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AzPHA Member Public Health Policy Update

Fri, December 09, 2022 5:13 PM | Anonymous

December 4, 2022


Governors & Executive Branch Agency Culture

The Governor is just one person. There are 32,000 people working in various capacities in state government. So how is it that just one person, the governor, can impact the work culture and morale of 32,000 employees? It’s all about leverage.

The governor is the most powerful person in the state. She or he has enormous statutory authority and can hire or fire just about any state employee (virtually all state employees are ‘at will’ these days - meaning they can be fired for no reason at all).

Governors seldom reach deep down into agencies and fire and replace people…  but it's common for governors to replace agency heads, deputies, legislative affiars people and communication directors (especially at the beginning of an administration). It’s also customary for the governor to make wholesale changes in governors office personnel.

So how does all that statutory authority including the authority to change agency directors and their deputies change the work culture of state government?

Perhaps the biggest thing is that agency directors set the tone for workplace behavior, agency priorities, flexible work schedules, whether to allow programs to hire folks, selects the deputy and assistant directors to carry out her or his wishes, gives the programs green, yellow, or red lights to apply for grants, and makes decisions about administrative rulemakings.

The decisions that the directors and her or his assistants make have a profound impact on workplace culture and morale. Add to that the kinds of executive orders the governor gives, like capping agencies at a certain FTE level or freezing changes to administrative code and you can start to see how a single person can have such a profound impact on work culture.

Agency director management style can influence culture in more subtle & insidious ways. For example, appointed directors can stifle innovation and harm morale by instructing staff to clear all decisions with them before proceeding. Even worse, appointees may tell staff to halt action until he or she "hears back from the governor's office"...  resulting in long delays or even a complete lack of progress.

When there’s a change in the governor, as there will be in about 30 days, it’s a real opportunity for cultural change.

Many persons that work in various sectors of public health in private, nonprofit, or among other levels of government will be looking forward to potential changes in the coming work environment and may be attracted to serve in the new administration if they believe the incoming governor better appreciates the importance of evidence-based public health practice and improves morale by creating a healthier agency culture.

Many people are likely looking forward to a cultural renaissance in Arizona state agencies and will be looking forward to working with the new administration.

Some folks who might not have considered working for the ADHS over the last few years might be willing to give the agency a 2nd look in the coming months. I expect interest in (and competition for) positions at ADHS to pick up once the governor is sworn in and new leadership is selected. Why not get in on the ground floor?

On one hand, it’s a shame that there are nearly 100 open positions at ADHS these days, but on the other hand – those vacant positions represent opportunities for folks to join the new team early in the administration.

A quick review of open positions on the AZ State Jobs website reveals openings for epidemiologists, emergency medical servicers staff, newborn screening positions, maternal health (PRAMS) jobs, laboratory and behavioral health tech’s, a tribal liaison, several positions in licensing and compliance, vaccine coordinators, opioid prevention, biomedical research, even the agency director.

You get the idea…  there are many open positions that many of you may be interested in exploring in anticipation of the cultural changes that’ll be coming to state government in the coming months. Now is a good tome to explore the possibilities.

You can start your search at this link – the AZ State Jobs Website.

Submit Your Resume to the Hobbs Administration Resume Bank to be Considered for a Leadership Post in the Administration


Arizona Child Fatality Review Program: 29th Annual Report 

Back in the mid 1990’s the AZ State Legislature established the Arizona Child Fatality Review Program to evaluate every child death and provide evidence-based policy recommendations to prevent child deaths.

Over the years many policy and operational interventions came out of these reports, from safe sleep to new seat belt laws for kids. The goal of each year’s report by conducting a comprehensive review of all child deaths and make policy recommendations to prevent as many as possible.

Last year's report found that firearm deaths increased 41% over the previous year, while child death rates were 250% higher than the national average (likely due to the lack of mitigation measures implemented by soon to be former governor Ducey and former director Christ. 

View the the Arizona Child Fatality Review Program 29th Annual Report

The Arizona Child Fatality Review Program’s goal is to reduce child deaths in Arizona by conducting a comprehensive review of all child deaths to determine what steps could have been taken, if any, to prevent each child’s death.

In 2021, 863 children died in Arizona, an increase from 838 deaths in 2020. Fourth-eight percent (48%) of the 863 deaths were preventable. The three most common causes of preventable death were motor vehicle crashes, firearm injuries, and suffocation. Fifty-six (56) children died from a firearm injury (100% of these deaths were determined to be preventable).

In 43% of the preventable deaths, substance use was a contributing factor, and in 33% of these deaths, poverty was a risk factor. There were 44 suicide deaths in 2021. In 68% of these deaths, recent warning signs for suicide were the most common risk factor, and 17 suicide deaths were due to firearm injury. 

Prematurity was the most common cause of death for neonates (infants less than 28 days old) while suffocation was the common cause of death among infants 28 days to less than 1 year of age. Drowning was the most common cause of death in children 1-4 years of age as 68% of the 44 drowning deaths occurred in this age group.

There were 65 SUIDs in 2021. An unsafe sleep environment was a factor in 95% of these deaths and bedsharing in 58% of the deaths.

Arizona’s abuse/neglect mortality rate increased 36% from 5.8 in 2020 to 7.9 in 2021. Of the 128 children who died in 2021 from abuse/neglect, substance use was a contributing factor in 59% of the deaths, and the child’s families had prior involvement with a CPS agency in 46% of the deaths.

Importantly, the report proposes several evidence-based interventions that should be implemented that would reduce preventable childhood deaths. Those recommendations are laid out on pages 90-99 of the Arizona Child Fatality Review Program | Twenty-Ninth Annual Report.

Intervention recommendations are proposed for preventing abuse & neglect, COVID-19, drowning, firearm injuries, car crashes, prematurity, substance use, SIDS, and suicide.

We expect this year's Child Fatality Review Program report to be more infuential in informing public policy as the incoming governor is more receptive to prioritizing evidence-based public health policy & practice than the outgoing administration.


AzPHA Firearm Injust & Death Surveillance Report Coming in January

Report to Include a Policy Intervention Evidence Review

The AZPHA Board of Directors met in early 2022 for a strategic planning session. One of the outcomes from the session was to set longer term public health policy priorities for AZPHA to work on. 

Among those priorities was a focus on prevention of deaths from firearm injuries and deaths. Our workplan for that priority started with pulling together a public health surveillance report of firearm injuries and deaths in Arizona and a literature review of evidence-based interventions (no such surveillance report has been produced by ADHS during the Ducey administration - leaving an 8-year gap in surveillance evidence).

We expect our report to be published in mid-January. In the mean-time we will be presenting snippets from the report in these weekly policy updates.

A huge shout out to our authors for the report, Julia Jackman &  Allan Williams, who have put in countless hours preparing our report!

About the Association

Established in 1994, the Arizona Rural Health Association, Inc. (AzRHA) serves as an independent organization after serving as the Advisory Committee of the Arizona Center for Rural Health for many years. 

Learn more about the association here

Contact Us

Arizona Rural Health Association
55 Lake Havasu City South, Ste. F #271
Lake Havasu City, AZ 86403

Phone: (928) 222-2289

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