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Highlights key public health interventions to address healthy aging and older adult health that health agencies are equipped to champion or support.

This AJPH article shares the results of a survey and showcases how state and territorial health agencies struggle to meet the mounting challenge of climate change.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges article yes

This article in Journal of Public Health Management & Practice discusses ASTHO's strategies for reducing maternal mortality and morbidity.

This article in Journal of Women's Health describes the implementation of a temporary field placement approach and suggests that this approach could be replicated to enhance state and local capacity to respond to the opioid crisis or other high-consequence events.

This article in Journal Of Women's Health explores the actions of jurisdictions that participated in the Increasing Access to Contraception Learning Community, and how they continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation.

Strategy to Action: Incorporating CDC's 10 Evidence-Based Strategies in Overdose Prevention and Surveillance Efforts website yes

This journal article provides an evidence base for communication efforts, experiences, and views of travelers during the summer of 2020. It was examined through a telephone survey of 1,968 US adults, conducted in English and Spanish, July 2 through July 16, 2020. Findings are summarized in this journal article.

Highlights evidence-based state policies that improve outcomes across a number of chronic disease outcomes, with an emphasis placed on policies where S/THOs have authority or influence in the policy process.

This article in Public Health Reports shares results from a study to demonstrate the usefulness of applying an implementation science framework-the Consolidated Framework for Implementation Research (CFIR)-to increase understanding of implementation of complex statewide public health initiatives, using the example of Medicaid immediate postpartum long-acting reversible contraception (LARC) policies.

This article in Journal of Maternal and Child Health demonstrates the application of implementation science methodology to study the complexities of rolling-out policies that promote immediate postpartum long-acting reversible contraception (LARC) use across states.

Joseph Kanter, MD, MPH, joined ASTHO as CEO in spring 2024. Former Louisiana state health officer and emergency physician, he champions upstream optimal health for all, crisis management, and opioid mitigation at the state and national levels.

Kimberlee Wyche‑Etheridge, MD, MPH brings 20+ years of public health and pediatric care experience to advance culturally competent services, maternal and adolescent health, and additional health initiatives.

Last updated March 1, 2024

Policy Trends Shaping Healthy Food and Chronic Disease in 2026 Policy Trends Shaping Healthy Food & Chronic Disease in 2026 Learn about policy trends shaping healthy food and chronic disease in 2026, such as regulating ingredients and modifying SNAP. A growing focus on links between nutrition and public health outcomes is driving legislative efforts across the country, with states actively responding to rising rates and the cost of chronic disease. As state legislatures consider ways to combat chronic diseases, they are also implementing policies aimed at addressing the food environment by introducing and enacting bills that regulate ultra-processed foods (UPFs), adjust SNAP benefits, and improve access to healthy food. Regulating Food Ingredients and Ultra-Processed Foods While efforts to define and regulate UPFs are still in development at the federal level, several states have decided to move forward with legislation targeting the use of specific artificial dyes and chemical preservatives in food products. West Virginia enacted HB 2354, prohibiting the sale or manufacturing of any food containing a list of specified dyes and certain preservatives. Similarly, Vermont is considering H 260, and New York is considering companion bills S 1239/A 1556. These bills aim to ban the manufacture, sale, or distribution of food containing a core group of chemicals (e.g., potassium bromate, propylparaben, and Red 3). Meanwhile, North Carolina introduced HB 440, which would prohibit additional color additives and ban the sale of food products containing nine specific dyes and chemicals. Pennsylvania introduced HB 1134, which focused on warning labels and would require foods with dyes Blue 1, Blue 2, Green 3, Red 40, Yellow 5, or Yellow 6 to include a label that states, “This product contains synthetic colors, which may have an adverse effect on activity and attention in children.” Leg Prospectus-2026 - CD - CA Restricting Ingredients in School Meals While previous years have focused on access to school meals, a growing wave of recent state legislation aims to eliminate UPFs, synthetic dyes, and chemical preservatives from children's diets. Several states have enacted or advanced bans on specific chemical additives in school meals: Utah’s HB 402 and Virginia’s HB 1910 prohibit schools from offering food containing common food dyes (Blue 1, Blue 2, Green 3, Red 3, Red 40, Yellow 5, and Yellow 6) or certain preservatives like potassium bromate and propylparaben. Similarly, Texas enacted SB 314 prohibiting specific additives in free or reduced-price school meals and SB 25, which mandates warning labels and expands state nutrition curriculum. In addition, other jurisdictions have introduced but not passed numerous bills proposing similar restrictions including South Carolina's HB 4339, which would prohibit certain additives in school meals. Modifying SNAP SNAP is the nation's largest federal food assistance program, providing benefits to low-income households. While the program is federally funded and administered by USDA through its Food and Nutrition Service, individual state agencies operate and manage eligibility and distribution. Since SNAP is governed by federal law, states must obtain a USDA waiver to implement changes that deviate from the federal rules. Several states are exploring waivers to limit the use of SNAP funds for purchasing candy and sweetened beverages or soft drinks, with Arkansas (SB 217), Idaho (HB 109), and Texas (SB 379) having passed legislation. Arkansas's new law requires the Department of Human Services to request a waiver to exclude candy and soft drinks, and reapply annually if denied. This dual ban was also the subject of bills introduced in Wyoming (HB 323) and South Carolina (HB 4061). Indiana (HB 1486) considered broader restrictions on “accessory foods,” aiming to prohibit the use of SNAP benefits for items like chips, energy drinks, sweetened beverages, soft drinks, and prepared desserts while New Jersey (A 5697/S 4348) introduced a narrower set of proposed restrictions, focused on soft drinks (including soda and sugary/sweetened beverages). Expanding Detection and Coverage for Chronic Diseases In response to high chronic disease rates — including diabetes, cardiovascular disease, cancer, and respiratory illnesses — states are enacting and proposing legislation focused on treatment coverage, awareness, and prevention. Several states are directly addressing obesity and pre-diabetes by mandating insurance coverage. Colorado (SB 25-048) enacted legislation requiring large group health plans to cover treatment for obesity and pre-diabetes, including medical nutrition therapy and metabolic/bariatric surgery. In Nevada, AB 555 caps patient cost-sharing for a 30-day supply of insulin for people with state-regulated commercial health plans. To aid early detection of diabetes, New Hampshire (SB 102), Louisiana (SB 26), and Florida (SB 958) enacted new laws requiring the creation of informational materials on Type 1 diabetes risk factors, warning signs, and screening available to students and parents. To reduce financial barriers to necessary cancer screenings, several states have enacted bills to mandate insurance coverage and/or lower the cost of diagnostic breast exams and supplemental testing. Virginia (HB 1828), Florida (SB 158), and Oklahoma (HB 1389) have enacted bills to limit or lower the cost of such breast imaging. Meanwhile, Colorado enacted HB 25-296, clarifying that health insurers cover medically necessary diagnostic and supplemental breast imaging that goes beyond routine screening. Looking Ahead ASTHO expects state and territories to continue advancing legislative proposals that focus on the prevention of chronic diseases and access to healthy foods in 2026. Future legislative action may include: Establishing policies to address food insecurity and promote access to nutritional foods by targeting food deserts. Exploring policy and leadership options to discourage the consumption of high-sugar drinks. Developing and adopting standards for healthy food procurement policies for state agencies and public institutions to increase the demand for nutritious products. Continuing to enact insurance coverage mandates for comprehensive chronic disease screenings and treatment. OE22-2203 PHIG article yes

Partner Spotlight: Q&A with Kate Menard on Levels of Maternal Care State Implementation Advancing Levels of Maternal Care: Q&A with Kate Menard Lexa Giragosian Learn how health agencies should approach levels of maternal care implementation, with key insights from Kate Menard, a key leader and expert on the topic. As the maternal health crisis continues nationwide and states face hospital closures and workforce challenges, health agencies are increasingly implementing levels of maternal care (LoMC) to improve access to maternal health services. LoMC provides a standardized way to classify health care facilities based on their ability to manage maternal risk conditions and complications during birth. LoMC implementation helps to ensure that perinatal patients receive the appropriate care for their specific health needs, supporting optimal health outcomes. When states or territories adopt LoMC, it can strengthen access to risk-appropriate care and build more coordinated systems of perinatal regionalization. LoMC implementation is a critical lever in systems level improvement and supports efforts to reduce severe maternal morbidity and mortality. ASTHO spoke with Kate Menard, a key leader in advancing LoMC implementation nationally, to learn more about how health agencies should approach LoMC implementation in their jurisdictions. She co-led the development of the original LoMC guidelines by the American College of Obstetrics and Gynecology/Society for Maternal Fetal Medicine, collaborated with CDC on its Levels of Care Assessment Tool (LOCATeSM), and partnered with the American College of Obstetrics and Gynecology on pilot testing onsite LoMC verification. For jurisdictions beginning implementation of LoMC, what are the critical first actions to take? Establishing a shared understanding of why LoMC matters, and how it supports access to RAC, is vital for sustained commitment. Begin by engaging diverse stakeholders, such as public health leadership (including rural health, maternal child health, minority health, and regulatory agencies), clinical leadership, payers, health administrators, patient advisors, and emergency medical services. I would also recommend conducting a thorough assessment of the existing regionalization system in your jurisdiction, identifying strengths and opportunities. This assessment can help tailor the LoMC implementation process to specific regional needs and contexts. Using CDC LOCATeSM can enable some aspects of this preliminary assessment. Which stakeholders should be involved from the beginning, and how can health agencies effectively engage them? Relevant partners may include clinicians (obstetricians, pediatricians, anesthesiologists, etc.), hospital associations, health system administrators, payers, community representatives, emergency medical services, and legislative authorities. Health agencies are in a unique position to convene stakeholders and bolster early and effective engagement. They can organize stakeholder convenings that bring all parties together and facilitate collaborative discussions, foster relationships, and ensure that diverse perspectives are considered in the planning process. Are there any lessons learned from your experiences that would be beneficial to those in the process of LoMC implementation? I would recommend leading with the ‘why’ as you begin this process. Clearly articulating your jurisdiction’s most urgent maternal health challenges and how LoMC can help address them will create alignment from the beginning. For example, if closure of obstetric services in rural hospitals is a major concern, focus on the design of a regionalized system that supports rural hospitals through education, training, and seamless systems for escalation of care when needed (antenatal consultation/referral or maternal transport). Jurisdictions can use Maternal Mortality Review Committee findings and hospital-based severe maternal morbidities reviews to identify key needs. Building trust is equally critical and strong relationships among stakeholders helps overcome resistance to change. Using data and evidence-based practices will enhance credibility and encourage partner buy-in. What are the key considerations and best practices needed to effectively implement LoMC? Firstly, define specific objectives for the implementation process through collaboration with stakeholders, ensuring they are measurable and achievable within the timelines set. Leverage stakeholder engagement to collaboratively determine how your jurisdiction will implement LoMC (e.g., legislation, regulation, governing body, adoption of the American College of Obstetrics and Gynecology/Society for Maternal Fetal Medicine guidelines as is or with state specific adaptations, designation method, onsite verification). Through this process, maintain open lines of communication among all stakeholders to foster transparency and collaboration. Once your jurisdiction is prepared for implementation, agency leaders should ensure adequate training for health care providers and administrators to understand the LoMC system and their role within it. Don’t forget to embrace quality improvement and utilize data and feedback from the implementation process to make informed adjustments and improvements, confirming that care delivery continuously aligns with best practices. How can jurisdictions use their LoMC data to demonstrate its value and return on investment to hospital leaders and decision-makers? Defining LoMC is the first step. Building shared language to advance collaboration, risk appropriate care, and improved maternal outcomes is how the investment is realized. Jurisdictions should track and report on key performance indicators, such as reductions in maternal morbidity and mortality rates, improved access to care, and increased adherence to best practices in maternal health. To make the business case, highlight cost benefits that effective LoMC implementation creates, such as fewer unplanned ICU admission, shorter hospital stays or readmissions, and avoidance of medical legal claims. Emphasize that effectively utilizing a LoMC system may actually improve retention of providers and staff in rural hospitals. Patient feedback may additionally demonstrate improved experiences for mothers and newborns, reinforcing the need for continuous investment in LoMC. article yes

ASTHO conducted focus groups to examine overdose-related issues and identify potential engagement opportunities for public health and public safety around overdose prevention. This brief outlines key takeaways and is designed to serve as a guide for public health building and strengthening relationships with public safety.

This toolkit provides actionable strategies for choosing a CRM tool best for your public health agency.

This white paper shares how states have identified a number of successes, challenges, and lessons learned about how to effectively use health information systems (HIS) to improve hypertension identification, management, and control.

Partnerships between state health agencies and public and private payers are critical to effective statewide efforts to improve hypertension identification and control. This white paper describes opportunities, strategies, and example partnerships identified through the ASTHO Million Hearts Learning Collaborative.