Will Humble Professional Development, Wills Blog

AzPHA Board of Directors: Call for Nominations

The Arizona Public Health Association is governed by our 16-member Board of Directors. The Board exercises the power, responsibilities and duties of our organization in accordance with best management practices, and consistent with Arizona statutes, IRS requirements and our AzPHA Bylaws.

Board members are expected to be an active participant in at least one committee or subcommittee of the Board. Specific powers and duties of all Board Members include:

  • Determining overall direction, role, and mission of the organization;
  • Formulating and approving strategic and financial goals and plans;
  • Review the organization’s performance in relation to the mission;
  • Setting policy for the organization consistent with these bylaws;
  • Appropriating funds entrusted to this organization;
  • Appointing, removing, or suspending the Executive Director as necessary;
  • Amending these bylaws on a provisional basis;
  • Recruiting and retaining members of the organization; and
  • Contributing financially to the organization annually.

AZPHA is accepting nominees for two Public Representatives on our Board of Directors.

You can review our AZPHA Bylaws for a complete picture, but below are the excerpts from the By-laws for these positions.

Public Representatives are individuals who represent the issues and concerns of the public as they relate to public health matters. Two Public Representatives shall be elected to the Board of Directors. Each shall serve a 2-year term with an option to serve an additional two years. Public Representatives shall participate and engage in activities that strengthen grassroots efforts within the state. Each Public Representative will serve on at least one committee, subcommittee, or ad hoc committee.

The AZPHA Board of Directors meets for two hours monthly. Most Board Meetings are via Zoom, but we have quarterly in person meetings with a hybrid option. 

Persons interested in applying or nominating someone are encouraged to fill out this Board Member Application and submit it to kellidonley@gmail.com by September 16, 2024.

For additional information about AZPHA including board responsibilities and information about our financial position please review the following documents:

Board Member Application
Will Humble Professional Development, Public Health, Wills Blog

2024 AzPHA Public Health Awards: Accepting Nominations Now!

Pictured: 2023 AzPHA Award winners: From Left, Haley Coles, Sen. Theresa Hatathlie, Dr. Theresa Cullen and Lindsey Perry

Each year AzPHA recognizes public health professionals, health professionals and community members across Arizona who are performing extraordinary services to our community at our annual awards event. Many of our awards go back decades.

We’re proud to announce that the 2024 awards program will be held on:
Thursday, October 24, 2024: 5:30 – 8:00pm
Equality Health: 7720 N. Dobson Rd., Suite 200 Scottsdale, AZ 85256

Please take a moment to view our award categories and submit your entries by September 1, 2024

Submit Nominations Here
This Year’s Award Categories:

1. Policy Maker of the Year

2. Senator Andy Nichols Honor Award

3. Pete Wertheim Public Health Leadership Award

4. Cele Cohen Nursing Award

5. Elsie Eyer Commitment to Underserved People Award

6. Harold B. Woodward Award

7. Corporate Public Health Service Award

8. Health Education Award

Will Humble Public Health, Wills Blog

Unlocking Health Equity with ‘The Community Guide’

Public health professionals are constantly searching for the most effective ways to improve health outcomes and advance health equity. The Community Guide, or The Guide to Community Preventive Services, is a trusted resource that provides evidence-based recommendations to help achieve these goals. It’s a treasure trove of systematic reviews and strategies that can guide county and state health departments in their mission to foster healthier communities.

The Guide to Community Preventive Services

The Community Guide is particularly valuable for its rigorous approach to evaluating public health interventions. It categorizes evidence into three levels: Strong Evidence, Sufficient Evidence, and Insufficient Evidence.

Strong Evidence means an intervention has been thoroughly evaluated and consistently shown to be effective. Health departments can confidently implement these strategies, knowing they are backed by solid research. For instance, tobacco cessation programs with strong evidence have been shown to significantly reduce smoking rates, leading to better health outcomes.

Sufficient Evidence means that while an intervention is effective, more research could further confirm its impact. These interventions are still useful and can be considered as part of a comprehensive health strategy. For example, certain community-based physical activity programs might fall into this category, suggesting they are beneficial but could benefit from further study.

Insufficient Evidence points to areas where the current research is either lacking or of lower quality. This doesn’t mean the intervention isn’t effective, but rather that more information is needed. Health departments might approach these strategies with caution, potentially using them in a pilot phase to gather more local data.

County and state health departments can use The Community Guide to find and tailor their public health initiatives to the specific needs of their populations. By focusing on interventions with strong or sufficient evidence, they can ensure their efforts are not only effective but also fair.

Because the Guide includes the strengths and weaknesses of the evidence of various interventions, it allows top leadership to make the case to their county managers and boards of supervisors of the need for policy changes or financial resources – providing key information they can use to estimate a return on investment for the intervention(s).

For example, if a health department is addressing childhood obesity, they can find evidence-based interventions such as school-based physical activity programs or nutritional guidelines and adapt these to their local context.

It’s regularly updated with new reviews and recommendations, ensuring that users have access to the most current and relevant information. This is crucial for addressing emerging health issues and adapting to changing community needs.

In short – The Community Guide is a valuable resource that helps public health professionals at all levels of an organization to stay informed about the latest research and trends.

Bookmark The Guide to Community Preventive Services in your Favorites bar today!
Will Humble Medicaid, Wills Blog

Medicaid 101: Waivers, Plan Amendments & Contractor Operations Manuals

Medicaid is a joint venture between the federal government and individual states, providing health coverage to low-income individuals and families. This partnership means both the federal government and states share the costs and responsibilities of running the program.

Its main purpose is to ensure that vulnerable groups like children, pregnant women, elderly adults, and people with disabilities have access to necessary medical care and community-based services.

1115 Demonstration Waivers

One of the unique aspects of Medicaid is the flexibility it offers states through things called ‘1115 waivers. These waivers allow states to explore new ways of delivering and paying for Medicaid services that differ from standard federal requirements.

In order to get an ‘1115 waiver’ to explore creative and new ways to provide services, states need to prove to the Centers for Medicare and Medicaid services that they will measure and publish the results of their innovative strategies.

They also have to show that the waiver’s cost won’t be more than it would have been without the waiver (i.e., the total federal cost if the state didn’t have the waiver.

For example, states can propose innovative pilot projects aimed at improving care quality and efficiency while potentially reducing costs. A state might use an 1115 waiver to extend Medicaid coverage to groups not traditionally eligible or to try out new payment models for healthcare providers (e.g. AHCCCS’ Targeted Investment strategies).

State Plan Amendments

States can also use a less complicated tool to amend their Medicaid program called a State Plan Amendments, (which also need to be approved by CMS).  SPAs let states adjust their Medicaid plans within the existing federal framework. Think things like changing eligibility criteria, changing benefits, or updating payment rates.

While SPAs must align with federal regulations, 1115 waivers offer more leeway, enabling states to implement unique approaches outside standard guidelines. Perhaps that’s why 1115 waivers require more information to be approved and receive more scrutiny by CMS than SPA’s do.

Contractor Operations Manuals

You’ve also probably heard the words AHCCCS Contractors Operations Manual (ACOM) bandied about in the field. Among other things, ACOMs provide information to Contractors and Providers regarding services that are covered within the AHCCCS program.  You can think of ACOMs as the way AHCCCS actually implements the terms of their various 1115 waivers and SPAs.  

ACOM manuals don’t require CMS approval but are designed to make sure their contracted Managed Care Organizations follow the terms of AHCCCS’ waivers, SPAs and other state and federal regulations. ACOM manuals are also designed to make sure their contractors keep consistent care standards and manage Medicaid resources efficiently.

Here’s a video that explains more https://www.youtube.com/watch?v=5r8c0mGEG64 and here are some recent examples of AHCCCS’ SPAs and Waivers:

1115 Waiver Example: Housing

AHCCCS also recently received an 1115 waiver to help their members with housing – called the Housing and Health Opportunities (H2O) Demonstration Waiver. The AHCCCS H2O demonstration waiver enhances and expand housing services and interventions for AHCCCS members who are homeless or at risk of becoming homeless. Key elements of the waiver focus stabilizing members’ mental health conditions, reducing substance use, increasing the use of primary care and prevention services, and increased member satisfaction.

The waiver also focuses on housing stability initiatives that focus on reduce the cost of care for individuals successfully housed through decreased use of crisis services, ED use and inpatient hospitalization; reducing homelessness and improving  skills to maintain housing stability.

1115 Waiver Example: KidsCare Expansion

Arizona recently received approval for an 1115 waiver to expand its KidsCare program, which provides health coverage to children from low-income families who don’t qualify for Medicaid. This waiver allows Arizona to increase the income eligibility threshold, making more children eligible for the program. The aim is to ensure that children have access to preventive and comprehensive healthcare, improving overall health outcomes.

Recent State Plan Amendment: Doula Care

AHCCCS, recently submitted a State Plan Amendment to include doula care as a covered (reimbursable) service. This change acknowledges the important role doulas play in supporting pregnant women through childbirth and postpartum care. The SPA ensures that Medicaid enrollees can access continuous, personalized support during pregnancy from a doula, which has been shown to reduce complications and improve birth experiences.

Will Humble Environmental Health, Wills Blog

The Health Risks of PFAS in Drinking Water and Regulatory Challenges Ahead

Per- and polyfluoroalkyl substances (PFAS) were widely used over the last several decades especially around military complex areas. Over time, they have become more and more of a public health concern due to their widespread presence and persistence in the environment (and the fact that modern laboratory techniques can now detect the chemicals at very low levels).

You’ve probably heard them referred to as “forever chemicals, because they’re so resistant to degradation (e.g. microbes can’t eat the chemicals so there’s no biodegradation in the environment).

One of the most significant sources of PFAS water contamination in the US is around military bases from the use of firefighting foam in training exercises. Factories that manufacture or use PFAS in products like non-stick cookware, water-repellent fabrics, and stain-resistant carpets have also contaminated groundwater with PFAS’.  Landfills that receive PFAS-containing waste also contribute to water contamination.

Exposure to PFAS in contaminated drinking water includes increased risks of cancer, liver damage, immune system dysfunction, and developmental issues in children. Of course, the extent of the risk depends on the level of exposure.

In response to several years of advocacy (especially around former military facilities) the EPA went through a year’s long process of developing a new maximum contaminant level (MCL) for PFAS in drinking water.

Note: MCL’s are contaminant limits for allowable concentrations of chemicals in regulated public and semipublic water systems (systems serving more than 25 people or having 15 service connections).

The new MCL of 4 parts per trillion is scheduled to become effective in December 2024 and enforceable in June 2025. Once the rule kicks in, regulated water systems will be required to test for PFAS’ and prove that they aren’t delivering water that has more than 4ppt of PFAS in it. Water systems regulated under the Safe Drinking Water Act will have to test for PFAS’s quarterly. Unregulated private well owners oof course don’t need to test or comply with EPA’s testing requirements.  

Sadly, regulation of PFAS in drinking water is now at risk despite EPA’s new rules because of last week’s U.S. Supreme Court ruling in Loper Bright Enterprises v Raimondo (aka the ‘Chevron’ case…  a decision that potentially undermines EPA’s ability to enforce the new standard.

The ruling means that any ambiguity in the EPA’s regulations could be subject to stricter judicial scrutiny, making it harder for the agency to implement and uphold the new MCL for PFAS.

Read Also: Supreme Court’s Chevron Ruling: A Blow to Public Health Protections

This is just one example of the hundreds of ways the Chevron ruling may pose a long-term risk to public health – as federal agencies as diverse as the FDA, Department of Labor and Transportation face the very real prospect of legions of lawyers descending on federal agencies and challenging long established as well as new important federal regulations.

The only intervention I can think of is to make sure you pay attention to who you vote for in the race for President and the Senate – as we are seeing more and more in very real terms what the power is of an activist Supreme Court that is hostile to public health protections.

Will Humble Professional Development, Public Health Law, State Legislature, Wills Blog

Legislative Council Analyses of the Ballot Propositions Drafted: Ballot Language in Development

The Arizona Legislative Council is a 14-member statutory committee of the Legislature chaired by the President of the AZ Senate. The Legislative Council right now is a blend of 14 members of the AZ House and Senate – 8 Republicans and 6 Democrats (because Republicans are in the majority in both chambers).

That statutory committee of legislators then hires the staff who work at the Legislative Council. A person named Michael Braun is the executive director for the Legislative Council (Braun is not a legislator – he’s appointed by the members on the Legislative Council).

The staff at Leg Council’s main job is to provide a variety of nonpartisan bill drafting, research, computer and other administrative services to all of the members of both houses of the Legislature. They are the folks that provide the bill summaries during legislative session for example. They also actually draft many of the bills legislators propose (at each legislator’s direction).

Ballot Proposition Analyses

State law requires the Arizona Legislative Council to prepare ‘impartial’ analyses of ballot measures, which are then included in the publicity pamphlet that goes out to voters. Last week the Legislative Council staff finished developing draft analysis of each of the 14 Ballot Measures that will be on the fall ballot.

The 14-member Legislative Council met this week to review, edit, and approve the language developed by Leg Council staff – the language that will ultimately be included in the voter publicity pamphlet.

While some of the draft analyses prepared by the AZ Legislative Council went smoothly – there were disputes about language in certain Propositions – especially the one relating to abortion care.

You can read a bit about the drama in committee this week about whether the publicity pamphlet should use the word ‘fetus’ or ‘unborn human’ in the test in this piece by Stacey Barchinger at the Arizona Republic: Arizona for Abortion Access sues GOP-backed voter pamphlet language

After a long and somewhat contentious meeting on Monday the 14-member Leg Council body of legislators approved the language for each measure that’ll be included in the publicity pamphlet. You can see the language for each at this link: Ballot Measures 2024 Analyses. You can see in the analysis that in the end Leg Council approved using both the word fetus and unborn human (the word ‘unborn human’ appears in the first sentence).

Actual Ballot Language

The actual language for each proposition that will be on the ballot is decided by the Secretary of State in collaboration with the Attorney General.

The Secretary of State (Fontes) is supposed to prepare the ballot title and summary. Attorney General Mayes) reviews and approves the language that will actually be on the ballot to make sure it accurately reflects the measure’s intent and follows legal standards.

That actual language is still in flux (hasn’t been approved by AG Mayes yet)…  but here’s the DRAFT ballot language for a few of the propositions developed by Fontes’ team: General Election Ballot Measure Language.

For example, here’s the draft language for the harmful Proposition 134 – which for all intents and purposes would eliminate all future voter initiatives:

A “yes” vote shall have the effect of requiring an applicant wishing to place a measure on the ballot to collect a certain percentage of signatures in each of the 30 legislative districts. Signatures from 10% of the voters in each district would be required for a statewide initiative to appear on the ballot.

Signatures from 15% of the voters in each district would be required for an amendment to the Arizona Constitution to appear on the ballot. Signatures from 5% of the voters in each district would be required for a statewide referendum to appear on the ballot. If a proposed measure does not obtain the minimum percentage of signatures in any one of the 30 legislative districts, it would fail to qualify for the ballot, and would not be presented to voters.

A “no” vote shall have the effect of keeping the current constitutional language requiring only the signatures of 10% of the total number of statewide voters for an initiative, 15% of statewide voters for an amendment, and 5% of statewide voters for a referendum.

Here are links to our arguments for and against the various AZ ballot propositions (these arguments will appear in the upcoming Voter Publicity Pamphlet):
Will Humble Professional Development, Wills Blog

Public Health Journalism this Week

4 new mental health laws are cause for hope, AZ Mad Moms group says (azcentral.com)

Arizona obscures marijuana edibles facility health code inspections (azcentral.com)

Lawmakers approve language for lengthy list of November ballot questions (azmirror.com)

Hantavirus cases continue to increase in Coconino County (azcentral.com)

New COVID-19 vaccine coming in 2024: Here’s what top experts recommend (azcentral.com)

Arizona farmers turn to solar panels to shade crops, save water and generate power • Arizona Mirror (azmirror.com)

Will Humble Public Health, Wills Blog

The Hidden Dangers of Adolescent Cannabis Use

With retail marijuana programs proliferating across the country, more and more people are wondering what the impact of this increased access to Cannabis is having on public health. While there’s some risk for dependency and abuse among adults, the real risk posed by marijuana use is among adolescents and young adults.

Why? Because the adolescent brain, still in its crucial development phase, is uniquely vulnerable to the adverse effects of cannabis.

Regular cannabis use during adolescence can interfere with brain development, leading to long-term cognitive impairments including diminished memory, attention, and learning capabilities (skills essential for academic success and overall life trajectory). Early cannabis use can even lower IQ points over time.

The psychoactive part of cannabis (THC) can worsen mental health issues in some young adults. Adolescents who use cannabis are more likely to experience anxiety, depression, and even psychosis. The impact on mental health can extend into adulthood, compounding the challenges faced during these formative years.

Contrary to the belief that cannabis is non-addictive, regular use can lead to dependency, with withdrawal symptoms such as irritability, insomnia, and cravings making it difficult for young users to quit.

What’s the intervention?  Comprehensive education and prevention programs are essential to mitigate these risks and ensure that adolescents. Enforcing laws that prevent straw buying and diversion to adolescents and young adults is also helpful (but very hard to enforce).

Will Humble Professional Development, Wills Blog

Arizona’s 2024 Legislative Session: The Bills, the Budget & the Ballot Measures

Free Webinar: Friday, July 12, 2024:  9-10am

Arizona’s 2024 legislative session saw the passage of about a dozen laws that will be good for public health and state government accountability – especially in the areas of behavioral health and licensing of care facilities.

There were also many missed opportunities – mostly in the areas of behavioral healthcare and care home assurance accountability. Some detrimental bills were successfully vetoed or blocked.  

The budget saw across the board modest cuts for many agencies and sweeps of several professional license funds.

The legislature also placed 11 measures on the November ballot. AZPHA will be opposing 7 of them. Voters are likely to place an additional two propositions on the ballot.

This session will cover the Bills, the Budget and the Ballot Measures. Below is a PowerPoint summarizing what we’ll be covering in this webinar. 

2024 Legislative End of Session PowerPoint
View a Recording of the Webinar
Will Humble Reproductive Health, Wills Blog

Texas Infant and Neonatal Mortality: A Grim Warning for Restrictive Abortion States

In the latest twist of public health policy repercussions, Texas finds itself grappling with an unsettling increase in infant and neonatal mortality rates. This spike follows the state’s implementation of highly restrictive abortion policies.

According to a recent study published in JAMA Pediatrics, this uptick is no coincidence. The data suggests a direct correlation between these restrictive laws and the rising number of infant deaths.

Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy | Women’s Health | JAMA Pediatrics | JAMA Network

Here’s the grim reality: When states restrict access to safe and legal abortions, the consequences ripple far beyond the immediate scope of reproductive rights.

Texas is now a case study in what happens when policymakers prioritize ideology over evidence-based health practices. The study highlighted that the restrictive policies have contributed to a rise in neonatal deaths, with the numbers speaking volumes about the health risks imposed on newborns and their mothers.

Why is this happening? Women denied abortions often face increased health risks, including complications during pregnancy and childbirth. Many of these pregnancies are unwanted or high-risk, leading to adverse outcomes for both mother and child. The stress and financial strain of carrying an unplanned pregnancy to term can also reduce the quality of prenatal care, directly affecting infant health outcomes.

Now, here’s the broader implication: Texas is not alone in its restrictive stance. Other states adopting similar measures could see parallel increases in infant mortality rates. This is a cautionary tale for policymakers everywhere. If the goal is to reduce infant mortality, then ensuring access to comprehensive reproductive health services must be a part of the strategy.

The takeaway? Restrictions on abortion don’t just limit choices—they imperil lives. We need to listen to the data and prioritize the health of our most vulnerable.

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