Each year, the policy process helps give shape to the advocacy efforts of APHA.  There is a fresh opportunity for members to offer new policies for consideration that could guide APHA if adopted.  The process begins in December and wraps up at the annual meeting with hearings on the new proposed policies and a vote by the Governing Council.  If approved, the policies are announced publicly and become the basis for APHA positions on the issues and action by the staff and the membership.  

The Policy Process.          

The steps leading up to adoption of new policies begin with work by the Action Board and the Joint Policy Committee (JPC) to identify gaps in APHA policies.  Gaps or new issues may also be identified by the members.  These committees also identify policy areas that should be reviewed for archiving or updating (see below).  By mid-February, proposed new policy resolutions and position papers are due in electronic form at policy@apha.org.  The new policies are then posted on the APHA webpage.  For the subsequent month, comments are welcome. 

        The policies and any comments are reviewed in late April by three APHA Committees (Joint Policy Committee, Science Board, and Education Board).  After the policies accompanied by assessments and/or comments are returned to the authors, the authors have a month to send revised policies or appeals of negative assessments.  The Executive Committee considers appeals of negative assessments.  In mid-September, the final proposed policies are posted on the APHA website for review by the membership. 

        Public hearings for the proposed new policies are held at the Annual Meeting.

        After the hearings, the JPC develops final recommendations on the proposed policies to present to the Governing Council.  The policies are voted on at the Annual Meeting during the meeting of the Governing Council.   There is also a mechanism for “Late breaking” policies that have become a pressing issue only after the deadline for submission back in February.  This deadline coincides with the start of the Annual Meeting.     

   Policy Proposals 2008. 

The policies posted at this time for consideration by the membership before hearings and a vote by the Governing Council at the Annual Meeting are listed under four headings:  Health Disparities, Environmental Health, Access to Care, and Public Health Science and Infrastructure.  The only proposed policy in the Health Disparities area calls for education and research into Vitamin D deficiency and insufficiency based on evidence that it frequently goes undetected, and may lead to higher mortality rates in a range of conditions, some currently identified and some not-yet identified.      

            There are two proposed Environmental Health policies.  The first would place the APHA as a discouraging influence on the depiction of smoking in feature films based on good evidence that this influences youth to smoke.  The second policy advocates a world-wide ban on the use of lead in residential paint and children’s products.  While there is currently a ban on use of lead in the United States, this is not the case in other countries that export products that are contaminated with lead, including children’s toys.  The proposition stipulates that agencies of the US federal government, including, but not limited to, the Consumer Product Safety Commission, the Environmental Protection Agency, and the Department of Commerce, be directed to enforce a ban on the manufacture, import, distribution, and sale of all children’s and consumer products containing nonessential lead and, together with the private sector, devise and implement a robust and effective monitoring and quality control and quality assurance program.

          It calls for the expeditious completion by the Consumer Product Safety Commission and ASTM International of a lead-in-vinyl standard.  It further stipulates that all trade agreements between US corporations and overseas corporations and all global trade agreements completed by the World Trade Organization, the World Bank, and other entities and other relevant international conventions include provisions that formally and effectively ban the use of lead in residential paint and children’s products and that all such agreements ban the nonessential use of lead in all consumer products.

          The Access category offers two policies.  The first re-states and updates support for Roe vs. Wade which is facing challenges in many states and could be in danger from the Supreme Court, depending on the outcome of the Presidential election and future appointments to the court.  It notes that abortion bans were introduced in 12 states to replace Roe v. Wade, in case it should be overturned at the federal level.   Mandatory waiting and counseling periods have been introduced in 25 states.  Proposed laws placing additional limits on public spending for abortions for low income women have been introduced in 15 states.  Laws requiring that minors obtain parental consent or that at least 1 parent be notified were introduced in 15 states.  New statistical reporting burdens on physicians have been introduced in 12 states; limitations on private insurance coverage or specific abortion procedures have been introduced in 9 states.    The second Access policy opposes prophylactic removal of third molars (wisdom teeth).

        In the Public Health Science and Infrastructure category, there are four proposed policies.  The first is labeled the patient’s right to self-determination at the end of life.  It would place the APHA in support of measures to ensure that patients eligible to choose aid in dying receive information about, and are able to choose alternatives such as aggressive pain and symptom management, palliative care, hospice care, and care to maximize quality of life and independence. An earlier version of this policy was considered by the Governing Council last year.  Discussion continues in 2008. 

         The second Infrastructure policy addresses oral health.  It re-states and updates support for fluoridation of community drinking water.  It notes that dental caries are one of the most common chronic diseases of children.  Surprisingly, only 67% of people served by public water supplies are fluoridated despite overwhelming evidence of its effectiveness to prevent tooth decay.  The Healthy People 2010 goal is 75%.  Those who get their water from wells or drink bottled water only often lack appropriate fluoride intake.  Other measures are needed for this population.   It also advocates low fluoride toothpaste for children under age 6 who may be at risk from over-exposure from adult fluoride containing toothpastes.  This proposal updates prior policies on oral health and fluoride, the last of which was passed in 1975.  Other Infrastructure proposals address the promotion of interprofessional education and support for strengthening health systems in developing countries.

        These policies will be discussed at the Annual Meeting at hearings that are open to all members.   The authors and Joint Policy Committee members will take the products of the hearings and refine them for final presentation for consideration by the Governing Council.  Proposals are presented to the Council for consideration and debate.  A final vote is taken of Council members. 

Archiving Process. 

Another important part of the policy process is the archiving and updating of policies that are already “on the books.”  In February the JPC considers the list of policies identified by staff for an archiving review which involves review groups for each subject area.  By late May, each Policy Review Group completes its reviews of the policies assigned to it and reports their recommendations to the JPC.  Comments from individual members are also due at this time.  APHA staff collates the recommendations of the Policy Review Groups and provides the list to the JPC.  In July, the preliminary consent calendar and recommendations for archiving are posted on the APHA website.  The APHA Executive Board also considers the preliminary archiving consent calendar.

The membership has another month to submit comments on the archiving consent calendar which is then finalized by the JPC in September. 

 Policy Process and the Medical Care Section. 

Within the Medical Care Section, proposed policies are reviewed by section councilors and governing councilors and all members are encouraged to participate.  Ideally, any concerns about a policy are identified and addressed through the normal review process, however, any remaining concerns can be raised during the section business meeting at the Annual Meeting on Saturday, the day before the hearings, and a decision made as to whether to support the policy as written or recommend changes. Each public hearing is attended by at least one section councilor or other designated section member who will raise the section’s concerns or support.  This process helps inform the vote of our governing councilors.

Similarly, concerns relating to the archiving of policies are ideally dealt with in the process outlined above.  However, if a concern is raised during a business meeting relating to a policy on the consent calendar for archiving, a governing councilor can ask that the policy be pulled. 

Ideas for new policy or updating an out-of-date policy can be suggested by any member.  The section business meetings at the Annual Meeting provide the venue for discussion and preparation for policy development.  Please join us!

You can help: 

If you are interested in reviewing any of the policies mentioned above go to http://www.apha.org/advocacy/policy/. You will need your APHA membership number (userid) and password (first initial and last name).  As you read, make note of any concerns you have about the proposed policy.  You can send your comments to me, mona.sarfaty@yahoo.com, or come to the section business meeting on Saturday night, at 5:30 p.m.  You can also find out about late breaking policies at the Saturday section business meeting.