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 [email protected] 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?

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.

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.

Oral Arguments Monday in Petersen v. Hobbs Agency Director Nominations Case

After Sen. Hoffman’s failure to hear nominations for several of Governor Hobbs’ nominees to direct state agencies (and his bizarre behavior during the very few “Director’s Nominations” Committee hearings that did occur), it became clear that Hobbs’ nominees to lead state agencies wouldn’t be getting a fair shake at confirmation from the Committee or the Senate.

See: Senate committee doesn’t ‘vet’ nominees. It sabotages them

We posted a blog back then arguing that the Governor should use provisions in state law to get her nominees onto more stable ground: Time to Play Hardball with Agency Director Nominations? Here’s a Playbook. Hobbs ended up going with Option 3 in that blog post as outlined in Governor Hobbs Letter to Senate President Petersen. Hobbs first withdrew the 13 nominations of the agency directors that she had previously sent to the Senate.

See: Governor Katie Hobbs Pulls Nominees from Partisan Political Circus Created by Extremist Jake Hoffman
See: 38-211 – Nominations by governor; consent of senate; appointment

Hobbs appointed Ben Henderson as the Interim Director for each of the agencies. Mr. Henderson proceeded to name the person who had previously been nominated to be agency director to the title of Executive Deputy Director.

State Senate President Petersen sued Governor Hobbs in Maricopa County Superior Court last year, challenging Hobbs’ end-around the Senate.

Judge Blaney will hear the first round of oral arguments in court Monday at 10am in the Maricopa County Superior Court building (Room 411).

See: Civil Court Case Information: Petersen v. Hobbs Maricopa County Superior Court Case Number CV2023-019899/

My sense is this case will ultimately be appealed regardless of what Blaney decides – so it may be several months to more than a year before we have a final resolution in this important policy matter.

If the State Senate flips to the Dems or is 15-15 tie after the November election, things could change rapidly, and the case could end up being dismissed once a new Senate president is sworn in and Hoffman is discharged from the Director Nomination Committee (or it’s abolished).

I hope to be able to get a seat in the courtroom on Monday and provide an update next week.

AZPHA’s Potential Positions on November Ballot Propositions: Part 5 – Arizona for Abortion Access Act

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 referral. 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 in 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 4 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.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

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 from May 20 to June 20.

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View a summary and our draft argument FOR the Arizona for Abortion Access Act
See Our Draft Argument (For)

This voter driven constitutional amendment would establish the fundamental right to abortion that the state of Arizona may not interfere with before the point of fetal viability unless justified by a compelling state interest (e.g. improving or maintaining the health of the individual seeking abortion care that does not infringe on that individual’s autonomous decision making).

AZPHA’s Potential Positions on November Ballot Propositions: Part 4 – Locking in Partisan Primaries

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 referral. 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 in 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 4 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.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

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 from May 20 to June 20.

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View a summary and our draft argument AGAINST the Partisan Primaries Regardless of Party Affiliation Amendment
See Our Draft Argument (Against)

This measure (referred to the ballot by the legislature) would require partisan primary elections for partisan offices; prohibits primary elections where all candidates, regardless of political party affiliation, run in the same primary election, such as top-two, top-four, and top-five primaries; and provide that the state’s direct primary election law supersedes local charters and ordinances.

AZPHA’s Potential Positions on November Ballot Propositions: Part 3 – Open Primaries

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 referral. 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 in 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 4 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.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

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 from May 20 to June 20.

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See a summary and our draft argument FOR the Arizona Eliminate Partisan Primaries Amendment
See Our Draft Argument (For)

This voter-driven amendment would eliminate partisan primaries and replace them with an electoral system where individuals may vote for the candidate of their choice, regardless of the party affiliation of the voter or the candidate.

AZPHA’s Potential Positions on November Ballot Propositions: Part 2 – Signature Distribution Requirement for Voter Initiatives

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 referral. 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 in 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 4 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.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

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 from May 20 to June 20.

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Below is a summary and a draft argument AGAINST the Arizona Signature Distribution Requirement for Initiatives Amendment
See Our Draft Argument (Against)

This proposition (referred to the ballot by the legislature) adds a new signature distribution requirement to get citizen initiatives on that ballot. It would require organizers of future voter initiatives to gather 10% of votes cast for governor from each of the 30 legislative districts in order to qualify for the ballot. For constitutional amendments voters would need to collect 15% from each legislative district.

Future voter initiatives designed to address public health threats (such as the Arizona Abortion Access Act), the Smoke Free Arizona Act, the Predatory Debt Collection Protection Act and the voter initiative that expanded Medicaid to 100% of poverty would be MUCH harder time making it to the ballot if voters approve this measure.

AZPHA’s Potential Positions on November Ballot Propositions: Part 1 – Emergency Authority

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 referral. 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 in 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 4 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.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

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 from May 20 to June 20.

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Below is an analysis and Draft Argument AGAINST the Arizona Emergency Declarations Amendment
See Our Draft Argument (Against)

This proposition (referred to the ballot by the legislature) ends states of emergency and emergency powers after 30 days unless the legislature extends the emergency powers granted to the governor. Emergencies related to floods and fires are exempt.  I’m crossing my fingers that the next governor serving during a public health emergency will use that emergency authority as intended. If approved, this ballot referral would severely restrict that future governor’s ability to save lives.

The AZ Corp Commission & Public Health (Part III): Southwest Gas

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.

In our first piece we discussed how the Commissioners’ rubber stamping of APS rate increases over the last couple of years is harming the social determinants of health. Last week we wrote about how recent Commissioner decisions are disincentivizing rooftop solar.

This week we’ll cover the Commission’s regulation of methane gas monopoly rates and how that impacts the social determinants of health.

  • Just last year (2023), Southwest Gas and its shareholders were celebrating the “largest revenue increase in company history,” thanks to the company’s back-to-back rate hikes on customers in 2022 and 2023 in Arizona. Like we discussed in week one – those rate increases disproportionately impact the budgets of low-income Arizonans.
  • While many Arizonans struggle to pay their bills, gas utility executives are getting rich. Southwest Gas reaped $54.3 million in record revenue in Arizona, while its executives pulled in huge salaries. For example, President and CEO Karen S. Haller made more than $4.3 million in 2022, while former CEO John P. Hester took in more than $6 million
  • Now Southwest Gas is asking the Commission for another large rate increase – its third increase in three years on Arizona customers. The utility is seeking a $125 million increase to its revenues, a nearly 12% increase.
  • They’re also asking Commissioners to allow it to charge ratepayers $385K each year to support their membership to trade associations, including the American Gas Association, a special-interest group that has organized legislative attacks on electrification, including in Arizona.
  • On top of that, Southwest Gas is continuing to seek a subsidy, known as a “line extension allowance,” forcing customers to pick up to pay for new gas lines to commercial and residential properties for wealthy developers. 

Utility regulators (elected Corporation Commissioners) should be protecting consumer interests, but recent history shows they’ve been on the side of utility executives and shareholders rather than everyday Arizonans.

My point with this post is that the elected Commissioners in the Arizona Corporation Commission can have a substantial impact on the social determinants of health – especially when they defer to well-heeled utility executives instead of their constituents.

If you care about the social determinants of health – and I know you do – make sure you do your homework vetting candidates to decide whether you think they’ll have the backs of utility executives and investors or ordinary Arizonans.