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

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

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

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

Federal Discussions on Aging Move Center Stage Catherine Jones Reviewing the latest federal discussions on healthy aging policies. As the November elections approach, aging remains a key topic for the candidates themselves as well as for the capacity and quality of nursing homes, assisted living facilities, and the long-term care workforce, which by all accounts is desperately in need of reserves. Congress, the Biden-Harris administration, and federal agencies are racing to keep up with the growing demands and costs of quality of care, and fully addressing inequities and inequalities. It is vital for public health to advocate for healthy aging over the life course and to be inclusive of older adults in all population health efforts. As of 2020, 56 million—or 16.8% of—U.S. adults were ages 65 or older. By 2060, that number will exceed 94 million and represent nearly 25% of the entire population. The older population is becoming more racially and ethnically diverse. Between 2019 and 2040, the proportion of Hispanic or Latino, Black or African American, American Indian or Alaska Native, and Asian American older adults is expected to increase by 115%; the non-Hispanic white older adults’ group will grow by 29%. The U.S Census Bureau projects that, by 2034, older adults will outnumber children for the first time in U.S. history. Social Security and Medicare expenditures will increase from a combined 9.1% of gross domestic product in 2023 to 11.5% by 2035 because of the larger share of older adults. Recent Congressional Hearings In January, the Senate Special Committee on Aging held a hearing focused on assisted living facilities (ALF) and other aspects of long-term care. There are currently more than one million Americans living in ALFs. Witnesses pointed to exorbitant costs and hidden fees (average annual cost is $54,000), lack of transparency and accountability, negative and harmful experiences for patients and family members (including financial exploitation), workforce shortages, inadequate staff training, and lack of additional or specialized care for people living with dementia and Alzheimer’s. Senators sharply questioned the impacts of private equity takeovers and real estate buying sprees of ALFs, public payments, such as Medicaid waivers, and lack of data being collected to guide reforms. Since federal agencies regulate nursing homes, ALFs receiving federal dollars can arguably be held accountable to federal standards. In March, the Senate Committee on Health, Education, Labor and Pensions held a hearing to examine the Older Americans Act (OAA), which passed in 1965, was last reauthorized in 2020, and needs to be reauthorized by the end of 2024. With 10,000 Americans turning 65 every day over the next 20 years, there was bipartisan agreement that the OAA needs to be fully funded. Research shows that the OAA saves money by reducing emergency department visits, nursing home admissions, and preventing complications from chronic diseases. The committee agreed that older Americans are not getting enough support to age in place, including daily meals, adequate nutrition, physical activity, socialization, medical care, fall prevention, transportation, employment, protection from abuse, and housing. One in four older Americans has an annual income of less than $15,000; a near equal proportion lives in poverty. With 40% of OAA funding going to Meals on Wheels and other nutrition programs, it remains a lifeline for many. In April, the Senate Special Committee on Aging held another hearing to address shortages and improve the long-term care workforce. The vast majority (80%) of long-term care facilities report significant staffing shortages, affecting their ability to provide services, accept new clients, or even remain open. In 2022, the median hourly wage for direct care workers was just above $15. The hearing also highlighted bipartisan solutions to improve pathways to enter the workforce, compensation, and the working environment. Biden-Harris Administration Unveils Workforce Rules Nationally, seven million older adults and people with disabilities rely on home- and community-based services (HCBS) under Medicaid at an annual cost of $125 billion. Approximately 2.8 million workers provide in-home care, and predictions are that the industry will need an additional one million workers by 2030. On April 22, the Biden-Harris administration unveiled The Ensuring Access to Medicaid Services final rule aimed at improving job quality and pay for direct care workers. This CMS ruling (sometimes referred to as 80/20) requires that, in six years, states ensure a minimum of 80% of Medicaid payments for services go toward compensation for direct care workers furnishing these services, as opposed to administrative overhead or profit. The rule calls for more transparency in how facilities pay for HCBS, as well as how they set rates. Boosting the low pay will entice qualified workers and lower turnover; home health agencies warned it could drive them out of business. The Biden-Harris administration also set nationwide minimum staffing ratios for registered nurses and nurse aides for nursing homes. The rule requires nursing homes to have a registered nurse on site 24 hours, seven days a week. Facilities must also ensure registered nurses work a certain number of hours per day based on the number of residents. CMS has phased in the requirements, with limited, temporary exemptions. Experts call the rule a significant step toward bolstering nursing home quality and safety, but again, a understaffed nursing homes forced to hire more workers claim they cannot take on the financial burden. Reframing Aging Summit in Washington, D.C. The Gerontological Society of America’s Reframing Aging Summit kicked off in April with a dynamic discourse on reframing aging through a wider, more inclusive and compassionate lens, poignantly summed up by Kina White, DrPH, MHSA, FACHE, Office Director, Office of Community Health Improvement, Mississippi State Department of Health. “As you take a breath you age. We must normalize age and integrate it across all public health systems. Embed it in all funding. There is no room for ‘othering’ when we’re all aging with every breath,” said White. ASTHO’s government affairs team will continue to track policy and legislation related to healthy aging and share the latest news. website yes

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

Public Health Leader Profile: Joy Borjes on Leading Teams Through Change ASTHO Staff, Center for Health Care Strategies Staff ASTHO | Joy Borjes of Texas HHS shares perspectives on leading teams through change. Introduction As a child, Joy Borjes witnessed firsthand the power of state programs to improve the lives of those they serve: Joy’s parents received government support related to their disabilities, which inspired her to become a civil servant. “I grew up seeing that government services can make a difference, and I wanted to be a part of that,” she reflected. Now as part of the Texas Health and Human Services Commission (HHSC), Joy supports programs that impact the lives of more than 7.5 million Texans every month. In 2022, after working in state government for more than 10 years, Joy was promoted to a new position as the associate commissioner for family health strategy in HHSC's family health services division and began leading a team working on women’s and children’s health initiatives. In this role, she oversees the coordination of programs within the women’s health portfolio, which includes family planning services and breast and cervical cancer services. Across the country, health care policy at the state level is often complicated by evolving dynamics, changing demographics, and emerging needs; state public health leaders must navigate the confluence of relationships, policy, and change. With help from Joy’s leadership, the family health services division has celebrated several recent successes, including the impending release of a redesigned long-acting reversible contraceptive (LARC) toolkit, strengthened partnerships with external groups, and a 65% increase in funding through the Texas Legislature for the state family planning program in 2024. To support some of these achievements, Joy and her HHSC colleagues joined the Contraception Access Learning Community (CALC), led by ASTHO in partnership with the Center for Health Care Strategies. The learning community offered an opportunity for dedicated staff time and external support to work on improving women’s health outcomes in the state. This leadership profile highlights lessons from Joy’s nearly 12-year career working for the state, with a focus on her successes in advancing women’s health access through strategic oversight of the learning community workgroup. Rich Text Block-Blog - Joy Borjes on Leadership - CALC Leadership Lessons Investing in Relationships The learning community workgroup Joy pulled together included staff from the family health services division and Texas Medicaid, along with external advocates from the Texas Women’s Healthcare Coalition (TWHC), academic researchers, and others. For the workgroup to succeed, Joy knew the importance of cultivating relationships and fostering trust, especially with people she had not worked with before. “As we were coming together with our external partners, we had frank conversations with them about what our roles were, what our goals would be, and what capacity we had,” Joy shared. The workgroup decided their first goal would be to redesign a 2018 provider toolkit that focused on increasing knowledge and effectively using LARCs. Redesigning the toolkit had long been a desire of the family health strategy team, but competing priorities prevented them from doing so without extra support. Because Joy had invested in building relationships with her workgroup members, she knew their expertise, passions, and priorities. Joy was able to explain the importance of redesigning the toolkit to the workgroup’s external members and increase their investment in this work. Through collaboration and with momentum and support from the learning community, the workgroup is nearing completion of the redesigned toolkit. Rich Text Block-Blog - Joy Borjes on Leadership - Key 1 Motivating a Team Through Change At the start of the learning community, HHSC underwent a reorganization of the commission’s client services programs, including Joy’s family health strategy team and the women’s health programs with which her team works. Simultaneously, Joy’s external partners restructured. This concurrent period of transition disrupted the work of the learning community workgroup, as members were focused on their own internal reorganization. Leading the workgroup through these changes was difficult; the workgroup struggled with high staff turnover both at HHSC and within TWHC. The remaining members had limited work capacity, with many taking on work left by their previous colleagues. Through the restructuring and staff departures, the workgroup lost key experts and the priorities of the workgroup became unclear. In reflecting on this period, Joy shared, “I wish I had been more intentional about reaching out to our external partners in the learning community to explain what we were doing, instead of making assumptions that everyone knew. We struggled because of the change and lack of clarity.” Throughout this period of uncertainty, Joy realized the power of leading with transparency and vulnerability. “There’s value in being vulnerable by acknowledging when work is difficult,” Joy reflected. “I don’t sugarcoat things, but even when things get tough, I’m still enthusiastic about the work we’re doing to serve Texans.” After a few months of reprioritization, Joy was able to reconvene and motivate the learning community workgroup to continue working toward its goals. Rich Text Block-Blog - Joy Borjes on Leadership - Key 2 Setting a Vision Through “Yes, and...” Many leaders struggle to find time to plan strategically—it is easy to get tunnel vision, focusing only on the present. After the multi-organizational restructuring, Joy met with workgroup members to discuss new roles, responsibilities, and goals for the learning community. As the workgroup thought about their goals, Joy realized the potential to leverage the time and resources of the learning community to prepare for her other large focus: the 89th Texas legislative session starting in 2025. The Texas Legislature convenes every two years to pass laws and make decisions that impact HHSC and other state agencies. For state officials, preparing for the biennial legislative session is a crucial part of their work. During the 88th legislative session in 2023, Joy partnered with HHSC’s family planning program leadership to request increased program funding. Together, they saw a 65% increase in funds allocated to the agency’s family planning programs. Knowing that planning for the 2025 session would help both the family health services team and their partners, Joy leveraged the learning community to set a vision for the legislative session. She noted, “I wanted to make sure we were prepared for the next session instead of getting stuck with focusing only on the present one. The legislative cycle moves so fast. The 89th session will be here before we know it, and it only lasts 140 days. So, a little bit of planning—making sure the agency knows what our stakeholders will be advocating for, for instance—can go a long way in helping legislators make complicated policy and funding decisions.” In developing a vision for the next legislative session, Joy encouraged the workgroup to collaborate in shaping their goals. She reflected, “In my interpersonal interactions, I’m a believer in the ‘yes, and’ approach, borrowed from improvisational theatre. Even in difficult moments, being able to say, ‘I see your point and here’s something I can do to build off of that idea,’ helped keep our team motivated and excited about the work.” Rich Text Block-Blog - Joy Borjes on Leadership - Key 3 Closing Joy’s approach to leading both the HHSC family health strategy team and the learning community workgroup highlights key lessons for public sector leaders. Under Joy’s leadership, the updated LARC toolkit will reach thousands of providers across the state, and the increase in funding the Texas Legislature provided will allow Joy and her partners to increase access to their family planning programs in 2024. The successes of Joy’s team were driven by her approach to leadership. Joy invested in relationships by making time to talk with others in her field. She set the right goals for the right time by taking advantage of available resources and support. Finally, Joy embraced authenticity by leading with self-awareness and transparency. Contraception Access Learning Community Arnold Ventures Funding website yes

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

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

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

Public Health Full-Court(s) Press Court Cases That Impact Public Health Policy and Practice Christina Severin Court cases can impact public health policy and practice. Learn about recent relevant cases from the Supreme Court, lower federal courts, and state courts. Like legislative enactments and executive actions, judicial decisions impact public health policy and practice. The Supreme Court of the United States (Supreme Court) recently decided several cases expected to impact public health and health policy more broadly and will hear several more in its upcoming term this fall. Meanwhile, lower federal courts continue to consider cases about significant public health programs (e.g., Title X family planning program, the Affordable Care Act) and are tasked with applying new Supreme Court precedents to future cases of public health concern. And state courts are still deciding COVID-19 related cases, with the potential to impact future executive actions to control diseases like avian influenza and mpox. Supreme Court Cases While the Supreme Court begins its new term the first Monday in October, several cases from the current term addressed topics of interest to state and territorial health officials and other public health professionals. Social Media For the first time, the Supreme Court considered the limitations on public officials using social media platforms (i.e., blocking comments and commenters). This opinion is expected to impact the social media landscape for public officials, including health officials, and should be reviewed by agency legal counsel. Government or “state actions” are generally subject to constitutional limits and protections, including those guaranteed by the first amendment. Here, the Supreme Court found that social media activity about an official’s job is “state action” and subject to constitutional considerations if the official has the authority to speak for the state and appears to utilize that authority on social media. Administrative Law The Supreme Court decided several administrative law cases in the 2023 term that are expected to impact federal agency rulemaking, litigation, and enforcement activity. None of these cases were about public health or health care regulation, but all federal agencies (including HHS, EPA, and FDA) could be impacted as lower courts apply these decisions going forward. In two related cases, the Supreme Court considered whether to overrule a longstanding administrative law framework known as Chevron deference, where courts deferred to a federal agency’s interpretation of a statute when that interpretation is reasonable and the statute is ambiguous. The Court overruled Chevron, finding that federal law requires judges to independently determine what the words in a statute mean. In the months since this decision, lower courts have been asked to apply this new framework as they consider challenges to federal rules. The Supreme Court also decided two cases that are expected to impact litigation about federal rules by allowing more time to bring a court challenge and limiting an agency's ability to impose penalties for certain types of agency actions. Together, these changes open up longstanding federal rules to challenge and may lead to additional litigation over agency administrative actions (e.g., the imposition of fines). Finally, the Supreme Court utilized its emergency docket to pause an EPA rule while litigation continues, finding that EPA erred while considering public comments during its rulemaking process. Cases with Public Health Implications The Supreme Court decided several other cases with the potential to impact public health priorities. Harrington v. Purdue Pharma L. P. Bankruptcy law does not allow the proposed Purdue Pharma opioid settlement, which included funding for state and local governments, to release the Sackler family from liability without the consent of those who could sue (i.e., the claimants). United States v. Rahimi. Upholds a federal law that prohibits firearm possession by individuals who have domestic violence restraining orders filed against them. City of Grants Pass v. Johnson. Local ordinances that impose civil and criminal penalties for individuals sleeping outside are not unconstitutional. Several jurisdictions have recently considered actions to limit camping or sleeping outside in certain areas, including Florida, Kentucky, Indiana, California, and Missouri. Becerra v. San Carlos Apache Tribe. The financial responsibilities of the Indian Health Service (IHS) to tribal governments that administer health care programs on its behalf require IHS to pay for certain costs borne by tribal governments when running these programs (i.e., costs from billing third parties like Medicare and Medicaid). IHS and HHS have acknowledged this decision and the federal budget implications. Future Cases In its upcoming term, the Supreme Court will decide whether a lower court’s decision to set aside FDA’s denial of marketing approval for new e-cigarette products was appropriate, as well as how to calculate Disproportionate Share Hospital (DSH) payments. They will also hear a challenge brought by San Francisco about whether the Clean Water Act allows EPA to issue permits that lack specific language or limitations regarding wastewater discharge. Finally, they declined to hear Oklahoma’s emergency appeal of a lower court decision that upholds HHS’s termination of the state’s Title X funding over its refusal to provide individuals with counseling for all pregnancy options. Lower Federal Courts The federal appeals courts have also decided important cases with impacts for health agencies and public health more broadly. First, in Braidwood Management v. Becerra, challengers to the Affordable Care Act’s (ACA’s) preventive services coverage requirements argued that the power of the United States Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA) to set those coverage requirements was unconstitutional. This case has a complex history and addresses more obscure provisions of the constitution (e.g., the appointments clause). While the preventive services coverage requirements remain in place more broadly, the fifth circuit court of appeals found both that the role of the USPSTF was unconstitutional, and that the lower court should reconsider whether the ACIP and HRSA recommendation-based frameworks—the basis of coverage requirements for certain vaccines, cervical cancer screenings, and mammograms—pass constitutional muster. Notably, several states have recently considered legislation protecting preventive health coverage, including Oregon, which codified the ACA’s requirements effective January 1, 2024, as well as Pennsylvania, Michigan, and Washington. The fifth circuit also decided a case about the interplay of Title X and state law regarding parental consent. In Deanda v Becerra, a parent challenged Title X’s confidentiality provisions, citing a Texas state law requiring parental consent for minors to obtain contraceptives and a parent’s constitutional right to make decisions about their children. While this case and the Title X regulations themselves have a complex procedural history, the court did not decide whether Title X violated the father’s constitutional rights. The court found that Title X does not overrule Texas state law requiring parental consent, and that the lower court’s actions to set aside portions of the federal regulation regarding confidentiality were improper. State Court Actions Nearly five years after the first COVID-19 case, courts are still hearing challenges to state actions taken during the pandemic. The North Carolina Supreme Court allowed a lawsuit claiming selective enforcement of COVID-19 orders and violation of the state’s constitutional right to earn a living to proceed to trial. The Michigan Supreme Court declined to hear cases arising out of COVID-19 related health orders, leaving lower court decisions in place that dismissed the claims of certain business owners and college students. And finally, the Minnesota Supreme Court upheld the Governor’s right under state law to declare a peacetime emergency due to a pandemic. ASTHO will continue to monitor the public health legal landscape and provide relevant updates to its members. OE22-2203 PHIG article yes

How Washington State Leverages Data to Improve Emergency Preparedness Erin Laird Learn how Washington State has created a robust system for distributing public health and medical supplies during emergencies. When an emergency strikes, supplies like personal protective equipment (PPE) need to be deployed rapidly and strategically. Local, state, and federal partners must work together to identify and meet community needs—a process that requires timely access to actionable data about medical countermeasures and other vital public health supplies. State health agencies need to know how many public health supplies are on hand so they can make informed decisions and react to developing situations. In March 2024, ASTHO, with support from the Administration for Strategic Preparedness and Response (ASPR) and HHS Coordination Operations and Response Element, selected three state health agencies—Ohio, Massachusetts, and Washington—to identify and pilot scalable solutions to improve data and information sharing for public health response. ASTHO conducted a site visit to the Washington State Department of Health (WA DOH) in June 2024 to learn about their medical logistics center and observe the first in a series of regional tabletop exercises—Highly Efficient Local Logistics Operations Tabletop Exercise (HELLO TTX)—they conducted to better understand logistical considerations of requesting, receiving, and distributing PPE and medical countermeasures and tracking last mile distribution. Medical Logistics in Washington State: Moving Faster to Save Lives Key Term - Blog - How WA Leverages Data to Improve Preparedness The Washington State Medical Logistics Center plays a pivotal role in emergency response, supporting WA DOH’s ability to quickly distribute vital supplies and medical countermeasures before and during major incidents. Through the COVID-19 response, the WA DOH medical logistics effort expanded to include vehicles, systems, and a 198,000 sq. ft., temperature-controlled warehouse. This effort ultimately supported WA DOH’s ability to distribute over 150 million gloves, 66 million surgical masks, 30 million N95 respirators, and other vital supplies throughout the COVID-19 emergency response. This increased logistical capacity has allowed WA DOH to respond to many other events. In 2023, in response to wildfire smoke, WA DOH distributed 850 air cleaners across the state in just two days to support points of dispensing (PODs) in tribal communities. The Yakima Fire Department experienced an opioid overdose outbreak in September 2023 and WA DOH coordinated statewide to identify supply of naloxone and support mutual aid. Finally, in May 2024, WA DOH distributed 96 portable air cleaners and pallets of N95 respirators to the Benton Franklin Health District to support POD operations for communities with air quality impacted by the Lineage Cold-Storage Fire. Receiving, storing, and distributing medical countermeasures and other supplies requires strong data management systems and practices. WA DOH strives for a collaborative approach to enhance data management for logistics. By facilitating bidirectional data sharing among health care, emergency management, public health, and tribal partners, WA DOH aims to enhance its ability to track assets and “last mile” logistics. To this end, WA DOH conducted a series of in-person tabletop exercises (TTXs) with each region of the state. These TTX discussions focused on the logistical considerations of requesting, receiving, and distributing PPE and medical countermeasures using a scenario of a novel influenza outbreak. Leveraging TTX Discussions to Understand Local Logistics Washington Department of Health staff gathered for a tabletop exercise with ASTHO staff. The tabletop discussions were organized into two modules: Medical Logistics Requesting, and Medical Countermeasures Planning and Last-Mile Distribution. The tabletop discussions focused on understanding how local jurisdictions source, receive, and distribute supplies. Cory Portner, director of WA DOH’s Office of Emergency Medical Logistics, praised the discussions: “The HELLO-TTX series highlighted the power of collaboration and gave us actionable insights into refining our response strategies and logistics operations. Effective communication across agencies is key. As always, at the end of the day it comes down to relationships and knowing who to call.” Many jurisdictions indicated they do not have the space or staff to manage more than a small stockpile of supplies. Once requested from the state, local jurisdictions coordinate with local partners—such as libraries, foodbanks, fire departments, and immigrant assistance centers—to get materials distributed to the community, often using either PODs or using trusted partners to distribute to the population they serve. Space came up as an issue repeatedly, with some jurisdictions utilizing creative solutions such as leveraging storage available at fairgrounds, a county-owned airport, and even an old jail (a solution that raised some unique challenges for receiving). Last mile tracking depended on the type of asset. For example, tracking for PPE typically ended at the community partner level (the agency or site that received the supplies), while tracking for vaccines could show more data on number of vaccines administered by a provider. The focus of last mile tracking for local jurisdictions centered around using last mile information to ensure that the requestors received what was needed. Looking ahead, additional last mile tracking could shed light on equity and a better sense of whether community needs were met, rather than just whether orders were filled. Portner reflected, “HELLO TTX showcased that local partnerships vary widely: larger urban areas typically focus on health care and emergency management organizations, while smaller rural areas engage a broader range of local sectors like fire departments and veterinary services. Medical logistics operations also differ, with urban areas having greater storage capacity and more advanced data tracking, while rural areas face limitations in both. Additionally, local prioritization of PPE and medical countermeasures affects how each area tracks logistics and manages storage.” Looking Ahead This 198,000 sq. ft., temperature-controlled warehouse serves as the Medical Logistics Center for WADOH, housing PPE, medical countermeasures, and other supplies. Effective public health response requires an understanding of what supplies are needed, where they are needed, and to track whether those needs were met. To achieve this, coordination and communication across multiple levels of public health is critical. "Next up, we’re focusing on asset tagging and improving supply chain visibility through enhanced data readiness. Our goal is to create a more transparent and responsive logistics system, to make sure that we’re fully prepared for any future emergencies in support of communities in Washington state and beyond,” explained Portner. The strategies explored by these data readiness pilot sites can improve critical processes and demonstrate sustainable methods to meet the demand of bidirectional information sharing for public health agencies and their partners. article yes

Learn about the importance of equity, diversity, and inclusion in public health—three pillars that are crucial to building healthier societies.

Reviewing federal policies to mitigate public health risks of heat exposure.

Ohio Department of Health Using Partnerships to Improve Public Health Data and Emergency Preparedness Margaux Haviland Learn how Ohio leverages partnerships to promote data modernization and improve public health emergency preparedness. In a public health emergency, it’s crucial to quickly and strategically deploy supplies such as personal protective equipment and medical countermeasures (MCM). This requires coordinated efforts among local, state, and federal partners to assess and address community needs. Timely access to actionable data about MCMs and other essential public health supplies is vital for this process. State health agencies need up-to-date information on available public health supplies to make informed decisions and respond effectively to evolving situations. In order to explore opportunities to improve data sharing for public health response, in March 2024 ASTHO, with support from the Administration for Strategic Preparedness and Response (ASPR) and HHS Coordination Operations and Response Element, selected three state health agencies—Ohio, Massachusetts, and Washington—to identify and pilot scalable solutions for enabling bidirectional information sharing regarding ASPR-deployed assets across all levels of public health. The Ohio Department of Health (ODH) proposed a highly collaborative approach to their data readiness proposal that encompassed ongoing strategic planning, which included MCM plan revisions, broadening coalitions, data modernization through standardizing systems, and last-mile delivery using equity-based allocations. Incorporating Local Perspectives As a home rule state, where public health authority is decentralized, the ODH team worked to ensure that local health department perspectives were included in the ODH data readiness project work. The ODH project team collaborated with the Association of Ohio Health Commissioners (AOHC) as well as Ohio’s seven regional health care coordinators to solicit feedback on barriers to sharing MCM inventory data, challenges with data reporting, and operational changes that could improve bidirectional MCM data sharing. ODH engaged directly with long-standing partner AOHC, a nonprofit organization representing Ohio’s local health districts, to capture the local health department perspectives by establishing a diverse focus group, facilitating surveys, and gathering feedback. With AOHC support, ODH was able to successfully field its first survey with responses from 111 public health leaders and emergency response coordinators. Survey results indicated consistent responses when considering challenges experienced or expected with reporting MCM data, with three clear themes emerging: A lack of continuity between systems and compatibility (i.e., the duplication of efforts due to having both local and centralized data solutions). Staffing constraints, including time, money, and personnel. Issues with data accuracy and efficiency, having no standard nomenclature for reporting resources and allocation. The survey also captured proposed solutions for enhancing bidirectional MCM data sharing, with a centralized system being the top-ranked theme as the most relevant to respondents. A state-wide system would allow for state and local health agencies' visibility and real-time documentation that could be easily reported for state and federal requests. Another recurring theme was the importance of collaboration and diversifying partnerships, which will only aid in furthering MCM efforts within Ohio. MCM Summit To further collaborate with local public health and health care stakeholders, ODH held a one-day summit—Medical Countermeasures for a More Prepared Ohio—focused on enhancing MCM preparedness and response through improved integration with public health partners. The summit offered an opportunity for participants to develop local and regional relationships, initiate discussions, and increase awareness and collaboration through operational data sharing. The presentations and workshop included speakers from Ohio State University, Columbus Public Health, Cardinal Health, MMCAP Infuse, the Department of Health and Human Services, and the Ohio Department of Health. The sessions centered around developing a unified operational view, the equitable and timely distribution of MCMs, better integration of the health care supply chain into public health preparedness, and medical surge response during public health emergencies. The workshop then allowed attendees to work through a developing medical surge scenario, including steady-state situational awareness and the transition into initial response decisions and subsequent MCM distribution and logistics. Feedback from the event has been extremely positive, with participants sharing takeaways that could be leveraged in their jurisdictional planning: “How we may be able to better plan for shortages by leveraging private sector opportunities.” “We have a strong working relationship with our partners that needs to be protected and promoted.” “Showing the importance of MCM and keeping better inventory along with learning more about MCM supply chain process, how my organization uses it, and who they order from.” “Overall, I enjoyed the event. I felt the morning speakers were strong and informative. I really took away a lot regarding supply chain dynamics.” Opportunities to Improve Data Readiness and Response During the data readiness project, ODH identified critical opportunities for local, state, and federal partners to bolster data modernization efforts and improve efficiencies, mainly through standardization and interoperability. Currently, MCM distribution and reporting are largely directed by two federal agencies, CDC and ASPR, which use different processes as well as reporting and tracking systems. Improving the alignment of requesting and reporting processes for local agencies would reduce administrative burden during an emergency response. The standardization of data elements across agencies, as well as the reporting requirements, would reduce duplication of effort and improve jurisdictional capacity to respond to public health emergencies where MCMs are deployed. The next phase for Ohio includes leveraging the relationships developed during the project to continue to improve state responsiveness and effective through planning, exercising, and determining a feasible data solution that supports the goals of the state’s evolving MCM strategy. article yes

Learn about ASTHO's Peer Assessment Program and how it served as a critical resource for modernizing the Texas Department of State Health Services' workforce efforts.

Learn how federal and state policies are lessening the presence and negative health effects of PFAS in water and consumer products.

Advanced Grant Payments: Creating a More Equitable Public Health System Advanced Grant Payments Promote Equity in Public Health Jignasa Jani, Ryan Rivera Learn how advanced grant payments can ensure smaller community-based organizations have necessary resources, creating greater equity in public health. Community-based organizations are critical partners to state health agencies in implementing public health programming, often reaching underserved populations and those at greater risk of experiencing health disparities. However, smaller or less-established organizations frequently face significant barriers when receiving grant funding (e.g., not having the necessary upfront capital to cover initial project costs). The Colorado Department of Public Health and Environment (CDPHE) recognizes these challenges and is taking bold steps to improve administrative processes for grant funded programs. These steps will go a long way towards ensuring that smaller community-based organizations have the resources they need to succeed, creating greater equity in the public health system. Redesigning Payment Structures for Greater Access To improve its administrative process, CDPHE is redesigning its payment structure for grant-funded programs. Historically, many grants have operated on a cost-reimbursement basis, where organizations must first cover the costs of services or goods before being reimbursed by the state department. This approach can exclude or unfairly burden smaller or less-established organizations that lack the upfront capital to participate fully in grant-funded initiatives, many of which serve disadvantaged and under-resourced populations. As such, CDPHE identified advanced payments as a priority, reflecting the department’s commitment to inclusion, diversity, equity, and accessibility. Following the enactment of Colorado House Bill 21-1247, CDPHE worked with policymakers to allow the department to provide advance payments to certain grantees and were granted the authority to provide certain grant recipients up to 25% of the total award value immediately on execution or renewal of the contract. By doing this, CDPHE may provide funding opportunities for eligible organizations to have the financial support they need from the start to support their communities. Jignasa Jani 1 - Advanced Grant Payments Promote Equity in Public Health The Prevention Services Division (PSD) within CDPHE led implementation of House Bill 21-1247 and administers a wide range of programs, including those focused on chronic disease prevention, tobacco cessation, injury prevention, suicide prevention, sexual health, and women’s health. By offering advanced payments, PSD empowers smaller organizations to carry out these important public health programs, which are essential to improving the health and well-being of Colorado’s most vulnerable populations. Ryan Rivera - Advanced Grant Payments Promote Equity in Public Health Overcoming Challenges in Implementation While the benefits of advanced payments are clear, implementing this new process has come with its fair share of challenges. The complexity of state and federal rules often places smaller organizations at a disadvantage, making it difficult for them to navigate the administrative requirements of grant funding. PSD staff dedicated significant time and effort to developing the necessary guidelines, policies, and procedures to support the advance payment process. These safeguards were crucial in gaining the support of department fiscal staff, ensuring that taxpayer funds are used appropriately and effectively. PSD staff had to go above and beyond their regular duties to create a robust process that would mitigate risks while providing necessary support to grantees. Their dedication to this initiative reflects a deep commitment to equity and inclusion, and to ensuring that all organizations, regardless of size, have equitable access to grant funds for public health work. Jignasa Jani 2 - Advanced Grant Payments Promote Equity in Public Health Supporting Grantees Through Ongoing Assistance To ensure the success of the advance payment process, PSD staff work closely with grantees to help them understand and comply with the new requirements. This includes providing technical assistance on financial management, invoicing, and compliance with state and federal regulations. By offering this support, CDPHE helps organizations build the capacity they need to manage grant funds effectively and reduce the likelihood of being classified as high-risk in the future. PSD’s efforts extend beyond the initial implementation of the advance payment process. The division is committed to continuous improvement, regularly gathering feedback from grantees and internal staff to refine and enhance the process. This approach ensures that the system remains responsive to the needs of community-based organizations and continues to support their success. Looking Ahead This initiative has the potential to increase the number of applications and funding awards to community-based organizations serving under-resourced populations, further enhancing the diversity and reach of public health programs in Colorado. As more organizations successfully navigate the grant funding process, the overall capacity of Colorado’s public health system will grow stronger, leading to better outcomes for all communities. article yes

Learn how Massachusetts has bolstered its public health supply data sharing infrastructure to improve emergency preparedness and response in this blog article.