Policy Statement Archiving Process: Over time, policy statements become out of date and not reflective of current science or the current environment. The goal of the archiving process is to archive policy statements that are no longer current and to identify important policy statements that need to be updated and submitted to the annual policy statement development process. Policy statements approved for archiving by the Governing Council are noted as archived in the APHA policy statement database--they no longer guide APHA policy and practice, but serve as historical documents. In 2016, the archiving process was updated in an effort to more efficiently and effectively address the large number of active policy statements that need to be archived or updated. Plan for Archiving in 2018: If no new proposed policy statements are submitted in 2018 that would replace or update policy statements listed as update by 2018 then those with the 2018 designation will be automatically archived at the 2018 annual meeting. o There are 21 policy statements identified for update by 2018, no update was received and they will therefore be automatically archived. Future Process for Archiving: At APHA s 2016 Annual Meeting, the Governing Council updated the archiving review process so that beginning in 2019, policy statements adopted 20 or more years ago, will automatically be archived unless deemed current after a thorough review by the Science Board and approved to remain as active by the Governing Council. In order to remain active, the science, references and action steps in the policy statement must be current. o The list of policy statements adopted 20 or more years ago by 2019 is posted on the policy statement review and archiving portion of the APHA website (member s only).governing Councilors and other APHA members will have two policy statement development cycles to either submit a recommendation to the Science Board that the science is current or update the policy statement and submit for review. Guidelines for this process are posted on the policy statement review and archiving portion of the APHA website and are also detailed in APHA s Policy Statement Development Process Guidelines. In 2013, the Governing Council updated the policy statement development process guidelines so that new policy statements adopted in 2014 or later will be automatically scheduled for archiving after 10 years. APHA will post the list of policy statements due for archiving at the end of year 8 in order to give potential revisers time to review and submit updated documents for review by the JPC prior to the 10 year archive date if appropriate (e.g., a policy statement passed by the Governing Council in 2014 will be scheduled for archiving in 2024, and will be listed as such in 2022). At the annual meeting, any Governing Councilor may remove a policy statement from the 10- year archiving consent agenda and propose moving it to another category or removing it from consideration entirely. If the motion fails, the policy statement remains on the consent agenda. Eventually these two archiving processes will come together and only the 10 year automatic archiving process will be needed.
2018 Proposed Policy Statements: Science Board and JPC assessments In May 2018, the Science Board and Joint Policy Committee reviewed 24 proposed policy statements. The Science Board reviewed the proposals and member comments and assessed the proposals based on the strength of the evidence presented and the strength of scientific reasoning. A detailed description of the Science Board s assessment criteria is found in Appendix A. The JPC reviewed the proposals, member comments and Science Board s review in preparing its assessment of each proposal. The table below summarizes the Science Board and the JPC s assessments. Group A: Access to Care and Environmental Health Proposed Policy Statement Science Board Assessment JPC Initial Assessment A1: Promoting Leadership to Scale Up of Oral Rehydration Salts with Zinc Uptake and Reduce Diarrhea Mortality Globally in Children Under 5 Years A2: Supporting and Sustaining the Home Care Workforce to meet the Growing Need for Long Term Care A3: Dietary Guidelines for Americans: Foundation for Broad Nutrition Policies A4: Pregnancy and Oral health: A Public Health Issue A5: The Environmental and Occupational Health Impacts of the Unconventional Oil and Gas Industry A6: The Public Health Impact of Energy Policy
2018 Proposed Policy Statements: Science Board and JPC assessments Group B: Health Promotion and Prevention and Immigration and International Health Proposed Policy Statement Science Board Assessment JPC Initial Assessment B1: Reducing Suicides by Firearms : 2. Sufficient Scientific Reasoning B2: Violence as a Public Health Issue B3: Supporting Regulation of Electronic Cigarettes B4: Evidence-Based Policies to Prevent Excessive Alcohol Consumption and Alcohol-Related Harm B5: Building a Public Health Response to Organ Transplant Abuse in China 2. Sufficient Evidence 2. Sufficient Scientific Reasoning 2. Sufficient Scientific Reasoning Group C: Human Rights Proposed Policy Statement Science Board Assessment JPC Initial Assessment C1: Protecting the Health of Deferred Action for Childhood Arrival Immigrants 2. Sufficient Scientific Reasoning C2: The Prevention and Elimination of Tuberculosis Among Health Care Workers C3: Support for Long-Term Public Health Research in Puerto Rico After Hurricane Maria C4: The Health of Refugees and Displaced Persons: A Public Health Priority 2. Sufficient Scientific Reasoning
2018 Proposed Policy Statements: Science Board and JPC assessments Group D: Social Determinants of Health and Equity Proposed Policy Statement Science Board Assessment JPC Initial Assessment D1: Health Equity: A Cornerstone of Public Health D2: Achieving Health Equity in the United States D3: Strengthening SNAP to Improve Nutrition and Reduce Diet-Related Disease D4: Global Food Security and Public Health: Supporting Initiatives and Actions D5: Processed Meat Warning Labeling and Elimination from Institutional Menus D6: Standardizing SO/GI Data Collection across Clinical and Public Health Research Records D7: Criminalization of Black and Brown Children in Schools D8: Addressing Law Enforcement Violence as a Public Health Issue D9: A Public Health Perspective and Policies to Improve Understanding of and Prevent the Health Impacts of Police Violence
2018 Proposed Policy Statements: Science Board and JPC assessments Appendix A: Science Board Assessment Criteria Strength of the Evidence - Ratings in this section reflect the strength of evidence included only (i.e., all seminal works were included, strength of evidence based on the study design/findings), regardless of whether the evidence is presented in a logical manner. 1. Strong Evidence - Evidence includes consistent results and/or conclusions from well-designed, well-conducted studies in representative populations that directly address/reflect the relevant considerations and/or outcomes associated with the proposed policy. 2. Sufficient Evidence - The available evidence is sufficient to support the scientific basis of the proposed policy, but the strength of the evidence is limited by: The number or size of the studies included The quality (minor flaws in study design or methods) of the studies included Minor inconsistency of findings across the studies included Lack of coherence in the chain of evidence Limited generalizability of findings to the associated populations Limited information in regard to important considerations or associated outcomes - The evidence included in the proposed policy is insufficient because of: The substantially limited number or size of the studies included The quality (moderate or major flaws in study design or methods) of the studies included Substantial inconsistency of the studies included Gaps in the chain of evidence Study findings are not generalizable to the associated populations Lack of information in regard to important considerations or associated outcomes Proposals are rated as one of the following: 1. Strong Evidence 2. Sufficient Evidence Strength of Scientific Reasoning - Ratings in this section reflect the quality of the scientific reasoning, or logical progression of ideas to support the claims made, regardless of the strength of the evidence presented. 1. Strong Scientific Reasoning 2. Sufficient Scientific Reasoning
Appendix B AMERICAN PUBLIC HEALTH ASSOCIATION Joint Policy Committee Proposed Policy Statement Review Form The Joint Policy Committee is charged with overseeing the APHA s annual policy statement development process. It is the Committee s task to review and assess all proposed and late-breaking policy statements and report its final recommendations for adoption to the Governing Council at the Annual Meeting. Policy statements adopted through this process provide a record of the Association's stance on a variety of public health issues and reflect the diverse interests of the APHA membership. Please use the criteria below to assess the proposed policy. When completing your review, consider all of the questions presented and summarize your findings in a succinct manner. Not all questions will be relevant for each proposal; please note such questions with N/A rather than leaving it blank. Policy Statement Number and Title: Reviewer s Name: Reviewer 1 or Reviewer 2: Reviewer Disclosure Statement Disclose any relationship of a financial, professional, or personal nature that may have an impact on your ability to objectively review the policy statement proposal or that may be perceived as a conflict of interest. Conflicts of interest (competing interests) include facts known to a participant in the policy statement development process that if revealed later, would make a reasonable reader feel misled or deceived (or an author or reviewer feel defensive). Conflicts of interest may influence the judgment of authors and reviewers; these conflicts often are not immediately apparent to others or to the reviewer. They may be personal, commercial, political, academic, or financial. Financial interests may include employment, research funding (received or pending), stock or share ownership, patents, payment for lectures or travel, consultancies, nonfinancial support, or any fiduciary interest in the company. The perception or appearance of a conflict of interest, without regard to substance, alone creates conflict, because trust is eroded among all participants. All such interests (or their absence) must be declared in writing by authors upon submission of the proposed policy statement. If any are declared, they will be included with the policy statement proposal during the review process. If there is doubt about whether a circumstance represents a conflict, it should be disclosed.
Title Criteria Write your comments (as the reviewer) in this column Write a summary statement and include recommendations to the author. Please note that these recommendations may be shared with the author verbatim. Does the TITLE accurately reflect the problem statement, recommendations, and/or action steps? Relationship to existing APHA policy statements Is there an existing APHA policy statement that covers this issue? What is the RELATIONSHIP TO EXISTING APHA POLICY STATEMENTS? (Please identify the related existing policy statements by number and note if the proposal updates the science of the older policy statements? Rationale for consideration Does the proposed policy statement address a POLICY GAP or requested UPDATE identified for the current year (see attachment)? IF YES, please identify the topic area. If NO, please comment whether the author adequately describes the relevance and necessity of the proposed policy statement (i.e., why APHA should adopt a policy on this issue now). Problem Statement Does the PROBLEM STATEMENT adequately describe the extent of the problem? a. Are there important facts that are missing from the problem statement? If so, describe them. b. Document any disproportionate impact on underserved populations? For example, what is the burden of the problem among low-
income and minority populations, persons with a disparity, persons with certain sexual identity and orientation, etc.? c. Identify any relevant ethical i, equitable ii, political or economic iii issues. Opposing Arguments/Evidence Does the proposal include OPPOSING OR ALTERNATIVE VIEW POINTS? a. Does it adequately refute the opposing viewpoints presented? If not, please explain. b. Are alternative viewpoints, ethical, equitable and reasonable? Were any opposing views missing? Evidence-based Strategies to Address the Problem Does the proposal describe what STRATEGY/STRATEGIES is/are being PROPOSED TO ADDRESS the problem? a. Is/are the proposed strategy/strategies evidence-based? b. Is/are the proposed strategy/strategies, ethical, equitable and reasonable? If not, describe why not. c. What other strategies, if any, should be considered? Should additional evidence for the proposed or other strategies be included? If so, please provide data or references that should be considered. Action Steps Are the ACTION STEPS: a. Externally-directed (i.e., directs an external entity, NOT APHA, to promote or implement a specific strategy)?
b. Focused on policy/principle, and not on specific legislation/regulation? c. Supported by the evidence or rationale documented in the proposal? Are the action steps evidence-based, ethical, equitable and feasible? If not, please explain? d. Culturally responsive to the under-represented and underserved populations being addressed, if appropriate? If not, describe why not. References Are the REFERENCES connected to the text? Are references complete, up-to-date, and peer-reviewed? Social justice and human rights metrics Does the proposal primarily focus on an issue of human rights and social justice? If no, proceed no further. If yes, see below: a. Does International Human Rights Law [http://www.asil.org/erg/?page=ihr] support this issue? b. Is the proposal consistent with the Universal Declaration of Human Rights [http://www.un.org/en/documents/udhr/]? c. Is the proposal consistent with the WHO Commission on Social Determinants of Health (CSDH) [http://www.who.int/social_determinants/the commission/en/]? d. Is the proposal consistent with guidance (if any) from APHA constituent groups on the topic, specifically, the International Human rights Committee and the Ethics Section?
Member comments (See Appendix A for a list of APHA components) a) Which (if any) APHA Units co-sponsored 1 or endorsed 2 this proposal at time of submission (should be listed on the proposal)? b) What are the major comments by APHA units with expertise on the issue? Please summary recommendations from these Units/members in the 2 nd column. c) Which (if any) APHA Units/members gave this proposal a positive review? d) Which (if any) APHA Units/members gave this proposal a conditional review? Please summary recommendations from these Units/members in the 2 nd column. e) Which (if any) APHA Units/members gave this proposal a negative review? Please summary recommendations from these Units/members in the 2 nd column. Relationship to current proposals Does this proposal RELATE TO OTHER CURRENT PROPOSALS? Would you recommend that they be combined into one proposal? 1 Co-sponsorship is official acknowledgement of component involvement in the development of the proposed policy statement. 2 Endorsement represents official support for the proposed policy statement.
Additional review Does this proposal require ADDITIONAL REVIEW from additional APHA components or external experts? If so, please identify reviewers (individuals and/or organization): Overall assessment of proposal: Positive - Policy statement meets all guidelines, is scientifically sound and concisely written; any changes necessary are minor and can be addressed in the copyediting phase Policy statement meets most guidelines but requires some revision to strengthen the arguments and evidence presented and improve minor grammatical and formatting issues - Policy statement does not meet guidelines, lacks or improperly cites scientific evidence, arguments presented are biased or one-sided; contains major grammatical and formatting errors. i Public health ethics can be subdivided into a field of study and a field of practice. As a field of study, public health ethics seeks to understand and clarify principles and values which guide public health actions. Principles and values provide a framework for decision making and a means of justifying decisions. Because public health actions are often undertaken by governments and are directed at the population level, the principles and values which guide public health can differ from those which guide actions in biology and clinical medicine (bioethics and medical ethics) which are more patient or individual-centered. As a field of practice, public health ethics is the application of relevant principles and values to public health decision making. In applying an ethics framework, public health ethics inquiry carries out three core functions, namely 1) identifying and clarifying the ethical dilemma posed, 2) analyzing it in terms of alternative courses of action and their consequences, and 3) resolving the dilemma by deciding which course of action best incorporates and balances the guiding principles and values. CDC. Advancing excellence and integrity of CDC science. Public health ethics. Available at: http://www.cdc.gov/od/science/integrity/phethics/. Accessed March 18, 2014.
ii Health equity is achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment. CDC. Chronic disease prevention and health promotion. Health equity. Available at: http://www.cdc.gov/chronicdisease/healthequity/. Accessed March 18, 2014. iii Economics is the study of decisions the incentives that lead to them, and the consequences from them as they relate to production, distribution, and consumption of goods and services when resources are limited and have alternative uses. CDC uses economics to identify, measure, value, and compare the costs and consequences of alternative prevention strategies. CDC. State, tribal, local and territorial health public health professionals gateway. Public health economics and tools. Available at: http://www.cdc.gov/stltpublichealth/pheconomics/. Accessed March 18, 2014.