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CDC success story: using AI to improve public health efficiency and outbreak response readiness through data modernization.

Ohio state policy for the use of AI in state government solutions: governance, risk management, and responsible deployment.

New York City AI Action Plan: strategy for responsible AI use in city government, services, and public engagement.

New Jersey interim guidance on responsible use of generative AI in state government: risk management and acceptable use rules.

State of Indiana AI policy for state agencies: responsible use principles, data governance, and human oversight requirements.

City of San José AI guidelines and policies: transparency, privacy, bias prevention, and staff accountability for government AI use.

Evidence-based analysis of AI capabilities and limitations in public health: what AI can and cannot yet reliably do.

Delphi study defining principles and priorities for responsible AI in public health based on expert consensus.

Challenges and solutions for integrating AI into governmental public health decision-making, including governance and trust.

Discussion of health equity and ethical considerations when using AI in public health programs and policy decisions.

Review of AI's impact, current use cases, and implications for public health practice, policy, and workforce capacity.

Government agency guidelines for using content-generating AI tools: acceptable use, citation, disclosure, and quality review.

Local government generative AI policy establishing responsible use rules, disclosure requirements, and approved tool guidelines.

State generative AI policy for government employees: acceptable use, data protection, and accountability requirements.

Government generative AI policy: principles for responsible, ethical use of generative AI tools by public employees.

Learn how to build a business case for data modernization efforts to translate technical needs into impact-driven narratives.

Learn how states are improving data collection and analysis to build more robust public health programs in this brief.

Learn how education and health agencies can work together to address adolescent health through school-based programs.

Best Practices for Sustained Community Engagement Learned from the STRETCH 2.0 Midpoint Best Practices for Sustained Community Engagement from STRETCH Jessica Fepelstein The brief reflects on critical takeaways and key insights from a community health and health equity program. Creating systemic change within state public health agencies while simultaneously curating authentic, sustainable relationships with community partners can be challenging. Whether it’s issues with sustainable funding, conflicting priorities, or the toll of undertaking transformative work, making progress in these areas are often slow-moving. To assist state agencies with this work, the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative was born. Funded by the Robert Wood Johnson Foundation, STRETCH is a co-creation between ASTHO, the CDC Foundation, and the Michigan Public Health Institute focused on building lasting, systemic change to advance equity in all sectors of public health. The first iteration of STRETCH was from October 2021 through May 2023, with STRETCH 2.0 launching in January 2024 and going through May 2025. During STRETCH 1.0, its creators learned that community partners not only needed to be more involved in assisting state public health agencies in setting their equity priorities, but also needed to be leading this work in step with agency staff and leadership at the onset of decision-making conversations. Therefore, in STRETCH 2.0, community-based organizations became the project's primary applicants and fiduciary recipients, creating a state collaborative with public health agency staff. Collaboratives from seven states comprise the STRETCH 2.0 cohort, who receive technical assistance and support via personalized core response teams and engage in peer-to-peer learning through monthly practical application workshops. Creating this level of learning and sharing among states was another key lesson learned by the STRETCH partners; those working in health equity and systems change are hungry for connection with their peers. These connections not only allow staff to share best practices and common pain points, but also allow them to lean on each other emotionally and create a space of psychological safety in this sometimes-taxing work. This lesson has been operationalized with the creation of the STRETCH Network of Health Equity Practitioners virtual community. This community is open to anyone in the health equity and/or systems change public health ecosystem who would like to connect with fellow practitioners, participate in monthly “Speak and Share” discussions, and receive additional materials and best practices from across the country. Also open to the public are the STRETCH 2.0 national convenings, quarterly virtual events aimed to disseminate STRETCH lessons and create a connected network of systems change practitioners. These national touchpoints aim to expand the reach of the STRETCH initiative beyond the cohort and allow all state public health agencies to better operationalize health equity and move towards lasting, systemic change. Midway through the second iteration of STRETCH, there are already key themes and critical takeaways the partners have observed while working with the cohort of state collaboratives. Among them is ensuring community voice is always front and center in all state public health initiatives, even internal operations. Secondly, valuing the lived experiences of community members and their organizations—particularly with financial incentives—is a critical component in ensuring capacity for this valuable work. Finally, while having a plan is beneficial, the ability to be flexible and meet the needs of the collaboratives as they shift is a critical aspect of success when working on multi-sector initiatives. Key Takeaways: Lessons Learned Midway through the STRETCH 2.0 Cohort With Us, Not for Us Centering community voice is not a novel concept in community engagement and health equity efforts. One of the best practices the STRETCH initiative has found in centering community voice is allowing each state collaborative to set the purpose and agenda for their core response team’s site visit. One participant from South Carolina expressed that this model of having “on the ground” partners in charge of planning the visit was a key success of the experience and recommended continuing the use of this model moving forward. On a micro-level, this is an example of the importance of centering the community’s voice and allowing those with lived experience to lead the work. Along with systemic change, this focus on community leading the work is a central tenant of the STRETCH Initiative. Time is Money Another common theme in health equity work is the lack of sustainable funding to achieve systemic change, specifically when working directly with community partners and nonprofit organizations. To reduce the financial burden of participating in STRETCH, the second iteration of the project offered funding directly to the applying community-based organization to assist in strengthening the organization’s capacity to fully engage with this work right at the beginning. Providing a financial investment for the project not only allowed organizations to dedicate time, staff, and resources to the work of STRETCH, but it also “walked the walk” in terms of valuing community members' lived experience and expertise. While strengthening community compensation guidelines and initiatives is not novel to the STRETCH project, it is a key component of the success of the second iteration. Flexibility is Critical While the STRETCH partners did plenty of planning when developing the program’s activities, a critical theme of the initiative has been learning to meet each state collaborative’s unique and ever-changing needs throughout their participation. Whether it was leadership changes, hurricane responses, or shifts in staffing capacity, each state was faced with its own unique needs and challenges over the first half of STRETCH 2.0. A key lesson learned from the project is understanding how to alter plans and meet the states where they are with what they need, rather than focus on creating a uniform experience. In practice, this has taken shape by turning check-in meetings into working sessions, providing virtual and in-person options for relationship-building activities, and staggering site visits throughout the project year based on the priorities of each state. By remaining flexible and working in step with state collaboratives to best meet their needs, the STRETCH project has continued to be valuable to all cohort members. Want to learn more about the STRETCH project and other work of ASTHO’s Programmatic Health Initiatives and Strategies team? Check out the STRETCH framework microlearning course, our website, or email the team. article yes

Strategies and Innovations to Address Long COVID Strategies to Address Long COVID Alyssa Boyea Learn innovative strategies to address Long COVID, with examples from the field. Long COVID, or post-COVID condition, is a chronic condition that occurs after SARS-CoV-2 infection and afflicts approximately 20 million people in the United States. It is a multifaceted disease with symptoms or health problems lasting for at least three months as a continuous, relapsing, remitting, or progressive disease state affecting one or more organ systems. In 2024, the National Academies of Sciences, Engineering, and Medicine released a report defining Long COVID to harmonize terminology and measurement approaches. Long COVID has far-reaching implications beyond individual health, affecting health care systems and broader societal structures. Global economic impact of Long COVID is estimated to be approximately $1 trillion per year, including medical costs, productivity losses, and other compounding effects. Ongoing prevention efforts for Long COVID rely upon vaccination and primary prevention strategies for COVID-19 infection. The lasting impact of Long COVID requires unique health policy approaches, sustained research funding, and coordinated health and public health action to support affected individuals and mitigate long-term societal costs.  Key Challenges Diagnostics: There is no laboratory test for diagnosis nor standardized clinical diagnostic test. As a result, clinical clarity in diagnosis remains challenging. Reduced testing for acute COVID-19 infection has also hindered diagnosis and public health disease surveillance of Long COVID. Engagement: COVID-19 pandemic fatigue and reduction in trust can make it challenging to establish a trusted public health response to support impacted communities. Information is constantly evolving as more is learned about the condition, which can lead to confusion and misinformation. There is also little real-time data on community needs related to Long COVID to help tailor messaging or provide effective education. Funding: Many jurisdictions do not have dedicated Long COVID funding and are grappling with cuts to federal and state funding for Long COVID. Without sustained funding, it is challenging to retain dedicated staff — increasing reliance on part-time personnel — and continue initiatives. Jurisdiction Highlights: Advancing Long COVID Efforts Colorado In 2022, the Colorado General Assembly passed HB22-1401, directing the Office of Saving People Money on Health Care (OSPMHC) to examine and make policy recommendations that address the impacts of post-viral illness resulting from COVID-19, and directing the office to support efforts improving public health outcomes in the state. OSPMHC releases annual reports summarizing Long COVID impacts in Colorado, as well as key activities and accomplishments. Key statewide activities include developing surveys to assess socioeconomic impacts of Long COVID in Colorado, conducting a modeling study to examine factors and utilization patterns pre- and post-Long COVID diagnosis, and launching an initiative to better understand the association between clinical events prior to death and the designation of Long COVID on death certificates. Additionally, a Colorado Long COVID Community of Practice was established to discuss recent developments, share lessons learned, and inform strategies for surveillance and care, plus web/social media content to raise awareness. Minnesota The Minnesota Department of Health (MDH) launched the Long COVID program in 2021 to increase awareness and monitor potential long-term health issues following COVID-19 infection. In 2023, MDH secured state funding to expand the program and offer grants to organizations that support communities disproportionately impacted by COVID-19. Key initiatives include raising awareness about Long COVID and other infectious-associated chronic conditions (IACCs) through presentations, social media, and online resources; engaging individuals affected by Long COVID and conditions like myalgic encephalomyelitis/chronic fatigue syndrome; conducting epidemiological surveys and studies; forming a Long COVID Provider Guiding Council to foster collaboration, education, and system improvements among health care providers; and establishing the Long COVID Community Voices partner group, which led to a statewide network of organizations addressing Long COVID needs. Additionally, MDH has started a steering team of professionals and people with lived experience to guide the development of an actionable statewide framework for addressing IACCs and identify opportunities for cross-sector collaboration. New York City The New York City Department of Health and Mental Hygiene has focused its efforts on raising awareness and community engagement around Long COVID. Key activities include multilingual trainings for community and faith-based organizations and other partners to incorporate Long COVID information into their messaging with their respective communities, a study to assess long-term impacts of COVID-19 on New Yorkers, a three-part messaging campaign to share lived experience and stories of those living with Long COVID, and web/social media content to raise general awareness. Key Considerations Utilize public health resources such as the 10 Essential Public Health Services framework, “The Role of U.S. Public Health Agencies in Addressing Long COVID” and the health+ “Long COVID Human-Centered Design Report” to guide implementation of robust programs for Long COVID and related conditions. Share information on health agency websites, newsletters, or other forums to help raise awareness. Access to relevant information and resources is critical. Foster relationships and trust with various partners (e.g., health care, community-based organizations, and patient and caregiver communities) to learn about challenges/needs related to Long COVID and opportunities for collaboration. Collaborate with trusted messengers, such as community health workers and champions, to share community specific and linguistically appropriate information. Focus outreach efforts on under-resourced populations through culturally responsive frameworks. Partner with clinicians and health care systems to support clinical education and share relevant patient-focused resources for Long COVID and associated conditions. Promote sustained investment and support for Long COVID policies and research. Engage with key partners including health agency leadership, governor’s offices, state legislators, and advocacy groups to raise support for initiatives. Utilize local data and stories to show impact and advocate for dedicated resources. Long COVID Community of Practice article yes