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This blog describes FSM’s efforts to improve access to care in some of the most remote and underserved areas of the Pacific.

Tobacco Control Programs Use Business Process Mapping to Strengthen Workforce tobacco control programs, preventable disease, tobacco industry, diverse workforce, grants management, mapping workshops, technological support, united states, tobacco product, young people, comprehensive tobacco control programs, public health, tobacco company, department of health, cigarettes and smokeless tobacco, smokeless tobacco products, health care system, youth and young adults, smoking cessation, reduced smoking, tobacco related disparities, astho, association of state and territorial health officials Amy Ciarlo Since the beginning of the COVID-19 pandemic, public health agencies have experienced significant turnover across leadership and staff throughout various programs, including tobacco control. Between 2021 and 2023, nearly 30% of all state and territorial program managers were experiencing turnover (e.g., in some cases, vacancies lasted months) or were new to this role, having less than two years of experience. This decline in workforce reduces capacity to address tobacco use—the nation’s number one cause of preventable disease, disability, and death. Tobacco control program staff require a level of knowledge that can take time to build, including: Historical context of tobacco industry marketing influence. Policy, systems, and environmental change strategies. Emerging products and changing regulations. The complexity that goes into helping people who use tobacco to quit. Finding qualified applicants that will stay in these roles long term has been challenging across jurisdictions. In response to this need, the Tobacco Control Network, in collaboration with CDC’s Office on Smoking and Health, convened a nine-month learning community with three state tobacco control programs (Alaska, Arizona, and New Jersey) to address hiring and onboarding challenges, which concluded in March 2024. Subject matter experts Health Management Associates (HMA) supported by educating participants on business process improvement (BPI) methods, facilitating business process mapping workshops, and consulting on the development of individual state implementation plans to address key challenges identified during the mapping processes. A similar model with specific OD2A grant recipients focused on procurement, contracting, and helping address spend-down of funding. Business Process Mapping and Implementation Planning Each state participated in a two-day, in-person BPI workshop to outline all steps, from filling a vacancy to completing the onboarding of new hires. This was a lengthy exercise, as agencies often have many elaborate processes in place, due to an organizational requirement, an expectation held by leadership, or a past purpose that is no longer relevant. Understanding why the process happens and visualizing the steps in sequential order helped teams identify “waste” or areas for improvement, including overwork (e.g., too many meetings), waiting (e.g., on an approval, for a training to become available), extra processing (e.g., duplicating efforts), and unused talent (e.g., insufficient training and alignment of skillsets). States then drafted implementation plans to address key issues, outlining steps with detailed timelines and tasks assigned to individuals to increase accountability. Each state team finalized their plans as part of the learning community, with some activities in progress or already completed. However, all three varied in their processes, their approaches to solutions, and the activities outlined in their implementation plans: One state’s BPI workshop focused on grantees at the county-level and streamlining onboarding, as counties lacked consistency in their hiring and onboarding approach. Their implementation plan focuses on a team of state health agency staff and local partners establishing a guidance document that assists new local staff in their first three months. Another state’s BPI workshop centered on addressing challenges in building a diverse workforce, with goals to establish a standardized practice for job postings and reduce re-posting of vacancies. The mapping process allowed collaboration across multiple departments and with health agency leadership. During the final state BPI workshop, the team identified excess meetings as a pain point and are reworking them to reduce redundancy and streamline the onboarding process. The implementation plan also prioritizes making training materials more engaging and better understanding training needs among new program staff. Lessons Learned The state teams gathered to share key takeaways from the learning community, as reported by HMA, informing recommendations for other programs looking to address hiring and onboarding challenges. Successes Participation led to team building and a mutual understanding of the process. Participants trusted one another to share with transparency. The mapping activities remained agnostic by highlighting inefficiencies in the process and not the people. Individuals with new perspectives had the opportunity to comment on system improvements. Teams recognized the numerous demands on team members and grantees, how much duplication existed across processes, and the number of approvals or layers in the hiring procedures. Teams created clearly identified roadmaps to improve hiring and onboarding staff. The learning community brought together partners across the state to address challenges that impacted their work but were not part of their everyday tasks. Challenges Staff representatives from HR or Grants Management were not present during the mapping workshops, causing gaps in information during these sessions. Power dynamics created difficulty for all participants to contribute equally. There was a lack of consideration for equity and challenges from new hire perspectives. More structured technical assistance and check-ins following the development of implementation maps were needed to support follow-through. Some participants had a sense of ownership or attachment to the established process and were protective of maintaining the status quo. Recommendations Ensure all participants understand the vision by providing an example of similar work in advance as reference material. Prior to the mapping activities, conduct a series of key informant interviews to ensure the right people are in the room, gain an understanding and awareness of organizational and interpersonal dynamics that may impact the process, and identify opportunities to establish bidirectional communications between state and local staff. Plan for ongoing technical assistance follow-up to ensure understanding of the initiative and support implementation. Ensure logistics can accommodate the process, such as proper room size and technological support. In Conclusion Given the challenges identified in this pilot learning community, states would likely benefit from change management prior to beginning BPI activities. Having intentional conversations up front can prevent these common challenges, as outlined previously. Overall, all state participants agreed that the learning community was valuable to their work, increased their organization’s knowledge and capacity, strengthened their relationships within their agency, and they intend to continue working on their improvement plans. One state team shared, “A major success from this mapping workshop was understanding the significance of engaging and listening to colleagues from diverse departments. The workshop facilitated a clearer understanding of civil service and HR operations, emphasizing the hurdles faced by hiring managers.” While business process mapping and implementation plan development can be laborious, the results are well worth the effort. website yes

Health Agencies Keeping Cottage Foods Safe Heather Tomlinson Rows of homemade jams at the local farmer’s market and a neighbor’s birthday cake on social media have something in common: they are both cottage (or homestead) food products. Cottage foods are home-based, home-made food products prepared outside of a commercial kitchen and sold to the public. Cottage food producers operate on a small scale, often from a home kitchen, selling goods locally. Although cottage foods provide opportunities to small, locally owned businesses, they also create complexity in selling food products to the public that are not inspected and may not meet basic food safety standards. And while home kitchens are not considered food establishments in the FDA Food Code, states are able to define “food establishments” by amending provisions in their food code adoption process or enacting legislation or regulations. In addition to regulating, state health agencies can play a role in keeping cottage foods safe through education, training, and other mechanisms. Cottage Food Regulation Currently, all 50 states and Washington, D.C. allow the sale of cottage food products directly to consumers. Several foodborne illnesses have been linked to products improperly prepared at home, such as botulism outbreaks in home-canned products and E.coli contamination of jerky. Many foodborne illnesses can be prevented by safely preparing, processing, and storing foods, processes often outlined by health regulations. Health agencies use a variety of tools to regulate cottage food production. Types of Foods: The types of foods permitted can vary across jurisdictions with some allowing only non-time/temperature controlled for safety (TCS) foods (e.g., baked goods, jams, candies), while others allow a wide range of products including TCS foods and items that require specialized processes (e.g., pickled vegetables). Some jurisdictions may use an exhaustive or illustrative list outlining permitted foods, while others limit specific food production processes but allow all other food items. Licensing and Inspection: Cottage food producers must follow a variety of rules in the form of permits, licenses, and registration. Although cottage foods are exempt from many inspection requirements, at least fifteen states require an initial inspection of home kitchens before they can sell items. All states allow the investigation of foodborne illness complaints; some states require annual licensure. Food Safety Training: States can require a food safety course to ensure that all cottage food producers understand the basic food safety requirements. Sales Caps: Gross sales caps limit the scale of operations allowed without full food safety precautions. After a cottage food operation exceeds their gross sales cap, they would be required to register as a food establishment and permitting rules would take effect. Sales Venues: States typically only allow direct-to-consumer sale of cottage foods (e.g., farmers’ markets) but some states permit online sales. Federal food safety regulations, which prohibit cottage foods, apply when food products are sold across state lines. Cottage food sales, whether in-person or online, should remain within the state they were created to avoid violating federal regulations. Labeling: All states have a labeling requirement for cottage foods. These labels can vary but typically include the food producer’s name and address, the product name, an ingredients list, allergens, product weight, date of production, and a disclaimer identifying that the product was prepared in a home kitchen that is not inspected. Recent Cottage Foods Legislation in the States Legislators often face tension in weighing the balance between maintaining food safety regulations and supporting small cottage food businesses by reducing the entry barriers (e.g., leasing commercial kitchen space). In recent years, there has been an increase in legislation expanding cottage food parameters ranging from product and preparation inclusions to modifying the gross sales cap. The Arizona House of Representatives passed and the Senate is currently considering HB 2864, which would expand the state’s cottage food item list to include precut and processed freeze-dried fruits and vegetables. Arizona enacted HB 2042, which expands the definition of cottage foods to include foods that require time and temperature control if they're exempt under federal regulations. The Hawaii legislature passed HB 2144 which is now awaiting action from the Governor, which would expand the definition of cottage foods to include pickled products and non-hazardous products that do not contain dried meat or seafood, permit the sale of products in retail stores, and allow for customer delivery via third party vendors or shipping. Several states have introduced legislation to increase the gross sales cap for those who qualify as a cottage food producer. Mississippi (MS SB 2638) and Washington (WA SB 5107) introduced bills that proposed to increase the annual gross sales cap, but both failed in session. There has also been legislation surrounding cottage food preemption. Massachusetts is considering S 2761, which would establish a cottage food regulatory framework and prohibit local health agencies from being able to establish their own cottage food regulations. Microenterprise Home Kitchens In expanding cottage food production, there has been increased legislation on microenterprise home kitchens. Microenterprises typically allow the production of more types of foods, including fully prepared hot meals, but also require stricter regulations (such as preparing and selling the food on the same day). Minnesota (MN SF 4501) and Hawaii (HI HB 1591) have introduced legislation that would allow microenterprise home kitchens and establish a regulatory framework for licensing and safety standards. Raw Milk Considerations Raw milk is an animal milk that has not gone through pasteurization (process of heating milk to a specific temperature for a set period of time) to kill harmful bacteria. Raw milk can carry dangerous bacteria that can cause food poisoning and has recently been shown to test positive for the recent highly pathogenic avian influenza (HPAI) virus. As of March 2024, 30 states allow the interstate sale of raw milk. This session, West Virginia passed legislation (WV HB 4911) and at least six states, Michigan (MI HB 5603), Hawaii (HI HB 1989), Missouri (MO HB 1711), Massachusetts (MA S 43), Louisiana (LA HB 467), and New Jersey (NJ A 1086), considered legislation that would allow unpasteurized, raw milk to be sold to consumers. How State Health Agencies Can Keep Cottage Foods Safe Health agencies consider cottage food inclusions based on food production risks. For instance, many agencies will allow baked goods but do not permit pickling due to the botulism risk associated with pickling. Health agencies evaluate food science to educate their legislatures on the considerations of cottage foods and where they would recommend public health regulations. Health agencies also ensure cottage food guidance is easily accessible and written in plain language, so producers have the needed information to follow regulations. Relevant information may include the permitted products, how to become a cottage food producer, and food safety considerations when preparing home-made foods. For example, the Illinois Department of Health, in collaboration with a diverse collection of stakeholders, created a robust cottage food guide to help producers and regulators understand state requirements and cottage food safety standards. Author card spacing 4 State policy surrounding cottage foods is constantly evolving. ASTHO will continue monitoring these changes and provide relevant updates. website yes

DELPH Reflections: A Journey Towards Creating a More Equitable and Just Democracy Fredrick Echols DELPH has helped public health professionals reflect on their purpose, cultivate compassionate leadership, understand system dynamics, and build a community of advocates to create a more equitable and just democracy. As an African-American male living in the United States, I have encountered numerous obstacles in life, particularly in my efforts to reform systems that fail to support marginalized and vulnerable populations. These systems have had devastating effects on myself and other individuals belonging to Black, Indigenous, and People of Color (BIPOC) communities as they restrict access to essential health and social services. As a Black physician and public health professional, I continue to encounter this stark reality that engenders a sense of hopelessness in communities across the United States. These systems obscure their true intentions and deceive individuals into believing that they operate in the best interest of marginalized populations while perpetuating inequitable and disparate health outcomes. In consideration of these personal and professional experiences, the Diverse Executives Leading in Public Health (DELPH) program has played a significant role in shaping my career and purpose: Fostering Critical Reflection: It provided me with a journey that encouraged me to think critically about my future and how I can leverage my platforms and relationships to help propel the public health ecosystem toward a system that embraces the humanity of all individuals and prioritizes uplifting and empowering the most vulnerable and marginalized populations. Important note: That said, the presence of silos, political posturing, and missed opportunities due to inefficient and ineffective operational practices resulting from insufficient fiscal investment continue to plague the public health ecosystem—limiting its ability to make strides toward a system that wholeheartedly supports the pursuit of health equity and social justice. Cultivating Compassionate Leadership: The program also provided access to experts and public health thought leaders who helped my colleagues and I understand the evolution of health and social service delivery in the United States (particularly for indigent populations), increase our capacity to embrace divergent thinking, and engage in constructive dialogue. The availability of such a space provided us with an opportunity to establish a secure and conducive environment, one that upheld the virtues of compassionate leadership and fostered effective relationship building. Our ability to engage with stakeholders, both like-minded and those with differing opinions, was characterized by a spirit of intentional listening that sought to comprehend their perspectives. Through this, we were able to create an atmosphere that supported open dialogue and nurtured mutual understanding. Understanding System Dynamics: The experience has enriched my comprehension of the intricacies that drive the amplification of inequality and the resulting health disparity gaps that are pervasive among communities and individuals across the nation. The knowledge thus obtained is of paramount importance to ensure my competency in identifying and avoiding perpetuating the issues that I aspire to address. This, in turn, will prevent any inadvertent harm to the communities I seek to uplift and empower. Building a Community of Advocates: Moreover, the program has enabled me to connect with individuals who are unwavering in their commitment to upholding justice. Despite our diverse backgrounds, we set aside cultural differences to work toward a common goal: the accessibility of quality healthcare and the delivery of justice for all humanity. The DELPH program's fundamental principles and culturally sensitive support structure have played an instrumental role in shaping my professional growth as a public health expert. As I chart the course for my future professional endeavors, I intend to leverage the lessons learned and the tools provided by DELPH to strengthen the public health ecosystem. My ultimate goal is to foster collaboration across various segments of society to create a more equitable, just democracy. The DELPH program has equipped me with invaluable knowledge and skills that will enable me to make meaningful contributions to society's betterment. For this, I express my profound gratitude to the Association of State and Territorial Health Officials, the Morehouse School of Medicine's Satcher Leadership Institute, and CDC for their unwavering commitment to advancing BIPOC leadership in public health. Their steadfast support for this program has enabled me and countless others to acquire the skills and knowledge necessary to effectively lead and drive the transformative change that public health requires. I sincerely appreciate their continued investment in this vital initiative, which has empowered many to become the change agents that public health needs. website yes

Wraparound Services for All: How Public Health Departments are Connecting Communities to Critical Support ASTHO, Association of State and Territorial Officials, wraparound services, astho delph, diverse executives, linkage to care, medical care, health care, community well being, public health, health outcomes, evidence based, quality of life, strength based, local community, health promotion, improvement health, infectious diseases, maternal and child health, local health departments, public health services, mental health services, public health practices, public health leaders, public health systems, behavioral health ASTHO Staff How health departments across the country are working to link clients to diverse public health services and supports to address their specific challenges and help them succeed in different aspects of life. As the heartbeat of community well-being, health departments find strength in collaboration. Services provided by health departments cannot stand alone when supporting their residents and communities significantly, as several simultaneous and interrelated factors can influence health. In this blog post, ASTHO’s DELPH scholars from cohort #3, Tosha Bock and Sam To, share how their organizations across the country are striving to implement systems to link clients to a diverse range of public health services and supports to address their specific challenges and help them succeed in different aspects of life. Give an overview of your organization and the ‘linkage to care’ efforts. TOSHA: The Oregon Health Authority (OHA) is a government agency in Oregon. OHA oversees Oregon’s health-related programs, including behavioral health (addictions and mental health), public health, Oregon State Hospital for individuals requiring secure residential psychiatric care, and the state's Medicaid program called the Oregon Health Plan. The nine-member Oregon Health Policy Board oversees its policy work. OHA’s goal is to eliminate health inequities in Oregon by 2030. Addressing health inequities in Oregon is crucial as it ensures everyone has equal access to healthcare resources regardless of socio-economic status or background, promoting a more just and inclusive society while improving public health outcomes. One way OHA does this is by supporting investments in Community Information Exchange (CIE). CIE is a network of collaborative partners using a multidirectional technology platform to connect people in Oregon to services and support. Through CIE technology, users can search a shared resource directory, document consent, and make and hear back on the referral status (closed loop). Communities across Oregon are implementing CIE. SAM: Within the Division of Preparedness at the Arizona Department of Health Services, the Office of Rapid Response Disease Investigation (ORRDI) was established during the COVID-19 pandemic and launched statewide case investigation and contact tracing (CI/CT) to support local health jurisdictions (LHJs) with critical investigative support. Soon after, a referral process to connect residents to community organizations was incorporated into all investigations; this provided the ability to directly link residents with vital resources and assistance programs while they navigated their situation. Give an example of the work and why it's impactful. TOSHA: Below is an example of the importance of CIE expressed by a Community-Based Organization interviewed for the CIE: Community Engagement Findings and Recommendations Report. Community-based organizations, peer-run organizations like ours, we are, you know, feet on the ground organizations, we're grassroots, and I think this tool to be able to reach out because we're always underfunded, we're always understaffed, you know, and this cuts down on hours and hours and hours of time that we would be on the phone, we have to do one referral, we can send it out, we can make notes, we can talk back and forth with other people, we only have one consent form, you know, all these things have made it a lot easier for us to operate, making it to where we can spend more time with our feet on the ground. – Interviewee SAM: Throughout Arizona, especially for the state’s most vulnerable populations, isolating or quarantining was found to be a hardship, with adherence to guidance greatly dependent on each individual’s ability to access medical care, attend work, pay for rent and utilities, and to acquire food or medication; those who struggled became a risk for increasing the spread of COVID-19. Community navigators offered a personalized approach to providing services and programs aimed at helping residents achieve self-sufficiency. During one of the most substantial periods of COVID-19 response (between July 2021 and June 2022), ORRDI connected 17,290 cases and 939 contacts to community navigator organizations and successfully administered 18,229 referrals. The top three requested resources across the state were utility assistance, eviction prevention or rental assistance, and emergency food box delivery. This partnership connected various established services and magnified trust with the ORRDI team and within Arizona communities. What do you wish could be done to enhance your programs? TOSHA: CIE networks are foundational to building a more equitable system in Oregon. Additional funding must be provided to implement systems change and expand these networks to create statewide coordination across organizations, sectors, and systems. These investments should also include technical assistance, training, education, and advancing privacy and data protection. SAM: The ADHS ORRDI programs continue to manage COVID-19 CI/CT for much of the state and leverage this partnership to support the needs of Arizona residents affected by COVID-19. However, they have also taken on several other morbidities of public health significance. The objective of the Office is to maintain current community navigator partnerships by offering supportive services, continually improving outreach efforts to cases and contacts, and encouraging enrollment in referrals. Concluding Thoughts In conclusion, breaking down the silos between public health and health care opens avenues for a more holistic approach to community well-being. By simultaneously addressing various determinants of health, organizations can create a comprehensive and interconnected system that fosters lasting improvements. This collaborative effort enhances the effectiveness of interventions and paves the way for a healthier and more resilient community. In embracing this integrated approach, we move closer to a future where the boundaries between public health and health care are blurred, giving rise to a more cohesive and impactful model for community health and wellness. website yes

PHIG: A Transformative Infrastructure Grant for Health Equity and Inclusive Workforces ASTHO, Association of State and Territorial Health Officials, phig grant, infrastructure grant, public health, health equity, public health grant, inclusive workforce, public health infrastructure grant, health departments, public health funding, public health institutes, data systems, public health workforce, community engagement, federal grants, restrict spending, health disparities, community partnership, underserved populations, diversity equity inclusion, educational institutions, high risk and underserved, ethnic minority, rural communities, overall capacity, minority institutions Amber Williams, Lindsey Myers The Public Health Infrastructure Grant (PHIG) program provides flexible, non-categorical funding to help public health departments across the United States build their infrastructure and capacity to meet their unique needs and address barriers in health equity and workforce development. Following the COVID-19 pandemic, Congress made a historic investment in public health workforce and infrastructure, presenting a game-changing opportunity for public health transformation. In the fall of 2022, CDC rolled out a first of its kind, five-year grant program called the Public Health Infrastructure Grant (PHIG) to address critical governmental public health workforce and system improvement needs. This program is all about supporting health departments across our states, territories, and freely associated states to ensure every community has the people, services, and systems needed to promote and protect optimal health for all. Along with funding 107 health departments, CDC also partnered with three organizations: the Association of State and Territorial Health Officials, the National Network of Public Health Institutes, and the Public Health Accreditation Board to help agencies modernize data systems, recruit and retain a skilled public health workforce, and address longstanding public health infrastructure needs. Challenges in Public Health Funding and the Pivotal Introduction of PHIG The majority of public health department funding comes from topic-specific federal grants, which usually restrict spending to prescribed programmatic activities and do not allow agencies to build foundational capabilities—like improving hiring or procurement processes, communication, and community engagement. For example, while advancing health equity and addressing health disparities is often emphasized as a central goal of public health practice, many jurisdictions face barriers to fully incorporating health equity into their strategies. Additionally, the public health workforce often does not reflect the communities they serve, which can impact their ability to build community partnerships and fully respond to the needs of underserved populations. PHIG is different in that it provides flexible, non-categorical funding that health departments can use to build their infrastructure and capacity to meet their unique needs and address barriers. PHIG Impact: Advancing Health Equity and Promoting Inclusion in Public Health Agencies Many agencies are using their PHIG funding to boost efforts to tackle health disparities in their jurisdictions and promote diversity, equity, and inclusion within their agencies. Internally they are focusing on examining compensation, assessing equitable pay, developing leadership programs for staff of color, streamlining hiring processes, and assuring unbiased hiring practices. Some agencies are creating paid internships, hiring people with lived experience, and building new workforce pipelines through engagements with minority-serving educational institutions. Plus, they are training managers and staff to create more inclusive workplace environments and partner with and serve diverse communities better. Other approaches include: Taking lessons learned from other funded programs, such as the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant, to focus and build on successes. Strengthening the overall capacity of the agency to address health equity, such as by incorporating health equity into agency-wide performance improvement offices and ensuring equity principles are embedded in health assessments and strategic plans. Improving partnerships with community organizations—looking at opportunities to simplify processes; support minority-owned institutions in competing for and managing federal funding; and hiring new staff dedicated to health equity, liaisons with special populations including tribes, and community health workers. This is a remarkable time for public health. Improving public health infrastructure and strengthening the workforce will lead to better health outcomes for all. These grants are critical, providing much-needed funding and flexibility to make real progress in promoting diversity, equity, and inclusion in the workforce and ensuring health equity in public health strategies. Author card spacing 2 Related Content-Blog - DELPH Magazine 3 OE22-2203 PHIG website yes

Mejorando el Manejo de Desempeño en las Operaciones de Salud Ambiental del Condado de Licking, Ohio Colton Anderson El manejo de desempeño es crucial para garantizar la efectividad y eficiencia de las operaciones de un departamento de salud. En salud ambiental, donde las regulaciones, los estándares y las preocupaciones de salud pública son primordiales, un manejo de desempeño efectivo asegura que tareas como la supervisión de la calidad del aire y del agua, la inspección de instalaciones para el cumplimiento de normas y la respuesta a emergencias ambientales se realicen con precisión y puntualidad. Además, permite que un departamento de salud identifique áreas de mejora, asigne recursos de manera eficiente y se adapte a las condiciones ambientales cambiantes o a los requisitos regulatorios. El Departamento de Salud Ambiental del Condado de Licking, Ohio, no solo está implementando prácticas de manejo de desempeño, sino que también las está alineando con los Estándares y Medidas de Reacreditación de Salud Pública, mientras rastrea diligentemente los datos para facilitar la mejora continua, que compartieron durante un seminario web sobre el Manejo de Desempeño en Salud Ambiental para fortalecer la capacidad de los beneficiarios de la subvención para la Infraestructura de Salud Pública. Optimizando el seguimiento de desempeño Mejorar el seguimiento del desempeño puede variar desde utilizar una hoja de cálculo de Excel bien estructurada con gráficos de líneas claros hasta emplear un software sofisticado de manejo de desempeño. Al desarrollar y seguir consistentemente medidas que se adapten a las necesidades del departamento de salud ambiental, el proceso no solo se vuelve claro, sino también sostenible, fomentando la toma de decisiones informadas. El Departamento de Salud Ambiental del Condado de Licking ha implementado un enfoque exhaustivo para organizar su sistema de seguimiento, segmentándolo por área de programa y adaptando las medidas para satisfacer las necesidades y objetivos específicos de cada dominio. Se han logrado éxitos notables al integrar sin problemas las medidas de desempeño en el sistema general de manejo de desempeño del condado, un logro alcanzado tras exhaustivos esfuerzos de mejora de calidad en su programa de plomería y operaciones de servicios fiscales. Entre estas iniciativas, se lanzó un proyecto notable para abordar problemas relacionados con los permisos de plomería a punto de expirar y la falta de un mecanismo de seguimiento confiable para las fechas de vencimiento. A través de mejoras estratégicas en los procedimientos de almacenamiento y seguimiento de permisos, el condado ahora cuenta con la capacidad de evaluar con precisión la tasa de vencimiento mensual de los permisos de plomería. De manera similar, se inició otro proyecto para reducir la emisión excesiva de reembolsos dentro del departamento. Al investigar las causas raíz de las solicitudes de reembolso, esta iniciativa facilitó el establecimiento de una medida de desempeño destinada a monitorear los montos mensuales de reembolso, asegurando así la adhesión a la asignación presupuestaria anual para reembolsos. Comunicando las medidas de desempeño Comunicar de manera efectiva las medidas de desempeño es esencial para la transparencia, la responsabilidad y la alineación con los objetivos organizacionales. Comunicar claramente y de manera regular los datos de desempeño permiten a los interesados comprender el progreso del departamento, identificar áreas de mejora y celebrar los éxitos. Un aspecto crucial de la comunicación de las medidas de desempeño es el uso de formatos accesibles y comprensibles. El departamento utiliza diversos canales de comunicación (por ejemplo, reuniones de personal, boletines departamentales, portales de intranet) para difundir los datos de desempeño de manera efectiva. Los recursos visuales, incluidos gráficos, tablas y tableros, presentan información compleja en un formato comprensible, facilitando la comprensión y el compromiso del personal. Estrategias de Manejo de Desempeño Equitativas En la búsqueda de la equidad dentro del manejo de desempeño, el Departamento de Salud Ambiental del Condado de Licking ha establecido vínculos transparentes entre los objetivos de los empleados y las prioridades organizacionales, apoyando la flexibilidad para acomodar diversas necesidades. Reconociendo el papel fundamental de los gerentes, el departamento invierte en mejorar sus habilidades de coaching para garantizar una toma de decisiones justa en las operaciones diarias. Además, el departamento implementa un enfoque matizado para la evaluación del desempeño, recompensando efectivamente el desempeño sobresaliente en ciertos roles mientras aborda y mejora el desempeño en otros. Como parte de su compromiso con la salud pública y la equidad, el departamento también opera un Programa de Cumplimiento Mejorado, ofreciendo inspecciones adicionales de seguridad alimentaria a las instalaciones que no cumplen con el Código de Seguridad Alimentaria de Ohio. Las inspecciones mensuales proporcionan apoyo continuo a estas instalaciones en la implementación de procedimientos adecuados de seguridad alimentaria, complementadas con sesiones de capacitación gratuitas en el sitio para capacitar a los operadores de alimentos con el conocimiento y las habilidades esenciales. A través de estos esfuerzos concertados, el departamento se esfuerza por fomentar la equidad en las prácticas de salud ambiental dentro de la comunidad Lecciones aprendidas y direcciones futuras A partir de la experiencia del Condado de Licking, es fundamental establecer un ritmo adecuado para integrar el manejo de desempeño en las operaciones del departamento. Comenzar con pocas medidas nuevas y monitorearlas regularmente para establecer pequeñas victorias al principio es clave para una implementación sostenible a largo plazo. Por ejemplo, documentar las fuentes de datos o los informes utilizados para actualizar sus tableros hizo que mantener las medidas de desempeño actualizadas fuera mucho más sencillo, especialmente para el personal nuevo. El Condado de Licking cree que su departamento de salud local debe esforzarse por operar todos sus programas de manera óptima. Tienen un gran número de medidas de desempeño vinculadas a las operaciones para garantizar una entrega óptima de los programas. Si bien las tareas programáticas se ejecutan a un alto estándar, si no logran mejoras en los resultados de salud o equidad, esto sirve como un catalizador para discutir posibles ajustes en el modelo de entrega del programa. A medida que el Condado de Licking continúa refinando su enfoque, busca activamente mejorar su sistema de manejo de desempeño alineando más estrechamente las medidas con los resultados de salud, enfatizando el impacto y la equidad. En última instancia, como indicó el Subcomisionado de Salud del Condado de Licking, Greg Chumney, "el manejo de desempeño se ve diferente para todos". A través de la dedicación, la innovación y la colaboración, el manejo de desempeño continuará siendo un pilar fundamental para avanzar en la salud ambiental y el bienestar público. article yes

State and federal actions to expand the doula workforce and improve maternal health.

From the Chief Medical Officer: Key Takeaways from ASTHO’s HPAI Scientific Symposium hpai scientific symposium, highly pathogenic avian influenza, one health, public health, state and local public health officials, wild birds, human health, infectious diseases, disease control and prevention, centers for disease control, infected with avian influenza, symptoms of illness, domestic animals, working closely, united states, health department, food safety, public health practice, domestic poultry, contact with infected, health official, health risks, infect humans, dairy cattle, exposure to infected Marcus Plescia, Jessica Baggett, Meredith Allen A recap of ASTHO's Scientific Symposium on Highly Pathogenic Avian Influenza While only one human case of Highly Pathogenic Avian Influenza (HPAI) has been reported in the United States this year, the discovery of transmission of HPAI in cattle has led to an increase in the need for federal, state, and local public health agencies to enter a heightened phase of readiness. The risk to the general population remains low but this change signals the need for an increase in collaboration, research, and communication. Last week, ASTHO hosted a virtual symposium in partnership with the Infectious Diseases Society of America and the Council for State and Territorial Epidemiologists that featured public health leaders and scientists driving the U.S. government’s response to HPAI. Experts outlined potential actions for managing further spread and identified areas requiring additional investigation and guidance. Using a One Health Approach is Critical One Health recognizes that the health of people is closely connected to the health of animals and our shared environment. This is not a new concept but has become more important in recent years. The disciplines of public health and agriculture are inextricably linked. The symposium emphasized the importance of building and maintaining partnerships between CDC, USDA, FDA, ASPR, NIAID, and state and local public health departments. Recognizing the interconnectedness of these domains is essential for effective disease prevention and control. Public Health Recommendations will Evolve with the Science A key insight from the symposium was the dynamic nature of the situation. While we know a great deal about pandemic flu response, spread through dairy cattle is new. More in-depth epidemiologic studies will call out changes in transmission between cattle, people and cattle, and the potential for person-to-person spread. Collaboration between public health, agriculture, and farm owners will allow public health to gather epidemiologic data that can be translated into clear and data-supported recommendations to prevent continued transmission. As scientific understanding evolves and new evidence emerges, so must our public health response. As always, the public health community will commit to continuous learning, flexibility, and readiness to adjust strategies accordingly to ensure that interventions remain evidence-based and effective. Assessing the Current State of Readiness The supporting federal government response to HPAI appears to be well positioned; our federal partners don’t anticipate challenges with the commercial supply chain for personal protective equipment (PPE), vaccine, or therapeutics. The commercial system continues to be the primary source for PPE, but there are federal stockpiles available from ASPR, and the Food Safety and Inspection Service (FSIS) national veterinary stockpile. There is no indication of viral resistance to existing antiviral treatments and, in addition to commercial supplies, "tens of millions of courses" of Tamiflu area available through the strategic national stockpile should they be needed. CDC is providing ongoing surveillance of emerging flu strains and anticipates rapid availability of vaccine should infection begin to occur in workers in high-risk settings. State and Local Public Health Officials are Increasing Planning and Coordination The interface between public health agencies and state or local agriculture departments is critical. A public health response includes rapid situational awareness, laboratory testing, implementing public health recommendations around screening/isolation, and providing appropriate care (medications). Questions and planning scenarios specific to health officials may include the following: How will your team determine whether people are exposed and, importantly, symptomatic? Who will you dispatch to the farm to obtain testing for those symptomatic individuals? What is your approach to case investigations? How will you engage in symptom monitoring in this population? On the laboratory side, how will specimens be transported to the public health lab? Are your laboratories ready to receive/run those specimens, even if they are, for example, conjunctival? If positive, how will that specimen be sent to CDC for confirmatory testing? If positive, how will you communicate the result to the individual and counsel them on isolation? How will Tamiflu be provided (if indicated)? From what cache? What is your communications plan if positive? ASTHO will continue to work closely with our partners to monitor this situation and provide updates as they become available. website yes

Empowering Community Health Workers to Advance Health Equity ASTHO, Association of State and Territorial Health Officials, community health workers, health equity, covid-19, health inequities, public health infrastructure, public health, public health professionals, public health workforce, healthcare system, advancing health equity, contact tracer, testing treatment, local health department, government agencies, community engagement, advancing equity, advancing equity grant, health and human services, social determinants of health, community partnerships, marketing and outreach, sustainable funding, health outcomes, health department Keon Lewis, Karla Granado, Yoann Sophie Antoine Jean-Felix ASTHO | The importance of recognizing the critical impact of community health workers (CHWs) in advancing health equity, sustaining their partnership with local health departments, and setting them up for success by implementing sustainable funding sources and employing the CHW settings continuum framework. The COVID-19 pandemic exposed the health inequities and deficiencies in our public health infrastructure that leave many communities behind. To close the health equity gap and meet the challenges ahead, public health professionals must institutionalize the role of community health workers (CHWs) within the healthcare system and public health workforce. Doing so will take recognizing the critical impact of CHWs and equipping them with the necessary tools for continued success and advancing health equity. Recognizing the Impact of Community Health Workers in the Public Health Workforce Pandemic and Beyond During the peak of the pandemic, local health departments employed CHWs as contact tracers, health educators, and care navigators for individuals diagnosed with COVID-19. CHWs promoted and increased access to testing, treatment, and vaccination. At a time when there was a sense of mistrust towards government agencies and the COVID-19 vaccine, CHWs also educated their communities. As the pandemic continues to subside, local health departments must sustain their partnership with CHWs to close the health equity gap and build a relationship with the communities they serve—thereby enhancing trust and a sense of belonging among residents. With proper training and sustained funding, CHWs will be crucial in bridging the gap between government agencies and promoting community engagement on issues other than COVID-19. Case Study: Advancing Equity Grant When the CDC (Centers for Disease Control) announced its two-year $2.25 billion Advancing Equity Grant (AA466), the funds addressed COVID-19-related health disparities and advanced health equity. One central component of achieving the established deliverables of the grant was assessing participating agencies' ability to expand their capacity to serve historically marginalized populations. The North Carolina Department of Health and Human Services was fortunate to receive $39,638,025 in AA466 funding to distribute to 57 participating agencies for joining this worthwhile mission. As one of the 57 recipients, the Cabarrus Health Alliance (CHA) utilized CHWs as trusted liaisons with lived and learned experiences to advance the organizational strategic plan by addressing the social determinants of health. By adopting a deployment model centered on Public Health 3.0, the CHWs effectively launched a referral program that helped close accessibility gaps by improving communication methods, expanding community partnerships, and leveraging technology. Results from satisfactory surveys and client-reported demographics demonstrated that of the nearly 3,000 community stakeholders who served from 2021 to 2023, 68.4% identified with the organization’s priority population. The outcome was immediate improvements in accessibility gaps for county focal areas such as food insecurity, housing instability, unemployment, healthcare access, and transportation. Recognizing the rapid impact of the referral program, CHA implemented a marketing and outreach strategy designed for public viewing and conference platforms to highlight its critical role in strengthening the public health infrastructure. Setting Community Health Workers Up for Success Implementing Sustainable Funding Sources As evidenced by the case study above, CHWs bring invaluable skill sets and experiences that can help achieve public health goals and advance health equity. However, they are undervalued for their contributions to improving health outcomes. Research shows that nearly half of health outcomes can be traced back to one’s zip code and social determinants of health. In Nov. 2023, the White House released the first-ever U.S. Playbook to Address Social Determinants of Health, which lays the foundation for agencies and organizations to provide a holistic approach to health by acknowledging and addressing social and economic conditions that affect well-being. CHWs will be the backbone of these efforts, as they bridge healthcare and social care systems by screening for social determinants of health and connecting individuals to social support—making it easier for patients or community members to navigate complex systems. To continue to support CHWs, there must be broad implementation of sustainable funding sources such as reimbursing CHW services at the Medicaid level. In a survey conducted among employers of CHWs in Texas, only 27% stated that their organization received funding from the Centers for Medicaid and Medicare Services, with 25% not receiving any federal funding. Texas is one of many states that will begin to require managed care organizations to reimburse for CHW services. As of Jan. 2024, only 24 states had reimbursement mechanisms for CHW services through managed care organizations, the 1115 demonstration projects, or Medicaid state plan amendments. Employing the CHW Settings Continuum Framework The Community Health Worker Core Consensus (C3) Project provides a setting continuum framework that highlights how a CHW might be employed in a community or clinical setting and, regardless, their role is consistent and rooted in community advocacy and support. Providing CHWs with training tailored to their community and the setting in which they are employed is crucial to their success. CHWs can be integrated at the local health department level, creating a sense of belonging among community members and removing fear of communicating with a government agency. The C3 Project recommends 10 core skills and competencies, from advocacy to communication, research, and evaluation. While CHWs already have a wealth of knowledge about their communities, their impact strengthens when equipped with the proper training to advocate for their community successfully and support long-lasting changes. Conclusion CHWs are vital to the success of public health efforts. They usually have shared lived experiences with the people and communities they serve, which creates a connection essential to advancing equity—as community members rely on individuals, they know they can trust to make informed decisions about their health. Ultimately, CHWs foster stronger relationships between community members, community organizations, local health departments, and healthcare organizations, which are essential to rebuilding trust that historically harmful and racist practices in the public health and healthcare field destroyed. As such, investing in CHWs as the heart of our public health workforce will help to eliminate inequities in health outcomes. website yes

Learn how CNMI and Palau successfully "planned to plan" in an effort to update and develop new public health plans—developing readiness assessments, team charters, and sequencing plans.

Looking ahead to FY 25 public health appropriations.

This ASTHO blog speaks to leading by example, and gives 3 recommendations for leaders to consider in their daily work habits.

This blog describes public health legislation introduced during the Island Areas’ 2024 legislative sessions.

Utilizing diverse perspectives allows for public health leaders to better serve their communities through leadership development.

Raising awareness about superbugs and promoting a health equity approach to combat them.

ASTHO compiled a list of informative and inspirational public health podcasts to listen to in 2024.

Public health policies that support healthy transportation options for nonmotorists.

Prioritize the mental health and well-being of public health workers who face stress and burnout due to their work; read about practical strategies for improving workplace wellness and the impact of declining workforce well-being on public health initiatives.

State and territorial health officials share priorities and build relationships on Capitol Hill.