Will Humble Air Quality, Climate Change, Wills Blog

AzPHA Action Alert: Comment on EPA’s Heavy & Medium Duty Truck Emission Standards Rule by Friday

Urge EPA to Select ‘Option 1’ for Heavy Duty Trucks & Add A Particulate Pollution Standard

The EPA has proposed new vehicle emission standards for medium and heavy-duty trucks! That’s a good thing because the last medium and heavy-duty emission standards were established in 2002, light years ago technology wise.

This important rulemaking will help to clean up and help transition the transportation sector toward lower emissions of harmful air pollutants and greenhouse gas emissions. 

Because vehicles purchased will be on the road for many years, potentially two decades, it’s critically important to start setting standards now. 

Heavy-Duty 2027 and Beyond: Clean Trucks Proposed Rulemaking – (EPA-420-F-22-007, March 2022)

Comment on the Proposed Rule Here

Heavy-duty trucks and buses drive American commerce and connect people across the country. Creating cleaner trucks is an economic opportunity to support jobs and make more efficient vehicles while reducing harmful pollution. Heavy-duty trucks and buses continue to contribute significantly to air pollution at the local, regional, and national level, often disproportionally affecting communities of color and low-income populations.

A EPA’s “Clean Trucks Plan” will result in significant emissions reductions from new medium- and heavy-duty vehicles, improve air quality, and addressing the climate crisis. The regulatory actions that make up the Clean Trucks Plan are as follows:

  • Setting stronger nitrogen oxide (NOx) standards for heavy duty trucks beginning in 2027; and
  • Tightening the “Phase 2” greenhouse gas emissions in 2027 and beyond.

The proposed standards would significantly reduce emissions of NOx from heavy-duty gasoline and diesel engines and set stronger greenhouse gas standards for heavy-duty vehicles.

EPA is proposing two regulatory options. We’re asking AZPHA members to comment on the EPA rules and urge them to select Option 1, which will implement stronger NOx standards in two steps. The first improvement would be required in 2027 with a second more stringent standard 2031 (under Option 1 the 2031 NOx standard would be 90% lower than today’s standards).

We’re also urging our members to ask EPA to include emission limits on particulate pollution in addition to the NOx standards. As it stands, the current rule only sets new goals for NOx – not particulate matter. While cutting NOx emissions can cut particulate matter emissions including more stringent particulate standards will motivate engineers to ensure that both goals are achieved. 

EPA’s public comment period ends Friday, May 16, 2022. It’s important that public health weigh in on the Rule because industry is pushing back.

Comment on the Proposed Rule Here

Rule: Control of Air Pollution from New Motor Vehicles: Heavy-Duty Engine and Vehicle Standards; Extension of Comment Period

Will Humble Reproductive Health, Wills Blog

Arizona Abortion Statistics

Back in 2010 the state legislature passed a bill (SB1304) that required clinicians that provide abortion services to report certain data points to the ADHS and talked the agency with writing an annual report. Ever since, the agency has been developing annual reports. Here is the 2020 Arizona Abortion Report, the last report for which data are available.

The report contains more than 15 tables with various statistical and demographic characteristics of abortions performed in Arizona. For example, about 95% of abortions are performed at less than 15 weeks gestation, and important statistic considering that, beginning later fall abortions will likely be limited to those less than 15 weeks because of the signing of SB1164 (although it’s also possible that all abortions except those necessary to save the lifo of the woman would become illegal to provide).

Other meaningful charts in the report document the marital status of the women seeking the abortion as well as the self-disclosed reasons for seeking the abortion. About 4% of abortions were to protect the health of the mother, and Table 7 documents the various maternal characteristics for that category.

Arizona’s 2020 abortion report found that 1,218 of the 13,186 abortions provided in 2020 were among teens (9.3% of the total).  By contrast, 1,512 of the 11,438 abortions provided in 2010 were among teens (13.2%).

Will Humble Reproductive Health, Wills Blog

Arizona Abortion Rights In a Post Roe U.S.

All of you know by now about the draft opinion that leaked out of the U.S. Supreme Court suggesting that the court is seriously considering overturning the Roe v Wade case in its entirety. If that stands, it will remove constitutional protections for abortion rights and send the regulation of abortion to the states.

Naturally, that brings up speculation about what the impact might be in Arizona. If Roe is overturned, the impact will hinge on whether the newly signed SB1164 (restricting abortions to the first 15 weeks gestation) is the law of the land, or whether a territorial-era law from 1901 [ARS 13-3603] takes precedence.

13-3603. Definition; punishment

A person who provides, supplies or administers to a pregnant woman, or procures such woman to take any medicine, drugs or substance, or uses or employs any instrument or other means whatever, with intent thereby to procure the miscarriage of such woman, unless it is necessary to save her life, shall be punished by imprisonment in the state prison for not less than two years nor more than five years.

If courts determine that the new statute that Ducey just signed (limiting abortions after 15 weeks but not outlawing them before 15 weeks) (SB1164) has precedence [Chaptered Version], then abortion services will still be available in Arizona (at less than 15 weeks gestation). Because about 95% of abortions in Arizona occur at less than 15 weeks gestation, there will be little change for the majority of women seeking an abortion.

The thing is that SB1164 also says:

This act does not: Repeal, by implication or otherwise, section 13-3603, Arizona 20 Revised Statutes, or any other applicable state law regulating or restricting abortion. 

While I’m not a lawyer, it looks to me like SB1164 makes it clear that the territorial era law would take immediate effect… making all abortions illegal to provide unless it is necessary to save the woman’s life (punishable by 2 to 5 years in ADOC).

Note: A plain reading of 13-3603 suggests that even “Plan B” and Intrauterine Devices may become illegal if they are determined to be a “… medicine, drug, substance or instrument” that causes a miscarriage. We’ll cover how that could impact public health and poverty on Wednesday. Tomorrow I’ll Arizona’s abortion statistics.

Will Humble State Legislature

May 8 Legislative Roundup

There wasn’t much action in the state legislature this week- at least out in the open. It’s possible there were behind-the-scenes budget negotiations – but none of it has been transparent if it happened.

The only thing I weighed in on this week was a bill that would require group homes that provide services to folks with developmental and cognitive disabilities to be licensed by the ADHS (SB1308). Right now, those homes are generally just overseen by ADES (who is also the agency funding the services). We’re signed up in favor of the bill and I explained to a few legislators why last week.

There was no action on the other bills we’re advocating for or against, so I’ll just refer to last week’s update on that: May 2 Legislative Roundup – AZ Public Health Association.

As expected, Ducey signed SB1009 this week, restricting future governors & ADHS directors to 120 days of public health emergency authority (amending ARS 26-303). 

Editorial Note: Perhaps next time we have a public health emergency we’ll be lucky enough to have a governor and ADHS director that will actually try to save lives and use evidence to drive decisions using their (now diminished) public health emergency authority. Sadly, that didn’t happen this time around, at a great cost of life.

Will Humble Public Health Law, State Legislature

Legislative Roundup

There wasn’t much action in the state legislature this week- at least out in the open. It’s possible there are behind-the-scenes budget negotiations happening- but none of it has been out in the open.

The only thing I weighed in on this week was a bill that would require group homes that provide services to folks with developmental and cognitive disabilities to be licensed by the ADHS (SB1308). Right now, those homes are generally just overseen by ADES (who is also the agency providing the services). We’re signed up in favor of the bill and I explained to a few legislators why last week.

There was no action on the other bills we’re advocating for or against, so I’ll just refer to last week’s update on that: May 2 Legislative Roundup – AZ Public Health Association.

As expected, Ducey signed SB1009 this week, restricting future governors & ADHS directors to 120 days of public health emergency authority (amending ARS 26-303). 

Perhaps next time we have a public health emergency we’ll be lucky enough to have a governor and ADHS director that will actually try to save lives and use evidence to drive decisions using their (now diminished) public health emergency authority. Sadly, that didn’t happen this time around, at a great cost of life.

Will Humble Prevention

New Book: Healthy Aging Through The Social Determinants of Health

Healthy Aging Through The Social Determinants of Health

AzPHA Member  M. Aaron Guest, PhD, MPH, MSW; Elaine T. Jurkowski, PhD, MSW

People are growing older and experiencing a much longer life span than that of prior generations. Many people over the age of 60 are healthier today and living in place within their home-based communities with noninstitutionalized care. In addition, only about 5% of the older adult population is living in institutional care.

Despite this reality, the focus on older adults in much of the previous research has focused on institutional care. It is only within the last decade that we have begun to see publications related to healthy aging and community-based opportunities through the lens of public health. To date, there has been precious little attention to how we discuss and frame aging through a public health lens.

To this end, the Aging and Public Health Section of the American Public Health Association has worked to provide a seminal piece of work, this book on healthy aging, to help practitioners and public health professionals better prepare for their work with the older adult populations.

Section I of this book provides an overview of how the social determinant of health care and access to health care play a role in the course of healthy aging.

Section II on neighborhood and the built environment addresses the impact that neighborhood and different types of built environments have on the health and social outcomes of older adults.

Section III addresses the critical role that social support plays within the process of healthy aging. Social support, caregiving, and the role of these supports are important factors within the healthy aging process.

Section IV addresses education, access to education, and the impact of education on health outcomes and health literacy.

Lastly, Section V deals with economic and policy issues that play a role in the healthy aging process. Factors such as pensions, economic resources, and policies that shape these outcomes are discussed in this section.

You can order this important book through APHA
Print: Healthy Aging Through the Social Determinants of Health
E-book: Healthy Aging Through The Social Determinants of Health ($62)
Will Humble Professional Development

NAU Center for Service and Volunteerism Awarded $2.1M

NAU Center for Service and Volunteerism Awarded $2.1M to Build Public Health AmeriCorps. The money will support 50 AmeriCorps members to meet public health needs of local communities and help rebuild the nation’s public health sector. The project will help meet public health needs of local communities by providing surge capacity and support while also creating pathways to public health-related careers.

NAU’s College of Health and Human Services’ Public Health Program will provide paid internship opportunities for 50 students in their final semester of undergraduate coursework to increase public health capacity across the region, while helping to prepare the next generation of public health professionals.

For more information about AmeriCorps, CSV or Public Health AmeriCorps, please contact the NAU Center for Service and Volunteerism: [email protected] or 928-523-6395

Will Humble Health Equity

Maricopa County Invests $21M in American Rescue Plan Act Funds in Key Community Health Centers

Maricopa County awarded $21.4M in American Rescue Plan Act funds to 5 community health centers for capital improvements and renovations that aim to improve access to services for low-income residents. The work will be done in coordination with the Arizona Alliance for Community Health Centers.

The money is from the American Rescue Plan Act… and this is a really good way to use these one-time funds because these projects will improve infrastructure at key community health centers – paying long term dividends with improved access to care and outcomes.

Here are the projects that were funded:

  • Wesley Community & Health Centers will receive $7.5 million to support the development of a new “Central City” location to replace their original clinic at 1300 S. 10th Street near downtown Phoenix. The new location will allow the Wesley clinic to see an additional 3,500 to 7,000 patients each year.
  • Terros Health will receive $5.5 million for renovations at the Community Health Center at 4909 E. McDowell Road, in Phoenix. The renovation will include additional patient care rooms and waiting room enhancements that will help facilitate integrated care and expand access to primary care, opioid use treatment, HIV testing and prevention, and youth services for the 9,000 patients served as this location.
  • Neighborhood Outreach Access to Health (NOAH) will receive $4.1 million in funding to support the development of a large, new comprehensive Community Health Center at 8705 E. McDowell Road. The new location will serve as the new Cholla Health Center and allow for the consolidation of three existing sites by providing the space and operational efficiencies needed to continue to provide quality health care to over 16,000 individuals with low incomes in Scottsdale, east Phoenix, Tempe, and Mesa.
  • NATIVE HEALTH will receive $3.68 million to renovate a vacant business suite at their Southern Business Center at 777 W. Southern Avenue in Mesa. The renovation will facilitate the expansion of dental, optometry, podiatry, pharmacy, and telehealth services and generate an additional 4,200 patient visits over the first two years.
  • Valleywise Health will receive $656,000 for facility improvements at their Community Health Center at 950 E. Van Buren Street in Avondale. The facility upgrades will be implemented using evidence-based design and support a safe, effective, and efficient setting for the 5,000 patients served at this location.

These projects will help prepare Maricopa County to meet current and future public health crises, as well as daily health care needs. The Maricopa County Board of Supervisors approved spending priorities in ARPA funds that can be tracked on a public dashboard. 

Will Humble State Legislature

May 2 Legislative Roundup

As expected, Governor Ducey signed two harmful COVID-19-related bills last week. HB2616 and HB2498 restrict the ability of governmental entities to require mitigation measures, the first one on school masks and the second on vaccines. These are just two of several pieces of legislation related to COVID-19 this year. We expect additional bills to pass and be rubber stamped by Ducey in the coming days/weeks.

For example, the House gave their final approval to SB1009 last week. That bill will restrict future governors to 120 days of public health emergency authority (amending ARS 26-303). After that, the state legislature would need to reauthorize additional extensions (in 30-day increments). The bill also restricts future ADHS directors to the same authority timeframe (the ARS 36-787 authority).

Most governors protect the executive authority of their successors while they’re in office. Ducey has shown no such proclivity, and he will sign it this coming week. He already signed a bill very similar to SB1009 in last year’s budget (fortunately the AZ Supreme Court threw out that provision on procedural grounds). 

There was a snippet of good news last week. SB1162 opioid prescriptions; intractable pain; exceptions was signed, providing some exceptions from some of the restrictions in the 2018 Opioid Epidemic Act for persons in chronic/intractable pain was passed and signed into law: Chronic pain exception added to Arizona opioid law.

Still no sign of progress in the very important SB1716 which would move operation of the Arizona State Hospital out of the ADHS. The Superintendent would report to a 5 member governing board. This one is important because of the tremendous mission conflict with the current set up in which ADHS both runs and ‘regulates’ ASH (the fox watching the henhouse). It needs to be heard in House Rules and then go to the floor. Rules is meeting on Monday afternoon but sadly SB1716 isn’t on the agenda. 

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Bill Overview: Select Bills AzPHA is Supporting

Maternal/Child Health

SB1272 AHCCCS; postpartum care; eligibility; Passed Senate 26-2; Still needs House Rules and Floor Vote & Built into the Budget

Access to Care

HB2144 health insurance coverage; biomarker testing Passed House; Passed Senate Amended, Sent back to House

Special Needs

HB2157 supplemental appropriations; community-based services SIGNED

HB2113 developmental disabilities; Down syndrome SIGNED

HB2111 appropriation; healthy families program – Passed house 40-17; Waiting for Senate Rules Committee

Social Determinants

HB2060 supplemental nutrition assistance program; Passed House 44-15; Passed Senate Health 7-1. Still Needs Senate Rules & Senate Floor

HB2484 forcible entry; detainer; filing fee Passed House 59-0; SIGNED

Environmental

HB2255 fireworks use, limitations, prohibition Passed House. Ready for Senate Floor

State Hospital/Behavioral Health

SB1716 state hospital; governing board; governance Passed Senate 27-0; Still needs House Rules & Floor

SB1444 state hospital; administration; oversight Passed Senate; Passed House Health; Rules then Floor

SB1641 health care institutions; civil penalties Passed Senate 28-0. Failed in House Appropriations. DEAD

SB1162  opioid prescriptions; intractable pain; exceptions SIGNED

SB1210 mentally ill; transportation; evaluation; treatment; Passed Senate. Passed House (amended) and sent back to Senate

Bill Overview: Select Bills AzPHA Is Opposing

Vaccines/Disease Control

HB2086 ADHS; school immunizations; exclusions Passed House 31-28; Ready for Senate Floor vote

SB1009 state of emergency; executive powers Passed Senate 16-13; Passed House 31-27. Sent to Governor for an Inevitable Rubber Stamp

HB2453 mask requirement; prohibition Passed House 31-28. Ready for Senate Floor Vote

HB2616 mask mandates; minors; parental consent SIGNED 

HB2161 parental rights; schools; educational records On Governor’s Desk Waiting for Rubber Stamp

HB2498 COVID-19; vaccination requirements; prohibition. SIGNED

Social Determinants

SB1164 – abortion; gestational age; limit SIGNED

Government

SB1175– noncustodial federal monies; appropriation Passed Senate 16-13; Ready for House Floor 

Will Humble Early Childhood, Firearm Safety, Injury Prevention

Journal Article of the Week: Child Firearm Deaths Overtake Deaths from Car Crashes in U.S.

Crossing Lines — A Change in the Leading Cause of Death among U.S. Children | NEJM

Injuries are the most common cause of death among children, adolescents, and young adults between 1 and 24 years of age in the United States; indeed, injuries are responsible for more deaths among children and adolescents than all other causes combined. For more than 60 years, motor vehicle crashes were the leading cause of injury-related death among young people. Beginning in 2017, however, firearm-related injuries took their place to become the most common cause of death from injury (see graph).

This change occurred because of both the rising number of firearm-related deaths in this age group and the nearly continuous reduction in deaths from motor vehicle crashes. The crossing of these trend lines demonstrates how a concerted approach to injury prevention can reduce injuries and deaths — and, conversely, how a public health problem can be exacerbated in the absence of such attention. 

Research has shown that most injuries can be prevented by means of the manufacture and appropriate use of safe products and the implementation of policies reducing product-related danger and the occurrence of hazardous situations — the principles of harm reduction.

Since the 1960s, continuous efforts have been directed toward preventing deaths from motor vehicle crashes. As a result, there has been a substantial reduction not just in fatality rates, but in rates of serious nonfatal injuries associated with motor vehicle crashes, among people of all ages.

 In 2000, motor vehicle–related injuries resulted in 13,049 deaths among young people (13.62 per 100,000 persons). Twenty years later, there has been a nearly 40% decrease, with 8234 motor vehicle traffic deaths (8.31 per 100,000 persons) recorded in 2020.

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