The American Public Health Association adopted 17 new policy statements at its annual meeting Nov. 2-6 in Boston, issuing ambitious recommendations to public health officials and also trying to rebrand the field of public health.
Along with voting for a new president-elect, Shiriki Kumanyika, a University of Pennsylvania medical school epidemiology professor specializing in obesity research, the APHA is stepping into a number of important, sometimes controversial policy areas — for instance, urging a repeal of a federal funding ban for safe syringe access — as part of a broad call to action for expanding preventive health services.
“We’ve developed our new tagline to reflect these values and to act as our rallying cry: For science. For action. For health,” said APHA executive director Georges Benjamin, MD, in a media release.
Reflecting the APHA’s growing interest in epidemiology, next year’s focus will be on “Healthography: How where you live affects your health and wellbeing.” As Kumanyika told a local public radio station, “We don't want people to have to test their water before they drink it.”
Among the recommendations, the APHA is calling on state and local governments to consider the health effects of noise pollution in siting regulations and to expand pedestrian-friendly transportation networks with land use policies that “prioritize access to natural areas and green spaces for residents of all ages, abilities and income levels.” In addition to bike lanes and walking paths, the organization is reaching out to health professionals, hospitals and school districts to try and help them get people outdoors and to increase the understanding of the benefits of nature and outdoor recreation.
The APHA is also calling for expanded access to medical and workplace benefits, such as sick and family
paid leave and palliative and hospice services in gerontology care.
Amid the expanding waves of retirees and seniors, the APHA is envisioning public health models of palliative care that incorporate patient-centered medical home design, and is calling for investments in the palliative care workforce and for public education campaigns explaining patient rights in pain management and end-of-life care.
Along with population health, the APHA is also calling for expanded access to personalized medicine.
With the federal government’s Healthy People 2020 goals including wide access to genomic testing for cancer patients, the APHA is encouraging public health professionals “to address disparities in who is offered cancer genetic testing” and supporting expanded Medicaid and Medicare coverage for personalized diagnostics and therapies — an area that’s already raising public debate about what the state will and will not cover. The Oregon's Health Evidence Review Commission has faced criticism and charges of rationing Medicaid care in its decisions to limit coverage for treatments shown to have very low chances of leading to long-term survival.
Moving through this decade, many of the APHA’s policy goals face funding pressures at the local, state and federal level, a reason why the organization is trying to evolve the whole field of public health.
Here are the APHA’s new policy statements:
Child care health and safety standards — Extends APHA's support of "Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs" to the document's third edition, which was published in 2011. Calls on child care providers, child care health consultants, state health and child care administrators as well as child care licensing organizations to adopt Caring for Our Children as their standard of care. Also encourages federal policymakers to assist states in motivating child care programs to adopt the standards set forth in Caring for Our Children.
Breastfeeding call to action — Continues APHA's strong support of breastfeeding and recognizes efforts to increase breastfeeding rates and narrow breastfeeding disparities as fundamental public health issues. Calls for increasing access to lactation services, especially among under-served populations, and making sure such services are properly reimbursed. Also urges restricting infant formula marketing practices that can discourage breastfeeding, promoting breastfeeding in developing nations to help decrease HIV infection rates and endorsing the breastfeeding actions outlined in the 2013 federal "Report of the Secretary's Advisory Committee on Infant Mortality."
Preventing opioid overdose deaths — Supports preventing opioid overdoses through public education efforts, dissemination of best practices and distribution of naloxone, a drug used to treat an opiate overdose. Calls on the federal government to undertake a coordinated approach to preventing opioid overdose deaths via efforts such as raising public awareness of the signs and symptoms of an overdose, supporting access to treatment and recovery services, and enabling access to naloxone. Also urges federal officials to provide state and local health officials with resources to support public education and naloxone distribution programs.
Public health and palliative approaches to care— Considering the growing burden of life-limiting and chronic disease among older adults, calls for public health-based prevention strategies to improve overall population and gerontological health. To achieve such goals, calls for moving beyond traditional medical practices and using public health policy to foster intersectoral collaboration, innovation and models of patient-centered palliative care. Calls for increasing access to palliative care, supporting development of the palliative care workforce, conducting public education on the right to palliative care and pain management, and funding for additional research.
Responding to environmental noise pollution — Citing findings that chronic environmental noise can cause negative health issues, urges officials with the National Prevention Strategy to include environmental noise pollution in its action plan. Calls on the U.S. Environmental Protection Agency to collect data on noise-related health effects, and the Centers for Disease Control and Prevention to collect data on the burden of disease potentially related to noise exposure. Also calls on states and municipalities to update noise regulations with regard to the health effects of noise pollution and include noise pollution in health impact assessments.
Paid sick and family leave policies — Noting that the U.S. is the only developed nation that does not require paid sick leave, calls on federal lawmakers to amend the Family and Medical Leave Act to apply to more employers than it already does. Recommends lawmakers extend the law's reach to include same-sex households. Also calls on federal lawmakers to adopt federal law based on San Francisco's sick leave policy, which allows workers to accrue paid sick leave and use it to care for themselves or a family member.
Nature, health and wellness — To aid in promoting healthy and active lifestyles, encourages land use decisions that prioritize access to natural areas and green spaces for residents of all ages, abilities and income levels. Calls on public health, medical and other health professionals to raise awareness among patients and the public at-large about the health benefits of spending time in nature and of nature-based play and recreation. Also urges such professionals to form partnerships with relevant stakeholders, such as parks departments, school districts and nature centers. Calls for promoting natural landscaping.
Preventing workplace injury and illness — Citing the absence of federal requirements that employers enact illness and injury prevention programs, calls on the U.S. Occupational Safety and Health Administration to disseminate a standard that requires such programs. Encourages continued federal research into barriers that prevent workers from reporting workplace injury and illness. Calls on federal agencies such as OSHA and the Mine Safety and Health Administration to support the development of educational materials. Also calls for meaningful penalties for employers found to have policies that discourage workers form reporting illness and injury.
Rejecting 'personhood' legislation for fetuses — To maintain women's constitutional rights and access to health services, calls on federal and state lawmakers to reject efforts that codify the legal status of a fetus as a person or as separate from a pregnant woman, as well as proposals that define life as beginning at conception. Urges health care providers to advocate for access to reproductive health services, including abortion and infertility treatments. Encourages judiciary bodies and law enforcement to renounce the use of murder, child welfare and other laws to treat the fetus as impendent from the woman.
Addressing solitary confinement as a public health issue — Noting that the solitary confinement of prisoners and detainees can cause significant mental health problems and create barriers to needed health care, urges correctional officials to discontinue solitary confinement as a punishment and to create alternatives for prisoners living with mental and chronic illness. Encourages officials to limit solitary confinement to the most extreme cases and include appropriate monitoring for health issues. Also calls on officials to exclude all juveniles from solitary confinement regardless of the type of correctional institution in which they are serving time.
Support for people released from jails, prisons — Calls on the U.S. Department of Labor to support policies that offer stable housing for people re-entering the community and links them to primary care providers. Also encourages changing job applications so that a person's criminal justice history is not the first item a potential employer sees as well as opposing policies that require stable housing and employment to avoid jail. Encourages federal leaders to scale up incarceration alternatives for people with mental illness and substance use disorders. Calls on public health professionals to help increase access to supportive community services.
Public health response to drug use — Noting that substance use treatment is often inaccessible and unaffordable for those who need it, recommends that federal officials and agencies convene stakeholders to review current drug policy and discuss the core components needed for a health-based drug policy. Also encourages federal, state and local policymakers to implement evidence-based prevention and intervention strategies, such as expanding access to treatment programs and redirecting resources from criminal justice programs to public health ones, . Also calls on Congress to permanently repeal the ban on funding for safe syringe access.
Defining the public health workforce — Urges public health stakeholders and key federal agencies to move toward creating consistent classifications for describing public health jobs and functions. Encourages stakeholders to collaborate on efforts to meet the target date of 2018 for recommending changes to the Standard Occupational Classification System. Calls on federal policymakers to fund the National Health Care Workforce Commission authorized via the Affordable Care Act and to charge the commission with creating a separate group to address public health workforce issues. Also calls for a White House Conference on Public Health.
Quality improvement in public health — Calls on federal health officials to partner with state, local, territorial and tribal officials in identifying quality improvement measures and in supporting the infrastructure needed to collect quality improvement data in real time. Encourages training current and future public health professionals on quality improvement and developing a culture of quality improvement practices. Also encourages funding for public health quality improvement as well as accreditation, and urges government agencies and private stakeholders to develop a research agenda dedicated to public health quality improvement.
Sustaining Social Security to protect health — Noting that Social Security is among the nation's most effective anti-poverty programs and that income is closely tied with health status, urges Congress to revise the Social Security Act to reduce the minimum credit requirement for eligibility and to allow all spouses to quality for benefits regardless of the length of marriage. Also calls on federal officials to oppose efforts to reduce Social Security benefits, and fund research on the links between income security and better health outcomes for older adults and others who benefit from Social Security.
Supporting the public health nursing workforce — Calls for more funding to support post-secondary education in nursing and public health, particularly in under-represented communities. Also calls for federal funding for a partnership between the Centers for Disease Control and Prevention and the American Association of Colleges of Nursing that supports training opportunities for entry- and advanced-level public health nursing and to train population-focused nurse educators. Encourages public and private employers to offer public health nurses benefits that are equitable to registered nurses. Urges federal labor officials to develop classifications to monitor the public health nursing workforce.
Cancer genomics and public health — Noting that cancer genetic testing is among the Healthy People 2020 objectives, urges health departments to include data on heritable cancer conditions and related service utilization into surveillance efforts and distribute the findings to relevant stakeholders. Calls for incorporating cancer genomics testing and education into public health cancer programs, and for raising public awareness about the value of cancer genetic testing. Encourages public health professionals to address disparities in who is offered cancer genetic testing and to support expanded coverage of such services via Medicaid and Medicare.
