Will Humble Professional Development, Wills Blog

Sign Up for Our Professional Learning Communities

Over the next month, we’ll be setting up some Professional Learning Communities in our Basecamp where members with similar interests can share information with one another, update each other about actions that state and federal agencies are taking (or not taking), and share best practices that influence public health.

Lauren Savaglio (our Board Member for Professional Development and Academic Relations) has set up a tool so you can sign up to participate on one of 5 pilot Professional Learning Communities.  In order to sign up, simply go to our Survey Monkey Link and ask to sign up for one of our initial Communities in Basecamp.  Our pilot PLC’s will be in the areas of:

  • Behavioral Health

  • Public Health Nursing

  • Maternal and Child Health 

  • Oral Health

  • Nutrition & Physical Activities 

Also, let me know if you’d like to be added to our Public Health Policy Committee Basecamp site and I can get you all set up.  We have about 50 folks already set up on that site.

Will Humble Professional Development, Wills Blog

Participate in our Volunteer Event!

Please consider participating in our December Volunteer Event to hand-pack meals specially formulated for malnourished children! We still need 5 more people to help us hand-pack meals that will be sent around the world where they feed orphanages, schools, and clinics to break the cycle of poverty. 

When: Monday, December 10. 2018, 8:30 PM – 10:00 PM

Where: 1345 S. Alma School Rd, Mesa, AZ 85210

Register: https://www.fmsc.org/join-group?joincode=1931W2 

Group Name: Professional Development AZPHA  Join Code: 1931W2

For questions and/or an outlook calendar invite, please contact Lauren Savaglio-Battles at [email protected]. 

Will Humble State Legislature, Wills Blog

2019 Legislative Session

The 2019 Legislative Session will begin on January 14.  The Session usually starts with a State of the State address by the Governor followed by a proposed executive branch budget. 

Here’s a PowerPoint RE 2019 Legislative Priorities that I put together.  Like other years, lots of things will come up during the session that we will support or be opposed to.  Our Public Health Policy Committee will share information and meet during the session as we prepare our positions and conduct our public health advocacy.

The party balance in the State Senate will remain 17-13; while the balance in the House will be 31-29 (a much closer party balance than there has been in recent years).

The President of the Senate will be  Karen Fann (R) LD-1 and House Speaker will be  Rusty Bowers (R) LD-25.  There will be 12 Senate committees and 20 House committees starting in January.  The Senate Health and Human Service Committee will be chaired by Senator Kate Brophy-McGee (Sen. Heather Carter will be Co-chair).  The House Health Committee will be chaired by Representative Nancy Barto (Rep Jay Lawrence as Vice Chair)

Senate Committees:

Appropriations: Sen. David Gowan (LD14), Chair

Commerce: Sen. Michelle Ugenti-Rita (LD23), Chair

Education: Sen. Sylvia Allen (LD6), Chair and Sen. Paul Boyer (LD20), Co-chair

Finance: Sen. J.D. Mesnard (LD17), Chair

Government: Sen. David Farnsworth (LD16), Chair and Sen. Sonny Borrelli (LD5), Co-chair

Health and Human Services; Kate Brophy McGee (LD28), Chair & Heather Carter, Co-chair

Higher Ed. & Workforce Dev: Heather Carter (LD15), Chair and Sen. J.D. Mesnard, Co-chair  

Judiciary: Sen. Eddie Farnsworth (LD12), Chair

Natural Resources and Energy: Sen. Frank Pratt (LD8), Chair

Rules: President-Elect Karen Fann (LD1), Chair  

Transportation and Public Safety: Sen. David Livingston (LD22), Chair  

Committee on Water and Agriculture:  Sen. Sine Kerr (LD13), Chair Sen. Frank Pratt (LD8), Co-chair

House Committees:  

Appropriations: Rep. Regina Cobb (LD5), Chair and Rep. Kavanagh (LD23), Vice Chair

Commerce: Rep. Jeff Weninger (LD17), Chair

County Infrastructure: Rep. David Cook (LD8), Chair

Education: Rep. Michelle Udall (LD25), Chair

Elections: Rep. Kelly Townsend (LD16), Chair

Federal Relations: Rep. Mark Finchem (LD11), Chair

Government: Rep. John Kavanagh (LD23), Chair

Health & Human Services  Nancy Barto (LD15), Chair and Jay Lawrence (LD23), Vice Chair

Judiciary: Rep. John Allen (LD15), Chair

Land & Agriculture: Rep. Tim Dunn (LD13), Chair

Military & Veterans Affairs: Rep. Jay Lawrence (LD23), Chair

Natural Resources, Energy & Water: Rep. Gail Griffin (LD14), Chair

Public Safety: Rep. Kevin Payne (LD21), Chair

Regulatory Affairs: Rep. Travis Grantham (LD12), Chair

Rules: Rep. Anthony Kern (LD20), Chair

Sentencing & Recidivism Reform: Rep. David Stringer (LD1), Chair

State & International Affairs: Rep. Tony Rivero (LD21), Chair

Technology:  Rep. Bob Thorpe (LD6), Chair

Transportation: Rep. Noel Campbell (LD1), Chair

Ways & Means: Rep. Ben Toma (LD22), Chair

Will Humble Behavioral Health, Early Childhood, Public Health, State Legislature, Wills Blog

2018 Child Fatality Review Report Published

The death of any child is a tragedy – for the family and for the community. Everybody wants to prevent childhood deaths. But making policy interventions to prevent childhood deaths requires information in order to develop effective policy interventions.  That’s where the Arizona Child Fatality Review State Team comes in.

More than 25 years ago the state legislature passed a law establishing the Arizona Child Fatality Review Program (A.R.S. § 36-342, 36-3501-4).  It’s a great example of establishing public policy designed to build data and evidence so policy makers can use evidence to build future interventions.

The State Team includes representatives from the Academy of Pediatrics and from the ADES Divisions of Developmental Disabilities and Children and Family Services, as well as from law enforcement and the ADHS. The team’s role is to review all childhood deaths in AZ and produce an annual report to the Governor and legislature with a summary of findings and recommendations based on promising and proven strategies regarding the prevention of child deaths.

In past years this focus has raised the awareness about child drowning and the importance of putting babies to sleep on their backs or making sure all children are always secured in car seats. Other recommendations included taking action to reduce the number of uninsured, decrease medical complications of pregnancy and increase safe sleep practices.

The 2018 Child Fatality Review Report was published last week- and as usual it provides a host of data and recommendations that are directly tied to evidence. Here are some examples from this year’s report.

Child suicides increased an astonishing 32% and accounted for 6% percent of all child deaths. A history of family discord was the most commonly identified preventable factor in suicides followed closely by a history of recent break-up, drug/alcohol use and an argument with a parent. 

Firearm deaths increased 19% from the previous report.  Suicides and homicides accounted for 88% of firearm-related deaths in 2017. Fifty-one percent of firearm related deaths were a result of suicide (n=22) and 37% of firearm related deaths were homicides (n=16).

Injury deaths increased 4% from the previous reporting period and comprised 23% of all child deaths. The leading cause was car crashes and 31% of the injury deaths were among kids less than 1 year old… and important piece of data considering Arizona has yet to adopt a law requiring kids under 2 years old to be in a rear facing car seat.

The number of unsafe sleep deaths increased 5% from the previous year.  60% were bed sharing with adults and/or other children. Child fatalities due to maltreatment decreased 4% and accounted for 10% of all child deaths in Arizona.   Substance use was a factor in 65% of maltreatment deaths.

Drowning deaths increased 30% over the period and accounted for 4% of all child deaths. 63% occurred in a pool or hot tub. Lack of supervision was a factor in 69% of drowning deaths.

Substance use was a factor in 17% of all child fatalities (n=136).  The majority of substance use related deaths involved the child or the child’s parent as the main user contributing to the death of the child. In 49% of substance use related deaths, the parent was misusing or abusing alcohol or drugs.

The full report covers each of these areas including some recommendations for policy and program interventions in each area.  Sometimes the recommendations are more related to increasing awareness but many are more policy based.

Lots of work went into this report- so if you’re somebody in a position to influence either lawmakers or agency officials to implement preventative policies in these areas- please get familiar with this   important research product – it will really help inform your advocacy efforts.

Will Humble Prevention, Public Health, Vaccination, Wills Blog

Research Published about Vaccine Exemption Policies

It’s no secret that many states including Arizona are struggling to maintain enough vaccination coverage to achieve “herd immunity”.  Herd immunity simply means that you have enough vaccination coverage to protect the entire community – including people that for medical reasons can’t be vaccinated and folks who’ve been vaccinated but still may be susceptible (because vaccines aren’t 100% effective).

Requiring kids in public school to be vaccinated is one of the most important public policy tools to ensure herd immunity.  Arizona does that through statutes labeled ARS-872 & ARS-873 – which require kids to be vaccinated if they attend public school (unless they have an exemption). In Arizona, there are medical, religious, and “personal” exemptions. The problem over the last few years is that more and more parents are exercising the personal exemption option.

Arizona’s immunizations rates continue to decline: 1) immunization rates have decreased across all age groups from 2012 to 2017; 2) personal exemption rates continue to be highest in charter schools, followed by private and public schools in 2017; and 3) overall personal exemption rates increased in the last year- going from 3.9% to 4.3% for pre-school; 4.9% to 5.4% for Kindergarten and 5.1% to 5.4% among 6th graders.

Of course- when looking toward interventions to stem the tide it’s important to look to the scientific literature to see what’s going on in other states.  A very informative article about personal vaccine exemptions was published recently entitled The state of the antivaccine movement in the US: A focused examination of nonmedical exemptions in states and counties.

The researchers conducted a detailed analysis of personal exemptions within each of the 18 states that allow nonmedical exemptions to their school vaccine requirements. Here’s a map of which states allow non-medical school exemptions.

The researchers found that several counties, especially those with large metropolitan areas, are at high risk for vaccine-preventable pediatric infection epidemics.  Since 2009, personal exemptions have risen in 12 of the 18 states that currently allow philosophical-belief exemptions.  On average, states that allow non-medical exemptions have 2.5 times higher exemption rates.

The also dove into the data and found that there is a direct correlation between higher personal exemption rates and lower vaccination rates.  That might be intuitive- but it’s important because it shows that personal exemption rates for school requirements is a good measure of real immunization rates.

The discussion portion of the article discusses the efficacy of interventions in various states, and basically found that more aggressive approaches – like eliminating personal exemptions entirely- are more effective at long term improvements in vaccination rates than softer approaches.

Definitely worth a read.

Will Humble Opioids, Prevention, Public Health, Wills Blog

AZ Develops Pain & Addiction Curriculum for Clinicians

It’s no secret that getting a public health handle on the opioid crisis will take a multi-pronged effort for an extended period.  Part of the solution was the policy development, passage and implementation of the Arizona Opioid Epidemic Act.  Other elements include developing and implementing new Opioid Prescribing Guidelines and developing new regulations for pain management clinics.

Another huge element is changing the culture of pain and addiction care.  ADHS has completed a Arizona Pain and Addiction Curriculum that approaches pain and addiction in a new way – as complex, interrelated, public-health issues. 

The curriculum was jointly developed by Deans and Curriculum Representatives from every MD, DO, NP, PA, ND, DMD and DPM program in Arizona.  The program stresses not only the new evidence base of pain and addiction care.

Resources for programs consist of both a Pain and Addiction Curriculum and a Pain and Addiction Faculty Guide.  Because it was created and facilitated by public health, it’s accessible online at any time, to the appreciation of other teaching programs across the country.

Kudos to ADHS and the dozens of stakeholders for this novel work and especially AzPHA member Lisa Villarroel MD.  Work on this scale hasn’t been done before in the US – so kudos to our Arizona teaching programs for being so open and collaborative. This is another example of the stakeholder driven innovative work being done right here in Arizona that’s likely to be adopted as a best practice in other states.

Will Humble Physical Activity, Prevention, Return on Investment, Wills Blog

Tucson Voters Lead the Way

Last week Tucson voters approved Proposition 407 approving $225M in Bonds for improving the outdoor built environment.  The funds will be used over the coming years for playgrounds, sports fields, pools, splash pads, recreation centers, pedestrian pathways, bike pathways, and pedestrian & bike safety infrastructure. 

The plan includes 25 new splash pads, 22 new playgrounds and 17 shade structures installed at city parks in the next several years.  Tucson will be reopening 2 city pools that have been closed and will make renovations the 22 other public pools.  Improvements are also planned for sports fields, 28 new walking paths in parks, 26 new ramadas, 19 new restrooms and an amphitheater.

Safety and mobility projects will connect people to parks, schools, shopping and transportation. New sidewalks, enhanced major street crossings, off-street biking and walking paths and residential street traffic calming are also slated in the plan which will provide more than 210 km of enhancements across Tucson.

The improvements won’t happen overnight though.  The $225M in improvements is spread over 9 years.  You can learn more about the proposed Parks and Connections projects using Tucson’s Interactive Story Map.

Congrats to the voters of Tucson for investing in their built environment and creating more opportunities for folks to enjoy the outdoors and get some exercise!

Will Humble Medicaid, Medical Marijuana, Public Health Law, Wills Blog

Public Health Ballot Measures Approved in Other States

Here’s a summary of what voters approved in other states that link to public health policy.  There are a few surprises in here- at least things that I found surprising.

Idaho, Nebraska, and Utah voted to expand their Medicaid programs (up to 138% of the federal poverty level).  Idaho’s Proposition 2 was approved by 61% of voters and Nebraska’s passed with 53% approval (called Initiative 427 to expand Medicaid). Interestingly, neither of those states established a funding mechanism.  

Utah’s Proposition 3 was approved by 54% of voters and funds the expansion with a 0.15% increase to the state’s sales tax. There are now 14 states  left that haven’t expanded Medicaid.  With gubernatorial party changes in Wisconsin & Kansas perhaps those states may be next.

Proposals related to marijuana were on the ballot in five states. Utah voters approved a medical marijuana initiative (Proposition 2) by a 53-47 percent margin. Interestingly, it will be a strictly “edibles” based program (prohibits the medical marijuana). 

Missouri voters approved Amendment 2 (with 66% of the vote) that gives the Missouri Department of Health & Senior Services oversight of the state’s new medical marijuana program. 

Michigan approved a measure to allowing adults to use marijuana for non-medical purposes and a retail sale program.  Proposal 18-1 directs Michigan’s Department of Licensing and Regulatory Affairs to oversee the commercial production and retail sale of marijuana. 

Will Humble Health Insurance, Medicaid, Wills Blog

Wisconsin Medicaid Work Requirement Approved

CMS approved Wisconsin’s Medicaid work requirement waiver, making them the 5th state to have their work requirement waiver approved.  Wisconsin is the 1st state to receive approval for work requirements since a federal court ruled them unconstitutional in Kentucky.

Medicaid members between the ages of 19 and 49 will be required to work, volunteer, be in school or in a job training program for at least 80 hours a month. Recipients who don’t comply after 48 months will lose their eligibility.  The state is also allowed to charge premiums for what is normally free and to raise those premiums for people with riskier health behaviors like smoking.

Of the four other states CMS has given the greenlight to, only Arkansas has implemented work requirements. Indiana and New Hampshire will start enforcing them in January, and Kentucky’s have been sent back to CMS for review.

Arizona’s Work Requirement Request

A 2015 AZ law requires AHCCCS to annually ask the CMS for permission to require work (or work training) and income reporting for “able bodied adults” and a 5-year lifetime limit on AHCCCS eligibility. 

Late last year AHCCCS submitted their annual official waiver request including a requirement to become employed, actively seek employment, attend school, or partake in Employment Support and Development activities (with exceptions) and a requirement to bi-annually verify compliance with the requirements and any changes in family income.  CMS hasn’t yet ruled on the AZ request.

HB 2228 requires AHCCCS to exempt of tribal members from the work requirements but CMS has suggested that they won’t be approving waiver requests that exempt tribal members because they believe exempting them could raise civil rights issues.  

For now it’s status quo.

Will Humble Uncategorized, Wills Blog

MMJ Edibles Case Appealed to State Supreme Court

Back in 2013 a medical marijuana patient (who had a valid ADHS Medical Marijuana Card) was arrested for possession of a small amount of hashing (a preparation of marijuana) in Yavapai County.   Even though he had a valid card, he was convicted by a jury of a class 6 felony and spent nearly a year in jail. 

Mr. Jones continued to appeal his conviction (State v. Jones).  Over the Summer, the AZ Court of Appeals in the case upheld the conviction, maintaining that the hashish that he possessed did not meet the definition of mixtures or preparations of marijuana as defined in the Arizona Medical Marijuana Act.  An appeal to the Arizona Supreme Court was filed this week.  

If Mr. Jones’ appeal is successful, Arizona’s medical marijuana program will stand as is.  If it is unsuccessful, it’s reasonable to expect ADHS to completely overhaul their medical marijuana regulations and to impose a completely new regulatory scheme that would exclude extracts, resins, and edibles. Dispensaries and patients would no longer have access to these mixtures and preparations of the Cannabis plant, and dispensaries would be required to discard the instruments and equipment needed under the current regulatory scheme and overhaul their business models to one that focuses exclusively on marijuana flowers.

I filed a Declaration in the case on behalf of Mr. Jones (CR-18-0370-PR).  My Brief basically argues that hashish and other mixtures or preparations of marijuana are indeed covered under the voter approved statutory language and the regulations that we developed at the ADHS while I was Director.  I filed the Amicus as the former ADHS Director, not in my capacity as the Executive Director of AzPHA.  Here’s more background about the core issue.

The Arizona Medical Marijuana Act provides qualified patients and dispensaries a number of legal protections under the voter approved  Act.  The Arizona Medical Marijuana Act definition of “Marijuana” in A.R.S. § 36-2801(8) differs from the Arizona Criminal Code’s definition of “Marijuana” in A.R.S. § 13-3401(19). In addition, the Arizona Medical Marijuana Act makes a distinction between “Marijuana” and “Usable Marijuana” A.R.S. § 36-2801(8) and (15).

I expect to see the Arizona Supreme Court to accept the case because this is an important matter of public policy.  More to come.

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