2014 NCSC

Social Determinants of Health Among Key Topics Delegates Tackle

May 07, 2014 04:14 pm Chris Crawford Kansas City, Mo. –

Cathleen London, M.D. (left), women's delegate from New York, testifies on a resolution she co-authored that addresses emergency contraception, as Heather Nichols, M.D., new physician delegate of Boise, Idaho, waits her turn to speak.

During the 2014 National Conference of Special Constituencies (NCSC), held May 1-3, AAFP members from the five constituency groups -- women, minorities, new physicians, international medical graduates (IMGs), and gay, lesbian, bisexual, and transgender (GLBT) physicians and those supportive of GLBT issues -- acted on resolutions considered by the Reference Committee on Health of the Public and Science.

One recommendation adopted during the May 3 business session addressed "gentrification," which occurs when poor communities are displaced from inner cities by new development. Specifically, the resolution recommended that the AAFP request the Robert Graham Center for Policy Studies in Family Medicine and Primary Care and other research organizations to investigate how the process of gentrification impacts the health outcomes of minority populations.

Minority delegate Khalil Alleyne, M.D., of Topeka, Kan., supported the resolution, saying that he would be interested in the research on gentrification addressing the accessibility to housing, food and health care choices in these communities.

Arthur Ohannessian, M.D., a new physician general registrant from Los Angeles, spoke in support of the measure, saying he had witnessed gentrification firsthand.

"I am coming from L.A., where (gentrification) has had a huge impact, especially in the downtown community," said Ohannessian. "I've definitely seen a big change where we've had a large displacement, specifically among the African-American community, located mostly in South Central L.A. in the vicinity of the Staples Center in downtown."

Beulette Hooks, M.D., women's delegate from Midland, Ga., co-authored another resolution that delegates adopted, which included a recommendation that the AAFP lobby Congress to pass legislation to raise the federal minimum wage to keep up with inflation, with the goal of trying to reduce health disparities.

Story highlights
  • Delegates to the 2014 National Conference of Special Constituencies adopted, among other items, a measure exploring the health impact of "gentrification" on minority communities.
  • Delegates also adopted a resolution asking that the AAFP lobby Congress to pass legislation to raise the federal minimum wage as a way to help address health disparities.
  • Another resolution adopted asked the AAFP to request that the FDA modify labeling of certain contraceptives to indicate which agents are effective in overweight and obese women.

Hooks noted that the federal poverty level for 2014 is $15,730 for a family of two and $23,850 for a family of four. Although minimum wage varies by state, the U.S. federal minimum wage is $7.25.

"If you work 40 hours a week at minimum wage, you are only making $14,500," she said. "So we think the minimum wage really needs to be increased because it is a major social determinant of health."

Renee Crichlow, M.D., a GLBT delegate from Robbinsdale, Minn., also supported the recommendation, calling social determinants of health "the upstream determinants of health." If physicians want their patients to be healthy, the patients need to be able to buy healthy foods, she said.

"A lot of the time when we have an issue like this, we'll say this is a social issue -- we do health care," Crichlow said. "But I think it's time we start realizing that it is health care. If (a patient) is working at a minimum wage job, and I ask him to eat more vegetables, it isn't going to happen. We need to stand up and say, 'We believe our patients should be able to afford the things that we are telling them to eat.' And this resolution is something that might help them do so."

During the business session, Lacey Cavanaugh, M.D., a women's delegate from Sulphur, La., expressed concern that the AAFP's proposed support for increasing the minimum wage could lead to backlash at the state level with members who disagree.

"If you take on a pretty heated political topic, you can alienate members because they don’t agree with the politics of it," she said. "Then you can hurt your state chapters."

In other business, Cathleen London, M.D., women's delegate from New York, co-authored a resolution that asked the AAFP to petition the FDA to require updated labeling for certain contraceptives. London testified that the change was needed because the oral contraceptive levonorgestrel is less efficacious at a body mass index (BMI) greater than 25, and ulipristal acetate is ineffective for emergency contraception at a BMI greater than 35.

Half of the pregnancies in the United States are unintended, and the majority of those occur when contraception is actually being used, London said. For levonorgestrel, the increased BMI quadruples the risk of pregnancy. For ulipristal, increased BMI doubles the risk of pregnancy. This connection is not widely known, she added.

"Even in our own caucus, there were women physicians who were unaware of the issue of increasing BMI and emergency contraception," London said. "So we are asking that the Academy ask the FDA to change the labeling of the oral contraceptives to reflect the increased BMI risk."

Suzanne Goodman, M.D., women's delegate from Oakland, Calif., and co-author of the resolution, said women presenting for emergency contraception (EC) weren't necessarily interested in long-term contraception, such as through placement of an intrauterine device (IUD).

"But studies have shown that up to 30 percent of women would be interested and would take the time that day to have the IUD placed," she added. "Also, early studies of this have shown that women willing to get (an IUD placed) have a much lower rate of unintended pregnancy that next year compared to women getting other forms of EC."

Among other measures considered by the reference committee, NCSC delegates voted to adopt recommendations that asked the Academy to

  • amend its school nutrition policy to advocate for locally grown foods in schools,
  • write a letter to the FDA and HHS Advisory Committee on Blood and Tissue Safety and Availability asking for modification of the lifetime deferral of blood, tissue and organ donation for men who have sex with men; and
  • explore options to better educate members on the social determinants affecting health status.