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Amid so much uncertainty, it might feel naïve to make any claims about what the future holds. But it is in these moments that it becomes more important than ever to have beacons to guide us and give us hope. As we look ahead to 2022, here are four priorities that must steer the public health course in the year to come.

Strengthening Leadership, Risk Communications, and Preparedness in the Islands Strengthening Public Health Preparedness in the Islands Sidnie Christian, Alyssa Boyea Key strategies in on leadership, risk communications, and preparedness, can help island jurisdictions prepare for and respond to emerging public health threats. ASTHO convened a two-day, in-person workshop in Honolulu from June 25 – 26, bringing together public health preparedness staff from American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Hawaiʻi, the Republic of the Marshall Islands (RMI), and Palau, as well as federal partners from CDC, the Department of Homeland Security, and the Administration for Strategic Preparedness and Response. The workshop focused on leadership and workforce development, risk communications, administrative preparedness, and more to support island areas as they prepare for and respond to natural disasters and other emerging public health threats, of which emerged key learnings that can benefit all island jurisdictions. Leadership and Workforce Development Leading through change requires transparency, trust, and collaboration. Planned change involves assessing readiness for change, identifying resources needed, securing buy-in, and determining a path forward. However, sometimes change can leave little to no time for preparation. Island jurisdictions have encountered challenges in the face of change, with many workshop participants sharing firsthand challenges around retaining institutional knowledge, infrastructure, and receiving assistance from the mainland United States in a timely fashion. As such, change readiness, succession planning, and effective change management practices are of utmost importance in the islands. Key recommendations and takeaways include: Utilizing a reputable framework, such as Kotter 8-Step Change Model, is pivotal for improving change readiness and change management. Change management frameworks and methods can assist with different types of change including structural change, strategic operational change, people-centric change, etc. Trust is hard to build, but easy to lose. Participants spoke about characteristics of high trust relationships including open communication, consistency, good judgement or expertise, and cultural sensitivity, while low trust relationships characteristics include lack of communication, inconsistency, and lack of teamwork. Succession planning is important to ensure institutional knowledge and capabilities remain in the wake of staff turnover or retirement. Identifying the necessary expertise, skills, and capabilities for each role is vital in the case of unplanned changes in staffing. Promising practices include annual review of critical positions, conducting talent calibration sessions, defining action plans, and obtaining buy-in from leadership and relevant partners. Risk Communications The island jurisdictions face emergencies that require creative response efforts. Both Hawaiʻi and RMI demonstrated innovative approaches in risk communications during COVID-19, finding success in forming critical partnerships, utilizing trusted voices within the community, and bridging communication gaps: Hawaiʻi utilized social media to showcase individuals such as doctors, pastors, social media influencers, and even local sports teams getting vaccinated, and utilized trusted voices to deliver messages. Additionally, they translated their materials into three languages (Marshallese, Samoan, and Hawaiʻian), modeling that no one gets forgotten, the true meaning of “ohana.” RMI created a working group with a mix of partners that curated press releases, educational materials, and sitreps, and served as a liaison between RMI Ministry of Health and Human Services and the community. It also partnered with several media outlets (e.g., radio stations, local papers, and other private sectors) and utilized mass text messaging to spread information quickly. The latter proved to resonate with most island jurisdictions who struggle with staying connected to hard-to-reach populations, namely those in more rural and disconnected communities. RMI was able to connect with these populations through WhatsApp to keep them updated throughout the COVID-19 response. Administrative Preparedness Improving administrative preparedness plans and processes ensure timely and efficient access to needed resources for a public health response. Most workshop participants are currently in the process of updating existing administrative preparedness plans, while some are working with other departments to create and implement new plans. Attendees discussed key partnerships for collaboration including other departments, Medical Reserve Corps, and other volunteer organizations. One common key challenge that emerged was around staffing (e.g., finding qualified people to fill vacancies, hiring process issues, making sure positions are competitive, etc.). To address this issue, island jurisdictions can work closely with other departments or jurisdictional agencies to streamline current processes, establish memorandums of understanding with different partners/facilities to assist with emergency procurement, and ensuring staffing vacancies are competitive and match public health classifications. Disease Forecasting A survey on state and territorial expertise and needs for infectious disease forecasts, models, and other outbreak analytic techniques—implemented by ASTHO with support from CDC’s Center for Forecasting and Outbreak Analytics—revealed that respondents from island jurisdictions experienced several barriers that led to limited use of infectious disease forecasts to inform communication and decision making. Challenges noted include limited software access, limited disease modeling capacity or skills, and lack of uniform reporting systems. Through a discussion-based exercise, workshop participants shared their challenges and considerations for ASTHO and CDC to assist with disease forecasting in the island jurisdictions moving forward. Challenges include but are not limited to: Delays with sending samples to labs and receiving results in a timely manner. Without timely results, it is challenging to take swift action. Lack of staff / staff wearing many hats with limited capacity. In most cases, there is no specific communication plan for disease forecasting within the departments. Communication can be challenging without clear processes and channels. Participants noted the desire for additional disease forecasting training and opportunities for collaboration. They suggested an integrated training session with island epidemiologists and other relevant staff to enhance disease forecasting knowledge and communication, as well as strengthen collaboration. Preparing for and Responding to Climate Events From hurricanes to typhoons to volcanic eruptions, the island jurisdictions are no strangers to the effects of changing climate. Willliam “Brandon” Aydlett, science and operations officer at the National Weather Service, and Shelbi Davis, Senior Analyst on the Environmental Health team at ASTHO, offer the following recommendations to island jurisdictions for preparing and responding to unprecedented climate events, as discussed with workshop participants: Create or update standard operating procedures for various climate related responses unique to the island. Always prepare for a category higher storm than is expected. Consider conducting regular vulnerability assessments to better understand areas where the island or its people may be most susceptible to adverse health impacts from climate events. Jurisdictions can learn from one another and find a sense of camaraderie in their preparedness efforts, much like the workshop participants. For example, one island jurisdiction noted that they currently do not have a warehouse to store equipment but are working on a plan to secure one; another jurisdiction, having recently revamped their warehouse, noted that they could assist their island neighbor in this endeavor and provide lessons learned as well as strategies to help secure a warehouse that will fit their needs. Looking Toward the Future Sharing lessons learned with one another and reflecting on how to apply those learnings in respective communities is crucial. Workshop participants shared their intent to share and utilize resources and information shared throughout the workshop with their leadership and team to begin implementing in their jurisdictions, as well as using strategies and skills learned to enhance partnerships. To all the participants and our Hawaiʻian hosts, we say mahalo. Related Resources Modernizing Infrastructure and Facilities for Readiness and Response | ASTHO PH-HERO Workforce Resource Center | ASTHO ASTHO STAR Center | ASTHO Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response | JPHMP article yes

Here are some things health officials should consider when developing a strategy to improve trust between health departments and their audiences.

Accurate and timely communication from health officials during a public health emergency is critical to ensure people can reduce their risk of illness or death. Karen Smith (alumni-CA) talks about her experiences communicating policy changes, as well as key strategies for maintaining public trust.

A Q&A with DELPH participants James Bell III and Sandy Noel about their experiences in the program and why it is so important to develop your own brand as a leader.

If there is any word to describe 2020 it is “unprecedented,” with the work of health agencies front and center since COVID-19 emerged in the U.S. But as we approach Public Health Thank You Day and the Thanksgiving season, ASTHO wants to send a special appreciation to our entire state and territorial public health workforce. We have been so impressed by your tireless work to address COVID-19 in your jurisdictions and you have wowed us all with your dedication and commitment to the work of health protection and improvement. Thank you all for all you do to keep your communities healthy!

As public health officials lead the pandemic response, clear direction-setting in every state and territories is vital to assure our planning and implementation is fair and focused on those most at need. These are not entirely unprecedented times—1918 pandemic flu killed almost 700,000 Americans. Even then, despite increasing understanding of respiratory disease transmission, many leaders—including public health leaders—downplayed the pandemic and refused to take effective steps to limit large gatherings and encourage mask wearing. Changing behavior, or introducing new social norms, was as difficult then as it is now. We have to learn from history if we are to effectively respond to our present reality.

A discussion with Meredith Allen, ASTHO’s Vice President for Health Security, about how the first shipments of the COVID-19 vaccinations have been a major turning point for the pandemic and a milestone moment for U.S. public health history.

In August 2020, the Big Cities Health Coalition and the Association of State and Territorial Health Officials released a co-produced public service announcement to support public education in our members’ communities. The call to action in the PSA is straightforward: Americans need to put aside our respective differences and, simply, #MaskUp.

While COVID-19 remains a top public health priority, the pandemic has also intensified the need for strong tobacco control policies and marketing campaigns. CDC recognizes current or former tobacco users as one of several groups at higher risk of severe illness, including hospitalization and death, after contracting COVID-19. It is distressing to see signs that our success in encouraging tobacco users to quit has been slowed over the course of the pandemic. Fortunately, amid these challenges, many tobacco control groups have stayed focused.

Public health is rapidly changing, especially during the COVID-19 pandemic. Public health professionals are having to navigate their way through these changes all while remaining steadfast in their ability to help their communities. With new information emerging every day, it's essential to have a backlog of sources you can reference that are trustworthy, up-to-date, and easy to access.

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

Leading a governmental health department is a complex job during the best of times, but particularly so during a pandemic when leaders must navigate every step carefully. In this episode, our guests introduce and discuss a concept called "polarity thinking," which invites leaders to embrace situations or problems from the opposing perspectives, or "poles."

ASTHO Communications Trainings ASTHO has collaborated with a former New York Times journalist with over two decades of experience to offer three media training videos that can be viewed at your convenience. The 12-minute recordings cover media interview best practices, space preparation and interview tactics, and digital strategies and best practices. Reach out to media@astho.org with any questions. website no

Seven books for public health leaders that focus on a range of communication topics and best practices.

This interview is part of ASTHO’s Leadership Trailblazers series, which shares outstanding public health leaders’ inspirations, motivations, and accomplishments. This post features Mark Levine, MD, commissioner of the Vermont Department of Health.

Kim Henderson, formerly of DC Health, reflects on her experience and role leading public health communications for the nation’s capital.

Michigan Court Decision on Health Official's Case is Bad for Public Health ARLINGTON, VA—Michael Fraser, CEO of the Association of State and Territorial Health Officials (ASTHO), issued the following statement today in response to a Michigan court's decision to proceed with the prosecution of a sitting health official for decisions made in notifying the public about an outbreak of Legionnaires' disease in Genesee County in 2014 and 2015: "We are very disappointed that the court decided to allow the prosecution against Nick Lyon to proceed to trial. ASTHO firmly believes criminally charging a public health official for deaths related to an outbreak sets a dangerous precedent for leadership and decisionmaking during a public health crisis. The ultimate goal among our nation's state and territorial health officials is to protect the health and well-being of their constituents. State health officials and their leadership teams are trained to make thoughtful, scientific, and data-driven decisions, while limiting undue public panic. As this case moves forward to trial, ASTHO will continue to articulate the serious ramifications and lasting impact the court's decision will have on our profession as a whole." ASTHO Press Release Boilerplate website yes