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Leading Health Security Efforts Through Strategic Collaboration and Innovation Margaret Nilz This blog post illustrates how health agencies' strategic plans can improve health security and emergency preparedness. Strategic planning is a cornerstone of effective public health systems, guiding organizations in preparing for and responding to health threats. Three pivotal documents—the CDC Office of Readiness and Response (ORR) Strategic Plan, the ASTHO Strategic Plan, and the ASTHO Environmental Scan—are part of the foundation of ASTHO’s work. Each plays a critical role in shaping public health policies and practices. Understanding their synergies and differences is beneficial and crucial for enhancing our collective efforts in safeguarding public health. ASTHO’s Environmental Scan tracks U.S. public health concerns and trends. Through qualitative analyses of select health agency materials and health official feedback, this blog identifies state, territorial, and freely associated state health agencies’ (S/THAs) top current and emerging priorities across public health programs, infrastructure, and health equity and agency strategies to address them. Across 2023 and 2024, S/THAs consistently identified emergency preparedness and response as a critical priority. Callout 1-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation It is essential to align strategic plans and address emerging public health priorities in order to effectively respond to new health challenges. The ORR and ASTHO Strategic Plans share several common goals, such as implementing equitable, evidence-based practices, partnering for sustainable infrastructure improvements, and focusing on operational excellence while providing technical assistance. However, each plan also has unique missions. Callout 2-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation ASTHO’s Health Security team has a unit mission and vision that align with ORR goals and focus on supporting the needs of ASTHO members, as identified in the Environmental Scan. Callout 3-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation Aligning these strategic goals with current public health priorities is crucial in addressing existing and emerging health threats. Values The ORR and ASTHO plans express shared values like collaboration and innovation. These values guide strategic decisions and foster a cohesive public health community. Table-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation Competencies and Priorities Both organizations focus on developing competencies like leadership and technical expertise. ORR concentrates heavily on competencies specific to preparedness, including planning, response, and research for public health emergencies. ASTHO emphasizes competencies to support S/THAs, such as technical assistance, communication, capacity building, and advocacy. Building and aligning these competencies is essential for improving public health outcomes and ensuring workforce preparedness. With that in mind, ASTHO’s competencies are specifically aimed at aiding and supporting its members, and consequently the nation, in achieving the ORR competencies. Environmental Scan Observations The ASTHO Environmental Scan thoroughly evaluates current public health trends, challenges, and opportunities. Key highlights from the 2023 and 2024 Environmental Scans include: Focus on emerging threats such as infectious diseases and the impact of climate change. Changes in public health funding and resource availability. Technological advancements and their implications for public health practice. Common trends identified include a heightened focus on health equity, the importance of data-driven decision-making, and the need for increased interagency collaboration. Organizational competencies, including performance management and quality improvement, were listed as current priority areas for public health infrastructure and capacity-building. Focus issues include financial infrastructure, business processes, including procurement, recruitment, and grants management, policy development, and public health governance structures. Workforce development was listed as a priority for public health infrastructure and capacity building. Focus issues include recruitment and retention, local academic pipelines and training opportunities, staff compensation, and staff salary gaps. Data modernization and informatics are priority areas in states with state health improvement and strategic plans and were listed as current public health infrastructure and capacity-building priorities. Accountability, performance management, and quality improvement are priority areas in states with state health improvement and strategic plans and were listed as current public health infrastructure and capacity-building priorities. Implementation While ORR and ASTHO aim to achieve similar overarching goals of supporting health agencies, their implementation strategies vary. The ORR Strategic Plan focuses on four primary strategies that directly address the emerging threats and challenges highlighted by S/THAs, including: Modernizing and integrating data and systems across multidisciplinary public health entities to support data readiness and interoperability. Advancing readiness and response science to improve public health practice, including maturing and implementing evidence-based research in preparedness. Building and enhancing the response capability of CDC and state, tribal, local, and territorial health departments and driving collaboration among partners to enable rapid and effective response to public health emergencies through improved capabilities, partnerships, and funding mechanisms. Conducting rapid and ongoing readiness and response evaluation to inform continuous improvements across the detection of public health threats, readiness science, and emergency operations. While ASTHO’s Strategic Plan is less explicitly focused on preparedness, its guiding mission in supporting, equipping, and advocating for S/THOs and their agencies with a focus on leadership development highlights several strategic priorities critical to improving public health preparedness and addressing emerging priorities. Health and Racial Equity: A state and territorial public health system that prioritizes implementing policies and programs advancing health and racial equity to achieve optimal health for all. Workforce Development: A diverse state and territorial public health workforce that is engaged, well-resourced, well-trained, and connected to the communities it serves. Data Modernization and Interoperability: A state and territorial public health system supported by an enterprise-level data infrastructure in which public health data systems are interoperable, secure, and supported by a well-trained workforce. Collaborative Opportunities Maximizing the impact of these strategic plans involves leveraging the strengths of each organization through collaboration and innovation. There are numerous areas where ORR and ASTHO can collaborate to enhance public health outcomes: Joint programs leveraging CDC’s national scope and ASTHO’s state-level connections. Shared research initiatives pooling resources and expertise from both organizations. Coordinated emergency response efforts that create a unified front addressing public health emergencies. By continuing to communicate, these organizations can effectively address complex public health challenges and enhance overall public health resilience. Future Outlook Looking ahead, the strategic efforts of ORR and ASTHO will play a crucial role in shaping the future of public health infrastructure and preparedness. Engaging with and supporting these initiatives is essential for all stakeholders. To adapt to the changing health security threats, future iterations of all documents must be routinely updated to meet the needs of the nation and ASTHO’s members. A collective effort is required to improve public health resilience and response capabilities, ensuring we are well-prepared for future challenges. Ultimately, the synergy between ORR and ASTHO’s strategic plans presents a powerful opportunity to enhance public health outcomes. We can create a more resilient and effective public health system by fostering collaboration, building competencies, and addressing emerging trends and challenges. website yes

Learn how embedding disability specialists into health agencies improved preparedness programs and initiatives in this blog.

Learn about efforts in New York and Florida to prevent the spread of congenital syphilis.

Fortunately, looking at the ASTHO Directors of Public Health Preparedness (DPHP) peer group and seeing the great work of public health emergency preparedness and response programs across the nation, we recognize that there is much to be celebrated this month—but also much more work that needs to be done.

Members of the Making Dialysis Safer for Patients Coalition discuss the role of public health in dialysis safety and the impact the coalition has had on their work.

Jonathan Mermin of CDC discusses how using a syndemic approach could help health departments to address rising STI rates more effectively

Six DELPH scholars share personal reflections about LGBTQ+ identity, representation at work, and how allyship within public health leadership is critical when responding to a crisis.

Vivian Lasley-Bibbs, Board President of NASOMH, discusses helping minority/health equity offices with capacity building, policy, and workforce development.

Inclusive practices that prioritize the safety and well-being of all residents, regardless of age or ability, are essential in ensuring effective disaster preparedness and response.

ASTHO invited five DELPH scholars to provide examples of how community and diversity shape their leadership within their local health department and share recommendations for a more inclusive workplace.

Cultivating Gen Z as Partners for Healthier Communities astho, association of state and territorial health officials, gen z, young adults, public health campaigns, stronger communities, public health, physically active, gen zers, adults ages, pew research center, members of gen, united states, young adulthood, young people, baby boomers, diverse generation, local communities, digital natives, age 18, people born, entered the workforce, previous generations, birth years, social media, health care, older generations Brandi Hight Bank, Emily Bonaparte, Nick O’Toole ASTHO | The importance of engaging and recruiting Gen Z in public health workforce. As seen in the midterm election results, young adults in Gen Z are a powerful, growing force in electoral politics and our communities. One in every eight voters in this past mid-term election was under age 30. Public health leaders are wise to communicate with this group, as a constituency whose interests—be it climate, economic security, or racial and ethnic equity—often align and intersect with public health. The COVID-19 pandemic introduced many young people to public health for the first time as they witnessed and participated in local response. Interest in public health careers has grown over the past decade, but the desire to contribute spiked during the pandemic. In fact, applications to public health graduate programs applications rose more than 40% in 2021 compared to 2020. Taking stock during pandemic recovery and preparing for the challenges ahead, it is a unique moment to build and strengthen trust in public health with young adults. Why Connect with Young Adults More than 40% of the U.S. population—140 million Americans—is either in the Millennial (born from 1981-1996) or Gen-Z (born 1997-2012) cohort. Not only do young adults have significant influence over our collective future, they also have an uncharacteristically large stake in shaping that future. Debt, the climate crisis, and rapid technology shifts are just a few of the pressing issues waiting for them as they enter the workforce. Young adults are at a nexus of being both digitally native and highly concerned with societal woes. Given their heavy online presence, young adults are a critical audience for public health messaging and a potential powerful amplifier of behavior change and key messaging. Concern over major issues (e.g., mental health care, economic inequality, and racism) primes young audiences to be more aligned with organizations that have a strong mission statement and are passionate about the global good. How To Reach Young Adults It’s not news that young adults spend much of their time online. Young audiences expect public health campaigns to mirror their experience as a consumer, and public health leaders should be familiar with how to develop digital-first approaches. Going digital shouldn’t preclude partnerships and in-person events, but a strong online presence amplifies community engagement. It’s important to define your audience and which platform best reaches them. Snapchat, TikTok, and Instagram rank highest in usership for young audiences, while Baby Boomers (or, simply Boomers) mostly utilize Facebook and YouTube. It’s critical to know both which platforms to use and how to convey your message. A few rules include: Make content digestible, visually appealing, mobile friendly, and video-based. Engage young audiences in co-creating products and messages on issues that affect them. Ask engaging questions, use hashtags, and invite engagement with your organization. Don’t be afraid to think outside the box! Consumer brands often create a noisy online environment and best practices mandate a social media presence. It’s more important than ever to ensure audiences can hear your “voice” and find your content. Luckily, public health officials have two important tools: authenticity and a social mission that naturally connects with many Millennials and Gen Z. These are strong competitive advantages that allow public health messaging to resonate with young audiences and cultivate their trust and engagement in building healthier communities. website yes

Susan Tharpe, the ASTHO disability and preparedness specialist placed in the Georgia Department of Public Health, discusses the importance of partnering with the Autism community on emergency preparedness.

The COVID-19 pandemic has changed the landscape of we go about preparing and responding to public health threats. In collaboration with CDC, ASTHO embarked on an initiative to identify effective resources, policies, and model practices utilized by state and territorial health agencies throughout the pandemic response. In this blog, we highlight four areas of focus that are central to any successful preparedness effort.

Braiding and Layering Funding Resources Communities face a wide range of needs, from food and housing access to transportation and beyond, and no single funding stream is typically built to address them all. Braiding and layering funding, the practice of combining multiple funding streams to support a common initiative, allows state and territorial health agencies to assemble the resources needed to meet diverse community needs comprehensively and sustainably. The white papers on this page highlight case examples and provide best practices for using braiding and layering strategies to achieve sustainable funding. website no

During the COVID-19 pandemic, vaccine hesitancy has increased because of misinformation and disinformation spreading across social and traditional media platforms, targeting vulnerable and underserved communities, and further stalling vaccine uptake. ASTHO hosted representatives from faith- and community-based organizations, universities and colleges, healthcare systems, and other stakeholder groups to discuss the drivers of misinformation and disinformation during the COVID-19 pandemic, and how public health can move forward to address vaccine hesitancy.

The emPOWER program provides federal data, mapping, and artificial intelligence tools, as well as training and resources, to help communities nationwide protect the health of at-risk Medicare beneficiaries who live independently and rely on electric-powered medical devices or receive certain medical services, such as outpatient dialysis, home-based oxygen service, hospice care or other types of home care medical support.

Developing and implementing contact tracing programs in K-12 schools presents a crucial opportunity for both health department and school leaders to keep students healthy, and schools open. This brief shares considerations for health departments working with schools to develop and implement contact tracing programs.

In the United States, suicide and overdose are among the top 10 leading causes of death. At the intersection of suicide and overdose are shared factors that can be assessed to support a comprehensive approach to prevention. The COVID-19 pandemic has created additional stress on communities and individuals, straining resources and exacerbating the suicide and overdose epidemics. This infographic is a tool that can assist states and territories in fostering cross-sector partnerships by demonstrating the intersection of suicide and overdose and how a multi-sector approach can lead to comprehensive prevention. This infographic also reminds us that we can build healthy and supportive communities together, in a strategic and unified way.

The Boundary Spanning Leadership Framework’s Impact on Public Health Boundary Spanning Leadership's Impact on Public Health Alice Schenall, Tyrone Bethune, Alyssa Merski Explore three examples of Boundary Spanning Leadership's public health impact, from overdose to Alzheimer's to youth behavioral health. Since 2018, ASTHO has customized the Boundary Spanning Leadership (BSL) framework for the public health workforce. BSL develops leaders’ ability to create direction, alignment, and commitment (DAC) across both vertical and horizontal relationships within health departments and with community partners. The framework aims to work across differences in geography, demographics, leadership level, department, or unit. It’s designed for settings where the goal is not only to lead people but to lead across these differences, bridging agencies, sectors, levels of authority, and communities. In short, while many leadership models help individuals become more effective leaders, BSL equips public health professionals to mobilize collective leadership across systems, which is essential for addressing complex issues such as behavioral health and emergency response. Here are three examples of BSL’s impact and utility in public health, two of which are multi-state projects. Preventing and Responding to Overdose Overdose Data to Action (OD2A) leaders are faced with boundaries that can inhibit overdose surveillance and prevention activities without proper navigation. For example, partnership with community organizations to reduce overdose may not be effective without first exploring differences between the state health agency and community organization goals and working to build trust. Throughout BSL trainings, OD2A leaders have demonstrated many ways they bridge these boundaries and apply DAC in their overdose surveillance and prevention work. OD2A leaders may need to span boundaries… Between departments within the agencies in which they work. Between hierarchical levels within the organization. With external partners like community-based organizations. With diverse cultures, demographics, and populations with which they work like people who use drugs. Across rural/urban regions, states, or localities. Collaborating across these boundaries ensures stronger team relationships, exchange of perspectives, expertise, and experience, and alignment of vision and strategy to improve program impact. For example, BSL can help OD2A leaders secure critical health agency buy-in while meaningfully engaging people with lived experience in the planning, implementation, and evaluation of prevention programs. “This program allowed me to focus on specific skills and teach me things I had never learned before. My work will be significantly better because of this. I cannot tell you how important it has been to be able to network with the others as well.” — Participant of OD2A Reducing Risk for Alzheimer’s Disease and Related Dementias In 2025 and 2026, ASTHO and the Alzheimer’s Association hosted two BSL trainings for health departments and their partners throughout the Healthy Brain Initiative. These helped equip them with a dynamic approach to addressing Alzheimer’s disease and related dementias (ADRD) by aligning partners across public health, aging, and other sectors. Through DAC, participants engaged in dialogue that bridged boundaries to integrate brain health into chronic disease, injury prevention, and other public health initiatives. Applying BSL practices to brain health created synergies that addressed shared risk factors such as hypertension, obesity, and lack of physical activity. BSL enabled state and jurisdictional teams to adapt quickly to the latest science, engage nontraditional partners, and build the skills needed to navigate potential boundaries. These practices strengthened cross-sector collaboration and built sustainable systems of shared investment and learning, positioning brain health as a priority across the public health landscape. ASTHO selected the BSL training because leaders who effectively collaborate across boundaries are better positioned to address complex public health challenges such as ADRD, which requires interagency and multisector action. Public health leaders need solutions, and there is evidence to support and measure the usefulness of BSL concepts. Participants successfully met the expectations and objectives of the workshop: Breakthrough Innovations: Drove creative solutions that integrated culturally responsive care and brain health promotion across settings. Cross-Functional Learning: Built shared understanding between public health, aging services, and community stakeholders to address complex problems (e.g., ageism, risk reduction, caregiver burnout, access to care). Partnership Development: Leveraged cross-sector collaborations to expand age-friendly environments and relationships. The BSL training left a lasting impact on those who completed the workshop, with participants reporting increased knowledge of major boundary types and mechanisms needed to boost ADRD strategies. Participants shared their excitement to immediately implement BSL elements into their public health practice. As BSL gains momentum and attention across the field, we urge organizations to leverage the framework as a conduit to build the capacity needed to accelerate brain health strategies and beyond. “My participation in this BSL training will have a lasting impact by strengthening both my individual capacity and our team's ability to approach strategic planning, stakeholder engagement, and the development of sustainable. For my team, this will translate into stronger collaboration, clearer direction, and more cohesive implementation of our ADRD strategies.” — Participant of the Healthy Brain Initiative Building Bridges for Youth Behavioral Health in New Mexico In April 2026, leaders from New Mexico’s Departments of Health and Education came together — not just to coordinate but to truly collaborate. Partnering with ASTHO, they convened an in-person BSL training designed to move beyond siloed work and toward a shared vision for adolescent behavioral health in schools across the state. A total of 18 participants joined the training, representing a cross-sector mix of state agencies and community-based organizations. While the group brought diverse perspectives, they shared a common purpose: improving outcomes for young people across the state. The BSL framework offered them a structured way to navigate differences, build trust, and define collective direction. Throughout the workshop, participants deepened their understanding of the boundaries that often limit collaboration, whether structural, relational, or based on differences in processes and priorities. More importantly, they built the skills to identify and bridge those divides. For many, the experience shifted how they think about partnership — not as coordination across systems, but as intentional, interdependent, and relationship-driven leadership. The impact was immediate. Participants reported increased confidence in their ability to break down barriers and apply BSL strategies to advance adolescent behavioral health. Just as critical, they described forming authentic connections with colleagues across sectors, which laid the groundwork for more cohesive, aligned work ahead. Perhaps most telling: Every participant committed to using BSL strategies in the next 30 days to six months. This wasn’t a one-time training, it was the start of a new way of working. The group plans to continue meeting monthly to apply these tools, strengthening direction, alignment, and commitment in their shared efforts. “Addressing boundaries is a great practical step in all of the projects we will have going forward.” — Participant of New Mexico School-Based Health Program For public health professionals, the takeaway is clear. Complex challenges like youth behavioral health don’t sit neatly within one sector and they can’t be solved there either. Boundary spanning leadership offers a practical, human-centered approach to building the partnerships needed to create lasting change. Explore more of ASTHO's work in Boundary Spanning Leadership. article yes

How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership Saisha Adhikari Discover how Palau is improving public health data by leveraging private-sector partnership in this blog post. The Republic of Palau is navigating a rapidly shifting public health landscape with an approach rooted in creativity, clarity, and community. Rather than slowing down in the face of limited staffing and competing priorities, the Ministry of Health and Human Services (MoHSS) has chosen to use this moment to build systems that will last. Through Public Health Infrastructure Grant (PHIG) funding, Palau hired HealthEfficient, a health care consulting organization, to support data modernization (DM) initiatives, including a new national electronic health record (EHR). Palau previously collaborated with HealthEfficient through the Pacific Islands Primary Care Association (PIPCA), which introduced HealthEfficient to the region through a multi-year initiative to support regional EHR planning, readiness, and adoption. During that time, HealthEfficient developed a strong understanding of Palau’s priorities, needs, and operating context. Palau subsequently joined HealthEfficient's Health Center Controlled Network. This multi-phased, ongoing partnership has helped Palau bring structure to complex work, expand internal capacity, and make progress on long-standing priorities. Laying the Groundwork for Meaningful Progress As part of its PHIG workplan, MoHSS is committed to adopting modern, flexible technologies and standards, reducing data silos, and strengthening its workforce. Given the need for external support to implement the EHR, Palau also considered how to leverage its partnerships to advance broader DM efforts. MoHSS collaborated with ASTHO to clarify needs and what success should look like. This preparation, combined with HealthEfficient’s familiarity with Palau’s health system and cultural context, created a strong foundation for their partnership. HealthEfficient has been instrumental as Palau transitions from a largely manual system to a modern, comprehensive EHR. The consultant’s ability to understand local realities of how staff work, how communities engage with health services, and what modernization means in Palau’s context has helped decisions remain grounded in what the country truly needs. Project Management as a Capacity-Building Strategy HealthEfficient serves as an extension of the MoHSS team, managing day-to-day coordination and creating structure around the DM work. They lead agendas, capture meeting notes, track progress, and manage overall project flow. This allows Palau MoHSS staff to stay focused on vision, strategy, and local leadership. Palau MoHSS and HealthEfficient meet on a consistent cadence: twice weekly on EHR implementation and twice monthly on broader DM activities. As demand has increased, additional meetings and hours are scheduled as needed throughout the week. This rhythm keeps the work aligned while giving each workstream to move at its own pace. Due to capacity, MoHSS moved the EHR launch from December 2025 to the first half of 2026. Rather than treating this as a setback, they used the new timeline as an opportunity to refine workflows and better support staff. Together, MoHSS and HealthEfficient updated their approach and kept the work moving. Although the workload is still considerable, the partnership has made it manageable. Clear roles, shared communication, and reliable structure have allowed the team to maintain momentum without overwhelming MoHSS staff. This progress is also driven by a strong internal MoHSS team of five staff members, several of whom are featured in this blog, who are working closely with HealthEfficient and the EHR vendor to move implementation forward. Sherilynn Madraisau, Director of the Bureau of Public Health Services at MOHSS, explained: “Even with limited staffing, leadership recognized how critical this project was for Palau and contracted HealthEfficient not only to manage much of the day-to-day work but also to help build our internal capacity, ultimately strengthening overall systems and creating long-term impact.” Navigating Challenges with Cultural Awareness Like many small jurisdictions, Palau MoHSS faces: Limited staffing and competing priorities. Navigating technical jargon. The need to coordinate across multiple external partners. These challenges show up in real ways: teams are stretched across responsibilities, vendors may not understand local context, and cross-agency communication requires ongoing attention. Edolem Ikerdeu, Executive Director of the Palau Community Health Center, noted the importance of cultural mediation in this work: “Our consultants bring valuable expertise and guidance, but it’s equally important that the work reflects our culture and our priorities.” Her role includes working with staff members to help partners understand context, smoothing miscommunication, and ensuring all stakeholders stay aligned around the mission of serving Palau’s people. That spirit of shared learning and adaptation is echoed across the team. Tmong Udui, Acting Chief of Division of Health Informatics and Intelligence at MoHSS, added, “A lot has been new for [staff], but learning together and building skills in this new area has been a good experience.” Partner engagement remains personal and intentional. The MoHSS team keeps partners engaged by having real conversations, naming the shared purpose, and showing exactly how the EHR will help the whole country, not just the health sector. Early Wins and Emerging Strengths Even just a few months into the EHR migration, MoHSS is already seeing measurable progress: Accelerated EHR Implementation: After years of anticipation, MoHSS now has a clear structure, dedicated support, and renewed momentum behind the EHR work. Informed Technology Decisions: With HealthEfficient at the table for external stakeholder discussions, MoHSS has had a trusted advisor to help evaluate system options and advocate for what best fits the country’s needs. Growing Internal Capacity: Through trainings and ongoing collaboration with subject-matter experts, staff are strengthening their skills in cybersecurity, systems upgrades, and process improvement. Stronger Organizational Coordination: Clear oversight and consistent communication have helped reduce the burden on staff and increased alignment across the ministry. These wins reflect progress beyond just technology, but in confidence, communication, and long-term planning. The work is strengthening the system as a whole and not just a single project. A Foundation for the Future With HealthEfficient managing much of the operational load for DM, Palau can focus on guiding strategy and determining long-term direction. HealthEfficient advances the work; MoHSS shapes the vision. Edolem Ikerdeu shared, “If you hire people and the funding goes away, then what is this for? We want a stronger system that includes the people who are already here.” Palau’s approach offers a compelling model for other resource-limited jurisdictions: Start with clarity. Build the right partnerships. Protect space for local leadership. Design systems that will outlast short-term funding. By centering community, embracing thoughtful project management, and working with culturally aligned partners, Palau MoHSS is building public health infrastructure that will serve its people well into the future. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes