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ASTHO interview with T Benicio Gonzales and Shelley J. Lee, members of the first DELPH cohort, about their leadership journey.

This blog shares key takeaways from the first Island Areas COVID-19 Health Equity Action Institutes.

Suicide is a leading cause of death in the United States and widely recognized as a crisis, specifically among our youth, a population in which incidences have been rapidly increasing. Fortunately, suicide prevention and mental health support are issues that benefit from bipartisan support.

The National School Lunch Program, a federally-assisted meal program run by USDA, has provided millions of children with nutritionally balanced, low-cost or no-cost lunches each school day.

The Louisiana Department of Health launched an employee mentorship program in 2021. Two members of LDH discuss the program, which has been a huge success despite launching during the COVID-19 pandemic.

The COVID-19 pandemic highlighted workforce challenges and longstanding health inequities within the healthcare and public health systems, because of this there has been an increased interest in developing the community health worker workforce in states all around the country.

ASTHO convened a Workforce Think Tank for public health leaders in 2021 during which Trista Harris—a philanthropic futurist—identified the seven trends most likely to impact the future public health workforce: sector shifts, pivot to the future, just-in-time learning, remote work, accelerated data collection and sharing, public health burnout, and reimagining systems.

This interview is part of ASTHO’s Leadership Trailblazers series, which shares outstanding public health leaders’ inspirations, motivations, and accomplishments. This post features Karen DeSalvo, MD, MPH, MSC, Chief Health Officer, Google.

An analysis of CDC's 2022 update of its universal recommendation for the hepatitis B vaccine for adults.

Incidences of tick-borne disease is on the rise and state legislatures around the country have found ways to address the issue of tick-borne diseases.

In this video Kimberlee Wyche Etheridge and Paula Tran discuss topics ranging from from community engagement to COVID-19 boosters and implementing health equity strategies within the Wisconsin Department of Public Health.

A guide for health officials relationships with members of congress.

In commemoration of National Influenza Vaccination Week ASTHO is highlighting work in Arkansas and South Carolina, where unique collaborations with health care and public health have allowed them to effectively promote flu vaccinations within their communities.

Families who wish to breastfeed in the United States often face barriers in workplace and school settings. To address these disparities, federal, state, and territorial governments are adopting policies to improve lactation accommodations in school and workplace settings.

Midterm Elections: Predictions on Congressional Priorities for Upcoming Session astho, association of state and territorial health officials, public health, opioid crisis, congressional priorities, sequestration cuts, healthy future task force, emergency supplemental appropriation bills, drug overdose deaths, centers for disease control, opioid overdose, affordability subcommittee, budget control act, fiscal year, opioid epidemic, legislative priorities, disease control and prevention, overdose deaths involved, prescription drugs, synthetic opioids, misuse prescription, opioid misuse, prescription opioids, american health care system, spending cuts, public health, control act of 2011, health care Jeffrey Ekoma Federal Health Policy Update | ASTHO makes predictions on congressional priorities for the upcoming session. 2022 is rapidly coming to an end, which also means we are getting closer and closer to events and activities that many of us look forward to each year. And no, I am not referring to the change in weather (which I love) or the upcoming fall holiday celebrations (which I also love), but rather the 2022 midterm elections! Below are some predictions on priorities Congress may seek to address when it kicks off its 118th session on Jan. 3, 2023. Healthy Future Task Force House Minority Leader Kevin McCarthy (R-CA) created the Healthy Future Task Force to modernize our healthcare system, develop better cures and treatments, and promote overall health and well-being—just to name a few. The task force is composed of various subcommittees, ranging from modernization and treatment to affordability and security. Each subcommittee was charged with producing solutions to problems facing our healthcare system that will serve as a blueprint for Republicans if they can secure a majority in the House of Representatives after the midterm elections. Some of the solutions offered by the various subcommittees include maintaining access to telehealth services, using the private sector to help address public health preparedness, expanding healthcare options for patients, and conducting oversight on all things related to COVID-19. Oversight, Oversight, and More Oversight The overall response to the COVID-19 pandemic was—in a word—massive. Six emergency supplemental appropriation bills provided approximately $484 billion to support critical work happening across public health. These six bills also contained requirements for agencies like the Government Accountability Office to conduct nonpartisan monitoring and oversight related to both the pandemic and funding provided as part of the response. Concurrently, Republican members of Congress have expressed their interest in oversight-related activities. Notably, soon-to-be-retired Senator Richard Burr (R-NC), along with other members of the Senate Health Education, Labor, and Pensions Committee, have called for accountability surrounding COVID-19 supplemental funds, including unspent funds and funds that were used for activities such as vaccine awareness. Other members have hinted at their interest in learning more about the origins of COVID-19 and auditing public health agencies on their responses to the pandemic. In addition to oversight, there have been mixed thoughts on CDC’s potential restructuring. For example, the ranking member of the House Committee on Energy and Commerce, Cathy McMorris Rogers (R-WA), seems interested in authorizing the scope and mission of CDC as determined by Congress, while Senator Mitt Romney (R-UT) proposed a “new entity” to improve access to public health data. Opioid Crisis According to CDC, more than 107,000 people died from a drug overdose in 2021, and members on both sides of the aisle continue to express concern about the epidemic and its impact on their communities. Most recently, in a hearing with federal public health officials, several senators voiced their concerns with opioid prescription practices and with relabeling opioids currently on the market. This issue is also a hot topic in several congressional races across the country, and will likely be top-of-mind when Congress returns to Washington, D.C. Reproductive Health Reproductive health is on the ballot in many states and it’s a priority for many who are either running for re-election or seeking a congressional seat. Members of both parties have expressed protecting access to reproductive services and/or codifying the most recent Supreme Court ruling. Did Someone Say Debt Ceiling and Sequestration? It’s fair to wonder why the debt ceiling may be an issue, considering that it was just raised last year to more than $31 trillion. However, our overall national debt just surpassed $31 trillion and it is expected that the ceiling may likely need to be raised again in the summer of next year or as early as the spring with some estimates. As always, discussions about the debt ceiling vary across the Capitol, and it’s impossible to mention the debt ceiling without also bringing up sequestration and the possibility of its return. As a friendly reminder, the Budget Control Act of 2011 created the Joint Select Committee on Deficit Reduction, or supercommittee, which was charged with finding a solution to reducing the federal deficit. However, the supercommittee was unable to meet its charge and a budgetary mechanism called sequestration kicked in, which imposed limits on annual appropriations through 2021. While Congress took occasional steps to mitigate sequestration cuts during that period, they proved harmful to critical public health programs over time. Fast forwarding, some members would prefer for the federal budget to be balanced and for additional rules to be in place related to fiscal accountability. Others have sought to reform the budget process altogether. Therefore, it's hard to rule out the return of sequestration or other fiscal measures that members may employ to reach these goals. As is always the case with a new session of Congress, there is a unique window to further highlight the importance of public health. Furthermore, a new session provides the opportunity for state and territorial health officials to strengthen, rebuild, and develop relationships with members of Congress and their staff on public health priorities impacting their communities. ASTHO looks forward to supporting those efforts as we all continue our work to advance the public’s health and well-being. website yes

Do Cottage Foods Really Come from a Cottage? Beth Giambrone Even if you're not familiar with the term "cottage foods," chances are you have purchased them—think getting a loaf of bread from your weekend farmers market or cookies from a friend's home-based baking business. In some cases, they can also be sold online. So, what exactly are they? Cottage foods are home-based, home-made food products prepared outside a commercial kitchen and sold to the public. Cottage food producers operate at a small scale, often from a home kitchen, selling goods in the jurisdiction where they are created. Cottage foods are exempt from many state food and safety regulations, with supporters of expanding cottage food laws asserting that existing laws burden small business and restrict competition and consumer freedom. Those opposing the expansion of cottage foods argue the need to ensure food safety and to protect consumers from food borne illness. Here's a primer on cottage foods and how they're regulated. What's the difference between a cottage food kitchen and a commercial kitchen? Commercial kitchens (sometimes known as shared use kitchens) are large, industrial spaces where food can be produced in high volumes; they can also be rented out for shared use. While every state subjects commercial kitchens to food safety inspection and regulations, a few states require inspection of microenterprise or home kitchens producing cottage foods. Does the government have a role in regulating cottage foods? While several federal agencies regulate commercial food products—such as USDA for meat processing and FDA for produce—cottage foods are not subject to federal regulation because they are typically only sold within a state and not across state lines. At the state level, cottage food producers are subject to the health and safety laws and regulations of the state in which they are operating. Some states require cottage food producers to register their business or to have training and/or certification in safe food handling. Currently, all 50 states and Washington D.C. have some sort of cottage food law in place. Under most state laws, cottage food producers are exempt from food safety laws that apply to food establishments. These exempt rules are usually based on the type of food product produced, the point of sale, and the labeling requirements associated with the food. Although cottage food producers are exempt from certain requirements, all states allow the Department of Health to investigate complaints related to foodborne illness and fine producers if there are violations. Since the 2020 legislative sessions, at least 17 states (Alabama, Arkansas, California, Connecticut, Florida, Iowa, Illinois, Maryland, Missouri, Mississippi, New Hampshire, New Jersey, Oklahoma, Tennessee, Utah, West Virginia, and Wyoming) considered bills related to cottage foods, often centering around product sales, food products, and labeling. An overview of the conditions and a snapshot of the laws passed in states are below. What are common cottage food products? Most state laws limit which food products can be produced and sold as cottage foods. And while specific allowable foods vary state to state, some common restrictions on the type of food sold include foods requiring temperature control (e.g., meat and dairy products) and fermented or pickled foods. Foods such as dairy-free baked goods (e.g., breads and biscuits), candies, and jams are popular cottage food products. Over the last few years, states have expanded the types of foods that qualify to be a cottage food. In 2021, Illinois enacted SB 2007, amending the types of foods permissible under the cottage food law from a delineated list of canned foods (e.g. jams and syrups) to a general standard that mirrors the FDA definition of "low-acid canned food." The New Jersey legislature passed A 3991 in 2022 to exempt raw, unprocessed honey from the state's cottage food regulations. The bill is currently awaiting action by the governor. Oklahoma enacted its "Homemade Food Freedom Act" (HB 1032) in 2021. This new law allows any packaged food or beverage (excluding alcoholic beverages, unpasteurized milk, or cannabis products) to be considered a cottage food rather than only baked goods made without meat or fresh fruits. Additionally, the law allows beekeepers who produce less than 500 gallons of honey per year to qualify for the state's food freedom exemptions if the honey is produced from hives located in the state and sold directly to the consumer. Similarly, the 2022 "Tennessee Food Freedom Act" (HB 813/SB 693) broadly expands the types of homemade foods eligible for sale under the cottage food law to include any non-time/temperature-controlled food item or non-alcoholic beverage. What limitations do states place on cottage food sales? Most states limit cottage food producers to direct-to-consumer sales, such as at a farmers market or roadside stand. More than half of states allow online and direct-to-consumer sales as long as they are to in-state consumers only. While the producer is usually required to deliver the products, at least five states allow delivery by a third party. Several states have considered allowing the sale of cottage food in retail settings. In 2020, Wyoming enacted HB 84, which increased the gross sales cap for producers and allowed producers of non-temperature controlled foods (e.g., jams, vegetables, dried soup mixes) to use third-party vendors like a retail shop rather than solely relying on gross sales. Furthermore, the Wyoming legislature expanded the use of third-party vendors to include the sale of eggs in 2021 by enacting HB 118. A 2021 Arkansas law (HB 248) also allows for the sale of cottage food products at retail stores. Additionally, many states define cottage foods based on the number of items sold or the annual gross sales. The gross sales cap limits vary greatly across states, ranging from $3,000 to $250,000. At least twenty states have no gross sales limit. At least one state (Ohio) places a limit on meals sold per week from home kitchens. What are common labeling requirements for cottage foods? Most states require cottage food producers label their goods. While specific labeling requirements vary state to state, producers generally must provide the name of the product, a list of ingredients, known allergens (e.g., nuts), contact information of the producer, and a statement declaring the product was made in a kitchen exempt from licensing and inspection regulations. In some states, cottage food producers are allowed to use an identification number in place of contact information on product labels. Maryland enacted HB 1017 in 2020, which allows cottage food producers to use a unique identification number issued by the Department of Health in lieu of the business name and address. Arkansas HB 248 (referenced above) also allows producers to use an identification number. What's next? State policy surrounding cottage foods is constantly evolving, with more foodstuffs exempt from state food and safety regulations increasing the risk of foodborne illness outbreaks necessitating a public health response. ASTHO will continue monitoring these changes and provide relevant updates. website yes

Food insecurity is a pervasive barrier to the health and well-being of many differing vulnerable populations in the United States, including minority populations and rural communities.

The ASTHO Federal Government Affairs team answers questions about the work Congress has done for public health so far in 2022.

The COVID-19 pandemic has elevated and kept public health top of mind world-wide. One issue highlighted by the pandemic that has been keenly felt in New York State and Rhode Island is housing policy.

Laura Parajón, MD, MPH, deputy cabinet secretary for the New Mexico Department of Health details the process of building a pilot internship program with the University of New Mexico.