fosemckay Current Priorities

PROPOSITION 449

AZPHA RECOMMENDS A YES VOTE ON PROPOSITION 449

Maricopa County voters are being asked to continue the property tax levy for the Maricopa County Special Health Care District. The assessment is due to expire in 2024 when its 20-year life span comes to its conclusion. The tax levy represents about 12% of the District’s revenue which is approximately $81.9M and is crucial to maintaining Valleywise Health’s mission.

Valleywise Health (formerly known as Maricopa Integrated Health System) is Arizona’s only public teaching health system and serves the needs of anyone who comes through its doors. Its mission is to “provide exceptional care, without exception, to every patient, every time.”

More than 65% of Valleywise patients are uninsured, underinsured, or covered by AHCCCS, Arizona’s Medicaid program, or Federal Emergency Services. Annually, Valleywise serves nearly 400,000 patients with its staff of nearly 3,700 medical and healthcare professionals.

Valleywise Health was established in 1877 as a place to care for the sick in the one of the fastest growing areas in our country and is governed by an elected Board of Directors. Today, Valleywise is a growing presence for health care services in Maricopa County.

That extended system of health care consists of:

  • Valleywise Health Medical Center, the only hospital in Maricopa County verified by the American College of Surgeons to provide adult (Level I) and pediatric (Level II) trauma care;

  • The Arizona Burn Center;

  • Three behavioral health centers;

  • 12 Community Health Centers – Federally Qualified Health Centers throughout the Valley;

  • The McDowell Healthcare Center, the largest provider of HIV primary care in Arizona, women’s and pediatric refugee health services;

  • The Arizona Children’s Center.

Valleywise has been working hard to keep Arizonans safe from Covid-19 and has acquired an advanced testing technology that can detect the virus in 45 minutes or less. It has conducted community education projects across the county in ten languages.

Valleywise is also home to the Arizona Burn Center, widely regarded as the finest in the US for emergency treatment and burn survivorship. First responders across the Valley routinely express their wishes to be taken to Valleywise for treatment if injured on the job.

Valleywise has expanded behavioral health services across Maricopa County, including the creation of the Valleywise Behavioral Health Center in Maryvale where medical care and behavioral health care services are administered together, at the bedside.

The First Episode Center in Tolleson serves patients and their families experiencing their first episode of psychosis. Valleywise is also the largest provider of court-ordered behavioral health testing and care in Maricopa County.

Valleywise is addressing a nationwide doctor shortage through a partnership with Creighton University Medical School, District Medical Group, Dignity Health and St. Joseph’s Medical Center. Its goal is to grow the number of new doctors, nurses and medical professionals in Arizona, which currently ranks near the bottom of all states in the number of practicing physicians per capita.

Residencies at Valleywise continue to be some of the most sought-after in the nation. As an example, each year there are 14 ED (emergency department) residencies available at Valleywise. The hospital receives 1600 applications for those 14 spots.

The Arizona Public Health Association strongly recommends a YES vote on Proposition 449.

fosemckay Current Priorities

PROPOSITION 208

AZPHA RECOMMENDS A YES VOTE ON PROPOSITION 208: INVEST IN ED

FACT SHEET: ARIZONA’S EDUCATION SYSTEM IS CRITICAL IN PROMOTING PUBLIC HEALTH GOALS

According to the CDC, the direct contact and amount of time schools have with 95% of our nation’s children and youth make them critical in promoting student health and safety and helping them to establish lifelong health patterns. The National Longitudinal Study of Adolescent Health found that student connection to adults at school is strongly positively correlated with reductions in violence, substance-use, emotional distress and pregnancy.

Adult health status is directly associated with higher educational levels, regardless of income. Children who do not learn to read in the first few grades, who read poorly, or who are retained in grade more than once are more likely than their peers to be drawn into a pattern of risky behaviors. People who acquire more education not only are healthier and practice fewer health risk behaviors, but their children also are healthier and practice fewer health risk behaviors.

According to 2020 U.S. Census data, Arizona spent $8,239 per pupil in FY2018 (federal, state and local sources) as compared to the U.S. average of $12,612. The chart below displays the trend in Arizona public education funding over the past two decades (all sources, in 2007 dollars).  Total funding has recently begun to approach levels in the early years of the recession but has not reached the funding level of 2007. 

One of the greatest impacts of inadequate funding is inadequate pay for teachers and Arizona ranks 48th in the nation for elementary teacher pay and 49th for secondary teacher pay.  Chronic underfunding and inadequate pay for staff translate into underserved students:

  • 1800 unfilled teacher vacancies (Arizona School Personnel Administrators Association, December 2019)

  • Largest class sizes in the nation

  • Over 3000 teachers not meeting standard requirements, for example, not certified

  • Highest student to counselor ratio in the nation with 903 to 1

  • Enough nurses to serve only one-third of schools

Invest in Ed Initiative

The Invest in Ed Initiative, supported by education, health, small businesses, faith and civic groups, and now AzPHA raises revenue for K-12 education by creating a dedicated, voter-protected fund.  Funds raised must be spent according to the following requirements:

  • 50% for hiring and pay increases for teachers and classroom support personnel including counselors and nurses

  • 25% for hiring and pay increases for student support services personnel, including classroom aides, school safety and student transportation

  • 10% for teacher mentoring and teacher retention

  • 12% for Career and Technical Education vocational training programs

  • 3% for the Arizona Teachers Academy for scholarships

The Initiative generates necessary revenue through a 3.5% surcharge on earnings over $250,000 for single filers or on earnings over $500,000 for married filers. The surcharge is applied only after deductions, on taxable income. The vast majority of Arizonans (99%) including the average small business owner, lawyer, doctor and dentist will not pay this surcharge. Only the top 1% of earners will contribute.

The federal tax cuts of 2017 saved these highest earners over $47,000 on average. This method of revenue generation avoids further negative impact on low wage earners, who pay a higher portion of their income in state and local taxes.

References:

About CDC Health Schools. U.S. Department of Health and Human Services, 2019., https://www.cdc.gov/healthyschools/about.htm

Blum, Robert. “Forward.”  Prevention Science in School Settings, edited by Kris Bosworth, Springer, 2015, p. v.

National Center for Education Statistics, Office of Educational Research and Improvement, U.S. Department of Education. The Condition of Education 2002. NCES 2002–025, Washington, DC: U.S. Government Printing Office. May 31, 2002. Online: http://nces.ed.gov/pubs2002/2002025.pdf.

Tyson H. Kappan special report–A load off the teachers’ backs: Coordinated school health programs. Phi Delta Kappan. Jan 1999:K-1. Online: http://www.pdkintl.org/kappan/ktys9901.htm.

Lowry R, Kann L, Collins J, Kolbe L. The effect of socioeconomic status on chronic disease risk behaviors among U.S. adolescents. JAMA 1996;276:792-97.

Arizona Interfaith Network. “Education in Arizona.” Education Civic Academy, 2020, Phoenix AZ.

Teacher Pay. Expect More Arizona, 2020, https://www.expectmorearizona.org/progress/teacher_pay/

School District Employee Report, Arizona Department of Education, 2020, http://www.ade.az.gov/sder/PublicReports.asp

Where Will the Money Go? Invest in Education, 2020, https://investined.com/get-the-facts/where-will-the-money-go/

Arizona Interfaith Network. “Education in Arizona.” Education Civic Academy, 2020, Phoenix AZ.

fosemckay Current Priorities

PROPOSITION 207

PROPOSITION 207 (SMART AND SAFE ARIZONA ACT) POSES BOTH PUBLIC HEALTH RISKS AND BENEFITS

AZPHA IS NOT TAKING A POSITION ON PROPOSITION 207 BECAUSE OF THE NUANCED PUBLIC HEALTH RISKS AND BENEFITS

AzPHA is neutral on Proposition 207 aka the Smart and Safe Arizona Act. It would legalize the possession and use of up to 1 ounce of marijuana (for people 21 and over) and set up licensed retail stores where up to 1 ounce of Cannabis can be sold to adults 21 and over. It would also offer expungement of some previous convictions for marijuana convictions. Here’s a link to the statutory language.

AzPHA has an existing Resolution regarding the legalization and retail sale of marijuana (it’s posted on our members only website) but the Resolution doesn’t specifically address the Initiative that will likely be before Arizona voters this fall.

There are public health risks and benefits with the Initiative. One public health risk is that it will likely increase access to marijuana for adolescents (it is clearly harmful to them). It will likely cause increases in ED visits from edible overdoses and may increase impaired driving and it’s consequences.

On the benefit side, everybody with convictions of less than an ounce can apply for expungement of their conviction, which will help their ability to make a living and improve the social determinants of health for themselves and their families.

Another big benefit is the criminal justice reform parts of the law. Adults will no longer be charged with nor convicted of possession of less than an ounce, with benefits to social determinants of health in my opinion (currently, possession of even very small amounts of marijuana are a Class 6 felony unless the person has an Arizona Medical Marijuana Certification).

Also, people of color are disproportionately charged with and convicted of marijuana possession even though they don’t disproportionately use the substance.

We had some interns do an analysis of the risks and benefits… here are their reports:

In short, the AzPHA Board of Directors elected to not take a position on Proposition 207 because there are both clear public health benefits and risks.

We also encourage Arizona voters to read the reports from our interns and think through whether they believe the public health benefits of the criminal justice reform portions of the law as well as the increased funds that would become available for public purposes outweigh the public health risks from increased access to Cannabis.

We believe that individual voters should carefully examine those benefits and threats before deciding how to vote on Proposition 207.

fosemckay Disease Control, Public Health

What Is Herd Immunity for COVID-19 & How Will We Know We’ve Achieved It?

Herd immunity has become a popular and important concept to help us understand our progress in combating the Covid-19 pandemic. If herd immunity is one of our goals, it’s important to understand what it is, when we will reach it, and what that will do for us.

The concept of herd-immunity makes common sense: once enough people have acquired immunity – whether acquired from vaccination or a prior infection – they’re no longer susceptible to catching it again, or at least it is very unlikely due to partial immunity. Unvaccinated persons in “the herd” will be less likely to be grazing, sneezing, and eating next to a herd-mate who can pass the disease along.

Can someone who is living in a place that has achieved “herd immunity” still get sick? Yes, because herd-immunity is a population level construct. It doesn’t apply to an individual. Someone may be less likely to contact an infectious person if they’re living in a place that has achieved herd immunity, but if they aren’t immunized, they can catch the virus (and spread it to other unvaccinated persons).

Ok, So What Does Herd Immunity Mean in a Practical Sense?

No doubt you’ve heard many statements like “experts believe we will reach herd immunity at around 70%”. What does this mean? It depends. Herd-immunity doesn’t have an agreed upon definition. It doesn’t mean that there are no cases of COVID-19 in the community. If that were the case, everyone would have to be immune, so we would require 100% of everyone to be immune and stay that way.

We think herd immunity means that disease transmission starts going down on its own (without interventions in place) because there’s enough immunity in the herd to block just enough secondary (and tertiary, etc.) transmission that it burns out the continued spread.

We can understand this by talking about R-values. We’ve all learned that if the effective R value is greater than 1, the disease is spreading exponentially. If it is less than 1 it’s declining, (also exponentially).

Ideally, policy makers would keep non-pharmaceutical interventions like mask wearing and limited indoor capacity in crowded bars, nightclubs, and restaurants until the R values are less than 1. They would then slowly relax those measures and continue to monitor the R value to make sure it stays below 1 before relaxing more measures. This would help us ease into a soft-landing that mimics the benefits of herd-immunity before we fully achieve it.

Eventually, you reach a spot where you no longer have any non-pharmaceutical interventions in place and the R value is still below 1 (cases per capita continue to fall).

Voila, you have achieved herd immunity!

How Will We Know When Arizona Achieves Herd Immunity?

Our governor and health director have already eliminated every single required mitigation measure except for vaccinating people. So, in a sense, we are at a baseline place where there are already no required mitigation measures. Yet, some people are continuing to respect distancing, wear masks in public, and are altering their routines to avoid crowded places.

Some businesses are still voluntarily following CDC recommended mitigation measures, but we’re getting close to the place where there are very few interventions in place.

For example, the DBacks home games will be played at 50% capacity beginning this week (they are not really limiting attendance because they almost never sell more than 50% of their seats).

To reach herd-immunity, we need to have case counts that are still decreasing (with an R less than 1) even after we have full stadiums, crowded bars, full classrooms, and we’ve all taken our masks off.

Right now, Arizona’s Rt (reproduction rate) is about 1.2 indicating that cases are steadily rising. The only intervention in place is vaccination, so we will likely continue to see an increase in cases until we hit the vaccination tipping point and we begin to see a decline – and herd immunity.

Will people still get sick after we reach herd immunity? Yes, absolutely! Herd-immunity only means that cases stop growing. It doesn’t mean COVID-19 has been extinguished. Who will be most likely to get sick? Well, obviously the unvaccinated folks will.

Herd immunity isn’t permanent. Antibodies and cell mediated immunity can wane over time – regardless of whether they are acquired naturally or from vaccination. When this happens, the amount of immunity in a population can decline. Novel variants can also make herd-immunity harder to reach if antibodies aren’t cross-protective.

Diseases also have an opportunity to become endemic meaning that they are always around and never fully die out. Enough disease sticks around in susceptible folks (or herd-mates) until a few lose their immunity and get sick. So, herd immunity needs to be thought about year-after-year. The only alternative is to eliminate a disease completely, which is unlikely for this coronavirus. We already have four endemic coronaviruses, and SARS-CoV2 is trying to become the fifth.

The original ASU forecasting models suggested that we will achieve herd immunity when about 75% of the people in Arizona have either been vaccinated or had been infected with the virus and recovered.

The ASU Biodesiign Institute recently modified their model because the new (and more transmissible) British B.1.1.7 variant is now the dominant strain in Arizona. Their new estimate is that we will need to get to 80-85% of Arizonans immunized or infected before we get to “herd immunity” under our definition.

Our promise to you is that we’ll continue to look at the data objectively and let you know when we think we’ve hit a threshold of a sustained downward trajectory in community spread in an environment where there is hardly any mitigation underway (except for vaccinations).

But remember, new variants could change the calculus, and we could again be placed into an environment where spread is rising again. The likelihood of that happening depends largely on how quickly the rest of the world achieves herd immunity. The longer that takes, the more likely it is that a new variant will throw a monkey wrench at us.

Tim Lant, Ph.D.

Will Humble, MPH

fosemckay Disease Control, Early Childhood, Prevention

Director Christ & Governor Ducey Blind-side Superintendent Hoffman & the K-12 School System by Abruptly Eliminating School-based Mask Mandates

Governor Ducey and Director Christ just summarily eliminated a previous executive order that had required K-12 schools to have mask policies in place for students, teachers, staff and visitors. As of today, schools MAY have a mask mandate policy but it is no longer required.

That means that schools will need to individually keep and defend any mask requirement that they currently have in place. Many schools will drop their requirements. Those that keep their policies will have worse adherence.

In the opening statement of their media release that announces this foolish change, Director Christ and Governor Ducey state that:

“In alignment with Centers for Disease Control and Prevention (CDC) guidance, Governor Doug Ducey and the Arizona Department of Health Services today rescinded orders that direct K-12 schools to require masks.”Governor Ducey

That statement is a lie and they know it. CDC’s guidance and recommendations for schools makes it clear that they urge schools to use “universal and correct usage of masks” in the K-12 school setting”.

These two are really a piece of work. They couldn’t even wait for the remainder of the school year to finish with the existing mask policies in place. Instead, they made mask wearing at schools optional with only 23 more days of school left in most districts.

They have really made some tremendously bad policy decisions over the last year. Now we can add another one to the list.

Editorial Note: Superintendent of Public Instruction Kathy Hoffman found out about this move only moments before Director Christ and Governor Ducey issued their press release announcing the Edict. Director Christ would have known about this for days, and yet failed to have the common courtesy to give Superintendent Hoffman a heads up.

Actually, common courtesy would have consisted of actually CONSULTING with Superintendent Hoffman before they issued this edict.

Shameful.

fosemckay Vaccination

Federal Pharmacy Program Expansion Complete: Access Points All Across Arizona Now

Two weeks ago the White House announced that the Federal Retail Pharmacy Program for COVID-19 Vaccination is expanding from 17,000 participating pharmacies to nearly 40,000 stores by tomorrow. This achievement will make it so a vaccine site will be within five miles of 90% of all Americans. The participating pharmacies in the Federal Retail Pharmacy Program are in communities across the country – including 45% in the highest-need neighborhoods.

This is a very important program because these pharmacies get shipments directly from the federal government and don’t rely on meager allocations from the ADHS, who has been prioritizing allocations toward the state financed and university run mega-sites.

I just checked on www.vaccinefinder.org and found numerous convenient appointment that are available at several pharmacies near my house. 

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