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Addressing the impact of substance use disorder on pregnant and postpartum individuals: a critical analysis of SUD policy, access to care, and lessons from the field.

State and federal efforts to bolster health care access for underserved rural communities.

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 Success Story: In Massachusetts, Building Public Health Infrastructure Starts with a Strong Workforce Elise Moore Massachusetts open houses, supported by CDC's Public Health Infrastructure Grant (PHIG), connect the community with public health careers. Open houses are an opportunity for health departments to engage the community, foster trust and transparency, and build pathways for people seeking a career in public health. In late 2023, the Massachusetts Department of Health (DPH) held two virtual open houses—supported by the Public Health Infrastructure Grant (PHIG)—for students and alums of Massachusetts colleges and universities. More than 400 participants connected with state and local public health officials in various panels and networking events. DPH’s Workforce Director Arnaldo Machado shared his insights, lessons learned, and testimonials from staff about the experience with ASTHO. What strategies did DPH employ to engage participants? ARNALDO MACHADO: The "Who's in the room?" activities helped engage the participants and highlight our focus on racial and health equity. We were very clear about the reason for that exercise: ensuring we are reaching the communities we serve. The one-hour themed breakout rooms (15 minutes of staff presentations and 45 minutes of Q&A) were the highlight of both events. They fostered an interactive experience for participants. Lombardo-MA Building PH Infrastructure Starts with Strong Workforce - Block 1 What challenges did you encounter during the open houses and how did you meet them? MACHADO: A significant challenge was overcoming the immediate results mindset, which can sometimes be in conflict with the efforts needed for pathway events such as open houses. Unless that mindset changes, we will forever be working on short-term initiatives. A lot of times, people want to see immediate changes to hiring numbers. However, just as community engagement efforts do not result in enhanced public health outcomes overnight, pathway events yield results over time. After each event, more than 200 prospective candidates for the public health workforce are better informed about career paths, the human side of the department, and how to get more help. We aim to dismantle the large institutional view many people may have of us as an organization in the distance. Hopefully, we took one step further, through transparency, in building a relationship of trust with those present. So, we don't only measure the event's success based on immediate hires. Rather success is in the reach of our events, which will bear fruit for years to come. Beluk-MA Building PH Infrastructure Starts with Strong Workforce - Block 2 What insights have you gained from the post-event evaluation survey? MACHADO: My biggest measures were the levels of participation and overall satisfaction with the event. The participation rate of attendees versus registrants was around 50%, which is the average for DPH during recruitment events. We filled those registrations relatively quickly with minimal promotion to social networks and leveraging our academic health department partnerships. We also saw the satisfaction ratings grow between the first and second events. Participants appreciated the transparency in the hiring process presentations and felt more prepared to apply for DPH jobs. They also loved the opportunity to connect with people who worked in the department. Participants also asked for the opportunity to participate in more than one breakout session—and even though that opportunity was available at the second event, it came at the cost of losing content since all breakout sessions were concurrent. We resourced some of the session, so people won't have to experience repetitive content in the future. Turner-MA Building PH Infrastructure Starts with Strong Workforce - Block 3 Looking ahead, how do you anticipate leveraging PHIG funding to promote public health careers and engage with students and alumni from Massachusetts colleges and universities? MACHADO: With a shift to skills-based hiring in Massachusetts, I am thinking much beyond formal academic institutions for future outreach. We will continue to invest in academic pathways, and our academic health department manager is committed to that. Still, we are also forging partnerships with local career centers and veteran service programs and planning to reach young adults in the K-12 system. Additionally, we are using PHIG funding to implement significant career promotion efforts on our website through workforce highlights and clarification on many roles in the department. For year two of the grant, we have identified employees in nine domains determined by need—measured in long-time-to-hire metrics tracked for PHIG—and by strategic alignment. Contact Department-Blog - In Massachusetts, Building Public Health Infrastructure Starts with a Strong Workforce OE22-2203 PHIG 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

Learn how public health agencies are improving their financial management strategies and systems.

Learn how state and territorial legislatures can bolster or restrict public health legal authority, with examples from early COVID-19 as well as 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.

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

Reviewing states' efforts to reduce children's exposure to lead.

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

Heart Disease and Stroke Prevention in the Pacific Territories heart disease, stroke prevention, american heart month, cardiovascular health, chronic disease, pacific territories, environmental infrastructure, disease epidemic, tobacco use, mental health, united states, physical activity, health problems, leading cause of death, health conditions, american heart, cardiovascular disease, chest pain, type of heart disease, coronary heart disease, heart health, flow to the heart, risk of heart disease, heart disease and stroke, prevent heart disease, astho, association of state and territorial health officials Marcus Plescia Heart disease and stroke prevention in the pacific territories. Each February, American Heart Month raises awareness for heart disease and cardiovascular health—a matter that warrants attention year-round. In ASTHO’s 2023 Environmental Scan, territorial health officials highlighted chronic disease prevention and treatment as top current public health program and service priorities, emphasizing heart disease and stroke as key focus areas. As such, I want to highlight heart disease as a public health issue in the U.S. territories, which have played an important role in ASTHO’s chronic disease prevention efforts. Several years ago, ASTHO CEO Mike Fraser pointed out Mark Durand’s work in the Pacific territories. Durand developed a list of prioritized chronic disease-related health policies and a matrix to map progress across six jurisdictions. This ultimately provided the basis for ASTHO’s Essential Policies for Chronic Disease Prevention and Control—which served as a foundation for ASTHO’s Heart Disease and Stroke Prevention (HDSP) Learning Collaborative—and led to the launch of ASTHO’s technical packages in all program areas. Heart Disease and Stroke Prevalence in the Pacific In the United States, heart disease is the first leading cause of death and stroke is the fifth. Disparities exist across several demographic lines, including race, ethnicity, and nationality. U.S.-Affiliated Pacific Islands (USAPIs) adults have the second-highest death rate from cardiovascular disease in the country. Additionally, in all USAPIs involved in ASTHO’s HDSP Learning Collaborative—Commonwealth of Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), Guam, and Republic of Palau—heart disease and stroke are in the top three leading causes of death, with cases soaring in recent years. The U.S. territories are home to small and diverse populations with rich history, cultural practices, and languages. Unfortunately, the long-lasting impacts of colonialism have weakened the social, cultural, and environmental infrastructure that has historically protected the health of USAPIs communities. In recent decades, health threats have shifted from infectious diseases to preventable chronic diseases; the Pacific Island Health Officers Association even declared a Regional State of Emergency in 2010 because of their non-communicable disease epidemic. Since this declaration, there has been increased interest in and efforts toward policy and health system interventions in USAPIs, which ASTHO has been proud to support through our learning collaborative. Heart Disease and Stroke Prevention Learning Collaborative: Key Accomplishments Since 2013, ASTHO has partnered with CDC to develop and sustain the HDSP Learning Collaborative, focused on improving rates of hypertension. In all, 36 participating states, territories, and freely associated states have implemented innovative strategies through systems, policy, and quality improvement processes. Historically, this learning collaborative—open to both states and islands—has focused on the design and implementation of hypertension control programs. In USAPIs, program efforts evolved to address and improve cardiovascular health more broadly. Although USAPIs workplans differ from each other, they all have advanced health equity by understanding community needs and adapting to health system capacity. Table-CMO Heart Disease Stroke Prevention in the Pacific Tools for Change/Spotlight-CMO Heart Disease Stroke Prevention in the Pacific website yes

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

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

Tobacco control has been a public health success in states across the nation, but there is still work to be done, especially surrounding the popularity of menthol and other types of flavored tobacco.

While communities transition from emergency response to long-term monitoring and recovery, the federal government and states are taking legislative action to improve emergency preparedness capabilities.

Federal and state legislation can play a role in promoting positive infant mental health by providing funding and policies that support early intervention, caregiver assistance, and the creation of nurturing environments conducive to their emotional well-being.

There are a number of court cases playing out across the country that could affect the options state and territorial health officials have to limit the spread of disease and promote health and well-being.

To address the youth tobacco epidemic, jurisdictions filed lawsuits against JUUL to end their marketing practices aimed at youth and to obtain compensation from the financial toll experienced by communities.