ARGC!
Say what?! Like many large organization, American Public Health Association
(APHA) has an alphabet soup of acronyms. The “ARGC” is the Affiliate
Representative to the Governing Council. As ARGC for NHPHA, I am your
voting representative on the Governing Council of APHA. The GC establishes
policies of APHA, amends the bylaws, and elects the Executive Board (the
body that meets monthly and has the fiduciary responsibility for APHA).
But what does all that mean? By sharing a day-by-day account of my time at
the APHA annual meeting, I hope you will feel more connected to the “big
picture” and can learn along with me.
November 7, 2009: APHA Day 1
As the representative of NHPHA, I have meetings that began at 8 am this
morning. After Board meeting yesterday and the 9-hour drive to
Philadelphia, I decided I would not try to arrive by 8! By 9, however, I
sat down with the representatives from Vermont, Maine, Massachusetts, Rhode
Island, and Connecticut (Region 1 states) as well as reps from most of the
other regions, and listened to presentations from the “Committee on
Affiliates” (CoA) and the staff at APHA who support the state affiliates. They
discussed several items that I will bring back to some of the Board
committees but not bore you with here. After a break, we divided into
groups to discuss successes and challenges. I sat in on the discussion of
leadership of state affiliates where we discussed leadership development,
recruiting and involving students, and leadership burn-out. Lots of ideas
to think about.
After an orientation to the role of the Governing Council and the various
representatives (including the ARGC), I attended the first business session
of the Governing Council. The candidates for APHA President Elect and for
Executive Board each spoke and I was able to narrow down who to vote for
when the election takes place on Tuesday. We also heard reports from the
APHA Executive Director, Treasurer and several task forces. All quite
interesting (no really! I enjoyed it!).
Tomorrow (well, now it opens today!), the annual conference opens formally
at noon. More later!
Policies and More! November 8, 2009: APHA Day 2
Today began early. Dennis and I got up in time to catch the 7:45 train into Philly (we are staying with our sons in West Philadelphia). We waited at the station with about 30 other people and the train didn't come. Finally someone called someone and found out that the printed schedule was wrong-the first train would come at 8:45-and then it was late!
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The APHA Opening Session began at noon. The highlights for me were hearing the new Surgeon General and the Director of the EPA. The Senate confirmed Dr. Regina Benjamin as Surgeon General at the end of October. Dr. Benjamin shared a little of her life and learnings. While still in medical school, she learned how much difference one voice can make. Later she learned that even a doctor whose background is similar to that of her patient can act in a culturally incompetent way. And she learned about the working poor who cannot afford medical care. Dr. Benjamin is kind, humble, and hard-working. What a privilege to hear her speak.
Lisa Jackson, the new administrator at the EPA, said, "Environmental protection is health protection." She is a woman on a mission: rebuild the foundations (especially science and enforcement authority) of environmental protection and then build up from there. She outlined some of the basic principles by which she intends to accomplish this mission. Two of these particularly inspired loud applause. First, she believes that those who develop and manufacture chemicals should be required to provide the data EPA would need to evaluate the safety of what they make. She pointed out that, of the more than 80,000 chemicals in common use today, less than a dozen have been evaluated for their impact on human health. In assessing and managing the health risks of the chemicals we use, Mrs. Jackson also emphasizes focusing on vulnerable populations, especially children and those who have greater exposure because of where they live and/or work.
Later in the afternoon I attended some of the hearings to discuss proposed policies I will be voting on Tuesday. There are 15 policies-all have been reviewed and rewritten multiple times. The hearings divided the policies into 4 groups: Health Disparities/International Health, Environmental Health, Access to Care, Public Health Science and Infrastructure. How could I choose?!! I had read all the policies. Nothing in them caught my eye as being particularly issues I would want to discuss on behalf of NHPHA so I listened to the one of most interest to me personally. Policies in the Health Disparities/International Health include one on community health workers, border crossing deaths in the southwest, addressing the world food crisis, incorporating the UN Millennium Development Goals into APHA language and advocacy, and "The Role of Public Health Practitioners, Academics and Advocates in Relation to Armed Conflict and War". All very interesting!
EXHAUSTED! More tomorrow.
SOOOO Many Choices: November 9, 2009: APHA Day 3
I’ll let you do the math. There are five sets of break-out sessions each day; each break-out session time slot has about 80 choices; and each of those choices has 4-5 presentations!
I decided that today I would focus on sessions I wanted to go to for me personally/professionally. Early in the morning, I attended a session on Maternal and Infant Epidemiology. I can’t say that the epi is my strongest suit but I understood the research being presented and found it quite interesting. The studies presented included one on post partum depression which confirmed that one out of every seven women experiences pp depression. The study developed and tested methods for screening and assessment and will now begin a randomized trial comparing usual care (education about pp depression and referral to community resources) with a coach/navigator program.
The second break-out session presented an interesting series of discussions of Institutional Review Boards (IRB), ethics, and Community-based Participatory Research (CBPR). I am preparing to do qualitative research in the Dominican Republic and have been going through the IRB process. I had just completed about 20 hours of training on protection of human research subjects so the discussion of biomedical ethics versus “communitarian” ethics as the basis for IRB decisions was particularly interesting. I had not heard of communitarian ethics prior to this so that will be an interesting topic to explore.
In the afternoon, I attended a session on “transformational learning” activities to teach social justice and social determinants of health in nursing curricula: another topic to explore in more depth and lots of interesting ideas. Next, I attended a session presenting nursing research on “population-focused” interventions. While interesting, the interventions were actually focused on individuals. I may not be interpreting population-focused interventions correctly. I think do not think of individual home visits to families of children with poorly controlled asthma as population-focused. One of the presenters discussed research comparing the “Stages of Change” model with another one, the Interaction Model of Health Behavior. Having just completed David Laflamme’s class on behavioral health which, I thought, covered every behavior change model imaginable, it surprised me to hear of yet another one!
Finally, I attended a session on climate change and nursing. One speaker made a distinction between mitigation—avoiding the unmanageable—and adaptation—managing the unavoidable. I’ll have to think more about that distinction and what it means but the speaker mentioned that NH is one of the states with a comprehensive “adaptation plan”. Is this something many of you know about? One more item on my “follow-up” list!
The weather in Philly has been beautiful! Clear skies, cool air. The Reading Terminal Market is across the street from the Convention Center—a combination of local market (fresh produce, meat shops, bakeries), food court (Pakistani, Lebanese, Chinese, seafood, coffee, cookies, chocolate) and tourist market. Dennis and I have enjoyed interesting lunches sitting outside and also have enjoyed walking between hotels for various sessions and to-from the trolley stop.
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At the Heart of It All: November 10, 2009: APHA Day 4
The profound and the mundane; talking heads and deep passions—Governing Council is the heart of APHA. And, like a heart, it is invisible to most people. It is like what you would imagine for any “house of delegates” kind of meeting—except on a budget. Long rows of hotel conference tables—without even the fancy table linens. Placards identifying the various delegations—clearly these have been reused for many years. A head table (sans linens) with a couple of table microphones and a microphone at the podium—but to speak from the “floor” you had to go to one of three floor mikes. And at the end of the meeting we were asked to leave the binders so they could reuse them next year! Great to see a big organization using their funds carefully!
The morning began with testing the electronic voting pads. These were used for all votes except elections. We started the agenda with a couple more reports and then a lengthy discussion of a theme for the annual meeting in 2011. The one that we eventually selected is something about healthy and sustainable communities, healthy minds, healthy bodies but I don’t have the exact wording as it was finally amended and adopted.
Much of the day was spent working on and voting on policy statements. As I shared in an earlier post, most of these policy statements had been reviewed and rewritten multiple times, most recently yesterday after Sunday’s hearings. As a result, most of them were placed on a “consent agenda” to be voted as a block. Two of the 13 got pulled off the consent agenda because a delegate requested that. We passed the consent agenda policies and then dealt with the other two. Both were passed after some discussion and before breaking for lunch.
During lunch, I met with the other ARGCs from New England—a nice group of folks. We discussed our impressions of the various candidates as well as sharing any information (I had none) of experiences with the work of the candidates in other APHA settings. The election came immediately after lunch. One of those elected to the Nominating Committee was Adewale Troutman who spoke at the NHPHA Fall Forum in 2008. We elected Linda Rae Murray as President-Elect. Those who know her believe she will be an energizing advocate for local and state affiliates.
In addition to the election after lunch we debated two “late breaking” policy proposals. These are proposals on issues that arose after the deadline for regular policy consideration. They have a shorter review/revision cycle and only remain in effect for one year. If the issue remains current, the policy must go through the regular policy process and be voted on next year. We did not pass one proposal, mandatory seasonal flu vaccination for health care workers, though that will likely come to the GC next year. We had a lengthy debate on the other policy opposing an anti-abortion amendment in the current House version of health care reform. No-one spoke in opposition to the concept of the policy, only that APHA already has policies opposing limits on abortion and, in fact, APHA had already very actively advocated against that amendment to the House bill. In spite of the feelings of some that it was unnecessary to pass another policy that duplicates policies being actively used, the Council adopted this policy.
We ended the day with a debate on a resolution to appoint a working group to evaluate the whole process for reviewing and rewriting policy proposals. Again, there was not real argument about the need for this, just the specifics of who should be included and when the work should be completed.
We managed to adjourn early—thus I am able to send this tonight. I will try to write one more account after tomorrow’s scientific sessions and the closing keynote. I have enjoyed serving you at the NHPHA ARGC—I will continue to give my best to this role through the coming year. I welcome your input, comment, and opinions!
12,500:November 11, 2009: APHA Day 5
Well, this year’s APHA annual meeting is over. Today I went to several sessions—nothing very inspiring. One speaker pointed out that, with gas at $3 a gallon, we ought to be grateful that our cars do not run on bottled water which is about $4 a gallon and produces lots of waste! I thought maybe I was just too tired to be inspired but the closing session proved me wrong. Dr. Howard Koh spoke. Dr. Koh has been a health equity advocate in Massachusetts for many years until President Obama tapped him as Assistant Secretary of Health (that may not be quite his exact title but it is the role). He spoke with passion, eloquence and humor. He calls public health a “fascinating and frustrating field of study and service” which saves lives “millions at a time.” He talked at length about the importance of building public health infrastructure as well as sharing information about the goals being developed for Healthy People 2020. I apologize that I did not get them written down before he had moved on but I am sure we will all see them many times in the future.
Another inspiring speaker at the closing session was Dr. Carmen Nevarez, the incoming APHA President. She is the first APHA President of Mexican heritage and talked about her family’s experiences as immigrants. She explained that, like many immigrant families, her parents had come at the healthiest time of their lives to work in terrible conditions and to support their children achieving their highest potential while their own health steadily declined. Dr. Nevarez encouraged us to reach out to students; to pull them into our associations and our activities; and to enjoy their energy, vision, and optimism as we all work on “prevention and equity for ALL who live, work, and play in this country.”
We also heard from Dr. Yvette Roubideaux. Dr. Roubideaux is the new Director of Indian Health Service. She is also of the Rosebud Sioux nation and has served as an IHS physician so she has seen IHS from several perspectives. She is also the first woman to serve as the agencies director.
The final tally of attendees was over 12,500. With that many people, the well of energy, passion, inspiration, and ideas is deep indeed. I love attending APHA and have been grateful for this opportunity to represent NH. Thank you!
