Author: Will Humble

108 years ago, Arizona’s founders protected ordinary voters with a state constitution that guaranteed AZ residents the power of referendum, recall and initiatives.  Many of the bold moves to improve public health policy have come via citizens initiatives. A few examples are:

• The Smoke Free Arizona Act;

• The TRUST Commission for tobacco education and prevention;

• First Things First;

• Proposition 204 (from 2000) which extended Medicaid eligibility to 100% of federal poverty

The next set of Voter Initiatives (if any qualify for the ballot given the new restrictions and requirements) will be on the ballot in November of 2020- and the deadline for filing the required signatures is July 2, 2020.  Because it takes a long time to get the required signatures (and because of the new restrictions) folks that want to run voter initiatives need to start collecting signatures pretty soon.

Several entities have filed to notice their intent to get on the ballot so far (here’s that list on the Secretary of State’s website) but the only one that looks legit so far is one called the “Voters’ Right to Know Amendment”.  Terry Goddard is the Applicant and Chair for that one.  Here’s a link to the voter initiative language and here’s the summary from the site:

Under this Amendment, it will no longer be possible to hide from public view the true sources of campaign spending. Anyone spending more than $20,000 on a statewide campaign or $10,000 on a local campaign must disclose contributions of $5,000 or more used to fund campaign expenditures. Major contributions must be tracked to their original sources. Violators are subject to fines. 

Because elections can have a profound impact on public health policies- we’ll be diving into the details of this Initiative to determine whether and how to support this effort.  More on that in a future update.

No doubt additional Initiatives that will have an impact on public health policy will be filed soon (including one that will legalize the retail sale of Cannabis).  We’ll continue to watch for those and will dive into the details after they’re released – probably in next week’s Policy Update.

Here’s the Public Health Impact

The US House and Senate passed the “Bipartisan Budget Act of 2019” this week.  The president is expected to sign this bill into law soon.  Here’s what the budget bill will do:

• Discretionary Spending: Increases the allocation for non-defense discretionary spending to $621.5 billion for FY20, which is an increase of $24.5 billion from FY19 non-defense discretionary caps. It also provides $626.5 billion for FY21, which is a $5 billion increase from FY20.

• Census: Provides $2.5 billion for the 2020 Census.

• Offsets: This legislation includes $77 billion in offsets achieved through increased fees and extending the sequestration cuts for non-exempt mandatory programs such as the Prevention and Public Health Fund through FY29. In other words- the Prevention and Public Health Fund won’t be cut this fiscal year – but the budget agreement contemplates cutting the fund in future years.

In Arizona the Prevention and Public Health Fund investments include immunizations, smoking cessation, diabetes prevention, opioid treatment, and more.  Here’s a report we wrote that summarizes what the Fund does here in Arizona.

It’s been awhile since I mentioned out Upcoming Events public health calendar.  Our website at https://azpha.org/upcoming-events contains a listing of upcoming webinars and meetings that might be of interest to our members- so make sure to bookmark it and visit the site from time to time. 

Also, let me know when you see something interesting that’s coming up at [email protected] and I’ll add it to the calendar.

A light rail extension on Central Avenue in South Phoenix will have a long-lasting, positive impact on community health in South Phoenix.  That’s not just an opinion, that comes from a scientific and detailed 2015 Health Impact Assessment by the Maricopa County Department of Public Health and the Arizona Alliance for Livable Communities.

The South Central Neighborhoods Transit Health Impact Assessment concludes that a thoughtfully planned transportation plan that includes a light rail extension in South Phoenix will result in positive long-term health outcomes for residents, including lowering rates of chronic disease, improving pregnancy outcomes, and reducing violent deaths.

The City of Phoenix’s current transportation plan has been developed over a decade and approved by voters 3 times.  The public has been heavily engaged in this planning effort which has included more than 500 public meetings held to gather input.

Proposition 105 will dismiss this planning and prohibit Phoenix from investing in any kind of rail project – including light rail, commuter rail, or other potential train connections despite the fact that light rail extension have a long-lasting positive public health impact and reinforce the positive aspects of the community.

The Existing Transportation Plan is Good

Four years ago, Phoenix voters passed Proposition 104, a comprehensive transportation plan that included input from public health stakeholders.  The plan incorporated evidence-based provisions to improve many facets of transportation – including things to make transportation easier for folks with disabilities and improving opportunities for physical activity with more walkable and bike-able transportation options.

The voter approved plan extended Phoenix’s existing 4/10ths of a cent transportation sales tax (originally passed in 2000) and increased it by 3/10ths of a cent to:

• Greatly enhancing Dial-a-Ride for persons with disabilities;

• Add 1,150 new bike lanes;

• Add 170 miles of new sidewalks;

• Increase bus frequency by 70%;

• Increase transit hours of operation by 20%;

• Invest $280 million for new roads and bridges;

• Repair 750 miles of asphalt streets; and

• Increase investments in light rail.

Phoenix’s existing Plan is well-balanced to provide various services based on differing community needs, contributing to improved transportation flexibility options and improving social determinants of health related to transportation.

For example, the existing transportation plan includes substantial investment in new transportation options in South Phoenix including a light rail extension.  That’s important because South Phoenix households are four times more likely to not have a car compared to other households throughout the Valley. 

The existing plan also enhances public transit services to South Phoenix and provides families with convenient access to key destinations such as work and school. In fact, over 70% of South Phoenix residents voted in favor of the current transportation plan. 

For all these reasons the Arizona Public Health Association urges Phoenicians to VOTE NO on Proposition 105.  Our health depends on it.

We’ve had a terrific FY-19 as an organization.  Our membership has grown more than 30% in the last two years and we’ve been increasingly becoming a force for positive public health policy development.  We also have a growing list of Organizational Membership supporters- which you can view on our Supporters Page: https://azpha.org/oursupporters 

Here’s a link to our end of FY-19 MEMBERSHIP REPORT and some current membership SUMMARY CHARTS.  As a refresher- here’s a link to our PowerPoint Summary of the 2019 Legislative Session (PDF)

The US has the highest maternal mortality rate of any developed country.  Sadly, it’s getting worse each year.  About 800 American women die and 65,000 almost die during pregnancy or childbirth. The number of deaths in AZ jumped from around 10 in 2015 to about 30 in 2016 (the last year for which ADHS has data posted- the numbers are cell-suppressed to protect confidentiality). 

Nationally, back women die from pregnancy-related causes at three to four times the rate of white women, even after controlling for social determinants. Women in rural areas also have higher maternal mortality rates than urban women.  Here’s a story that highlights some of the issues in an easy to read way.

Evidence-based policy making is a key.  Twenty-nine states (including Arizona) have committees that review maternal deaths and make public policy recommendations.  Arizona took a big step forward this last legislative session with the passage of SB 1040 Maternal Mortality Report which will establish an Advisory Committee on Maternal Fatalities and Morbidity.

It requires ADHS and the Committee to hold a public hearing to receive public input regarding the recommended improvements to information collection concerning the incidence and causes of maternal fatalities and severe maternal morbidity and complete a report (including recommendations) by the end of this year.

Arizona Law is Having Chilling Effect

The opioid epidemic is one of the greatest public health crises of our time.  The roots that caused the epidemic are deep and the public health interventions that will be needed to ease the crisis are many.  Those interventions include dramatic changes to prescribing practices, things like the distribution of naloxone, more robust treatment options including Medically Assisted Treatment, and harm reduction and engagement strategies like Syringe Services.

We need all those tools working together in order to mount an effective response.  Last year’s Arizona Opioid Epidemic Act was an important new law that is addressing many of those factors- but not all.  A real outlier is that the Act didn’t make an important change that is needed in Arizona – decriminalizing syringe service programs. As this excellent report by Stephanie Innes in the Republic this week shows, needle exchange efforts in Arizona have been impaired because some of the things that syringe service programs do are considered felonies under state law.

Syringe services programs are community-based prevention efforts that offer a range of interventions. They provide access to and disposal of sterile syringes and injection equipment, linkage to substance use disorder treatment, and naloxone distribution.  People who use syringe service programs gain access to other vital services including vaccination, testing, and linkage to care and treatment for infectious diseases including viral hepatitis and HIV. 

Nearly 30 years of research shows that comprehensive syringe service programs are safe, effective, and reduce overall health costs. They play an important role in reducing the transmission of viral hepatitis, HIV, and other infections and are a major component of the Ending the HIV Epidemic: A Plan for America initiative. The U.S. Surgeon General determined that syringe service programs don’t increase the illegal use of drugs by injection. Studies also show that they protect the public and first responders by providing safe needle disposal.

Sadly, syringe service programs in Arizona are illegal because syringes are considered drug paraphernalia under Arizona law (a class 6 felony). While arrests, indictments and convictions of workers that operate syringe service programs are rare- the fact that syringe service programs are illegal has a marked chilling effect on the ability of organizations and individuals to operate and fund these important programs. 

After all- it’s pretty hard to get a grant award if you need to disclose to the funder that you intend to commit felonies with the money!

A cohort of public health organizations led by Sonoran Prevention Works have been trying for the last few years to simply decriminalize syringe service programs.  Pretty simple, right?

Sadly, the effort has been unsuccessful. 

In 2018 HB 2389 Syringe access programs; authorization passed the full House of Representatives, was dramatically weakened by a poor amendment in the Senate but ultimately failed to come out of a Conference Committee.  This year, HB 2148 Syringe Services Programs failed to even make it to the House Floor for a vote.

Public health stakeholders will continue to try to get our Legislature to pass a bill that will decriminalize this important evidence-based public health practice.

By the way, the CDC has released materials that health departments can use to provide information on the critical role of SSPs in prevention and treatment, including:

• A summary of information on the safety and effectiveness of SSPs in reducing viral hepatitis and HIV;

• A fact sheet outlining the various ways syringe service programs can prevent transmission of blood-borne infections and link people to care, reduce and treat substance use, and enhance public safety;

• A fact sheet for health departments and community partners that defines syringe service programs and their public health impacts; and

• Frequently asked questions and answers about syringe service programs.

All of these materials are available to you online on the CDC’s Syringe Services Programs website.

Here’s a statement from the CDC on the subject: “It is our hope that by sharing these materials with you, we will engage the full strength of the nation’s public health and community infrastructure to reduce the toll of opioids and infectious diseases in our communities. We have the tools. We have the science. We can work together to improve the health and security of current and future generations.”