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A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

Linking Datasets to Address Racial Equity in Maternal and Child Health Outcomes astho, association of state and territorial health officials, data sources, people of color, centers for disease control, racial inequities, advance racial equity, maternal morbidity, maternal death, maternal health, child health, participate in prams, risk assessment monitoring system, disease control and prevention, maternal and child, morbidity and mortality, pregnancy risk assessment monitoring, pregnancy related death, racial justice, linked data, achieve health equity, advancing health equity, racial equity, maternal and child health, maternal mortality and morbidity, racial disparities, health equity, data linkages, vital records, pregnancy risk assessment monitoring system Stephany Strahle ASTHO | Strategies for promoting racial equity in maternal and infant health through data linkages. Racial disparities in maternal and child health outcomes impact populations across the United States. Having robust data to understand these disparities may inform more comprehensive initiatives and policies that address the impacts and root causes of inequities. Looking at administrative datasets, such as hospital discharges and vital records, allows health professionals to monitor inequities by racial and ethnic communities. Often not captured in these data, however, is the complex interaction of social determinants—such as access to social support, racial discrimination, insurance coverage throughout pregnancy and postpartum, and access to paid family and medical leave—and their impact on health outcomes. Public health surveillance systems monitor these outcomes and aim to answer questions on a broad range of contextual experiences. These systems can be combined with administrative data through data linkage, “a process that matches records representing the same person or entity derived from different data sources in order to generate new and more comprehensive datasets.” These linkages can help identify areas for patient-centered outcomes research and inform policy recommendation and programs that address maternal and child health disparities across racial and ethnic groups. State Approaches to Data Linkages Linking Vital Records with Income Data California In a recent working paper on maternal and infant health inequities in California, researchers linked administrative vital records with parental income data. This research found that “infant and maternal health in Black families at the top of the income distribution is markedly worse than that of White families at the bottom of the income distribution.” Linking vital records, a source that typically does not capture income information, with data sources that do, provided a novel and robust dataset illuminating the exacerbated disparities experienced by racial and ethnic minorities at all income levels. Using PRAMS to Monitor Health Outcomes The Pregnancy Risk Assessment Monitoring System (PRAMS) allows jurisdictions to monitor various maternal and infant health indicators before, during, and after pregnancy. As one of the few public health surveillance systems collecting data on race-related experiences and discrimination, it also provides a better understanding of disparities among racial and ethnic groups. As part of ASTHO’s Linking PRAMS and Clinical Outcomes Data Multi-Jurisdiction Learning Community, two state teams from Massachusetts and Georgia used data linkage of PRAMS to explore racial disparities in maternal and child health outcomes. Massachusetts The Division of Maternal and Child Health Research and Analysis at the Massachusetts Department of Public Health linked PRAMS data with the Pregnancy to Early Life Longitudinal Data System (PELL), a data system linking birth files to hospital discharge records that can be later used to link hospital-based service records, data on early intervention services, and other data documenting maternal and infant health experiences beyond birth. Previously, both PRAMS and PELL data informed Massachusetts’s 2022 report from the Special Commission on Racial Inequities in Maternal Health, which provided policy-related recommendations on doula workforce development and equitable implementation of paid family and medical leave within the state. Sarah Stone, PhD, MPH, the director of the Massachusetts Office of Data Translation, notes that linking PRAMS, which provides insights into the social determinants shaping people’s experiences during pregnancy, with the more administrative data included in PELL can further inform additional evidence-based initiatives to address inequities in maternal mortality and severe maternal morbidity. Georgia At the Maternal and Child Health Section of the Division of Epidemiology in the Georgia Department of Public Health, linkages between PRAMS and Georgia Vital Record data can provide insight into the observed differences in health outcomes among the state’s diverse population. Jenna Self, MPH, Georgia’s PRAMS project director and health surveys team lead, explains that “the linkages will help explore the association between maternal postpartum behaviors and negative infant health outcomes (e.g., mortality, hospitalization, emergency department visits) with the goal of understanding the health disparities” to inform future equity-focused initiatives. The development of a linked data environment will allow the Georgia Department of Public Health to ask and answer previously time and resource prohibitive questions. Recommendations Data linkage can be a powerful tool to create enhanced datasets that better inform state initiatives to improve racial equity in maternal and infant health outcomes. To use data linkages that identify areas needing equitable public health efforts, states should: Build and strengthen cross-collaborative relationships within and between various state agencies owning the datasets to facilitate data sharing. Consider the racial equity impacts of performing data linkages by exploring research questions that lead to more evidence-based decision-making. Understanding the linked data using a racial equity lens can better inform equitable policy recommendations and programmatic planning. Examine which data sources, when linked, could fill in gaps of understanding and provide a wealth of information to identify disparities and point to specific gaps in quality health care. Brief - Linking Datasets to Address Racial Equity in Maternal and Child Health Outcomes - Special Thanks website yes

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Leveraging Healthy People 2030 to Build Non-Traditional Multisector Partnerships multisector partnerships, healthy people 2030, health equity, health outcomes, social services, health disparities, preventable disease, premature death, health literacy, economic stability, social determinants of health, department of health, improving the health, united states, long term, life expectancies, population health, chronic diseases, prevention and health promotion, health care system, disease prevention and health, health systems, healthy people 2030 objective, subject matter experts, office of disease prevention, personal health literacy, achieving health equity, health problem, population groups, astho, association of state and territorial health officials Corinne Gillenwater, Megan DeNubila-Griffin ASTHO | This toolkit helps public health build and maintain relationships with non-traditional partners across a multitude of sectors. The goal of this toolkit is to help state and territorial health agencies (S/THAs) build non-traditional, non-public health sector partnerships to improve health outcomes and advance health equity. The Healthy People 2030 objectives, aligned closely with the Social Determinants of Health (SDOH) framework and Health in All Policies (HiAP) lens, can serve as the cornerstone of these collaborations. This toolkit is implementation-focused, providing partnership-building and -sustaining skills that are rooted in Healthy People 2030 tools and success stories and can be operationalized for community needs. Overall, this toolkit encourages S/THAs to implement these described strategies in their own public health practice to: Establish and maintain partnerships within and across sectors at the state and territorial level to create a shared vision of health. Respond to public health priorities collaboratively and strategically. On This Page Using Healthy People 2030 in Non-Traditional Partnerships to Improve Public Health Types of Non-Public Health Sector and Non-Traditional Partnerships for Consideration Foundations of Strong Partnerships Sustainability of Partnerships 10 Steps for Strong Public Health Multisector Partnerships Conclusion Additional Resources website yes

Neonatal Abstinence Syndrome (NAS) has become more prevalent in the United States, with the hospitalization rate increasing from 2.9 to 7.3 hospitalizations per 1,000 newborn births between 2009 and 2017. NAS occurs in newborns who experience withdrawal from substances they were exposed to during pregnancy. While NAS is most often associated with exposure to opioids (e.g., Neonatal Opioid Withdrawal Syndrome), it can also be caused by exposure to other drugs such as cocaine, amphetamines, or barbiturates. Infants with NAS experience withdrawal symptoms including tremors, irritability, poor feeding, vomiting, dehydration, and increased sweating. These symptoms usually appear within 72 hours of birth.

How Massachusetts is Advancing Public Health Data Standards How Massachusetts is Advancing Public Health Data Standards Saisha Adhikari Learn how Massachusetts is leveraging funding from the Public Health Infrastructure Grant to improve how it handles and shares public health data. The Massachusetts Department of Public Health (DPH) has long understood that strong public health systems rely on strong data. But with thousands of staff, dozens of programs, and dozens of data sources, achieving consistency across the department is no small task. Rather than treating data modernization, performance management/quality improvement (PM/QI), and data standards as separate efforts, Massachusetts is intentionally bringing them together. Through Public Health Infrastructure Grant (PHIG) funding, the department is accelerating progress toward common data standards by strengthening internal capacity, improving coordination, and laying the groundwork for meaningful impact. Massachusetts is turning standards into shared practice, using measurements to connect teams, strengthening communication and change management, and tracking early wins that signal meaningful progress. Building a Strong Foundation Data standards are not new to Massachusetts. For more than a decade, DPH has collaboratively developed standards with voluntary work groups composed of subject matter experts from across the department to improve how data are collected and used. Today, the department maintains eight approved data standards. PHIG funding enabled DPH to develop training modules for three approved data standards (disability, housing and homelessness, and employment) and to create a new module on a data standard related to adults with disabilities. With leadership support, PHIG funding has allowed the department to move forward quickly and strategically, including aligning training content with updated federal guidance such as the 2024 Office of Management and Budget revisions. “These standards have existed for a while,” shared Emily Neumann, Coordinator of Data Standards, “but PHIG allowed us to invest in training and communication so that more people across the department understand not just what the standards are, but why they matter.” Turning Standards into Shared Practice A key focus of the PHIG-supported work has been accessibility. DPH developed short, digestible training videos and housed them on the state’s internal learning platform, making them available not only to DPH staff but also to the broader Executive Office of Health and Human Services, vendors, and partners across the Commonwealth. “It’s hard to expect adoption if people don’t even know the standards exist,” said Brett Turner, Director of Data Strategy & Transformation. “The trainings are our first step toward building that awareness across a department of more than 3,000 people.” With this increased awareness through training, staff can begin to meaningfully connect systems and improve reporting. Measurement as a Bridge Between Data Modernization and PM/QI This is where PM/QI plays a critical role. By tracking participation in training modules and aligning efforts with the department’s strategic plan, PM/QI teams help translate awareness into measurable progress. Rather than setting overly broad or unrealistic goals, DPH is taking a targeted approach. For example, one performance measure focuses on data stewards (staff responsible for managing datasets) completing trainings related to race, ethnicity, and language data standards. This allows the department to set concrete, achievable goals while still moving toward broader adoption. PM/QI teams are also using data inventories and surveys to understand what datasets exist, who manages them, and where programs are already using standards. This shared visibility helps identify opportunities to connect previously siloed data and ensures that modernization efforts are grounded in real operational knowledge. Navigating Challenges Through Communication and Change Management Like many large public health agencies, DPH data systems work within a complex system that include state and federal requirements, governmental and non-governmental partners, and legacy technologies. To address this complexity, the department has leaned into advocacy and documentation. Teams are creating clear guidance for partners, engaging early in conversations with organizations that collect key datasets, and using every opportunity to promote alignment. In some cases, this has led to near-complete adoption of Massachusetts’ standards by external partners. Internally, change management remains essential. Many staff have stepped forward to contribute to data standards work beyond their primary roles, acting as champions across bureaus and offices. At the same time, the department is working to embed these processes into routine operations so that standards become part of core practice rather than a separate initiative. To support sustainability, the department is investing in knowledge management to document lessons learned, track implementation challenges, and reduce the burden on individual staff to repeatedly explain standards. “It comes back to communication,” said Kate Saunders, Director of Quality Improvement, Bureau of Health Care Safety & Quality. “When people understand the why, compliance improves. This isn’t just about technical definitions, it’s about improving health outcomes. Early Signals of Progress While the work is ongoing, Massachusetts is already seeing encouraging signs: Increased Awareness and Engagement: Training modules have expanded reach across the department and partner organizations. Stronger Measurement Practices: PM/QI teams can now track participation and link progress to strategic goals. Improved Coordination: Data inventories and shared workflows help identify where standards are being used and where support is needed. More Inclusive Data: Aligning standards makes it easier to incorporate smaller, specialized datasets, such as those related to long-term care or pediatric populations, that might otherwise be lost. Together, these efforts are helping leadership better understand the value of data modernization not as just a funded initiative, but as a driver of equity, efficiency, and prevention. A Model Grounded in Collaboration What stands out most about Massachusetts’ approach is how collaborative it has been. Staff from across bureaus and offices have helped shape the work, creating shared ownership and stronger connections across the department. “This was a ground-up effort,” Neumann reflected. “It was eye-opening to see how many people wanted to be involved once they understood the bigger goal.” That goal remains clear: improving health outcomes for everyone in Massachusetts. Common data standards provide the shared language needed to identify inequities, track progress over time, and understand the full experience of individuals and communities. As PHIG funding continues to support this work, Massachusetts is focused on next steps: refining communication strategies, engaging leadership and management, and embedding data standards into everyday practice. For other PHIG recipients navigating similar alignment challenges, the lesson is simple but powerful: start with the “why,” build collaboratively, and don’t let perfection stand in the way of progress. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes