Medical Care
Section Newsletter
Fall 2004

2004 Advance Program Information

Greetings members of the Medical Care Section:

I am happy to share with you the Advance Program information for Scientific Sessions and Business Meetings that will be sponsored by the Medical Care Section at the 2004 APHA Annual Meeting (see attached file). More detailed information is available on the APHA Web site at <>. Please note that Medical Care Section-sponsored sessions will all be located in the Convention Center. Please check the printed or online program at the meeting for the exact room locations.

While the listing of Scientific Sessions is pretty straightforward, and we do have a very exciting program of scientific sessions, let me highlight one particular session which is a little different.

That session is the Medical Care Section Committees Roundtable Session, scheduled for Tuesday evening from 8:30 to 10 p.m., right after the "Viseltear Award and Evening With" session. There are a great many opportunities for networking and involvement through the Committees. This session is designed so that interested members of the Section can gather together to meet existing Committee leaders and members to get involved. The Committees of the Medical Care Section are: Drug Policy and Pharmacy Services; Ethnic and Racial Disparities; Health Economics; Health Services Research; History; Jail and Prison Health; Quality Improvement; Rural Health; Social Sciences in Health; Urban Health; Veterans' Health; and Women's Health. Committee members review contributed abstracts, and can help organize scientific sessions for the Annual Meeting, as well as network with each other in their area of interest throughout the year. Let me note that we do plan to have some food and beverages available for this evening session to offer you sustenance at the end of a long day.

In addition, please allow me to offer some explanations for the Business Meeting listing. There are two major categories of Committee Meetings in the Business Meeting schedule that are each named similarly, plus a couple of others that are named differently.

(1) On Sunday, there are eight Study Groups sponsored by the Committee on Health Services Research. These are listed in sequential number with the same generic name for the purposes of this preliminary program. These Study Groups are officially classified as Business Meetings, and we use them as roundtable sessions on work in progress to distinguish them from Scientific Sessions. As yet, the specific topics have not been announced because they are still being finalized.

(2) Each day during the Annual Meeting, there is a Medical Care Section Council Business Meeting, so these are also listed in sequential number with the same generic name. On Saturday and Sunday they occur in the early evening, while on Monday, Tuesday, and Wednesday they occur in the early morning. The agenda for each day's meeting is different based on working our way through standing reports and also based on preparing for specific events during the meeting, such as Governing Council, election of officers, and policy resolutions. The chair of the Medical Care Section (John B. Wayne, <>) sets the agendas for these meetings, and they are usually finalized shortly before the Annual Meeting in November. All active members of the Section are invited to participate in these daily Section Council Business meetings.

Finally, please note that I am recruiting for a new chair (or co-chairs) of the Committee on Health Services Research. The responsibilities include: (1) organizing reviews of contributed abstracts in the category of Health Services Research; (2) organizing scientific sessions for the presentation of contributed abstracts that are accepted; (3) organizing the "Update on Health Services Research" solicited scientific session; and (4) organizing the Sunday Study Groups. Anyone interested in getting involved in some or all of these activities, please send me an e-mail at <> or call me. I have done this all before myself, and I will be available to assist you in "learning the ropes." Also, I'm very open to the idea of co-chairs in order to divide up the responsibilities. It's a great opportunity to both have a finger on the pulse of what's happening in the field, as well as make a much-needed and much-appreciated contribution to the Section and to APHA.

I look forward to greeting as many of you as possible during the Annual Meeting.

Best regards,

Bruce Davidson

Bruce N. Davidson, PhD, MPH
Program Chair, Medical Care Section
Acting Chair, Committee on Health Services Research, Medical Care Section
American Public Health Association

Director, Resource and Outcomes Management
Cedars-Sinai Health System
8700 Beverly Boulevard, Suite 2227
Los Angeles, CA 90048
(310) 423-6203 (voice)

Related Files:

Announcement: Sunday Study Group Topics Finalized

Sunday Study Group Topics -- Listed as Medical Care Section Business Meetings

10:30 to 11 a.m.
Study Group on International Collaborations on Improving Prison Health Care
(Committee on Health Services Research Study Group #2)

2 to 3:30 p.m.
Study Group on the Drug-Uninsured: Measurement and Access Issues
(Committee on Health Services Research Study Group #3)

Study Group on Advances in Economic Evaluation Techniques, Part 1
(Committee on Health Services Research Study Group #4)

Study Group on Initiatives Addressing Prescription Drug Comparability, Part 1
(Committee on Health Services Research Study Group #5)

Study Group on Global Trade, Affordable Drugs, and Public Health's Right to Regulate
(Committee on Health Services Research Study Group #6)

4 to 5:30 p.m.
Study Group on Initiatives Addressing Prescription Drug Comparability, Part 2
(Committee on Health Services Research Study Group #7)

Study Group on Advances in Economic Evaluation Techniques, Part 2
(Committee on Health Services Research Study Group #8)

Report from TFAIR

TFAIR, APHA's Task Force on Organization and Governance, is in its second year of work and is planning a report and several sets of discussions with sub-groups of APHA membership for the Annual Meeting. This year, TFAIR got off to a slower start than we would have liked. With a change in leadership from Jay Berkelhamer to Paul Locke, we were not active until April of this year when Paul felt he really had authorization and a clear sense of how TFAIR would work with the new Executive Board and a variety of other organizational change projects simultaneously occurring. For example, while TFAIR is focusing on organization and structure of APHA, the Committee on Affiliates (COA) is working actively with Georges Benjamin (Executive Director of APHA) on forging an actual formal agreement with affiliates to strengthen both local and national organizations. This is quite important to TFAIR's work and APHA's ultimate effectiveness, so TFAIR is working collaterally with this development. Likewise, Intersectional Council (ISC) is refining definitions and criteria for becoming a Section and a SPIG as many groups want to get recognition as SPIGs from APHA, and several smaller sections are having problems fully functioning and are seeking support from APHA. (These discussions were a focus of the ISC last year, and the ISC Steering Committee continues to follow-up). Last, as part of Strategic Planning and APHA's new Strategic MAP, introduced last year, the Executive Board and Executive Director are spending some time on Executive Board roles and functions and relationships between staff and membership. Therefore, in reality, TFAIR is part of just one of many important processes looking at organizational effectiveness and change.

TFAIR, consequently, looked at the range of items emanating from its charge as set by Governing Council (GC) and decided to use the Annual Meeting and several pre-meeting conversations to focus on the following:

1) Overlap, consistency and function among the variety of task forces, standing committees, ad hoc committees and standing Boards, like Science Board, Action Board, etc. of APHA, and the identification of a process for promulgation, sunset, accountability and efficacy of these Advisory Units (our term for them all) – something like a CQI process for next year to develop recommendations with respect to existing Advisory Units;

2) Membership Units’ (SPIGs, Sections, Caucuses) roles generally, support, status and decision-making roles (and secondarily those of affiliates as we work collaterally with the COA); and

3) Students, specifically, what kind of organizational structure is required to maximize participation, recruitment and leadership development.

TFAIR either will have recommendations on some aspects of the three issues above, or will frame GC break out discussions and dialogue to reach recommendations for next year (2005). We have some options and ideas that we wish to test out this year in the breakout groups of GC (on Sunday) with respect particularly to advisory and membership units.

Our report will also list other issues that we have not tackled this year. Many of these issues are most critical such as: a) whether there is a need to further clarify roles and functions between GC and Executive Board and staff; b) what structures promote accountability and transparency of leadership most effectively; c) what GC structure in the future would promote decision making and membership engagement most effectively; and d) to be more effective politically, what kind of government relations and advocacy structure and process does APHA need parallel to the existing policy development and Joint Policy Committee (JPC) process.

The JPC process currently allows members to identify diverse issues across the spectrum of public health. Yet, TFAIR wants to explore what kind of policy analysis and implementation resources APHA needs not only to respond to member priorities (as the JPC process now does), but to effectively activate all members on the issues that bring us together as public health workers, on the priorities that GC establishes annually and on which we must be more effective. This area of advocacy effectiveness and organizational change in support of advocacy will be raised.

Last, TFAIR will ask the GC to reauthorize it -– to pull together final recommendations on this year's issues (after GC deliberations and break-out groups) and to tackle the issues on which we have not yet fully developed proposals or consensus. One last note: we are very mindful of developing alternative strategies and having majority and minority reports where relevant to encourage decision making and debate and where we do not have consensus within TFAIR. Until TFAIR actually does more work, I am not sure how this will play out. There is a great deal of consensus on many items within our group, although there is disagreement sometimes, perhaps, on emphasis. Until we are farther along, I am not sure where committee member demarcation lines are drawn. Like the organization as a whole, TFAIR is still figuring things out. Our members are great, flexible, and well-meaning, and it is too early to tell where and if there is even disagreement after discussion. So, I hope GC gives us at least one more year to keep plugging away.

If you have comments on the above, please send them to <>.

By Leatrice Berman Sandler
Immediate Past Chair, Medical Care Section
TFAIR Member

Trade Agreements Threaten Drug Reimportation, Public Health Protections

“There is growing concern that international trade agreements such as the Central American treaty threaten health care and the health of communities. Provisions in that treaty, for example, could reduce affordable access to vital human services, including health care, water supply, education and energy as well as availability of medications.” APHA President Virginia Caine summed up these concerns about trade agreements and public health in her August 2004 editorial in The Nation’s Health. She concluded, “The public health and health care communities must be party to discussions on trade agreements and must work hard to reframe the trade debate so that health and health protections are included as priorities.”

Many members of Congress now agree.

The Center for Policy Analysis on Trade and Health (CPATH) was alerted in early 2004 by the Australia Public Health Association that the proposed U.S. administration trade agreement with Australia reflected a new U.S. policy of seeking to raise drug prices in other developed countries. In response to growing discontent over high drug prices in the United States, the administration claimed that raising prices abroad would shift the burden of paying for drug research and development costs off of U.S. consumers, and thereby lower the cost of drugs in the United States.

The Australia agreement as initially presented in the United States early in 2004 reportedly had several features:

1. It modified Australia’s Pharmaceutical Benefits Scheme (PBS), which negotiates affordable drug prices using a system of “reference pricing.”

2. It could outlaw the reimportation of lower priced drugs into the United States.

Facing public outcry on both issues and bipartisan concern by members of Congress, the U.S. Trade Representative (USTR) claimed that both provisions were rescinded.

CPATH reviewed the relevant sections of the Agreement, when it was released publicly, and determined that the Agreement:

1. Still threatened Australia’s PBS, although it had been modified from the original version;

2. Still potentially outlawed reimportation of prescription drugs into the United States; and

3. Also potentially threatened the systems that U.S. agencies use to negotiate affordable drug prices for the Veterans Affairs (VA) Department, Medicare, and Medicaid.

In response to CPATH briefing papers and written testimony to Congress, the Senate Veterans’ Affairs Committee wrote a letter of inquiry to the VA in mid-May, asking for their interpretation of the trade rules. The California Senate Office of Research, in response to a request from state Sen. Liz Figueroa, provided an opinion on the implications for Medicaid. Rep. Tom Allen of Maine and many other members of Congress circulated “Dear Colleague” letters raising serious questions about the Agreement.

On July 12, 2004, the New York Times published a major front page story presenting the concerns about the prescription drug provisions of the Agreement.

For a variety of reasons, the Australia Agreement was always expected to be approved by Congress, and it was. However, almost without exception, every member of the House and Senate who rose to speak on this Agreement during the vote in mid-July addressed the following points proposed by CPATH.

1. Trade agreements must not undermine Congress’ right and responsibility to pass future legislation that would provide affordable medications for Americans, and to protect current programs that offer affordable drugs, including those through the VA Department, Medicare and Medicaid.

2. The provisions of the Australia FTA related to pharmaceuticals should not set a precedent for future trade agreements (including the pharmaceuticals annex, government procurement and intellectual property sections).

3. The public health community must be officially represented in trade negotiations, which should promote transparent, democratic decision-making. Congress, the USTR and the American public must be informed of the impact of trade agreements on the public’s health.

4. U.S. policies should support enforceable commitments to advancing population health, and to achieving access to affordable medications, health care, and other vital services in the United States and internationally.

Members of Congress have now become aware of the links –- and conflicts –- between international trade agreements, the pharmaceutical industry, and the interests of U.S. constituents in access to affordable medicines. Members of Congress have further committed to take action as these issues resurface, which will surely be the case as trade negotiations progress with the Andean nations, southern Africa and Thailand. The Central American Free Trade Agreement (CAFTA) has been completed, containing a number of barriers to access to medicines; CAFTA could come before Congress during a lame duck session in December.

Further background information is available on the CPATH Web site: >>.

A study session at the APHA Annual Meeting will explore how trade agreements threaten access to affordable medicines and related public health issues. The session is scheduled for:

Sunday, Nov. 7, 2004 at 2 p.m.
Study Group on Global Trade, Affordable Drugs, and Public Health's Right to Regulate
(Session 235.0, Committee on Health Services Research Study Group #6)
Washington Convention Center, Room 208B

By Ellen R. Shaffer PhD, MPH

Jail and Prison Health Committee Report

This fall is an important moment for work within APHA for jail and prison health. In October, Bobby Cohen will represent APHA in the Netherlands as an observer at the World Health Organization Health in Prison Project (HIPP) annual meeting. Members of WHO HIPP and the UK Prison Health Service will attend the APHA Annual Meeting in Washington, D.C., where we will host a study session on Sunday on International Collaborations for Prison Health. We are pleased to announce that John Boyington will present information about how the UK has integrated its prison medical care into the National Health Service, and Lars Moller will discuss the work of WHO HIPP. Anyone interested in details of our work or sessions at the Annual Meeting, please contact Corey Weinstein at <>.

By Corey Weinstein