Washington, D.C., December 22, 2008 - The American Public Health Association (APHA) recently adopted 12 policies at its 136th Annual Meeting in San Diego. The newly adopted policies address a broad range of public health issues from Vitamin D deficiency and smoking in films to reproductive health and removal of wisdom teeth.
Following are descriptions of the measures approved by the Association’s Governing Council during the Annual Meeting from Oct. 25-29, 2008. For the full 2008 policies, visit www.apha.org/advocacy/policy.
● 20081 - Vitamin D deficiency/insufficiency — Recognizes that vitamin D deficiency and insufficiency are major public health concerns for both children and adults in the United States, leading to muscle weakness, osteoporosis and other health concerns. Notes that black Americans are at highest risk for vitamin D deficiency and that although intoxication with the vitamin is rare, it can cause health problems such as hypercalcemia. Calls for more research to determine therapeutic or optimal levels of vitamin D that would help prevent disease, especially in high-risk groups such as the elderly. Calls for research into food fortification and the optimal levels to reduce the chance of toxicity.
● 20082 - Smoking in feature films — Notes that growing literature links adolescents’ exposure to viewing smoking in movies to initiation of their own smoking behavior. Urges the Motion Picture Association of America to endorse and initiate efforts to implement the four objectives of the Smoke Free Movies Project: rate new films showing or implying tobacco use as “R,” post a certificate in the credits at the end of the movie declaring no pay-offs for using or displaying tobacco products, require strong anti-smoking ads before any film with a tobacco presence, and stop identifying tobacco brands in any movie scene. Encourages state attorneys general to endorse and advocate for the implementation of objectives in the Smoke Free Movies Project. Requests that Congress pursue opportunities to regulate the showcasing and use of products with public health consequences, such as tobacco.
● 20083 - Safe, legal abortion access — Urges state lawmakers to repeal or oppose state laws that in any way limit access to safe abortion services, including mandatory delays and information or counseling that is not science-based, bans on specific abortion procedures, parental consent or notification requirements, targeted regulation of abortion providers, and limits for advanced practice clinicians in providing abortion services. Supports state laws that improve abortion access, including funding for abortion via state Medicaid funds and protecting health facilities and clinicians that provide abortion services. Also supports state laws that maintain medical decision-making within the patient-health care provider relationship, that strengthen the current federal protection on the right to access abortion under Roe v. Wade, and that allow trained advanced practice clinicians to provide medical and aspiration abortions.
● 20084 - Ban on lead use in paints, consumer products — Urges a worldwide ban on the continued use of residential lead-based paint, the removal of lead content in all paint and children’s products, and the elimination of all nonessential uses of lead in all consumer products. Urges all trade agreements include provisions that formally and effectively ban the use of lead in residential paint and children’s products as well as nonessential use of lead in consumer products. Urges the Consumer Product Safety Commission and the American Society for Testing and Materials International to quickly complete a lead-in-vinyl standard. Calls for agencies of the U.S. federal government to enforce a ban on the manufacture, import, distribution and sale of all children’s and consumer products containing nonessential lead, and to devise and implement an effective monitoring, quality control and quality assurance program.
● 20085 - Routine removal of wisdom teeth — Recommends that public information about the removal of third molars be based on evidence of diagnosed pathology or demonstrable need. Opposes prophylactic removal of third molars. Recommends that the Agency for Healthcare Research and Quality, the National Institutes of Health and other independent researchers call for convening an expert panel that considers evidence-based research on the effectiveness and appropriateness of prophylactic removal of third molars and generates a consensus statement. Recommends that oral health researchers and funding agencies include in their research agendas support for the application of evidence-based dental practice. Urges all public health agencies and dental professional organizations to disseminate information explaining why prophylactic removal of third molars is not recommended.
● 20086 - Patients rights to death with dignity — Supports allowing a mentally competent, terminally ill adult to obtain prescriptions for medication that the person could self-administer to control the time, place and manner of her or his impending death, whereas safeguards equivalent to those in the Oregon Death with Dignity Act are in place. Encourages that where such option is available to vulnerable populations, including people with a disability that existed prior to the terminal illness, data be collected on the incidence when vulnerable populations and people whose disabilities are independent of their terminal illness choose to hasten their death. Supports provision of information about the full range of end-of-life care options to terminally ill patients permitted by law in the state in which the patient is receiving care.
● 20087 - Community water fluoridation — Reiterates a strong endorsement and recommendation for the fluoridation of all community water systems as a safe and effective public health measure for the prevention of tooth decay. Recommends that federal, state and local agencies and organizations in the United States promote water fluoridation as the foundation for better oral health. Recommends promotion and increased support by federal, state and local entities for adequate public health infrastructure to assure safe and effective water fluoridation practices, including monitoring, training, technical and financial assistance. Recommends increased federal support for continued research on the safety and effectiveness of water fluoridation and other measures to deliver fluoride to communities and individuals. Supports education efforts on community water fluoridation and other appropriate uses of fluoride to prevent tooth decay.
● 20088 - Interprofessional education — Calls on health professions education programs and schools of public health to incorporate coursework and clinical training emphasizing cross-disciplinary and interprofessional interactions including the development of an interdisciplinary curriculum. Calls upon those programs and schools to evaluate the impact of interprofessional education on professional practice and health care outcomes as well as to evaluate curricular changes to assess differences in students’ and graduates’ communication skills, knowledge, attitudes and understanding of the roles of different members of the interprofessional health care team. Encourages providers of continuing professional education to offer training and courses in interprofessional care featuring a multidisciplinary faculty from different disciplines and health care fields. Urges the Agency for Healthcare Research and Quality and other agencies to fund research on the effectiveness of interprofessional health care education.
● 20089 - Health systems in developing countries — Encourages the U.S. government to support and finance initiatives that are explicitly aimed at building the capacity of health systems in developing countries to address prevention, promotion and curative health care needs. Urges international nongovernmental agencies to sign on to the Code of Conduct for Health System Strengthening in Developing Countries. Recommends that international nongovernmental organizations include capacity building and strengthening of national and local health systems in their projects to ensure long-term sustainability after the project period ends. Urges the International Monetary Fund to alter its policies that have prevented developing country governments from adequately expanding health system capacity and national health work forces. Recommends the U.S. government and other donors increase the resources dedicated to strengthening primary health care in developing countries.
The following three policies were passed as latebreakers and will serve as interim policies until confirmed by the APHA Governing Council at its 2009 meeting.
● LB–08–01 Global food crisis — Encourages the U.S. government to support and finance initiatives that are explicitly aimed at improving food security and developing long-term and sustainable food production and supply systems around the world to prevent any further acute food crisis and its related consequences. Urges governments and international organizations to provide solutions that will stabilize food production and distribution to meet the global demand for nutritious, adequate and affordable food. Encourages genuine partnerships with affected countries to strengthen food security and join policy development and implementation. Urges those involved in the food and agricultural sectors to be mindful of the environment and climate change when developing food security policies and programs. Recommends the United States revise its food and agriculture policies to decrease shipping and processing costs of food aid.
● LB-08-02 Legal U.S. drinking age — Recognizes that research shows that as states lowered the legal drinking age during the 1970s, there was an increase in alcohol use, traffic crashes and other alcohol-related problems among individuals younger than 21 and that when the drinking age was increased to age 21, consumption and alcohol-related problems decreased. Recognizes that the effectiveness of 21 as the legal drinking age is acknowledged by national agencies and organizations such as the National Resource Council, the Institute of Medicine and the American Medical Association. Urges Congress and the states to maintain and enforce the current drinking age of 21 across all states and resist any efforts to lower the minimum drinking age.
● LB-08-03 Health inequities and transportation — Resolves that transportation and land policies need to include consideration of the impacts on social determinants of health and equity, such as access to health services, healthy food, safe physical activity resources, education and employment. Urges transportation and land-use policies and programs to consider and address disproportionate impacts on vulnerable populations. Recommends that public health students and professionals be trained on the linkages between transportation and land-use systems and policies and their relation to public health. Calls for federal incentives, mandates and regulations to promote state expansion of programs that have been proven to improve traffic injury prevention. Calls for additional research to document the adverse and beneficial health impacts of various elements of the built environment related to transportation and land-use patterns.