Appathurai Balamurugan, MD, DrPH, MPH
Assignment Location: Arkansas Department of Health
Project: Failed House Bill 1711 (Tobacco 21)
Appathurai used CDC’s policy analysis framework to identify the policy lever in raising the minimum age for tobacco purchase to 21 years of age through a state-wide policy initiative. He described the public health and economic impact; assessed the feasibility of implementing the policy; evaluated the return on investment; identified potential proponents and opponents; and clarified some policy alternatives.
Background: Tobacco use is one of the leading public health challenges for Arkansas and the nation. In 2014, Arkansas ranked #1 and #5 in the nation among states with the highest heart attack and stroke mortality rates. Tobacco use is a major risk factor for both heart attack and stroke. Health policy and evidence-based program implementation are key public health tools to mitigate the burden due to tobacco use. During the 2017 Arkansas State legislative session, the Arkansas Tobacco Control Coalition filed House Bill 1711 that would prohibit the sale of tobacco products to persons under 21 years of age (T-21 initiative). However, the bill failed to pass the Arkansas State Legislature.
Learner Contribution: Appathurai estimated that raising the tobacco-purchasing age to 21 would result in a 2-to-3 percent annual decrease in total tobacco sales in Arkansas. This translates to a decrease in state general revenue of $3.52 – $8.32 million. An estimated $253 million health-related cost savings would result if T-21 was implemented in Arkansas. The state would see $30 in cost savings for every dollar lost if T-21 were fully implemented.
Michelle Chevalier, MD, MPH
Assignment Location: Center for Global Health, Centers for Disease Control and Prevention
Project: Transitioning Funding for Global Blood Safety Programs
As funding for blood safety activities transitions from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to country Ministries of Health (MOH), Michelle developed guidance that highlighted innovative strategies to maintain these activities using MOH and CDC country office resources. She surveyed key blood safety indicators for 14 PEPFAR priority countries and utilized the data to emphasize the importance of country MOHs continuing to fund blood safety programs after the transition from PEPFAR. Michelle shared her findings in an article titled “Trends and Gaps in National Blood Transfusion Services — 14 Sub-Saharan African Countries, 2014–2016,” in the December 21, 2018, issue of the Morbidity and Mortality Weekly Report and CDC webinar where she highlighted recent achievements and programmatic gaps in blood safety in PEPFAR-supported countries.
Background: Since 2004, PEPFAR has provided technical and financial support to countries in Africa and the Caribbean with a high prevalence of HIV infection for activities related to strengthening national blood safety activities. As PEPFAR support for blood safety activities ends, funding for these activities will need to be absorbed by the country MOHs. Ensuring availability of adequate and safe blood products is essential for public health. In 2015, 16 PEPFAR priority countries produced an estimated 926,630 units of whole blood. Consequently, as blood safety support transitions, countries will need to ensure that investments in blood safety will continue to support the World Health Organization (WHO) targets for national hemovigilance, blood center accreditation, and blood product safety/testing and availability.
Learner Contribution: Five CDC PEPFAR country offices accounting for more than 380,000 units of blood transactions have begun to collaborate with their respective MOH and national blood transfusion services in a targeted effort to reach WHO global blood safety targets in a sustainable manner as PEPFAR funding has decreases. Michelle’s work resulted in CDC funding two U.S. blood safety partners for continued work in strengthening blood safety programs in PEPFAR priority countries as countries transition to MOH support between 2018 and 2020.
Shereitte Stokes IV, PhD, MPH, MIAD
Assignment Location: Center for State, Local, Tribal, and Territorial Support, Centers for Disease Control and Prevention
Project: Public Health Associate Program Curriculum Analysis
Shereitte described the current Public Health Associate Program (PHAP) curricula; quantified associate programmatic activities related to the program learning objectives; and applied CDC’s Policy Analytical Framework to analyze the PHAP educational policies. He identified several deficiencies in PHAP curriculum, the most prominent being a lack of population health content; proposed three policy options to address these deficiencies; and developed a strategy to implement the best policy option.
Background: Over 1,000 associates have participated in PHAP since its inception in 2007. These associates have engaged in a number of programmatic activities that have had an impact on CDC population health strategic priorities. The PHAP curriculum is foundational to associates’ programmatic success in the field but the program did not yet have a continuous quality improvement process in-place.
Learner Contribution: Implementation of the best policy option will lead to an estimated $55K in cost savings. In addition, the immediate impacts are: 1) 225 associates (2017–2018 cohort) can now receive a complete population-health curriculum, and 2) the population health impact of 664 associates (2014-2017 cohort) has been quantified for the first time. Over 1,000 associates (2018-2027 cohort) will provide exemplary population health-based services, thus leading to a significant improvement in health.