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This interview is part of ASTHO’s Leadership Trailblazers series, which shares outstanding public health leaders’ inspirations, motivations, and accomplishments. This post features José Romero, MD, the former state health official in Arkansas.

Federal lawmakers have a long list of public health priorities to address before the current fiscal year ends on September 30, 2023, including must-pass annual appropriations, reauthorizing the Pandemic and All-Hazards Preparedness Act, and taking on emerging challenges such as the opioid epidemic and drug shortages.

From the Chief Medical Officer: Preventing Respiratory Disease Spread with Less Authority, More Influence ASTHO, Association of State and Territorial Health Officials, respiratory disease, disease spread, cdc public health, public health, public health leaders, local public, health leaders, influenza and rsv, hospital systems, staffing capacity, infectious disease, public health agencies, access to vaccines, health systems, vulnerable populations, policy makers, health departments, trusted source, public messaging, science based, federal partners, viral respiratory illness, public information, healthcare system leaders, long term care Marcus Plescia ASTHO | Public health strategies to prevent flu and RSV this winter. Earlier this year, CDC and other public health leaders began shifting their focus from primarily COVID to include a broader range of respiratory diseases including influenza and RSV. As COVID hospitalization rates have slowed, and with RSV and flu infections on the rise, many hospital systems are preparing for similar bed and staffing capacity challenges they saw at this time last year. In August, ASTHO convened a workgroup of public health national organizations from CSTE, NACCHO, BCHC, APHL and AIM. In addition to facilitating opportunities for state and local public health to offer early guidance to CDC and other federal agencies, the group discussed potential scenarios for the respiratory disease season and prioritized specific strategies for state, territorial, and local public health leaders. Shifting from Authority to Influence With the end of the federal public health emergency in May, much of our collective response to infectious disease has shifted back to the private sector. COVID vaccine and therapeutics are now being supplied by commercial channels and are no longer being managed through public health agencies. Additionally, manufacturing issues with Nirsevimab have been frustrating. That said, public health leaders can work with commercial sector partners to address challenges and communicate to the public that we are doing everything we can to monitor, facilitate, and coordinate efforts to prevent and manage respiratory diseases in our communities. The workgroup further recommends that state, territorial, and local public health leaders convene hospital systems and pharmacies to troubleshoot and address issues with access to vaccines and therapeutics. Public health can direct federal resources to those serving the most vulnerable populations (e.g., nursing homes and federally qualified health systems). In some instances, regional ordering systems could be organized to lower the threshold for minimum orders for individual/small providers. When there is political support, state and local policy makers could provide funding for health departments to augment federal funding and supplies for needed resources. Public health continues to play a lead role in communicating about COVID and other respiratory diseases and is still widely regarded as a trusted source of information. As our greatest technical assistance need from federal partners, the workgroup recommends developing tested, science-based, public-facing messaging that: Emphasizes that viral respiratory illness is not only COVID. Urges the public to stay home if sick and employers/schools to support this behavior. Provides frequent, accurate public information regarding availability of local vaccine and therapeutic agents (e.g., where, when, and who can access them). Describes what federal, state and territorial, and local public health are doing to address respiratory illness and alleviate barriers or challenges. Condenses highly scientific guidance into clear, plain language. Collaborating with the Health Care Sector Members of the workgroup suggest that public health leaders meet with health care system leaders to build on relationships and collaborations forged during the pandemic and to discuss how to prevent and manage potential surges in respiratory disease in the upcoming winter months. Some key strategies include: Develop agreements or collaborations for health care systems to encourage employee vaccination and provide vaccinations on-site during work hours. In many regions, staffing capacity is a greater concern than bed capacity during an infectious disease surge. While vaccinating most staff cannot completely prevent disease transmission, it limits infections and reduces transmission to patients. Health care systems may be reluctant to implement vaccine mandates, and JCAHO quality measures for influenza vaccination were recently scaled back, but there are a number of effective voluntary strategies health care systems can take. Discuss efforts to vaccinate patients who are being discharged to long-term care facilities. There are significant economies of scale to providing vaccination in health care settings, but some hospitals report that they are being cautious vaccinating nursing home bound patients who have moderate illness. During the pandemic, 90% of new patients in nursing homes were discharged from hospitals, but only 10% of these patients were vaccinated prior to arrival. In addition, emergency departments serve as the primary health care access point for up to a fifth of the U.S. population. Urgent care clinics handle more than 29% of all primary care visits in the country. Expanding COVID-19 vaccine availability via these settings can therefore increase access to vaccinations. Discuss strategies for ordering, stocking, distributing, and monitoring COVID-19 and other vaccines. While pharmacies have proven a highly efficient mechanism to vaccinate motivated individuals, people who are undecided or hesitant are unlikely to use them. Making vaccines widely available in health care settings is crucial because people are very likely to listen to their providers' recommendations and there are a number of evidence-based strategies to increase vaccination rates including standing orders, patient reminders and provider counselling. Discuss criteria to implement universal masking, other infection control strategies and crisis standards of care in health care settings. CDC has not fully updated its guidance for hospital infection control since 2022 but many systems have reinstated these strategies during the last wave of COVID infections. What’s more, physicians and other health care professionals are trained to routinely make these decisions when resources are scarce, but many state and local health departments have developed integrated crisis standards of care across systems. Understanding data, thresholds and processes health care systems use can help public health leaders support this effort. Focus on vulnerable settings (e.g., nursing homes) and engage communities when promoting prevention and treatment strategies. In the long run, a national adult vaccination program (like the vaccines for children program) would help address access issues and give public health departments greater authority and resources to lead these efforts. There is still time for public health leaders to adopt strategies recommended by the workgroup. Influenza and RSV rates are just beginning to rise and COVID rates have currently plateaued. These targeted vaccination strategies can be initiated quickly and make a significant impact on infection control. While public health leaders no longer have some of the authorities granted during the pandemic, we still have significant influence to impact the winter respiratory disease season. website yes

This ASTHO blog discusses the benefits and risks of AI in healthcare and federal legislation, including privacy, bias, and safety concerns.

In 2023 legislative sessions, states considered measures to improve access to care for pregnant people experiencing substance use disorder, increase provider knowledge of screening and treatment practices, coordinate care for conditions co-occurring with SUD, and keeping families together.

This blog post explores the impact of mpox, state health agency response, and the way forward.

Effective Public Health Approaches to Reducing Congenital Syphilis astho, association of state and territorial health officials, provider bias, syphilis screening requirements, medicaid family planning programs, medicaid eligibility, congenital syphilis, musculoskeletal defects, pregnant people, public health, trans men, medicaid family planning, gender identity, early congenital syphilis, tested for syphilis, neutral terms, blood test, musculoskeletal system, inclusive language, reproductive health, medicaid coverage, transgender and nonbinary people, medicaid programs, family planning benefits, birth control, carpal tunnel syndrome, musculoskeletal disorders, treponema pallidum, gender neutral language, health care Julia Greenspan, Alex Kearly, Rachel Scheckman, JoAnne McClure, Sanaa Akbarali Effective Public Health Approaches to Reducing Congenital Syphilis Rates of congenital syphilis (CS)—when an infant contracts the disease during pregnancy or birth—are continuing to climb at an alarming rate in the United States. Although preventable, rates more than tripled between 2017 and 2021, with more than 2,800 cases reported in 2021 alone. CS can cause stillbirth, infant death, or other serious and permanent complications including musculoskeletal defects (e.g., impairments in the muscles, bones, and joints leading to temporary or lifelong limitations in functioning), vision and hearing problems, and developmental delays. An ASTHO technical package is a summary of a select group of related interventions that, taken together, help achieve and sustain improvements related to risk factors or health outcomes. ASTHO technical packages are based on programmatic subject matter experts' assessment of evidence-based interventions, expert recommendations, overviews of current activities, and a review of CDC and other federal funding guidance. They are not intended to be comprehensive and can be iterative. ASTHO’s Congenital Syphilis Technical Package focuses on policy-level interventions that states and territories can pursue starting in pregnancy. ASTHO acknowledges other evidence-based or promising policy interventions that broadly address sexually transmitted disease (STI) prevention that are not reflected in this technical package. Further, this technical package will be updated when updates to CDCs guidance on recommended syphilis screening for pregnant persons are available. A summary of ASTHO’s Congenital Syphilis Technical Package is outlined in the this table. Increase Universal Screenings for Pregnant Persons Testing pregnant people for syphilis at three points of pregnancy—first and third trimesters and at delivery—is an evidence-based approach to reduce CS. The American College of Obstetricians and Gynecologists and CDC currently recommend universal first trimester screening and additional screening for those who are at risk or live in areas of high rates of syphilis. However, these screening recommendations rely on providers’ knowledge of the epidemiology in their area and to take patient histories to accurately judge risk. Additionally, jurisdictions may have other laws or recommendations that reflect variability in testing requirements. Jurisdictions can increase syphilis screening of pregnant people by modifying their laws to require screening at three points during pregnancy. They can do so through direct authority of state health officials, Medicaid, state medical licensing boards, and other enforcement mechanisms. How Public Health can Leverage Medicaid to Reduce CS Rates Medicaid provides coverage for low-income adults nationwide and covers more than 40% of all births. Syphilis rates are nearly six times higher among women insured through Medicaid compared to women insured through commercial insurance. Optimize Medicaid Eligibility, Services, and Providers for At-Risk Pregnant People and their Partners States can expand eligibility for Medicaid Family Planning Programs, which provide family planning benefits and STI services to people who would not otherwise qualify. In most states, services are available for individuals up to 200% Federal Poverty Level (FPL). Some states (e.g., Iowa) are expanding eligibility beyond that threshold. Additionally, implementing State Plan Amendments (SPA) to expand Medicaid postpartum coverage can allow coverage of postpartum treatment for syphilis. States can work with Medicaid agency partners to ensure Medicaid services comprehensively cover STI testing, treatment, and counseling with minimal cost-sharing. States can also submit 1115 waivers to cover unmet health-related social needs, or HRSN services (e.g., housing, nutrition, transportation), that exacerbate poor health outcomes and should be addressed in tandem with medical treatment. Further, states can weigh in on Medicaid managed care organizations (MCO) contract requirements to ensure coverage of HRSN services. States can leverage alternative provider types, such as community health workers (CHWs), doulas, and perinatal case managers to facilitate access to services, encourage first and third trimester STI screenings, and provide support services. Currently, nine states and Washington D.C. reimburse doula services under Medicaid. CHWs are already providing services for people living with HIV and can perform a variety of roles, improving access to care for people with syphilis. They can help with care coordination, coaching, providing social support and health education. S/THAs can work with their Medicaid agency partners to submit an SPA or 1115 waiver to cover CHWs, doulas or perinatal case managers, or create managed care requirements to require use of these provider types. Incentivize Providers to Comply with Universal Syphilis Screening Requirements S/THAs can work with Medicaid agency partners to adopt and incentivize the Prenatal and Postpartum Care CMS Core Measure (National Committee for Quality Assurance Measure #1517) as part of the state’s quality strategy. Incentivizing the quality measure encourages providers to meet performance metrics through a financial incentive. Further, states can update practice guidelines to encourage providers to conduct universal STI screenings during prenatal care visits, including syphilis testing in the first and third trimester. S/THAs can work with their Medicaid agency partners and MCOs to develop additional provider incentives. For example, AmeriHealth Caritas—a Louisiana-based MCO—offers provider incentives for third trimester syphilis testing. The performance is measured based on the percent of live deliveries that had at least one test for syphilis. Practices that score above the 55th percentile for third trimester screenings are eligible for bonus payments. States can also partner with their Medicaid agency partners and incentivize consumers through MCOs. Several states offer incentive programs for pregnant persons who attend one or all prenatal appointments. For example, Kentucky offers gift cards and South Carolina offers items such as strollers or car seats. Establish an Implementation Plan for the Quality Strategy S/THAs can work with their Medicaid agency partners to develop consumer education materials, including information on how to enroll in Medicaid, covered services, provider availability, and how to reduce the risk of CS. Targeted enrollment outreach to pregnant persons in their first trimester is critical for early testing and treatment since being screened for syphilis is more likely if a person is enrolled in Medicaid earlier. S/THAs can also work with their Medicaid agency partners and MCOs to ensure Medicaid providers are aware of quality measure changes and how to leverage incentive payments by including information through communication materials including Medicaid provider bulletins and state quality strategies.   Establish Cross-Agency Collaboration and Governance Structures A critical step in ensuring implementation of payment incentives and legislation is creating mechanisms for S/THAs and their state Medicaid agencies to better coordinate services and polices directed toward low-income individuals at risk for CS and other syndemic conditions. Strategies for cross-agency collaboration and governance could include: Establishing a joint Medicaid/public health quality committee related to syndemics (e.g., CS and/or HIV). Creating a standing policy body that has a designated position for OB/GYN physician leaders to advise and engage in practice change. Building relationships and engaging with Medicaid quality committees to highlight public health data, policy, best practice, and support available to respond to the rise in cases. Remove Barriers to Care by Addressing Stigma and Provider Bias Removing barriers to screening and treatment and addressing stigma and implicit bias are critical to reducing CS rates. Structural racism and prejudice contribute to and reinforce disparities in maternal and neonatal morbidity and mortality, including rates of CS. To address stigma, policymakers must implement strategies that address systematic prejudice and discrimination including developing systems that have several points of entry for care, provide culturally competent training for the providers and perinatal workforce, and fostering multi-sector referral relationships. Additionally, leveraging the perinatal workforce, including doulas, can support pregnant and postpartum people in seeking and remaining in prenatal and postnatal care. Doulas act as advocates and educators for pregnant people and using them improves maternal and neonatal outcomes. To increase access to doulas, states should consider expanding doula coverage under Medicaid. Medicaid reimbursement of doula services—which are typically covered out-of-pocket—helps make their services available to low-income and underserved populations. Blog - ASTHO's Congenital Syphilis Technical Package Conclusion States and territories can address the rise in CS infections by focusing on

This post examines the youth mental health and loneliness crises and shares guidance for how public health agencies can work alongside schools to address these crises through social connection.

Members of the Making Dialysis Safer for Patients Coalition discuss the role of public health in dialysis safety and the impact the coalition has had on their work.

Interest is using psilocybins to treat some disorders has reemerged. Some states are taking steps to put that interest into practice.

Late on June 26, 2023, five cases of locally acquired (i.e., non-travel related), mosquito-transmitted malaria were reported in Florida and Texas. To prepare for the future, health officials should consider critical infrastructure needs for vector surveillance and control.

What We Learned at the Public Health TechXpo and Futures Forum ASTHO | Our staff's top takeaways from the TechXpo. astho, association of state and territorial health officials, public health techxpo and futures forum, public health leaders, u.s. public health system, public health policy, data sharing and modernization, population health, governmental health agencies, public health infastructure, workforce resilience, public health workforce, techxpo and futures forum, public health infrastructure, build workforce resilience, future of public health, health techxpo and futures, health leaders and experts, experts across the technology, health workforce, health outcomes, futures forum, health leaders, health departments, public health professionals, today and the future, public health services, public health techxpo Dylan Reynolds Marcus Plescia and Garfield Clunie present "The Future of Measuring Health Equity - A World of Evolving Data." Last month, ASTHO kicked off the Public Health TechXpo and Futures Forum in Chicago, an opportunity for some of the world’s top leaders in technology and to engage public health leaders on challenges and solutions for successfully modernizing the U.S. public health system. Over 600 participants were in attendance, with 200 more attending virtually from around the world. It was a packed three days. Our speakers demystified the world of public health policy, opened doors to new funding streams, and gave us a glimpse into the glittering future of data sharing and modernization. Heavy hitters from Amazon and Google weighed in as well, showing us how they’re working hand-in-hand with health agencies to change the way they approach population health and well-being. So as we look back on a busy week—and look ahead to our virtual follow-up event on June 15—here are some of the messages that stuck with us the most: "Standards are like toothbrushes. Everyone has one, and no one wants to use some else’s." The line from Gabriel Seidman, director of policy at the Ellison Institute for Transformative Medicine, was met with a belly laugh from a crowded room during one of the week’s most well-attended sessions, a panel conversation on the future of measuring health equity. However, Seidman’s comparison was an apt one. There is certainly much to be said for a public health data system that is engineered to meet the specific needs of its target community. However, for public health experts to do their best work, they must be able to speak a common language—at a local, state, territorial, and national level. When each level of public health is operating with different standards in place and with a different definition of success, data gets lost and people get left behind. One of the loudest calls to action from the week was for governmental health agencies to break down these data siloes and establish common standards between agencies. The "Next Pandemic" is a Priority—But It's Not the Only One There is—understandably—mounting national attention on preparing for what many public health experts believe will be the inevitable "next pandemic." The COVID-19 pandemic showed us what a lack of preparedness could mean for population health, and there is so much unknown about what the future of pandemics has in store. However, experts at the TechXpo reminded us that public health is about more than responding to a singular crisis. "I think many of the conversations we're having are so focused on COVID-like pandemics," said John Auerbach (alumni-MA) "But if we look at the things that are still killing people, for the most part it's not infectious disease." Instead, Auerbach cited challenges that have long been a part of the public health story, such as diabetes, the fentanyl overdose crisis, and climate change. Before COVID-19 entered the national spotlight, public health’s day-to-day work was largely centered on chronic disease and behavioral health. Auerbach reminded us that amid all of the unknowns of our future, there is plenty we do know—and plenty we can be doing to address it. "Modernizing data systems is more than buying a big computer." While there were many versions of this message over the course of the forum, Auerbach perhaps said it most concisely of all. In other words, it doesn’t matter if a public health agency has a chrome-plated exterior and a cloud-based data system, so long as the underlying infrastructure isn’t sustainably and thoughtfully built. Whether it’s a matter of restricted funding, antiquated processes, or siloed thinking, health agencies and their leaders must have a plan to address these challenges before assuming that “buying a big computer” will catch their data dashboards up to speed. This was one of the ironies of this future-forward event: Amid so many exciting innovations and inventions, many of the challenges boiled down to basic, equity-centered questions about the best way to get this new technology in the right people’s hands. If public health is going to take a technological leap at a national level, then it must also be able to make a leap at a community level—in communities of color, in territorial health agencies, and in our policies. Jumping lightyears ahead doesn’t count if entire populations are still being left lightyears behind. Workforce Resilience Cannot Be Taken for Granted We cannot separate the future of public health from the future of its workforce. The COVID-19 emergency response has left many public health workers feeling burned out and harboring traumatic levels of toxic stress, pushing many of them to seek out jobs outside the field. In fact, according to a recent analysis of data from the Public Health Workforce Interests and Needs Survey, 46% of state and local public health employees left their jobs between 2017 and 2021. For public health to reach its full potential in the future, we must begin investing in that workforce today. Over the course of the week, we heard often from mental health experts and senior health officials to learn about their priorities, challenges, and paths to improve workforce well-being in their health agencies. This included the unveiling of the PH-HERO Workforce Resource Center, which arms health agencies with the resources and knowledge they need to support their workforce. Whatever the future of public health holds, it begins with a workforce who is motivated to make that future a reality. More than anything, the TechXpo was a reminder that public health’s future is as multiple as it is uncertain. We are working toward a future that is more adaptable than ever before—with thought innovators and health experts who are constantly reflecting, pivoting, and adjusting to the moment. There are so many conversations yet to be had. For those who have not done so already, we invite you to register for our fully virtual TechXpo follow-up forum on June 15, and add your voice to the growing chorus. website yes

ASTHO asked six DELPH scholars to reflect on their DiSC assessment results and how they use the findings to tap into their leadership influence and impact.

Rural hospital closures exacerbate poor socioeconomic conditions, job loss, cost of health services, transportation times and barriers, and inequitable access to quality care, all of which contribute to unfavorable maternal and infant health outcomes.

In this blog post, six DELPH scholars share their thoughts on what it means to have influence as a leader and the individuals that have most influenced their leadership styles.

ASTHO has been helping jurisdictions prepare for and respond to the needs of people with disabilities during public health emergencies by embedding disability preparedness specialists in 16 state and 2 territorial health agencies.

Understanding boundary spanning principles helps public health practitioners recognize the types of boundaries that come naturally when navigating relationships that may involve managing up, down, and across.

Jonathan Mermin of CDC discusses how using a syndemic approach could help health departments to address rising STI rates more effectively

As new diseases or emergencies arise, working alongside trusted committees can help health officials quickly respond and prevent undue burden on at-risk groups such as people with disabilities, pregnant people, and children.

In the U.S., jurisdictions vary in their newborn screening practices and requirements related to the scope of testing, approach to parental consent, options for blood sample destruction, sample retention periods, and permissible uses of newborn blood samples.