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Supporting Resilience in Rural Areas Through Cross-Sector Partnerships ASTHO, Association of State and Territorial Health Officials, rural health, public health, public health partnerships, health in all policies, government agencies, community organizations, academic institutions, rural populations, infrastructure improvement, healthcare systems, environmental determinants, climate change, sustainable practices, environmental challenges, extreme weather, environmental health risks, protective factors, engaging rural partners, building trust, idaho department of health and welfare, michigan department of health, health equity, austin climate equity plan, healthy start oregon, kansas department of commerce, wisconsin broadband access, chesapeake housing mission Ali Aslam The key to making rural communities more resilient is for public health to partner with community organizations, governmental agencies, and other critical partners. Working across sectors of government agencies, community organizations, businesses, and academic institutions is critical to address public health challenges in rural communities. Using a Health in All Policies (HiAP) approach helps public health agencies better address the interconnected social, economic, and environmental determinants of health impacting rural communities and improve community well-being. HiAP brings together a multitude of perspectives to develop holistic strategies that can support infrastructure improvements, sustainable land use practices, diversified economic opportunities, safer and healthier home environments, and robust health care systems in rural communities. Through community leadership and collaboration, this cross-sector approach can enhance the capacity of rural communities to build resilience, adapt to climate change, and foster long-term sustainability to improve public health outcomes. Learn how states are implementing HiAP strategies to improve health in their rural communities in this report. Get the Report (PDF) website yes

This ASTHOReport serves as a primer for state and territorial health agencies seeking to assess the public health impacts of lead exposure in drinking water.

States are preparing to keep their communities safe during severe storms and low temperatures this winter.

While COVID-19 is still present and ever-changing, public health professionals must also grapple with new challenges such as monkeypox, increasing firearm homicide, and widespread heat waves. In the wake of such emergencies, public health preparedness is more critical than ever.

While communities transition from emergency response to long-term monitoring and recovery, the federal government and states are taking legislative action to improve emergency preparedness capabilities.

State and Federal Actions to Reduce Per- and Polyfluoroalkyl Substances’ Impact on Public Health safe drinking water act, per and polyfluoroalkyl substances, water supplies, contaminated groundwater, chemical companies, pfas contamination, forever chemicals, synthetic chemicals, maximum contaminant levels, industrial pretreatment program, polyfluoroalkyl substances pfas, chemical sales, chemical industry, bottled water, safe drinking water act sdwa, unregulated contaminants, companies in the world, united states, consumer products, 1996 amendments, national primary drinking water, surface water, water system, largest chemical companies, pfas strategic roadmap, primary drinking water regulations, pfas chemicals, pfoa and pfos, drinking water, testing for pfas, astho, association of state and territorial health officials Maggie Davis, Beth Giambrone State and Federal Actions to Reduce PFAS Impact on Public Health Since 2018, when the city of Stuart, Florida filed its lawsuit, communities across the United States have filed lawsuits against manufacturers that produce Per- and polyfluoroalkyl substances (PFAS), alleging that they contaminated groundwater and exposed residents to these harmful chemicals. In June 2023, manufacturer 3M agreed to pay at least $10.3 billion to settle the Stuart lawsuit and others across the country with public drinking water systems. Similarly, chemical companies DuPont, Chemours, and Corteva reached $1.18 billion settlement with local communities that have detected PFAS in their water supplies. PFAS are synthetic chemicals used in products like nonstick cookware and firefighting foam, which can migrate to soil, water, and air during production and use. Most of these chemicals remain in the environment without breaking down—hence the nickname “forever chemicals”—and can cause harmful health effects (e.g., higher risks of kidney or testicular cancer, and pre-eclampsia or high blood pressure among pregnant people) and are prevalent across the nation. Evidence shows the widespread nature of exposure to the chemicals and the economic costs of exposure. For example, a 2023 USGS study estimated that at least 45% of tap water nationwide could have one or more PFAS, while recent research estimates the annual cost of the disease burden attributable to long-chain (i.e., six or more carbon) PFAS exposure to be at least $5 billion. As communities seek restitution for PFAS contamination, federal and state policymakers are working to eliminate PFAS from ground water and drinking water and to mitigate exposure to these forever chemicals. Eliminating PFAS in Drinking Water Under the Safe Drinking Water Act, EPA has the authority to regulate the public drinking water supply in the United States. These regulations establish legally enforceable Maximum Contaminant Levels (MCLs) or Treatment Techniques and non-enforceable Maximum Contaminant Level Goals (MCLGs) for public water systems. EPA’s recently proposed PFAS National Primary Drinking Water Regulation could potentially add six different PFAS compounds to the list of regulated contaminants. Within the PFAS chemical family, PFOA and PFOS are proposed to each have MCLs of 4.0 parts per trillion (ppt), while PFNA, PFHxS, PFBS, and GenX would be regulated collectively as a mixture using EPA's Hazard Index approach. The proposed rule also could require public water systems to monitor and notify the public of PFAS levels and reduce the levels in drinking water if they exceed proposed standards. According to a survey conducted by the Environmental Council of the States, state guidelines vary; at least eleven states have established statewide MCLs for PFAS in drinking water. Some states prohibit their agencies from setting standards more stringent than federal ones and, in the absence of a federal standard, state agencies may hesitate to establish one that could easily be invalidated. In other cases, a lack of resources inhibits the agency’s capacity to set and enforce a PFAS standard. When a federal standard is established by EPA’s final rule, expected by the end of 2023, state primacy agencies will need to enforce the federal standard and adopt standards aligned with the federal standard or stronger within two years. Additional State Efforts to Reduce PFAS Exposure Even without MCLs, states are finding ways to mitigate the public’s exposure to PFAS. In 2023, states enacted legislation on banning PFAS in consumer products, increased requirements for testing and reporting of PFAS, and PFAS mitigation. Banning PFAS in Products Indiana enacted HB 1341 prohibiting fire departments from purchasing gear unless it contains a permanent label indicating whether it does or does not contain PFAS as of June 30, 2024. Minnesota’s HF 2310 prohibits selling or distributing products containing intentionally added PFAS beginning January 1, 2026. An exception may be made if the manufacturer submits information to the commissioner of the Pollution Control Agency such as the product, the amount of PFAS used, and the amount of PFAS in the product. The Oregon legislature enacted SB 543, which prohibits the selling or using polystyrene foam containers for prepared food, food containers containing intentionally added PFAS, and polystyrene packaging peanuts. Washington enacted HB 1047, which prohibits manufacturing, distributing, and selling cosmetic products with PFAS and other chemicals or chemical classes as of January 1, 2025. Testing/Reporting Indiana enacted HB 1219, establishing a pilot program that collects blood samples of previous or current firefighters, analyzes the samples for serum PFAS levels, and determines whether there are corresponding health implications associated with elevated serum PFAS levels. Maine’s LD 1248 requires bottlers who extract water from the state to sell as bottled water to test, regularly monitor, and report the presence of PFAS to the Department of Health and Human Services and post the results on a public-facing website. Sales of bottled water are prohibited if PFAS levels in the water source exceed the state or federal community water system standards, whichever is lower. Currently, Maine has an interim MCL standard of 20 ppt. Virginia’s HB 2189 directs the State Water Control Board to adopt regulations requiring industrial users of publicly owned treatment works to test waste streams for PFAS before and after cleaning, repairing, refurbishing, or processing items the user knows or reasonably should know uses PFAS chemicals. West Virginia’s HB 3189 requires its Department of Environmental Protection to identify and address sources of PFAS in raw sources of public drinking water systems. It also requires facilities to report the use of PFAS if they discharge to surface waters under a National Pollutant Discharge Elimination System (NPDES) permit or to a Publicly Owned Treatment Works under an industrial pretreatment program. Mitigation Connecticut enacted SB 100 establishing a PFAS testing account, which provides municipalities with grants or reimbursements for testing and remediating PFAS in drinking water. Maine enacted LD 289, which requires the state to purchase the real estate of a commercial farm found to be contaminated by PFAS before January 1, 2023 at the assessed fair market value but at no less than $20,000 per acre, and provides that the fair market value assessment cannot take PFAS contamination into consideration. Two enacted bills in Rhode Island (SB 724 and HB 5861) amend current law to add that if PFAS in drinking water exceed the state’s interim standard of 20 ppt, the state and the public water supply will enter into an agreement that requires dates for submittal of water treatment plans that will reduce the PFAS levels to or below the interim level. As more information emerges about the health effects of PFAS, states will be sure to continue their work to combat, mitigate, and report on their presence in the environment. ASTHO will continue to monitor and report on all legislative and regulatory activity around this issue. Special Thanks-Blog - State and Federal Actions to Reduce PFAS Impact on Public Health website yes

Earth Day is a natural time to examine current and future climate change policies that impact human health, including clean air, safe drinking water, access to food, and secure shelter.

States Are Innovating to Improve Indoor Air Quality Abe Kulungara Indoor air quality can significantly impact health and well-being—learn how states are using policy to address this issue. Whether at home, in the workplace, or in schools, the air we breathe inside is affected by improper ventilation, exposure to toxic chemical cleaning agents, buildup of moisture, and the presence of pests—all of which contribute to poor indoor air quality (IAQ). In addition, increases in extreme weather conditions (e.g., heat, hurricanes, flooding) can deteriorate buildings, reducing the physical barriers between outdoor and indoor spaces. And inadequate weatherization of schools and buildings can lead to indoor fungi and mold growth. Indoor air pollutants can have both short-term and long-term impacts on public health and well-being. Some examples of health outcomes (and their associated hazards) include: acute injury (carbon monoxide and other asphyxiants from combustion and safety hazards from improper design), cancer (asbestos and radon), infectious disease (COVID-19), as well as allergic disorders and asthma (mold and other products of damp indoor environments. Furthermore, poor IAQ in school can potentially affect comfort, concentration, and student performance. While the United States has made significant progress in improving outdoor environmental quality, improvements in indoor environments have been much slower, despite Americans spending approximately 90% of their lives indoors. In many cases, the responsibility for improving IAQ falls to individual states, resulting in a patchwork of regulations and varied approaches across the country. Indoor Air Quality at the Federal Level The federal government’s authority over indoor air quality is limited to federal buildings but there is no current comprehensive national regulation specifically focused on indoor air quality. Notwithstanding, federal laws and regulations addressing outdoor air quality can indirectly impact indoor air quality. For example, the Clean Air Act gives EPA the authority to establish and enforce National Ambient Air Quality Standards (NAAQS) for pollutants in outdoor air, such as ground-level ozone, particulate matter, and carbon monoxide. Improvements to ambient air quality will have an impact on indoor air quality as well. Even though the federal government’s role in IAQ is less direct, agencies including EPA have issued voluntary guidelines and best practices. This gap in federal regulations offers state and local governments the opportunity to set standards for their jurisdictions. The Model Clean Indoor Air Quality Act The Model Clean Indoor Air Quality Act (MCIAA) provides a framework for states to adopt and implement measures that are most relevant to their local needs and circumstances, much like the Model Food Code is used by states for food safety regulations. The Act consists of six main articles, each containing key sections designed to support a comprehensive mission of safeguarding and enhancing IAQ in public buildings through collaboration among public and private entities. The Act also presents extensive statutory language on IAQ and offers states the flexibility to choose the components that best suit their specific needs, priorities, and local conditions. By adopting the Model Act or portions of it, states can establish standards for ventilation, moisture control, hazardous materials use, and public education efforts. State Actions on Indoor Air Quality A growing number of states are proactively improving indoor air quality. Massachusetts recently introduced SD 2588, which incorporates language from MCIAA, while others are addressing IAQ issues more broadly, enacting legislation that prohibits smoking in indoor public spaces or responding to specific local challenges (e.g., mold, radon, volatile organic compounds ). At least five states are considering various bills relating to air quality in public schools. Massachusetts (SD 173 and SD 630) and New Jersey (S 1033) are establishing task forces or commissions to study indoor air quality. Connecticut (HB 5873), New York (A 2649) Virginia (HB 2618 and SB 1413) are establishing or amending indoor air quality standards for public schools. Massachusetts (HD 2890) is also prohibiting cleaning agents that could have an adverse effect on health. As states consider streamlining indoor air quality standards using the MCIAA, there are a large number of current statutes that improve IAQ. For example, Florida requires their Department of Health to have an IAQ testing and monitoring program to assess health risks from exposure to chemical, physical, and biological agents in the indoor environment. In Hawaii, the Department of Health is authorized to correct indoor air pollution problems in all buildings. The agency must establish and coordinate an IAQ assessment network involving state agencies and managers of publicly owned buildings to identify, evaluate, and resolve indoor air pollution problems. The statute also grants the agency the authority to implement a program for approving plans to construct, inspect, and monitor ventilation systems, as well as to provide IAQ information to managers, owners, and occupants of both public and private buildings. Other states, such as Washington and Oregon, have implemented programs that focus on IAQ in schools, acknowledging children’s unique vulnerabilities to poor air quality. ASTHO will continue to monitor and provide updates. article yes

Learn how states are regulating kratom, a plant-derived substance growing in popularity, in this Health Policy Update.

This report contains lessons learned and examples of messaging strategies that were successful during cyanobacterial bloom responses, they were collected from 17 state health agency staff members across 12 states.

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

This episode will focus on lessons learned from Oregon Health Authority’s cyanotoxin education and outreach efforts, and how a water contamination emergency caused by cyanotoxins can quickly become a public information emergency. Three guests from OHA will share how they used science-based health messaging as part of their risk communication strategy, and how important partnerships are in tackling cyanotoxins. In addition, OHA staff will discuss tools on the horizon to help conduct surveillance for cyanotoxins and prepare for future events.