Archive for the ‘Advocacy Process’ Category

Missouri: Time to monitor prescription drugs

March 12, 2017


One might guess that being the only state without something may not be a good distinction to have. In the case of the map to the left they would be correct. Missouri, highlighted here, is the only state to not have a prescription drug monitoring program or PDMP. PDMPs are tools used by doctors to look up what narcotic and potentially addictive drugs like opioid medications a patient receives in the hopes of stopping those that are abusing them or selling them. Deaths due to opioid and heroin have reached epidemic proportions; Missouri needs a PDMP.

The Centers for Disease Control and Prevention estimate that approximately 91 Americans die every day from an opioid overdose and since 1999 the amount of pain medication sold has quadrupled! On its website the CDC even recognizes how important PDMPs can be to reducing prescription drug deaths.

Countless other organizations such as mental health groups, drug policy think-tanks and physician groups, including the nation’s largest doctor group, the American Medical Association, have come out in support of states establishing these databases. One scientific study showed that using PDMP reduced the supply and abuse of opioid medications.

Why then does Missouri not have one? The answer lies with political action groups and conservative statesman that have blocked legislative efforts that create PDMPs. United for Missouri and Missouri Alliance for Freedom both believe that legislation like this erodes a citizen’s right to privacy and constitutes government over-regulation. Their biggest ally, State Senator Robert Schaaf, has gone so far as to filibuster bills that introduce them.

The truth is the people of Missouri must establish programs that have decreased opioid deaths. Senator Schaaf should stand down and the legislature should join the rest of the nation in establishing a prescription drug monitoring program



The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Controlling gun violence: Maryland’s 2013 Firearm Safety Act

March 12, 2017

Gun violence is an urgent public health issue in the United States. Many states, including Maryland, struggle with increasing numbers of firearm-related homicides. In 2016, Baltimore had 275 gun-related homicides despite increased arrests for gun crimes. This is a 44% increase from 2014 when 191 homicides occurred in the city.

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Among the 50 states, Maryland has been at the forefront of leading the gun safety movement in the country. In 2013, Maryland passed the Firearm Safety Act that bans the sale of commonly owned high-capacity firearms and magazines in the state. However, this law has been quite controversial.

Maryland Shall Issue, a gun store, and four Maryland residents filed a lawsuit against the Firearm Safety Act with the support of the Maryland State Rifle & Pistol Association. Initially, the U.S. District Court judge in Baltimore stated the law was constitutional and upheld the law. However, in 2016 the U.S. Court of Appeals for the Fourth Circuit overruled this reasoning by 2-1 vote, stating that high-capacity guns included in the ban were in common use.

Former Maryland Governor Martin O’Malley who led the passing of the 2013 law, as well as community groups such as Marylanders to Prevent Gun Violence, have lobbied other states to enact similar policies, believing that this law led to a reduction in gun-related homicides.

Despite the ongoing debate regarding the policy, the Maryland Department of Health and the Maryland State Police have not formally stated their positions with regard to the Firearm Safety Act. In order for the State of Maryland to protect the community from gun violence, it is important for the Maryland Department of Health and the Maryland State Police to release an evidence-based statement of their organizations’ positions. Furthermore, they should do this in a timely manner, before the case’s upcoming court proceedings.

National Health Reform in Mexico

March 12, 2017

Photo credit: The Yucatan Times via google


In 2003, Mexico legalized a health reform policy that endorsed the introduction a health insurance mechanism called Seguro Popular de Salud (SPS).   SPS was designed to secure universal health coverage (UHC) for all citizens.

Dr. Julio Frenk, who was then the secretary of the health, led the team of reformers who drew upon years of accrued evidence to build support at the federal level through successful lobbying efforts and by sidelining opponents in the executive and legislature.  Their efforts proved successful at ensuring the program’s adoption into policy.

However, one issue of fragmentation in health services provision was not adequately addressed. Prior to the policy’s adoption, formal workers received services through either the Social Security Institute (IMSS) or the Institute for Social Security and Services for Civil Servants (ISSSTE).  Informal workers received health services under public assistance or from the private sector, with no financial protections. 

Frenk and his team pushed for a nationally integrated insurance scheme through the  Family Health Insurance Scheme (FHI) run by the IMSS that would be independent from a competitive market for services provision.  Threatened by Frenk’s competitive model , the IMSS and Ministry of Health providers resisted. So, rather than becoming a national insurance scheme, SPS was left to function as a subsidy service for the poor.

SPS has recorded notable successes in increasing coverage for mostly informal workers and for the poor. However, the program can ensure greater coverage and financial protection through risk sharing across the entire Mexican population. Additionally, the introduction of consumer choice through competition will ensure greater efficiency in service provision. To achieve these, the federal government must secure buy-in from the IMSS and MOH unions  to pass a nationally integrated insurance scheme that ensures a maximal pool and adequate competition among providers.


Liquid Calories: Fighting Childhood Obesity due to Sugar-Sweetened Beverages

March 11, 2017

The Baltimore City Health Department states that 1 in 3 school aged children are clinically overweight or obese. One of the major causes of this is the consumption of sugar sweetened beverages (SSBs). SSBs are drinks that contain high sugar content with little nutritional value such as sodas, energy drinks, and sports drinks, which due to their unfulfilling nature cause children to consume much more than their daily recommended caloric intake.


Image Cred: The Capher


Research compiled by the Department of Nutrition at Harvard has shown that for every 12oz soda, children have a 60% increased odds of becoming obese, a 26% increased odds of developing diabetes, and a 20% and 75% increased risk, respectively, of heart disease and gout as an adult. Consequently, the U.S. spends roughly $190 billion treating children for traditionally adult obesity related complications yearly.

There are, however, interventions that are effective in curbing this epidemic. A 2016 study demonstrated that when SSBs are simply accompanied by a warning label that states “Drinking beverages with added sugars contributes to obesity, diabetes, and tooth decay”, almost 20% fewer adolescents chose to drink an SSB compared to SSBs without labels. In January of 2016 Nick Mosby, Baltimore City Councilman, proposed a bill to the City Council requiring billboard advertisements, restaurants, transit adds, retailers and food service facilities post this warning label, with a $500 fine for noncompliance.

Although scheduled for a committee voting session in November of 2016, the legislation has stalled and it’s not clear presently when it will be voted on. This stagnancy makes it vital that the Baltimore City Health Department increase their own campaigns in support of the legislation, in addition to their support of NGO’s like The Sugar Free Kids Coalition which has testified for the Health Committee and continues to advocate for passage of the bill.

Paid Sick Leave in Maryland

March 11, 2017

Source: Family League of Baltimore 

In Maryland, an estimated 750,000 employees must make the difficult choice between caring for themselves when they are ill, and losing income or even their job. Yet, a paid sick leave policy has failed to pass the Maryland legislature in the last 4 years.

Opponents of paid sick leave, including business advocacy groups, express concerns about the economic burden on businesses and a negative impact on employers’ ability to hire additional employees. However, outcomes of states and cities in the US who have paid sick leave policies is evidence otherwise. After San Francisco mandated paid sick leave in 2007, 70 percent of employers reported no effect of the policy on profitability, and more than two-thirds of employers supported the policy. There were higher rates of job and business growth than neighboring counties, including the sectors most affected by the policy.   

Others recognize that paid sick leave is crucial to public health and the economy. During the H1N1 pandemic, employees attended work while sick, causing spread of infection to some 7 million co-workers in the USA alone. Paid sick leave also reduces the risk of workplace injuries. It has been recognized as a Human Right in the International Covenant on Economic, Social and Cultural Rights.

Other than increased healthcare costs due to more severe illnesses resulting from delay in seeking care, economic costs arise from lower productivity, in addition to collective costs of growing health and social inequalities. The lack of paid sick leave disproportionately affects workers in the service industry and those without a full-time job.

We call upon the Maryland Senate to build a legal basis for paid sick leave by passing the pending bill. The Maryland government has the responsibility to support the health of employees, the productivity of employers, and the public health of all Marylanders.


Source: Sick Leave in California 2017

The Global Gag Rule

March 11, 2017

The Mexico City Policy, introduced at the 1984 United Nations International Conference on Population, was an expansion of the 1973 Helms Amendment that restricted NGOs receiving US federal funds from providing abortions as a family planning method. This policy, commonly known as the Global Gag Rule (GGR), prevents NGOs from performing or promoting abortion as a condition of receiving US federal funds earmarked for family planning purposes. This controversial policy has been repealed or reinstated by Executive Order with each presidential administration since the 1990s.

The Trump Administration iteration of the GGR goes a step further and applies the same limits to all US global health funding.


via NPR

Groups currently receiving US global health funds are either remaining quiet about the policy or speaking against it. Those rejecting the policy stand to lose millions of dollars typically allocated to sexual and reproductive health (SRH) services globally, which could result in the closure of clinics, decreased access to care, and the associated increases in unplanned pregnancies, unsafe abortions, and maternal mortality.

Organizations working in SRH not reliant on US funding are coming out in opposition to the policy, signaling to other organizations their resistance to limitations on free speech in the delivery of care. Despite not receiving funds, these organizations will be indirectly impacted by the GGR as women seek care in areas where access is limited as a result of the GGR.

In the face of the GGR, the international community has stepped forward, with governments pledging funds for SRH organizations in an effort to cover the loss of funds, services, and care resulting from the policy.

To continue to undermine the efficacy of the policy, international NGOs and governments should reject the Mexico City policy while advocating for women’s rights and health globally. The US government should follow the lead of other western nations, permanently block the GGR (and Helm’s Amendment)and fight for the quality of SRH services, rather than their existence.

Mental Illness and Gun Ownership in America

March 8, 2017


In February 2017, President Donald Trump signed a bill, blocking an Obama-era rule that would have prevented people with mental disorders from buying guns. The rule was part of former President Barack Obama’s push to strengthen the federal background check system in the wake of the 2012 Sandy Hook Elementary School shooting in Newtown, Connecticut.


President Donald Trump signs an Executive Order on Feb. 28, 2017. (Credit: Aude Guerrucci-Pool/Getty Images)

The regulation under the Obama Administration would have required the Social Security Administration to add about 75,000 people currently on disability support to the national background check database and deny them gun purchases. These individuals suffer from mental impairments and other problems to such an extent that they are unable to manage basic tasks without help.

Both American Civil Liberty Union (ACLU) and National Rifle Association (NRA) are for the resolution, as supporters of the Second Amendment and advocates for the mentally ill. These organizations argue that the restrictions would possibly stereotype the mentally ill as violent. However, gun control advocacy organizations such as Coalition to Stop Gun Violence (CGSV) is actively fighting back to prohibit the mentally ill from possessing firearms. A recent example in Wellington, Missouri is another reason for gun control advocates to prevent weapons from falling into the hands of the mentally ill.

Instead of taking the regressive measure, the government should fight for stronger gun controls and better mental health care. For example, even if an individual passes the federal background check, he or she should be disarmed for expressing a credible threat to public safety. There needs to be a comprehensive analysis on gun control and mental illness in a broader context. Although not all gun violence is attributable to mental illness, actions to minimize firearm injuries and violence must be taken to avoid another massacre.

Increased Utilization of Physician Associates in the UK

March 5, 2017


A June 2016 national survey by the British Medical Association highlighted a shortage of General Practitioners (GP) in the UK, finding that 17% of GP positions are unfilled. The shortage of GPs is compounded by an aging UK population requiring more healthcare resources. Physician Associates (PAs) help narrow the GP staffing gap and increase access to care for National Health Service (NHS) patients.

However, PAs in the UK are unable to practice to the full extent of their training, experience and ability because PAs are unregulated medical providers. Unregulated means there are regulatory barriers forbidding PAs to write prescriptions or order x-rays or labs for patients. As a regulated medical profession, those barriers could be removed and PAs would fully function as members of a physician-PA medical team.

Comments to Parliament from the British Medical Association such as “physician associates must not replace doctors” and Royal College of General Practitioners “skeptical of the intention behind expanding the PA profession” ring of trade unionist protectionism and ignore numerous studies that validate PAs value to healthcare teams.

A 2015 observational study of PAs and GPs in the UK show that for same-day walk-in appointments there was no significant difference between PAs and physicians in re-consultation ratios, rates of diagnostic tests ordered, or patient satisfaction.

The Royal College of Physicians and Faculty of Physician Associates regularly advocate for stronger physician-PA relationships in the NHS by educating GPs and others who are skeptical about the value of PAs. In 2017, NHS committed to spend £15m on training 1,000 GP physician associates by 2020 to address the shortage of primary healthcare providers.

Removing regulatory barriers that prevent PAs from practicing to the full extent of their training will allow NHS to narrow the GP staffing gap and improve access to care for NHS patients.

Legalizing Cannabis Sales in DC is a Matter of Public Safety and Public Health

August 22, 2016

In 2014, voters legalized the personal possession of cannabis for adults 21 years or older via ballot initiative. However, unlike the states of Colorado and Washington which legalized in 2012, the District’s ballot initiative did not include a system to legalize the sale of cannabis. This is due to a clause within the Home Rule Act, the District of Columbia’s version of a constitution, which prevents ballot initiatives from containing provisions which affect the city’s budget. In an effort to close this gap, elected officials in the District were planning on implementing a system to tax and regulate commercial sales of the plant, when the United States Congress, which has historically had legislative and fiscal authority over the District, attempted to block the District from moving forward with this plan by restricting the use of city funds to implement the law. While this is the prevailing belief of most drug policy observers, the city has methods of creating a taxation and regulation system for cannabis in spite of the attempted Congressional blockade.


As previously mentioned, the Home Rule Act establishes the legal foundation for local government in the District. It also contains a provision which establishes a special fund, which allows the Mayor of the District of Columbia to use monies saved in the fund for unforeseen, nonrecurring, needs that arise during the fiscal year, including natural disasters, unexpected obligations created by federal law, new public safety or health needs identified after the budget process has occurred, and other fiscal shortfalls arising in the District’s budgetary process. Having a law which allows for the personal possession of cannabis, but provides no means for individuals to acquire cannabis has creates a situation where black market sales have proliferated, and individuals continue to find ways to undermine other public institutions, like the United States Postal Service, in order to circumnavigate the law. More importantly, by not having a system for regulated sales, citizens of the District of Columbia lack the safe guards and quality assurance that comes from making purchases in a storefront. Clearly there are matters of public safety and public health before the elected officials of the District of Columbia, and using monies from the special fund to legalize the sale of cannabis seems most prudent.  USPS

Advocacy organizations like the Drug Policy Alliance, DC Vote, and DC Appleseed have lobbied elected officials to take action on using special funds to establish a system to regulate cannabis in the city. The efforts have been reinforced by polling in the city which shows that approximately 80% of District residents want this change as well.


The political pressure has resulted in some action on the part of the elected officials in the city, as recently the DC Department of Health released a report calling for regulations to be established around cannabis in the city. Furthermore, the District’s Attorney General given the legal blessing to using the District’s special funds for this purpose. Currently the fund has $135.9 million, of which, only a fraction would be needed to pass this legislation. Mayor Muriel Bowser has been on record in support of creating a system for taxing and regulating cannabis in the District since as early as 2014. With all of this political, legal and fiscal support, why does she not draw down the funds to make the change happen? The public safety and public health of the citizens depend on it.