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Disease Forecasting and Modeling Data for Public Health Action Disease Forecasting Benefits Public Health Planning Disease forecasting and modeling help prepare public health departments for future infectious disease outbreaks and epidemics. Disease forecasting and modeling data can be powerful tools for state and local health agencies (S/THAs) that respond to outbreaks, develop appropriate policies, and ensure interventions have maximum impact. Actions for which decision-makers can leverage such data include: Surveillance. Forecasts and modeling help public health agencies anticipate the spread of disease or outbreaks. This advance warning allows public health officials to inform public health recommendations, preparation, and response. Communication. Disease forecasts help relate the risk of disease outbreaks to various audiences accurately and quickly, which, in turn, can inform messages on important preventive measures and encourages compliance with recommended interventions. Resource allocation. Modeling data can help decision-makers better allocate resources by predicting where and when disease outbreaks are likely to intensify and create the greatest need. Evaluation. Forecasts and modeling can help make evaluating the effectiveness of public health policies and interventions more efficient by comparing predicted outcomes with observed data and adjusting as needed. Considerations Informed by S/THA Forecasting Jurisdictions with forecasting experience identified key indicators to monitor as part of outbreak forecasting, which fall into three main categories: Epidemic spread indicators (e.g., symptom monitoring, morbidity and mortality data, percent positivity, regional pictures of transmission). Health care system capacity (e.g., essential and/or surge personnel, available beds, ventilator usage, and supply of personal protective equipment. Public health capacity for testing capacity and contact tracing. Further considerations for S/THAs: Know your strengths. Identify the unique skillsets among partners in public health, academia, and the private sector and consider how they foster reciprocal relationships. Recognize capacity/expertise gaps. Consider leveraging partnerships for specific types of analytics expertise while exploring internal capacity building opportunities (e.g., job shadowing and resource-sharing programs on workflows and methodologies). Engage legal and compliance teams. Ensure policy and practice are aligned among partners. Explore data access/sharing pipelines. Connect public, private, academic partners, and their audiences. Start small. Identify discrete forecasting and modeling projects to demonstrate success. Identify decision-makers’ needs. Provide quick access to analyses, metrics, dashboards. Michigan Used Models and Forecasting for Hep C Cases In response to Hepatitis C virus (HCV) in young adults from 2010-2018, the Michigan Department of Health and Human Services (MDHHS) simulated how HCV treatment could significantly reduce HCV prevalence among young people who inject drugs, especially for those both previously or currently injecting drugs. MDHHS used several novel predictors to paint a local picture of probable HCV diagnoses among residents up to age 40. These predictors included measures related to a variety of population characteristics (e.g., access to transportation, college education, presence of non-family households) and public health indicators (e.g., heroin treatment admissions, newborns with neonatal abstinence syndrome, and sexually-transmitted infections). MDHHS also leveraged county-level assessments of HCV vulnerability to identify locations for new syringe services programs in the state. MDHHS has recognized several modeling and analytics use cases that benefitted their work during responses to HCV and COVID-19: Short-term forecasts (i.e., weeks) helped predict likely transmission patterns and potential ranges of projections. Longer-term forecasts (i.e., months) explored scenarios based on new recommendations and policy changes. Retrospective counterfactuals evaluated the impact of policies or other changes by examining “what-if” situations. MDHHS is considering using forecasts and models for COVID-19, influenza epidemics, tuberculosis vulnerability, and C. auris spread. Resource constraints require decision-makers and public health practitioners to consider how they are using available resources for the highest return on investment. Models generated momentum to respond to threats and evaluate whether interventions were successful. CDC-RFA-OT18-1802 2018-2024 article yes

Learn about how five jurisdictions approached self-measured blood pressure monitoring programs to reduce hypertension and uncover systemic barriers to care.

In an effort to help meet demand, some states and territories have joined interjurisdictional licensing compacts that allow a mental health care provider licensed in one state to provide care in another state—without needing to gain licensure in multiple states. These agreements also offer guidance on patient privacy for services rendered remotely or from out-of-state.

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.

During the 2022 state legislative sessions, at least 20 states considered bills that would require a religious exemption to a vaccine requirement. As state legislatures continue considering vaccine protocols for COVID-19, HPV, and other diseases—along with what types of exemptions should be given—courts are reconsidering what type of vaccine requirements are constitutional.

ASTHO’s Leadership Trailblazers series shares outstanding public health leaders’ inspirations, motivations, and accomplishments. This post features Joneigh S. Khaldun (alumni–MI), Vice President and Chief Health Equity Officer at CVS.

Reviewing states' efforts to reduce children's exposure to lead.

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

Explore the transformative power of community engagement and community power building in public health research, and learn how these initiatives can enhance racial and health equity. Discover strategies for addressing structural determinants of health and empowering communities to drive positive change.

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

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.

With Omicron surges pushing jurisdictions to activate protocols for providing healthcare during crisis, it is important to incorporate disability inclusion into these crisis standards of care.

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

In Michigan, CDC's Comprehensive Suicide Prevention (CSP) program, Preventing Suicide in Michigan Men (PRiSMM), focuses on a population that is disproportionately affected by suicide, men over the age of 25.

Discover how improving public health data infrastructure can create more robust care for people with disabilities in this blog post.

Exercise Excellence: Michigan Reflects on a National Level Exercise Exercise Excellence: Michigan Reflects on a National Level Exercise Adrianna Evans Learn how Michigan's health department collaborated with state and federal partners for a radiation preparedness exercise. In March 2025, the Department of Energy hosted a national level exercise designed to promote radiation readiness. This exercise, called Cobalt Magnet 25, brought together a wide variety of interdisciplinary partners from federal, state, local, and international governments, among other partners. Michigan hosted the exercise. ASTHO’s Director of Preparedness, Adrianna (Annie) Evans, sat down with representatives from the Michigan Department of Health and Human Services (MDHHS) to learn about their experiences with Cobalt Magnet 25, how they’ve applied lessons learned one year later, and how those lessons might be applied to different threats. This blog post will be the first in a series “Exercise Excellence” that shares insights and perspectives from emergency preparedness exercises. This first blog post will share insights from Michigan on Cobalt Magnet 25 overall preparation, planning, collaboration, and more. Tell us about your experience with Cobalt Magnet 25. Jason Smith, Emergency Management Coordinator: While Michigan State Police, our state’s emergency management agency, took a key role with the U.S. Department of Energy on lead exercise planning, MDHHS served as lead exercise planner, player, and co-chaired a public health and environment working group alongside partners from Ontario and the Michigan Department of Environment, Great Lakes, and Energy. MDHHS leveraged this opportunity to initiate internal play and engage local public health and health care partners across the region. This included representation from two health care coalitions, five local health departments, and four major health care systems — many of which were outside the directly affected communities for this scenario. MDHHS activated our emergency coordination center. Overall, the Cobalt Magnet 25 Full Scale Exercise featured over a thousand injects emphasizing field sampling, decontamination, and reception centers. Our participation spanned preparedness, laboratory, environmental health, behavior health, disability health, and communications, including our public information officers. This experience strengthened cross-jurisdictional coordination and enhanced MDHHS's operational readiness for radiological incidents. Terra Riddle, Director, Division of Emergency Preparedness and Response: From my perspective, Cobalt Magnet 25 was impressive. Each player jurisdiction had the opportunity to make the exercise meaningful. It was really great to see all the partners come together and how each jurisdiction worked through these scenarios. It was unique in the communications world due to the depth, richness, and realness of the exercise play. Jay Fiedler, Director, Bureau of Emergency Preparedness, EMS, and Systems of Care: I participated when the larger group convened as part of the planning process. I hadn't seen something like this before in an exercise of this caliber. One of those activities was a briefing held for departmental leadership of state and federal agencies leading into the full exercise. I also served in the response coordinator role in our Community Health Emergency Coordination Center during the exercise itself. What was the preparation and planning process like for this exercise? Fiedler: This was roughly a yearlong planning process facilitated by a federal contractor, but it required extensive engagement with our state and federal partners. Jason worked in regular planning meetings and activities throughout that year. Some ways that the players were pulled together in meetings leading up to the exercise were really valuable for creating partnerships. Our partners from Ontario joined us. We don’t always get to work with them. That helped facilitate enthusiasm for the exercise itself and enhanced coordination between all the players involved. Smith: In addition to the exercise planning itself, the beauty of Michigan hosting Cobalt Magnet 25 was the opportunity to capitalize on existing trainings, whether it be through Counter Terrorism Operations Support, general radiological emergency preparedness training, and programs through CDC — primarily their public health decision-making course for radiological emergencies. There was a lot of training going on behind the scenes to build up awareness and capacity over the year. I thought the education opportunities made the exercise itself a success. Riddle: I'm glad you mentioned that, Jason, because it brought up another thought about the in-depth training led by the federal partners in the communications world. They invited our partners at the state and local levels to participate in radiological and communications training that was pretty niche. Our partners appreciated that this training prepared them for the exercise and it has spurred lot of conversation since about where we go next. This type of scenario requires a lot of collaboration with government agencies across levels of government, different fields, and even other countries. How did you manage that collaboration and what lessons did you learn? Riddle: The big takeaway is that trust built before a crisis sustains coordination during a crisis. This exercise required management across local, state, federal, and international partners with clear roles, consistent communication channels, and shared objectives early on. Fiedler: The pre-meetings were a unique aspect of this exercise and the connections built were really valuable. I hadn't seen that until an exercise of this scope and scale, but will be helpful going forward as we think about how we work and plan exercises as a whole. Smith: One lesson learned was that there is a bigger appetite for training, both in our department and local partners. Michigan has three nuclear power plants. That prevailing threat does build some desire for general awareness throughout the state, particularly among our 45 health departments. We also realized we need to work a little bit more collaboratively with our environmental partners, our agricultural partners, and have a more unified response effort. Riddle: If I can add, there's always an appetite for training and for support for our local partners, but Cobalt Magnet 25 brought visibility into different types of training. Jason explored radiological training. We explored communications training. Now I wonder all the time if there is a partner that could offer new trainings that we haven’t done before. What’s next for MI? Does MI have any other upcoming exercises — radiological/nuclear or otherwise — that you’re looking forward to? Smith: We’re focusing on a comprehensive overhaul of our response plans — not only our radiological nuclear hazards, but also for other functional and hazard specific annexes. In February 2026, we worked with our emergency management agency, local health departments, and health care coalition partners on a severe weather functional exercise. We also have a few workshops and tabletops scheduled for spring 2026 on volunteer management and vector-borne diseases. Additionally, we're prioritizing One Health coordination and formal agreements with agriculture and environmental agencies to strengthen collaboration across the quality-of-life sector. Lastly, we have a climate change tabletop exercise planned in partnership with environmental health teams within MDHHS. These initiatives reflect our commitment to building resilience across multiple hazards while continuing to advance radiological preparedness. Riddle: The depth of relationships continue to be a leading priority. Regardless of the emergency, our teams working together will be our strength. We're all interconnected and that plays into different activities. For example, our patient movement work, which inherently has many partners and requires close coordination like we saw with Cobalt Magnet 25. Exercise Excellence - Radiation Resources article yes

Learn about the importance of immunization information systems to public health in this Health Policy Update.

Learn how Michigan has applied lessons learned a year later from a radiological exercise in this blog post.

Learn about the importance of exploring intermediaries that work alongside existing data platforms in addressing ongoing public health challenges.