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In this episode, we explore Pennsylvania’s multi-pronged approach to addressing the opioid epidemic in the state and efforts to expand access to Medication Assisted Treatment.

This episode emphasizes the importance of addressing heart disease and stroke prevention through approaches that center on health equity, including systems-level changes, quality improvement, and community development. CDC’s Division for Heart Disease and Stroke Prevention is partnering with ASTHO to support jurisdictions in successfully integrating efforts with healthcare and community partners and implementing best practices and evidence-based policies to identify, control, and improve blood pressure.

Co-authors from CDC and the Alzheimer’s Association provide details about the new 2018-2023 Healthy Brain Initiative Road Map, which offers strategies for public health agencies to promote cognitive health and support people living with dementia and their caregiver, and a forthcoming companion guide for Indian Country.

This episode highlights ASTHO’s President’s Challenge, “Building Health and Resilient Communities,” which is a multi-year campaign that calls on state, territorial, local, and tribal health officials to align strategic investments and promote community-driven, place-based solutions to empower communities to be as healthy as possible, reduce health disparities, and stimulate economic development. The challenge is aligned with the National Association of County and City Health Officials (NACCHO) and the U.S. Surgeon General’s focus on community health and economic prosperity.

In this episode, we will hear national and state perspectives on the prevention and containment of unusually resistant bacteria, which is a growing threat in the United States. Containing its spread through action when even a single case of an antimicrobial resistant bacteria is identified is a priority public health strategy.

In the Public Health Review podcast debut, host Robert Johnson speaks with public health officials from Alaska, Kentucky, and West Virginia about the ongoing opioid epidemic in the U.S. and its intersections with other epidemics like neonatal alcohol syndrome and hepatitis C.

Don't Panic! A Panel on How to be an Effective Crisis Communicator This ASTHO webinar explored strategies for strengthening jurisdictional capacity for public health risk communication. The panel discussion featured insights from the subject matter experts, state health department representatives, and public health leaders listed below. The session showcased best practices for communicating about trending public health threats, innovative resources for applying the latest risk communications research, and an overview of practical tools to help public health communicators effectively address crises and emergencies across diverse jurisdictions. Speakers Amanda Kwong, MPH: Director, Public Health Communications Collaborative Kelley Richardson, MPH, CHES: Communications Supervisor, Division of Public Health, North Carolina Department of Health and Human Services Ann Rowe: Executive Board President and Member-at-Large, National Public Health Information Coalition Kasisomayajula Viswanath, PhD: Lee Kum Kee Professor of Health Communication, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health Moderator Susan Kansagra, MD, MBA (Alum-NC): Chief Medical Officer, ASTHO article yes

Investing in Public Health Infrastructure: Indiana's Success Story website yes

Leading Through a Pandemic: Teamwork and Crisis Communication Hear former and current State Health Officers and their Public Information Officers reflect on working together during the COVID-19 pandemic. 1/4 bottom Speakers Lee A. Norman, MD, MHS, MBA: Alum-KS John Wiesman, DrPH, MPH: Alum-WA Jessica Baggett, MPH: Former Public Information Officer (WA) Ashley Jones-Wisner: Former Public Information Officer (KS) Arundi Venkayya: Current Public Information Officer (OH) website yes

Arkansas Department of Health Secretary Nate Smith Named ASTHO President BETHESDA, MD—The Association of State and Territorial Health Officials (ASTHO) announced the appointment today of Nate Smith, MD, MPH, secretary of health at the Arkansas Department of Health, as ASTHO’s new president, effective Sept. 25. “I’m thrilled to serve as president and look forward to working hard to ensure that everyone has the access and ability to be healthy,” says Dr. Smith. “I look forward supporting my colleagues at the federal, state, and local levels to address the many public health challenges and opportunities affecting the United States.” Dr. Smith has served as Arkansas’ state health official since 2013, where he provides senior scientific and executive leadership and strives to help colleagues achieve their full potential using public health best practices supported by science-based decisions. Dr. Smith previously served the Arkansas Department of Health as branch chief for infectious diseases, state epidemiologist, and deputy director for public health programs. He is board certified in internal medicine and infectious diseases and holds voluntary faculty positions in the Division of Infectious Diseases at the University of Arkansas for Medical Sciences (UAMS) College of Medicine and in the Epidemiology department at UAMS’ Fay W. Boozman College of Public Health. He was elected president-elect of ASTHO in September 2018. Born in Massachusetts, Dr. Smith lived in multiple countries and U.S. cities before attending Rice University, Baylor College of Medicine, and the University of Texas School of Public Health. He is also an ordained minister in the Anglican Church. Dr. Smith and his wife, Kim, served two terms as medical missionaries at Kijabe Hospital in Kenya, where he was involved with the President's Emergency Plan for AIDS Relief, a program that reduced the adult HIV prevalence from over 10 percent to less than 6 percent. In Kenya, Dr. Smith’s roles included chief of internal medicine, medical intern program director, infectious diseases consultant, country medical director for the University of Maryland School of Medicine in Kenya, and senior medical technical advisor for the AIDSRelief program in East Africa. “We are thrilled to have Dr. Smith as our new president,” says ASTHO Chief Executive Officer Michael Fraser. “His impressive background in infectious disease demonstrates an expertise that will be crucial to facing the threat of antimicrobial resistance in the United States. His compassion, public health insights, and wealth of medical and scientific knowledge, sharpened during his work abroad and in his service to the state of Arkansas, will be truly valuable assets as the nation contends with public health emergencies like the ongoing opioid crisis. I know that Dr. Smith will move our organization—and public health—forward in the year to come.” Rachel Levine, MD, secretary of health at the Pennsylvania Department of Health, will serve as ASTHO president-elect. ASTHO Press Release Boilerplate website yes

Illinois Department of Public Health Director Ngozi Ezike Testifies on Lung Disease Outbreak WASHINGTON—Ngozi Ezike, MD, director of the Illinois Department of Health, testified today before the House Oversight and Reform Committee, Subcommittee on Economic and Consumer Policy on the current multistate outbreak of lung injury associated with e-cigarette product use. The hearing, “Examining the Outbreak of Lung Disease and CDC’s Urgent Warning Not to Use E-Cigarettes,” provided members of Congress the opportunity to discuss and examine the cause of the outbreak, which has affected more than 530 individuals within 38 states. The Association of State and Territorial Health Officials (ASTHO) is pleased that Congress is investigating the outbreak and supports aggressive efforts to reduce all tobacco use, including e-cigarettes and their associated liquids containing nicotine and other harmful agents. “While the negative effects of vaping and related products are yet to be fully understood, what we are certain of, is that vaping and e-cigarettes are unequivocally detrimental to the health and wellbeing of adolescents and anyone who has never smoked tobacco,” says Ezike. “Nicotine is highly addictive, and more so for the youngest of vape users. Contemporary product designs, attractive technology, and associated items, like vape wear, appeal to our youth and serve only to enable use of these products by young people. We cannot stand idly by and watch the high-tech e-cigarette erase the incredible progress of the last 10 years with enticements to vape by marketing to young people through flavors such as strawberry, watermelon, mango, and blue raspberry e-juices.” For more information and to read Ezike’s testimony, visit the committee’s website. ASTHO Press Release Boilerplate website yes

ASTHO Applauds Administration’s Decision to Halt Sales of Flavored E-Cigarettes ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) applauds the Administration and the U.S. Food and Drug Administration (FDA) for its announcement to halt sales of non-tobacco flavored electronic cigarettes (e-cigarettes) in the coming weeks. “ASTHO applauds the Trump Administration’s move to ban non-tobacco flavored e-cigarettes. Regulating the tobacco industry in a way to protect the public’s health is an essential part of the puzzle to protect our population, especially youth, from the harms of tobacco products,” says Nathaniel Smith, MD, MPH, president-elect of ASTHO and secretary of health at the Arkansas Department of Health. “Federal policy to support and bolster the vital work that state, territorial, tribal, and local public health do to prevent youth from becoming addicted to nicotine is bold and necessary. Governmental public health cannot always do it alone, and on tobacco policy, the force of the FDA is one that cannot be underestimated in the effort to curb tobacco use in our country—especially among young populations.” ASTHO has long advocated that flavored tobacco products threaten and undermine the progress made to prevent youth from smoking combustible tobacco. ASTHO members strongly support the notice of proposed rulemaking to regulate flavoring in all tobacco products. This announcement is a step in the right direction in maintaining this momentum. ASTHO Press Release Boilerplate website yes

ASTHO Members and Staff Named to Inaugural List of 40 Under 40 Public Health Leaders ARLINGTON, VA—Members and staff of the Association of State and Territorial Health Officials (ASTHO) received recognition today from the de Beaumont Foundation for their contributions and leadership in the public health field. The de Beaumont Foundation’s inaugural "40 Under 40 in Public Health" list honors several health officials, health department staff, and ASTHO staff and affiliates, including: Jonathan Ballard, Chief Medical Officer, New Hampshire Department of Health and Human Services Christa Cupp, Public Health Educator, Wisconsin Department of Health Services, Division of Public Health, Office of Policy and Practice Alignment Julian Drix, Asthma Program Manager, Rhode Island Department of Health Eric Harkness, Director, Office of Health Policy, Tennessee Department of Health Jeffrey Howard, Commissioner and Chief Medical Officer, Kentucky Department for Public Health Joseph Kanter, Assistant State Health Officer and Region One Medical Director, Louisiana Department of Health Joneigh Khaldun, Chief Medical Executive and Chief Deputy Director for Health, Michigan Department of Health and Human Services Carolyn Mullen, Chief of Government Affairs and Public Relations, Association of State and Territorial Health Officials Kaitlyn Neises-Mocanu, Special Assistant for Policy, Sustainability, and Development, Commonwealth Healthcare Corporation Jamila Porter, Director of Programs and Evaluation, Safe States Alliance (ASTHO Affiliate) Lauren Powell, Director, Office of Health Equity, Virginia Department of Health Alison Traynor, North Dakota Suicide Prevention Program Director, North Dakota Department of Health  Mariah Wilberg, Communications Specialist and Health Educator, Minnesota Department of Health "I am thrilled and honored to see ASTHO leaders represented on this list," says Michael Fraser, ASTHO's chief executive officer. "Their inclusion speaks to the passion, commitment, and tireless effort demonstrated every day by both ASTHO and the state and territorial public health leaders we represent in order to improve the nation's health."  A panel of judges selected these individuals based on their fresh perspectives, creative problem-solving, and innovative health solutions in communities across the country. Nominees for the "40 Under 40 in Public Health" list included a wide range of public health professionals, including health commissioners, directors of health equity, doulas, and epidemiologists. For more information about the "40 Under 40 in Public Health" honorees and their accomplishments, visit de Beaumont Foundation's 40 under 40 page. ASTHO Press Release Boilerplate website yes

Health Officials Combat Nation’s Maternal Mortality Rates ARLINGTON, VA—State and territorial health officials are assessing maternal care programs within their states to address the rise in maternal deaths across the nation. According to a new Centers for Disease Control and Prevention (CDC) Vital Signs report, each year more than 700 women in the United States die during pregnancy, delivery, or up to a year postpartum, with three out of every five of these deaths being preventable. The Association of State and Territorial Health Officials (ASTHO) and its members are committed to protecting the health of mothers through multidisciplinary efforts to address preventable deaths, such as closing gaps in access to quality preconception and prenatal care, care for chronic conditions, missed diagnoses, and maternal education. “Across the country, state and territorial health officials are continually analyzing women’s health data, programs, and outcomes to address and prevent maternal mortality and morbidity,” says Michael Fraser, CEO of ASTHO. “As with all public health issues, officials take this trend very seriously, and we know that tackling this issue involves addressing the unique social, economic, and healthcare challenges that impact women’s health on multiple levels in every state.” The causes of maternal mortality and morbidity vary widely, depending on many local factors and stage of pregnancy or post-pregnancy. For example, weakened heart muscles (cardiomyopathy) are the leading cause of death between one week and one year postpartum. Postpartum care, however, often focuses on the infant—not the mother. Providing and covering high-quality care for mothers the first year following birth would ensure prompt follow-up care and communication about issues like severe bleeding, high blood pressure, and infection. “The majority of deaths from pregnancy-related complications are absolutely preventable,” says Nicole Alexander-Scott, MD, MPH, director of the Rhode Island Department of Health and president of ASTHO. “We also know that significant racial and ethnic disparities exist in the rates of fatalities from pregnancy-related complications. Health systems, healthcare providers, and public health professionals need to continue taking measures to improve access to and coordination and delivery of quality care for all women, regardless of their ZIP code. We also need to engage patients and communities in this work so that everyone knows that their voice matters, and that they are being heard.” Many states are assessing maternal and perinatal levels of care and the standardized capabilities of individual hospitals to ensure pregnant women deliver at facilities equipped for a range of medical outcomes. Some of these efforts include: Indiana passed a perinatal levels of care law (SB 360) last year so the state health department could establish a program to certify perinatal levels of care designations for licensed hospitals and birthing centers. The Indiana State Department of Health also works alongside the Indiana Hospital Association, the Indiana Rural Health Association, and the Indiana Family and Social Services Administration’s Office of Medicaid Policy and Planning to investigate opportunities to keep rural hospitals and obstetric units open, as 35 of Indiana’s 92 counties either have no hospital or have a hospital without obstetric services. The Texas Department of State Health Services (DSHS) established a multidisciplinary Maternal Mortality and Morbidity Task Force to review cases of pregnancy-related deaths and severe maternal morbidity, identify trends and disparities, examine best practices, and make recommendations to reduce the incidence of pregnancy-related deaths and severe maternal morbidity. Additionally, Texas DSHS is leading the statewide TexasAIM initiative to help hospitals and clinics in Texas carry out maternal safety projects. The North Carolina Maternal Mortality Review Committee identified significant racial disparities in maternal deaths, causing the state to place a greater emphasis on addressing the non-medical issues responsible for exacerbating these disparities. These efforts led to a reduction in disparities in pregnancy-related deaths over a 10-year period. North Carolina continues to work to confront the remaining increased risk of pregnancy-related deaths among black women. ASTHO Press Release Boilerplate website yes

ASTHO Celebrates National Public Health Week ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) joins the American Public Health Association (APHA) to observe National Public Health Week, recognizing the contributions of public health professionals to create a healthier nation. Each day, National Public Health Week will focus on a particular public health topic, including violence prevention, rural health, and healthy communities, which resonates with the 2019 ASTHO President’s Challenge, “Building Healthy and Resilient Communities.” This multiyear initiative, led by ASTHO’s president and director of the Rhode Island Department of Health, Nicole Alexander-Scott, MD, MPH, in partnership with the National Association of County and City Health Officials (NACCHO) and aligned with the U.S. Surgeon General’s focus on community health and economic prosperity, calls on state, territorial, local, and tribal health officials to promote investments in community-led, place-based solutions to empower communities and reduce health disparities. “This year, we join APHA in celebrating advancements in public health and bring a renewed focus to the important role state and territorial health departments play in promoting health, wellness, safety, and opportunity in our communities,” says Alexander-Scott. “ASTHO commends APHA for placing an emphasis on healthy communities during National Public Health Week. We all have a responsibility to make the critical effort necessary to ensure optimal health for everyone in every community, especially our most vulnerable. Here in Rhode Island, as well as in Georgia, California, Texas, and states across the nation, initiatives are already underway that are creating opportunities for public health to partner with community advocates, policymakers, business leaders, and others to make lasting changes that transform the health of the entire population. Empowering decisionmakers to make health a priority plays a critical role in this work. By working together, we can create the type of strong public health system promoted by the ASTHO President’s Challenge and build healthy, resilient communities across the nation.” View ASTHO’s 2019 President’s Challenge for more information. Visit APHA to learn more about National Public Health Week. ASTHO Press Release Boilerplate website yes

ASTHO Commends President Trump's Commitment to Ending HIV Transmission by 2030 ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) commends President Trump's State of the Union pledge to end HIV transmission by 2030. "As state and territorial public health leaders, we are eager to collaborate with the Administration and with Congress to end the HIV epidemic in America by 2030," says John Wiesman, secretary of health for the Washington State Department of Health and ASTHO's immediate past president. "We know what works to halt the spread of HIV. I look forward to working with federal partners and colleagues across the country to bring these effective strategies to scale—both as a health official and as co-chair of the Presidential Advisory Council on HIV/AIDS. For decades, public health leaders and our community partners have led comprehensive efforts to reduce the stigma and disparities surrounding HIV, along with implementing routine testing and pre-exposure prophylaxis (PrEP). We must ensure that state, territorial, local, and tribal jurisdictions and our community-based organizations and healthcare partners have the resources necessary to enhance and deliver these evidence-based public health interventions." "I am pleased that the President has identified ending HIV transmission as one of the top priorities of his Administration this coming year. I am confident that the President and others in the Administration and in Congress know how crucial state and territorial health officials are to implementing this initiative," says ASTHO CEO Michael Fraser. "For this promise to be fully realized, Congress must address sequestration funding cuts immediately and look at how to increase funding for critical HIV/AIDS treatment and prevention initiatives without cutting programs that address other public health priorities. This effort cannot move existing resources from one public health program and repurpose them to end HIV without serious consequences to our public health system. Our leadership is encouraged and committed to working with the President and with members of Congress to secure adequate investments in public health to meet this bold goal and end HIV transmission in the United States in the next ten years." ASTHO Press Release Boilerplate website yes

State and Territorial Health Leaders Commend Selection of John Wiesman as Co-Chair of Presidential Advisory Council on HIV/AIDS ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) commends HHS Secretary Azar for appointing John Wiesman, immediate past president of ASTHO and Washington State Secretary of Health, to serve as co-chair of the Presidential Advisory Council on HIV/AIDS (PACHA). “Both as a clinician caring for patients with HIV and as a policymaker working to eliminate the disease, I have witnessed firsthand John’s commitment, passion, and expertise when it comes to HIV. He is supremely qualified to co-chair the reconstituted Presidential Advisory Council on HIV/AIDS and will lead bold public health actions to stop HIV,” says Nicole Alexander-Scott, ASTHO President and director of the Rhode Island Department of Health. “State and territorial health leaders throughout the country are committed to collaborating with the council to implement its recommendations. It is through these efforts at the federal, state, and local levels that we can bring an end to this disease that affects so many communities throughout the country.” Wiesman was the president of ASTHO from 2017-2018 and has served as secretary of health for the Washington State Department of Health since April 2013. Wiesman began his public health career in 1986 as an HIV/AIDS test counselor in Connecticut where he was a member of the first group of people in the state trained to conduct HIV counseling and testing services. Today, he is working in Washington state to end AIDS, create the healthiest next generation, and expand foundational public health services across the state. Wiesman is a native of Wisconsin and has worked in four local public health departments in Washington state and Connecticut. He earned his doctor of public health (DrPH) in public health executive leadership in 2012 from the University of North Carolina-Chapel Hill. He received his master of public health (MPH) in chronic disease epidemiology from Yale University in 1987, and his bachelor of arts (BA) in biology from Lawrence University in Wisconsin in 1983. ASTHO Press Release Boilerplate website yes

ASTHO Awarded W.K. Kellogg Foundation Grant To Support Healthy Communities ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) received a $450,000 grant from the W.K. Kellogg Foundation to improve child health and family well-being through advancing community-led and place-based approaches and will support ASTHO’s 2019 President’s Challenge. Through this project, ASTHO will position state and territorial health officials to lead multisector efforts to advance health equity by improving state readiness to implement place‐based models to build healthier, more resilient communities across the nation. Additionally, ASTHO will focus on increasing the capacity of state health agencies to implement place-based approaches by identifying evidence-based resources and promising practices to advance supportive policies and flexible funding strategies. “Research has demonstrated the importance of zip codes as a predictor of health and the impact that place has on health outcomes,” says Nicole Alexander-Scott, MD, MPH, president of ASTHO and director of the Rhode Island Department of Health. “The role and future direction of public health is to develop and support interventions that address the social and environmental determinants of health at the community level.” The grant will allow ASTHO to assist states and territories through a learning community so they are better prepared to tackle complex socioeconomic challenges by learning how to implement high impact, place-based policies that foster authentic community engagement and development. ASTHO Press Release Boilerplate website yes

ASTHO President States Third Year of Declining Life Expectancy is a “Wake-Up Call” ARLINGTON, VA—Suicides and drug overdoses caused life expectancy in the United States to fall again in 2017. In what is the longest downward trend since World War I, Americans born in 2017 are expected to live 78.6 years, down slightly from the previous year, according to new data from CDC. The Association of State and Territorial Health Officials (ASTHO) finds this decline extremely alarming since life expectancy is a key indicator of our nation’s overall health. We must do more to target the preventable conditions that are cutting short the lives of too many Americans, including heart disease, diabetes, drug overdoses, suicide, and influenza. “Sadly, our nation is in the midst of a public health crisis driven largely by suicides and the opioid epidemic, which we know are responsible for these year-over-year declines in life expectancy. One way to start reversing this trend is for state and territorial health agencies to partner with communities to address critical underlying issues, such as access to behavioral healthcare, education, employment, and social isolation. When we are trying to weather life’s storms, there is nothing more important than the support we have from our community, and the relationships we have with the people in our lives,” says Nicole Alexander-Scott, president of ASTHO and director of the Rhode Island Department of Health. “Many states and communities are working hard to assist individuals and families experiencing diseases of despair, but an issue most jurisdictions face is limited resources to identify people at risk for suicide or drug misuse early on and connect them to the appropriate services. A decline in our life expectancy rates should be a wake-up call for us to mobilize resources and strengthen our resolve to prevent these tragedies from happening.” ASTHO Press Release Boilerplate website yes

Health Officials Alarmed by Declining U.S. Vaccination Rates, Country Could Face Scenario Like Europe's Measles Outbreak ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) is concerned about the latest skepticism and resistance originating from the anti-vaccination movement, especially as we enter another deadly flu season. Health officials are alarmed that this pushback may put our country at risk for significant infectious disease outbreaks and their related health consequences, including death, because of declining vaccination rates. “Vaccines prevent diseases,” says Nicole Alexander-Scott, ASTHO president and director of the Rhode Island Department of Health. “It is absolutely paramount that public health and healthcare professionals across the nation join together to share the facts about the safety and efficacy of vaccines. The health concerns that parents have over the risks of vaccination need to be addressed with compassion and with care, but also with facts so that informed decisions can be made, and so that people can protect themselves and their loved ones from dangerous, vaccine-preventable diseases.” Last year’s flu season was one of the deadliest in years, with a record-breaking estimated 960,000 hospitalizations and nearly 80,000 deaths in the United States. “It is unconscionable to see a child or adult suffer from any vaccine-preventable disease because an individual decides against immunization based on bad information and unsupported claims,” says Michael Fraser, CEO of ASTHO. “Parents with vaccination concerns should consult a healthcare provider, as they have spent years in training to understand the science behind vaccines and have seen countless studies proving they are safe.” There are some risks associated with vaccines, but they are not what the anti-vaccination movement claims. “The false science being spread erodes trust in the public health system. Clearly, the anti-vaccination movement is taking advantage of the current climate of government distrust and the trend toward believing political statements over scientific ones to question vaccine safety. At a time when investments in public health resources have been declining, recent reports from CDC about declining vaccination rates in the United States and a widespread measles outbreak in Europe should be of great concern to all Americans,” continues Fraser. “What’s really unsafe here are the cuts to public health programs that support vaccine education and immunization nationwide,” says Claire Hannan, executive director of the Association of Immunization Managers. “Our members see the disease outbreaks. They see the devastating impact of decisions not to vaccinate. There is no question that their benefits exponentially outweigh any risks associated with their administration. Let’s get real: we didn’t make great advances in life expectancy and disease elimination without vaccines. It’s not even a question.” ASTHO Press Release Boilerplate website yes