We begin 1999 like we begin most new years: not altogether certain what changes the New Year will bring, but certain that there will be changes. Moreover, the fact that we are counting down to a new millennium seems to add another level of excitement and anticipation to our collective thoughts and dreams. And although the utopian visions of a fully automated and disease free "Life in the Year 2000" still elude us, we nonetheless find ourselves in the midst of unprecedented social and technological change.

As an association of physicians dedicated to assuring and improving public health, we must anticipate some of the changes that will likely affect -- or have the potential to affect -- the health of the people in our states and communities. As we look ahead through 1999 and into the next century, it is in fact technology that will drive our agenda. And insomuch as technology itself is neither good nor bad, it is the application of certain technologies -- most notably those having to do with the ability to alter DNA -- that both hold the promise of unprecedented healing, and pose the threat of unimaginable destruction.

In the news of late, and with increasing frequency it seems, is bioterrorism -- terrorist acts which involve the release of infectious agents or toxins into the population and environment. Genetic engineering technology, which is already making in-roads in treating hereditary disease, also allows viruses and bacteria to be made more infectious, more potent, and more lethal. Certainly, while we must be concerned with preventing a bioterrorist event, we must also be on the leading edge of understanding what such an attack would mean, and how public health systems might mount an effective response.

Part of the answer to that is also technological in nature. Specifically, I am referring to the Public Health Alert Network (PHAN) currently being developed by the CDC. The PHAN is a state-of-the-art communications and information network being put into place specifically to link federal, state, and local health authorities in the event of a public health emergency or crisis. The AAPHP has an active role to play in the development of this network, through working with local communities to assist its implementation, and certainly by keeping the issue before state and national lawmakers.

On a less technological though perhaps equally important note, the AAPHP in 1999 is working to identify a national headquarters, and to put funding mechanisms in place so that we might staff our association. Dr. Virginia Dato, a member of the AAPHP Executive Committee, has been instrumental in leading this effort, and I wish to both acknowledge her leadership and express my gratitude on behalf of AAPHP.

As in years past, we must continue our efforts to recruit physician leaders into our association. The AAPHP is not only for public health physicians, but also for any physician who believes in public health and wants to have a voice to advocate for it. Our voice grows to the degree our membership grows, and recruiting physicians who represent the multitude of disciplines that truly make up "public health" is to our mutual benefit. Likewise our leadership on developing physician training programs which integrate prevention, public health, and community leadership should be a priority in 1999.

Finally, we recognize that public health is, and continues to be, the foundation of individual and community health. The AAPHP is well on its way to becoming recognized as the voice of physicians who are dedicated to public health. We are leaders, and we must continue to be public advocates for public health locally, on the state level, and nationally. It is my hope that 1999 is a truly remarkable year for the AAPHP; I wish each of you a most happy and healthy New Year.

All members of the board of trustees and officers now have email. In addition, we the executive board communicates via conference call once per month and the full board has a second conference call. The email addresses are published on the last page.

For our official mailing address we have contracted with American Home Base, Inc.. Our official mailing address is AAPHP, MSC # 1720, PO Box 2430, Pensacola, Fl 32513-2430. Mail from that address is forwarded to one of the officers.

John Poundstone has been working diligently on our finances and is now handling all checks personally. He reports that we now have $25,914.84 in our bank account. However $13,274.68 is reserved for payment to the AMA for past administrative charges. We hope to decrease that amount. In addition, John is just now getting some of the bills for other essential services such as conference calls, mailing service for our home base, and this mailing.

With this bulletin, the 146 members paid for 99 are receiving a registration form for the conference. The 106 individuals who have not yet paid the 99 membership dues are receiving combined invoices/registration forms. An additional 60 individuals who were on old mailing lists will receive this as there last mailing since they are not noted as having paid for 98 or 99, unless they can show that they are lifetime members or rejoin.

There are many things that we would like to do but can not because of resource constraints. A new member form is on the back of the bulletin. Please give it to public health physicians that you know. If we increase our membership, we can increase what we are able to do. This is truly an organization of members for members. We hope as many members as possible can make it to our March meeting. Your voice will be heard.

Dear Mr. Race:

The American Association of Public Health Physicians wishes to take this opportunity to congratulate the Governor on his victory in November and wish him a most fruitful second term in office. In these difficult times, a productive future is often based upon the quality of the people appointed to carry out the important functions of government. Those of us concerned with the public's health are pleased that you and the Governor are considering many outstanding candidates for the position of State Health Officer, several of whom have distinguished careers in the leadership of public health organizations.

Leading a large state health agency requires more that a degree in medicine. The American Medical Association, the New York State Medical Society, and our organization all have policy which emphasizes the necessity that a state health officer should be a clinician with specialty training in public health and preventive medicine. He or she should also have had experience leading a public health agency. Without training, and in the absence of experience in health administration, only the most unusual physician will be able to survive the complex bureaucracy of government and be successful as the leader of the state health system.

I understand that several of the candidates you are considering have this background, have served as county or state health officials, having to balance political, administrative and medical issues when making decisions. We urge that when you choose the next health officer for the State of New York, you choose the most qualified public health trained physician available to lead your health department.

Thank you for your consideration. Sincerely,

Douglas Mack M D, MPH President, American Association of Public Health Physicians
cc: E. Ratcliffe Anderson, Executive Vice President American Medical Association

This petition, brought by seventeen hospitals and a bevy of anti-tobacco organizations, was to urge the court to block Pennsylvania acceptance of the multistate tobacco-industry settlement until certain provisions could be clarified.

The settlement, as read by the petitioners, basically eliminated their right to sue the tobacco companies for any damages or costs they might have

incurred due to tobacco-related illness or related issues. The PA Attorney

General read the settlement as simply prohibiting other public or non-profit

entities for suing the tobacco companies to recover the Medicaid moneys that the multi-state settlement was based upon. The petitioners were asking the court to clarify this issue, since they did not feel the Attorneys General had the right to take away their right to sue the tobacco industry for damages. In this action, the petitioners did not request any money, they just requested their legal standing to sue the tobacco industry, should they elect to do so, and to be able to collect the damages from the industry, rather than have their recovery taken out of moneys that would otherwise have been paid to the states. The PA action differed from similar legal actions in Texas, California and New York. Suits in those states, by similar parties, petitioned for a portion of the settlement funds.
The wording within the settlement, that was being challenged, is as follows: Section XII. SETTLING STATES' RELEASE, DISCHARGE AND COVENANT
(a)Release ( 1 ) Upon the occurrence of State-Specific Finality in a Settling State, such Settling State shall absolutely and unconditionally release and forever discharge all Released Parties from all Released Claims that the Releasing Parties directly, indirectly, derivatively or in any other capacity ever had, now have, or hereafter can, shall or may have, and Section II (pp) "Releasing Parties" means each Settling State and any of its past, present and future agents, officials acting in their official capacities, legal representatives, agencies, departments, commissions and divisions; and also means, to the full extent of the power of the signatories hereto to release past, present and future claims, the following:
(1) any Settling State's subdivisions (political or otherwise, including, but not limited to, municipalities, counties, parishes, villages, unincorporated districts and hospital districts), public entities, public instrumentalities and public educational institutions; and
(2) persons or entities acting in a parens patriae, sovereign, quasi-sovereign, private attorney general, qui tam, taxpayer, or any other capacity, whether or not any of them participate in this settlement,

1. for past conduct, acts or omissions (including any damages incurred in the future arising from such past conduct, acts or omissions), those Claims directly or indirectly based on, arising out of or in any way related, in whole or in part, to
2. (A) the use, sale, distribution, manufacture, development, advertising, marketing or health effects of,
   (B) the exposure to, or
   (C) research, statements, or warnings regarding, Tobacco Products (including, but not limited to, the Claims asserted inthe actions identified in Exhibit D, or any comparable Claims that were, could be or could have been asserted now or in the future in those actions or in any comparable action in federal, state or local court brought by a Settling State or a Releasing Party (whether or not such Settling State or Releasing Party has brought such action)), except for claims not asserted in the actions identified in Exhibit D for outstanding liability under existing licensing (or similar) fee laws or existing tax laws (but not excepting claims for any tax liability of the Tobacco-Related Organizations or of any Released Party with respect to such Tobacco-Related Organizations, which claims are covered by the release and covenants set forth in this Agreement);

(3) for future conduct, acts or omissions, only those monetary Claims directly or indirectly based on, arising out of or in any way related to, in whole or in part, the use of or exposure to Tobacco Products manufactured in the ordinary course of business, including without limitation any future Claims for reimbursement of health care costs allegedly associated with the use of or exposure to Tobacco Products.

This wording, to the petitioners, seemed to effectively eliminate the possibility of any future civil litigation against the tobacco industry. On January 14, Judge Herron of the Philadelphia Common Pleas Court rejected the petition, in its entirety. This paves the way for Pennsylvania to participate in the multistate settlement. The original petitioners are now considering whether or not to appeal. Joel l Nitzkin MD

Article VIII Section A. – change the word "shall" to "may" in the sentence "The Board of Trustees shall select an Executive Manager"

Add Article VIII. Section F. In the event that the executive manager position is vacant, the individual officers shall fulfill without the assistance of the executive manager, those duties assigned to them in Article VII Duties of officers. Support personnel may be engaged as necessary and approved by the Board of Trustees. The role of Parlimentarian will be designated by the President as appropriate. Other duties listed under Article VIII - Executive Manager may be delegated by the president as necessary with support personnel engaged as necessary and approved by the Board of Trustees.

Remove Article XI Section B (which refers to maintaining our headquarters with AMA )

Re-letter sections C to B. and. D to C in Article XI

In Article X Section D change the word Secretary-Treasurer to Treasurer.

I. Article I -Name and Definition of "Public Health Physician"

A.The name of the organization shall be the American Association of Public Health Physicians

B. Definition:

For purposes of AAPHP membership, the term "Public Health Physician" shall be taken to mean a physician dedicated to helping guide a community, agency, health organization, medical office or program in pursuit of group or community health goals." This shall include but not be limited to, physicians who plan, provide and administer public health and preventive medicine services in public, private or voluntary settings.

Article II - Mission, Motto and Objectives

A. Mission:

· Advocacy for public health issues and services

· Advocacy intended to create an environment in which physicians contemplating a career in public health can anticipate job opportunities rich with quality offerings, stability of employment and portability of retirement benefits.

· Fostering communication, education and scholarship in public health.

B. Motto:

The Voice of Public Health Physicians, Guardians of the Public's Health

C. Objectives

1. Advocate for public health and preventive services

2. Advocate on behalf of Public Health Physicians

3.Serve as a forum for Public Health Physicians, and by doing so, strengthen sense of "community" and facilitate exchange of ideas among geographically dispersed Public Health Physicians

4.Provide and facilitate career enhancement support services for Public Health Physicians

5.Serve as the voice of Public Health Physicians to the American Medical Association (AMA), sister public health organizations, news media, government and the general public

6. Facilitate recruitment and retention of Public Health Physicians into the AMA

3. Article III – Membership

A. Eligibility for Dues Paid Membership, by Category:

1.Period of Membership is January 1 to December 31 of each year, renewable by payment of dues appropriate to designated category of membership.

2.Any member in arrears for a period of twelve (12) months shall be dropped from membership.

3. Regular Member: Physician (MD, DO. or international equivalent thereof) licensed to practice medicine and surgery in the United States, willing to self-designate as a Public Health Physician" as defined in these bylaws. In cases with questionable credentials eligibility for membership shall be decided bv the Executive Committee.

4.Resident/Physician-in-training: physicians who are residents in an allopathic or osteopathic training program approved by a nationally recognized aecrediting agency.

5.Student: medical student enrolled in an allopathic or osteopathic medical school approved by an appropriate acerediting agency.

6.Retiree: any public health physician retired from active practice.

7.AAPHP shall reserve the right to withhold membership from any applicant who does not meet the membership criteria specified above. This provision shall not obligate AAPRP to check credentials of applicants.

B.Non-Dues Membership:

1.Honorary a)A physician may be elected to Honorary Membership by a majority vote of Officers and Trustees, following nomination for this honor by those attending any General Membership meeting.

b)Physicians who are not currant members of AAPHP, but who are pro-eminent in public health or preventive medicine or have achieved outstanding public health accomplishments may be considered for Honorary membership.

c)Honorary membership shall be a lifetime designation, unless revoked or resisned. Honorary members shall not pay dues and may not hold office or vote.

2.Lifetime

Any regular or retired member may become a lifetime member by one-time payment often (10) times the current non-discounted annual dues in his or her current membership category.

C.General Membership Meetings

1.The Annual General Membership Meeting shall take place in conjunction with the annual "Prevention meeting"

2.A meeting of the General Membership shall also take place in conjunction with the annual meeting of the American Public Health Association (APHA)

3.Additional meetings of the General Membership may be held at the discretion of the Board of Trustees

IV Article IV - Board of Trustees

A,The Board of Trustees shall consist of the Officers and the ten Trustees. The President shall serve as Chairperson. The Vice President and Secretary shall serve as Vice-Chair and Secretary, respectively. The Board of Trustees shall conduct the business of the Association between annual meetings and shall report its actions to the full membership.

B. The Board of Trustees shall have complete charge of property and financial affairs of the Association, and shall perform such duties as are prescribed by law governing the directors of corporations, or as may be prescribed by the by-laws.

C. The Board of Trustees shall meet at least four (4) times per year. Such meetings may be in person, by telephone conference call, or by any other means of communication.

V. Article V - Executive Committee

A. The Executive Committee shall consist of the Officers of the Association.

B.The Executive Committee shall establish the agendas for the Board and General Membership meetings.

C.The Executive Comminee shall have the authority to act on behalf of the Board between Board meetings.

D, Actions of the Executive Committee shall be subject to ratification at the next Board Meeting.

VI.Article VI - Officers and Trustees

A.The officers of the Association shall be President, Vice President, Immediate Past-President, President-Elect, Secretary, Treasurer, Delegate and Alternate Delegate to the AMA House of Delegates.

B.Nominations: The President-Elect shall chair the Nominating Committee. The Nominating Committee shall include at least two other members, chosen by the President Elect.

C.Terms of President, President Elect and Immediate Past President

1.The President shall take office at the Annual General Membership Meeting in even numbered years to serve a terrn of two (2) years.

2.A President Elect shall be elected at the Annual General Membership Meeting in even numbered years to serve a term of two (2) years.

3.Upon seating of a new President, the current President shall become Immediate Past-President. He or she shall retain this position until replaced by a new Immediate Past-President.

D.Elections and terms of other elected officials

1.A Vice-President shall be elected and take office at the Annual General Membership Meeting in even numbered years to serve a term of (2) years. A Vice President may serve multiple consecutive two (2) year terms.

2.The Secretary and the Treasurer shalt be elected and take office at an Annual General Membership Meeting to serve a term of (3) years. The Secretary and the Treasurer may serve multiple consecutive three (3) year terms.

3.Trustees shall be elected to three (3) year terms, with three or four to be elected at each Annual General Membership Meeting. A trustee shall not serve for more than two (2) full consecutive terms, excluding unexpired terms of less than three (3) years, and excluding any time served as another elected official of the association

4The AMA Delegate and Alternate Delegate

a)Shall be elected at an Annual General Membership Meeting to serve a terrn of two (2) years. Delegate and Alternate Delegate may serve multiple consecutive two (2) year terms.

b)The Delegate and Alternate Delegate must be members of the AMA.

E.Successor to the President

1.If the office of the President becomes vacant, the President-Elect shall become President and serve the unexpired term of the President, plus the turn the President-Elect was originally elected to fill. If a vacancy exists in the office of President-Elect, the Vice-President shall serve as President-Elect until the next Annual Meeting. If all three positions are vacant, the Secretary shall act as President until the next Annual Meeting.

F.Successor to other Officials

1.If any of the other officer positions are vacated before the end of the specified term, the President shall appoint a currently sitting trustee or Appointee to fill that position until the next Annual Meeting.

2.If a Trustee position is vacated mid-term, that position shall remain vacant until a successor can be elected to fill the unexpired term at the nest Annual Meeting.

3. An individual person may occupy up to two (2) elected positions within the Association,

G.Election Process

1.Elections shall be held at Annual General Membership Meetings.

2.The slate shall be presented by the Nominating Comminee

3.Any election involving more than one (1) nomination shall be by secret ballot. A majority of votes cast shall be necessary to elect, where there are more than two (2) nominees, and none receive a majority of votes cast on the first ballot, a runoff vote shall be held between the top two. In case of tie votes, additional balloting shall be done until a single individual receive a majority vote.

VII. Article VII- Duties of Officers

A.President

1.The President shall preside at all General Membership, Board of Trustees and Executive Committee Meetings.

2.The President shall appoint all Committee Chairs and Appointees not otherwise specifically assigned in these bylaws.

3. The President shall supervise the Executive Manager

4.The President shall be co-editor of the Bulletin

5.The President shall represent the Association to other groups, organizations and individuals, except as otherwise specified in these bylaws, and shall conduct such other duties as may be appropriate for the conduct of the business of the Association,

6.The President shall act on behalf of the Board and Executive Committee between meetings.

B.President-Elect

1.The President-Elect shall assist the President in conducting the affitirs of the Association.

2.The President-Elect shall chair the Nominating Committee.

.3,The President-Elect shall serve as President in the temporary absence of the President and Vice President

C.Immediate Past President

1.The Immediate Past President shall otherwise serve as if a Trustee

D.Vice-President

1,The Vice President shall chair the Membership Recruitment, Program and Bylaws Committees

2.The Vice President Shall Chair the General Membership, Board of Trustees and Executive Comminees, in the absence of the President

3,The Vice President shall assist the President and President Elect in conducting the affairs of the Association.

4.The Vice President shall serve as President in the absence of the President.

E.Secretary

1.The Secretary, with the assistance of the Executive Manager, shall keep up-to-date membership rosters for all categories of Association membership.

2.The Secretary, with the assistance of the Executive Manager, shall generate and maintain minutes of all General Membership, Board and Executive Comminee meetings.

3.The Secretary, with the assistance of the Executive Manager, shall maintain all other Records of the Association.

4,The Secretary shall serve as President, in the absence of the President, Vice President and President-Elect.

F.Treasurer

1.The Treasurer, with the assistance of the Executive Manager, shall have the care and management of the fiscal affairs of the Association, and shall keep a record of all monies received and expended.

2.The Treasurer shall oversee the financial matters of the Association, and shall give written approval and authentication to Association checks.

3. The Treasurer, with the assistance of the Executive Manager, shall prepare present up-to-date financial reports at every meeting of the General Membership and Board of Trustees.

4. The Treasurer, with the assistance of the Executive Manager, shall present an annual budget, with recommendations for dues by membership category, at the Board of Trustees meeting immediately preceding the Annual General Membership Meeting.

H.Delegate to AMA House of Delegates

1.The Delegate shall represent the Association to the AMA House of Delegates and the AMA Section Council on Preventive Medicine, or its successor.

2 .The Delegate shall Chair the Resolutions, Policy and Legislation Committee.

I. Alternate Delegate to AMA House of Delegates

1.The Alternate Delegate shall assist the Delegate with all the responsibilities of that position.

2.The Alternate Delegate shall serve as Delegate, in the absence of the Delegate.

VIII. Article VIII - Executive Manager

A.The Board of Trustees shall select an Executive Manager; who need not be a member of the Association, to serve as chief Administrative Officer of the Association, assist the Secretary and the Treasurer with all responsibilities of these offices, and maintain the Association's Headquarters Office. Once appointed, the Executive Manager shall serve until removed or replaced.

B.The Executive Manager shall have charge of the headquarters office and shall employ such assistants and office staff as may be determined by the Board of Trustees. He and his assistants and the office staff shall receive compensation and travel allowances' and be covered by such insurance as may be determined by the Board of Trustees by agreement with the agency serving as host to the headquarters office.

C.The Executive manager shall have authority to write checks and manage the financial affairs of the Association, under the direct supervision of the Treasurer.

D.The Executive Manager sha1l serve as co-editor of the Bulletin, with the President and whoever the President designates.

F.The Executive Manager shall serve as Parliamentarian at all Executive Committee, Board and General Membership meetings.

IX Article IX - Appointments and Committees

A.Except as otherwise specified in these bylaws, all appointments are by the President and serve at the pleasure of the President

1.All appointees must be dues-paid members of AAPHP

2.All appointees shall be ex-officio members of the Board of Trustees. They shall participate in Board meetings, but not vote.

B. The following appointments shall be made by the President:

1.Chair and members of Awards Committee

2.Liaison member to the American College of Preventive Medicine (ACPM) Board of Regents

3.Liaison to National Association of City and County Health Officials

(NACCHO)

4.Liaison to the Center for Community Responsive Care (CCRC)

5. Any others, as may seem reasonable to the President

C. Standing Committee Appointments and Chairmanships Specified in Bylaws

1.Public Policy, Resolutions and Legislative Committee - to be chaired by Delegate to AMA House of Delegates

2. Nominating Committee - to be chaired by President Elect

3.Membership Recruitment Committee - to be chaired by Vice-President

4.Newsletter Co-Editors President and Executive Manager and others appointed by the president

5.Program Committee for semi-annual General Membership meetings -to be chaired by the Vice-President

6. Bylaws Committee - to be chaired by the Vice President

X Article X - Financial Matters

A. Funds Raised - Funds may be raised by annual dues or assessments upon the members upon recommendation by the Board of Trustees. Funds may also be raised from publications of the Association and in any other manner approved by the Board of Trustees. Funds may be appropriated by the Board of Trustees to defray expenses of the Association to carry on its publication, to encourage scientific investigations, and for any other purpose approved by the Board of Trustees.

B.Membership dues - Dues shall be established by the Board of Trustees, then approved by the General Membership, at the annual General Membership meeting.

C.Special Assessments - Special assessments may be leveled only after specification of the amount and purpose, by category of membership, by the Board of Trustees, and by a majority of the membership voting at the Annual General Membership Meeting or a majority of the membership voting by mail at any other time of year.

D.An annual Budget shall be recommended to the Board of Trustees by the Secretary-Treasurer, at the Board meeting immediately proceeding the Annual General Membership Meeting, then approved by the General Membership anending the Annual General Membership Meeting.

E. Expenditures shall be managed by the Executive Manager under the direct supervision of the Treasurer

XI Article XI - Relationship with American Medical Association (AMA)

A.AAPHP is a National Medical Specialty Organization. as defined in Section 8 of the AMA Bylaws, with all the rights and responsibilities of such designation, including representation in the AMA House of Delegates.

B.AAPHP, in accordance with the agreement secured with the AMA in October 25, 1996, shall maintain its headquarters office within the AMA Headquarters at 515 N. State Street, in Chicago, and secure office support and staff from theAMA.

C. AAPHP Shall

I.Attempt to retain "unified" status within the AMA, as agreed October 25, 1996, for purposes of being able to offer AAPHP dues to AMA members with a discount equal to 100% of AMA dues

2.Pursue the goal of 100% AMA membership among AAPHP members

D.Young Physician Section

1.To allow for regular input of young physician views into the issues before AAPHP, at least one Trustee seat on the Board of Trustees shall be filled by a physician less than age 40 and in active practice having completed residency and/or fellowship, or be of any age if within the first five years of practice, and be a member of the AMA in good standing.

2,The Young Physician Trustee shall be elected by the AAPHP General Membership, as specified in Article VI of these Bylaws.

3.AAPHP Young Physicians, meeting the qualifications noted in Section XII D 1, above, and present at the AAPHP Annual Meeting, shall elect, from within their membership, both a Delegate and Alternate Delegate to the AMA Young Physicians Section.

XIIArticle XII - Rules of Order

A.All Association meetings shall be governed by Roberts Rules of Order.

B.The Executive Manager shall serve as Parliamentarian at all meetings of the Association.

XIIIArticle XIII- Amendments

.These bylaws may be amended by a two-thirds vote of members present at any Annual Meeting, provided that written notice has been sent in advance of the Meeting. Publication of such notice in the Bulletin of the Association shall be considered as compliance with this requirement.

MINUTES of the November 14th, 1998 General Membership Meeting

Attendance: John Poundstone, Joel L. Nitzkin, Stanley Reedy, Alfio Rausa, Laura Kahn, Virginia Dato, Douglas Mack, CMG Buttery, William Keck, Mary Ellen Bradshaw, Jonathan B. Weisbuch, Anand Chabra, Stephanie Brundage, Hugh Fulmer, Jeqemiah Evans, Jim Felsen,E. Safran, M. Safran, David Cundiff, M. Salive,R. Maeshiro, Charles Konigsberg, Rene J. Sanchez, Norma Melendez, Tisha Dowe, Melinda Rowe

The meeting was called to order at 9:05. The meeting began with introductions of all members. The minutes from the previous general membership meeting were approved as written with one revision.

Correspondence - Dr. Mack called everyone's attention to a letter from Dr. Anderson that was distributed at the meeting in which he notify us of the AMA intent not to renew the administrative service agreetment with AAPHP that expires 12/98. They would maintain the unification agreement. Dr. Rausa asked about the 10 percent dues reduction for AMA-AAPHP members and suggested that we ask for at least one mailing from the AMA. Dr. Nitzkin stated that AMA was concerned about the slippage of membership and therefore saw unification as a means to improve AMA membership among public health physicians. In exchange the AMA agreed to provide us with the 10% of AMA dues ($42.00) which we used to lower our dues for AMA members. In addition they also agreed to provide administrative services for a monthly fee. Unfortunately we never got the support needed to purse our aggressive agenda.

The second letter that Dr. Mack verbally shared was an invitation to the AMA President’s forum being held in July of 1999. At this time the AMA is looking for input on the agenda. The President and President elect were both invited. Dr. Nitzkin suggested that a session on the integration of health care and prevention be placed on the agenda. Dr. Buttery reported that supplementary insurance does not pay for prevention for a regular checkup with the exception of some very specific items. None of the health plans reimburse for counseling. Dr. Liz Safran suggested that there were ways to bill for preventive efforts. Another member noted that there needs to be better software for clinical preventive medicine. Dr. Rausa suggested a taskforce be created. Dr. Felsen described the many organizations that are already involved in this issue. It was determined that this would be a good topic for prevention.

A third piece of correspondence was a letter from John Eisenberg asking for help for the national guidelines clearing house. Dr. Nitzkin suggested that we can be "wired in" to be part of practice guidelines. Dr. Maeshiro mentioned that partnership development is started. Dr. Bradshaw mentioned that she is on a committee with the focus of medicine and public health. Discussion again drifted to information needs with a variety of problems that need to be addressed. The problems are technical, administrative and political. Dr. Safran volunteered to attempt to coordinate a session at Prevention 99 on this topic. Dr. Weisbuch mentioned that this should also be listed as a resolution. A motion was made that we draw together a group of people to develop a theme for a session on the linkage of information. After additional discussion the motion carried unanimously with no abstentions.

Financial reports – Dr. Poundstone reported on our financial status. He reported that we have a balance in our bank account of $23,000 but that we owe the AMA for expenses incurred (including our agreed fee for administration) of $28,000. However that is offset by a credit of $14,000 from the funds generated by the 10% unification supplement. This would leave use with a balance of about $9000 before expenses for this meeting.

This now moved into a discussion of our need for administrative support for our organization. Dr. Mack contacted NACCHO and the Public Health Foundation. Unfortunately, one of NACCHO’s continuing grants just got significantly reduced and they may not be able to assist us. The Public Health Foundation felt that they would probably not be able to assist us since it was not a part of their mission. A member asked if ACPM was approached. They had been approached in the past but not recently. Another member suggested that a health officer might receive a grant to run it from a Health Department. Dr. Dato reported that Dr. Walter Tsou, a member unable to attend, suggested via email that a retired member with good computer skills take on the responsibility. Dr. Buttery suggested that ACPM should be our home, however, Dr. Nitzkin suggested that we do not want to be subservient to them. In addition, in the past at least, ACPM was only interested if we pulled the full freight plus a little extra. Dr. Rausa spoke about NACCHO and suggested APHA as another group to look at. There was also a suggestion that a state medical society might work. Dr. Dato pointed out that with relatively low dues and between 200 to 300 members we had limited income. Dr. Nitzkin said that we had developed a mission, and strategic plan. If we could do a really good job with recruiting we should be able to get a membership of 500 to 600. We might even to get up to 1000. If we could get kick started with staff support we could begin to apply for outside grants. Therefore the current income situation was not seen as static. Dr. Kahn suggested that we need to become more visible. Dr. Buttery mentioned that we need to do our own web page. The visibility is not there. There are a lot of physicians in NACCHO. The mailing was effective and so was the job session in 1998. Dr. Marc Safran suggested we need a better brochure and that in our mailings for bi-annual meetings, we focus on "The Voice of Public Health Physicians, Guardians of the Public’s Health". There was a suggestion that members of the board should each recruit at least 5 people by Prevention99. As a new member Dr. Felsen found the last membership recruitment mailing different and more substantive then previous mailings. Other organizations have no understanding of the concept of public health and he was looking for a group that was mission oriented.

A suggestion was made that we hire Dr. Buttery to put together a package for administration. There was another suggestion to dedicate twenty five hundred dollars to put together a package and to put this out to members for a bid. A motion was made to request Dr. Buttery and Dato to develop criteria and procedures for out-sourceing our organizational staffing and support, with the understanding that this would not preclude either or both of them from subsequently taking on a paid position on our behalf. And to authorize the board to act on our behalf between meetings, to make final decisions on meetings, to make final decisions on appropriate staffing and support. The motion unanimously by voice vote.

AMA report. Mary Ellen referred to a report that was given out at the meeting. Some of the highlights included the election of Dr. Anderson as executive VP and the first women president (Dr. Dickey) in the 150 years of the AMA. Two of our resolutions were reaffirmed. Transferable Pension Benefits for Public Health Professionals and no special protection for tobacco company owners or associates. A third on the "Current Knowledge of Early Brain Development – Implications for Medical Practice and Public Health and Social Policy (or the End is Determined by the Beginning) was referred to the board of trustees who will report back in A-99. The board report will be on the AMA web site where a report on asthma is present.

Next there was a discussion of patient privacy and confidentiality. The members were referred to in the June 28th issue of AMA news. Dr. Weisbuch felt that there were three areas of concern which were not appropriately addressed in the Board of Trustees Report 9 Patient Privacy and Confidentiality. Those areas were epidemiology, quality control and public health access to data. For example he pointed out that under principles pertaining to public health, access to data is allowed "only under specified statute and only after a showing of compelling public health need." Patient's privacy must be honored unless waived in a specific way or in rare instances when strong countervailing interests justify invasion or breaches. Our AAPHP delegates spoke against passage because of these issues. Despite this, the Board of Trustees Report 9 – Patient Privacy and Confidentiality, was adopted.

There was substantial discussion by the members about these areas. It was felt that a resolution for the next AMA meeting might be appropriate. Points brought up in the discussion included the point that the AMA should not be developing policy that interfered with the State’s duty to protect the public health. The Public Health communities’ need for prompt information was discussed along with some ways that local health officers develop good relationships with local physicians in to obtain needed data in a prompt manner. The needs of epidemiology and managed care were also discussed since they are a grey area between clinical medicine and public health. There are also problems with the grey areas of managed care and epidemiology. A list was circulated of individuals interested in working on these issues.

The last part of the AMA meeting discussed was the section council. Ron Davis is running as a delegate of the board of trustees. The Section Council on Preventive Medicine will be 25 years old. This lead to a discussion of the history of our organization. Dr. Rausa was reported to have some of the materials and will be reviewing them for the next meeting.

Dr. Cundiff gave the tobacco update. We have been leaders in the area of tobacco control with a goal of retaining legal accountability of what has done. We have had major success with support of resolutions. Most of our role at the interim AMA meeting was to say thank you. There is a wonderful summary in the upcoming public health reports. The McCain bill in the senate was amended to get rid of immunity. Tobacco opposed the bill once immunity was removed. The bill did not pass, however since no immunity deal was pushed down our throats, this is considered to be a good thing. There seems to be a dichotomy between two very sincere factions, one says if you can't get paid for it you can't do it. These folks are located in larger groups with well-funded administrations. They are grant seeking. The other group is unwilling to compromise for better funding. These are local groups that have been tackling tobacco on every level with minimal funding. These smaller groups are united and are skeptical about the agreements. They like litigation because it gets the truth out. AAPHP has been very successful in using our name to support this second group. Dr. Nitzkin reported that one major activity is consuming all of our time. A 100-page agreement between the states and the tobacco companies will be shared on Monday with the AG's in 46 states. They will be given 1 week to sign on. There was a release of a nine-page summary. The old polarization has come to the fore again. Some organizations want to focus attention on getting our support. There will be a tobacco fly in on November 24th. The topic will be how to get money. The nine page summary stressed a number of issues that are good, however when you read it closely there are hooks and barbs that take it back. It will not allow advertising larger than a poster in video arcades. They will not market their products to kids. They will have a moratorium on selling single cigarettes until March of 2001. The way the payments are structured under the settlement, the amounts grow 5 to 10 years out. We need a resolution to get a 30-day comment period. We can't adopt a policy of divvying up the money. We have to directly approach the issue. The alternative to the National settlement is single state litigation. We need to elaborate on this policy. One of the bad things about the settlement is that there is no one to oversee it. We need to deal with tobacco in the realm of addictive studies.

Another issue raised was the problem of getting our Young Physician Delegate credentials to the next AMA meeting. As of the last AMA meeting, the AAPHP YPS delegates were not formalized and we must work on formalizing this. Dr. Tuckson joined the meeting at this point in preparation for his noon lecture. He agreed to assist us with the credentialing process. Dr. Liz Safran then provided a proposal for Prevention 99 Program on Issues of Information Linkages between Health Departments and Clinical Physicians. The session would include a visionary overview on long-term benefits and potential linkages between health departments and clinical physicians, practice aspects of medical record confidentiality both with computers and on paper, public domain resources related to software and data elements to promote health information sharing and the conduct of clinical epidemiology and practical examples of the benefits and potential benefits of health information sharing between health departments and clinical physicians by a physician who has worked on both sides of the fence. There was uniform agreement that Dr. Safran should proceed with this submission to Prevention 99. The meeting adjourned until after our luncheon speaker Reed V. Tuckson M. D., AMA Group VP for Professional Standards and our Panel: Current Hot Topics for Public Health Physicians: Impact on Practice, Policy and Resources with Georgia Dunston Ph.D. Department of Microbiology, Howard University College of Medicine, Deborah R. Maiese, Senior Prevention Policy Analyst, ODPHP, DHHS, and Marcia S. Mabee MPH Dh.D, President Timothy Bell& Co., Nat’l Health Policy consultant.

Afternoon portion of the meeting -

Dr. Mack asked Dr. Nitzkin to facilitate the afternoon discussions. Preventive Medicine Residency Program- Hugh Fulmer, MD, MPH Executive Director of the Center for Community Responsive Care (CCRC) and AAPHP member talked an innovative national public health residency run by the CCRC. The residency grew from a program of community oriented primary care at Carney Hospital in Boston. A major component has been multidisciplinary teams. The demonstration was successful to the point that Kellogg asked them to replicate the model elsewhere. The next step was to leave the hospital where there was a whole new process of accreditation. CCRC managed to get provisional accreditation as an experimental residency. They are now up for re-accreditation and have a major funding problem since they are no longer part of a teaching hospital and are not able to get GME funding (direct or indirect). With the balanced budget law, regulations have been modified. Now non-hospital entities including federally qualified and rural centers can get GME funding but only the direct portion. Unfortunately this new funding also depends upon the number of elderly persons being cared for. CCRC would like to develop the residency program through health departments or other agencies interested in integrating medicine and public health. Residents would be trained in teams as part of the community health improvement process. Dr. Mack talked about his own community 4 500 bed acute hospital that has been the recipient of GME funding. They have 300 graduate medical education slots. The board agreed that putting aside 2 residency slots made sense. They pulled together a taskforce. It would be great for that to be redistributed nationally. Michigan has clear requirements for public health physicians. They have no pool to replace public health physicians who retire. The model has been tested.

We need some implementation of the model. Dr. Nitzkin asked about the distance learning mode. How would you assess the resident at a remote site? What is the carrying capacity at the central location? There would need to be local field faculty. In a program what is the cost per resident of physician faculty time. Dr. Fulmer stated that the design is applied public health training. The signature is that every fellow learns the community process or COPC process. The faculty is adult learning taking place in the community. It does not require a lot of traditional faculty. What is the cost for the given resident? There is an overhead need of $30, -$40000 per student. Each field site would have to start with one resident and examine to see if you can go further with it. There is a lot of adjunct faculty. There is real cost to the faculty. Dr. Nitzkin pointed at the time of the faculty at the remote site is also important. Dr. Fulmer stated they were designated the only experimental residency. Currently Dr. Keck has a third year resident. There are others who are also interested in hearing this setting. They would have to judge the quality. Dr. Weisbuch in Phoenix could not have a residency for reasons unrelated to the program. Dr. Weisbuch raised the issue of the difference between a third year resident and someone less experienced. He expects that you evaluate the individual based upon the process and described one way that you could evaluate epidemiology. His only current experience is with medical students but with in the context of a health department, the amount of time that each person would spend would be around 4 hours or 10%. There is a return on the investment as well since residents help carry out programs. The RRC has a set of questions that must be answered for full accreditation. CCRC is accredited as a preventive medicine in public health. Dr. Safran handed out a resolution for the AMA supporting the CCRC.

A motion was made that the four resolves in the resolution passed out by Dr. Liz Safran be submitted to the AMA. There was further discussion of the resolves and the needs of CCRC. The Journal of Academic Medicine has just accepted a paper on the project. The first goal is engage the community. The community is involved from the outset. The program is in need of new funding in order to continue beyond 12/98 and that some method of funding is needed in the resolution. Dr. Felsen suggested that the AMA goals for medicine and public health added to the resolution. Dr. Fulmer needs $200,000 to keep going through June 30, 1998. Dr. Fulmer also used the term "bridge" physician as someone who can bridge medicine and public health. The motion was amended to allow Dr. Liz Safran, Dr. Mack and the AMA delegates to craft resolutions expressing our full support. All approved with the exception an abstention of one individual who felt unable to participate in the vote because of federal employment.

Next a discussion on accreditation of local and state organizations was made. Weisbuch suggested a short note that the AMA works with relevant organizations to accredit local and state organizations. Dr. Felsen suggested that this is an area we should not move into since the constitution gives power to the states. Dr. Kahn pointed out NJ is now more regulatory. About 35 states still have a health officer as Florida has established a basic core process. Some argued that there ought be accreditation standards for local community health. If you measure it will be done. Dr. Dowe thinks it is important that standards be passed. Dr. Nitzkin indicated a need for infrastructure. Dr. Weisbuch suggested that the AMA should follow the previous voted policy of the House of Delegates and write letters to new governors suggesting they appoint MD MPH. Dr. Felsen agreed that there should be standards for doing things but that they should be voluntary. There may be a role for our organization. We should analyze current regulations and then send it to governors and state medical societies. Dr. Rausa suggested that we might be able to get a CDC grant. And that could start this process. It was suggested that the president appoint a committee to exam funding and present the report in 99. Resources are needed. If you have good training you don't need an accreditation process. You need a measurement process to define what you have to do. Dr. Kahn, Felsen and Nitzkin volunteered to address this issue.

It was pointed out that since we are a 503 organization we could apply for foundation money. CCRC is already a 501C however a national organization is needed to go the distance. A motion was made that Drs. Mack, Fulmer and Felsen develop ideas for AAPHP to work with CCRC in a more formal manner. The motion passed with one abstention from a federal employee. A motion was made to adjourn and was seconded. Dr. Bradshaw noted that she would like to work with NACCHO and that one of our meetings should be at the NACCHO/ASTO combined meeting. It was also announced that there would be a meeting at 4PM on GME funding in the lobby of the Metro Marriott. The meeting ended at approximately 6 PM

ANNUAL HOUSE OF' DELEGATES MEETING - CHICAGO JUNE 1998

The tone of the 147th Annual Meeting of the American Medical Association House of Delegates (HOD), June 14 -18, 1998 was a mixture of skeptical expectation and cautious optimism, ultimately ending on a positive note.

Notable activities of the four day meeting included:

* an 11 page report by the select seven physician HOD member Ad Hoc Committee to Study the Sunbeam Matter, appointed by the Speaker as per the December 1997 action of the HOD

* a last minute challenge to the nominee for President-Elect,Thomas R. Reardon, M.D., by a former Chairman of the AMA Board of Trustees (BOT), Raymond E. Scalettar, M.D., highlighted by a well-conducted two-person "Presidential Debate" and ultimate election of the original candidate;

*the presentation to the HOD of the new Executive Vice President (EVP), F. Radcliffe Anderson, Jr., M.D. chosen after an exhaustive national search;

* the swearing in of the first woman President of the AMA in its 151 year history, Nancy W. Dickey, M.D.;

* several Board of Trustees and Council on Scientific Affairs Reports and a variety of resolutions impacting both positively and negatively on the practice of public health.

* Section Council on Preventive Medicine meetings, June 13-16, chaired by AAPHP Delegate;

* the appointment of the Alternate Delegate AAPHP as Elections Teller.

The Sunbeam Report, provided to HOD members in advance of the Chicago meeting, discussed at a special session on Junel4th and accepted by the HOD, concluded with the submission of seven recommendations including:

* rededication to professionalism;

* clear affirmation of roles within AMA specifically HOD, BOT, EVP and AMA staff, i.e. HOD is the representative body of the AMA that establishes policy;

* participation of HOD in development, acceptance and maintenance of AMA Vision including core objectives and values;

* clear definition of roles and responsibilities of Trustees, Chair of Board and AMA President with reflection of same in AMA Bylaws;

* clear communication of operating procedures of BOT to HOD;

* institution of formal, ongoing training program for Board, especially for Board Chair; and

* six specific suggestions for referral to the Ad Hoc Committee on Structure, Governance and Operations regarding the various roles and interactions of the BOT, Board Chair, AMA President, EVP and AMA staff.

RESOLUTIONS

Three Resolutions were submitted by AAPHP:

#240 Transferable Pension Benefits for Public Health Professionals which requested that the AMA, through direct communication to Congress, support the legislation in the House of Representatives (H.R.3503) providing for the portability of pensions for public health physicians was, based on support of the concept in BOT Report Y, 1-92, reaffirmed.

#417 No Special Protection for Tobacco Company Owners or Associates which requested that the AMA oppose legislation that would offer any type or degree of special legal immunity, including assessment and payment of damages, for the tobacco industry's officers, agents, attorneys, accountants, or parent companies was, based on prior HOD policy, reaffirmed.

#520 Current Knowledge of Early Brain Development -Implications for Medical Practice and Public Health and Social Policy (or The End is Determined by the Beginning) which requested that the AMA through the BOT undertake a comprehensive review of the recent research on the development of the brain in order to : 1. Provide a uniform body of knowledge, and 2. Consider the implications of the results of this research on (a) the practice of medicine and public health and (b) the development of public health and social policy on a national level, and that a report to the HOD be in such form that it can be utilized as a basis for future development of appropriate policy affecting medical practice and public health was referred to the SOT with report back in A-99.

BOT Report on #224 from 1-97 Congressional House Bill 1062, Review and Amend which called on the AMA to review its endorsement of HR1062, "The HIV Prevention Act of 1997" has been postponed from A-98 to 1-98.

Other HOD Actions Relating to Public Health:

Council on Scientific Affairs (CSA) Report 4 - Asthma Control, which presented an examination of the "recent evolution of guidelines on the diagnosis and treatment of asthma particularly those released in1997 by the National Heart, Lung and Blood Institute (NHLBI)", focused on factors impacting "inner city ethnic minorities" and" the effects of environment and work place as triggers" and made recommendations on "how AMA can assist in educating physicians and consumers about asthma and... contribute to efforts aimed at decreasing the morbidity and mortality of this disease", was adopted.

CSA Report 9 - Reducing Illness and Death Caused by Cigarettes by Reducing their Nicotine Content, which discusses nicotine dependence, determination of threshold nicotine addiction, components of nicotine reduction strategy, labeling, research and treatment issues and includes policy recommendations including support for the FDA's authority over tobacco, was successfully amended by substitute language " that the AMA reaffirm its position that all tobacco products are harmful to health and that there is no such thing as a safe cigarette" and adopted

CSA 10 Airborne Infections on Commercial Flights which

reviews current literature and concludes that air quality in commercial flights does not present a significant risk for transmission of airborne infections and recommends that AMA (1) support efforts of the Aerospace Medicine Association and others to educate physicians and the public about risks of flying with airborne transmissible diseases and (2) support ongoing research of appropriate organizations to determine standards for cabin air quality, was adopted.

Board of Trustees Report 9 - Patient Privacy and Confidentiality

which addresses questions of medical record confidentiality and patient privacy, was submitted with 13 recommendations, which, in the aggregate would change the way in which medical records are used, and the degree to which patient information is used outside the clinical arena. Due to the significant impact on public health, the AAPHP Delegate vigorously made the following points on the floor of the HOD and in immediate follow-up communication to the BOT and EVP.

medical data for research and quality management more difficult than is currently the case, the sections relating to public health, if fully implemented through law and practice, could reduce the ability of public health professionals to determine the community health status with accuracy. The principle espoused is that only after a compelling public health need should clinical data be shared with public health officials; and then, only upon specific statutory authority on a disease by disease basis. The recommendation is that only ". . . in rare instances when strong countervailing interests in public health or safety justify invasions of patient privacy

When read as a whole, the report implies that public health professionals, quality managers, and epidemiologic or clinical researchers are somehow alien species who must be kept from reviewing private patient records without very stringent standards of accountability. No one would disagree with the need for privacy, confidentiality, and the careful protection of the patient record; public health standards of record protection, under law, are in most instances more stringent than those which guide the practice of medical record management in hospitals, insurance firms, corporate medical clinics, or private offices. The problem with BOT Report 9 is that it appears to give the practitioner the ethical right to withhold clinical information from the public health authorities when "strong countervailing interests" do not seem to be at stake. The AMA standards, if adopted, might increase the degree to which reportable illnesses are further under reported by clinicians

The clinical specifics on the birth record might be overlooked. Death records would cease to have value if practitioners chose to obscure the causes of death because they somehow violated the privacy of the deceased or the family. Cancer records reported to state registries require very specific data if they are to have value. And the name of each patient and the significant medical record on most infectious disease reports is essential if surveillance, follow-up, case finding, and specific treatment are to be performed.

Despite these cogent objections, the HOD adopted the Report.

Addendum:

A more complete analysis of BOT Report 9 appeared in the AMNews of June 22. The Report is available on the internet for AMA members to review. Resolutions will be introduced at the 1998 Interim meeting to soften the impact of the

recommendations that were adopted by the HOD and which may be harmful to the public's health

Adoption of resolutions calling for:

* support of Patients "Bill of Rights"

* AMA policy that HIV infection per se does not imply

disability and that impairment should be determined by a

physician based on established guidelines

* study of health and safety issues affecting child care

centers and development of recommendations for national

standards for improving quality of care

SECTION COUNCIL ON PREVENTIVE MEDICINE

During the AMA Annual meeting, the Section Council on Preventive Medicine was again chaired by the AAPHP Delegate. Highlights of these four sessions included: the usual review and support of various public health/preventive medicine resolutions included in the HOD Handbook;interviews/ presentations by candidates for various offices; discussion of declaration of candidacy for BOT at A-99 by Ron Davis, M.D. , Delegate from American College of Preventive Medicine (ACPM); presentations by and discussions with the new EVP,

F. Ratcliffe (Andy) Anderson, Jr., M.D. and Vice President for Professional standards, Reed Tuckson, M.D., concerning the relationship of the SCPM to the leadership of AMA and its role in the Medicine- Public Health Initiative; the expression of dpprecidtion dnd presentdtion of certificdte and gift to Hazel Keimowitz, Executive Director of ACPM on her departure from the Section and the College, further discussion of the so far limited success in acquiring the past records of the SCPM for the 25th anniversary and potential avenues of discovery through the AMA Archives. The American College of Occupational Medicine will chair the SCPM at 1-98 in Haiwaii.

DELEGATION AAPHP was represented by Jonathan B. Weisbuch, M.D., M.P.H.,, Delegate and Mary Ellen Bradshaw, M.D., Alternate Delegate and, with special assistance on tobacco issues, by David Cundiff, M.D., M.P.H., Chair, Tobacco Control Task Force.
Support for the AAPHP delegation in the HOD and Section Council on Preventive Medicine was provided by David Cloud, Executive Manager, AAPHP and his staff assistant.
Respectfully submitted,
Mary Ellen Bradshaw, M.D

LETTER FROM JEFF Koplan, Director CDC

Douglas Mack, M.D. M.P.H. President
American Association of Public Health Physicians
Kent City Health Department
700 Fuller Avenue
Grand Rapids, Michigan 49503

Dear Dr. Mack:

As you may know, I became Director of the Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR) on October 5,1998. I am excited about leading these important public health agencies and look forward to working with CDC and ATSDR's public health partners.

(1) Scientific, programmatic, and policy leadership; (2) responsiveness/tirneliness; and (3) collaborative efforts to bring individuals or groups together to focus on issues of concern.

If you have comments or suggestions, please send them by December 9, 1998, to Ms. Kathy Cahill, Associate Director for Policy, Planning, and Evaluation, CDC, at the following address or telephone number:

Ms. Kathy Cahill, Associate Director for Policy, Planning, and Evaluation
Centers for Disease Control and Prevention
1600 Clifton Road, N.E, Mailstop D23)
Atlanta; Georgia 30333 Telephone: (404) 639-7060
Your input is very important and will assist me in developing new or enhanced policies and priorities for CDC and ATSDR.
I look forward to working with you.
Sincerely,

Jeffrey P. Koplan, M.D., M.P. H.

CDC, Arthritis, Asthma, Birth Defects Prevention, Chronic Disease Prevention and Control, Colorectal Cancer ,Comprehensive School Health, Disability Prevention, Epidemic Services, Folio Acid, Food Safety, Genetics, Global Health, Health Promotion, Health Statistics, HIV/AlDS Prevention, Immunization, Infectious Diseases, Injury Prevention, Lead Poisoning, Laboratory Services, Minority Health, Occupational Safety and Health, Physical Activity, Preventing Tobacco Use, Prevention Centers, Prevention Research, Preventive Health Block Grant, Public Health Practice, Sexually Transmitted Diseases, Tuberculosis, Women's Health, ATSDR, Brownfelds, Child Health, Health Education, Health Studies, Health assessment and consultation, Medical Monitoring, Toxicological Profiles and attendant research