Simon Piller, MD

Action Board Representative for Medical Care Section

I had the opportunity to attend a mid-year meeting of the Action Board at APHA headquarters in Washington, D.C.   It was a good learning experience for me.  I am still the learning the ins and outs of the Action Board -- in the sense of what role it plays at this time and what possible role it could play.  In my opinion there is the potential for the Action Board to take a leading role in policy implementation within APHA.  To quote from a letter I received from APHA (signed by President-elect Cheryl Easley and Executive Director Georges Benjamin):

“The Action Board is charged with the facilitation and implementation of Association policies and positions.  The Action Board takes action on APHA priorities, action alerts and other advocacy activities as needed.  The Action Board selects three representatives for the Joint Policy Committee by participating in new policy review.  In carrying out its responsibilities, the Action Board appoints subcommittees; collaborates with other units of the Association and its Affiliates; and encourages relationships with other organizations interested in collaborative action and building coalitions.” 

I think there is more that the Action Board can do. As a member of the Action Board's Archiving Committee (more aptly named Existing Policy Review Committee), I was mandated to encourage APHA membership participation in review of policies from the recent or not so recent past.  The idea is to streamline the policies we have, guaranteeing their relevance, and utility.  I think the worry about permanently archiving policies that still have validity is overblown, because there are plenty of checks and balances that prevent this.  I think two of the best aspects of this process are the learning process for rank-and-file APHA members when they participate, and the identification of policy gaps in which important APHA concerns could be addressed.  Participation by the MC Section with this process was scant at best this year.  I think it would be useful to discuss this process and the MC Section's relationship to it in San Diego.

During the Washington meeting, many of us went to the offices of our respective Congressional representatives to raise issues of importance that were identified by APHA executive leadership.  It was a useful experience; certainly it helped me get an idea of where the politicians stand on some APHA issues. 

There was an interesting “Grass Tops” project presented at the Action Board meeting.  The project is intended to: “Identify, motivate, train and activate a core of capable, experienced advocates in the states who can communicate APHA's federal policy priorities to targeted public officials.” The goal is greater collaboration between APHA and state and local public health associations. Unfortunately some of this seems to be top-down prioritization of policies that the Action Board is encouraged to promote (either to our section membership, the public at large or our elected representatives).  It also seems that the policies or actions are more reactive than proactive, e.g., promoting important policies not yet on the politician’s radar screen (such as single party payer or opposition to the Iraq war).

Finally, the choice by APHA of what policies to support sometimes manifests itself as a trade-off (sell-out?).  This was clearly the case in a recent alert from the Government Relations team:  “Contact your representative and urge him/her to support a provision in the Iraq war supplementation spending bill that would place a temporary one-year moratorium on seven questionable Medicaid regulations that would make significant cuts to the Medicaid program over the next five years. On May 22 the Senate passed a supplemental appropriations bill that included a moratorium on seven Medicaid regulations by a veto-proof margin.  Including the Medicaid provisions in the Iraq war supplemental is our best chance of getting the president to sign the moratorium into law.”  Am I missing something?  Didn’t this pit one APHA policy (Medicaid funding) against another (opposition to the Iraq war)?  If it wins, it is a pyrrhic victory at best!

Comments about the Action Board and its potential as a leading force for APHA policy are now being accepted.  Ellen S. and Leatrice among others have expressed concern for quite some time and again, most recently. A significant discussion would be warranted in San Diego to help the Action Board chart its course and lead.

Please e-mail me with any concerns you might have.

Sincerely,

Simon Piller, MD