In 1994, President Clinton signed into law Executive Order #12898 that required the following: 

Each Federal agency shall make achieving environmental justice part of its mission by identifying and addressing, as appropriate, disproportionately high and adverse human health or environmental effects of its programs, policies, and activities on minority populations and low-income populations.”

It has been proven that we cannot address environment justice unless we tactical social justice. This form of social injustice clearly obvious when you look at the locations of various environmental destruction throughout history caused by mankind.

Recently, we experienced the Thomas Fire in Santa Barbara county and there was an issue about the emergency evacuation information not being delivered in Spanish. This issue was addressed by Santa Barbara’s Assemblymember Monique Limon in September 2018 with the introduction of AB 1877 (Limón) Office of Emergency Services: 15320communications: notifications: translation. This bill was signed into law by Governor Brown on September 21, 2018. This bill would require the Office of Emergency Services to create a library of translated emergency notifications and a translation style guide, as specified, and would require designated alerting authorities, as defined, to consider using the library and translation style guide that may be used by designated alerting authorities when issuing emergency notifications to the public. The bill would authorize the office to require a city, county, or city and county to translate emergency notifications as a condition of approving its application to receive any voluntary grant funds with a nexus to emergency management performance.

SDOHAccording to Health People 2020, “ the importance of addressing the social determinants of health by including “Create social and physical environments that promote good health for all” as one of the four overarching goals for the decade. The Social Determinants of Health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote good health for all. All Americans deserve an equal opportunity to make the choices that lead to good health. But to ensure that all Americans have that opportunity, advances are needed not only in health care but also in fields such as education, childcare, housing, business, law, media, community planning, transportation, and agriculture.”

Examples of social determinants include:

  • Availability of resources to meet daily needs (e.g., safe housing and local food markets)
  • Access to educational, economic, and job opportunities
  • Access to health care services
  • Quality of education and job training
  • Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
  • Transportation options
  • Public safety
  • Social support
  • Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
  • Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
  • Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
  • Residential segregation
  • Language/Literacy
  • Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
  • Culture

As a member of the health care profession social determinates are a growing number of issues within and outside of the health care system. Outside of the health care system, initiatives seek to shape policies and practices in non-health sectors in ways that promote health and health equity. Inside the health care system,there are multi-payer federal and state initiatives as well as Medicaid-specific initiatives focused on addressing social needs.



On February 3-5 – Moore On Health had the pleasure to join over 300 other Nurse Practitioners in Washington D.C at the 2019 AANP Health Policy Conference. During the conference we heard from policy and legislative strategy experts on issues limiting access to care. Every day, we should be working to create positive changes to the health care system, eradicating antiquated regulatory process and increasing direct access to care for the community at large.

Presently our federal legislative policy priorities are:

  • Authorize NPs to Certify Patient Eligibility for Medicare and Medicare Home Health Services
  • Authorize the assignment of NP patients to Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs)
  • Ensure Patients with Diabetes Have Timely Access to Therapeutic Shoes
  • Authorize NPs to Certify Medicare Patients for Hospice Care
  • Authorize NPs to Perform Admitting Examinations and All Required Patients Assessments in Skilled Nursing Facilities (SNFs)

AANP supports legislation and regulatory changes which removes barriers to practice so that NPs can practice to their full scope, ensuring that patients have access to these much needed high quality, cost effective, health care services. NPs are a critical part of the solution to our nation’s health care needs.

Question: How are our advocating to strength the NP profession and increases full and direct access to care?

If you did not attend the 2019 AANP Health Policy Conference you can still participate and help eradicate antiquated process that creates barriers to practice.

  • Ask your Senators to cosponsor Home Health Care Planning Improvement Act (S. 296) – Click HERE
  • Ask your Members of Congress cosponsor S. 237/H.R. 808 which would authorize nurse practitioners (NPs) to certify their patient’s need for therapeutic shoes. – Click HERE
  • Encourage Members of Congress to Cosponsor H.R. 900 to Allow NP Patients to be Counted in ACOs – Click HERE

As nurse leaders, NPs must be involved in health policy. The NPs who advocate for major health policies can influence countless people throughout their state and the nation, depending on the level of the health policy.

Involvement in health policy is the most important role an NP can have in impacting positive change in health care that will benefit multiple generations of patients across institutions, states, the nation, and even globally.

I recently discovered what the law requires for cosmetic products in terms of how they list the ingredients for cosmetics and what is considered a cosmetic. According to the U.S. Food and Drug,  “the law does not require cosmetic products and ingredients, other than color additives, to have FDA approval before they go on the market, but there are laws and regulations that apply to cosmetics on the market in interstate commerce.”

The FD&C Act defines cosmetics by their intended use, as “articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body…for cleansing, beautifying, promoting attractiveness, or altering the appearance” (FD&C Act, sec. 201(i)) Among the products included in this definition are skin moisturizers, perfumes, lipsticks, fingernail polishes, eye and facial makeup, cleansing shampoos, permanent waves, hair colors, and deodorants, as well as any substance intended for use as a component of a cosmetic product. It does not include soap.”

Screen Shot 2019-02-14 at 7.51.30 AMAfter discovering that the law does not require cosmetic products to disclose ingredients, other than color additives. I wanted to assess the chemical content of two products used daily within my home. I utilized the Environmental Working Group (EWG) website database to gather the following information. The mission of EWG is to protect human health and the environment. EWG’s Skin Deep database gives you practical solutions to protect yourself and your family from everyday exposures to chemicals. My two products analyzed are Aquaphor and Rembrandt toothpaste. Initially, I was shocked to see that they both had some negative data points related to developmental toxicity and immunotoxicity. I also discovered more information about Endocrine Disruptors – chemicals that may interfere with the production or activity of human hormones. According to NIH, Tox Town, the disruptors include dioxins, polychlorinated biphenyls (PCBs), pesticides, pharmaceuticals, and plasticizers such as bisphenol A (BPA) and phthalates.

Endocrine disruptors may be found in some plastic bottles, metal food can linings, cosmetics, detergents, medicines, flame retardants, food, toys, and pesticides.journal.pone_.0116057.g001

Some endocrine disruptors have been banned in the United States because of their human or wildlife health effects. The U.S. Food and Drug Administration advised physicians to stop prescribing DES (diethylstilbestrol) in 1971.

Screen Shot 2019-02-13 at 12.22.07 AMMy Cosmetic Discovery  – We will most likely continue to use the Rembrandt toothpaste. However, we might consider seeking a substitute body ointment to replace Aquaphor. I find it interesting that no matter WHAT price point – hygiene products contain chemicals associated with a negative impact on our health and wellness. Society operates by trust and thus the community is not trained to investigate the ingredients of their cosmetic products.  Society by default trusts manufacturers to do what is right.Screen Shot 2019-02-13 at 12.28.23 AM

That is until there is a direct hazard or health risk identified like smoking cigarettes causes cancer. After this type of information becomes available especially with correlated increases in costs (healthcare, legal, tax, product, etc) society will more easily accept the truth about a product’s impact the individual’s health. Current disclosure practices don’t normally cover everyday products that are viewed to be safe in the eyes of society.

As a medical provider I will take more time to ask my patients if they are aware of the ingredients related to the processed foods and/or cosmetics used in their daily lives. I believe there should be a full disclosure law of any chemicals considered toxic and associated with all products. Such a law will allow the public to make better informed decisions about what they ingest and use on their bodies. 

Members of the health care team should join together to increase the use of going green within hospitals, ambulatory outpatient clinics and long-term care / skilled nursing facilities. Institutions delivering any type of health care for the public at large should be the leading example and ambassador of energy-efficient features utilizing sustainable green products and practices. According to data from the Environmental Protection Agency (EPA), each day the nation’s hospitals generate close to 7,000 tons of infectious, hazardous and toxic waste. To incentivize the use of more green products and practices health care centers should receive a Green Rating and this number be placed in the entrance of the facility and publicized on their website.