Report to the Membership

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July/August 2005

July and early August have been very hot in Sacramento. The Legislature is in recess after having passed the State Budget in early July. Fortunately, the results were fairly good for most State health programs, with funding levels being maintained for most programs.

Exceptions, however, were continuing cuts to the operating support budget of the California Department of Health Services (CDHS). While not as visible as cuts to programs or caseloads, these cuts are likely to result in further reductions in public health and environmental health staff and program resources over the coming year—a further erosion of our public health infrastructure.

As you know, CPHA-N and the Southern California Public Health Association (SCPHA) have become increasingly concerned over reductions in State and local public health resources and capacities. We have written letters, provided testimony to the Little Hoover Commission, contributed to articles in the media, and collaborated with other public health advocates. Tangible progress, however, has been discouragingly limited.

Several other examples recently have emerged that document this continuing dismantling of the structural integrity of public health in California.

A CDHS program located within the Health Information and Strategic Planning (HISP) division illustrates the deterioration of the State and local public health and environmental health system. It is the Local Public Health Services (LPHS) Program. Operating for decades and known for many years as the “Contract Counties Program”, it has provided State Public Health Nurses (PHN), Environmental Health Scientists (EHS), and other health professional, technical, administrative support staff to eleven rural counties with less than 50,000 in population each.

The Program serves nearly 250,000 people spread over 22,218 miles. It represented a State-county partnership and utilized a regional approach, with economies of scale and a strong headquarters’ professional staff to assist in recruiting and supervising the field staff and also providing specialized expertise. Over the past five years, however, the Sacramento-based headquarters professional staff has been decimated and the field staff has been severely curtailed. Specifically:

• The only physician within the HISP division retired and the position has been eliminated
• The senior Environmental Program Manager retired and his position has been eliminated
• The senior Public Health Nurse retired and her position has been eliminated
• The only Health Educator position has been eliminated
• The only Health Program Specialist position has been eliminated
• Clerical support has been reduced by one position
• There is only one public health nurse supervisor for nine field nurses working in five very rural counties
• In addition, five field staff positions have been lost, either Environmental Scientists (ES) or Public Health Nurse (PHN) II/Is
• Lastly, four field positions (1 PHN and 3 ES) are vacant and may be lost if they are not filled quickly

As a result, a variety of public health and environmental services are no longer being provided on a timely basis in rural counties served by the LPHS program. State cars no longer are being provided for staff to travel and nearly all training funding has been cut. Promotional opportunities now are very limited and one of the nursing staff has been laid off. Morale among remaining staff is low and recruitment to fill vacancies has been very difficult. Conditions are expected to deteriorate even further unless immediate actions are taken to restore the Program.

So why is this happening? Did the need for high-quality public health and environmental health services in rural areas of California suddenly diminish? Will the State help the rural counties replace lost staff and budget resources? Are the savings being generated from these cuts essential to balancing the California State budget?

The truth is that the demise of the LPHS program has been caused by a “shortfall” of $1.5 million in funding (the CDHS budget for FY 05-06 is over $37 billion). The problem also has existed for 15 years, although it has grown in size each year, ever since the LPHS program was included in the Realignment of State and local human service programs in 1990. At that time, the State miscalculated the amount of funding required to support the LPHS program and did not allocate sufficient revenues to the counties to reimburse CDHS.

In addition, State costs have increased faster than Realignment revenues have increased because of position reclassifications, increased overhead costs, and cost shifts. Lastly, the LPHS program has suffered from the loss of positions due to general budget cuts and State rules eliminating position if they remain vacant more than six months.

Local health departments provide essential public health and environmental health services which protect the health and well-being of us all. CDHS is supposed to provide leadership, professional and technical support, and central resources in support of this mission. Some have suggested that the State also should set standards to assure the quality and performance of local health departments and that some services should be regionalized, and the LPHS Program should be an opportunity to demonstrate excellence and to pioneer regional collaborations and models in addressing rural public health issues. Instead, it appears that CDHS has turned its back on its responsibilities, hoping that the rural counties served by the LPHS Program the California public health community are too weak to respond.

Most of us know that the decimation of the LPHS Program is only illustrative of the overall decline of State and local public health and environmental health services. A recent article in the San Francisco Chronicle (Sabin Russell, 7/31/05) focused on the decline of State and local public health laboratories and the resignation of Dick Jackson.

The Little Hoover Commission (LHC) also released another assessment of California’s emergency preparedness systems and again expressed concerns over the capacity State and local public health agencies. The LHC repeated its call for a separate Department of Public Health, an advisory State Public Health Board, and physician State Health Officer.

Unfortunately, the legislation by Senator Ortiz (SB 172) establishing these much-needed reforms is not moving in the Legislature and currently will not be considered again until 2006. We must continue our efforts in asking the Legislature to act upon this important measure in the remaining days of the 2005 session.

In the meantime, concerned public health practitioners should be asking why the Governor and his health officials cannot find $1.5 million to restore public and environmental health services in rural California. It would be refreshing to see some leadership on this issue and also to stop hearing the standard excuses and empty rhetoric about difficult fiscal times and making tough decisions. This should be an easy problem to solve.

Peter Abbott, MD, MPH
President
pabbott@surewest.net

(Note: I served for twenty three years as the Chief of the Office of County Health Services within CDHS and for most of that time the LPHS Program was part of this office. I also am currently a Board member and the Treasurer of the California Rural Health Association.)

In other CPHA-N news, the Occupational and Environmental Health Section, headed by David Harrington and supported by Ann Blake, held another successful brown-bag lunchtime Seminar on July 13th. Entitled “Linking Public Health Data to Community Action: Process, Partnerships and Emerging Challenges”, it was well-attended and well-received.

If other CPHA-N members are interested in sponsoring similar activities, if you have ideas for these shorter, more informal exchanges, please contact Peter Abbott or Vicki Wolfson, and we can facilitate these programs.

Planning has been finalized for a Continuing Education Program, Update on Infectious Diseases, with faculty from CDHS. The Program will be held on September 29th at the State Building Auditorium (1515 Clay Street) and CEU credits will be available for physicians, nurses, health educators and any other professionals needing Category I credits.

Like many of CPHA-N’s efforts, this Program represents a collaboration among many organizations, including the UCB School of Public Health, Alta Bates Summit Medical Center, the Public Health Institute and NCSOPHE, and especially, CDHS. By next week, on-line registration capability will be set up.

Flyers will be distributed electronically and by snail mail, for those who do not have e-mail capability. Please feel free to post the flyers and distribute them widely across your networks.

CPHA-N continues to be part of a broad-based coalition focusing on the promotion of walkable communities, an outgrowth of an APHA-National Highway Traffic Safety Administration mini-grant. If you or your organization is interested in participating, please contact Mona Mena at the Alameda County Health Department (mona.mena@acgov.org)

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Report to the Membership

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June 2005

By now, you probably know that our State Health Officer, Dick Jackson, MD, MPH, has resigned his position effective June 30, 2005. For many of us, this presents yet one more sign of the serious deterioration of the public health programs of the California Department of Health Service (CDHS).

Dick’s appointment fourteen months ago was viewed as a possible sign that the Schwarzenegger Administration might be willing to reverse the years of budget cuts, personnel reductions, and pervasive decline in what used to be one of the best, if not the best, state health departments in the US. Dick has been exceptionally honest and forthright in describing current concerns over the capacity of our public health system to respond to infectious disease threats, the burdens of chronic diseases, and environmental health issues. His knowledge and leadership will be sorely missed within CDHS and the public health community.

However, his departure also should renew our sense of urgency and resolve to address rebuilding California’s public health system and both the State and the local levels.

Many organizations, commissions, and special studies have confirmed that our public health system is broken and needs fixing. A recent hearing by the Little Hoover Commission elicited wide-ranging criticisms and concerns over our preparedness to counter various types of threats to the public’s health, such as bioterrorism, flu pandemics, and exotic infectious diseases. Serious concerns were expressed over the staffing and performance/surge capacities of the State public health laboratories.

Another issue mentioned repeatedly was that the public health workforce in many disciplines is aging, often inadequately trained, and not being replaced as people retire. Data presented at the hearing by CDHS revealed nearly an 11% decrease in the number of public health scientific and professional positions over the last six years! If new positions recently funded through bioterrorism preparedness dollars were excluded, the reduction increased to over 15%. The Department also is facing further losses in its professional training and education programs. Morale and working conditions have worsened, as many of the Department’s remaining key staff members perform two or three jobs. Situations in many local public health departments are equally bad or, in some cases, even worse.

CPHA-N and the Southern California Public Health Association submitted a joint letter to the Little Hoover Commission expressing our specific concerns and I also presented further testimony during the hearing.

So what can we do? We must continue to advocate for a separate Department of Public Health, a strong and well-qualified State Health Officer at its helm, and a broadly representative State Board of Health reflecting the mulitiplicity of stakeholders in creating and sustaining healthy communities, and we must insist that these changes be done soon. Numerous statewide health organizations, including CPHA-N, have called for these changes. Dick Jackson’s appointment was supposed to lead to these much-needed structural reforms at the State level, but it has not happened – yet.

You can make a difference by writing to the Governor, Secretary Kim Belshe of the California Health and Human Services Agency, and CDHS Director Sandra Shewry and making your feelings known. We need to encourage the Administration to recruit an outstanding candidate to replace Dick, but we also need to assure that this individual has the authority and support to restore the excellence to our public health system.

The Steering Committee of the California Medicine and Public Health Initiative (CMPHI) recently sent a letter advocating these points to the Governor. It also can be viewed at www.cphan.org/watch.html#LtrGov605

CPHA-N continued to express its positions on various items in the State Budget. Letters were developed and submitted to the Senate and Assembly Budget Subcommittees in response to the Administration’s health program proposals contained in the May Revision. Prospects for a timely budget dimmed when the Budget Bill did not receive sufficient votes for a 2/3rds majority on 6/15 (the constitutional deadline for the Legislature to pass a budget). My thanks are extended to Jacquie Duerr, and the other members of the Ad Hoc Committee on Budget Issues, for their hard work.

CPHA-N is co-sponsoring legislation to combat the obesity epidemic among California's children. Recent studies have shown that more than a quarter of California children in grades 5, 7 and 9 are overweight, bringing elevated risks for Type 2 diabetes, high blood pressure, and asthma. Senate Bill 12 by Senator Martha Escutia will implement nutrient standards for competitive foods sold on all public school campuses. By taking these long-overdue and important steps, SB 12 will ensure that the eating habits promoted through the sale of food at our schools are aligned with the nutrition education students receive in the classroom. SB 12 is doing well in the Legislature and recently received the support of the Governor and of the California School Food Service Association.

CPHA-N, in collaboration with CDHS, is planning an “Infectious Disease Update” CE program this September 29th in Oakland. Look for more information on this informative and very popular program.

Peter Abbott, MD, MPH
President
pabbott@surewest.net

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June 17, 2005

Governor Arnold Schwarzenegger
State Capitol Building
Sacramento, CA 95814

Dear Governor Schwarzenegger:

The Governing Council of the California Public Health Association-North (CPHA-N) was very disappointed to learn of the resignation of our State Public Health Officer, Richard Joseph Jackson, MD, MPH. Dr. Jackson has provided greatly respected professional leadership, expert knowledge, and a wealth of experience to the California Department of Health Services (CDHS). It will be very difficult to replace Dr. Jackson unless conditions within the public health programs of CDHS are improved dramatically.

As you begin the recruitment of a successor to Dr. Jackson, CPHA-N strongly recommends that you also propose establishing a separate Department or Center for Public Health reporting directly to you and that you propose the establishment of a broadly representative State Board of Health to advise and support the State Health Officer. The Governing Council has noted on many occasions that the CDHS seems overwhelmingly preoccupied with the Medi-Cal program and other non-public health programs. Separating Public Health from current CDHS has been recommended by numerous organizations, including the Little Hoover Commission, your California Performance Review, the Southern California Public Health Association, the Public Health Institute, the California Medicine and Public Health Initiative, and the California Medical Association.

Members of the Governing Council have become increasingly concerned over the deterioration of California’s public health system at the State and local levels. The staffing and performance capacities of the Public Health programs of CDHS have decreased significantly over the past ten years. Data from CDHS presented to the Little Hoover Commission at its May 26, 2005 hearing revealed that the Department has lost nearly 11% of its professional and scientific staff positions (physicians, nurses, research scientists, epidemiologists) since FY 2000-01.

Without new positions funded by federal Bioterrorism preparedness funding, that loss would have exceeded 15%, or one of eight positions. Other information shows that the State Public Health laboratories have lost even a larger percentage of staff, and as a result, have significant performance and capacity limitations. The CDHS program providing public health nursing and environmental health services in very rural counties has lost nearly all of its senior professional staff positions in the last three years. Many of the remaining public health professional staff are nearing retirement age, so staffing shortages and the loss of professional expertise and knowledge may become even more critical in the near future unless decisive action is taken.

As you know, a state public health department must be the central resource for data, laboratory services, professional expertise, and emergency response to health threats such as West Nile Virus, influenza, HIV, and bioterrorism. The Department plays critical roles in health planning, policy development, health promotion, chronic disease control, and environmental health protection. It also provides leadership and support to California’s 61 local health departments, many of which are also in serious decline.

However, years of budget cuts, cuts in training and continuing education, increasing workloads, non-competitive salaries, resignations and retirements have badly eroded our public health resources at the State and local levels.

We know that you understand the value of strong health promotion and disease prevention capacities in addressing health threats, eliminating health disparities, and promoting a healthy California. We ask that you provide both your leadership and your personal support in restoring the excellence and capacity of our State public health programs.

However, merely establishing a separate Department or Center of Public Health is not sufficient to reverse the years of decline and neglect. We ask that you also establish a multi-year timetable for restoring lost capacity as well as developing and investing new resources in our public and environmental health programs. We believe that your plan should address staffing, professional recruitment and training, information technology, data and information, administrative capacity, and scientific and professional excellence.

The Governing Council of CPHA-N stands ready to work directly with you and your staff on these critically important issues. We offer our assistance to you and your staff.

Sincerely yours,

Report to the Membership

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April 2005

During the March 11, 2005 meeting of the Governing Council, several significant actions were taken. First, the Governing Council decided to send a letter to the Governor pointing out our serious concerns over the deterioration of California’s public health system and requesting that he take actions to restore the system to allow it to function optimally.

The letter was similar to one sent to the Governor by the California Medicine and Public Health Initiative (CMPHI). Second, Peter Abbott appointed Lisa Benton, MD, MPH, as the CPHA-N Liaison to CMPHI. Third, Peter has asked Dick Jackson, the State public health officer, to become an active member of the Governing Council, serving as the CPHA-N Liaison to the Department of Health Services (DHS). Fourth, the Council voted to oppose the elimination of State funding for the DHS Office of Bi-National Health, and also to send letters regarding concerns on various State Budget items, to the relevant Budget Subcommittees of the Legislature. Fifth, an Ad Hoc Committee on the State and Federal budget was formed, led by Jacquie Duerr. Lastly, most of the meeting was devoted to final planning and preparations for the April 4-5 Joint Annual Meeting in Oakland.

Nearly 300 people attended the Joint Annual Meeting at the Oakland Airport Hilton hotel. Successful illustrations of the “Power of Collaboration” were everywhere. Attendees were able to view 15 excellent posters on various public health topics that were on display. These were the work of students from four different schools. Exhibitors provided lots of interesting and informative materials and take-home gifts. The floral table and meeting room decorations, provided by Irene Jones, also were beautiful.

The audience enjoyed keynote presentations by Mildred Thompson (subbing for Angela Glover Blackwell who was ill), Dick Jackson, and Francine Kaufman. Each talk was stimulating and packed with useful information and strategies. Break-out sessions allowed attendees to explore many examples of collaborative strategies in public health practice. It was with great pleasure and appreciation that Joint Awards from CPHA-N and SCPHA were given to Antronette Yancey (Health Promotion Award), who shared her skills as a poet and an exercise break leader; to the Honorable Henry Waxman (National Legislator of the Year); Eileen Eastman (Lifetime Achievement); the Orange County Register (Journalistic Media) for its series on lead in Mexican candy; Morgan Spurlock (Cinematic Media, for “Supersize Me”), and Senator Tom Torlakson (State Legislator).

In addition, CPHA-N bestowed Ben Fraticelli with the Henrik Blum Award and recognized the Honorable Wilma Chan as the Northern California Legislator of the Year, and honored Kate Karpilow and her leadership with the Helen Rodriguez-Trias Lighting the Way Presidential Award. Not to be outdone, SCPHA also gave awards to Hanan Obeidi (President’s Award) and to America Bracho, ( the Milton Roemer Award).

Evaluations of the Joint Annual Meeting were very positive. Even the hotel accommodations and the food got good marks! I want to extend my appreciation to Adele Amodeo, Vicki Wolfson, the track Chairs, and the Planning Committee for their hard work and energy. Mike Kassis also deserves special kudos for providing “technical support” in resolving computer and audiovisual problems. Lastly, it was a great pleasure to work with Kathleen Chamberlin, President of SCPHA, and the other member of its Governing Council.

The Ad Hoc Committee on Budget Issues met by phone and e-mail to develop its recommendations on health issues in the proposed State Budget. Letters were sent to each member of the Senate and Assembly Budget Subcommittees which currently are holding hearings. Besides opposing the reduction in funding for the Office of Bi-National Health, CPHA-N is supporting proposed increases in funding for health service to children, AIDS Drug Assistance, and capturing additional Federal funding for the Access for Infants and Mothers (AIM) program (freeing up Prop 99 funding for other purposes). CPHA-N also supports restoring Prop 99-funded programs, but opposes adding a new program to Prop 99 (State Mental Hospitals) and using Prop 99 funds to replace current General Funds (Access to Primary Care and Medi-Cal services for Recent Immigrants).

CPHA-N also took positions in opposition to most of the Medi-Cal Reform proposals, especially those proposing to charge premiums to clients and to limit adult dental services to $1,000 annually. Jacquie Duerr and the other members of the committee deserve our thanks and appreciation. This is the first time that CPHA-N has developed and presented a comprehensive set of recommendations on the State Budget. In addition, CPHA-N is opposing Federal budget cuts, including opposition to the elimination of the Prevention Block Grant.

At the April 15, 2005 meeting of the Governing Council, recommendations to co-sponsor, support, or oppose various bills being considered by the Legislature were developed. Under the leadership of Mary Martinez, the Legislation Committee reviewed over a dozen bills.

The Governing Council took the following actions: 1) Making sure our letter of support was sent on SB 840 (Kuehl) Single Payer; 2) SB 12 (Escutia) Food standards for K-12, instead of current K-8_Support; 3)SB 965 (Escutia) Soda Ban in high schools –Support; 4) SB 358 Figueroa Requires Legislature’s consent before Governor can include California in any Federally negotiated trade agreement—Returned to Leg Committee for more analysis. Other bills will be discussed at the next meeting.

The GC also discussed the American Public Health Association’s concept paper on “Improving the Public’s Health Through Strong Public Health Associations”. Responses will be transmitted through Giorgio Piccagli, our representative to APHA.

Peter Abbott, MD, MPH
President
pabbott@surewest.net

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Report to the Membership

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March 2005

Your Governing Council met on Friday, February11, 2005, in the Oakland offices of the Public Health Institute.

Key actions taken by the Council included: 1) requested that a meeting between CPHA-N leaders and State Health Officer Jackson be arranged; 2) signed the Memorandum of Understanding with Southern California Public Health Association (SCPHA) for the Joint Annual Meeting in April; 3) approved sending a letter to APHA supporting a special session at the New Orleans meeting focusing on the public health impacts of international trade agreements; 4) approved the nomination of former CPHA-N President, Carmen Nevarez, MD, MPH, for consideration by the California Department of Health Services (CDHS) for its Beverlee A. Myers Award (to be presented at the Joint Annual Meeting; 5) heard a report on the activities of the California Center for Public Health Advocacy; and, 6) approved sending a letter to Governor Schwarzenegger expressing our concerns over the deterioration of California’s Public and Environmental Health systems at the State and local levels (this letter can viewed at www.cphan.org).

In addition, the Governing Council reviewed the preliminary budget for 2005, authorized the additional expenditure of $2,000 for grant writing, and voted to support Dr. Howard Backer becoming a member of the Advisory Committee on Immunization Practices (ACIP). The Council also spent considerable time on the planning of the Joint Annual Meeting.

By now, you should be registered to attend Improving the Public’s Health: The Power of Collaboration, the Joint Annual Meeting of CPHA-N and SCPHA, to be held April 4th and 5th at the Oakland Airport Hilton Hotel. If by some chance you did not receive the brochure or have not yet registered, you can view the brochure and register online at our web site, www.cphan.org. Information about numbers of continuing education hours is now posted. You can pre-register for those or do it on site.

Keynote speakers include CDHS Director Sandra Shewry, Dick Jackson, MD, MPH, Angela Glover Blackwell, JD, Francine Kaufman, MD, and Walter Tsou, MD, MPH, President of the American Public Health Association. Twelve workshops on a variety of public health issues and collaborative projects have been organized for the meeting. Poster displays of student work from across California will be on view. CPHA-N and SCPHA also will present several joint and individual awards for exemplary leadership and accomplishments furthering the public’s health. Please join us and your colleagues for an exciting and educational meeting.

A limited number of full or partial scholarships are available, on a first-come, first-served basis. Please contact our business manager, Vicki Wolfson, at office@cphan.org.

CPHA-N was pleased that the Governor has withdrawn his reorganization proposal (GRP1), which proposed to eliminate or consolidate 88 State boards and commissions. As reported in the February Issue of Public Health Watch, CPHA-N and many other health advocacy organizations had expressed serious concerns and reservations over GRP1 at hearings of the Little Hoover Commission. In a letter to the Commission, the Governor indicated that the proposal was being withdrawn to allow for further review and consideration. Since the Administration has indicated that more reorganization proposals can be expected, CPHA-N will continue to be alert for other proposals affecting public and environmental health programs.

An important step in the development of the State budget for FY 2005-06 occurred on February 24th with the release of the report of the Legislative Analyst’s Office (LAO) on the Governor’s Proposed Budget. This report and related documents can be viewed or downloaded at the LAO web site, www.lao.ca.gov. The LAO performs a nonpartisan review of the Proposed Budget and makes recommendations to the
Legislature for its consideration.

In addition, the Senate Committee on Budget and Fiscal Review released its “Overview of the 2005-06 Budget Bill”, which can be accessed through the California State Senate at www.sen.ca.gov. Both of these reports review the Governor’s proposals and provide analyses of their potential impacts and related issues.

The Senate and Assembly Budget Subcommittees have now begun reviewing and taking action on individual items of the Proposed Budget. The health portions of the Proposed Budget will be heard by Senate Budget Subcommittee #3 (Ducheny is the Chair) and Assembly Budget Subcommittee #1 (De La Torre is Chair). You can access the agenda of these subcommittees through the Senate web site mentioned earlier and the Assembly web site (www.assembly.ca.gov). Since State budget decisions and resources are critical at both the State and local levels, CPHA-N will be developing and presenting its recommendations to the Legislature on key health items. We will be posting bills of interest on the website, along with current CPHA-N positions. Your input is welcome.

Peter Abbott, MD, MPH
President
pabbott@surewest.net

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Report to the Membership

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Download Peter Abbott's testimony to the Little Hoover Commission

February 2005

January was a busy month for CPHA-N. New Officers and Members of the Governing Council assumed their offices on January 1st. You can visit our web site at www.cphan.org for a complete listing and other interesting information and links. At the January 21st Governing Council annual planning retreat, we decided to provide a monthly report to members. This is the first attempt. We would like your feedback.

On January 11th, the Governor released his proposed State Budget for FY 2005-2006. Most health advocates were pleased that the Budget was relatively kind to State health programs. Most public health programs were not cut, and several received additional funding. For example, the Budget proposes a modest, but nevertheless encouraging, Obesity Prevention Initiative and the expansion of the Newborn Genetic Screening program. Medi-Cal Reform proposals also were relatively limited in terms of projected savings and impact on providers and clients.

Exceptions are proposals to charge premiums to some clients and to cap of the dental restorative benefits for adults at $1,000 per year. Another proposal will move more Medi-Cal clients, primarily the elderly and disabled, into different types of managed care organizations. Of great importance to hospitals serving large numbers of Medi-Cal and indigent patients is the expectation that the State and the Federal government can agree upon a new hospital contracting and reimbursement methodology, specifically the disproportionate share (safety net) hospital payments.

The Budget also proposes to expand health insurance coverage for children and to provide a discount program for prescription drugs for some of the uninsured, predicated on voluntary participation by the pharmaceutical manufacturers. Lastly, in related human services areas, the Budget proposes many significant reductions in social service programs.

CPHA-N is very concerned over the Budget for FY 2005-2006. Advocates for education argue that the proposed Budget is short over $ 3 billion promised last year. If more funding is provided to education programs by the Legislature, then potentially health or other human service programs may be cut. Funding of many State health programs also is dependent on Federal levels of funding and rules, which face potential reductions and other changes. We all must remain aware of these developments and continue to advocate for adequate funding for health programs. The Legislature begins consideration the Budget in late February. CPHA-N will increase its budget advocacy efforts in 2005.

The Governor also introduced a "government reorganization" proposal in January, which eliminates or consolidates 88 State boards and commissions. Governor's Reorganization Proposal # 1 (GRP1) was submitted to the Little Hoover Commission, which has 30 days to review and comment. The proposal can be viewed the Commission's web site (www.lhc.ca.gov). It proposes to eliminate independent professional licensing boards, advisory boards, and commissions and generally to transfer their functions to departments or agencies within the Administration, thereby eliminating or greatly reducing outside oversight.

I represented CPHA-N and several other health advocacy organizations expressing our concerns over GRP1 testimony submitted to the Commission. You can view the full text of the testimony at the CPHA-N web site (www.cphan.org).

CPHA-N was very disappointed that the Governor has not yet acted on recommendations to form a separate Department of Public Health and to rebuild to State's public and environmental health systems. CPHA-N strongly supports a separate department and the creation of a strong, independent and representative State Board of Public Health and a mandated State Public Health Officer. We plan to continue to argue for these in our work with the Legislature and in our meetings with the Administration.

The Governing Council's planning retreat produced several areas of priority emphasis in the coming year for CPHA-N. The Council agreed to improve member outreach and communications, to grow the organization through a capacity study, to obtain grant funding for improved services, to strengthen our relationships with other health organizations, to improve our advocacy and visibility, and to provide better leadership and inclusion. You will learn more about these as the year progresses. If you have suggestions or want to become more involved with CPHA-N, please let us know. Our Governing Council generally meets on the third Friday afternoon of the month in downtown Oakland. Members are invited to attend, as all meetings are open except when the GC goes into Executive Session for confidential discussions. Contact our office at (510) 601-0900 or office@cphan.org, if you want to attend and/or have items you wish to place on the GC's agenda for discussion or information. Minutes of the meetings are available on our web site: www.cphan.org

The Steering Committee of the California Medicine and Public Health Initiative met in Sacramento on January 24th. Composed of leaders of statewide medicine and public health organizations, the Steering Committee has identified the deterioration of California's public health system, especially the California Department of Health Services, as one of its top priorities. The Steering Committee is expected to send a letter to Governor Schwarzenegger asking him to address this issue personally.

The Steering Committee also voted to sponsor a resolution before the House of Delegates of the California Medical Association. Both CPHA-N and the Southern California Public Health Association (SCPHA) are members of CMPHI.

Lastly, please be on the look out for the brochure to sign up for the Joint Annual Meeting of CPHA-N and SCPHA on April 4th & 5th at the Oakland Airport Hilton. The Planning Committee has produced an excellent program and we hope that you will attend. We will be featuring student posters from programs across California and know that you will find those to be exciting examples of the future of public health practice.

Peter Abbott, MD, MPH
President, CPHA-N

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Download Peter Abbott's testimony to the Little Hoover Commission