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Nov. 3, 2021, marks the sixth annual One Health Day, a global campaign to recognize and embrace how public health is connected to the health of animals and our shared environment. In this post, ASTHO talks about One Health with Wayne E. Cascio, MD, who serves as the Acting Principal Deputy Assistant Administrator for Research and Development at EPA.

Although suicide was a critical public health issue in the U.S. long before the COVID-19 pandemic began, Americans are now reporting increased mental health challenges like depression, anxiety, and suicidal behaviors. In addition, millions have experienced financial hardships, social isolation and loneliness, and increased stress—all of which are shared risk factors for mental health conditions, suicidal behaviors, and substance misuse. State public health officials have taken bold action over the past 12 months to mitigate the physical impacts of COVID-19, and the same swift action should be applied to mitigate the acute and potential long-term mental health, suicide, and substance use impacts. The National Response’s "An Action Plan for Strengthening Mental Health and Prevention of Suicide in the Aftermath of COVID-19" provides a roadmap for addressing the mental health, suicide prevention, and substance misuse prevention needs spurred by COVID-19.

Olmsted County Pilots a Regional Population Health Data Hub to Improve Data Accessibility Gelila Tamrat, Sara Black, Reema Mistry, Christina Severin Olmsted County, Minnesota, pilots a regional population health data hub to improve data accessibility, which supports improved decision-making and interventions. Historically, Olmsted County and other local counties in southeast Minnesota have faced barriers to accessing timely and actionable public health data, including limited data analytics workforce capacity, lack of data-sharing agreements (DSAs), and misaligned data suppression standards. To address these challenges, Olmsted County Public Health Services (OCPHS) piloted a regional population data hub, in partnership with the Minnesota Department of Health (MDH) and 10 local health departments (LHDs). OCPHS procured resources to develop a regional data-sharing platform, expanded their epidemiology team, and pursued DSAs. As a result, they gained access to critical data that supports informed decision-making and tailored interventions at the local level. Tina Jordahl - Brief - Olmsted County MN DMI Hub Developing a Regional Population Health Data Hub With financial support from the Minnesota legislature in 2021, OCPHS collaborated with MDH and its regional counterparts to develop a regional population health data hub for smaller LHDs to access community-level public health data. OCPHS maintains the hub by managing data from the state, regional partners, and 10 LHDs, and creating data dashboards to support southeast Minnesota counties’ population health data needs. This effort involved building and expanding relationships with MDH unit-specific epidemiologists, working closely with public health system consultants at MDH, and raising awareness of the need for sustained data analytics workforce support. Following the initiative’s success, OCPHS plans to engage with state and local leaders to identify funding sources that can sustain the hub beyond the pilot funding cycle. Promoting Data Accessibility through Strategic Partnerships and Agreements MDH’s Center for Public Health Practice supports public health system consultants, who offer technical assistance and consultation services to strengthen public health infrastructure across Minnesota. The consultant for the southeast region of the state was crucial in linking state and local staff to advance the development of the regional population health data hub. They helped triage and expedite requests from OCPHS by identifying the right points of contact for datasets and legal counsel within MDH. The collaboration of MDH, OCPHS, and participating LHDs facilitated the development of DSAs, which allowed for proper data flow and enabled OCPHS to request data from MDH on behalf of participating counties, reducing the need for each county to request data. It also helped OCPHS to become the first county in the state to adopt CDC’s ESSENCE tool to monitor hospital visits for syndromic surveillance across Minnesota and neighboring states, better enabling LHDs to address the needs of communities residing along state borders. Hiring Strategies for the Data Analytics Workforce OCPHS focused on hiring staff to support the regional population health data hub with data expertise, strong communication skills, and a particular interest in population health and social determinants of health. OCPHS created two permanent epidemiologist positions to promote sustainability for that position in the future. To expand their hiring pool, OCPHS relied on Olmsted County’s updated remote work policies following the COVID-19 pandemic when many shifted to remote or hybrid work. They also invited leaders from partner counties to help vet candidates who could support other LHDs’ needs. Meaghan Sherden - Brief - Olmsted County MN DMI Hub Advancing Equity Through Data Accessibility Due to data suppression rules, counties in southeast Minnesota had limited access to county-level data for certain statewide datasets. OCPHS worked with MDH to identify appropriate data suppression standards that supported access to community-level public health data and preserved privacy and security, and collaborated with the county IT department to develop the regional data hub with public-facing and internal dashboards, aligned with the required privacy and security standards. The public-facing dashboards show aggregate data with appropriate suppression standards at county, regional, and state levels. The internal dashboards provide complete data summaries and are protected with appropriate permissions and multi-factor authentication for LHD staff to perform population-level analysis. Providing timely, granular data to participating counties allows LHD staff to develop tailored strategies to address emerging health issues promptly, bridging health equity gaps. OCPHS also integrates standard demographic data on race, sex, gender, and age into its dashboards, enabling regional LHDs to gain deeper insights into their communities and fine-tune equity-centered public health initiatives and interventions. Jenny Passer - Brief - Olmsted County MN DMI Hub Implementation Considerations Foster collaborative relationships across state and local health departments to identify opportunities to share resources when advancing data-sharing efforts. Models in which larger LHDs support key data infrastructure needs on behalf of smaller LHDs may bolster data analytics/epidemiology capacity across multiple LHDs and streamline coordination with key partners at the state health department. Consider how state health department consultant or liaison roles charged with providing technical assistance to state or local partners may help facilitate key connections between state and local health department staff pursuing cross-jurisdictional data-sharing efforts. Invest in data analytics/epidemiology workforce strategies that help address specific needs related to population health and relationship building, along with technical skills. Cross-jurisdictional data-sharing efforts require staff with strong data analytics and communication skills, as they work with multidisciplinary leaders and across jurisdictions to inform community-based interventions. Collaborate proactively with legal and IT departments to identify data governance solutions and technical approaches to adhere to required privacy and security standards. Establishing DSAs is important, as it allows sharing of data within required legal guardrails. Similarly, IT leaders can identify technological solutions that support effective access to data. OT18-1802 website yes

Arizona Department of Health Services Pursues Policies to Advance Data Sharing with Tribal Nations Erik Skinner, Christina Severin, Reema Mistry The Arizona Department of Health Services is pursuing policies to advance data sharing with tribal nations, centered around partnerships, education, and more. With leadership support and funding to modernize its public health infrastructure, the Arizona Department of Health Services (ADHS) is pursuing policies to advance data sharing with tribal nations. This includes investing in partnerships with tribal leaders, educating the public health workforce about tribal governments and tribal health care, and working to improve data identification processes to support effective data sharing between the state and tribal nations. Data sovereignty is an important consideration for ADHS, as there are 22 federally recognized tribal nations in Arizona. ADHS recognizes the inherent right of tribal nations to access their citizens’ public health data and is developing a tribal data sovereignty policy that both acknowledges their unique data needs and aligns with state requirements around tribal engagement. Leadership Support and Effective Tribal Engagement ADHS leadership understands the importance of making strong connections with tribal nations and recognizing each nation’s public health priorities while meeting its statutory requirement to develop tribal consultation policies. To that end, ADHS developed the tribal liaison position to serve as a resource, advocate, and communication link between ADHS and Arizona’s Native American health care community partners, including tribal community leaders, health and epidemiology directors, Indian Health Service (IHS), and Tribal Epidemiology Centers (TECs). Understanding cultural norms is essential to building trust with tribal partners; the tribal liaison role has been vital to ADHS engagement with tribal nations on data sovereignty topics. People and processes are important to establishing data sharing policies, and a well-informed workforce is essential for effective collaboration with sovereign tribal nations. ADHS is working with the Native Nation Institute to provide training on tribal sovereignty and cultural humility for staff. It has also developed a tribal handbook for public health staff on sovereignty, cultural trauma, and the roles of IHS and TECs. Identifying Tribal Affiliation within Datasets and Tribal Public Health Priorities ADHS conducted a data assessment to identify instances in which data sharing was active and ongoing between ADHS and tribal nations, and instances in which it had expired. A notable technical challenge was identifying tribal members within existing datasets, as many public health datasets are incomplete (e.g., do not include tribal affiliation) or rely on IT systems that are unable to aggregate data appropriately—making it difficult to ensure tribal authorities receive relevant, comprehensive public health data for their communities. In addition, because each tribal nation’s public health priority areas and data needs could differ from the data that state health information systems collect, sharing relevant data with tribal nations can be challenging. ADHS is working with each nation to identify tribal public health priority areas, find solutions to identify tribal data within state collected datasets, and share it with the respective nations. Ken Komatsu - Brief - AZ DHS Pursues Policies to Advance Data Sharing with Tribal Nations Honoring Sovereignty in Data Sharing Relationships Data sharing agreements with public health agencies often establish that the state agency controls the disposition and use of the data, and that each party benefits. Acknowledging that tribal partners are entitled to their citizens’ data without conditions differs from how ADHS has historically approached data-sharing relationships with others. ADHS plans to formally establish a non-transactional data sharing policy with tribal public health partners, and establish data sharing agreements that align with this approach going forward. Implementation Considerations Considerations for state health agencies in fostering strong relationships and effective engagement with tribal partners around data-sharing efforts include: Center tribal sovereignty when framing data sharing agreements with tribal nations. Engage tribal liaisons in data-sharing efforts with tribal nations. They maintain close relationships with tribes and can help develop mutual cultural understanding, which is essential to engaging tribal partners. Assess datasets to determine data completeness with regards to tribal affiliation and identify opportunities to improve comprehensive data sharing with tribal authorities. Invest in state health agency staff training on tribal sovereignty and cultural humility, so staff can be well-prepared when engaging in data sharing conversations with tribal partners. Gerilene Haskon - Brief - AZ DHS Pursues Policies to Advance Data Sharing with Tribal Nations OT18-1802 website yes

This episode discusses why there needs to be a comprehensive response in public health surveillance, in particular around the opioid epidemic. After all, without thorough data, it’s tough for lawmakers to drive action that will reduce the prevalence and incidence of drug overdoses.

The second half of Public Health Review's story on the opioid epidemic explores how coalitions in Kentucky are driving prevention efforts, what public health practitioners in West Virginia are doing to identify and care for newborns who have been exposed prenatally to addictive drugs, and how one federal agency is working to ensure that rural communities get access substance abuse and mental health services.

Learn about Pima County's journey to advance data modernization efforts through an elevated partnership with County IT.

This brief details innovative uses of geographic information systems (GIS) in public health. It showcases original research conducted by ASTHO staff to better understand the value of GIS in mapping national public health emergencies

The Florida Department of Health created an effective algorithm to automate syphilis laboratory result processing that improves case assignment accuracy and prioritization. This tool outlines key steps and considerations for jurisdictions looking to adopt the algorithm.

Six DELPH scholars give their insights to learn more about how the data modernization initiative and DEI intersect with public health.

Policy Options to Improve Data Sharing Between State and Local Health Departments Organizational policies on data sharing between state and local public health agencies. This report explores organizational policies related to data sharing between state and local public health departments. ASTHO, in collaboration with the National Association of County and City Health Officials and the Network for Public Health Law developed this report, which aims to serve as a guide for state and local public health leaders as they consider organizational policy options to improve state and local data-sharing efforts. Get the Report (PDF) website yes

The adage “what gets measured, gets done” has had staying power for a reason. When we can accurately describe conditions, quantify impact, and elucidate connections, we have a better chance at taking collective (and effective) action to tackle even the most challenging problems facing our communities. The National Survey of Children’s Health is a powerful tool to provide this critical information to researchers, policymakers, and state-level decision makers.

The New Frontier of Digital Proximity Tracing Association of state and territorial health officials, astho, public health, covid-19, contact tracing, case investigation, public health surveillance, infectious disease, proximity tracing, exposure notification, public health agencies, data privacy, public health official, state legislature, geolocation, health data, test positive for covid-19, personal data, data collected, health departments Jeffrey Ekoma Digital proximity tracing is the cutting-edge for tracking outbreaks of COVID-19, but many have concerns about data privacy. States have proposed legislation to balance the two. As state, local, territorial, and tribal (SLTT) health departments continue to cautiously reopen parts of their economy, they also continue to take necessary measures to prevent the spread of COVID-19. A major component of this work is traditional contact tracing, a staple of public health surveillance where public health workers track down and notify anyone who might have contact with someone who tested positive for an infectious disease. However, new strategies that would supplement traditional tracing have been gaining momentum. Google and Apple collaborated to create an application programming interface (API) platform for public health agencies interested in a new type of “proximity tracing” or “exposure notification.” The platforms are expected to assist in the creation of apps between software developers and public health jurisdictions. It specifically utilizes Bluetooth technology —readily available in cellular devices—to randomly generate temporary keys on a user’s device when a user downloads an exposure notification application. This then enables the application to alert an individual if they have been or potentially exposed to someone who also uses the application and who tested positive for COVID-19. It’s worth noting the platform created by Google and Apple does not collect location information or information of users who do not voluntarily mark themselves as being positive for COVID-19. There are other notable exposure notification apps being used by SLTTs including Care19, an app developed by ProudCrowd that’s currently being used in North Dakota and South Dakota. Also, CommCare, which is currently being used in New Jersey and was developed by Dimagi. As expected, the introduction and potential influx of these types of apps have brought many different concerns, primarily centered around data privacy and how the platforms and applications would protect, store, and safely discard information that it collects. This issue became of interest to Sen. Maria Cantwell, current ranking member of the Senate Committee on Commerce, Science, and Transportation. In response she drafted S. 3861 Exposure Notification Privacy Act, which proposes assistance to public health jurisdictions exploring exposure notification applications and technologies. The act would ensure that such platforms have the necessary capacity to protect the personal data of consumers, limit the type of data collected, as well as the type of entities that would have access to such data. In addition, the legislation also: reaffirms the role of public health officials in requiring their involvement in the development and deployment of exposure notification systems; requires that participation from individuals be on a voluntary basis and with consumer consent; limits the collection and use of data; prohibits commercial use of data; and permits participants to delete their data at any time; among other things. The legislation was recently co-introduced with Sens. Bill Cassidy and Amy Klobuchar, and received support from the Washington State Department of Health, Council of State and Territorial Epidemiologists, and the National Coalition of STD Directors. This legislation is currently pending in the Senate and it is unclear if it will be considered in the upcoming months. There is also movement in state legislatures to address the use of technology. In California, legislation (AB 660) was introduced that would require any state agency contract that uses a mobile device’s geolocation data for exposure notification to a communicable disease to include provisions requiring the contractor to inform the app user of the authorized purposes of the app and collected data. Another bill (AB 1782) introduced in the state would require public health entities and businesses offering exposure notification services to allow users to revoke consent for the collection, use, maintenance, or disclosure of the user’s information. Businesses that provide exposure notification services but are not affiliated with a public health entity would be required to disclose its non-affiliation. The bill would also require the encryption of data collected by the technology, limit the use of the data as well as the amount of time the data can be maintained, and require reported exposures be verified by a healthcare provider before notifying logged contacts of their potential exposure. In New York, companion bills were introduced (A 10583A and S 8448B) that would establish requirements for the collection and use of emergency health data and the use of technology for collecting data during the COVID-19 emergency. Specifically, the bill requires the disclosure of certain information to those who install and use data collecting apps on mobile devices, including information about the right to opt-in, the right to privacy, the app’s privacy policy, time limitations for maintaining the data, and the individual’s right to access the data. Unlike the bills in California, individuals in New York would be able to sue for violations of the law. Several SLTT’s are currently either exploring, developing, or implementing proximity tracing applications within their respective jurisdictions. It remains critical that SLTT health departments evaluate the implementation of any proximity tracing option, while concurrently evaluating pertinent data and privacy related issues that may arise with the collection and sharing of information from individuals. In the coming days, ASTHO plans to release a guide to assist health officials as they think through the critical functionalities, technological options, and implementation of these emerging technologies. ASTHO will continue to track and monitor legislation that seeks to address data and privacy concerns with proximity tracing and exposure notification applications. website yes

CDC-funded program will accelerate data exchange between healthcare and public health to drive timely, data-informed public health action

Data-Sharing Strategies to Support Access to Care Interventions Anna Bartels, Chikamso Chukwu Learn how primary care offices improve community access to health care in this Health Policy Update. Every state public health agency houses a Primary Care Office (PCO), which monitors the effectiveness of that jurisdiction’s health system. HRSA funds PCOs to identify communities with health professional shortages, and PCOs may also administer workforce programs to place providers in those communities. To identify which communities are experiencing shortages, PCOs collect state-level data on where health care providers work, what services they offer, and how many hours they spend on patient care. PCOs also track data on community needs, such as household income levels and community transportation options, to create a holistic picture of whether health care is truly accessible. PCOs across the country have explored different policy pathways to access reliable, accurate data, including laws that support PCO access to certain data sets, cross-sectoral relationships, and data-sharing agreements. According to ASTHO’s national PCO workforce assessment, over 85% of PCOs are part of a formal data-sharing arrangement, with licensing boards and Medicaid agencies serving as two of the most common data sources. This health policy update describes several types of actions jurisdictions have taken to support PCO data access. New Hampshire Law Allows the PCO to Survey Providers During License Renewals The New Hampshire PCO’s Health Professions Data Center administers a survey tied to health care providers’ medical license renewals that gathers self-reported provider and practice data, such as where providers work, how many hours per week are spent delivering direct patient care, and anticipated changes in capacity over the next five years. New Hampshire law outlines the scope of the survey and authorizes the PCO to collect, store, analyze, and report on health care workforce supply and capacity through surveying during license renewal. Although survey responses are the primary source of data on the health care workforce, data from the state’s all payer claims database housed within the Medicaid division provides supplemental information. Given the type of data involved, legal agreements are required between the PCO, licensing agencies, and relevant parties to maintain privacy for providers. These data are critical for the PCO to evaluate current and future capacity — especially in regions with limited providers — and proactively focus recruitment efforts on those communities. Colorado Braids Data Collection Strategies Across Multiple Sources While the Colorado PCO has relied on a similar law that authorizes collecting licensure data for more than 10 years, its data collection efforts have since expanded. The state now collects and integrates data across 16 different sources, each requiring a different procurement strategy. While some data sources are simple to access because they are public use files (e.g., Medicare provider data), other sources — namely state agencies — require the PCO to submit an application or enter into a memorandum of understanding or contract for access. Pursuing multiple data sources in this way takes significant effort and staff time, necessitating the health department to supplement HRSA’s PCO cooperative agreement funding with other sources, including state appropriations and private funding. A commitment to collaboration and investment and a willingness to build new relationships and processes from scratch support the Colorado PCO’s wide-ranging data collection strategy. Iowa Builds on Existing Relationships to Access Provider Data Iowa’s PCO has a long-standing relationship with the University of Iowa and a joint interest in health care workforce data. Currently, the PCO purchases provider phone survey information from the University of Iowa’s existing program and receives data on a biannual basis. The university’s data collection is part of its own research efforts and not collected on behalf of the PCO, so while the data are broader than what the PCO needs, it is still a valuable source of provider information. Because of this existing arrangement, the PCO could pursue a more expansive agreement (that would likely require additional funding) and expand the scope of the data, such as by adding data collection on provider residence or sliding fee scales. Other PCOs may consider approaching partners that have pieces of the data they need so there is an established relationship in place that may be expanded as new resources become available. PCOs Secure Access to Medicaid Claims Data State Medicaid agencies are another frequent data partner for PCOs, with at least 16 receiving provider data from their state Medicaid agency in various formats. In some states the Medicaid agency shares a point-in-time file with the PCO, who may manually recode the data before submission to HRSA. In other states, the PCO has direct access to the Medicaid claims processing system to independently extract the necessary data points. The nature of the partnership between the PCO and Medicaid agency may vary based on the state’s organizational structure (e.g., whether the PCO and Medicaid agency sit within the same department). However, a PCO seeking access to Medicaid claims data should be prepared to justify the need for the data, articulate how it can support the Medicaid agency, and develop the necessary relationships to support a workable solution for both parties. Conclusion Each PCO and state health agency has its own unique structure, and there is no “right” way to collect health care provider practice or access data. However, exploring how different jurisdictions approach these processes can help PCOs think strategically about new initiatives and relationships. ASTHO will continue tracking PCO success stories and remains available to facilitate connections among health agency staff. 2 UD3OA22890-13-00 article yes

How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership Saisha Adhikari Discover how Palau is improving public health data by leveraging private-sector partnership in this blog post. The Republic of Palau is navigating a rapidly shifting public health landscape with an approach rooted in creativity, clarity, and community. Rather than slowing down in the face of limited staffing and competing priorities, the Ministry of Health and Human Services (MoHSS) has chosen to use this moment to build systems that will last. Through Public Health Infrastructure Grant (PHIG) funding, Palau hired HealthEfficient, a health care consulting organization, to support data modernization (DM) initiatives, including a new national electronic health record (EHR). Palau previously collaborated with HealthEfficient through the Pacific Islands Primary Care Association (PIPCA), which introduced HealthEfficient to the region through a multi-year initiative to support regional EHR planning, readiness, and adoption. During that time, HealthEfficient developed a strong understanding of Palau’s priorities, needs, and operating context. Palau subsequently joined HealthEfficient's Health Center Controlled Network. This multi-phased, ongoing partnership has helped Palau bring structure to complex work, expand internal capacity, and make progress on long-standing priorities. Laying the Groundwork for Meaningful Progress As part of its PHIG workplan, MoHSS is committed to adopting modern, flexible technologies and standards, reducing data silos, and strengthening its workforce. Given the need for external support to implement the EHR, Palau also considered how to leverage its partnerships to advance broader DM efforts. MoHSS collaborated with ASTHO to clarify needs and what success should look like. This preparation, combined with HealthEfficient’s familiarity with Palau’s health system and cultural context, created a strong foundation for their partnership. HealthEfficient has been instrumental as Palau transitions from a largely manual system to a modern, comprehensive EHR. The consultant’s ability to understand local realities of how staff work, how communities engage with health services, and what modernization means in Palau’s context has helped decisions remain grounded in what the country truly needs. Project Management as a Capacity-Building Strategy HealthEfficient serves as an extension of the MoHSS team, managing day-to-day coordination and creating structure around the DM work. They lead agendas, capture meeting notes, track progress, and manage overall project flow. This allows Palau MoHSS staff to stay focused on vision, strategy, and local leadership. Palau MoHSS and HealthEfficient meet on a consistent cadence: twice weekly on EHR implementation and twice monthly on broader DM activities. As demand has increased, additional meetings and hours are scheduled as needed throughout the week. This rhythm keeps the work aligned while giving each workstream to move at its own pace. Due to capacity, MoHSS moved the EHR launch from December 2025 to the first half of 2026. Rather than treating this as a setback, they used the new timeline as an opportunity to refine workflows and better support staff. Together, MoHSS and HealthEfficient updated their approach and kept the work moving. Although the workload is still considerable, the partnership has made it manageable. Clear roles, shared communication, and reliable structure have allowed the team to maintain momentum without overwhelming MoHSS staff. This progress is also driven by a strong internal MoHSS team of five staff members, several of whom are featured in this blog, who are working closely with HealthEfficient and the EHR vendor to move implementation forward. Sherilynn Madraisau, Director of the Bureau of Public Health Services at MOHSS, explained: “Even with limited staffing, leadership recognized how critical this project was for Palau and contracted HealthEfficient not only to manage much of the day-to-day work but also to help build our internal capacity, ultimately strengthening overall systems and creating long-term impact.” Navigating Challenges with Cultural Awareness Like many small jurisdictions, Palau MoHSS faces: Limited staffing and competing priorities. Navigating technical jargon. The need to coordinate across multiple external partners. These challenges show up in real ways: teams are stretched across responsibilities, vendors may not understand local context, and cross-agency communication requires ongoing attention. Edolem Ikerdeu, Executive Director of the Palau Community Health Center, noted the importance of cultural mediation in this work: “Our consultants bring valuable expertise and guidance, but it’s equally important that the work reflects our culture and our priorities.” Her role includes working with staff members to help partners understand context, smoothing miscommunication, and ensuring all stakeholders stay aligned around the mission of serving Palau’s people. That spirit of shared learning and adaptation is echoed across the team. Tmong Udui, Acting Chief of Division of Health Informatics and Intelligence at MoHSS, added, “A lot has been new for [staff], but learning together and building skills in this new area has been a good experience.” Partner engagement remains personal and intentional. The MoHSS team keeps partners engaged by having real conversations, naming the shared purpose, and showing exactly how the EHR will help the whole country, not just the health sector. Early Wins and Emerging Strengths Even just a few months into the EHR migration, MoHSS is already seeing measurable progress: Accelerated EHR Implementation: After years of anticipation, MoHSS now has a clear structure, dedicated support, and renewed momentum behind the EHR work. Informed Technology Decisions: With HealthEfficient at the table for external stakeholder discussions, MoHSS has had a trusted advisor to help evaluate system options and advocate for what best fits the country’s needs. Growing Internal Capacity: Through trainings and ongoing collaboration with subject-matter experts, staff are strengthening their skills in cybersecurity, systems upgrades, and process improvement. Stronger Organizational Coordination: Clear oversight and consistent communication have helped reduce the burden on staff and increased alignment across the ministry. These wins reflect progress beyond just technology, but in confidence, communication, and long-term planning. The work is strengthening the system as a whole and not just a single project. A Foundation for the Future With HealthEfficient managing much of the operational load for DM, Palau can focus on guiding strategy and determining long-term direction. HealthEfficient advances the work; MoHSS shapes the vision. Edolem Ikerdeu shared, “If you hire people and the funding goes away, then what is this for? We want a stronger system that includes the people who are already here.” Palau’s approach offers a compelling model for other resource-limited jurisdictions: Start with clarity. Build the right partnerships. Protect space for local leadership. Design systems that will outlast short-term funding. By centering community, embracing thoughtful project management, and working with culturally aligned partners, Palau MoHSS is building public health infrastructure that will serve its people well into the future. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes

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

Leading Health Security Efforts Through Strategic Collaboration and Innovation Margaret Nilz This blog post illustrates how health agencies' strategic plans can improve health security and emergency preparedness. Strategic planning is a cornerstone of effective public health systems, guiding organizations in preparing for and responding to health threats. Three pivotal documents—the CDC Office of Readiness and Response (ORR) Strategic Plan, the ASTHO Strategic Plan, and the ASTHO Environmental Scan—are part of the foundation of ASTHO’s work. Each plays a critical role in shaping public health policies and practices. Understanding their synergies and differences is beneficial and crucial for enhancing our collective efforts in safeguarding public health. ASTHO’s Environmental Scan tracks U.S. public health concerns and trends. Through qualitative analyses of select health agency materials and health official feedback, this blog identifies state, territorial, and freely associated state health agencies’ (S/THAs) top current and emerging priorities across public health programs, infrastructure, and health equity and agency strategies to address them. Across 2023 and 2024, S/THAs consistently identified emergency preparedness and response as a critical priority. Callout 1-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation It is essential to align strategic plans and address emerging public health priorities in order to effectively respond to new health challenges. The ORR and ASTHO Strategic Plans share several common goals, such as implementing equitable, evidence-based practices, partnering for sustainable infrastructure improvements, and focusing on operational excellence while providing technical assistance. However, each plan also has unique missions. Callout 2-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation ASTHO’s Health Security team has a unit mission and vision that align with ORR goals and focus on supporting the needs of ASTHO members, as identified in the Environmental Scan. Callout 3-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation Aligning these strategic goals with current public health priorities is crucial in addressing existing and emerging health threats. Values The ORR and ASTHO plans express shared values like collaboration and innovation. These values guide strategic decisions and foster a cohesive public health community. Table-Blog - Leading Health Security Efforts through Strategic Collaboration and Innovation Competencies and Priorities Both organizations focus on developing competencies like leadership and technical expertise. ORR concentrates heavily on competencies specific to preparedness, including planning, response, and research for public health emergencies. ASTHO emphasizes competencies to support S/THAs, such as technical assistance, communication, capacity building, and advocacy. Building and aligning these competencies is essential for improving public health outcomes and ensuring workforce preparedness. With that in mind, ASTHO’s competencies are specifically aimed at aiding and supporting its members, and consequently the nation, in achieving the ORR competencies. Environmental Scan Observations The ASTHO Environmental Scan thoroughly evaluates current public health trends, challenges, and opportunities. Key highlights from the 2023 and 2024 Environmental Scans include: Focus on emerging threats such as infectious diseases and the impact of climate change. Changes in public health funding and resource availability. Technological advancements and their implications for public health practice. Common trends identified include a heightened focus on health equity, the importance of data-driven decision-making, and the need for increased interagency collaboration. Organizational competencies, including performance management and quality improvement, were listed as current priority areas for public health infrastructure and capacity-building. Focus issues include financial infrastructure, business processes, including procurement, recruitment, and grants management, policy development, and public health governance structures. Workforce development was listed as a priority for public health infrastructure and capacity building. Focus issues include recruitment and retention, local academic pipelines and training opportunities, staff compensation, and staff salary gaps. Data modernization and informatics are priority areas in states with state health improvement and strategic plans and were listed as current public health infrastructure and capacity-building priorities. Accountability, performance management, and quality improvement are priority areas in states with state health improvement and strategic plans and were listed as current public health infrastructure and capacity-building priorities. Implementation While ORR and ASTHO aim to achieve similar overarching goals of supporting health agencies, their implementation strategies vary. The ORR Strategic Plan focuses on four primary strategies that directly address the emerging threats and challenges highlighted by S/THAs, including: Modernizing and integrating data and systems across multidisciplinary public health entities to support data readiness and interoperability. Advancing readiness and response science to improve public health practice, including maturing and implementing evidence-based research in preparedness. Building and enhancing the response capability of CDC and state, tribal, local, and territorial health departments and driving collaboration among partners to enable rapid and effective response to public health emergencies through improved capabilities, partnerships, and funding mechanisms. Conducting rapid and ongoing readiness and response evaluation to inform continuous improvements across the detection of public health threats, readiness science, and emergency operations. While ASTHO’s Strategic Plan is less explicitly focused on preparedness, its guiding mission in supporting, equipping, and advocating for S/THOs and their agencies with a focus on leadership development highlights several strategic priorities critical to improving public health preparedness and addressing emerging priorities. Health and Racial Equity: A state and territorial public health system that prioritizes implementing policies and programs advancing health and racial equity to achieve optimal health for all. Workforce Development: A diverse state and territorial public health workforce that is engaged, well-resourced, well-trained, and connected to the communities it serves. Data Modernization and Interoperability: A state and territorial public health system supported by an enterprise-level data infrastructure in which public health data systems are interoperable, secure, and supported by a well-trained workforce. Collaborative Opportunities Maximizing the impact of these strategic plans involves leveraging the strengths of each organization through collaboration and innovation. There are numerous areas where ORR and ASTHO can collaborate to enhance public health outcomes: Joint programs leveraging CDC’s national scope and ASTHO’s state-level connections. Shared research initiatives pooling resources and expertise from both organizations. Coordinated emergency response efforts that create a unified front addressing public health emergencies. By continuing to communicate, these organizations can effectively address complex public health challenges and enhance overall public health resilience. Future Outlook Looking ahead, the strategic efforts of ORR and ASTHO will play a crucial role in shaping the future of public health infrastructure and preparedness. Engaging with and supporting these initiatives is essential for all stakeholders. To adapt to the changing health security threats, future iterations of all documents must be routinely updated to meet the needs of the nation and ASTHO’s members. A collective effort is required to improve public health resilience and response capabilities, ensuring we are well-prepared for future challenges. Ultimately, the synergy between ORR and ASTHO’s strategic plans presents a powerful opportunity to enhance public health outcomes. We can create a more resilient and effective public health system by fostering collaboration, building competencies, and addressing emerging trends and challenges. website yes

ASTHO, with support from CDC, launched the first cohort of the Linking Pregnancy Risk Assessment Monitoring System and Clinical Outcomes Data Multi-Jurisdiction Learning Community in October 2021. This brief examines themes that emerged from conversations in the learning community about the challenges encountered during data linking activities and discussed lessons they learned.

ASTHO Partners with Veritas Data Research and HealthVerity to Launch the First-of-its-Kind Public Health Data Consortium ARLINGTON, VA — The Association of State and Territorial Health Officials (ASTHO) announced today a partnership with Veritas Data Research and HealthVerity that establishes a first-of-its-kind public health data consortium. This novel consortium brings together ASTHO, jurisdictional health departments and private partners united in a shared mission to improve public health outcomes through enhanced data access and quality, and to address long-standing challenges that hinder our nation’s public health data infrastructure. “There is tremendous opportunity when we connect the strengths of private industry with the mission of public health,” said Joseph Kanter, MD, MPH, ASTHO CEO. “By working together in a structured way, we can close long-standing data gaps and build a stronger, more responsive system for the future.” The consortium’s central mission is to improve the quality of and access to real-world data and public health data relied upon by a broad range of stakeholders to drive public and population health decisions and understand longitudinal outcomes. State health agencies, providers, payers, researchers, and others rely on this data, which is often difficult to obtain. Through this public-private partnership, members aim to expand access in ways that strengthen communities and support health care and public health systems. “Our nation and communities need a robust, sustainable model that leverages the capabilities and expertise across both private industry and public health. For too long, there have been challenges in bringing private and public entities together to address the gaps that plague our nation’s public health data and technology infrastructure,” said Jen Layden, MD, PhD, ASTHO senior vice president of population and innovation, and former CDC and state public health leader. “This consortium, by uniting on a common mission and placing governance in the hands of public health, is primed to be a game changer.” Jurisdictional health departments will gain access to real-world data and technical capabilities and will play a key role in strengthening the quality and availability of critical data. The consortium will initially focus on mortality data, a foundational asset for a variety of use cases. "This consortium represents an excellent example of public-private partnerships in healthcare," said Jason LaBonte, CEO at Veritas Data Research. "Under the governance of ASTHO, all state and territorial health agencies can securely pool their data to improve clinical practice and innovation. In return, the agencies can combine their data with national real-world data to power better public health. Veritas is pleased to facilitate these data exchanges using our robust ingestion and delivery platform, and to make appropriate data available to a wider group of stakeholders with use cases pre-approved by the state and territorial health agencies.” “We are proud to serve as a founding operating partner, applying our expertise in identity resolution and data privacy to solve the 'linkage' problem that has long plagued public health,” said Andrew Kress, CEO of HealthVerity. “Through this consortium, we are enabling a standard of data exchange that respects patient privacy while providing a level of clinical truth that will accelerate research and improve the speed of public health interventions.” To support the consortium, ASTHO is creating an advisory network to provide organizations with opportunities to stay informed and offer guidance as the initiative evolves. To learn more about the consortium or advisory network, please contact phdc@astho.org. ASTHO Press Release Boilerplate   Veritas Boilerplate   HealthVerity Boilerplate website yes