ACPM Resolutions Introduced at
Preventive Medicine 2001

01-01(A) Basic Health Insurance For US Citizens/ Residents
John T Ashley MD, MBA, FACPM
RESOLVES THAT, the ACPM urge the Bush Administration to exercise conservative principles by eliminating the regressive taxes of medical and hospitalization insurance premiums paid by industry and individuals and replace them with a unified progressive federal income tax amendment that provides a Basic Health Insurance package which covers primary care and proven prevention services and essential medical care for every citizen and full time resident through the insurer of their choice; and THAT industry be required by law to increase the taxable compensation to employees by the amount currently spent on medical and hospitalization insurance premiums and each employer or individual be allowed to supplement the Basic Health Insurance package from the same insurer of choice with taxable health benefits as can be arranged uniquely by each setting or individual
ACTION TAKEN:  The ACPM Policy Committee referred the resolution back to the author, asking that he coordinate with the author of resolution #03-01(A), Universal Coverage for Health Care, to develop a combined health insurance resolution and submit to ACPM for consideration at its Fall 2001 meetings.
REMARKS:  The committee felt that ACPM had developed prior policy positions on this issue in the past and that the authors should work with ACPM staff to identify and build on existing ACPM policy in this area. The author presented the issue at the Open Policy Forum, where a strong majority supported the proposal. The following friendly amendment was offered: "RESOLVED, that the ACPM urge the Bush administration to pursue, in a manner consistent with conservative, fiscal, and economic principles, a mechanism to fund basic preventive, essential, urgent, emergent, and primary medical care services for every citizen and resident of the U.S. through innovative funding mechanisms, such as (but not limited to) the following: the projected federal budget surpluses, federal income tax reform, insurance reform, and/or other innovative strategies." Forum participants suggested that the revised resolution be broad and that ACPM aim to build consensus on and support for the general concept, before proposing specifics (e.g., research, education, manpower, etc.).
01-02(A) Develop the New Frontier of Electronic Interactions
Phillip C. Gioia, MD MPH, FACPM, FAAP
RESOLVES THAT, the ACPM should work with the AMA, Intel, FCC (Federal Communications Commission), and to develop useable standards of security, authenticity and reliability of electronic interactions (the AMA and Intel have already started a secure electronic physician identification system);THAT, the ACPM should guarantee the electronic medical record systems (EMRS) emphasizes prevention and high quality efficient health care and is accessible to all people and providersTHAT, the ACPM with the AMA, AMIA (American Medical Informatics Association), HCFA (NCVHS), WHO, and others should develop an analysis of the system (box diagrams) and design (Preliminary Design Language or flow charts) the basic structure for EMRSa) develop a basic consensus structure for health data b) develop standards for structure and reliability for knowledgec) develop security standards for the public, patients, and providers of care (private and community) d) design easy to use quality control for life style and health caree) develop standards of electronic communications between/among the public, patients, and providers and their data systemsTHAT, the ACPM must ensure that data and knowledge in such systems must be audited, verifiable, and corrected in a timely fashion a) all parties involved in data elements would have secure access and a method to correct or indicate suspected errors b) knowledge bases would be maintained continuously THAT, such developed software and knowledge systems would be available to members of the developing organizations at a discounted user fee THAT, the ACPM should work with other health care organizations and industry to fund the coding (the detailed programming) publicly and cooperatively among many vendors and/or government. The basic rules and communication protocols of this EMRS would be free but government, providers and payor would save by decreasing transaction costs, preventing disease, injuries and duplication. Vendors would make money on providing hardware, communication links, and setting up the standard shared software on the hardware. Optional expensive add ons to a basic alpha numeric system, such as graphic capture and storage might also be sold.
ACTION TAKEN:  ACPM adopted the following amended resolve in lieu of the submitted resolves: "THAT, ACPM should work with kindred organizations to help form an electronic medical record process (EMRP) that will allow for connectivity with security to meet the public and private health needs of all. The issue was then referred to the ACPM Information Technology Committee.
REMARKS:  This resolution was presented at the ACPM Open Policy Forum. Concern was expressed about the scope of the resolution and that it did not meet the criterion related to the "unique contribution" that ACPM could make to the issue. There was strong sentiment that ACPM pursue the concept, but as one player among many other groups, not as the lead organization to take on EMRS and related standards.
01-03(A) Universal Coverage for Health Care
Robert H. LeBow, MD, MPH (active member, ACPM)
RESOLVES THAT, The ACPM support universal coverage for every person in America under a financing system that has one or more (e.g., national or state-by-state) publicly administered risk pools.
THAT: This system of universal coverage be accomplished and put in place by the end of the decade (2010).
THAT: Based on the potential that prevention has for improving overall health status and the affordability of health care in a global sense, the new system of financing include substantially increased resources devoted to prevention and public health.
ACTION TAKEN:  Referred back to the author (see 01-01(A)).
REMARKS:  This resolution was not presented at the Open Policy Forum, but was discussed by the Policy Committee in tandem with resolution #01-01(A) (see remarks above).
01-04(A) Support for Abstinence Education Programs Marcella Meyer, MD, MPH, FACPM
RESOLVES THAT, the ACPM go on record as approving those Abstinence Education Programs for young people which incorporate the 8 criteria for federal-to-state funding for Abstinence Education programs as stated in Section 510(b)(2) of the Welfare Reform Act of 1996 which amends Title V of the Social Security Act (see attachment to resolution).
ACTION TAKEN:  ACPM did not adopt this resolution.
REMARKS:  The Policy Committee felt that evidence supporting the effectiveness of such abstinence programs was lacking. Several committee members commented that any abstinence education program should be part of a more comprehensive sexual education curriculum.
01-05(A) ACPM Policy and Criteria for Responding to Proposed Legislation, Regulations, or Policies From State, Federal, Local or Other Entities
Kelly Woodward, DO, MPH (active ACPM member)
RESOLVES THAT, the ACPM Policy Committee annually, or more frequently, establish realistic policy goals and identify key priority initiatives for the following year considering the following criteria:
A. External
1. Mortality, morbidity, and economic burden on the population
2. Potential favorable impact of preventive measures on the health and quality of life of the population
3. Scientific validity of policy, if available
B. Internal
1. Extent to which an ACPM policy position will help to advance the mission and goals of ACPM
2. Extent to which ACPM can make a unique contribution or has a special interest in the issue
3. Potential for increasing visibility of ACPM and the preventive medicine specialty
4. Potential costs and benefits to ACPM in human, financial, and political resources
5. Prior analysis of ACPM policy compendium6. Potential to promote ACPM membership recruitment, involvement, and professional interests

Be it further resolved,THAT, the following criteria must be affirmed in order for ACPM to respond to proposed legislation, regulations, or policies:
1. Responding to the proposed action is consistent with the ACPM mission.
2. ACPM is the appropriate authority to respond.
3. ACPM has the necessary resources available to provide an adequate response.
4. There is little likelihood for a real or perceived conflict of interest if ACPM responds.

Be it further resolved,THAT, when consistent with established policy goals and priorities, ACPM will steadfastly act upon requests for comments on proposed or enacted health promotion and disease prevention legislation, regulations, or policies and will use the following principles and criteria when evaluating and preparing responses to actions proposed or taken by public or private agencies:
A. Principles
1. ACPM will maintain a position of advocating for population-based and individual health promotion and disease prevention programs based on the best available scientific evidence.
2. ACPM will exercise extreme caution when responding to proposals that advance the priority of health promotion and disease prevention but also deviate from specific recommendations of the College or other authoritative bodies.
3. ACPM will diligently avoid promoting positions that place, or appear to place, the interests of groups identified by common proprietary or other relationships above the interests of the populations affected by the proposed action.
B. Criteria (as applicable)
1. Proposed action is consistent with ACPM policy statements related to the issue, if any.
2. Proposed action reflects the best available scientific evidence.
3. Proposed action is promoting programs that are consistent with recommendations of ACPM or other authoritative bodies.
4. Proposed action elevates the priority for health promotion and primary prevention through risk reduction or early detection (screening) interventions.
5. While the proposed action advances the agenda of health promotion and prevention in general but deviates from specific recommendations of ACPM or other authoritative bodies, supporting the proposed action does not conflict with, or contradict, positions taken by the College.
6. Proposed action ensures that any interventions are equitably available to the entire at-risk population within the jurisdiction.
7. ACPM is responding with specific recommendations for modifying the proposed legislation, regulations, or policies so that they would be more consistent with these criteria.
ACTION TAKEN:  The resolution was referred to an internal policy process subcommittee.
REMARKS:  The Policy Committee determined that the resolution was internal to the ACPM policy process and, hence, not presented at the Open Policy Forum. The committee established a subcommittee to further develop and document the ACPM policy development process (including refining the resolution and Open Policy Forum processes) and agreed this resolution should be considered within the workings of the subcommittee.
01-06(A) Consultative Preventive Medicine for Each American
Daniel Barr, M.D., D.A.B.P.M. (non-member, ACPM)
Sponsored by Joel L. Nitzkin, MD, MPH, DPA, FACPM
RESOLVES THAT, the American College of Preventive Medicine form a Task Force on Consultative Preventive Medicine (a) to develop a model consultative preventive medicine practice simulation, (b) to formulate recommendations for residency training in general preventive medicine assuming realistic, widespread adoption of consultative preventive medicine practice (to bring to the Residency Review Committee in Preventive Medicine), and (c) to convey the implications of realistic, widespread adoption of consultative preventive medicine for public and private sectors and for reimbursement and insurance; andTHAT, the American College of Preventive Medicine advocate the initiation, conduct, and completion of a feasibility study by the Institute of Medicine of each American being evaluated by a general preventive medicine specialist led team periodically (e.g., every five years).
ACTION TAKEN:  Referred to the Job Market Subcommittee of the ACPM Policy Committee.
REMARKS:  This issue was presented by Dr. Nitzkin at the Open Policy Forum. Concern was expressed that this function should be the primary responsibility of the primary care physician and that the market place should set the pace. Others contended that preventive medicine is ideally situated to advise and train providers to effectively deliver clinical preventive services and this could provide a model. A straw vote yielded an evenly-divided audience. Following the forum, the ACPM Policy Committee voted to incorporate the proposal into the work of the Job Market Subcommittee, and Dr. Nitzkin (subcommittee chair) would recruit the author to work with him on the subcommittee. One member suggested that this could serve as a business model for how to deliver preventive medicine.
01-07(A) Primary Prevention Of Cardiovascular Disease
Lewis H. Kuller, MD, DrPH, FACPM
RESOLVES THAT, The American College of Preventive Medicine work with the Center for Disease Control and State Health Departments to establish a strong program in cardiovascular disease prevention including the training of public health leaders in the effective development of public health and preventive medicine programs to reduce cardiovascular risk factors. 
THAT: The American College of Preventive Medicine encourage programs in preventive medicine at professional health training institutions such as medical schools, nursing schools, schools of public health be encouraged to develop strong curriculum and outreach programs to reduce cardiovascular risk factors and the incidence of coronary heart disease and stroke in the community. 
THAT: The American College of Preventive Medicine should encourage improved training of dietitians, nutritionists and behavioral experts in nutritional interventions to prevent the rise in LDLc levels of reduce levels of LDLc level in the population. 
THAT: The American College of Preventive Medicine should work closely and develop a dialog with food manufacturers and with advertising agencies in the United States to encourage a further substantial reduction in the amount of saturated fat and cholesterol in the American diet, and a decrease in the amount of sodium. 
THAT: The American College of Preventive Medicine work with federal and state health departments and the health schools to substantially improve the treatment and control of elevated blood pressure in the United States. 
THAT: The American College of Preventive Medicine continues to make a major effort to encourage the use of the funds from the settlement with the tobacco companies to be used for programs to further substantially reduce the amount of cigarette smoking in this country and especially to prevent cigarette smoking among children. 
THAT: The American College of Preventive Medicine should reinforce to the public that cardiovascular disease is preventable and that it is possible to reduce cardiovascular mortality and morbidity by at least 5% per year over the next ten years in this country by effective preventive medicine programs.
ACTION TAKEN:  ACPM adopted the following amended resolve in lieu of the submitted resolves: "THAT ACPM take a leadership role in the primary prevention of CVD and identify those areas in which a plan for furthering its role can be implemented with existing resources or development of new resources."
REMARKS:  The resolution was presented at the Open Policy Forum. A friendly amendment was offered that called for an additional resolve focused on the lack of physical activity as a risk factor. There was unanimous support for ACPM pursuing this initiative, within ACPM's current resource constraints. The Policy Committee subsequently affirmed this position and encouraged ACPM to seek new resources (e.g., federal grants) to pursue the initiative. The committee suggested the issue first be addressed by a planning body (such as a subcommittee of the Policy Committee) to develop an action plan and timetable. The Board of Regents endorsed the Policy Committee's recommendations.

For more information, contact Mike Barry.