During the 2017 National Conference of Constituency Leaders (NCCL) held here April 27-29, AAFP members from the five constituency groups -- women; minorities; new physicians; international medical graduates (IMGs); and lesbian, gay, bisexual and transgender (LGBT) physicians and those supportive of LGBT issues -- acted on resolutions considered by the Reference Committee on Health of the Public and Science.
During a reference committee hearing at the 2017 National Conference of Constituency Leaders, Tisha Boston, M.D., a minority delegate from Blythewood, S.C., speaks about a resolution she co-authored, saying it's important the AAFP follow through on its vision of transforming health care to achieve optimal health for everyone.
Among resolutions discussed during the April 28 committee hearing were a handful that focused on social determinants of health and improving health equity.
Key Role for Center for Diversity and Health Equity
First, a substitute resolution adopted during the April 29 business session asked that the Center for Diversity and Health Equity partner with the Robert Graham Center for Policy Studies in Family Medicine and Primary Care or a similar group to study differential access to health care using social determinants of health data.
Additionally, the measure requested that the center submit a report to parallel the 2015 U.S. Report to the United Nations' International Convention on the Elimination of All Forms of Racial Discrimination (ICERD)(www.ushrnetwork.org) to address concerns and recommendations outlined in the 2014 ICERD report.(www.state.gov)
- During the 2017 National Conference of Constituency Leaders (NCCL) held April 27-29, AAFP members acted on resolutions considered by the Reference Committee on Health of the Public and Science.
- Among issues discussed during the April 28 reference committee hearing were a handful that focused on social determinants of health and improving health equity.
- The AAFP's newly created Center for Diversity and Health Equity will be tasked with leading efforts to implement a number of resolutions NCCL delegates adopted.
Tisha Boston, M.D., a minority delegate from Blythewood, S.C., and a co-author of the resolution, explained that many NCCL attendees heard about ICERD and the United States' involvement in the initiative for the first time during the keynote plenary speech by Camara Jones, M.D., M.P.H., Ph.D., on April 27. Her words, in fact, inspired the resolution.
"I think we all recognize the importance of racial discrimination as we attempt to provide care for our patients," Boston said. "And we want to keep this at the forefront as we identify barriers and evaluate social determinants of health."
Boston said she works in an indigent clinic that provides care mostly to minority patients, and she thinks it's important that the AAFP follow through on its vision of transforming health care to achieve optimal health for everyone -- including minorities.
Karla Booker, M.D., a women's delegate from Lawrenceville, Ga., pointed out that family physicians have a unique perspective on this issue because they are the only medical specialists who take care of patients from cradle to grave.
"Therefore, we see the effects of this on a continuity basis all around," she said. "Our new Center for Diversity and Health Equity has the perfect opportunity to make this known from our perspective."
A related resolution that delegates adopted asked the AAFP to collaborate with other organizations to develop a validated tool for social determinants of health screening.
Again, the Center for Diversity and Health Equity was called to action -- this time to develop criteria to evaluate measures of social determinants of health.
Megan Adamson, M.D., a new physician delegate from Fairlee, Vt., who represented the New Hampshire AFP, tells reference committee members, "We see a powerful new role for the Center for Diversity and Health Equity to assemble and disseminate tools for our members on screening and addressing social determinants of health."
Specifically, the authors asked the Academy to
- advocate for the development of curricular content for resident and student education on social determinants of health;
- promote best practices for coding related to social determinants of health, including for the purpose of collecting population data; and
- advocate for payment for care coordination and data collection related to social determinants of health.
Megan Adamson, M.D., a new physician delegate from Fairlee, Vt., who represented the New Hampshire AFP and was a co-author of the resolution, said the authors appreciated that the AAFP has made addressing social determinants of health one of its top priorities.
"We see a powerful new role for the Center for Diversity and Health Equity to assemble and disseminate tools for our members on screening and addressing social determinants of health, as well as give information on how to code for this and advocate that these services are paid for," Adamson said.
A third measure adopted asked that the AAFP develop a general statement on health policy that would incorporate seven core social justice values representative of family medicine. Those core values are:
- Health care is a human right.
- We believe in evidence-based medicine and public health policy.
- Behavioral health services are a fundamental part of health care.
- Women's health must be protected.
- People deserve health care regardless of immigration status.
- The neglect and mistreatment of marginalized communities affects health and must be opposed.
- All people, regardless of their gender identity or sexual orientation, must be treated with dignity and respect.
Arthur Ohannessian, M.D., a new physician delegate from Los Angeles and a co-author of the resolution, said family physicians can no doubt agree on many of the tenets described.
"I think it's very important for the Academy to make these explicit -- given the political realities nationally," he said. "I think it's time for the AAFP to ensure that the rest of the nation knows exactly where we stand on these core fundamental values."
The statement could be used as a guide when deciding whether health policies are consistent with those of the AAFP.
Finally, a fourth resolution delegates adopted asked that the Center for Diversity and Health Equity use "Health in All Policies" (HiAP)(www.cdc.gov) terminology in articulating its goals; advocate for legislation that mandates a HiAP framework at the federal, state and local government levels; and develop a policy statement addressing the AAFP's commitment to HiAP.
The CDC defines Health in All Policies as "a collaborative approach that integrates and articulates health considerations into policymaking across sectors to improve the health of all communities and people."
The resolution's authors pointed to California and San Francisco as examples of government entities that have adopted policies to implement a HiAP framework to evaluate health impacts of legislation across all sectors, including transportation, education, environment and housing.
Tobie-Lynn Smith, M.D., M.P.H., a women's delegate from Washington, D.C., who represented the Maryland AFP and was a co-author of the resolution, told reference committee members, "I think it's important we utilize this terminology because it offers a chance for the AAFP to be a leader in this by putting words to this collaborative approach in Health in All Policies."
Among other measures considered by the reference committee, NCCL delegates adopted resolutions that asked the Academy to
- update its position on decriminalization of possession and personal use of marijuana to include minors and young adults,
- provide a free and easily accessible gender and sexual health toolkit on the AAFP website,
- update its breastfeeding toolkit to share best practices for workplace accommodations for breastfeeding physicians, and
- strengthen and expand existing policy statements through its Congress of Delegates to more strongly support clean air and clean water protections.
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