Another ACA repeal bill may be gaining momentum

Posted on behalf of Paul Freeman, IH Section Action Board Representative

Colleagues, the battle continues. Please contact your Senate representatives for just 5 minutes as suggested below. It is crucial that you spend 5 minutes of your time for the ACA at this time.


In the coming days, the U.S. Senate may begin consideration of yet another proposal to repeal and weaken major portions of the Affordable Care Act. Like previous proposals defeated earlier this year in the Senate, this one, known as the Graham-Cassidy proposal, would cut health coverage and raise premiums and out-of-pocket costs for millions, eliminate the Prevention and Public Health Fund, slash federal Medicaid spending and end the ACA’s Medicaid expansion, and allow states to weaken protections for people with pre-existing conditions.

Your advocacy efforts were a key reason the Senate defeated the previous proposals to repeal or weaken the ACA. Take the time to contact your senators and urge them to oppose the disastrous Graham-Cassidy bill and any other proposal to repeal or weaken the Affordable Care Act either by using APHA’s action alert or by calling the Capitol switchboard and asking to be connected to the offices of your senators at 202-224-3121

Sample phone script:

Introduce yourself as a constituent and public health professional.

I urge Sen. XX to oppose the Graham-Cassidy Affordable Care Act repeal bill. This proposal would:

  • Cut health coverage and raise premiums and out-of-pocket costs for millions.
  • Eliminate the Prevention and Public Health Fund.
  • Slash federal Medicaid spending and end the ACA’s Medicaid expansion.
  • Allow states to weaken protections for people with pre-existing conditions.
  • Eliminate Medicaid reimbursements to Planned Parenthood for one year.
  • Instead, I’m asking my senators to support the bipartisan effort to strengthen and improve the Affordable Care Act.

Thank you for you continued advocacy to support and strengthen the Affordable Care Act!

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The Promise of Data for Transforming Global Health

I recently came back from a field visit and as my organization’s designated data person (among the many other hats I wear), I think constantly about the role of data in our work and more broadly, its role in global health.

We’ve always had a problem with data in our field, more specifically the dire lack thereof. Recent efforts to spotlight the lack of high quality data in global health has led to somewhat of a data renaissance. And you know it’s a big deal when Bill Gates throws his weight behind it. It seems like every global health innovation talk I go to nowadays portrays data (in all its forms, from big data, predictive analytics, and machine learning) as the ultimate game changer in global health. Data is so much easier to collect now with the various technologies and innovations available. Its potential is pretty obvious and I don’t disagree that data can and will create more positive changes in global health. But every time I attend one of these talks or I get an email alert about another new data innovation challenge, part of me gets really excited and the other part remains skeptical.

Anyone who has tried to implement a data collection initiative in the field, whether for research, monitoring and evaluation, or donor reporting, knows the many challenges faced when working in already resource-limited clinics and hospitals: the questionnaires are long and time consuming, we don’t have the resources to hire people to do just data collection (which is especially true in smaller facilities), data collection activities take away from clinical activities, data quality is poor, the staff spends a whole week every month doing reporting, every donor wants a report on different indicators, no one at the clinic knows how or has the time to analyze the data, the data is not in a format that is easy to use, etc. And the list goes on.

One huge barrier to accurate data collection involves the inordinate amount of burden placed on health care providers and/or clinic staff to collect and report data. Data collection is often a task that already busy doctors and nurses have to undertake in addition to their clinic duties. Hiring an extra data collection person is one solution, but may not always be sustainable outside of a research study setting. Reporting data to donors is not any less painful. It is too often a rote and uncoordinated endeavor. Donors ask for the same data, but sliced and diced in a slightly different way. Those asking for data haven’t exactly done a good job making data collection easy to do. Shorter questionnaires, standardizing indicators, simplifying and coordinating reporting are different approaches for addressing these issues. Getting providers and clinic staff to collect high quality data though is another beast. Some argue that doing regular data audits will fix the data quality problem. Others argue that mobile data collection has reduced data entry errors. Mobile data collection has certainly made it easier to collect data and scale-up data collection activities.

And while a lot of work is being undertaken by major development agencies and smaller NGOs alike to improve their data collection efforts in order to deliver on the promise that data has to offer, I’m not entirely convinced we’re there yet. A huge part of my skepticism in why data hasn’t yet reached its transformative power in global health is because even though I think we’ve spent lots of resources in building capacity to collect data, we haven’t spent equal amounts of efforts building capacity for local team members to use the data in a meaningful way.

If those who collect the data don’t understand why or how the indicators they collect impact patient care, then why do it? Although national level data is helpful in understanding what the different health needs are and how to allocate resources to address them, the interventions needed to dramatically move the needle when it comes to decreasing morbidity and mortality happen at the individual facility level, outside of the research setting. The frontline healthcare workers that help in the collection and reporting of data very rarely get the data back in a way that can help them understand how to improve care delivery and health outcomes for their patients.

I believe in the potential of data to transform global health but there are many obstacles to overcome before this happens. First things first, instead of thinking about data collection as an activity that providers and clinic staff have to do, it should be an activity they want to do. By having data available to providers that is easy to understand, timely, and meaningful, only then can the promise that data holds for transforming global health be fulfilled.

The Importance of LGBT Cultural-Competency: A Discussion Towards an Inclusive Approach

The LGBT community is diverse. Although L, G, B, and T are often tied together as an acronym that suggests homogeneity, each letter represents a wide range of individuals of different races, ethnicities, ages, socioeconomic status and identities. Each letter deserves the same amount of care, attention and healthcare services. Sadly, what binds them together as social and gender minorities, especially in international countries, are the common experiences of stigma and discrimination that occur within healthcare, the struggle of living at the intersection of many cultural backgrounds and trying to be a part of each. With respect to healthcare, a long history of discrimination, overall lack of awareness, and simple education of health needs by health professionals. As a result, LGBT people face a common set of challenges in accessing culturally-competent health services and achieving the highest possible level of health. Continue reading “The Importance of LGBT Cultural-Competency: A Discussion Towards an Inclusive Approach”

13 Years to Eliminate Morbidity and Mortality due to Viral Hepatitis- Global Partners Believe It Can Be Done!

The liver processes nutrients, helps to fight against infection, and aids in cleaning the blood in our bodies. Inflammation of the liver is generally known as hepatitis. Although hepatitis can be caused by autoimmune disorders, occur as a result of excessive alcohol consumption, or become induced after a toxin is introduced into the liver, the hepatitis of most concern has a viral origin. While there are 5 main viruses (Hepatitis A-E), Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) are responsible for the majority of morbidity and mortality cases associated with viral hepatitis infections globally- this is comparable to HIV/AIDS and TB, killing 1.34 million people a year. Hepatitis can either be acute (i.e. a short-term illness within 6 months of infection) or chronic. 75-80% of individuals infected with HCV will develop a chronic infection. The likelihood of HBV becoming chronic largely depends on the age at which infection occurs. According to the Centers for Disease Control and Prevention (CDC), 90% of infants, 25-50% of children between 1-5 years of age, and 6-10% of individuals over 5 years of age will develop chronic HBV. Although the majority of individuals are diagnosed at a young age, younger age groups are less likely to show symptoms.

Currently, there are 240 million people living with chronic HBV and 130-150 million people with chronic HCV around the world.

Risk factors for HBV and HCV include:

According to the World Health Organization (WHO), there are differences in global burden of disease trends for HCV and HBV:

  • HCV: Affects all regions although there are significant differences between and within countries. The WHO Eastern Mediterranean Region and the European Region have the highest reported prevalence of HCV.
  • HBV: Mostly affects the WHO African Region and the Western Pacific Region

The number of cases of hepatitis that are diagnosed increases every year as well as deaths, which have increased by 50% over the past 20 years. Even worse, most people with hepatitis are asymptomatic in the acute stage and the beginning of the chronic stage- those with symptoms may have fever, jaundice, loss of appetite, grey stools, dark urine, and abdominal pain.  Although a vaccine is only available to protect against HBV, effective treatment options exist for both chronic HBV and HCV. This is an important reality since therapy and proper case management can reduce the risk of complications such as cirrhosis, liver cancer, and premature death that are caused by chronic hepatitis infection. Access strategies supported by the WHO in 13 countries have helped more middle-income countries receive necessary medications such as Directing Acting Antirals (DAA). These drugs have a cure rate of over 95% within a 3-month timeframe, for HCV, and less side effects than other drugs- but 80% of HCV cases still have difficulties accessing the treatment and case management they need because it can be expensive. The WHO released the report, “Global Report on Access to Hepatitis C Treatment: Focus on Overcoming Barriers,” which discussed the importance of political mobilization, advocacy, and pricing negotiations on increasing access to necessary medications in low-middle income countries. Local, more cost-effective medications have even been manufactured in a few countries. In order to address the 80% of people still in need of help, in May 2016, at the World Health Assembly, 194 countries adopted the Global Health Sector Strategy on Viral Hepatitis with the goal of eliminating hepatitis by 2030. DAAs were also added to the List of Essential Medicines.

Information from the global strategy is incorporated into World Hepatitis Day activities. World Hepatitis Day occurs on July 28th every year and is focused on raising awareness about the global burden of viral hepatitis as well as the prevention and treatment options that exist. Watch these short videos to learn more about the WHO’s global strategy and the theme for this year!

Five minutes of your time could impact Senate health care funding decisions

Posted on behalf of Paul Freeman, IH Section Action Board Representative.


We urge you to ring your local Senator to encourage them NOT to vote in favor of the Better Care Reconciliation Act (BCRA) currently being considered by the Senate. If only a few more Senators oppose the Act it will not pass.

The evidence is that senators are influenced by phone calls and letters from their local voting constituents. Cumulatively, individual approaches can influence them as much as those from large organizations that they may see as not affecting local voting.

To reach your senators, ring the Capitol switchboard at 202-224-3121. You should mention your postcode and your residence there and you will be put through to the appropriate senator’s office.  All you need to do then is again mention: who you are, your residence in their electorate, your health expertise and calmly and civilly your health concerns in as short as a few minutes.

A few key talking points against this Act:

  • According to the June 26 analysis by the nonpartisan Congressional Budget Office, the Better Care Reconciliation Act would result in 22 million Americans, including children, losing health insurance coverage by 2026.
  • The Act would greatly cut funding through the Prevention and Public Health Fund. 
  • It is critical to maintain this funding which makes up more than 12 percent of the budget at the Centers for Disease Control and Prevention. The Better Care Reconciliation Act would eliminate the prevention fund placing our nation’s health security at risk especially from new infectious disease outbreaks either man made by terrorists or occurring naturally.  The financial costs of epidemics can far out weight those in preventing them.
  • Ongoing international cooperation, epidemic surveillance and timely vaccine development and modernization of systems is needed in an ongoing manner to prevent and rapidly respond to such epidemics as the recent Zika, and Ebola outbreaks. Unchecked infectious epidemics can reach the magnitude of the Spanish flu which killed over 50 million people in 1918. Similar could well occur again if we are unprepared.
  • The Better Care Reconciliation Act would allow states to opt-out of requiring health plans to cover the 10 essential health benefits such as maternity care, mental health and substance abuse disorder services and prescription drug coverage.
  • This provision would likely lead to significantly higher out-of-pocket costs for consumers who can only afford plans that may not cover the services they will need. 
  • The BCRA would phase out the ACA’s Medicaid expansion, cut federal contributions to Medicaid by $722 billion over 10 years, and starting in 2025, would cut the federal contribution to Medicaid even deeper than the House-passed bill.

Learn more on APHA’s Health Reform page here or visit APHA’s Take Action! website.