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The Gravity Project creates open data standards for sharing social care and health information to improve outcomes, equity, and interoperability.

Explore Florida's 5-Year Plan article

Partnering to Address Health Risks and Expand Communication Before and During Prescribed Fires Partnering to Address Health Risks and Expand Communication Before and During Prescribed Fires Kerry Wyss, Ali Aslam Learn how states can use risk communications to safely and effectively implement prescribed burns in this report. Prescribed fires are a land management tool used to help maintain forest health by not only returning nutrients to the soil and reducing buildup of unwanted fuels, but also potentially reducing the risk of catastrophic wildfires and the resulting large volume of smoke emitted. USDA and the Forest Service have a long-term plan to increase the pace and scale of prescribed fire across the country to reduce the risk of catastrophic wildfire. This means that some areas of the country may experience an increase in prescribed fire, and the subsequent smoke, that they have not historically experienced. While smoke can negatively impact public health, the planned nature of prescribed burning presents an opportunity to prepare individuals and communities for reducing smoke exposure — especially those at-risk of experiencing health effects. To better understand the connected partners involved in responding to wildland fire (i.e., wildfire and prescribed fire), ASTHO held a focus group in March 2025 targeting environment and health agency staff, as well as others involved in wildland fire response at the state level. The group focused on reinforcing partnerships across state agencies and other stakeholders, designing strategies for minimizing smoke exposure through timely and effective communication with communities, and long-term planning for safe prescribed burns with minimal smoke exposure. Read the full report to learn how state agencies are preparing for increased smoke. Get the Report (PDF) article yes

Assessment of Foundational Capabilities Assessment of Foundational Capabilities in Public Health Grace Gorenflo, Brian Lentes, Melissa Touma, Anna Bradley Learn how state health departments are implementing the Foundational Public Health Services model to bolster their public health work in this report. The Foundational Public Health Services model serves as the core framework for defining cross-cutting capabilities essential for public health departments to deliver a minimum standard of service. This report compiles examples and assessments from 25 states to illustrate the implementation and progress of these foundational capabilities. Highlighting the importance of public health infrastructure, the report also includes a summary of state activities, showcases models and strategies for modernization and transformation, and reference tools such as cost assessments, legislation, and funding mechanisms used to strengthen public health systems nationwide. Dive into the full report to access these resources. Download the Report (PDF) article yes

Tobacco Use in King County Washington: A Medicaid Data Analysis Report ASTHO Staff, King County Staff, University of Washington Staff Washington state provides an excellent model for integrating Medicaid data to address tobacco use. Commercial tobacco use remains the leading cause of preventable disability and death in the United States, yet state tobacco control programs often lack adequate surveillance infrastructure to identify tobacco users and reach populations in greatest need. Medicaid beneficiaries in particular would benefit from targeted public health and tobacco control interventions as they bear a disproportionately high burden of tobacco-related illnesses. Washington state addresses this gap through integrating self-reported tobacco use data through Medicaid enrollment with claims data. This integrated data provides the opportunity for health agencies to better target their outreach and assess the impact of tobacco control programs in the Medicaid population. This report examines how Washington state structures its tobacco surveillance and how other state and territorial health agencies can model their own data systems after Washington state’s example. Get the Report (PDF) website yes

Food System Resilience: A Planning Guide for State Governments Food System Resilience: A Planning Guide for State Governments Heather Tomlinson, Shihui Yang This adapted guide provides actionable strategies to support food systems in times of natural disasters and other disruptions. Environmental and human-made disasters and even seasonal changes affect people and the functioning of food systems. These shocks and stressors to food systems can be acute events such as extreme weather phenomena (hurricanes, earthquakes, etc.) or long-term political, economic, and/or environmental disruptions, during which food is not accessible, available, or acceptable. While these factors can impact everyone, those with the most vulnerabilities and who are the most marginalized are at the greatest risk. State governments around the United States are taking action to prepare for and prevent the consequences of these disruptions on their food systems, but there is limited guidance available to support states in this work. This planning guide provides actionable tools for developing strategies to create and support resilient food systems. This guide is an abridged adaption of the Food System Resilience: A Planning Guide for Local Governments, developed by the Johns Hopkins Center for a Livable Future and Bloomberg Center for Government Excellence with a local government community of practice. ASTHO has tailored this version to state governments. For more information on a specific topic, please refer to the local guide for additional context. Get the Report (PDF) article yes

Learn how California and Rhode Island are using health equity and environmental justice to enhance their public health responses to natural disasters and climate change.

Learn about how public health is employing ethical frameworks to support and improve wastewater surveillance and other community health monitoring measures.

Learn effective strategies for addressing workforce challenges in the islands, including geographic isolation and underdeveloped academic pathways.

Delve into the successes, challenges, and lessons learned to inform/advance FHIR adoption among state and local public health agencies and their health care partners.

Data Modernization Primer and Tactical Guides Dive into these data modernization reports for strategies and detailed steps to move from siloed systems to a connected, resilient data ecosystem. Public health data modernization is a collective effort by federal, state, local, and tribal organizations to strengthen public health data and surveillance systems. The ultimate goal is to move from siloed public health data systems to a connected, resilient, adaptable, and sustainable “response ready” data ecosystem. The primer provides state and territorial health officials with a high-level understanding of the objective and significance of data modernization as well as the roles that they play in a successful data modernization initiative. The five tactical guides detail key strategies and tactics for implementing and maintaining data modernization initiatives within public health agencies. article yes

How the Washington State Department of Health worked with communities to amend rulemaking processes using a health equity lens to reduce disparities.

Measuring Health Equity for Planning and Performance Improvement astho, association of state and territorial health officials, environmental scan, health equity, health equity metrics, health equity strategies, social determinants of health, improve health, gender identity, sexual orientation, united states, race ethnicity, health outcomes, public health practice, health disparities, external factors, conducting an environmental scan, highest level of health, health and health, local health, measuring health equity, reduce health disparities, achieve health equity, public health, advancing health equity, health and health care Heidi Westermann, Melissa Lewis Better defining and measuring health equity in ASTHO jurisdictions. With support from CDC’s Center for State, Tribal, Local, and Territorial Support, in 2021, ASTHO initiated a health equity metric assessment to strengthen the evidence base for measuring health equity by identifying and collecting known and emerging metrics that support health equity strategies and monitor advancements toward health equity. To better understand the state of the field, ASTHO conducted an environmental scan that looked at state and territorial planning documents and national frameworks. As the scan revealed wide variation in how jurisdictions use equity-related terms and limited established metrics, ASTHO convened an advisory group to help identify resources and guide the work’s direction. Participating health agencies told ASTHO about their challenges in developing health equity standards and measures, including obstacles related to the underlying culture and the change management required to evolve toward a more equitable public health system. The agencies described both data limitation challenges and workforce capacity and communication challenges. This report summarizes these challenges, proposes incremental recommendations, and acknowledges the need for states and territories to apply both health equity and performance management strategies to develop health equity standards and measures. ASTHO recommends: Addressing data limitations and being transparent about remaining gaps. Building workforce capacity to recognize and address complex concepts and evolving needs through strategic skills and structural, transitional, and transformational change. Employing inclusive planning and performance management promising practices to engage stakeholders to develop meaningful, community-driven metrics. Committing to human-centered communication and community engagement through data visualization, storytelling, and trusted messengers. While this assessment confirmed that states and territories are interested in a list of nationally vetted common health equity metrics, the findings demonstrate a need for true equity engagement between communities and governmental public health leading to a paradigm shift in how we partner to improve health, prevent disease, and eliminate disparities. In addition, given that this assessment began before the COVID-19 pandemic, it does not fully account for the ongoing change associated with dedicated COVID disparities funding, investments in data and infrastructure, and the pandemic’s complex mental, physical, political, social, and economic impacts. As a result, several jurisdictions may need to adapt strategies already underway that are aligned with ASTHO’s recommendations. Health agencies should also consider their level of influence and authority and which partners they would engage to implement these strategies; this may vary by jurisdiction and governance structure. ASTHO will continue to strategize ways to improve and formalize health equity metrics to help public health agencies better serve their communities. Get the Report (PDF) article yes

Public Health Data Disclosure or Request Readiness Assessment Chris Alibrandi O’Connor Explore key steps and lessons for effective public health data sharing. Organizations that want to share or request data to support public health work should take several preparatory steps. An organization’s data sharing efforts will develop more quickly and smoothly if certain considerations have been analyzed, or actions taken before negotiations begin on a data sharing agreement. The same is true for organizations trying to obtain data to support their public health efforts. Consider the following prompts and questions before initiating data sharing or a request for data to prepare for a more efficient and effective negotiation for the data’s disclosure. That consideration will identify barriers to data sharing as well as result in greater clarity around organizational data sharing needs and data governance. For those seeking data, what data do you need? What type of public health work is on the table and what data is needed to achieve the related public health goals? Identify which entity has the needed data Identify the required data elements Specify the type of data needed (e.g., line level, identifiable, Limited Data Sets, de-identified, aggregated) Having identified the data elements and type of data needed will help later in the legal analysis of which laws apply to the disclosure of data Pre-Negotiation Considerations Review organization’s existing written data sharing or data governance policy. Determine whether the project is covered by it and whether any related data disclosures or uses would comply with it. If there is no such policy, consider developing one for adoption. That process will clarify and/or resolve many issues, including data governance guidelines, which could become barriers during data sharing agreement negotiation. Having an organizational “champion” in a position of authority to support a data project may help overcome internal obstacles. Identify a champion — or develop one. Identify and get to know the people who play key roles in data sharing agreements (data stewards, leadership, legal counsel) to facilitate project communication. Pre-Negotiations Review of Legal Issues Evaluate the answers to these questions about disclosing the data at issue: Can I? (i.e., does the law permit the data’s disclosure?) Must I? (i.e., does the law require disclosure?) Should I? (i.e., is disclosing the data the right call when considering legal, policy, and equitable factors) When considering the risks of disclosing data, also consider the risks of not disclosing it for public health purposes; consider what public health efforts will not succeed without the data. Author Funding Disclaimer - Resource - Data Sharing Request Disclosure Alaska article yes

Legionella Communications Factsheet: A Guide for Health Agency Staff Legionella is a type of bacteria found naturally in freshwater environments at generally low levels. It can become a health problem when its presence is amplified in building water systems, especially large, complex water systems such as those found in hotels, hospitals, and office buildings. When Legionella grows in the biofilm of premise plumbing and is aerosolized through devices such as showers, cooling towers, hot tubs, or fountains, people can breathe in small water droplets containing the bacteria. Inhalation of Legionella may result in a severe form of pneumonia known as Legionnaires’ disease, or in milder Pontiac fever. Legionella is the leading cause of waterborne disease outbreaks associated with drinking water in the United States. Control of Legionella and other plumbing pathogens is complicated and is a shared responsibility between water utilities, high-risk individuals, and commercial, industrial, institutional, and residential customers. Each of these partners has a role in reducing occurrence of and exposure to Legionella. The goal of this resource is to: Provide information that state health agency staff can use when talking to building and facility personnel about Legionella and other opportunistic biofilm pathogens. Provide information to increase building owner awareness of the potential for pathogens to grow in building water systems, including resources that can help them reduce or minimize pathogen growth in their plumbing. Outline proactive Legionella-related communications methods for state agencies to consider. Get the Factsheet (PDF) article yes

Using Water Quality Monitoring Data for Your Building Water Management Program In order to reduce the risk of opportunistic pathogens, such as Legionella, it is important to use water quality monitoring data as part of your building’s water management program (WMP). The first stage in developing a building water management program is to establish an understanding of baseline water quality at the point of entry and other select points in the building. This factsheet outlines how to monitor water quality in facilities to prevent the growth of Legionella and other opportunistic pathogens. It discusses important basic water quality monitoring parameters, including temperature, pH, turbidity, and disinfectant residual. An important aspect of developing and implementing a building WMP is understanding the water quality received by the water supplier at the building point of entry and how the water quality is affected as it is used throughout the building. This resource contains a five-step process for monitoring water quality that can be used to develop a building WMP. Get the Factsheet (PDF) article yes

50-state legal scan of requirements for state health agencies to fund local health department core health services.

Syphilis Campaign Planning Project These resources provide health agencies with the tools they need to plan messaging campaigns to promote syphilis testing and prevention. The Syphilis Communications Campaign Planning Project is a comprehensive suite of resources and tools — created in collaboration by ASTHO, CDC, and Trillium — designed to help health agencies create robust messaging campaigns aimed at increasing syphilis testing and prevention efforts. These worksheet templates can be used to develop and customize a messaging campaign tailored to your agency’s programs. Accompanying the templates are two reports exploring the development and efficacy of these resources.   article yes

ASTHO's Climate and Health Portfolio article no

This summary of our annual environmental scan identifies public health concerns and trends and health agencies’ top current and emerging priorities.