ORLANDO, Fla. —The American Medical Association (AMA) gathered physician and medical student leaders from all corners of medicine at its Interim Meeting of the House of Delegates to shape guiding policies on emerging health care topics.

The new policies adopted on the final voting day of voting at the AMA Interim Meeting include advocating for safeguards to protect children and adolescents using social media, protecting the public from mpox, improving rural access to comprehensive cancer care, urging private and public payors to cover donated human breast milk, and reducing sodium intake to improve public health.

Advocating for safeguards to protect children, adolescents using social media

According to a 2022 Pew survey, 95 percent of teens in the U.S. have access to digital devices such as a smartphone and 97 percent report using the internet daily. The survey also found that 35 percent of teens reported using one of the top five social media platforms almost constantly. While use of social media among children and adolescents is widespread, there is not enough evidence to determine if social media is safe for children and adolescents. The AMA’s new policy is aimed at making sure safeguards are in place to protect young people from potential harms associated with social media use, while also acknowledging the potential benefits. Specifically, the policy calls for media and social networking services to develop safeguards tailored to youth users, including ensuring robust protections for youth online privacy, providing effective tools to manage screentime content and access, considering special circumstances for certain youth populations, such as LGBTQ+ youth and youth with disabilities, and promoting the development and dissemination of age-appropriate digital literacy training.

The new policy also calls for the AMA to advocate for and support legislative, regulatory, and related initiatives that at minimum provide youth with strong data privacy protections, require platforms to be designed to align with child development, and provide transparency into the potential harms posed by platforms to young people and any steps taken to mitigate those harms. The policy also calls on schools to provide safe and effective, evidence-based educational programs to help ensure all students develop skills in digital literacy to serve as an individual protective foundation for interaction with various types of digital media, including social media. The AMA will collaborate with professional societies, industry, and other stakeholders to improve social media platform privacy protections, transparency, data sharing processes, and systems for accountability and redress in response to online harassment.

“It is essential that we work together across the health care and tech industries, the education system, and government to better understand the mental and physical health impacts of social media use on our nation’s youth. Together, we must take swift action to create digital environments that safeguard our children’s and adolescents’ mental health and well-being during critical stages of their brain development. We will continue to monitor and call for research on how social media is impacting our nation’s youth, and we urge physicians to educate themselves about social media and be prepared to counsel patients and their families about the potential risks and harms of social media,” said AMA Board Member Alexander Ding, M.D., M.S., M.B.A.

The Council on Science and Public Health report that served as the basis for this policy provides a review of the evidence on the impact of social media on adolescent health and outlines both its positive and negative trends.

Protecting the public against mpox

In August, the World Health Organization declared mpox in the Democratic Republic of Congo (DRC) and neighboring countries a public health emergency of international concern. Since December of 2023, the Centers for Disease Control and Prevention has issued several Health Alert Network (HAN) Health Advisories to notify clinicians about the transmission of Clade I mpox virus in the DRC. While no domestic cases of clade I mpox have been identified in the United States at this time, clade II mpox is still circulating at low levels. 

The AMA adopted policy promoting the recognition of mpox as a public health threat and the need for ongoing surveillance, preparedness, and resource allocation to prevent future outbreaks. 

Under AMA’s new policy, the AMA will advocate for the inclusion of community-driven, culturally competent prevention efforts and educational campaigns to reduce stigma, improve quality of life, and promote health equity for those disproportionately affected by mpox.

The policy also supports increased public and private funding for mpox research, education, vaccination distribution, and long-term patient care to ensure equitable access and address barriers to health care for at-risk populations. Through the policy, the AMA will strongly urge federal, state, and local agencies, in collaboration with public health organizations and medical associations, to develop and implement effective strategies for the prevention, control, and management of mpox, with particular focus on marginalized populations such as LGBTQ+ communities and those living with HIV.

“Although mpox is not currently circulating widely in the U.S., we should remain vigilant and take steps to prepare for and prevent the potential future spread of mpox. That’s why we’re encouraging coordinated national and international efforts to address mpox, including global surveillance, resource sharing, research, and outreach programs that enhance public knowledge of mpox transmission, prevention, and vaccine effectiveness, particularly in resource-constrained settings,” said AMA Board Member Lynn Jeffers, M.D., M.B.A.

Vaccines and other medical countermeasures are available and expected to be effective for both Clade I and Clade II mpox infections. However, vaccination coverage in the United States remains low. The majority of U.S. mpox cases continue to be in people who are not vaccinated or who have only received one dose of the vaccine. Two doses of the JYNNEOS vaccine are recommended for maximum protection.

The AMA’s new policy also calls for improved response by the Department of Health and Human Services to mpox outbreaks, addressing the failures identified in the Government Accountability Office report, including enhanced communication, distribution of vaccines and testing, and collaboration with local leaders.

Improving rural access to comprehensive cancer care services 

Given that rural communities in the United States continue to face significant disparities in cancer screening, diagnosis, treatment, and outcomes, the AMA adopted policy aimed at improving rural access to comprehensive cancer care services. As part of the new policy, the AMA will work with interested parties to develop a national strategy to eliminate rural cancer disparities in screening, treatment, and outcomes, and achieve health equity in cancer outcomes across all geographic regions. Additionally, the AMA will call for increased federal and state funding to support research on rural cancer disparities and equity in care, access, and outcomes and development of interventions to address those disparities.

The new policy also calls on AMA to advocate for evidence-based collaborative models for innovative telementoring/teleconsultation between health care systems, academic medical centers, and community physicians to improve access to cancer screening, diagnosis, treatment, rehabilitation, and patient services in rural areas.

“It is unacceptable that people living in rural communities in the U.S. have a higher death rate from cancer than people living in metropolitan areas of the country. We must continue to support policies and initiatives that improve health outcomes for all people, regardless of where they live,” said AMA Board Member Alexander Ding, M.D., M.S., M.B.A.

Editor’s note: AMA Viewpoint AMA President Bruce A. Scott, M.D.: Improving health in rural areas is within our collective reach. 

Urging private and public payors to cover donated human breast milk 

Delegates adopted a policy to require private and public insurers to cover donor human breast milk.  

The American Academy of Pediatrics recommends donor human milk for high-risk infants when a mother’s own milk is absent or insufficient in quantity. The AAP and the U.S. surgeon general also have called for changes in public policy to improve availability and affordability.  

Human milk is the ideal diet for infants and is associated with beneficial health outcomes. These benefits are especially potent for very premature and very low birth weight infants. Safety-net hospitals and hospitals with a high proportion of Black or Hispanic patients are less likely to use donor human breast milk compared to other hospitals. 

About 17 states and the District of Columbia have enacted legislation or regulations addressing Medicaid or commercial insurance coverage. While advocates have worked to increase access, few federal policies explicitly address the provision of donated human milk. The resolution calls for public and private payors to cover it. 

In light of the recent infant formula shortage, the resolution also calls on the AMA to advocate for an adequate supply and consistent sources of infant milk formula.  

“Sometimes donor human milk becomes essential when a mother’s own milk supply often isn’t enough. A federal policy would bring consistency to the patchwork of state policies and make available this vital health benefit to babies wherever they are born,” said AMA Board Member Scott Ferguson, M.D. 

Reducing sodium intake to improve public health  

With research showing that more than 70 percent of sodium intake in the U.S. comes from packaged food and food prepared away from home, the AMA adopted new policy aimed at reducing the amount of sodium Americans consume. Specifically, the new policy calls on the U.S. Food and Drug Administration (FDA) to publish future editions of their voluntary sodium reduction targets expeditiously to make further progress on sodium reduction. The FDA is currently seeking comments on its Draft Guidance for Industry on voluntary sodium reduction targets. The Council on Science and Public Health report that served as the basis for this policy noted that voluntary targets to reduce sodium in processed foods, and other food prepared outside of the home, is one of the most promising and well-evaluated large-scale policies to enact population level change in sodium intake and has been successfully implemented across the globe.   

The new policy makes clear that efforts to reduce sodium levels in products from food manufacturers and restaurants should not happen by increasing levels of other unhealthy ingredients, such as added sugars or artificial ingredients. The new policy also supports federal, state, and local efforts to regulate advertising of foods and products high in sodium—especially advertising targeted to children. Additionally, the AMA will support federal, state, and local efforts to set robust targets for reducing sodium levels in school meals, meals in health care facilities, and other meals provided by daily meal providers, and require front-of-package warning labels for foods that are high in sodium based on the established recommended daily value.   

“More than 20 years of research on dietary sodium and health outcomes show that reducing population level sodium intake can have beneficial public health outcomes and save billions of dollars in health care costs,” said AMA Board Member Lynn Jeffers, M.D., M.B.A. “With scientific evidence linking excessive sodium intake and heart disease, we continue to advocate for policies that help Americans reduce the amount of sodium in their diets—an important strategy for reducing hypertension and improving public health.”  

The new policy builds on AMA’s long-standing policy on sodium reduction and aligns with the AMA’s strategic work to significantly reduce the number of American adults living with uncontrolled high blood pressure—which without intervention can lead to heart attack, stroke, disability, and death.