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Maintaining the National Commitment to the Nation's Health

Policy Date: 1/1/1996
Policy Number: 9601

The American Public Health Association,
Recognizing by powerful moves in the federal government to weaken or nullify a broad range of policies, entitlements, and programs designed to protect the nation's health and social welfare; and
Cognizant of the historical development of those policies, entitlements, and programs over the course of more than six decades on the basis of a wealth of societal experience, both here and abroad, and a massive body of research in public health1-15 and social policy;16-l9 and
Recalling the Association's affirmation20 of the propositions that:
o the health of the people requires not only a universal national health care policy but also social and economic policies that foster the health, stability, and general welfare of the population,
o resources that are basic to health include affordable housing, a safe and nutritious food supply, a safe, peaceful environment, full employment opportunities for a meaningful role in society, and education and information throughout the life span,
o the responsibilities of government include a core of publicly supported services, income supplements, and social insurance; and
Considering the unprecedented sweep of efforts21-24 by the Congress and, in some instances, by the federal administration to:
o limit, reduce, or even eliminate the functions, services, and benefits provided under health, housing, environmental protection, and welfare programs that are important for promoting and maintaining the public's health (including but not limited to Medicaid,25 Medicare,26,27 food and drug protections,28-3l workplace health and safety,32-34 health services for undocumented and even for documented immigrants,35 public housing and housing supports,36-40 clean air,41 Supplemental Security Income,43 food stamps,32,44 and school lunches32,45),
o turn key programs over to the states without essential resources, by replacing entitlements with federal block grants to be administered by the states, as occurred with the replacement of the Aid to Families with Dependent Children (AFDC) entitlement with the Temporary Assistance for Needy Families (TANF) block grant,
o remove federal responsibility and regulation for assuring the provision of these services; and
Recognizing that poor people, people of color, women, children, and the elderly would be particularly victimized by such changes, changes that only compound the harm already being done by such developments in the labor market as declining real wages and the increasing prevalence of irregular and deskilled employment;46,47 and
Recalling the Association's commitment to the promotion of voter registration and electoral participation;48 therefore
1. Urges the President and Congress to defend and support the Medicaid, Medicare, and federal public health, environmental protection, and occupational health and safety programs as well as federal housing, food, nutrition, and income maintenance entitlements and programs, all of which contribute critically to maintaining and enhancing the public's health;
2. Urges the President and the Congress to oppose legislation that would substitute block grants to the states for Medicaid, that would limit Medicare funding, that would impose on eligibility for entitlements further arbitrary time limits unrelated to employability or job availability, that would exclude legal immigrants and certain children from TANF eligibility, that would deny public health services to any immigrants or that would permit states to deny public education to immigrant children;
3. Urges that the impact of the TANF block grant be monitored on an ongoing basis and that its implications for the public's health be widely publicized;
4. Calls for voter registration services in all public health agencies so as to afford a voice in future health-related policy decisions to larger numbers of persons subject to the impact of legislative proposals such as those discussed above and calls for full use to be made of the opportunities and mandates arising out of the Voter Registration Act of 1993; and
5. Commits itself to intensified efforts to promote public discussion and understanding of the foregoing concerns and stimulate legislative initiatives and electoral participation in support of those concerns. To the extent practicable, these efforts are to be pursued through grassroots action and collaboration and coalition with associations of health and welfare professionals and workers, as well as with organizations of those constituencies most likely to be hurt by the weakening of public health, social insurance and other federal safety net programs.


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  11. Fee E. Disease and Discovery: A History of the Johns Hopkins School of Hygiene and Public Health 1916-1939. Baltimore, MD: Johns Hopkins University Press; 1987.

  12. Committee for the Study of the Future of Public Health. A history of the public health system. In: Institute of Medicine, The Future of Public Health. Washington, DC: National Academy Press; 1988:56.

  13. Wilkinson WH, Sidel VW. Social interventions and applications in public health. In: Holland WW, Detels R., Knox G., eds., Oxford Textbook of Public Health. Vol. 3. 2nd ed. Oxford, UK: Oxford University Press; 1991:47.

  14. Rosen G. A History of Public Health. Baltimore, MD: Johns Hopkins University Press; 1993.

  15. Davies JK, Kelly M., eds. Healthy Cities. New York, NY: Routledge; 1993.

  16. Abramovitz M. Regulating the Lives of Women: Social Welfare Policy from Colonial Times to the Present. Boston, MA: South End Press; 1988.

  17. Katz MB, ed. The "Underclass" Debate: Views from History. Princeton, NJ: Princeton University Press; 1993.

  18. Bane MJ, Elwood DT. Welfare Realities: From Rhetoric to Reform. Cambridge, MA: Harvard University Press; 1994.

  19. Gordon L. Pitied But Not Entitled: Single Women and the History of Welfare. New York, NY: Free Press; 1994.

  20. APHA Principles of Social Welfare Policy. The Nation's Health. February 1995.

  21. National Low Income Housing Coalition, National Congress for Community Economic Development. Federal Policy in Transition. Washington, DC: National Low Income Housing Coalition, National Congress for Community Economic Development; 1996.

  22. Legislative Watch. Washington, DC: Natural Resources Defense Council; July 2, 1996.

  23. Abramovitz M. Under Attack, Fighting Back. Women and Welfare in the United States. New York, NY: Monthly Review Press, 1996.

  24. Sidel R. Keeping Women and Children Last. New York, NY: Penguin Books; 1996.

  25. HR 3507. The Medicaid Restructuring Act of 1996. US House of Representatives, 1996.

  26. Clymer A. Of touching third rails and tackling Medicare. New York Times. October 27, 1995.

  27. Georges C. GOP adopts risky strategy on Medicare, taking case for cuts openly to voters to blunt attack ads. Wall Street Journal. April 23, 1996.

  28. HR 1627. The Food Quality Protection Act. US House of Representatives; 1995.

  29. HR 3199. The Drug and Biological Products Reform Act. US House of Representatives; 1996.

  30. HR 3200. The Food Amendments and Animal Drug Availability Act. US House of Representatives; 1996.

  31. S 1477. The Food and Drug Administration Performance and Accountability Act of 1996. US Senate; 1996.

  32. Already declining OSHA inspections take severe blow from shutdown, funding cuts. Occupational Safety and Health Reporter. February 21, 1996.

  33. House plan to kill NIOSH resurrected; GOP proposal also calls for MSHA, OSHA merger. Occupational Safety and Health Reporter. May 15, 1996.

  34. HR 3755. Labor-HHS FY 1997 Appropriations Bill. Washington DC: US House of Representatives, 1996.

  35. HR 2202. The Immigration in the National Interest Act. US House of Representatives; 1995.

  36. Washington, DC: US Dept of Housing and Urban Development; The Transformation of America's Public Housing: A 1996 Status Report. 1996.

  37. HR 3019. The FY96 Omnibus Appropriations Bill. US House of Representatives; 1996.

  38. S 1260. The Public Housing Reform and Empowerment Act. US Senate; 1996.

  39. HR 2406. The United States Housing Act of 1995. US House of Representatives; 1995.

  40. HR 3666. HUD-VA Independent Agencies FY 1997 Appropriations Bill. US House of Representatives; 1996.

  41. HR 3446. The Regulatory Relief and Job Presentation Act of 1996. US House of Representatives; 1996.

  42. PL 104-121. Signed into law by President Clinton March 29, 1996.

  43. HR 1997. The Food Stamp Flexibility and Commodity Distribution Consolidation Act of 1995. US House of Representatives; 1995.

  44. S 904. The Nutrition Assistance Reform Act of 1995. US Senate; 1995.

  45. S 1841. The Work First and Personal Responsibility Act of 1996. US Senate; 1996.

  46. Dembo D, Morehouse W. The Underbelly of the US Economy: Joblessness and the Pauperization of Work in America. New York, NY: Apex Press; 1994.

  47. Mishel L, Bernstein J. The State of Working America 1994-1995. Economic Policy Institute. Armonk, NY: M.E. Sharpe; 1995.

  48. APHA Resolution 8322: Voter registration and the 1984 elections. APHA Public Policy Statements, 1948 to Present, Cumulative. Washington, DC: American Public Health Association, current volume.