suspends operations at a St. Luke’s psychiatric hospital
St. Luke’s psych hospital may re-open under new operator

In Arizona, the shortage of secure residential treatment capacity is particularly dire. 

In 2022 we were finally able to get badly needed funding ($25M) to construct 5 Secure Behavioral Health Residential Facilities (SBHRFs) with 15 beds each.

Unfortunately, that funding was swept in the 2023 state budget at the behest of the ACLU, leaving a critical gap in care that continues to affect Arizona’s most vulnerable.

Without secure residential facilities, some persons may end up cycling in and out of emergency rooms, hospitals, or even jails—none of which provide the sustained treatment needed to manage their mental health effectively.

When states lack enough secure residential treatment options (like Arizona) patients are left without access to the proper level of care, increasing the burden on emergency services and acute psychiatric hospitals.

For Medicaid programs to be successful in treating individuals with a SMI, they must have the infrastructure to support all levels of care, including secure residential treatment.

The absence of SBHRFs in Arizona is a huge gap in the care continuum and is compromising the health and safety of individuals and communities.

Arizona has an opportunity to correct this gap and reverse the tragic decision to nix funding for SBHRFs, but it will require state policymakers to prioritize the funding necessary to create these facilities.

Hopefully the next legislature and the governor will listen more to mental health professionals and families and less to the ACLU – and get these badly needed facilities up and running.

Without more secure treatment facilities Arizona will continue to fail to meet the needs of its SMI population, leading to poorer outcomes for patients and increased costs across the healthcare system.

The time to act is now—before more lives are lost or further destabilized by inadequate care options.

Call to Action: The Arizona Legislature must make secure residential treatment facilities a funding priority in the 2025 state budget. Providing comprehensive care for individuals with serious mental illness is not only a matter of public health but also a moral imperative.

Read the 3-Part Series
Helping Loved Ones Get the Care They Need: Navigating Arizona’s Court-Ordered Treatment Process for Persons with Mental Illness (Part I of III)
Helping Loved Ones Get the Care they Need: Secure Environments Can Enhance Care for People with Serious Mental Illness (Part II of III)
Helping Loved Ones Get the Care they Need – Secure Residential Treatment: A Crucial (and Scarce) Resource for Supporting Mental Health Treatment (Part III of III)
Will Humble Behavioral Health, Wills Blog

Helping Loved Ones Get the Care they Need: Secure Environments Can Enhance Care for People with Serious Mental Illness (Part II of III)

Recent literature supports the effectiveness of treating some people with serious mental illness in secure environments, particularly when they need intensive care.

Secure environments like psychiatric inpatient units or secure behavioral health residential settings provide a controlled and therapeutic space that can help stabilize patients while minimizing risks.

Inpatient Psychiatric Units and secure residential facilities provide a combination of safety and structured care that is crucial for folks with a SMI who may be at risk of self-harm or violence.

Research shows that when properly designed, secure environments help reduce adverse events, support mental health recovery, and create therapeutic relationships between patients and staff, while avoiding unnecessary coercion.

A 2022 meta-analysis on inpatient suicides emphasizes that secure, therapeutic environments with proper safety measures can significantly reduce risks in psychiatric patients. This highlights the critical role of secure settings in stabilizing patients during acute crises.

How Inpatient Psychiatric Units Can Be Both Safe and Therapeutic | Journal of Ethics

Mental Health America highlights that involuntary treatment (including inpatient commitment) is essential for patients who require structure to engage in treatment that they would otherwise avoid​: Involuntary Mental Health Treatment | Mental Health America

These findings underscore the importance of secure psychiatric environments for individuals with an SMI, especially those needing intensive, non-voluntary care. These settings not only provide safety but also enhance therapeutic engagement, facilitating long-term recovery.

In our next post we’ll discuss how Arizona’s shortage of secure treatment facilities is undermining care for persons who need a more secure setting for their court ordered treatment.

Read the 3-Part Series
Helping Loved Ones Get the Care They Need: Navigating Arizona’s Court-Ordered Treatment Process for Persons with Mental Illness (Part I of III)
Helping Loved Ones Get the Care they Need: Secure Environments Can Enhance Care for People with Serious Mental Illness (Part II of III)
Helping Loved Ones Get the Care they Need – Secure Residential Treatment: A Crucial (and Scarce) Resource for Supporting Mental Health Treatment (Part III of III)
Will Humble Behavioral Health, Public Health, Wills Blog

Helping Loved Ones Get the Care They Need: Navigating Arizona’s Court-Ordered Treatment Process for Persons with Mental Illness (Part I of III)

Dealing with a loved one’s serious mental illness (SMI) can be overwhelming, especially when they don’t recognize that they need help. This lack of awareness, known as anosognosia, can prevent people with SMI from accepting treatment.

In these situations family members in Arizona can turn to the legal process of court-ordered evaluation and treatment to ensure their loved one receives the care they need. Sometimes families need to seek a civil commitment to ensure treatment.

Civil commitment is a legal process to get treatment for persons who are a danger to themselves or others (or gravely disabled due to a mental illness) but who are unwilling to voluntarily seek treatment (see ARS 36-501).

How Court Ordered Treatment Works

Arizona law outlines a process to help families get their loved ones evaluated and treated through a court order. The process begins with a court-ordered evaluation.

First, a family member (or any responsible person over 18) files an application at a hospital (known as a screening agency). Screening agencies can help the family fill out the form, which goes to a doctor to review for approval.

A judge ends up getting the information from the screening agency and is the person who ultimately decides whether the person should be involuntarily hospitalized or get outpatient treatment in the community.

When a judge does decide the person needs treatment they’re often ordered to get a combination of inpatient and outpatient care for 365 days (most of those days being in an outpatient setting).

Orders in Maricopa County include the following:

  • See your prescriber once a month (for the next 365 days);
  • See your case manager once a month in the home; and/or
  • Take your medication as prescribed for the next year.
Where Does Treatment Happen?

In some cases outpatient treatment is sufficient, but people who are a flight risk or resistant to treatment sometimes need a secure residential or clinical setting, especially at first.

For people at risk of elopement, a secure facility offers an environment where treatment can be delivered consistently and safely. These settings (inpatient or secure residential) provide both clinical care and the security needed to prevent patients from leaving before their treatment is complete.

Navigating Arizona’s court-ordered treatment process can be complex, but it’s often a critical step in ensuring that individuals with serious mental illness receive the care they need.

By advocating for the right treatment environment—especially when security is a concern—families can help their loved ones stay on track with their recovery. More about that in the next post. 

Read the 3-Part Series
Helping Loved Ones Get the Care They Need: Navigating Arizona’s Court-Ordered Treatment Process for Persons with Mental Illness (Part I of III)
Helping Loved Ones Get the Care they Need: Secure Environments Can Enhance Care for People with Serious Mental Illness (Part II of III)
Helping Loved Ones Get the Care they Need – Secure Residential Treatment: A Crucial (and Scarce) Resource for Supporting Mental Health Treatment (Part III of III)
Will Humble Social Determinants, Wills Blog

KFF Releases Election Fact Sheets About the Health Care Landscape in Every State

A new KFF tool generates data-driven fact sheets that lay out the health care landscape in every state against the backdrop of the 2024 election.

These state “snapshots” provide information on a variety of health care topics that may be the focus of campaign and policy debates. Topics include health costs; medical debt; women’s health policy, including state abortion, contraception and maternity laws and policies; health coverage, including the Affordable Care Act, Medicare and prescription drug coverage, Medicaid, and employer-sponsored insurance; gender affirming care; and basic information on health status, population and income. 

The new tool is part of KFF’s broader collection of Election 2024-related resources, including our side-by-side comparison of the candidates’ positions and records on health policy issues.

Will Humble Public Health, Wills Blog

Public Health Journalism this Week

Props 315 and 135 take the legislative role too far (Rob Robb substack)

Proposition 135: Should you vote yes or no on the measure? (ktar.com)

Prop 315 supporters argue it will save money; opponents say it will cost lives (azcapitoltimes.com)

Former state employee faces charges in Arizona Medicaid fraud case (azcentral.com)

St. Luke’s lays off employees after license suspension | 12news.com

Phoenix workers at St. Luke’s behavioral health facilities face layoff (azcentral.com)

Arizona Horizon | Telehealth in Medicare PBS

Arizona opinion: Energy incentives empower our rural clinics (tucson.com)

OPINION: Sunshine to Savings: How solar energy became accessible for Arizona families (coppercourier.com)

Will Humble Injury Prevention, Prevention, Public Health, Wills Blog

Phoenix to Redeploy Some Red Light Cameras. What’s the Public Health Evidence?

Red light cameras save lives. Photo speed cameras probably don’t.

From 2001 to 2019 the City of Phoenix set up a handful of red-light cameras at strategic intersections with frequent violent crashes. The city council discontinued use of red-light cameras in ’19 because of concerns about “privacy, effectiveness and discrimination”.

Last year Phoenix Police asked the Council to reinstate them. The Council did so this week, approving the installation of 10 red light cameras across strategic Phoenix intersections. The Council was receptive to adding more red-light cameras in the future depending on the results.

Red-light cameras are coming back to Phoenix

In addition to the ten cameras, the Council approved deploying 6 speed cameras (they say to be moved throughout the city every four to six weeks at intersections with a high number of speed-related crashes and school zones).

What’s the Public Health Evidence?
  • Red-light running cameras (evidence-based)
  • Speed cameras at green lights (NOT evidence-based)
  • Fixed midblock speed cameras posted on long stretches of road (NOT evidence-based)
  • Portable speed towers (NOT evidence-based except around schools)
  • Mobile speed vehicles (NOT evidence-based except around schools)

Public health literature suggests well-placed red-light cameras save lives and reduce severe injuries. Photo speed cameras probably don’t.

Data collected by Phoenix PD suggests that the 12 cameras that had been used prior to 2019 resulted in a 31% drop in red light running crashes at the cross-streets they were used and a 57% drop in red light running crashes in the directions the cameras were facing.

A landmark study for photo enforcement was done by Retting et.al. and published in the American Journal of Public Health examining the impact that photo enforcement had in Oxnard CA after they implemented their photo enforcement program.

Intersections that had red light cameras installed had a 29% reduction in injury crashes. T-bone crashes from red light running were reduced 32% and violent T-bones causing injuries were reduced 68%. Overall accidents at the intersections were reduced by 7%.

There’s less clear evidence that speed cameras are effective public health interventions. There’s almost nothing in the literature that I could find one way or the other for speed cameras.

However, a few years ago a research team that included Dr. Chengcheng Hu, director of biostatistics for the Phoenix campus of the UA Mel and Enid Zuckerman College of Public Health, Dr. Steven Vanhoy, a recent graduate of the UA College of Medicine – Phoenix, and several colleagues from Banner – University Medical Center Phoenix, offers some insight.

The researchers examined crash data along a 26-mile segment of Interstate-10 in Phoenix where speed cameras had been placed every 2 miles as well as a 14-mile control segment where no cameras had been deployed.

They compared crash data from Jan. 1 to Dec. 31, 2009 (when cameras were in place) to data from Jan. 1 to Dec. 31, 2011 (after the cameras had been removed).  They found that the removal of the photo radar cameras was associated with a two-fold increase in admissions to Level 1 Trauma Centers from car crashes in the areas where the cameras were removed.

Editorial Note: Nobody likes getting a traffic ticket, but photo red light enforcement can significantly reduce severe injuries if placed in the right intersections. There’s less evidence that photo speed enforcement works.

When photo speed cameras are used as a revenue generating tool (as it is in Paradise Valley – which places speed cameras practically every 500 meters throughout the town especially on roads with artificially low speed limits) it undermines public support for photo enforcement as a public health intervention.

Unless jurisdictions like Paradise Valley (who use photo enforcement as a revenue tool as opposed to a public safety tool) cool their jets, we risk an eventual statewide preemption of all photo enforcement, to the detriment of public health.

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