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ASTHO’s 2024 Legislative Session Update: Part One legislative session, state policy, data collection, domestic violence, health information exchange, data privacy, substance misuse, overdose prevention, sexually transmitted infections, reproductive health, contraceptive care, climate change, public health, protect data, user data, personal data, centers for disease control, disease control and prevention, social media, data management, primary care, health organizations, higher risk, family planning, data sources, astho, association of state and territorial health officials Lillian Colasurdo, Maggie Davis, Lana McKinney, JoAnne McClure This past December, ASTHO announced the top 10 public health state policy issues to watch for during the 2024 state and territorial legislative sessions. With at least 30 states concluding their regularly scheduled 2024 sessions, here is a brief update on five of the topics to watch. Data Collection and Exchange As expected, there was an increase in proposed legislation that specifically advances electronic health data access, encourages interoperability, and safeguards identifiable patient health records; this was particularly true for vital records. Hundreds of bills have been introduced this session addressing state vital records systems. The state of Illinois alone has already passed several bills, including HB 2856, which requires veteran status to be designated on death certificates, and HB 2841, which prohibits the assessment of fees to victims of domestic violence who are seeking a certified vital record (birth or death certificate) from the state. Other states such as Arizona (SB 1252) considered legislation that would require the Department of Health to provide vital records information on deceased individuals to the qualifying health information exchange (HIE). Arizona is one of eight jurisdictions (AZ, FL, IA, IL, NH, NJ, OK, and WV) that have proposed legislation addressing HIEs this session. Most of these bills increase requirements to connect to HIEs, but New Hampshire HB 1663 and Oklahoma HB 3556 would allow patients and health care providers to opt out of HIEs. As many states look to address health data privacy concerns, New Hampshire recently passed a constitutional amendment granting the explicit right to privacy and has introduced HB 1663, which would update many of the state’s privacy laws regarding medical records to conform with the constitutional requirements. Just next door, Maine considered legislation (LD 1902) that would strengthen privacy requirements for reproductive and gender-affirming patient health information. Finally, the launch of the new federal Trusted Exchange Framework and Common Agreement (TEFCA) led to the Florida legislature proposing SB 668, which, had it passed, would have required hospitals to make patient records available through a nationally recognized trusted exchange framework. It would also have required the Agency for Health Care Administration to adopt relevant rules. Substance Misuse and Overdose Prevention Measures to prevent substance misuse and reduce overdoses, namely increasing access to opioid antagonists, such as naloxone and regulating substances with the potential for misuse, are priorities this legislative season. ASTHO anticipated that states would consider legislation to reduce fatal overdoses including decriminalizing drug checking equipment, expanding naloxone access and distribution, establishing overdose prevention centers, and establishing state regulatory frameworks for commercial substances with the potential for misuse, including kratom and Delta-8. Current legislative priorities to expand access to naloxone include public spaces, such as libraries, schools, workplaces. Island jurisdictions along with at least four states—Colorado (HB 24-1003), Tennessee (SB 2141), Virginia (HB 732), and Wisconsin (AB 223)—passed legislation to provide greater access to and/or proper storage of naloxone in school settings. Additionally, Virginia passed HB 342 that requires naloxone access in state agency buildings. These legislative actions, along with the approval last year by the FDA of two non-prescription naloxone spray products for over-the-counter use, are collectively powerful policy shifts to expand access to naloxone. In an attempt to regulate substances with the potential for abuse or misuse, specifically kratom, eight states have considered legislation that would restrict the sale to people under the age of 18. Similarly, twelve states have considered legislation that would restrict the sale of kratom to those under the age of 21. At least 22 states have considered legislation that would compel specific labeling requirements for kratom. Of those, California (AB 2365) and New Jersey (A 1188) would require kratom products to be registered with the state health department annually and require lab testing of the product to meet certain qualifications. Preventing Sexually Transmitted Infections ASTHO has spotlighted the growing concerns of rising rates of sexually transmitted infections and state actions reducing congenital syphilis rates and expanding access to HIV prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Rates of both syphilis and congenital syphilis continue to rise at an alarming rate, with more than 10 times as many babies being born with syphilis in 2022 than in 2012. Routine screening and timely and adequate treatment of pregnant people for syphilis, ideally more than 30 days before delivery, can effectively prevent this condition in newborns. Due to increasing cases, the American College of Obstetricians and Gynecologists recently updated their guidance for obstetrician–gynecologists and other obstetric care professionals advising serological screening for all pregnant individuals at the first prenatal visit and universal screening at the third trimester and at birth. During the 2024 legislative session at least two states—Missouri (SB 1260) and Maryland (HB 119)—are considering legislation that would require testing during pregnancy care at the third trimester for syphilis. Maryland’s legislature passed HB 119, which would require screening at the third trimester and at birth, as well as requiring the hospital to determine the syphilis status of the birthing parent before discharging the newborn. In 2023, New York enacted legislation (A 3007) that requires syphilis screening in the third trimester, and in the current legislative session they are considering S 2472, which would allow the state health department to provide education about congenital syphilis and screenings. At least six states have considered and passed legislation during the 2024 legislative session regarding expanded access for HIV prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Of those considered, Georgia enacted HB 1028 to allow PEP to be issued by a standing order; Florida’s legislature passed HB 159 that would allow pharmacists to screen for HIV exposure, order, and dispense prevention drugs PEP and PrEP and sent it to the governor. Similarly, in Delaware the Senate chamber passed SB 194 that would permit pharmacists to provide PrEP and PEP pursuant to an approved protocol. Family and Reproductive Health Policymakers across all levels of government continued taking steps to make it easier for people to access contraceptives. In 2023, at least 14 states enacted laws in 2023 to facilitate expanding access to contraceptive care by either expanding the ability for pharmacists to dispense birth control without an individualized prescription and/or allowing pharmacists to dispense up to 12 months of contraceptives at once. So far in 2024, at least 13 jurisdictions considered legislation allowing pharmacists to dispense contraceptives without a prescription and at least 18 states considered legislation supporting access to 12 month supply of contraceptives. Following FDA’s July 2023 approval of Opill—the first over-the-counter (OTC) birth control pill—the drug is currently available in stores with several major pharmacies and health plans announcing that they will provide the medication at zero cost for many health plan sponsors. To further support access to Opill, at least two states (New Mexico and Wisconsin) issued standing orders for Opill to facilitate Medicaid coverage of the medication. Additionally, Maryland’s legislature passed SB 527 in March 2024, which requires community colleges to develop and implement a plan to provide students access to OTC contraception. In February 2024, New York enacted S 8096 allowing the commissioner of health to issue a standing order allowing a pharmacist to dispense self-administered hormonal contraceptives, effective retroactively to January 1, 2024. Under the new law, New York’s Commissioner of Health issued a standing order to allow pharmacists to dispense up to 12 months of self-administered hormonal contraceptives like birth control pills, vaginal rings, and contraceptive patches. Optimal Health for All ASTHO anticipates policymakers will take steps to improve collection of health disparities data, address inequities rural communities face in accessing care, and to support climate change adaptation planning efforts. So far in the 2024 legislative session, several states are considering bills to improve health care access and outcomes in rural areas. California is considering legislation (SB 945) that would build an integrated data dashboard to provide the public with information on the health impacts caused by wildfires and the effectiveness of forest health and wildfire mitigation on health outcomes. Additionally, California (AB 2342) is looking to ensure critical access hospitals on remote islands receive adequate funding through a dedicated annual supplement. New York is considering at least two bills that would promote rural health care access. First, New York S 8582 would create a pilot program to identify rural health zones and convene a rural health zone board

Advancing State Maternal and Child Health Policymaking Through Boundary Spanning Leadership ASTHO, Association of State and Territorial Health Officials, state policy, maternal and child health policy, maternal and child health, maternal health, public health, health equity, access to care, boundary spanning leadership, medicaid coverage, postpartum coverage, missouri department of health, department of health, prism learning community, mch policymaking, pregnancy risk, pregnancy realated death, socioeconomic disparities, pregnant and postpartum women, multi sector action network, improve partnerships, establish direction, strengthen relationships, mental health, community based organizations, public health agencies, shared barriers, elementary and secondary education, collaboration and coordination, key legislation Maria Gabriela Ruiz, Ramya Dronamraju ASTHO | Advancing State Maternal and Child Health Policymaking Through Boundary Spanning Leadership Missouri is addressing a critical maternal health crisis characterized by rising pregnancy-related deaths, socioeconomic disparities, and limited postpartum coverage. This challenge prompted a bipartisan push for Medicaid postpartum coverage extension and the need for a cohesive, comprehensive state system involving diverse stakeholders to improve outcomes for pregnant and postpartum women. As a result, the Missouri Department of Health and Senior Services (DHSS) team joined the Promoting Innovation in State and Territorial Maternal and Child Health (MCH) Policymaking (PRISM) Learning Community in 2021: a partnership between ASTHO and the Association of Maternal and Child Health Programs. Through PRISM, Missouri worked to increase access to quality health care for pregnant and postpartum women through innovative policy solutions. The team established three overarching goals based on state priorities: Advocate for extending postpartum Medicaid coverage to 12 months. Establish a multi-sector action network to provide a multidisciplinary system of care, promoting health equity and ensuring appropriate care coordination for women and mothers with mental health and substance use disorders. Improve access to quality health care for low-income pregnant and postnatal women, including Medicaid coverage of services provided by professional midwives, doulas, and community health workers. Boundary Spanning Leadership Training Overview As part of DHSS’ engagement with PRISM, Missouri participated in a Boundary Spanning Leadership to improve partnerships, develop solutions to address the emerging needs of the MCH population, and foster trust among partners dedicated to improving maternal and infant health in Missouri. Boundary spanning leadership (BSL) is defined as the capability to establish direction, alignment, and commitment across boundaries to achieve a higher vision or goal. The main vision of Missouri’s BSL training was to build momentum on their PRISM goals and improve MCH outcomes in the state by strengthening relationships with relevant stakeholders. BSL training participants included representatives from DHSS and Departments of Social Services, Mental Health, Elementary and Secondary Education, along with other critical partners from community-based organizations, academic institutions, and local public health agencies. BSL introduced tactical skills to create psychological safety as a cross-sector team and respect for the values and unique challenges of each team/organization represented. This space provided the direction, alignment, and commitment that participants to leverage in addressing challenges among the MCH population. Lessons Learned Recognizing Shared Barriers: A central aspect of the BSL training is for participants to align on shared barriers and concerns. Participants identified funding as a challenge when developing programmatic and policy initiatives, highlighting complex state and federal funding structures, bureaucracy, and sustainability. Collaboration and Coordination: Participants discussed the disconnect between the availability and accessibility of MCH services in Missouri, which results from fragmented communication between agencies, leading to duplication of efforts and straining already limited resources as well as personnel. Throughout the BSL training, participants discovered ways to work together to amplify available resources, coordinate programmatic efforts, and reduce barriers to access for MCH populations. Public Health Workforce Capacity: The COVID-19 pandemic resulted in workforce turnover and decreased capacity, leading to further disruptions in service delivery, quality, and efficiency. BSL participants highlighted acquisition, training, and staff retention as priorities to focus on moving forward. State Successes Enacting Key Legislation In May 2023, Missouri passed SB 45, which extended Medicaid for birthing people to 12 months postpartum, including coverage for mental health and substance use disorder treatment. The extension of coverage for 12 months after delivery is estimated to cover more than 4,000 women who would otherwise become uninsured two months after the end of pregnancy. Developing a Coordinated Approach Since the in-person BSL training in April, Missouri has developed interagency connections and relationships to bolster MCH progress in the state. One example is a partnership forged between the DHSS Office of Dental Health and leadership at Uzazi Village, a community-based health organization that provides “adjacent models of care” for Black and Brown childbearing families to restore health, vitality, and joy to communities of color during the perinatal period. These organizations collaborated to bring oral health care to pregnant and postpartum people without access to dental care services. The State Dental Director and MCH Director coordinated the donation and transport of the larger dental equipment and the purchase of smaller equipment and supplies needed for the clinic; the State Dental Director also connected Uzazi with a dental provider. Missouri is poised to capitalize on the connections established during this training and further enhance collaborative efforts to improve MCH outcomes. Next Steps Missouri achieved all three of their goals through engagement in PRISM, exemplifying a proactive approach to addressing critical maternal health challenges. The team has made significant progress in advancing policy initiatives to improve access to quality health care for pregnant and postpartum women. Developing a coordinated approach to addressing MCH issues remains a priority as Missouri continues to foster collaboration among diverse stakeholders. The team will be able to leverage its new connections to address emerging issues, such as the current, which is disproportionately affecting children and families. Moving forward, Missouri is well-positioned to build upon its successes and further strengthen interagency connections to continue making impactful strides in maternal and child health. Special Thanks-Blog - Advancing MCH Policymaking Through BSL website yes

Infusing Diversity, Equity, and Inclusion Into State Public Health Agencies: Perspectives from Connecticut, New York, and Tennessee Association of State and Territorial Health Officials, diversity equity inclusion, public health, public health agencies, connecticut and new York, tennessee and new York, public health workforce, equitable access to care, health equity, access to care, share resources, diverse executives, delph scholars, leadership development, implement dei, health agencies, office of multicultural health equity, advisory council, racial equity, human rights, health and mental hygiene, board of health, anti racism, department of health, addressing dei, health disparities, political landscape Samia Hussein, Erika Kirtz, Jannae Parrott ASTHO | DELPH Scholars share insights on creating an inclusive and equitable workplace in public health agencies from Connecticut, New York, and Tennessee perspectives. A diverse public health workforce is essential for organizations to offer equitable access to care and address the many social and political factors affecting health. Public health agencies are most robust when they mirror the diversity of the communities they serve, as this enables them to access and share resources with the community and other stakeholders more easily through established connections. Therefore, infusing Diversity, Equity, and inclusion (DEI) into multiple levels of state and local public health agencies is vital. In a LinkedIn Study, 76% of employees indicated that diversity is essential when considering a job, and 80% of survey respondents indicated they want to work for a company that values diversity. With the recent resignation wave hitting many state and local public health agencies, the need for authentic attraction of new employees who share our DEI values is more urgent than ever. It is time for public health practitioners to transform the systems to be more inclusive and structured to provide the necessary resources and interventions to all individuals, especially the most vulnerable. As Diverse Executives Leading in Public Health (DELPH) Scholars, we value this DEI conversation centered around equity within the workplace. Our leadership development program has allowed us to connect with others working on this same effort nationwide. Together, we have learned valuable lessons as we implement DEI at our health agencies and are eager to share them with you. This collective effort and shared purpose drive us in our DEI journey. State Perspectives on Addressing DEI Connecticut: Samia Hussein The Office of Multicultural Health Equity (OMHE) was established in 1996 as an appointed office by the then Commissioner to create health equity programs and initiatives that address our staff and client needs, including establishing our Statewide Multicultural Advisory Council (MCAC). Recently, in Connecticut, the Commission on Human Rights and Opportunities and the Commission on Racial Equity in Public Health co-hosted a statewide symposium titled “Cementing Equity in State Government” that launched the results of two fundamental equity studies across the state. The studies are a result of legislation passed declaring racism a public health crisis. The first step in our DEI journey was to ensure a foundation of definitions, terms, and a safe space for dialogue around shared experiences, which can lead to culture change. This was accomplished through buy-in from leadership by consulting with a full-service DEI agency, Kaleidoscope Group, based in Chicago. The Commissioner, Executive Leadership Team, and Union Leadership collaborated in offering this mandatory full-day DEI training to our entire agency (~3400 staff). OMHE and MCAC create a shared three-year strategic plan that is a vehicle for making a substantial DEI impact (e.g., reviewing health inequities) and provides recommendations for the Commissioner through programs/initiatives and policy changes. It is imperative to collaborate with multiple internal and external stakeholders to have a pulse on DEI issues. This existing infrastructure allowed OMHE to oversee this training mandate and continue advancing DEI programs statewide. Our preliminary data for DEI training has shown that nearly 80% of staff reported the training as a worthwhile investment, and 82.1% strongly agree that they will apply the knowledge and skills learned from the training at their workplace. We continue to look at client data points for behavioral health inequities and address DEI concerns collaboratively. New York: Jannae Parrott The New York City Department of Health and Mental Hygiene (DOHMH) has embraced a proactive and inclusive strategy to tackle DEI by prioritizing integrating health equity and anti-racism throughout the agency. This work is primarily supported and driven by the New York City Board of Health resolution declaring racism a public health crisis. At DOHMH, the first step was to launch an agency-wide initiative to empower staff with the knowledge and tools to effectively address racial health disparities and enhance health outcomes for all New Yorkers. This initiative involves educating and training staff on how racism and other oppressive systems can impact healthcare, analyzing how racism may have influenced our past work, establishing new policies to mitigate such influences, and collaborating with local communities to explore additional strategies for combating systemic injustice. DOHMH will soon launch a new data equity skills training course to engage staff at all levels in applying practical data equity skills. Its objectives include fostering awareness of the importance of data equity, providing tools and training for people who work with data to enhance equity in data practices, and offering resources for staff involved in data-informed decision-making. Additionally, DOHMH has initiated comprehensive internal reforms aimed at dismantling silos and modernizing our data systems. This transformative process enables the agency to advance the linkage of public health, healthcare, and social service data, ultimately enhancing our understanding and efforts to improve population health. Tennessee: Erika Kirtz The Tennessee Department of Health (TDH) has been strategic in its approach to addressing DEI in the state. We have shifted our language to focus on eliminating disparities, which is the central focus of our equity work. A key priority is overcoming limitations in our data and surveillance systems to detect disparities in vulnerable populations better. Offices within TDH are linking multiple datasets to gather demographics and risk factors to understand how to serve the populations best. For example, the Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) program in TDH has implemented processes to link surveillance datasets to secondary data sources (inpatient and outpatient hospital discharge data, etc.) to gather information on demographics that aid in the understanding of risk factors associated with the acquisition of certain multi-drug resistant organisms. The findings from this data linkage allow the team to pinpoint risk factors that can be overcome with targeted interventions. We have also begun breaking down silos to collaborate across offices and divisions on the various equity-related initiatives. The overall goal is to transform the current systems to operate through an equity lens, which will be standard practice throughout TDH. There is also a push to continue diversifying the workforce by actively recruiting interns and staff from local Historically Black Colleges and Universities (HBCUs) and other institutions with minority populations. The TDH’s central office is in Nashville, TN, near two prominent HBCUs: Tennessee State University and Meharry Medical College. TDH staff have attended job fairs and specifically sent notifications to faculty at these institutions to help recruit for internships, fellowships, and employment. TDH’s approach is to remove the negative stigma around the term equity, which allows our department to continue serving the people of Tennessee. Call to Action The work of DEI can be challenging, and there is no specific blueprint for addressing it. However, we want to share key takeaways and lessons from this process. It is imperative to have leadership buy-in and support early in the process. The work will not be prioritized if it does not start with the Commissioner and the Executive Leadership Team. Also, this process is not one-size-fits-all and requires a clear vision. The first step is establishing a clear baseline of health equity measures to assess progress continuously. Guidance from the Robert Wood Johnson Foundation can assist in measuring equity in your state. Review what other agencies are doing to adopt best practices that can be applied to your agency. Please note that this process is not for one person and requires a diverse and dedicated team to champion this work. This process requires financial investment through consulting, training, or hiring core staff. There will be many people who are resistant to change or critical of this work. Remember the why and the importance of these practices. Use data to support decisions and stick to the strategies or action plans that lead to success. Also, identify key partners committed to this work and use each other to overcome challenges. Understanding the political landscape and concerns these initiatives might evoke is vital. These concerns can be overcome by being proactive in communicating the benefits and importance of this work, building relationships and awareness of social inequities, and inviting all employees to play a role in advocating for the advancement of DEI. When considering diversity and inclusion, we must think beyond gender, race, and ethnicity. Consider understanding the makeup of the diverse communities served. Expand upon client and staff demographic data. Even if the Federal and State

ASTHO Helping Agencies and Providers Advance Vaccine Equity vaccine equity toolkit, community-based vaccine outreach, public health vaccine partnerships, increasing vaccine confidence, vaccine equity strategies, vaccination rates, improving vaccination, community based organizations, health equity, vaccination coverage, trusted messengers, health care, health and human services, disease control and prevention, vaccine preventable diseases, centers for disease control, increasing vaccine, covid-19 pandemic, vaccination program, immunization program, public health departments, build vaccine confidence, control and prevention cdc, united states, health systems, ASTHO, Association of State and Territorial Health Officials Shalini Nair ASTHO | Highlights of ASTHO toolkit that helps health agencies and providers advance equity in their communities. Over the past several years, views on vaccination have fluctuated, with periods of widespread demand followed by waves of declining sentiment due to the spread of mis- and disinformation—ultimately contributing to worsening health disparities. Addressing immunization equity is essential to mitigating the effects of vaccine-preventable diseases among vulnerable individuals and communities who may be at higher risk for adverse outcomes. The COVID-19 pandemic response provided many lessons to take forward for health equity initiatives, specifically in highlighting the importance of community-centered outreach in addressing the health care divide. Introducing: Vaccine Equity Toolkit ASTHO’s Championing Change: A Toolkit for Addressing Vaccine Equity Through Community Mobilization helps state and territorial health agencies, community leaders, and health care providers advance vaccine equity in their communities. For the past three years, ASTHO’s award-winning Partnering for Vaccine Equity initiative has supported boots-on-the-ground efforts to increase vaccine confidence, drive demand for vaccines, and facilitate vaccine uptake. Alongside the Community Action network and a diverse group of advisors, ASTHO and national and local partners have collated this comprehensive resource, which highlights the promising strategies, lessons learned, outcomes, and more from the novel collaborative. Lille Seels_ASTHO Helping Agencies and Providers Advance Vaccine Equity From the Field Snapshot The Championing Change toolkit highlights the work of five local community action agencies across Alabama, Arkansas, California, Georgia, and South Carolina, to increase uptake of vaccines in their jurisdictions. Each agency took a slightly different approach to implementation, emphasizing the importance of tailoring interventions to local community needs. The toolkit includes in-depth case studies on the standout strategies, including: Partnering with health care and public health: Palmetto Community Action Partnership engaged with their health department and a regional federally qualified health care center to help maximize the reach and impact of their services in rural South Carolina. Meeting people where they are with fact-based messaging: Enrichment Services Program leveraged the power of targeted messaging campaigns to address the underlying opinions and attitudes of community members, and cultivate discussion around vaccination across three counties in Georgia and Alabama. Leveraging existing programming and partnerships to expand reach: Community Action Program for Central Arkansas looked to their internal programmatic initiatives around early childhood education and outreach for individuals experiencing homelessness to help amplify their vaccine equity work. Since the project’s inception, ASTHO’s community action partners have held more than 450 events, engaged more than 1.5 million community members in their efforts, and administered at least 5,500 vaccinations including those for COVID-19, influenza, Tdap (tetanus, diphtheria, and pertussis), shingles, and more. Susan Bailey_ASTHO Helping Agencies and Providers Advance Vaccine Equity Using the Toolkit State and territorial health agencies work to promote, improve, and maintain health for all. However, their ability to fulfill these responsibilities sustainably depends largely on public trust in public health institutions. One of the most effective ways to build trust is by engaging the communities most affected and leveraging existing, trusted organizations to help address the issues. Every site participating in ASTHO’s Vaccine Equity Project cultivated partnerships with their state or local health department to aid in their outreach efforts, which can transcend into other areas and stages of public health interventions. Aurora GrantWingate_ASTHO Helping Agencies and Providers Advance Vaccine Equity In Conclusion Jurisdictions can learn more about the innovative structure and outcomes from this project and implement similar partnerships that further the pursuit of equity in their communities. Access the Championing Change toolkit now. Special Thanks-Blog - ASTHO Helping Agencies and Providers Advance Vaccine Equity Padding - small 1 NU21IP000598 website yes

Licking County, Ohio uses performance management to advance environmental health, emphasizing impact and equity.

Learn about how ticks can spread alpha-gal syndrome, also called red meat allergy.

A One Health approach can give health agencies the connections they need to address climate and health.

Partner Spotlight: Q&A with Anne Remick, Program Director, Alaska Breast and Cervical Screening Assistance Program astho, association of state and territorial health officials, anne remick, breast and cervical screening assistance program, health equity, women's history month, public health, women trailblazers, united states, international women s day, women s history week, national women s history, 20th century, week of march, health disparities, president jimmy carter issued, social determinants of health, presidential proclamation declaring, proclamation declaring the week, achieving health equity, women s history alliance, highest level of health, public health professionals, health problems, library of congress, health inequality, african American, congress passed ASTHO Staff ASTHO and CDC’s Office of Health Equity established the Power of Partnerships Health Equity Alliance in 2023 to prioritize health equity during emergency and non-emergency situations. The Alliance is comprised of state, local, and territorial Offices of Health Equity, Women’s Health/Maternal Child Health, and other trusted leaders from community-based organizations and non-governmental organizations. ASTHO spoke with the Anne Remick, a steering committee member of the Alliance and the Program Director of Alaska’s Breast and Cervical Screening Assistance Program, which helps eligible Alaskans get breast and cervical health screenings, mammograms, provides financial support for diagnostic tests, and helps connect Alaskans to resources. How can public health enhance preventive care and health education initiatives to empower women to take charge of their health? My work is very focused on breast and cervical cancer screening, but I believe there are universal truths to be explored that cross all aspects of taking charge of our health. Using accessible language and acknowledging past trauma should be standard. When talking with people about accessing health care, I emphasize that we all deserve a health care provider who listens and respects us. This includes consent in a deep way. Not only giving our consent for the provider to touch us, but consent on what is being screened or tested with clear and understandable communication. When thinking about receiving health care as well as health education I think shifting the paradigm from a top-down directive approach to a more collaborative, judgement free approach is the direction we should be going. An approach that acknowledges that we all want good health as defined by us, but we might get there on different paths. This allows people to meet in a less confrontational space where true communication and trust can occur. How we communicate with each other is so vital. Creating a system where we are heard, respected, and valued will empower us to take charge of our health. In your experience, how important is policy and advocacy in improving women's health outcomes, and what role can leaders play in advancing supportive policies? Policy and advocacy are vital to improving women’s health. Policy and advocacy create the systems we must navigate for improving women’s health outcomes. We need leaders to advocate for policies that take away barriers to care rather than create more disparities and risk women’s health. If you could have dinner with a female leader that inspires your work, who would it be and why? What would you ask this person? I am inspired by the stories of women trailblazers who lead the way for social justice. Elizabeth Wanamaker Peratrovich is an amazing part of Alaska’s civil rights history. She was born in 1911 in Ketchikan. She was Tlingit and grew up in the era where discrimination against Alaska Native people was common. Signs in business windows like "No Dogs, No Natives” were not unusual. Elizabeth and her family moved to Juneau in the 1940’s so they could have more access to lawmakers to advocate for change. She served as the Grand President of the Alaska Native Sisterhood and was instrumental in the passage of the first state or territorial civil rights legislation in the United States, 19 years before then President Johnson signed the Civil Rights Act of 1964 into law. When an Alaska legislator voiced his opinion against allowing “…people, barely out of savagery…” to have equal rights Elizabeth reminded him of our United States Bill of Rights. She reminded the legislature that laws against discrimination will not end discrimination but “…at least you as legislators can assert to the world that you recognize the evil of the present situation and speak your intent to help us overcome discrimination." Her testimony was critical to the passage of our nation’s first civil rights legislation. If I had a time machine and could have dinner with Elizabeth Peratrovich, I would love to hear about how she found the strength to keep going in the face of ignorance and prejudice with resolve and dignity. How we use our voices makes a big difference. I think Elizabeth Peratrovich did this masterfully. website yes

Learn how state health and transportation agencies are partnering to improve physical access to healthcare.

Voices from Public Health AmeriCorps (PHA) offer insights into the benefits gained at PHA and detail the program's experiential learning and professional development opportunities.

Leading from the Inside: Advancing DEI at the State Level astho, association of state and territorial health officials, workplace cultures, financial performance, creates a positive, diversity equity and inclusion dei, united states, work life balance, hiring process, human resources, organizational culture, top talent, team members, employee engagement, recruiting process, long term, public health worker, socioeconomic status, races ethnicities, retain employees, company s culture, diversity equity inclusion, public service, recruitment retention development, public health workforce, work culture, organizational values, diversity matters James Bell III Three steps on how to implement DEI strategies at the organizational level. Campaigns for racial justice have grown throughout our country, and parallel conversations focusing on diversity, equity, and inclusion (DEI) have increased, especially in public service. We experience this effect through the lens of facilitating more equitable and responsive service delivery. Our programming, policies, and data must be culturally informed and relevant. But DEI must also be valued internally in how we contribute to employee recruitment, retention, and development. Today’s workplace is complex, and DEI is vital for improving outcomes for all the populations we serve. Most modern organizations have come to terms with the critical need for DEI initiatives. The evidence highlighting how these efforts can improve an organization’s productivity, creativity, retention, and financial success has been clear for some time. But, honestly, is that enough? And why haven’t we made the earth-shattering changes we all know are possible? Perhaps it could be traced back to the changes we hope to seek being assigned outside of our organization when it should be us who are leading and implementing change. Breaking down siloes for diversity requires new ways of working with fewer barriers among and across teams and their unique people. To remove these perceived barriers, I propose that a few key steps must take place. 1. Put the people first. I have been in too many meetings where employees are considered “resources” or “FTEs,” and it’s so unfortunate. As advantageous as it may be for some, the lure of DEI as a return on investment cannot be the sole purpose for pursuing such initiatives. We lose the essence of humanity and unique individuality that makes diversity so special when we limit people to a box on an organizational chart. If governments want to attract and retain the best possible talent, the actual business case to make is talent itself. Building a diverse and inclusive culture cannot only be a human resources function or a top-down effort. All people across departments should see themselves reflected in this work and be able to identify a path to make it their own. As leaders, we should work relentlessly toward understanding the needs of others while building a safe environment for the type of collaboration needed to solve complex problems better. This means constantly learning and embracing new concepts, ideas, and ways of doing things. Each of us has the power to create a more substantial, fairer workplace where everyone can contribute their strengths, talents, and ideas while being treated with dignity and respect. 2. Back your program with a budget. Organizations have shouted their pledges and promises to foster more diverse, equitable, and inclusive environments from any rooftop they could find for at least three years. Although determining which groups are walking the walk is challenging, a strong indication of one’s commitment is to look at budget line items. A lack of or limited budget is an immediate red flag that conveys that DEI is not a priority. Just like anything else, if something is important to you, you will spend the money required to implement it properly. One of the best ways to demonstrate your commitment to DEI is through sustainable, tangible financial investment. This allows our DEI initiatives to be continuous and to evolve over time based on the immediate need. We are not in a position to check the box or allow one implicit bias course to cover all the broad gaps we are experiencing. There is also the benefit of a broad supply of qualified DEI practitioners and consultants who are experienced in guiding organizations through complex DEI issues. Should we continue to face complicated and longstanding DEI issues, it isn’t up to our staff to try to resolve them. We must assign monthly, quarterly, or annual monies to address these problems. 3. Hold yourself and your organization accountable. Regardless of agency or size, DEI efforts within organizations often lack strategic follow-through and accountability. These endeavors are often reactive, episodic, or only prioritized after a public relations crisis. We can’t only respond when we are required to respond. The communities we serve—and our employees—expect that we will carry out our responsibilities and fulfill our promises. We have not consistently been diligent in creating mechanisms for feedback, and if we have, we fail to implement them. To truly embed DEI into our culture, we need meaningful metrics and the willingness and courage to use the data to hold ourselves accountable. How will we ever know if we are going in the right direction or making desired changes if we never discuss the data? And that isn’t to say results must be perfect because we know changes take time. But it communicates clear goals and allows for solid focus and discussion for alignment. This disclosure is necessary to drive change and inspire others by demonstrating that progress is possible. The future of state government must fully embrace diversity, equity, and inclusion both as an aspiration and as a responsibility. We must create a sense of belonging and environment for organizational justice, even if this means resisting the status quo that we have nurtured and become far too comfortable letting stand. We should be celebrating rather than marginalizing employees because of their individuality. We should be challenging business practices that undermine our organizational values and fail to treat employees equitably. Author card spacing 1 Related Content-Blog - DELPH Magazine 2 website yes

Reducing the Impact of Eating Disorders on Adolescent Girls eating disorders, adolescent girls, youth mental health, school-based health systems, prevention strategies, bmi, social media usage, public health, health problems, united states, risk factors. higher risk. mental illnesses, mental disorders, physical activity, wide range, mental health conditions, people with eating disorders, intense fear of gaining weight, body mass index bmi, eating disorder include, social media platforms, distorted body image, long term, treatment options, high school, age 18, family members, astho, association of state and territorial health officials Lexa Giragosian Eating disorders are behavioral health conditions that affect physical and mental health through altered ideas about food, eating habits, weight, exercise, body image, and related factors. There are many different types of eating disorders, the most common including anorexia nervosa, bulimia nervosa, and binge-eating disorder. They are among the deadliest mental illnesses, second only to opioid misuse, and co-occur often with anxiety, depression, obsessive-compulsive disorder, substance use, and post-traumatic stress disorder. Their economic cost in the United States is $64.7 billion every year. Eating disorder risk factors include experiencing weight stigma, bullying, limited social networks, trauma, and dieting, which can impact people of all ages, races, genders, and sexual identities. That said, adolescents are largely affected by eating disorders and experienced a 107.4% increase in eating disorder diagnoses from 2018 to 2022, which was exacerbated by the COVID-19 pandemic. The majority of parents reported their adolescents’ social media usage increased during COVID-19’s peak. Adolescent’s exposure to weight-stigmatizing content on social media also increased during this time and is correlated with increased rates of body dissatisfaction. Social media usage can negatively influence body image and lead to body comparison, body dissatisfaction, and disordered eating—all contributors to eating disorder development. Reports indicate that adolescent girls use social media more than adolescent boys and are disproportionately affected by eating disorders, having a higher prevalence of eating disorders with increasing incidence compared to the general adolescent population. Further, according to a recent CDC study, pediatric emergency department visits among adolescent girls with eating disorders doubled during COVID-19. State Policy Actions Addressing youth mental health and social well-being is a top public health program and service priority area for several state and territorial health departments, as indicated by ASTHO’s 2023 Environmental Scan of Current and Emerging Public Health Priorities. Many states have recently proposed or enacted legislation that supports this focus, which may alleviate the impact of eating disorders on adolescent girls. Recent bill highlights include: New York SB-S5225: This active bill of the 2023-2024 session would add eating disorder assessments to the existing health certificate requirements for public school students. Louisiana HB 440: This legislation, passed during the 2022 session, requires schools to provide age-appropriate education about eating disorders as well as how to prevent them. Schools can incorporate this information into their current health education, physical education, or other related courses. Pennsylvania HB-148: The Pennsylvania House of Representatives passed this bill requiring schools to provide educational information to parents of children in 6th-12th grade about eating disorders as well as create a state task force to develop guidance and resources about eating disorders among adolescents. The bill is currently in the Pennsylvania Senate. California CA SCR14: A legislative resolution designated the week beginning on February 20, 2023, as Eating Disorders Awareness Week to improve awareness, visibility, and support. Colorado SB 23-14 and SB 23-17: These complementary bills created a program within the state health department dedicated to preventing eating disorders, limit the use of body mass index (BMI) in determining treatment criteria and appropriate care levels, and restrict the sale of diet pills to minors. Texas HB-18: The governor signed this bill in June 2023 which aims to regulate social media content available to minors. The new law requires social media platforms to develop and implement strategies to prevent the exposure of minors to negative material, including content that promotes, glorifies, or facilitates eating disorders. 1/4 bottom Recommendations to Address Eating Disorders Among Adolescent Girls Collaborate within Multidisciplinary Teams to Promote Eating Disorder Care Coordination Diagnosing and treating eating disorders is a complex process that requires various players, such as primary care and mental health providers, dietitians, state health agencies, schools, clinics, and payers. Establishing care coordination systems for eating disorders with these players can improve diagnosis rates and access to appropriate treatment by developing services and partnerships, including referral pathways, provider training, and universal screening. They can be modeled after evidence-based care coordination systems for substance use disorders, which are effective in accomplishing these very goals. Vermont’s eating disorder workgroup recently developed a report for their legislature in accordance with these recommendations to improve care coordination and increase access to eating disorder services for all populations, including adolescent girls. Implement Prevention Strategies in Schools Focusing on school-based health systems offers an opportunity to improve adolescent mental health. School-based policy strategies to improve adolescent girls’ mental health may include incorporating eating disorder content into health education curricula, building staff capacity to address mental health concerns, and improving screening and treatment access for mental health issues such as eating disorders. Creating a supportive, accepting school environment that does not stigmatize weight is also an important role of schools in eating disorder prevention. The American Academy of Pediatrics provides additional key recommendations for schools and their collaborators regarding their role in addressing eating disorders among students. Support Policy Action Limiting the Use of BMI as an Indicator for Eating Disorder Treatment A stereotypical eating disorder patient is characterized as being “thin” with a low BMI; however, there are higher rates of disordered eating behaviors among those whose BMI classifies them as “overweight” or “obese.” There is an overreliance on BMI as a diagnosable criterion for eating disorders and a prevalence of weight stigma and assumptions in clinical care, contributing to the underdiagnosis of eating disorders. Even with a diagnosis, insurers often use BMI as an indication of treatment need, length of stay, and level of care, which inhibits access to appropriate treatment. In June 2023, the American Medical Association issued a new policy that recognizes the issues of using BMI to measure health as a step towards limiting the use of BMI. Address Social Media Use in Programmatic and Policy Initiatives Social media usage rapidly increased in recent years, and the effects on child and adolescent development are an ongoing concern. Evidence indicates that there is an association between social media usage and adolescent development of eating disorders due to unrealistic body expectations and diet culture outlined in media. The Surgeon General and the American Psychological Association developed guidance on addressing social media usage for children and adolescents, and specified strategies to support healthy social media use that can be utilized in public health initiatives. Moving Forward Eating disorders among adolescent girls are an urgent public health concern. State and territorial health agencies can move forward with prevention efforts by fostering care coordination, collaborating towards policy and programmatic developments in schools, improving access to care, and addressing social media usage. For more information about legislative trends related to eating disorders among adolescents, refer to ASTHO’s resource “Supporting Mental Health: Addressing a New Public Health Crisis,” from the 2024 Legislative Prospectus Series. website yes

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