Medical Care
Section Newsletter
Annual Meeting 2005

WHO Health in Prison Project Celebrates 10 Years

The 33 member States of the WHO Health in Prison Project met in the conference center of the Westminster Church House in London Oct. 17-18, 2005, to celebrate 10 years of accomplishments and discuss the challenges of the next decade. (See AJPH, Oct. 05, 2005, p.1695)

Representatives from the prison medical services of most of the cooperating pan-European nations were in attendance. It was a privilege and a pleasure to observe the deliberations of HIPP that have been central in facing the TB epidemic in Russian facilities, encouraging harm reduction strategies like needle exchange, condoms and opiate replacement and working toward equivalency of care and public health measures between inside and outside of prison.

HIPP brings together prison administrators, public health departments, academics and concerned NGOs to develop penal standards of care and areas of involvement ( National representatives are appointed through the ministers of health. HIPP has developed four consensus statements to date: HIV/AIDS, STD and TB in Prison; Mental Health Promotion; Prison, Drugs and Society; and Promoting Health of Young People in Custody. The Moscow Declaration clarifies that prison health is part of public health, with a resulting European Task Force to facilitate links between prison medicine and public health, to encourage operation within codes of human rights and medical ethics, to promote rehabilitation as the purpose of incarceration, to decrease exposure to communicable disease and to raise the level of medical care to meet community standards.

HIPP is creating a Prison Health Database that will allow online data entry by 2006, and a Prison Health Guide regarding best practice policies and procedures. I delivered the APHA Standards for Health Services in Correctional Institutions (2003) to Lars Moller, the head of the WHO HIPP office, and John Boyington, the director of the HIPP Collaborating Center in London.

During the first day’s Plenary Session, information was presented on the extent of substance abuse in prisons and public health solutions, mental health issues, and the continuing severe problem of TB in Russia and its relationship to incarceration. Nils Christie of the University of Oslo advised that the best way to increase prison health is to decrease the prison population.

The Task Force meeting on the following day included reports from member states. For example, Norway reported about an online course for physicians in prison health available in English ( Spain described seven years of successful needle exchange in prisons, Portugal discussed their peer education programs, and Rumania their TB control program. Kyrgyzstan has a needle exchange program, and opiate replacement (methadone maintenance) is becoming the standard of care among the HIPP nations. Best practice awards were distributed at an elegant dinner the same evening. Alex Gatherer received a special achievement award for his role in developing HIPP.

I am interested in hearing from anyone in APHA who has contacts in PAHO or among the Pan American nations who would be interested in exploring these issues with our international body. I can be reached at Corey Weinstein, MD, <>, 1199 Sanchez Street, San Francisco, CA 94114, (415) 333-8228.

What is Fascism?

What is fascism? It was certainly a question of hot debate at last year's meeting. I would submit that it is a breakdown in the state's ability to maintain the consent and loyalty of the governed, which necessitates the open use of ideology and force to reestablish control. Although we all think of goose-stepping troops when we hear this word, the ideas and practices which pave the way to overt fascism are more subtle. In times of peace and economic prosperity, the U.S. government, whose primary role is to protect the profits and interests of American capitalism, can persuade working people and professionals that their personal prosperity and happiness are aligned with the success of capitalists. However, when capitalists must fight wars to maintain control over resources and to decrease jobs, wages, and social services to maintain profitability, it is harder to maintain the illusion that all Americans are in this together. Some of the time-tested ideas that are brought out to reinforce the idea that the system is not the source of peoples' problems are:

  • racism and nationalism – our problems are the fault of those of another race or national origin;

  • extreme patriotism – it is unamerican to question government policies;

  • antiscientific thought – you must believe what you are told and not use rational thought to draw your own conclusions; and

  • individual responsibility for failure – if you are not happy, employed, educated, etc., it is because you are stupid or mentally impaired.

When all else fails, naked force comes into play – the decrease of civil liberties, strike-breaking, police brutality, and criminalization of school discipline.

As health workers, we should examine trends in health care and research which subserve the needs of the public, patients and science to the needs of the U.S. government and American capitalism. Much attention has been paid at our meetings to the sacrifice of public health funds to the campaign to immunize against smallpox or fight bioterrorism, and the total collapse of drug safety controls and unbiased drug research to pharmaceutical profits. Overt racism in research is again evident in the current scandal in New York City over the use of black and Latino foster children for HIV drug trials without consent or oversight. The current emphasis on the high prevalence of "mental illness," from the Surgeon's General Report of 1999 to the current Harvard study declaring 30 percent of us to be impaired, is not only a boon to drug companies but attributes people's unhappiness to their own inherent defects. The government has redefined torture and enlisted military doctors to participate. Health care for the poor and nonwhite is glibly abandoned as we see in Tennessee's cutting thousands off Medicaid, Arizona banning health care to immigrants, or state and local governments allowing thousands to languish for days without food or medicine in New Orleans.

All of us as individuals and in our organization fight against each of these trends separately, but we should also begin to view them as a pattern of ideas and practices intended to drive our loyalties away from patients and public health and toward being protectors of the interests of the state.

Meeting On Trade and Health: Come By to Discuss the Global Economy and Public Health

The APHA Working Group on Trade and Health will sponsor a business meeting on Sunday, Dec. 11, 2005, from 2 p.m. to 4 p.m., in the Philadelphia Convention Center, Room 112B. Please join us to discuss:

  • APHA’s policies on global trade and public health, present and future;

  • How the Central American Free Trade Agreement, and pending agreements with the Andean nations, Thailand and Southern Africa, will affect access to affordable medicines in the United States and abroad;

  • What the trade agenda means for the public health infrastructure and health services; and

  • Successes in winning democratic public health representation in trade negotiations.

Please join other members to discuss these important issues and our plans for 2006. In addition to Medical Care, sponsoring sections include Occupational Health and Safety, Environment, Alcohol Tobacco and Other Drugs, and International Health, as well as affiliates from Florida and Northern and Southern California.

The second Working Group activity will be on Tuesday, Dec. 13, 2005, 4:30 - 6 p.m. in room #101A of the convention center. This is a multi-section panel on the impact of trade on public health issues. Garrett Brown will be representing the OHS Section; join speakers from the Medical Care, Environment, and Alcohol, Tobacco and other Drugs sections.

Any Section member interested in becoming active in the Working Group is heartily encouraged to do so. If you have any questions or comments, please contact Ellen Shaffer at <> for further details.

David Graham wins 2005 APHA Award for Excellence!

David Graham, MD, MPH, associate director for science and medicine, Office of Drug Safety, Food and Drug Administration, is the winner of the 2005 APHA Award for Excellence. This award “recognizes an individual for exceptionally meritorious contribution to the improvement of health of the people.”

Medical Care Section member Julie Zito, PhD, MS, wrote in her letter nominating Graham for the award that his “scientific work spans more than 15 years and is entirely aimed at improving community health through increased knowledge of and policy change toward greater medication safety.” She went on to say Graham's "contribution represents both science and advocacy—a rare mixture in today’s biomedical/public health ranks.”

Congratulations, David Graham!

Announcement: Alison Hughes Retires

Alison Hughes, a long-time Medical Care Section activist, has announced her retirement as director of Arizona's Rural Health Office, located in the Mel and Enid Zuckerman College of Public Health, at the University of Arizona. For almost two decades, she has contributed to the Medical Care Section by serving as editor of the rural health committee newsletter, chairing the rural health committee, serving on Governing Council and Action Board, and serving as Medical Care Section secretary and membership chair.

She writes that the members of Medical Care Section contributed in deep ways to her appreciation of a set of core values that make the Section stand out as the most important in APHA – values that respect equality, justice, and the elimination of health disparities at all levels, among all populations in the country, indeed, in the world.

"I will always remember the Section's long-term activists and their contributions to social change, and offer these words to the new Section members. APHA is huge. You can get lost when you first start attending the Annual Meetings. Stick with it. Stick with Medical Care. Get to know the activists and the values they represent. Never give up advocating for social change, and let you advocacy represent those deep-seated core values that we all hold dear."

Alison will continue to work at the Rural Health Office on a part-time basis. She will still be with us at Medical Care in spirit, and sometimes, in person. She sends her love and regrets that she won't be at the Philadelphia Meeting.