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Monday Jul 02, 2018

AMA House of Delegates Weighs In on Health Equity

A founding principle of this country is that all citizens are created equal. But when it comes to health, that -- unfortunately -- is not the case.

Here is the AAFP's delegation at work in the AMA House of Delegates, where the AAFP has the second-largest specialty society delegation.

In a 2017 Health Affairs study(www.healthaffairs.org) of more than 30 developed nations, only two countries fared worse than the United States when considering differences in health based on income. Our health care system, in fact, is riddled with inequities based on income, race and gender. One's ZIP code is a more accurate predictor of health outcomes than one's genetic code. Consider, for example, that black women are 40 percent more likely to die of breast cancer than their white peers and more than three times more likely to die in childbirth.

It's particularly disturbing to note that we have these unbalanced results despite the fact that the United States spends 31 percent more per person(www.healthsystemtracker.org) on health care than the next-highest per-capita spender.

In 2016, the AAFP's Congress of Delegates (COD) directed the Academy to take a stronger stance on social determinants of health. The AAFP responded last year by creating a Center for Diversity and Health Equity that is intended to enhance physicians' cultural proficiency and increase diversity in the physician workforce. The Academy subsequently launched The EveryONE Project to provide family physicians and their practices with education, resources and advocacy on this issue.

Now other organizations are following suit.

At the recent AMA House of Delegates (HOD) annual meeting, delegates adopted recommendations in a Board report(www.ama-assn.org) on health equity that calls for the creation of a center similar to the AAFP's. Specifically, the report calls for the AMA to create a center to "facilitate, coordinate, initiate and track AMA health equity activities" and provide an annual report to the House of Delegates regarding the organization's activities and achievements related to health equity. The report also calls for the AMA to advocate for health care access, research and data collection; promote equity in care; increase health workforce diversity influence social determinants of health; and show commitment to health equity.

The AMA already has sought our input on this directive from its members.

The HOD also voted on other issues related to health equity, including adopting a resolution introduced by the AAFP that called for the AMA to "support adequate funding for the U.S. Census to assure accurate and relevant data is collected and disseminated."

The census is the basis for the distribution of funding for patient care, transportation, education and other community resources. For the first time, the U.S. Census Bureau plans to gather most of its responses online. That strategy has caused concern among stakeholders -- including the AAFP -- about the initiative's accuracy because inaccurate data could have significant consequences for vulnerable populations.

Delegates also considered a resolution that urged the AMA to recognize that health care is a human right. I testified that the AAFP already has a similar policy and challenged the HOD to join us in being bold champions for our patients. The resolution ultimately failed, however, and the House instead reaffirmed existing AMA policy related to access to care.

The HOD also acted on several other items of interest.

  • Delegates adopted a resolution that calls for the AMA to urge the Office of the National Coordinator for Health IT to establish requirements related to interoperability for electronic health records.
  • Delegates referred to the Board a resolution that called for an end to the AMA's opposition to single-payer health care. The AAFP delegation supported further study of the issue. During the upcoming COD, the Academy will introduce a Board report on health care reform. The proposed report has been sent to all our constituent chapter Boards for feedback, which will be considered before it is released.
  • There was passionate debate regarding a report from the AMA's Council on Ethics and Judicial Affairs, which reviewed an existing policy that opposes physician aid in dying. The council recommended keeping current policy rather than moving to a neutral position, and a reference committee recommended adoption of the report. The House, however, referred the report back to the council for more study. It's worth noting that the AAFP follows the AMA's Ethical Code guidelines, as called for by the AAFP Bylaws. Our delegation supported referral of the report.
  • Delegates also took numerous actions regarding gun violence,(wire.ama-assn.org) including modifying existing AMA policy regarding assault weapons to support banning "the sale and ownership to the public of all assault-type weapons, bump stocks and related devices, high-capacity magazines, and armor-piercing bullets." The actions of the House went beyond those called for in AAFP policy -- which our delegation followed in our testimony -- to support research that identifies which policies and interventions effectively reduce morbidity and mortality, while also respecting the Constitutional right to bear arms.

AMA specialty society delegations are based on the percentage of a specialty organization's members who also are AMA members. The AAFP has the second-largest specialty delegation in the HOD, which means we are a strong voice for members and patients.

The AMA meeting provides an excellent opportunity to advocate on behalf of family medicine within the House of Medicine. More than 100 family physicians participated in the HOD as representatives for their state medical societies. This provided the ability to host a family medicine caucus before the HOD convened in a town hall format. Members voiced their concerns on important issues, such as administrative simplification, payment, workforce and, of course, health equity.

We all face many of the issues raised in the HOD, and I anticipate they will be discussed and debated by our COD, which is scheduled to convene Oct. 8-10 in New Orleans.

Michael Munger, M.D., is president of the AAFP.

Posted at 12:39PM Jul 02, 2018 by Michael Munger, M.D.

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