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The movement to address racism through policy change in the U.S. is receiving significant political support at every level of government. Government institutions are acknowledging the systemic oppression of people of color that persists in the United States and elevating racism as an urgent public health emergency comparable to other public health crises.

Learn how states have increased and/or allocated funding to continue supporting core public health services.

In addition to PFAS exposure assessments, state and territorial health agencies may also consider the role of social stressors during the risk assessment process.

States Pursue Policy Options to Support Access to Over-the-Counter Contraception State Policy to Support Over-the-Counter Contraception Access Christina Severin Learn about state policy options that can help to support over-the-counter contraception access including levers within Medicaid programs. Effective contraceptive care improves maternal health outcomes by helping individuals plan if and when they become pregnant. Additionally, some contraceptive methods may reduce the risk of certain cancers and protect against sexually transmitted infections. While the most effective methods generally require a visit to a health care provider, over-the-counter (OTC) options may address certain barriers to accessing contraception (e.g., taking time off work for a medical appointment and lack of health insurance or access to health care providers/settings). The New Age of Nonprescription Oral Contraceptives A significant change in the marketplace of OTC options occurred in 2023 when FDA approved the first daily non-prescription oral contraceptive. This progestin-only pill —known as Opill — is considered both safe and highly effective at preventing pregnancy when taken correctly. Opill reached stores in early 2024 and has a suggested retail price of about $20 per month or $50 for a three-month supply. While OTC oral contraceptives like Opill may improve access among individuals not currently using contraception or those using a less effective method, high out-of-pocket costs can be a barrier. One way to limit out-of-pocket costs is to require private health insurance coverage of contraception without cost-sharing. ACA requires most private health insurance plans to do this, but it does not extend to all health insurances or contraceptives. For OTC contraceptives, the landscape is even more complex: While plans are encouraged to cover OTC emergency contraception at no cost and without a prescription, it is not required. HHS and the Departments of Labor and Treasury issued a proposed rule in 2023 that would have required broader coverage of OTC contraception without a prescription or cost-sharing, but the rule was later withdrawn. Without a federal mandate, states can pursue coverage requirements through the health insurance products they regulate. Jurisdictions can also support OTC contraception access in their Medicaid programs. While Medicaid requires coverage of family planning supplies without cost-sharing, jurisdictions have some flexibility in how they design this benefit, and the scope of coverage depends on jurisdiction and state plan-specific factors. Jurisdictions also have flexibility in determining how they provide prescription drug coverage for contraceptive medications and what OTC products are covered. State Legislative Action Legislation is one way for states to promote access to OTC contraceptives, including hormonal contraceptives, through state-regulated plans and provider scope of practice considerations. Since 2024, several states have enacted laws requiring coverage of OTC hormonal contraception, including Delaware (SB 232), which directs insurance carriers to cover FDA-approved OTC contraception with or without a prescription, and Maine (LD 163), which requires coverage of nonprescription oral hormonal contraception. At least two states have clarified the role of pharmacists in supporting access to OTC contraceptives. Massachusetts (HB 4800) allows pharmacist dispensing of OTC oral contraception per a standing order and provides liability protections, while California (AB 50) allows pharmacists to furnish self-administered OTC hormonal contraception without complying with the state’s protocols for prescription-only oral contraceptives. States have also enacted laws to explore or support broader access to OTC contraception, including at least three bills enacted in Maryland since 2024: HB 367/SB 527 requires community colleges to develop an OTC contraception access plan and allows the health department to serve as a resource, including for consultation on vending machine access. HB 1171/SB 944 allows local health department registered nurses to dispense OTC contraception. SB 674/HB 939 creates a collaborative tasked with studying and making recommendations on OTC contraceptive access, with a final report due to the governor and legislature by Jan. 1, 2027. Other Policy Levers Legislation isn’t the only policy lever available to jurisdictions looking to support OTC contraception access. A number of states have taken executive actions to improve access, including (but not exclusively) through Medicaid. While jurisdictions already have the flexibility to support OTC contraceptive access in their Medicaid programs, Medicaid rules require a prescription even for OTC products, which may present a barrier for some individuals. One potential solution is to use standing orders, which allow individuals direct access to OTC products at a pharmacy, without having to visit a separate provider for a prescription first. To ease access to OTC hormonal contraception specifically, several states have recently utilized standing orders that facilitate Medicaid coverage, including Wisconsin, Massachusetts, and New Mexico. Additionally, in 2024, North Carolina announced that it was removing barriers to OTC oral contraception, and would cover condoms and spermicide as OTC products. Outside of Medicaid, several other states have taken action to support access to OTC hormonal contraception: In 2024, the Governor of Arizona issued an executive order directing the Department of Administration to designate Opill and OTC hormonal contraception as a no-cost essential health benefit for state employees, among other actions to expand coverage and access. Also in 2024, Pennsylvania issued guidance to health insurers encouraging coverage of OTC hormonal contraception and highlighting two insurers intending to comply with the guidance. Finally, Michigan’s health agency, in partnership with the Governor’s office, implemented a Take Control of Your Birth Control campaign. This initiative distributed OTC contraception at hundreds of community sites across the state, with a stated goal of connecting individuals to insurance coverage, including Medicaid. While the campaign recently ended, the state distributed more than 400,000 OTC contraceptive resources (e.g., condoms, emergency contraception, and oral contraceptives) and saw an increased number of Medicaid applications. Jurisdictions can play a significant role in connecting public health and health care industry leadership, providers, and other experts — promoting awareness, increasing utilization, and encouraging connection to existing resources. Related Content - Blog - State Policy to Support OTC Contraception Access article yes

State and federal actions to expand the doula workforce and improve maternal health.

Establishing an Office of Health Equity or Minority Health Learn how to establish, structure, and fund a health equity or minority health office. A dedicated office of health equity or minority health can provide a focus on cross-cutting efforts and strategies that help to improve services, outreach, and engagement with marginalized communities. This report delves into the typical scope for setting up a health equity or minority health office, including how to establish, structure, and fund it—providing a blueprint to island areas working to build one or considering establishing one in the future. In addition, it explores lessons learned from state offices of health equity or minority health, including California, Michigan, Nebraska, Nevada, New Jersey, New York, Ohio, Vermont, and Washington. Get the Report (PDF) website yes

There are a number of court cases playing out across the country that could affect the options state and territorial health officials have to limit the spread of disease and promote health and well-being.

There are significant disparities in pregnancy-related outcomes in the United States. Many of these deaths considered preventable, so state and federal policy makers are taking steps to improve health outcomes for pregnant people.

The COVID-19 pandemic has negatively impacted youth mental health, particularly as a result of school closures, social isolation, family economic hardship, fear of family loss or illness, and reduced access to healthcare. However, states have many strategies to choose from to improve youth mental health and reduce suicide.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

The COVID-19 pandemic has exasperated challenges around access to nutritious and affordable foods. In response, the federal government has taken action to increase funding and access to programs to strengthen food security.

Responsible for planting, growing, harvesting, processing, and preparing the food we eat, agricultural workers are essential workers during the COVID-19 response to keep the U.S. food supply chain operating efficiently. But farmworkers are particularly vulnerable to COVID-19 due to lack of physical distancing, lack of access to health insurance and sick leave, and poor access to clean water for handwashing throughout the work day.

State efforts to reduce firearm injury and death with safe storage policies.

As the number of COVID-19 vaccinations grows, some states are looking at their vaccination rates to determine when to loosen measures that mitigate the spread of COVID-19, such as venue capacity limits, business closure times, and masking requirements. As vaccinations allow businesses to reopen and customers to return, questions have arisen about whether venues or services—especially those that bring people in close contact for long periods of times—such as retail stores, concert venues, entertainment venues, air travel, cruise ships, etc., can require patrons or customers to verify that they received a COVID-19 vaccine. So far, state policy makers have had mixed views on the issue.

State Policies Promote the Importance of Defibrillators and CPR astho, association of state and territorial health officials, automated external defibrillators, heart disease, cpr training, defibrillators and cpr, cardiac arrest, coronary artery disease, sudden cardiac arrest, ventricular fibrillation, heart failure, heart muscle, perform cpr, heart attack, shocks to the heart, heart problem, electrical system, blood vessels, united states, automated external defibrillators, call 911, heart rhythm, cardiopulmonary resuscitation, chest pain, pump blood, cardiac arrest occurs, blood flow Lana McKinney Health Policy Update | Reviewing state policies that promote increased access to Automated External Defibrillators and use of CPR. Heart disease remains the leading cause of death in the United States for men, women, and most ethnic groups—even during the COVID-19 pandemic. And while overall rates of death from heart disease have declined over the past couple of decades, non-Hispanic Black persons are more likely to die from heart disease than other racial and ethnic groups. Additionally, more than 400,000 cardiac arrests occur annually outside a hospital setting.  CDC recently revised its Best Practices for Heart Disease and Stroke, highlighting strategies to improve cardio- and cerebrovascular health. One goal is to increase public access to automated external defibrillators (AEDs). Early use of AEDs by bystanders or emergency medical technicians during out-of-hospital cardiac arrest has been shown to improve survival rates to greater than 50%; those rates can triple if CPR is performed within the first few minutes of cardiac arrest.  Policies to develop and maintain public access to AEDs and CPR training are crucial. Across the country, state legislatures are enacting or considering legislation related to AEDs and CPR that enhance bystander response to cardiac events and improve the chance of survival of persons who experience cardiac arrest. As policymakers develop and adopt these measures, they should also consider health equity and data implications. Legislative Actions to Increase AED Access and CPR Training  So far in 2023, several states have introduced legislation to require the placement of AEDs in certain publicly accessible locations, including highway rest areas (WV HB 3038), county government buildings (MA HD 1842), all public safety vehicles (MA SD 2342), hotels (NJ A 5105), urgent care and retail health clinics (NJ S 1768), and health clubs (MA HD 2574). Additionally, at least four states—Massachusetts (HD 774), Mississippi (HB 203), Missouri (HB 426), and New York (S 1698)—have introduced legislation requiring AEDs in schools this year. New York also proclaimed a CPR-AED Awareness Week. Although relatively uncommon, an estimated 2,000 children each year die from sudden cardiac arrest. As of 2021, 39 states and Washington D.C. required CPR training for high school students. In 2023, at least four states have introduced bills to expand CPR certification and AEDs training. These include a bill to further expand high school education on CPR and AEDs (OK SB 236), and a bill that requires every public and charter school in the state to (1) have at least one employee with a valid CPR certification and (2) to provide annual CPR training for all high school personnel and students (AZ HB 2421).  In Colorado, SB 23-023 encourages each public school to provide CPR and AED instruction to students in grades nine through 12. West Virginia introduced SB 469 to establish a revolving loan fund that provides funding for CPR instruction to high school students. Meanwhile, California legislators are considering   AB 245 to update school-based CPR and first aid training by adding a requirement to rehearse the appropriate responses to the signs and symptoms of concussions, heat illness, and cardiac arrest. Challenges of Equity in CPR and AED training   As the evidence base about the impact AEDs and CPR have as lifesaving measures for cardiac arrest continues to build, the equitable distribution of AEDs equipment, its maintenance, and training for AEDs must also be considered.  Strategies that optimize the location of public access AEDs based on the risk of cardiac arrest associated with the site can help improve accessibility. Such registries can inform the public and emergency dispatchers of the location of publicly accessible AEDs to facilitate use during an emergency. Registries may also contribute to improving AED readiness by informing owners and managers when batteries and pads need replacing.  In 2018, CDC issued a report providing evidence about the training of responders, and the placement and maintenance of AEDs. While jurisdictions recognize the importance of AED devices, their affordability is a continuing concern.  Further Considerations  Understanding how to best measure and influence cardiac event outcomes and their contributing factors is critical to informing policy decisions. There are several ongoing challenges to understanding the national epidemiology of cardiac arrest, including the incidence and outcomes of out-of-hospital cardiac arrest and the reporting of such events. Additional knowledge is needed about out-of-hospital cardiac arrest key components such as geographic incidence, risk factors, and the impacted populations.  Valid data can advance and improve health outcomes by providing appropriate resource allocation and evidence-based service provision. Despite being one of the leading causes of death, there are currently no nationwide standards for surveillance to monitor the incidence and outcomes of cardiac arrest. Public health officials can help policymakers by reviewing their jurisdictions’ current AED laws and by increasing awareness of the positive impact AED policies and CPR training have on responding to a cardiac arrest. Bystanders can improve the survival rate of a person who is experiencing sudden cardiac arrest with increased public access to AEDs and additional CPR training.  Overall, additional policy actions to support AED availability and CPR training will continue to improve health outcomes. It is important to continue to acknowledge American Heart Month and all the improvements policy makes to save lives. Special thanks to ASTHO’s Erin Bayer, Senior Director of Chronic Disease Prevention and Health Improvement and Andy Baker-White, Senior Director of State Health Policy, and Erin Gabert of the American Heart Association for their contributions to this blog post. article yes

In 2020 and early 2021, state policymakers took action to raise awareness of the impacts of racism on health outcomes, to reverse the damage of racist polices, and to implement policy changes to ensure that future policies are enacted with a racial equity lens. In the past two years, many states introduced and adopted resolutions declaring racism a public health crisis. In the early weeks of 2022, there is notably less legislation that has been introduced as compared to the same time last year.

Each year, ASTHO notes the top public health policy issues to watch in the upcoming year. ASTHO has published a prospectus on several issues, with more coming later this month. ASTHO kicked off its top 10 public health state policy issues to watch in 2022 with Immunization the first week in January. This week, we are focusing on e-cigarettes and flavored tobacco products.

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

This report is on the overlap of climate change and environmental justice.