BULLETIN
AMERICAN
ASSOCIATION OF PUBLIC HEALTH PHYSICIANS
“THE VOICE OF PUBLIC HEALTH PHYSICIANS,
GUARDIANS OF THE PUBLIC’S HEALTH”
Volume 49, Issue
BULLETIN Volume 49, Issue
Table of Contents:
President’s
Message……. 2
Spring Meeting
Minutes...3
Abstracts
AMA
Report……………..5
Adolescent
Health……….6
Liaison
Activities………...7
Single
Payer……………. .8
AAPHP
Leadership…….10
***********************
Fall Membership Meeting
Moscone
Center Room 250
PROGRAM
Call to Order
Introductions
Review of Minutes of February 2003 Annual
Meeting
Informational Reports:
President
Overview & Special Issues
President- Elect
AMA Delegation Report
Vice
President
Programs
Treasurer
Budget
Membership
Special
Committees & Initiatives:
Education & Training
Health Care Access
History & Archives
*50th
Anniversary & Awards
Additional Liaison Reports and Action Items
AMA Proposed Resolutions
ACPM Relationship
Job Market Initiative (JMI)
CDC “White Paper” Update
NACCHO
NCCHC
Service Contract Proposals
Old Business
New Business
Adjournment
Panel
on Public Health Law
Moderator: Kathleen Acree,
MD, JD
Panelists:
Edward Richards, JD
Harvey A. Peltier
Prof. of Law
Director, Program in Law,
Science
and Public Health
Robert England, MD,
Chief of Epidemiology
Arizona Department of Health Services
Jonathan Weisbuch, MD,
Georges Benjamin, MD
Executive Director APHA (Invited)
State
Chapter of Physicians for a National Health Plan
or
Additional Business, if needed
President’s Message
Mary Ellen Bradshaw, MD
Since
our last AAPHP Bulletin in February, we have found ourselves in a totally
changed national status – engaged in yet another war which looks like it will
continue for some time – facing a budget for health and social needs severely
compromised by heavy tax cuts and a
down-turning economy – increased homelessness, joblessness, epidemics of SARS
and spreading West Nile Virus – and the enhanced threat of terrorism – bio, chemo
and nuclear – the latter stirred up by
our invasion of Iraq. The numbers of those without health insurance continue to
mount with no reasonable solution being seriously considered. The environment
and the air we breathe is under unrelenting attack. Researchers involved with
grants studying HIV and teen
pregnancy/sexuality are being investigated. I could go on. It is not a happy
state that has evolved. With it have come several issues facing our members in
leadership positions in city, county and state departments of health and at the
federal level. Issues related to Bioterrorism, Home Land Security and their
authority as Public Health Physicians under the law. Issues related to lack of
resources as local and state coffers run dry. Issues related to the health and
well-being of the communities for which they have responsibility in the face of
no or inadequate health insurance.
It
is in response to these challenges that AAPHP has developed our Educational
Session at the Fall General Meeting on Sunday afternoon,
During these past several months, AAPHP has
been represented in a number of activities including the Preventive Medicine
Leadership Forum (which AAPHP chaired through February, 2003), AMA President’s
Forum,
Included
in this Bulletin, is a summary of the Spring Annual Meeting in San Diego, at which we elected new officers, reports of
the NACCHO-ASTHO and NCCHC meetings ;the AMA National Coalition on Adolescent
Health and the new ACPM Task Force on Adolescent Health as well as the AMA
Annual Meeting in June, 2003. During the months ahead, we anticipate bringing
resolutions to the AMA on Single Payer, Concern about Congressional intervention
in HIV and teen sexuality grants and supporting issues brought forth by our
colleagues at ACPM on Reauthorization and Strengthening of the 1994 Assault
Weapons Ban and Environmental and Policy Interventions to Promote Physical
Activity Exercise. We are also exploring proposals aimed at closer
collaborations with ACPM.
The
big event for AAPHP will be our 50th Anniversary Celebration at the Annual
Membership Meeting in February 2004 in
Come
join us at both events, follow the plans on our website, http://www..aaphp.org
… and bring along another potential member.
Given
the continuing and mounting challenges to Public Health and its practitioners
on the front lines - you, our AAPHP members and your colleagues - it seems that
more than ever, we need to come together to have our voices as Public Health
Physicians heard and our positions made known in every appropriate forum. Your
past contributions and involvement are greatly appreciated and cannot be
overestimated, but it is critical that you remain involved with the only
organization that represents you, the Public Health Physician, and encourage
others to join us. There is “ strength in numbers“ and the resources membership
provides can help AAPHP to accomplish more each year
Spring Membership
Meeting
Summary of
Minutes
The
Spring Meeting took place in
A Panel Discussion followed, addressing
two major topics. “Public Health Program
Implementation: A Proposal to CDC- A
White Paper” was presented by Joel Nitzkin,MD,
After
a refreshment break, the Business
Meeting was convened by Dr. Bradshaw at approximately
Dr.
Bradshaw gave highlights from the the AMA Delegation Report from the I-02
meeting in New Orleans, included in detail in the February Bulletin. She
commented on an excellent presentation and report on disparities in health
care, a priority interest for AMA.
Results of a survey of physicians indicating public health as a high priority
was shared at the Section Council on Preventive Medicine.
A
major undertaking of the AMA is the Committee
on Organization of Organizations (
Committee Reports:
By-Laws
Committee:
Dr.
Goyal, Chair, presented a document with the several
By-Laws changes, some significant, others editorial as recommended by the
Committee. With some minor adjustments,
the By-Laws changes were approved by the membership. The document includes rule
changes for General Membership meetings, actions of the Executive Committee,
unfilled terms, committee appointments, the executive manager, the payment and
timing of dues and the type of notice for amendments to the By-laws.
The
Revised By-laws will be made available on the website.
As
amended in the By-Laws, the annual membership dues shall be presented by the
Board at the last General Membership Meeting of a calendar year. The dues
statement each year will be mailed before the end of the preceding year. 2003
dues increase to $75 for regular membership and $700 for life membership were
approved by unanimous vote and will include a request for $50 contribution to
the 50th anniversary
celebration in February, 2004. Dues were stabilized for 2004 at this
rate by unanimous vote.
Dr,.
Rumm proposed that AAPHP meet with both party
congressional leaders or staff before the next Annual meeting as there are
contacts there that have expressed an interest in meeting with us.
Nominations
Committee:
The
following slate of candidates for office was presented to the membership and
elected unanimously;
Arvind Goyal, MD,
New
Board of Trustees members: Timothy P. Barth, MD, CCHP (2003-2006); Joshua Lipsman, MD,
Membership Committee
Dr.
Goyal, Chair, focused on the mechanisms to support
and expand membership with reference to AAPHP’s
contract relationship with NCCHC and requested what the membership thought
should be included in any contract for support/staff services. Responses
included basic minimums needed in a contract and/or need to be done by AAPHP:
These were in addition to the concept of
having a home base with address, phone and fax. The current contract with NCCHC
is for $400 per month.
There
followed a discussion of the NCCHC contract and the AAPHP roles and workload.
Dr. Marc Safran proposed that we move to every other
month executive committee meetings and every other month board meetings. Dr.
Doug Mack seconded the motion. The group expressed that AAPHP was too small to
have such an extensive agenda. Dr. Goyal offered an
amendment to state there would be no board or executive committee meetings in
the months we have general membership meetings. Discussion continued as to the
disparity between the resources of the organization and the workload. Motion
passed with two negative votes.
A
motion made to allocate $200 to upgrade the quality of our home page, passed
unanimously.
Training and
Certification Committee:
Drs.
Nitzkin and Weisbuch made
report. Multiple options were discussed. The proposal that seemed most
promising was a monthly or other periodic telephone conference call
There
was consensus that AAPHP provide or arrange
The
meeting was adjourned by Dr. Bradshaw at
Minutes prepared by Drs.
Joel Nitzkin and Peter Rumm
(Modified and expanded by
Dr. Bradshaw)
(Reprinted
from the February 2003 Bulletin)
Educational
Session
Public
Health Program Implementation Initiative
This proposal is a recommendation from AAPHP to CDC
to initiate a new research agenda and a new initiative to improve the performance,
leadership capacity and emergency preparedness capabilities of state and local
health departments.
This initiative would address two sets of issues:
1. Policy/politics and
organizational culture within professional and governmental agencies as
they relate to the roles and leadership capabilities of state and local health
departments.
2. Decision-support modeling and statistical issues (
The
initial research could be completed in three to five years at a cost not to
exceed $1 million per year to the stage where nationwide
implementation could begin, as subsidiary research continues to work out
selected details and develop additional decision-support modules.
Addressing the second of the two sets of issues within CDC could improve the
performance of CDC-funded programming,
nationwide.
If AAPHP is correct in its assessment of the
root causes of lackluster performance by state and local health
departments the stage will be set for quantum improvements in
the performance and leadership capabilities of state and local health departments within
the three to five years immediately
following completion of the initial research.
Naeglaria Case
Presentation
In October of 2002, in the
This very rare infection by the ameoba,
Naeglaria fowleri, was
unusual in many respects. None of the usual causal factors seemed to
apply; the children had no history of swimming in lakes or ponds, no common
exposure to sources of water spray, and neither had any history of having
traveled to areas of the country where the organism is more common than
The investigation of the clinical findings, the epidemiologic investigation,
and the in depth analysis of the local water system shared by these two victims
and their community is a classic public health analysis raising several
concerns for the era of bioterrorism. Was the event intentional? Was the management of the public panic and
concern carried out correctly?
Is the entire deep water aquifer system at risk to natural or intentional
infection by parasites for which no standard testing is done, nor most labs
equipped to handle? What are the implications for other deep wells
currently allowed to provide non-chlorinated water to thousands and possibly
millions of people around the world?
These questions and others related to the current problems in the public health
infrastructure and its implications for future massive biologic events were
discussed.
************************
AMA Annual HOD
Report
I was honored to have been asked to sit in as a delegate
representing the AAPHP at this meeting, pinchhitting
for Drs Weisbuch and Bradshaw who have been the
voices of reason on behalf of Public Health in the AMA house for several years.
The items of special interest included:
1.Elections:
John C. Nelson
MD,
2. AAPHP Resolutions:
Based on our
resolution #437, “Betterment
of Public Health” the AMA reaffirmed that the betterment of the
public's health is our highest goal and that our efforts...reflect that value.
Another of our resolutions #438,
“Public Health Leadership”, lead the
AMA to affirm that public health practice was indeed the practice of medicine
and to reaffirm that appropriately public health trained and experienced,
licensed physicians be employed in leadership positions by state health
departments.
AAPHP re-submitted Resolution #424
“Epidemiology of Firearm Injuries”
requiring that the AMA: strongly urge the Administration and Congress to
encourage the CDC to conduct epidemiological analysis of the data on firearm
-related injuries and deaths and to provide the CDC with sufficient resources
to both do the analysis and provide reports to Congress and the nation through
a broadly disseminated document ; and assist in convening a broad-based
coalition to thoroughly examine the issue of gun-related violence from a public
health perspective, was adopted.
3.Resolutions
co-sponsored by AAPHP, ACPM and
Addiction Medicine #423, “Tobacco
Advertising Aimed at Gay and Lesbian Community”
and #434, “Support for Federal
Interagency Committee on Smoking and Health Report” were adopted.
Resolution #219
co-sponsored with ACPM, “Elevating Health
Concerns in International Trade Agreements” pertaining to public health
considerations prior to signing of
International Trade Agreements was referred to the BOT for
decision/action.
4. Other public health related resolutions involving reducing the risk of flight
related DVT, tax free
tobacco products ,guidelines to return to work after injury or illness,and labelling and
promotion of alcoholic beverages were referred to the AMA Board for
decision/action.
5. Several
other tobacco related resolutions including AMA support for FCTC were approved. Opposition to
"securitization" of Tobacco settlement funds was referred to the AMA Board. A policy
asking for removal of Tobacco Products from pharmacies was reaffirmed.
Respectfully submitted,
Arvind K Goyal MD,
President-
Elect, AAPHP
(Amended by Editor)
****************************
The
AMA National Coalition on Adolescent Health met again in
The
Agenda for the May 16th meeting covered presentations by Mary
Tierney, MD,
The
morning session was followed by an Educational Forum on Adolescent Health
featuring a panel on “Nutrition and Physical Activity”. Speakers included
Leslie Lytle, PhD, RD, Professor at the University of Minnesota School of
Public Health; George Graham, PhD, President of the National Association of
Sports and Physical Education and a Professor at Penn State University ; Victor
Medrano of VERB - Its What You Do Youth
Media Campaign at Centers for Disease Control and Prevention; and Bonnie Spear,
PhD, RD, Associate Professor of Pediatrics, Division of Adolescent Medicine, University of Alabama –
Birmingham. There were several excellent handouts including “Eat Well and Keep
Moving” and “Planet Health” from Human Kinetics; National Initiative to Improve
Adolescent Health by the Year 2010 from Healthy People 2010; “The
The next meeting of the Coalition will take place in
November 2003 in
The
ACPM has taken as a focus “ the problems of
sexual activity during adolescence, obesity, substance abuse (with a special
emphasis on alcohol use) and violence prevention”.
The purpose of the first
meeting was to “1) exchange information about each organization’s adolescent
health activities , emphasizing ways that other Coalition members might
participate in those activities; 2) To determine a framework for an
action-oriented plan to apply the Coalition’s collective expertise and
influence on emerging policy issues in adolescent health and prevention.”. A
mission, objectives and a series of specific action steps for the next 12 months.were to be defined
during the meeting. A Discussion Question outline on the role of the
Preventive Medicine Adolescent Health Coalition and a “Domain of Influence”
matrix facilitated the achievement of the meeting goals.
In addition to exchanges of organizational
information, there were presentations on “Nutritional and Physical Activity
Health Policies: NANA by Margo Wootan,
A future meeting of the Consortium will be held in
mid-2004.
.
Jonathan Weisbuch, MD,
Recently,
The NACCHO/ASTHO meeting
featured George A. Straite, Jr./ the Assistant Vice
Chancellor, Office of Public Affairs at UC Berkeley as the keynote
speaker. He wove a story from the events
of last spring and summer, when
On Thursday, Secretary
Thompson spoke about the importance of public health, his commitment to
continue the funding, and his continuing support for the work of all public
health professionals in preparing the society and the public health system for
extraordinary events. His message, if
acted upon by the administration and the Congress would be a continuing benefit
to our profession and would make up for the twenty years of diminished support
for public health from
In late September, the
Arizona Public Health Association met in
When we meet in
Comments from
Correctional Health, the flip side of Public Health
The American Association of
Public Health Physicians is a long term member of the Board of Trustees of the
The linkages between
correctional systems and public health help to prevent disease transmission
within the prison walls and on the outside upon release. The PH skills of local and state
professionals should be utilized within corrections. The requirement that communication exists
between the two improves both. NCCHC has
been at the forefront of this movement.
The conference in
For those of us in active,
local or state public health, an occasional visit to the Annual Meeting of the
NCCHC would be a worthwhile experience.
Several correctional physicians took out membership in AAPHP; those of
us who work with prisons should consider reciprocating.
**********************
A Single Payer
System and the Impact on Public Health
Jonathan Weisbuch, MD,
An article by the Physicians Working Group in the
August 13 edition of JAMA, [i]
and accompanying editorials by Bindman and Haggstrom,[ii]
and Fein, [iii]
resurrect the debate on the nature of the
The American Association of Public Health
Physicians, a delegate member of the AMA House of Delegates, and an active
specialty society speaking for all physicians engaged in public health
practice, would disagree with the AMA, arguing that now is the time to reopen
the discussion. Public health
physicians, responsible for the health of entire communities, see the problem
from a different perspective than the average clinician. We face the failures
inherent to the current medical care system on a daily basis.
If we are responsible for a public hospital and
clinical service system serving the medically indigent, we serve a proportion
of the 43 million Americans with no health insurance or with limited ability to
pay for services. The uninsured often
have extraordinary acute and chronic care needs; they have received infrequent
preventive services and limited early diagnostic work for their problems. These patients enter the system only when
very sick, entering through the hospital emergency departments. Their work-up is expensive, often un-reimbursed,
and additive to the grave financial strain on the hospital. Patients with demonstrable clinical needs may
not be denied service by an emergency department; and all the dunning in the
world can not squeeze payment from the truly indigent who constitute up to
thirty percent of patients requiring emergency care in public hospital
emergency rooms. The unpaid medical
needs of these patients are driving the public hospital systems in this country
deeper and deeper into debt. Many have
already closed, and more will follow to the detriment of the public’s health.
But public hospitals are not the only facet of the
system crippled by the profit driven, pluralistic, chaotic American medical
care system. Private physicians,
squeezed by large insurance plans, pressured to provide less service to more
patients than in the past, are unable to meet the demands for care their
patients require. Faced with long
scheduling delays for simple preventive procedures such as immunizations and
unwilling to pay mounting co-payment fees, many insured individuals come to
public health clinics established to serve the medically indigent. One third of
patients served in the
Public health sees other failures from the
inadequate coverage system. We identify the population groups that suffer
infant mortality and other health problems at a higher rate than the community at large. These disparities, often two or three times
the more favored populations in the same community, are linked to poverty, lack
of education, and inadequate medical access. We see TB patients undiagnosed for
weeks and months because they lack access to care. We see undocumented
immigrants, unable to purchase drugs, lab services or prenatal during their
pregnancy, entering the delivery room untested for many problems including
syphilis; increasing the risk for congenitally infected infants. A Single Payer
System for all members of the community, not linked to employment, indigency, age, or immigration status would simplify the
system, assure all would be served in a timely manner, and enhance the chance
that more individuals would receive the preventive services they deserve and
clinical care early in the disease process.
Such a system would improve the health of individuals and the health
status of the community.
Another population seen by public health but not by
the traditional clinical community are jail and prison inmates. Often from the poorest segment of society,
prisoners have had limited access to care.
They carry a heavy burden of disease into the jail or prison, a burden
that must be treated with public funds.
Prisoners are the one group in society with a constitutional right to
receive quality medical care, [iv] obligating the government to pay the
cost. Resources are frequently drawn
from public health prevention programs to serve the needs of sick inmates. A Single Payer System that guaranteed access
to care for all those outside prison would lower the cost of care in prison,
especially for the state and local governments that now must pay full cost for
inmate care.
Public health physicians have seen their system
ravaged during the past thirty years as public funding for community prevention
has declined in part to pay for the rising cost of clinical services for
prisoners, for the medically indigent under Medicaid, and for the support of
the ailing public hospital system. A
Single Payer System could allocate a small proportion, say 2 to 3%, to the
public health system yielding nearly $40 billion for federal, state and local
public health departments. A Single Payer System would reduce the current
administrative overhead of 30% ($400 billion) in the $1.4 trillion American
health care system to the 5% to 10% characteristic of Medicare. These savings would easily cover the 3%
allocation to Public Health that would make that system whole. [v] With 3% of the total health system funding,
public health would be able to protect the nation from bio-catastrophe, natural
or man made, respond to all its legislative mandates, and educate our
successors in the bargain.
Today, nearly 60% of the health system is paid by
federal, state or local government ($ 750 billion), [vi]the
remainder by companies that choose to purchase employee health insurance (about
100 million Americans). Were a Single Payer System in place, with the Federal
and State governments continuing to pay what they are now spending through
general tax revenue and the Medicare deduction, most of the health care costs
for the nation would be covered. The amount
industry pays could be rolled into their corporate income tax, and that would
cover administrative overhead and other miscellaneous costs. States and local governments would have
adequate funding for public health because it would be part of the total
package. Public health agencies would have the resources to build the
appropriate infrastructure to be ready for any hazard that might befall the
community, making the nation a safer place to live.
[1] The Physicians’ Working
Group for Single-Payer National Health Insurance, JAMA, 2003;290:798-805
[1]
[1] Fein, R, “Universal Health
Insurance – Let the Debate Resume,” ibid
[1] Estelle v. Gamble, etc.
[1] McGuinness,
et al, etc.
[1] Woolhandler,
et al, June 2003. The Federal Share of
Health Care,
*********************************************************************
AAPHP
Leadership
Mary Ellen Bradshaw, MD
E-mail: mebmd@aol.com
VICE PRESIDENT
Email: Alfio.Rausa@msdh.state.ms.us
PRESIDENT- ELECT
Arvind K. Goyal,
MD,
Email: arvindkgoyal@aol.com
SECRETARY
Camille Dillard, DO,
E-mail: cdilldo@aol.com
TREASURER
John Poundstone, MD,
Email: jpound@infionline.net
IMMEDIATE PAST PRESIDENT
Dave Cundiff, MD,
E-mail: cundiff@reachone.com
Note: The Board of Trustees
includes all elected officers, editor of the Bulletin, the AMA delegate and the
Immediate Past President.
BOARD OF TRUSTEES
Kathleen H. Acree, MD, JD,
Timothy Barth,
MD, CCHP
Annette Kussmaul,
MD,
Joshua Lipsman,
MD,
Sindy Paul,
MD,
Peter Rumm,
MD,
Elizabeth Safran,
MD,
Marc A. Safran,
MD
Ex officio members of
the Board of Trustees:
C.M.G. (Kim) Buttery, MD,
Douglas Mack, MD,
Chair, PH Training/CCRC
Jean M. Malecki,
MD,
Joel L. Nitzkin,
MD,
Kevin Sherin, MD
AMA Delegate
Jonathan
B. Weisbuch, MD,
E-mail: jbweisbuch@earthlink.net
AMA Alternate
Delegate
Mary Ellen Bradshaw, MD
Young Physician
AMA Delegate
Cheryl Iverson, DO,
Young Physician
AMA Alternate Delegate
Vacant
Preventive
Medicine Section Council Representatives
Peter Rumm,
MD,
Arvind Goyal, MD,
Bulletin Editor
Mary Ellen Bradshaw, MD
Newsletter
Editor
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Web: http://www.aaphp.org
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