2015 Consent Calendar for the Reference Committee on Health of the Public & Science

Transcription

1 0 Consent Calendar for the Reference Committee on Health of the Public & Science National Conference of Constituency Leaders Sheraton Kansas City Hotel at Crown Center The Reference Committee on Health of the Public and Science recommends the following consent calendar for adoption (page numbers indicate page in reference committee report): RECOMMENDATION: The Reference Committee on Health of the Public and Science recommends the following consent calendar for adoption: Item 1: Adopt Resolution No. 001: Breastfeeding Support for Family Medicine Residents (p. 1). Item : Adopt Resolution No. 00: Expansion of AAFP s Policy Regarding Excise Taxes on Tobacco (p. ). Item : Adopt Substitute Resolution No. 00: Health Impact of Incarceration on Families in lieu of Resolution No. 00 (p. ). Item : Adopt Substitute Resolution No. 00: Support Placement and Coverage of Long- Acting Reversible Contraceptives (LARC) in the Early Postpartum Period in lieu of Resolution No. 00 (pp. -). Item : Refer to the Board of Directors, Resolution No. 00: Anal Pap Smears (pp. -). Item : Adopt Substitute Resolution No. 00: PrEP Recommendation in lieu of Resolution No. 00 (p. ). Item : Adopt Substitute and Refer Resolution No. 00 to the Board of Directors: Acknowledgement and Inclusion of Two Spirit in lieu of Resolution No. 00 (pp. -). Item : Adopt Substitute Resolution No. 00 and Refer to the Board of Directors: Increasing Access to Qualified Physicians for Health Resource Shortage Areas in lieu of Resolution No. 00 (pp. -). Item : Adopt Resolution No. 00: AAFP Affirmation of Supporters for All Families (p. ). Item : Adopt Resolution No. 0: Support for Comprehensive, Culturally Competent Transgender Care, and for Coverage for Comprehensive, Culturally Competent Transgender Care (p. ). Item : Adopt Substitute Resolution No. 0: Native Americans, The Invisible Minority in lieu of Resolution No. 0 (pp. -). Item : Adopt Resolution No. 0: AAFP Recommendations on Daily Sugar Intake (p. ). //0 Page 1 of

2 0 Consent Calendar for the Reference Committee on Health of the Public & Science National Conference of Constituency Leaders Sheraton Kansas City Hotel at Crown Center Item : Refer to the Board of Directors, Resolution No. 0: AAFP Policy on Needle Exchange Programs (p. ). Item : Adopt Substitute Resolution No. 0: Inconsistent Policing and Law Enforcement Standards as a Social Determinant of Health in lieu of Resolution No. 0 (pp. -). Item : Adopt Resolution No. 0: Violence, Harassment and Bullying (p. ). //0 Page of

3 0 Report of the Reference Committee on Health of the Public & Science National Conference of Constituency Leaders Sheraton Kansas City Hotel at Crown Center The Reference Committee on Health of the Public & Science has considered each of the items referred to it and submits the following report. The committee s recommendations will be submitted as a consent calendar and voted on in one vote. Any item or items may be extracted for debate. ITEM NO. 1: RESOLUTION NO. 001: BREASTFEEDING SUPPORT FOR FAMILY MEDICINE RESIDENTS RESOLVED, That the American Academy of Family Physicians reaffirm its policy regarding breastfeeding by trainees, and be it further RESOLVED, That the American Academy of Family Physicians advocate for establishment of lactation rooms in hospitals where family medicine residents train, and be it further RESOLVED, That the American Academy of Family Physicians support education of family medicine residency program directors on the issue of breastfeeding by trainees including content at the Program Director s Workshop. The reference committee heard testimony in support of the resolution indicating that family medicine residencies create a culture that encourages residents to breastfeed their infants. The American Academy of Family Physicians (AAFP) position paper entitled, Breastfeeding, Family Physicians Supporting advocates for mothers to breastfeed their infants, encourages workplace support for breastfeeding, and support for breastfeeding colleagues. Residents who are breastfeeding should be provided the support they need in the way of designated lactation rooms and time away from rounds to pump breast milk. The reference committee discussed the AAFP s new Breastfeeding Toolkit and recognizes that the AAFP endorses the core competencies set forth by the United States Breastfeeding Coalition, which encourages a comprehensive approach to breastfeeding. Resources from the Breastfeeding Toolkit could be used to facilitate changes to culture and policy with respect to breastfeeding during residency. RECOMMENDATION: The reference committee recommends that Resolution No. 001 be adopted. //0 Page 1 of

4 ITEM NO. : RESOLUTION NO. 00: EXPANSION OF AAFP S POLICY REGARDING EXCISE TAXES ON TOBACCO RESOLVED, That the American Academy of Family Physicians update its Taxation and Subsidies policy statement on tobacco to endorse state level increases on tobacco excise taxes. The reference committee heard testimony supporting states raising taxes on tobacco. When taxes are increased, consumption of tobacco products decreases. Funds raised from taxes are used for prevention and cessation efforts. The reference committee agreed with the testimony. RECOMMENDATION: The reference committee recommends that Resolution No. 00 be adopted. ITEM NO. : RESOLUTION NO. 00: HEALTH IMPACT OF INCARCERATION ON FAMILIES RESOLVED, That the American Academy of Family Physicians collaborate with other agencies to study the effect of incarceration on population health, and be it further RESOLVED, That the American Academy of Family Physicians collaborate with other agencies to formulate policies regarding families of incarcerated citizens. The reference committee heard testimony in favor of the resolution. Three issues were raised. The first issue was disparities in incarceration rates by race and ethnicity. The second issue was the potential for abuse among men who have sex with men and transgender individuals. The third issue discussed was about the United States having the highest rate of incarcerated females. The reference committee discussed the need for systematic review of the existing literature on this topic. The first resolved clause was amended to narrow the focus and create a more actionable item for this important issue. The reference committee felt that a systematic literature review, as opposed to a study, would not require a fiscal note. No. 00, which reads as follows, be adopted in lieu of Resolution No. 00: RESOLVED, That the American Academy of Family Physicians perform a systematic literature review and identify knowledge gaps on the effect of incarceration on population health, and be it further RESOLVED, That the American Academy of Family Physicians collaborate with other agencies to formulate policies regarding families of incarcerated citizens. ITEM NO. : RESOLUTION NO. 00: SUPPORT PLACEMENT AND COVERAGE OF LONG-ACTING REVERSIBLE CONTRACEPTIVES (LARC) IN THE EARLY POSTPARTUM PERIOD RESOLVED, That the American Academy of Family Physicians support a policy that Long-Acting Reversible Contraceptives methods be a recommended option for postpartum women prior to hospital discharge, and be it further //0 Page of

5 RESOLVED, That the American Academy of Family Physicians support a policy assuring coverage of Long-Acting Reversible Contraceptives device and placement prior to hospital discharge, separate from the global fee, for all women who select this method, and be it further RESOLVED, That the American Academy of Family Physicians submit a resolution asking the AAFP to support a policy that Long-Acting Reversible Contraceptives methods be a recommended option for postpartum women prior to hospital discharge, and be it further RESOLVED, That the American Academy of Family Physicians (AAFP) submit a resolution asking the AAFP to support a policy assuring coverage of Long-Acting Reversible Contraceptives device and placement, separate from the global fee, prior to hospital discharge for all women who select these methods. The reference committee heard testimony in favor of the resolution. Women may miss opportunities after childbirth for follow-up care and family planning counseling. This may prevent women from having timely access to long-acting reversible contraceptives (LARC). The reference committee discussed adopting the resolution because LARC reduces the risk of unplanned pregnancies and unintended pregnancies and improves the health of newborns due to appropriate spacing between children. The last two resolved clauses were removed from the resolution because they were included by mistake as per advisement by the authors. 00, which reads as follows, be adopted in lieu of Resolution No. 00: RESOLVED, That the American Academy of Family Physicians support a policy that Long-Acting Reversible Contraceptives methods be a recommended option for postpartum women prior to hospital discharge, and be it further RESOLVED, That the American Academy of Family Physicians support a policy assuring coverage of Long-Acting Reversible Contraceptives device and placement prior to hospital discharge, separate from the global fee, for all women who select this method. ITEM NO. : RESOLUTION NO. 00: ANAL PAP SMEARS RESOLVED, That the American Academy of Family Physicians recommend the annual performance of screening anal Pap smears for human immunodeficiency virus and/or human papillomavirus positive patients, and every three years for any individuals who have engaged in receptive anal intercourse. The reference committee heard testimony both in support and opposition to the resolution. Testimony in support included the fact that the rate of anal cancer is double the rate of cervical cancer in women, which promotes screening for cervical cancer in women. There was also testimony that anal sex is perceived as safer sex by young women. The New York Department of Health and the American Academy of HIV medicine supports screening for //0 Page of

6 human papilloma virus (HPV) and rectal dysplasia via anal pap smears. Further testimony indicated anal pap smears are easy to perform and inexpensive. The opposition against this resolution stemmed mainly from conflicting scientific evidence to support effectiveness of anal pap smears, as well as concern that in resource-poor areas there would not be an appropriate health care provider to refer for follow up or treatment, if the test is shown to be positive. While the reference committee agrees with the testimony, it was agreed to refer this resolution to the AAFP Board of Directors for further investigation. RECOMMENDATION: The reference committee recommends that Resolution No. 00 be referred to the Board of Directors for further research based on controversy of the evidence and concerns about availability of follow-up for positive tests. ITEM NO. : RESOLUTION NO. 00: PrEP RECOMMENDATION RESOLVED, That the American Academy of Family Physicians recommend training of primary care providers in the implementation and use of Pre-Exposure Prophylaxis (PrEP) for at-risk individuals. The reference committee heard testimony in favor of the resolution. Family physicians see individuals who are at high risk for being exposed to HIV. In contrast, infectious disease physicians see patients who have an existing infection and would miss a majority of patients who would benefit from pre-exposure prophylaxis (PrEP). Testimony was also provided stating that family physicians may not be adequately trained in PrEP. As such, family physicians need support and information about implementing PrEP. The goal of PrEP is to reduce risk of HIV acquisition for those at high risk of HIV exposure. PrEP has been shown to be over 0% effective when used correctly. Many institutions have policies that prevent family physicians from instituting PrEP. These policies are difficult to change by individual family physicians. Action by the American Academy of Family Physicians (AAFP) could facilitate change in these organizations and the AAFP should provide training to implement PrEP because this falls within their scope of family medicine. No. 00, which reads as follows, be adopted in lieu of Resolution No. 00: RESOLVED, That the American Academy of Family Physicians recommend training of family physicians in the implementation and use of Pre-Exposure Prophylaxis (PrEP) for at-risk individuals. ITEM NO. : RESOLUTION NO. 00: ACKNOWLEDGEMENT AND INCLUSION OF TWO SPIRIT RESOLVED, That the American Academy of Family Physicians recognize that Two Spirit is a term used in reference to a subgroup of gay, lesbian, bisexual, and transgender Native American people, and be it further //0 Page of

7 RESOLVED, That the American Academy of Family Physicians support the inclusion of the concept of Two Spirit in educational materials and cultural competency with other gay, lesbian, bisexual, and transgender issues. The reference committee heard testimony supporting the resolution. Testimony was heard explaining that Two Spirit is a subgroup in the Native American community and that the American Academy of Family Physicians should include cultural competency material on the Two Spirit concept. It was also mentioned that Two Spirit can encompass the GLBT Native American community and many in the GLBT community may not even be aware of Two Spirit. The reference committee discussed the issue and decided more information is required, as Two Spirit can have multiple meanings. In order to identify and provide culturally competent care, the reference committee agrees that the AAFP collaborate with outside organizations to gain a better understanding of Two Spirit. No. 00, which reads as follows, be referred to the Board of Directors: RESOLVED, That the American Academy of Family Physicians recognize that Two Spirit is a term used in reference to a subgroup of the Native American people, and be it further RESOLVED, That the American Academy of Family Physicians support the inclusion of the concept of Two Spirit in educational materials and cultural competency with other gay, lesbian, bisexual, and transgender issues. ITEM NO. : RESOLUTION NO. 00: INCREASING ACCESS TO QUALIFIED PHYSICIANS FOR HEALTH RESOURCE SHORTAGE AREAS RESOLVED, That the American Academy of Family Physicians in conjunction with state medical boards, advocate for the World Health Organization accredited physician to fill the need for health resource shortage areas, and be it further RESOLVED, That the American Academy of Family Physicians send a letter of support to the state of Missouri in passing the state senate bill (Section.) and (Section.00,.0,.0,.0, Section 1). The reference committee heard testimony in favor of the resolution. There is a shortage of primary care physicians in many areas of the United States. The approach is innovative in addressing the shortage of primary care physicians. It was recognized, however, that this approach has the potential to deplete other countries of trained health professionals. Additionally, the reference committee was concerned about the standing of the World Health Organization as a physician-accrediting body. Finally, the reference committee was concerned about the potential to restrict practice settings for internal medical graduates. No testimony was provided to clarify the bills cited in the second resolved clause. The reference committee discussed the issue and recognizes its complexity. The reference committee feels this issue merits review by the AAFP Board of Directors. //0 Page of

8 No. 00, which reads as follows, be referred to the Board of Directors: RESOLVED, That the American Academy of Family Physicians Board of Directors review existing and proposed federal and state models for addressing health professional shortage areas as it relates to physicians licensed outside of the United States. ITEM NO. : RESOLUTION NO. 00: AAFP AFFIRMATION OF SUPPORT FOR ALL FAMILIES RESOLVED, That the 0 National Conference of Constituency Leaders express sincere appreciation and gratitude to the American Academy of Family Physicians for its support of all families. The reference committee heard testimony indicating that this resolution closes the loop on activities from previous conferences. The National Conference of Constituency Leaders wanted to thank the AAFP for listening to their voices about marriage equality. The reference committee unanimously voted to adopt the resolution. RECOMMENDATION: The reference committee recommends that Resolution No. 00 be adopted. ITEM NO. : RESOLUTION NO. 0: SUPPORT FOR COMPREHENSIVE, CULTURALLY COMPETENT TRANSGENDER CARE, AND FOR COVERAGE FOR COMPREHENSIVE, CULTURALLY COMPETENT TRANSGENDER CARE RESOLVED, That the American Academy of Family Physicians adopt a policy in support of comprehensive, culturally competent transgender health care, and be it further RESOLVED, That the American Academy of Family Physicians adopt a policy in support of insurance coverage for comprehensive, culturally competent transgender health care. The reference committee heard testimony in support of the resolution. The AAFP has no current policy about providing care nor advocating for coverage of care for transgender individuals. As an ethical and moral issue, transgender individuals deserve the same care as other patients. Testimony was given that transgender individuals continue to face disparities in health care and health outcomes. Additionally, transgender individuals often lack coverage for needed health services. Family physicians often provide care for transgender patients and need resources to provide culturally competent and quality care. RECOMMENDATION: The reference committee recommends that Resolution No. 0 be adopted. ITEM NO. : RESOLUTION NO. 0: NATIVE AMERICANS, THE INVISIBLE MINORITY RESOLVED, That the American Academy of Family Physicians recognize Native American minorities throughout the Americas, and be it further //0 Page of

9 RESOLVED, That the American Academy of Family Physicians include further training about Native American health care and cultural issues in cultural competency training, and be it further RESOLVED, That the American Academy of Family Physicians assist chapters in recruiting and promoting to leadership positions members of the Native American communities. The reference committee heard testimony in support of the resolution. Testimony recommended that the AAFP make health care for Native Americans a priority as it has with other minorities. Native American culture is not monolithic and the different cultural contexts need to be understood by family physicians. AAFP members who care for Native American patients need support in the way of education and resources. The reference committee feels that the first resolved clause is important, but not actionable. No. 0, which reads as follows, be adopted in lieu of Resolution No. 0: RESOLVED, That the American Academy of Family Physicians include further training about Native American health care and cultural issues and cultural competency training, and be it further RESOLVED, That the American Academy of Family Physicians reaffirm the Native American category within the minority constituency and assist chapters in recruiting and promoting to leadership positions Native American physicians. ITEM NO. : RESOLUTION NO. 0: AAFP RECOMMENDATIONS ON DAILY SUGAR INTAKE RESOLVED, That the American Academy of Family Physicians support and publically endorse the 0 World Health Organization recommendations on sugar intake for adults and children, and be it further RESOLVED, That the American Academy of Family Physicians endorse updating and revision of its current educational resources to reflect the 0 World Health Organization recommendations on sugar intake for adults and children. The reference committee heard supportive testimony. In March, 0, the World Health Organization (WHO) recommended that sugar comprise no more than % of daily caloric intake. Consuming too much sugar leads to increased weight, which has become a global public health issue. Being overweight increases the risk for diabetes and many other diseases. Obesity has tripled in the last 0 years and % of young adults are too overweight to serve in the military, which is a national security issue. RECOMMENDATION: The reference committee recommends that Resolution No. 0 be adopted. //0 Page of

10 ITEM NO. : RESOLUTION NO. 0 AAFP POLICY ON NEEDLE EXCHANGE PROGRAMS RESOLVED, That the American Academy of Family Physicians review the available data regarding the various types of needle exchange programs and other organizations policies regarding needle exchange programs, and be it further RESOLVED, That the American Academy of Family Physicians develop an evidencebased position paper on the use of needle exchange programs to decrease the transmission of HIV, Hepatitis B, Hepatitis C, and other illnesses. The reference committee heard testimony in support of the resolution. The AAFP has a policy on substance abuse and even though the policy contains a statement about needle exchange programs, the authors wanted a separate policy developed that could be used when lobbying for needle exchange programs in states and localities. Needle exchange programs decrease the rate of transmission of HIV, Hepatitis B, and Hepatitis C, as well as offer opportunities for drug rehabilitation and support. Needles are considered drug paraphernalia in some states, however, with potential legal ramifications in dispensing them. The reference committee feels that this represents a pressing public health issue exemplified by the recent HIV outbreak occurring in Indiana associated with intravenous drug use. The reference committee decided to refer the resolution to the AAFP Board of Directors for expedient review. RECOMMENDATION: The reference committee recommends that Resolution No. 0 be referred to the Board of Directors. ITEM NO. : RESOLUTION NO. 0: INCONSISTENT POLICING AND LAW ENFORCEMENT STANDARDS AS A SOCIAL DETERMINANT OF HEALTH RESOLVED, That the American Academy of Family Physicians (AAFP), through its Board of Directors and its Commission on Health of the Public and Science (CHPS), review the recommendations of the president s Task Force on 1 st Century Policing, find concordance with AAFP existing policy and present discordances with AAFP policy to CHPS, and be it further RESOLVED, That the American Academy of Family Physicians (AAFP) immediately assign AAFP representatives to collaborate with development and implementation of the recommendations of the president s Task Force on 1 st Century Policing, and be it further RESOLVED, That the American Academy of Family Physicians (AAFP) draft a letter addressed to Surgeon General Vivek Murthy and Attorney General Loretta Lynch outlining the AAFP s position regarding the public health and safety concerns related to the inconsistent application of policing and law enforcement standards in different communities, including the disproportionate use of force by some members of law enforcement against communities of color, and be it further //0 Page of

11 RESOLVED, That the American Academy of Family Physicians direct its delegation and member sections delegates to the American Medical Association (AMA) to introduce an emergency resolution with the same objectives as Inconsistent Policing and Law Enforcement Standards as a Social Determinant of Health to the AMA House of Delegates for the 0 Annual Meeting, and be it further RESOLVED, That the American Academy of Family Physicians American Medical Association (AMA) delegation seek support and co-authorship for a parallel resolution related to the inconsistent application of policing and law enforcement standards from other AMA delegations and constituencies that would be supportive of such including, but not limited to, the AMA Minority Affairs Section, Medical Student Section, Resident and Fellows Section, Young Physicians Section, and individual regional and specialty caucuses. The reference committee heard testimony in support of the resolution. Testimony was heard citing recent events as well as member s personal experiences to demonstrate a pattern of disproportionate targeting of minorities by some members of law enforcement. Inconsistent policing standards are a social determinant of health. The medical community needs to voice its concerns about violence, as a result of and in response to inconsistent policing standards. The AAFP has a policy entitled, Violence as a Public Health Concern and the position paper titled, Violence that could be used to communicate a position on inconsistent policing standards as it interfaces with public health. The reference committee created a substitute resolution because the third resolved clause as written could lead someone to search for an AAFP policy that does not currently exist. No. 0, which reads as follows, be adopted in lieu of Resolution No. 0: RESOLVED, That the American Academy of Family Physicians (AAFP), through its Board of Directors and its Commission on Health of the Public and Science (CHPS), review the recommendations of the president s Task Force on 1 st Century Policing, find concordance with AAFP existing policy and present discordances with AAFP policy to CHPS, and be it further RESOLVED, That the American Academy of Family Physicians (AAFP) immediately assign AAFP representatives to collaborate with development and implementation of the recommendations of the president s Task Force on 1 st Century Policing, and be it further RESOLVED, That the American Academy of Family Physicians (AAFP) draft a letter addressed to Surgeon General Vivek Murthy and Attorney General Loretta Lynch citing the AAFP s current policy titled Violence as a Public Health Concern and position paper titled, Violence as it relates to the inconsistent application of policing and law enforcement standards in different communities, including the disproportionate use of force by some members of law enforcement against communities of color, and be it further RESOLVED, That the American Academy of Family Physicians direct its delegation and member sections delegates to the American Medical Association //0 Page of

12 (AMA) to introduce an emergency resolution with the same objectives as Inconsistent Policing and Law Enforcement Standards as a Social Determinant of Health to the AMA House of Delegates for the 0 Annual Meeting, and be it further RESOLVED, That the American Academy of Family Physicians American Medical Association (AMA) delegation seek support and co-authorship for a parallel resolution related to the inconsistent application of policing and law enforcement standards from other AMA delegations and constituencies that would be supportive of such including, but not limited to, the AMA Minority Affairs Section, Medical Student Section, Resident and Fellows Section, Young Physicians Section, and individual regional and specialty caucuses. ITEM NO. : RESOLUTION NO. 0: VIOLENCE, HARASSMENT, AND BULLYING RESOLVED, That the American Academy of Family Physicians Violence, Harassment, and Bullying Among Children and Adolescents policy be renamed to reflect the inclusion of adults in the current policy, such as Violence, Harassment, and Bullying Among Children, Adolescents, and Adults. The reference committee heard limited favorable testimony that adults, as well as children and adolescents, can be bullied. The reference committee thought that the word adults should be included in the title of the policy, Violence, Harassment, and Bullying Among Children and Adolescents. RECOMMENDATION: The reference committee recommends that Resolution No. 0 be adopted. //0 Page of

13 I wish to thank those who appeared before the reference committee to give testimony and the reference committee members for their invaluable assistance. I also wish to commend the AAFP staff for their help in the preparation of this report. Respectfully Submitted, Andrew Goodman, MD - Chair Ozioma Gab-Ojukwu, MD Minority Mary Stock Keister, MD Women Marie-Elizabeth Ramas, MD New Physicians Ikemefuna Okwuwa, MD IMG Jonathan F. Wells, MD GLBT Scott Hartman, MD (Observer) //0 Page of