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This post highlights three strategies health department leaders can explore to reduce staff stress and burnout in the office: quiet spaces, art on display, and allowing pets in the office.

Xylazine: What Health Agencies Need to Know astho, association of state and territorial health officials, xylazine trend, xylazine, overdose epidemic, overdose deaths, harm reduction, drug overdose deaths, drug related harm, blood pressure, respiratory depression, medical examiners, mental health, reducing the harms, substance use disorder, harm reduction services, drug overdose, people who use drugs, drug overdose epidemic, skin ulcers, puerto rico, overdose prevention, early 2000s, harm reduction programs, synthetic opioids, overdose deaths involve, prescription opioids Stephanie Swanson, Richa Ranade ASTHO | How health agencies are handling the rise of xylazine in the illicit drug supply. Communities across the United States are facing an evolving and complex overdose epidemic, which claimed more than 100,000 lives in 2022. Recent increases in overdose deaths have largely been attributed to illicit fentanyl, which has increasingly been combined with both opioid and stimulant drugs and used to lace counterfeit pills.     Federal agencies have been warning that xylazine, a non-opioid tranquilizer used in veterinary medicine, is infiltrating the drug supply and being mixed with other illicit substances—most commonly heroin and fentanyl. Xylazine threatens to worsen outcomes for people who use drugs and complicate the overdose prevention landscape across the country.  Xylazine is approved for veterinary use in the United States but is not approved by FDA for human medicine. The drug, which is not currently controlled under the Controlled Substances Act, first appeared in the Philadelphia drug supply in the mid-to-late 2010s, but has since spread throughout the northeast and westward. The Philadelphia Department of Public Health reported that more than 90% of opioid samples tested in the city in 2021 tested positive for xylazine. Heroin or fentanyl cut with xylazine is often referred to as "tranq" or "tranq dope." Substances containing xylazine can be ingested orally, snorted, sniffed, or—mostly commonly—injected intravenously. Leading Concerns  People may not know whether they are exposed to xylazine when using other substances, which may place people who encounter it at greater risk for harm. Xylazine is a central nervous system depressant, causing drowsiness, slowed breathing, reduced heart rate, and hypotension, which may increase the risk of a fatal overdose.   The symptoms of xylazine use and opioid use are similar, making it difficult to differentiate whether an individual has used both substances. Xylazine use is associated with skin ulcers, lesions, and abscesses. Individuals who develop a physical dependency on xylazine may develop severe withdrawal symptoms. What Steps are Health Agencies Taking? State and territorial health agencies can take several steps to prevent harm related to xylazine. Agencies can partner with harm reduction organizations, hospitals, substance use treatment providers, High Intensity Drug Trafficking Areas, and medicolegal death investigators to understand whether xylazine is present in the local drug supply.  Connecticut conducted a pilot project with hospitals to collect urine samples from patients who experienced nonfatal overdoses. The Connecticut State Public Health Lab tested the samples between 2021 and 2022, and found that 13% contained a combination of fentanyl and xylazine.  During a presentation about xylazine to medicolegal death investigators in January, 2023, Shobha Thangada, a specialist at the Connecticut Department of Public Health, said, "In cases of fatal overdose, we cannot communicate with those people. However, when patients with a non-fatal overdose come to the hospital setting, we can inform them to watch their drugs and know what is in what they are using." In areas where xylazine is detected, raising community awareness of risks associated with xylazine is critical. Philadelphia, New York City, Connecticut, Massachusetts, and Rhode Island have developed campaigns and awareness materials to alert people about the risks of xylazine and to inform them of ways to prevent xylazine-related overdose. Philadelphia also plans to utilize opioid settlement funding to implement wound care sites for those affected by xylazine.  Those responding to a suspected xylazine overdose are advised to administer naloxone. Though xylazine is not an opioid and does not respond to naloxone, xylazine is commonly mixed with opioids. If an overdose is not responsive to naloxone, providers are encouraged to provide supportive measures.   article yes

As many state legislatures seek to expand vaccine exemptions, it’s important to understand the fundamental differences in exemption type and their impact on a community.

Accompanying an infusion of federal funding, states are considering several policy changes to strengthen the public health workforce and address challenges within the health care workforce.

As the conversation about the importance of mental health continues to unfold, health agencies have a critical role to play in supporting positive mental health outcomes through nutrition support and food assistance programs.

Public health officials have a significant opportunity to provide leadership on the issue of Long COVID, through their own authorities, and by capitalizing on their influence in the public health and healthcare sectors.

Hearing the Hill astho, association of state and territorial health officials, opioid crisis, covid-19 funds, public health, public health data and workforce, american rescue plan, promoting health, drug overdose death, coronavirus preparedness and response supplemental appropriations act 2020, de beaumont foundation, infectious diseases, substance use disorder, health equity, drug overdoses, january 2022, state local, opioid epidemic, opioid use disorder, workforce development, synthetic opioids, overdose deaths, prescription opioids, cares act, health departments, covid-19 pandemic Devon Page ASTHO | Takeaways from congressional meetings on leading public health topics. CSPAN is no Netflix. But that’s not to say this endless stream of content fails to entertain. In one short month, the new Congress has held several richly informative—and sometimes lively—hearings regarding the nation’s most pressing public health topics. The debates over COVID-19 funding, government oversight, and substance control—to name a few—illuminate the multiplicity of party agendas, how members of Congress are grappling with different issues, and opportunities for bipartisan collaboration. Since assuming the majority, House Republicans have been dutifully fulfilling their promise to scrutinize the origins of, funding for, and agency response to COVID-19. Three hearings were held in the first two weeks of February alone. The House Committee on Oversight and Accountability held a Feb. 2 hearing to discuss what Chair James Comer (R-KY) called “the greatest theft of taxpayer dollars in American history,” namely the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. The hearing spotlighted the tradeoff between urgency and accountability: essentially, getting loans out the door quickly created vulnerabilities for fraud. To make matters worse, agencies were slow to implement modernization policies, such as data sharing between agencies, which only exacerbated the problem. While politicking reared its face in some cross-aisle imputations, committee members on the whole recognized that the issue warranted attention and demonstrated a willingness to work together to produce solutions to avoid similar instances of fraud in the future. Just down the hall, the House Committee on Energy and Commerce was holding a hearing titled, “Challenges and Opportunities to Investigating the Origins of Pandemics and Other Biological Events.” Here again, agreement penetrated party lines. Proactively addressing pandemics seemed a unanimous priority, albeit with some caveats: House Republicans focused chiefly on identifying the origin of the COVID-19 pandemic to help the U.S. better prepare for the next pandemic, where House Democrats tied this into preparedness and infrastructure. The blockbuster event of the COVID-19 hearings occurred a week later, featuring Lawrence Tabak of NIH, FDA Commissioner Robert Califf, and CDC Director Rochelle Walensky. Representatives, with a markedly more partisan fervor, explored a myriad of topics—from the impact of CDC guidance on declining public trust to NIH laggard interventional clinical trials for long COVID research—and expressed a mix of dissatisfaction and approval. Amid criticism from largely the conservative members, Walensky was steadfast in requesting broader public health data and workforce authority, as well as robust funding for public health core capacities. Rep. Diana DeGette (D-CO) echoed the director, calling for updated agency data infrastructure. The strong partisanship and serrated critiques of the agencies made clear the canyon-sized gap separating Democrats and Republicans on the federal COVID-19 response. In each of these hearings, at least one representative made mention of a different priority of this Congress: the fentanyl crisis. On Feb. 1, a House Energy and Commerce Health Subcommittee hearing was devoted entirely to the subject. And while Chair Brett Guthrie (R-KY) and Ranking Member Anna Eshoo (D-CA) appear postured to produce bipartisan legislation, differences in how the parties want to approach the issue are not insignificant. Republicans, on the one hand, favor classifying fentanyl as a Schedule 1 drug and cracking down on smuggling across the United States-Mexico border, while some Democrats strongly resist such measures. These points will likely be hashed out in future debates concerning H.R. 467, the Halt Fentanyl Act, and similar legislation. The committee also touched on the importance of investing in mental health. Rep. Tony Cárdenas (D-CA) emphasized the value of the 988 Hotline, and introduced H.R 498, the 988 Lifeline Cybersecurity Responsibility Act, to protect the hotline from cybersecurity incidents. Additionally, Rep. John Sarbanes (D-MD) requested that SAMHA’s Chief Medical Officer Neerja Gandotra, one of the hearing’s witnesses, explain why continued investment in mental health programs is paramount. Gandotra noted that the investments, specifically in youth, lead to decreased criminal justice involvement, fewer hospitalizations, and improved performance in school. There was also a Feb. 9 Senate hearing examining the state of the U.S. territories, which included testimony from the governors of the U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and Commonwealth of the Northern Mariana Islands. Both parties were resolute in supporting the governments. Several senators, including Ranking Member John Barrasso (R-WY) and Senator Mazie Hirono (D-HI), emphasized the importance of supporting Compacts of Free Association (COFA) citizens’ health and social safety nets. With just about 90% of this Congress’s session ahead of them, these issues, among others, will certainly be probed further as the object of congressional concern. Regarding public health, much remains to be said and—hopefully—done. Bipartisanship, no doubt to the surprise of many commentators, seems to be the reigning attitude: a sign of things to come or merely pretense? Only time will tell. website yes

ASTHO's Kimberlee Wyche Etheridge reflects on the state of public health in Honduras, after a recent trip with her medical students.

Exploring the Effect of Public Health Crises on Health Equity Leadership ASTHO, association of state and territorial health officials, public health, social determinants of health, centers for disease control, public health crisis, health disparities, health crises, health leaders, health departments, public health professionals, health leadership, achieve health equity, advancing health equity, health equity, public health crises, public health leadership, covid 19, covid-19 pandemic, public health leaders, health equity leader ASTHO Staff ASTHO | DELPH scholars reflect on the impact of the COVID-19 pandemic on public health leadership. Health equity is at the center of the Diverse Executives Leading in Public Health (DELPH) program. ASTHO, in partnership with the Morehouse School of Medicine’s Satcher Health Leadership Institute, challenges DELPH scholars to reflect on what it takes to bring this equity work to their own health departments. Given the unique circumstances presented over the past few years by the COVID-19 pandemic, ASTHO reached out to a few of our DELPH scholars to discuss what type of leader this moment in public health requires and their experience in health equity leadership during the pandemic. In this blog post, DELPH scholars Ryan Natividad, Sounivone Phanthavong, Krystle White, and Felicia Veasey contemplate whether the times produce the leader or the leader produces the times. This conversation continues a discussion held with the same scholars in a post about elevating community voices through health equity leadership. KRYSTLE WHITE: I recently found a quote from Joaquin de Castro, co-founder of MindReform, that stated, “Great leadership arises through the proper action at the proper time,” and I couldn’t agree more. When it comes to being a public health leader and, more importantly, a health equity leader, what is impacting our community the most shapes our efforts. In a picture-perfect world, certain health crisis interventions would not exist if it wasn’t for health leaders responding with innovative tools to combat the issue. Without the severe impact of the COVID-19 pandemic, the way we responded to certain underserved communities would not have been as robust and impactful. The pandemic, along with the layered issue of medical mistrust, forced us to be innovative in our approach when attempting to remedy social determinants of health for certain communities where the pandemic further exacerbated these engrained issues. We had to adjust or redevelop local policies and interventions during this time, as what had worked in the past no longer served those impacted. Effective leaders are tried and tested and can push past difficulties and power forward during some of the tensest times in our history. FELICIA VEASEY: Who I am as a leader now versus who I was before COVID-19 are different. Three years ago, I would have never thought that I could or would serve as the COVID-19 Operations Director for 11 counties while maintaining my role as the community systems director. However, seeing the need of the community, its correlation to chronic diseases, and those most impacted by COVID-19, fueled my desire to lead. I saw the need to lead, in part to speak up for those not around the table making decisions. The pandemic stretched me professionally and spiritually. The ever-changing COVID-19 environment birthed abilities and skills that I didn’t know I possessed. RYAN NATIVIDAD: “Extraordinary times call for extraordinary measures. We saw a need that needed to be filled, and we stepped in to help.” This Benet Wilson quote captures the ardent spirit of my current millennial generation. Among previous generations, millennials are considered the unluckiest generation after surviving various recessions (i.e., the dot-com bubble recession, the Great Recession, and the COVID-19 recession) and powering through the COVID-19 pandemic. Due to these circumstances, I feel that millennials are the “Resilient Generation.” Whatever we endure, we keep our heads high and work towards the future we want. SOUNIVONE PHANTHAVONG: Leaders must be responsive to the environment and conditions in which they are operating. Promoting health equity requires not only an understanding of the structural, social, political, and environmental conditions of health but also the root causes of such conditions. Even with these understandings, well-structured plans are still subject to infinite variables. A leader should be ready to adapt to changes and address emerging needs. A leader working with the times considers what is needed, works towards growth, leverages strengths, identifies opportunities for improvement, provides responsive support, and builds capacity. A leader should aid in addressing conditions that impact the time it takes to make progress towards achieving health equity. A leader who aims to produce the times may face unanticipated challenges that will hinder their ability to achieve their desired outcomes. Systemic issues have limited health equity, with many issues rooted in historical and intentional oppression. These systemic issues require systemic changes. A health equity leader must prepare to work within these systemic conditions to produce macro- and micro-level outcomes. Large Padding 3 Related Content-Blog - DELPH desciption - cake layer website yes

CDC's 2011-2021 Youth Risk Behavior Survey results, summarizing data from the past decade, show some alarming trends in mental health conditions, especially for teen girls, LGBQ-identified youth, and youth of color.

Five great reasons to attend ASTHO's 2023 Health Equity Summit.

The Louisiana Department of Health HAI/AR program highlights the current landscape of HAI/AR programs, the benefits of having leadership dedicated to the HAI/AR program mission and priorities, and the need for alignment of HAI/AR program communications and structure with state and territorial health agencies.

Economic security and well-being, job stability, access to safe and affordable housing, access to healthy and nutritious foods, and access to resources to manage mental and physical health—all of these things impact individual, family, and community health. The COVID-19 pandemic has fundamentally impacted each of these social determinants of health for many Americans. Furthermore, some communities and industries have faced harder economic impacts than others, including households with low incomes, non-white households, and households with children. Human services and public health leaders can collaborate to make sure we are rebuilding systems and programs in a way that creates healthier, more resilient families and communities.

An increasing body of research finds racism can have a significant impact across one’s lifespan. Research shows that persistent exposure to racial discrimination may result in premature aging, poor health outcomes, and increased prevalence of certain chronic diseases. At every level of government, policymakers are seeking to acknowledge the systemic oppression of people of color that persists and to elevate racism as an urgent public health crisis comparable to other public health emergencies.

As COVID spread through the country and infection rates rose in every state, many of the the U.S. Affiliated Pacific Islands (USAPI) received media attention for remaining relatively COVID-free. The USAPI’s unified response in the face of a global pandemic is a history-making tale of collaboration, communication, and partnership. The successes of public health leaders provide important lessons for preventing, preparing for, and responding to future public health emergencies.

The opioid crisis continues to claim the lives of thousands across the United States and has cost the economy billions in health care, mortality, and criminal justice costs. In 2018, it’s estimated that 67,367 people died of overdose, with opioids (prescription opioids, heroin, and other synthetic opioids other than methadone) made up almost 70% of overdose deaths. Provisional data for the twelve-month period ending December 2019 shows that there were 71,130 overdose deaths, with 50,178 overdose deaths attributed to opioids. The COVID-19 pandemic has also exacerbated the drug overdose crisis. Data shows that in the time of continued lockdowns and social distancing that overdose rates have increased, indicating a sustained need to support people with substance use disorder.

Two rising health trends are negatively affecting women’s health across the United States: maternal mortality (death from pregnancy or delivery complications) and severe maternal morbidity (mental and physical health consequences from a pregnancy or delivery.) Maternal mortality review committees (MMRCs) are one of the best ways to gather information on why pregnancy-related deaths occur and how to prevent them. Studies show that MMRCs can reduce maternal mortality by 20-50% since they examine the underlying causes of maternal mortality, use data to identify gaps in care, and inform a focused approach to prevent deaths and reduce disparities.

Whatever stage agencies are in addressing the intersection of suicide, overdose, and ACEs, ASTHO’s SPACECAT Capacity Elements Toolkit simplifies action ideas for health agency staff and leadership to begin or continue their efforts.

In the current legislative cycle, there are several policy strategies that support the development and integration of community health workers into the public health workforce, including dedicated federal funding and state laws supporting workforce development programs, certification standards, and Medicaid coverage.

We can prepare for the future of health equity and data by ensuring the equitable collection of data and building systems that are flexible enough to account for forward progress.