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Strengthening Public Health Systems: CNMI Food Safety Program Spotlight Strengthening Public Health Systems: CNMI Food Safety Spotlight Anya Groner, Taylor Francis Learn a few essential steps for strengthening public health systems, as exemplified by CNMI and their work to adopt the FDA Food Code. Public health systems are designed to protect and improve population health. These vital systems — from food safety programs to disease surveillance — help to prevent disease, respond to health threats, and ultimately improve well-being. To best benefit communities, public health agencies must remain committed to strengthening these existing systems. The Commonwealth of the Northern Mariana Islands (CNMI), a U.S. territory in the western Pacific with a population of approximately 50,000, models this work in their exceptional efforts to improve their food safety system. Managing the risks of foodborne illness requires clear guidelines, government support, and regulatory authority. Yet, when the Environmental Health Disease Prevention Program (EHDP), part of the Commonwealth Healthcare Corporation in CNMI, conducted a voluntary review of their food regulations, the jurisdiction met only a small percentage of the FDA retail program standards, which define what constitutes a highly effective and responsive program for the regulation of retail food establishments. From there, EHDP launched an ambitious plan for the jurisdiction to adopt the FDA Food Code for the first time. The EHDP Office spent several years analyzing the legal and technical implications of adopting the FDA Food Code and garnering leadership support. In November 2024, it was officially adopted — an extraordinary accomplishment. EHDP will now embark on a five-year implementation process which has a strong focus on training, technical assistance, and partnerships with local stakeholders — with an emphasis on education instead of enforcement. Their journey serves as an example for other jurisdictions working to strengthen their public health systems. Getting Started Building better systems starts with identifying opportunities to strengthen those already in place. When EHDP reviewed their existing local regulations against the 2017 FDA Food Code, they found that theirs fell short of the criteria related to risk factor interventions, good retail practices, and effective compliance and enforcement measures. This led to the realization that they needed to strengthen their food safety program and adopt their first FDA Food Code. Pangelinan 1 - CNMI Food Safety Program Spotlight By moving from their old code to the FDA code, EHDP shifted from a focus on basic sanitation to foodborne illness risk factors. With limited resources and staffing challenges, it was vital that the EHDP team knew where to focus their workload and how to streamline inspections. This change will also help EHDP better protect the public’s health. Measuring Progress As health agencies embark on building better systems, it’s vital to have a specific measure to assess progress against. EHDP spent several years working toward adopting the 2022 FDA Food Code. Their previous regulations were outdated, vague, and inconsistent. Plus, there was a lack of clarity around critical food safety practices, like cooking temperatures, cooling procedures, and sanitization. The retail food program standards gave the team a measure to assess their food safety program compared to other programs nationally and helped them better understand gaps. Getting Buy-In and Mobilizing Stakeholders Two additional essential steps are garnering support and coordinating action. For EHDP, there was a lot of training to get internal support not just within the team but also from leadership. Fortunately, the adoption process to implement new regulations was fairly smooth. Their next focus is building the infrastructure, training the staff, and ensuring that the local operators have access to the necessary equipment, supplies, and sample policies. They are also looking to offer certified Food Protection Manager training to food operators. EHDP plans to focus on small behavioral changes, making sure everyone’s on the same page with employee health so retail food establishments can meet the requirements on employee health and reporting. Every September, EHDP hosts food safety week as part of Food Safety Education Month and brings together food handlers and food operators — some of whom are familiar with the FDA Food Code due to working in the continental United States. The EDPH team always talks to them about potential changes that could come about from this new code and, so far, have received great feedback. Pangelinan 2 - CNMI Food Safety Program Spotlight Collaborating with Partners As with any effective public health initiative, collaborating with partners at all levels is crucial – as agencies can learn from others’ skills and experiences. At both the federal and local levels, EHDP worked closely with their FDA retail specialists who provided technical support and training throughout the process. The team also did a three-year mentorship with Northern Nevada Public Health, which helped them improve their field inspections and strengthen internal policies and procedures. These were the key steps in making progress towards the standards and preparing for adoption. In addition, ASTHO connected EHDP with other health departments who had gone through the food code adoption process, enabling them to hear their firsthand insights and practical guidance. The team is willing to support other Pacific Island jurisdictions, like American Samoa, as they work to adopt the FDA Food Code for the first time, too. Pangelinan 3 - CNMI Food Safety Program Spotlight Celebrating Successes It’s always important to take a step back and acknowledge wins throughout essential public health work. EHDP’s work towards the FDA Food Code strengthened the team's skills and expanded training opportunities, as they shifted from focusing on rules and regulations to risk-based inspection and partnering with food operators — emphasizing education, prevention, and collaboration, to get everyone on board. Their biggest success, however, is of course adopting their first FDA Food Code. Pangelinan 4 - CNMI Food Safety Program Spotlight In Conclusion Through EDPH’s efforts to improve their food safety program, they are reducing foodborne illness, protecting public health, and safeguarding their community. As exemplified in CNMI, improving public health systems takes time and hard work — but with that investment comes key successes that benefit communities for years to come. CDC-HHS - $1,000,000 article yes

What’s Driving Public Health Legislation in 2026? What’s Driving Public Health Legislation in 2026? Beth Giambrone Learn about the prospective legislative landscape for public health in 2026 from chronic to infectious disease and more. Drawing from ASTHO’s legislative tracking efforts and member feedback, the State Health Policy team identified five key issues state and island legislatures will likely address in their upcoming sessions. The resulting tool, ASTHO’s 2026 Legislative Prospectus Series, provides public health leaders and policymakers with a synopsis of the topics, recent policy trends, and anticipated legislation in upcoming sessions. Public Health Funding and Administration While the federal government has invested in long-term public health through legislation such as the Public Health Infrastructure Grant and the Prevention and Public Health Fund, states are preparing for possible reductions or cancellations in federal funding. The Public Health Funding and Administration Prospectus highlights state efforts to improve public health investments, such as creating public health rainy day funds, while still balancing their budgets. States also enacted legislation that improves core public health services at the state and local levels, a trend that ASTHO sees continuing into 2026. Access to Care The Access to Care Prospectus focuses on policies that reduce gaps in health care services for communities across the United States. In 2025, ASTHO saw enacted legislation that strengthened the utilization of community health workers who serve as vital links between individuals and health service providers, through certification programs and Medicaid coverage requirements. States also considered policies supporting access to health care in rural areas, where individuals have limited access to health care providers and facilities. Iowa’s HF 972 directs the health department to seek CMS approval for a new funding model that would support rural health providers. The prospectus also addresses legislation supporting women at multiple stages of life by increasing access to doulas, establishing programs providing increased maternal care in rural areas, and supporting women in perimenopause with increased information and access to treatment. Behavioral Health More than one in five people in the United States experience mental illness and opioid overdose is a leading cause of death. Given this, state legislatures continue to consider legislation to strengthen behavioral health systems, address unregulated substances, and promote access to overdose prevention tools — discussed in the Behavioral Health Prospectus. In 2025, at least 13 states considered legislation to strengthen behavioral health crisis services. Washington enacted HB 1813, directing managed care organizations to establish or expand arrangements with behavioral health administrative services organizations to provide crisis services for Medicaid enrollees. State legislatures also considered bills to expand clinical research or regulate substances such as psilocybin and ibogaine, with at least three states enacting legislation to allow psilocybin prescribing if FDA approved. Additionally, at least 10 states considered legislation allowing for the study of ibogaine as a potential treatment for conditions such as PTSD and opioid use disorder. Infectious Disease Prevention While some infectious diseases are declining in the United States, others — like measles — are increasing. This year’s Infectious Disease Prevention Prospectus explores legislative policies to combat infectious disease through prevention, testing, and treatment. While the Advisory Committee on Immunization Practices (ACIP) updated vaccine recommendations for children and adults, several states enacted legislation expanding the sources they use for developing policies related to school immunization, universal vaccine purchase programs, and more. States also considered expanding access to testing and treatment that prevents the spread of sexually transmitted infections. At least seven states enacted bills requiring or expanding syphilis screenings during pregnancy to combat rising congenital syphilis rates, while at least ten jurisdictions considered bills expanding access to HIV pre and/or post exposure prophylaxis. Healthy Food and Chronic Disease The Healthy Food and Chronic Disease Prospectus highlights legislative efforts to address food’s impact on public health and combat chronic disease. In 2025, several states considered legislation prohibiting the sale of food products that contain certain artificial dyes and/or chemical preservatives, with West Virginia enacting HB 2354 to prohibit the sale or manufacturing of food containing certain dyes or preservatives. Similarly, at least three states enacted legislation prohibiting foods containing certain dyes or preservatives in school meals. States also sought to promote nutritious food choices in their USDA SNAP benefits, with at least four states enacting legislation directing their state health departments to apply for waivers that would prevent individuals from using SNAP funds to purchase candy and soft drinks. Current Outlook for the 2026 Sessions In 2026, 46 states will hold legislative sessions (Montana, Nevada, North Dakota, and Texas do not meet in even numbered years). Most states will conclude their sessions by June 30, with at least 20 states scheduled to conclude in April. Additionally, 24 states carry over 2025 bills into the 2026 session, including some bills mentioned in the prospectus briefs. Because of this, ASTHO expects a large amount of legislative activity in the first few months of the year. The ASTHO State Health Policy team will monitor legislation related to the Legislative Prospectus Series and other public health issues during the 2026 sessions and provide a mid-session update in the spring. OE22-2203 PHIG article yes

March-July 2026

Learn about public health in American Samoa, including key health priorities, challenges, and ASTHO’s support for strengthening systems and improving outcomes.

A letter from ASTHO CEO, Michael Fraser, PhD, about the organization's annual legislative prospectus series.

Learn more about the island jurisdictions that are represented in ASTHO's membership, each of which has its own unique context, history, and needs.

Education & Events Association of state and territorial health officials, Washington week, techexpo, health equity summit, insight and inspiration series, public health thought leaders, public health professionals, state and territorial public health, public health practice, public health policy, microlearnings, astho microlearnings, learning communities, public health innovations, professional development, elearning center, astho elearning center, public health improvement ASTHO offers tools, resources, and events designed to help leaders respond to challenges and guide public health into the future. Explore our offerings now! ASTHO offers a robust library of educational tools, resources, and events. These resources help leaders respond effectively to daily challenges and guide public health improvements for the future. Explore our offerings to see what best suits your learning style and needs. Related topic: Leadership Development Events Events Page Intro Webinars ASTHO, in collaboration with various public health thought leaders and subject-matter experts, present an interactive virtual learning series for public health professionals. Our ASTHOConnects webinar series provides the latest and most relevant information on a broad range of emerging trends and issues affecting state and territorial public health. These free, zoom-based events are designed to provide the skills, knowledge, tools, and collaborations needed to formulate sound public health policy and ensure excellence in state-based public health practice. e-Learning Center The ASTHO e-Learning Center houses on-demand professional development offerings, including event and meeting recordings, and microlearnings. Microlearnings are bite-sized teaching sprints with just the right amount of information to help a learner achieve a specific goal. These web-based, self-paced bursts of content are designed for engagement and fast learning while still supporting long-term retention. They are the perfect way to communicate complex information—from onboarding staff, to introducing new concepts, and more. Learning Communities Learning communities are cohort-based communities that seek to advance an area of public health practice. These communities create unique opportunities to shed light on job-specific challenges and work towards actionable improvements. We collaborate with experts to create purposeful groupings across state health agencies, territorial health agencies, and multi-sectoral partners to drive public health innovation. website

This training is designed to be used with the ASTHO Opioid Use Disorder Toolkit: Supporting the Public Health Response in Maternal, Child and Adolescent Health to “role play” or practice what you learned about screening, referring, and offering support to people who are at risk for or experiencing substance use or opioid use disorder.

Explore ASTHO’s blog for expert perspectives on public health trends, policy updates, and strategies driving healthier communities.

Change Management eLearning Course website yes

Highly Pathogenic Avian Influenza Scientific Symposium <!-- All events will be virtual and are listed in ET. Please check back often, as the agenda is subject to change. --> On Thursday, April 25, 2024, ASTHO hosted a virtual symposium to facilitate a discussion between public health leaders and scientists driving the U.S. government’s response to Highly Pathogenic Avian Influenza (HPAI). The event was moderated by ASTHO CEO Joseph Kanter, MD, MPH, and featured leaders from ASTHO, the Infectious Diseases Society of America, the Council of State and Territorial Epidemiologists, and federal partners. The focus of the event was: Highlighting current science and epidemiology of HPAI. Providing an overview of the current outbreak. Outlining potential actions for averting or managing further spread or crossover. Identifying scientific areas requiring additional investigation and guidance. website False

Virtual course provided by ASTHO's e-learning center focused on building capacity among states based around health equity-focused TA requests.

Public Health TechXpo and Futures Forum Come to the Public Health TechXpo and Futures Forum! TechXpo, tech expo, public health, data modernization, public health event, astho, association of state and territorial health officials, public health officials, territorial health officials, state health officials, public health workforce, public health workers, data solutions, nation health features, data management, data platforms, virtual event exploring challenges, data architecture, technology solutions, data lakes, health of all people, monitoring health threats, real time, health care, healthcare ASTHO Public Health TechXpo and Futures Forum 2023 website

This virtual learning prepares data teams and their agency to build their understanding of data visualization’s role in public health.

Health Equity Summit: A Movement for Justice health equity summit, public health infrastructure, commitment to health equity, health equity leaders, racial equity, advancing health equity, public health and racism, racism as a public, people of color, public health issue, centers for disease control, racial inequities, address racial, medical students, health equity, united states, diversity equity and inclusion, equity summit, health outcomes, disease control and prevention, public health system, racial justice, social justice, black americans, public health, control and prevention cdc website

In this online course designed for public health agencies, you will explore key components and tools for braiding and layering funding.

In Vermont, CDC's Comprehensive Suicide Prevention (CSP) program uses a comprehensive public health approach to prevent suicide among disproportionately affected populations.

The Benefits of Primary Prevention article

ASTHO Change Management eLearning Course article no

States and municipalities are adopting tobacco retailer licensing (TRL) policies to control tobacco prevalence and impact. Learn more about TRL programs.