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In-depth analysis on state health policy surrounding health equity. This is part of ASTHO's annual legislative prospectus series.

During the COVID-19 pandemic, public health authority has been used to require the use of face masks and encourage social distancing, and other measures. In several states these legal authorities have been challenged and, in many jurisdictions, limited or eliminated by the legislature. Maintaining the legal authority to prevent and control the spread of infectious disease is crucial to preparing for and addressing disease outbreaks.

ASTHO’s legislative prospectus on Immunization Information Systems, Health Information Exchanges, and balancing data privacy with sharing

The State Health Policy portfolio includes an annual legislative prospectus series. These briefs summarize upcoming legislation proposals that impact public health across the states and territories.

The State Health Policy portfolio includes an annual legislative prospectus series. This document is from 2021 and addresses the COVID-19 pandemic.

Explore how states are enacting legislation to help justice-involved people avoid overdose illness and death and foster a smooth transition after release.

Learn about chairs of key committees in the 119th Congress, their priorities, and what may be in store for public health funding in this federal health policy update.

Learn how the Maryland Department of Health leveled up their strategic planning process to improve their critical public health work in this blog post.

Thousands have been diagnosed with cyclosporiasis, which can cause explosive diarrhea and be tough to track. Learn the latest outbreak and investigation details.

Explore how community coalitions and public health agencies work together to prevent youth substance use.

Cases of sepsis and septic shock can be prevented with strong health policies as shown in New York. Several states have taken action to enact mandatory early detection and treatment protocols.

Read ASTHO's latest on how appropriations bills and budget cuts could affect the Debt Ceiling and the U.S. economy.

The VDH Internship Academy, funded by PHIG, is a key pipeline for public health careers with paid, growth-focused internships.

2026 Blog Posts article

Learn how states braid funding, build partnerships, and advance policy to tackle ACEs, overdose, suicide, and mental health.

Learn how Wisconsin is streamlining processes to improve the administrative experience for local health departments.

Communication, Community, and Power-Sharing: A Conversation with DELPH Scholars Communication, Community, and Power-Sharing Learn how public health leaders are moving from a top-down approach to a collaborative model that builds and sustains trust with community partners. The current public health landscape can feel daunting, uncertain, and increasingly stressful for leaders to navigate. While public health professionals have a wealth of expertise, reliance on expertise isn’t enough; collaborative leadership points the path forward. Moving away from traditional top-down approaches, effective and innovative leaders are learning to share power, practice meaningful community engagement, and create environments where partners, community, and staff feel valued and heard. Three scholars from ASTHO’s Developing Executive Leaders in Public Health (DELPH) program discuss how they apply these principles to strengthen collaboration within public health and build more resilient communities. Meet the Scholars Working in public health is not individualistic; it requires working collectively to achieve a common goal: healthier communities. These three scholars are championing collaboration. Brandon Horvath, Assistant Program Manager of Preparedness at the Philadelphia Department of Health, believes in the power of collaboration to navigate periods of uncertainty and that moving away from top-down leadership allows space for new ideas to flourish. Ethan Greenblatt, Health Education Supervisor at the Saint Louis County Department of Public Health, focuses on building partnerships to combat misinformation, amplify accurate messaging, and support overlooked populations. Halana Kaleel, Public Health Community Engagement Specialist at Austin Public Health, centers her work on developing genuine engagement between partners before making decisions that impact the collective, emphasizing that participation and power-sharing build trust. “When city council, city management, and other departmental leadership attempt to implement programs, policies, and budgetary changes without doing engagement and collaboration with the impacted community first, they lose trust with the communities we are trying to serve.” — Halana Kaleel Brandon, you oversee emergency communications as part of your role with the Philadelphia Department of Public Health. Can you talk more about the strategies and frameworks you have applied and how they help your team manage complex projects during both emergencies and blue-sky days? BRANDON HORVATH: When deciding how best to infuse collaborative leadership principles into our current reporting structure, I wanted to ground my approach in something relatable that staff would typically associate with comfort and relaxation. That’s when I thought back to the activities that worked best for relieving stress during the COVID-19 pandemic response. In my case, those were running, binge-watching a new TV show, or endlessly scrolling through TikTok. Each of these activities has a few key ingredients in common: time and energy set aside to make the activity happen, and controls to customize the experience. I factored these in when developing two activities that encourage staff participation, collaborative leadership, and feedback. The energy check is a self-reflection activity I like to start off our weekly touch-base meetings with, intentionally setting aside time to highlight accomplishments, discuss challenges staff were experiencing, and set attainable goals and priorities for the next week. Let’s talk it out is a collaborative leadership exercise where staff are encouraged to lead the conversation, using a set of functions you’d find on a remote control: Settings, Pause, Rewind, Fast-Forward, Record, and Power On/Off. The conversation begins with Settings, where we establish ground rules and outline expectations, acceptable behaviors, and how decisions will be made. Regardless of how the activity unfolds, it is important to document what’s discussed, identify any successes or pain points, and work together to draft next steps and potential solutions. Some optional functions can be folded in, depending on time and complexity. Pause (Reflect) involves making space for reflection, which can help ensure continuous improvement and make adjustments easier, regardless of where you’re at in a project. Rewind (What Worked) involves looking back at past decisions or progress since the last check-in, which can help ensure successful strategies are repeated and mistakes are avoided. Fast-Forward (What Do We Want to See) encourages discussion of what you would consider a successful partnership or collaboration. This is especially helpful when a project is complex and involves many stakeholders. Power On/Off (Let’s Revisit This) should be considered when a project is not progressing or we’ve identified pain points that require follow-up. This can bring the conversation to an intentional end, and another time can be set when all involved will regroup and resume planning. The strategies and frameworks you choose to apply will likely vary based on the role you play, the collaborations already underway, and the level of buy-in within your organization or team to shift away from the current project management approach. Ethan, in Saint Louis County your department has utilized community-based partnerships for vaccination efforts and to address the opioid epidemic. How does focusing on building community partnerships help address misinformation, reduce stigma, and increase trust? ETHAN GREENBLAT: Community partnerships allow public health agencies to meet people where they are, both physically and culturally. By working with trusted local institutions and leaders, our partners can deliver public health messages with voices that communities already know and respect. These collaborations also provide valuable feedback that helps programs remain responsive, relevant, and grounded in community needs. Halana, you emphasized that collaborative leadership requires a paradigm shift away from performative community engagement. How can governmental public health agencies transition to power-sharing to rebuild trust with community members who have been historically disenfranchised and excluded? HALANA KALEEL: In discussions with community members and stakeholders, time and time again they saw that they were only being consulted after decisions had already been made. Saying things like, “we want to hear from you” is performative engagement when you already know how you are going to approach an issue. At the end of the day, many communities would rather have honesty about a bad system than feel tricked by tokenistic engagement. To share power with community and stakeholders, governmental public health agencies need to provide opportunities for the communities they serve to participate in decision making at the beginning of the process, and we should empower and hire staff or liaisons who reflect the communities we are trying to reach. We also need to meet people where they are through more informal engagement instead of continuing to force community members who have been disenfranchised to come into governmental spaces that may be hard to reach and perceived as too formal. Lessons Learned and Actionable Advice Reflecting on your experiences, how do you actively build and maintain trust with community partners, staff, and stakeholders? HORVATH: Building and maintaining trust with staff requires leaders to be consistent, reliable, and authentic in their approach. For me, it’s always been about showing up and following through. Creating safe spaces, both formal and informal, where staff can share feedback and ideas, is the first step to making two-way communication happen. Recognizing staff for their accomplishments and highlighting team wins reinforces both trust and integrity. These same approaches can be applied when working in the field or communicating with a variety of stakeholders. GREENBLATT: Building trust requires consistent communication, transparency, and a shared sense of purpose. I focus on developing relationships over time and ensuring our partners feel heard and included in decision-making processes. It is also important that teams and stakeholders align around the organization’s mission, vision, and goals. When partners have a role in shaping the direction of an initiative, they are far more invested in its success. KALEEL: One of my best practices is focusing on closing the feedback loop by showing community members exactly how their input and feedback directly inform final plans and policies. What practical strategies can public health leaders use to strengthen partnerships and build more resilient public health systems? KALEEL: Something that can be daunting, especially during times of uncertain funding, is compensating community for their time and expertise, but this can be something as simple as small stipends, gift cards to local grocery stores, or feeding people at events. HORVATH: Start with a clear purpose. Set aside time to meet with your team to talk not only about what each person will be doing but why it matters. Find ways to infuse collaborative leadership into the culture, such as trying out a new approach to staff check-ins or promoting shared ownership of projects. Most of all, it is important to meet your staff and community members where they are and to be flexible with your approach. Mistakes will happen, but how we learn from them and adapt can help us be more prepared and resilient the next time. GREENBLATT: Public health leaders can strengthen partnerships by being intentional about how they engage with communities and partners. An important starting point is understanding the local landscape — specifically the initiatives, organizations, and trusted leaders in your community — so you can build on what’s already working rather than duplicating efforts. It’s also important to identify shared goals, making

Partnership as the Foundation for Advancing Adolescent Health in American Samoa Partnership Advances Adolescent Health in American Samoa Gabby Ruiz Learn how American Samoa advances adolescent health in American Samoa through collaboration among state and local health and education agencies. Cross-sector partnerships are essential to advancing adolescent health, particularly in school-based settings. The intersection between public health, education, and clinical health is vital to the delivery of integrated services. In the United States, it is estimated that children in grades K-12 spend at least 1,231 hours each year in school, not including time dedicated to clubs or extracurricular activities. When schools function as trusted environments where health and learning meet, they become powerful access points for early identification of needs, preventive services, and supportive relationships. The public health sector brings expertise in prevention, population-level data, and community engagement. Meanwhile, the education sector provides youth engagement and the ability to creatively embed health into learning environments by leveraging diverse resources. When sectors work in isolation, resources are used inefficiently and adolescents may experience gaps in care, fragmented supports, and inconsistent access to essential services. With support from CDC’s Division of Adolescent and School Health, ASTHO leads the Leadership Exchange for Adolescent Health Promotion Plus Community of Practice, an initiative that promotes collaboration among state and local health and education agencies to strengthen health education, connect schools to services, and foster safe, supportive learning environments. This initiative provides a space for teams to share ideas, troubleshoot challenges, and build sustainable partnerships. Through this effort, the American Samoa team built a strong partnership between the Department of Health and the Department of Education to expand and enhance effective communication about sexual and reproductive health to reduce risk taking behaviors and promote protective factors. Peer-to-Peer Learning as a Catalyst for Youth Engagement Grounded in the belief that young people are often the most trusted messengers for their peers, the American Samoa team launched the Students Promoting Education, Awareness, and Knowledge (SPEAK) project: a student-led, peer mentor collaborative effort between the American Samoa Department of Education (ASDOE), the American Samoa Department of Health (ASDOH), and youth peer leaders. The project builds a network of trained peer educators who engage students on topics such as healthy relationships, personal responsibility, privacy, consent, HIV, STI, and pregnancy prevention. SPEAK peer leaders are students in grades 10 through 12, with two or more representatives from each grade level. High school counselors help identify students suited for this role, which includes: Co-creating educational materials that reflect their identities (i.e., their values, abilities, and lived experiences). Fostering safe spaces for support and dialogue. Managing online platforms that allow youth to ask questions anonymously. Collaborating with schools, communities, and health care providers to develop and promote educational campaigns through social media channels. SPEAK promotes student leadership, shared accountability, and open, stigma-free dialogue. Forging Strong Relationships Alignment and Sustainability From the beginning, ASDOH and ASDOE committed to building a unified team to support adolescent sexual and reproductive health. This collaboration became one of their greatest strengths. The team noted that establishing a shared vision early on helped them maintain momentum through challenges. Donation Ape, ASDOE Program Director, played a pivotal role in bridging agencies and strengthening the network that supported the project’s success. While Ape’s dedication and tenacity have been key to nurturing this partnership, both sides of the team are working to ensure that this partnership is sustainable. “With the right network, we were able to do it.” — Donation Ape, ASDOE Program Director Thoughtful Health Education In addition to coordinating across school systems and community partners, long-standing cultural values that emphasize privacy around family and personal matters made open discussion of adolescent health topics more challenging. Prior to SPEAK, students were not receiving structured health education in this area. ASDOE staff and leadership initially expressed understandable concerns about ensuring any peer-led approach would be age-appropriate, culturally respectful, and aligned with community standards. A key strategy for addressing these concerns was thoughtfully engaging youth alongside educators, families, and community stakeholders to help demonstrate the need and shape a solution to delivering health education. “When you see young people not just as children but as contributors to society, you start to see what’s possible.” — Fatih Seiuli, Health Educator, ASDOH Key Considerations for State and Territorial Health Agencies American Samoa’s experience offers key insights for other jurisdictions seeking to strengthen adolescent health through school-based partnerships: Integrate public health into education, clinical health, and mental and behavioral health to ensure a more holistic and sustainable cross-sector approach. Together, these sectors form a coordinated system that has the capacity to address pertinent adolescent health concerns. In addition, youth hold a critical role in their own care, and engaging them as part of these cross-sector partnerships is essential to adolescent health program uptake and understanding. Involve essential community voices by engaging key stakeholders and end users early on. Creating a peer educator network and creating space for youth-led engagement ensures programs reflect young people’s lived realities — increasing relevance and reach, and fostering trust and ownership among students who may otherwise feel disconnected from traditional health messages. Adapt curricula with cultural responsiveness. Integrate bilingual materials and tailor them to the unique needs of communities — expanding reach across cultural contexts and addressing stigma or other social and structural barriers. Additionally, ensure the framing of the program is appropriate for audiences and helps to overcome cultural barriers. Looking Ahead American Samoa’s journey demonstrates how intentional partnerships, youth leadership, and culturally grounded approaches can advance adolescent health in meaningful and sustainable ways. Their work reinforces that collaboration is a critical strategy that serves as the foundation for lasting impact. ASTHO will continue supporting jurisdictions through the Leadership Exchange for Adolescent Health Promotion Plus Community of Practice by fostering connections, strengthening multi-sector partnerships, and creating spaces where teams can learn from one another. As American Samoa’s experience shows, meaningful progress in adolescent health is possible when sectors and systems align around a shared purpose. Reviewed by - Akbarali, Mackie, Vance article yes

Workforce Trends in Public Health Preparedness Workforce Trends in Public Health Preparedness Kelsey Tillema, Adrianna Evans Learn about ongoing changes to the public health preparedness workforce and how to best support these workers. Public health preparedness professionals fulfill critical functions in the event of a public health emergency, such as coordinating emergency response planning, managing incident command structures, and ensuring readiness for a multitude of threats. This essential group of workers faces significant strain, especially after the COVID-19 pandemic, which accelerated major workforce changes within public health. The prolonged emergency response intensified staff burnout and increased turnover, prompting many professionals to retire or even leave the field. New data shows the public health preparedness workforce specifically is less tenured and navigating unique challenges when it comes to shifts in funding and policy priorities. When it comes to who’s behind the scenes of preparedness and response, it’s crucial to consider how to maintain an engaged workforce capable of scaling, coordinating, and sustaining response operations under pressure. The Workforce Landscape According to the 2024 Public Health Workforce Interests and Needs Survey, the preparedness workforce makes up roughly 13% of the state and local public health workforce. Of these approximately 30,000 workers, nearly a quarter (23%) are age 35 or younger, and another quarter (28%) are 55 and older. Although this is not unique to the preparedness workforce, this reflects an aging workforce as experienced staff approach retirement and new professionals enter the field. Further, about half of preparedness health agency staff (49%) have been with their agency for less than five years. Considering this transition, health agencies may face the loss of institutional knowledge related to emergency operations, incident command structures, and preparedness and response protocols. As experienced professionals exit the workforce, this may also create gaps in mentorship, leadership, and overall response experience. However, like the rest of the public health workforce, most preparedness staff (73%) show commitment to staying with their organizations for at least the next year. Preparedness staff cited benefits, job stability, and supportive coworkers as their main reasons for staying. On the other hand, the top reasons for leaving are pay, organizational culture/climate, and lack of opportunities for advancement. To gain insight into gaps within the workforce’s expertise, preparedness leaders may want to consider partnering with their agency’s internal workforce development team to conduct a workforce assessment within their program. Regularly assessing a preparedness team’s skillset and needs can give greater clarity on how to best support team development and growth. Agency leadership can create cohesion between tenured and new professionals by offering or supporting both formal and informal mentorship, and establishing avenues to create familiarity with response systems, interagency coordination, and real-world experience. Newer professionals may bring fresh perspectives and diverse skillsets to the workforce but need support from tenured staff to become well-versed in the preparedness sector. At this juncture, succession planning and supporting career advancement pathways are essential components to building up the next generation of leaders in public health preparedness. Knowledge Transfer and New Skills Whether responding to pandemics, natural disasters, or radiological events, working in preparedness requires strategic and cross-disciplinary capabilities that go beyond traditional emergency response. During a public health emergency, staff must rapidly activate response plans, coordinate across agencies, and make high-stakes decisions. Since evidence shows that many workers are new to the field, it’s crucial to ensure that staff are continuously learning internal systems and building preparedness-specific skills. Both new and rising preparedness staff members need a variety of skills to make informed decisions and grow within their organizations. Areas such as administrative preparedness, navigation of policy and legislative processes, and leadership development are all key to creating a cohesive internal workforce system. Leadership skills are crucial for preparedness staff, who must coordinate across agencies, communicate crisis and risk information to a variety of audiences, and operate within the Incident Command System. Other important and emerging topical considerations for skill expansion include data analytics, artificial intelligence, cybersecurity, multimedia risk communication, and specialized areas of preparedness (e.g., accessibility, radiation readiness, climate and animal health), to name a few. While some of this knowledge can be passed on through mentorship or job experience, staff should also have access to structured, high-quality learning opportunities. Continuing education courses, certificate programs, and tuition reimbursement can all support staff development. Policy and Funding Considerations Internal workforce policies have significant influence on an agency’s workforce retention, morale, and skill building. Beyond salary, policies related to flexible working arrangements, paid training time, career advancement opportunities, and recognition and well-being programs all contribute to how supported staff feel in their roles. Agency leadership can also assess their broader levels of policy, such as student loan repayment and tuition assistance, to make preparedness careers more competitive and accessible. Externally, public health preparedness programs rely heavily on federal funding streams such as the Public Health Emergency Preparedness cooperative agreement and the Hospital Preparedness Program. As a result, preparedness hiring and turnover cycles can be influenced by grant timelines. As federal priorities shift, this uncertainty can make it challenging for agencies to sustain long-term workforce investments and main continuity of operations. Many agencies are exploring ways to adapt, using strategies to braid and layer funding streams to stabilize staff, while others use supplemental funds such as the Public Health Infrastructure Grant to invest in foundational capabilities and workforce development beyond just preparedness activities. Preparing for the Future Agencies have an opportunity to address the primary drivers of attrition and strengthen the preparedness workforce. Expanding workforce development opportunities internally and externally will help to maintain institutional knowledge and prepare the workforce for evolving modern day threats. While the future of public health preparedness does rely on funding and policy, it also relies on skilled, committed workers. As the workforce landscape continues to evolve, investing in the development, retention, and lifting up of a generation of new leaders will determine how effectively we respond to future crises. Learn more about strategies and resources to support the public health preparedness workforce from ASTHO’s Inspire Readiness Workforce page and the ASTHO Workforce Resource Center. ASTHO will continue to share promising practices to support preparedness staff. Reviewed by - Allen, Peterson article yes

Learn how Missouri, Michigan, and Tennessee use integrated, accessible, and timely data to prevent the intersection and improve health outcomes.