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Investing in Indiana’s Public Health Infrastructure Through Community-Driven Policy Change public health infrastructure, community driven policy, indiana state health commissioner, public health system, indiana department of health, outpatient facilities, technical assistance, data and information integration, emergency preparedness, child and adolescent health, legislative action, state and local elected officials, health problems, health care, health system, health departments, federal agencies, essential public health services, centers for disease control, state and local levels, health outcomes, health organization, covid-19 pandemic, health infrastructure, promoting health, public health organizations, states public health, federal funding, astho, association of state and territorial health officials Maggie Davis, Keith Coleman Indiana enacts historic public health funding through community engagement and legislative support. In April 2023, Indiana passed bill SB 4, which was a historic investment in the state's public health funding and restructuring its public health system. This case study shares how the Governor's Public Health Commission and the Indiana Department of Health approached community listening sessions, formulated recommendations, and successfully built legislative support to reform the public health system in the state. Get the Report (PDF) website yes

Alabama shares six ways a cross-cutting approach successfully impacted its PHIG workplan implementation.

After years of advocacy, ASTHO and our partners are celebrating the recently signed Consolidated Appropriations Act.

On March 23, 2023, ASTHO President Anne Zink testified before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding sustainable and flexible public health funding.

ASTHO President Scott Harris, MD, MPH, Testifies to Congress Advocating for Sustainable and Predictable Public Health Funding ARLINGTON, VA — Scott Harris, MD, MPH, president of the Association of State and Territorial Health Officials (ASTHO) and state health officer for the Alabama Department of Public Health, testified today before the House Committee on Appropriations Subcommittee on Labor, U.S. Department of Health and Human Services (HHS), Education and Related Agencies. Harris emphasized the importance of providing sustainable and predictable federal funding for key programs and initiatives at the Centers for Disease Control and Prevention, Health Resources and Services Administration, and other federal health agencies that enhance our nation’s public health. In addition, he mentioned the challenges associated with the recent cancellation of COVID-19 grants by HHS. “Governmental public health agencies are on the front line protecting our nation and improving the health and well-being of the entire U.S. population. Our country continues to face many public health challenges, deaths associated with chronic diseases, the re-emergence of vaccine-preventable diseases, and opioid misuse,” says Harris. “To build long-term resilience, public health funding must be consistent, forward-looking, and rooted in community-driven initiatives that address the needs of people where they live.” ASTHO calls on Congress to provide stable and long-term financial support for public health agencies. Without consistent investment state, local, tribal and territorial health agencies will struggle to strengthen their infrastructure, build public trust and protect the health and safety of all Americans. We must have a firm commitment to lasting resources that ensure a healthier future for our communities. For more information about the hearing, please visit the committee YouTube channel and read Harris’s full testimony. ASTHO Press Release Boilerplate website yes

State and Territorial Health Leaders Convene on Capitol Hill to Advocate for Sustained Funding ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) leadership and public health officials will gather in Washington, D.C. from March 10-13 for the annual Spring Leadership Forum. Attendees will gather to discuss key policy issues, attend peer learning sessions, and advocate for critical funding on Capitol Hill. Health officials are expected to highlight the value of federal funding to public health agencies as well as infrastructure needs, with the looming expiration of federal funding on March 14. Specifically, ASTHO requests Congress provide $365 million in FY25 and invest $1 billion, which equates to about $3 per person in the United States, in FY26 for vital public health infrastructure. “This week, ASTHO members are meeting with Congress to advocate for adequate resources to sustain vital, life-saving public health operations,” says Joseph Kanter, MD, MPH, ASTHO CEO. “In-person meetings allow health officials to shed light on the impact of legislation on state-level health systems. Our goal is to foster bipartisan collaboration and advocate for Americans across the country who rely on federally funded programs to stay healthy.” Additionally, senior leadership from the five U.S. territories and three freely associated states (T/FAS) will participate in an island-tailored set of meetings with Congressional and federal agency partners. On Capitol Hill, ASTHO’s T/FAS members will discuss the impact of the recently renegotiated Compacts of Free Association, as well as emphasize the importance of territorial Medicaid funding and the challenges associated with the Section 1108b cap on territorial Medicaid funding. "ASTHO’s Spring Leadership Forum is a critical opportunity for U.S. territorial and freely associated state health officials to make our voices heard in Washington, D.C. We look forward to working with members of Congress and federal agencies on emerging federal and island public health priorities," says Dr. Esther Muña, CEO of the Commonwealth of the Northern Mariana Islands’ Commonwealth Healthcare Corporation, chair of the ASTHO Insular Affairs Committee, and Director on the ASTHO Board. ASTHO Press Release Boilerplate website yes

Discover why community health workers are crucial for health equity and require sustained investment in this episode of Public Health Review.

ASTHO and PIHOA Praise Approval of Medicaid Funding Fix for U.S. Territories ARLINGTON, VA—This week, Congress approved legislation to extend Medicaid funding for two years for the U.S. territories in their fiscal year 2020 appropriations bills and extenders package. Esther Muña, the chief executive officer of the Commonwealth Healthcare Corporation, Association of State and Territorial Health Officials (ASTHO) board member, and Emi Chutaro, executive director of the Pacific Island Health Officer’s Association (PIHOA), issued the following statements applauding the bipartisan and bicameral extenders package. The legislation avoided devastating cuts to the territories’ health care services for their most vulnerable residents, scheduled to take place at the end of the year—widely called the “Medicaid Cliff.” “The U.S. territories face unique healthcare and public health challenges and the support provided through the Medicaid program allows us to care for Americans who live on these islands in their communities,” says Chutaro. “It is vital that we prioritize public health for Americans living in the U.S. territories,” says Nate Smith, secretary of health at the Arkansas Department of Health and ASTHO president. “Ensuring access to care is essential to protect and ensure health equity among and well-being within this population. As state health officials, we know that what benefits the territories will help us in our quest to bring optimal health to all.” “We are grateful for the bipartisan and bicameral legislation which provides a two-year increase in funds and federal match for the Medicaid program in the U.S. territories," says Muña. “The increased funding will allow the health care and public health systems in the U.S. territories to further improve access and quality of care to the population. This funding continues to be vital to all of the U.S. territories, and while we are grateful for this temporary fix, we must find a long-term solution to Medicaid funding to provide stability to our system of care. In the upcoming year, we look forward to working collaboratively with Congress and the Trump Administration to further bolster health care and public health systems to build healthy and resilient communities throughout the U.S. territories.” ASTHO Press Release Boilerplate PIHOA Boilerplate website yes

Supporting Governmental Public Health Should be a Congressional Priority Says Dr. Nathaniel Smith at Today’s House Appropriations Hearing ARLINGTON, VA—Nathaniel Smith, MD, MPH, director and state health officer for the Arkansas Department of Health and president-elect of the Association of State and Territorial Health Officials (ASTHO), testified today before the House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies to discuss the importance of Congress providing enhanced resources for Centers for Disease Control and Prevention, HHS Office of the Assistant Secretary for Preparedness and Response, Health Resources and Services Administration, and other federal agencies to improve our nation’s health. “Governmental public health agencies work everywhere, every day to protect and improve the health of the entire U.S. population. Our work is often invisible and sometimes it is only in a crisis when the value and importance of sustained investment in public health becomes apparent. These crises unfortunately happen all too often – the current measles and hepatitis A outbreaks, the obesity and opioid epidemics, and many others, highlight the important work of disease prevention and health protection at the core of public health’s mission,” says Smith. “ASTHO urges Congress to sustain and increase funding for federal public health agencies so that state, local, tribal and territorial health departments can continue and enhance their work to prevent drug overdoses, save lives through chronic disease prevention, prepare for and respond to disasters and public health emergencies, combat infectious disease, and prevent and remediate environmental health hazards.” For more information about the hearing visit the committee’s website. To read Dr. Smith’s full written testimony, visit ASTHO’s website. ASTHO Press Release Boilerplate website yes

State and Local Health Officials at the Capitol to Urge Congress to Prioritize Funding for Public Health ARLINGTON, VA—Over 80 state, local, and territorial health officials from across the country will meet with members of congress on Capitol Hill together on March 13, 2019. The aim of their visits is to share the critical need to sustain investments in public health agencies that protect and promote the health of all Americans and prevent sequester cuts in the FY20 budget. This is the first-time members of the Association of State and Territorial Health Officials (ASTHO) and the National Association of County & City Health Officials (NACCHO) will combine their annual Hill Days to show a collective voice for governmental public health at the Capitol. Public health leaders are concerned about the impact of the potential $55 billion cut to non-defense discretionary spending that will happen in FY2020 if Congress does not act to prevent it. ASTHO and NACCHO strongly urge Congress to work in a bipartisan manner to raise FY2020 budget caps and provide needed funding for non-defense discretionary programs, and support increasing CDC’s budget 22 percent by FY22. “Our entire governmental public health system is strained. My colleagues are on the ground dealing with several measles outbreaks, the opioid epidemic, and natural disaster recovery, all while continuing the core work of disease prevention—especially at the community level. Unfortunately, we are consistently underfunded and must do more with less. As a nation, we must do better and prioritize investing in public health,” says Nicole Alexander-Scott, MD, MPH, ASTHO president and director of the Rhode Island Department of Health. “Every person and every community should have the opportunity to be as healthy as possible. As part of ASTHO’s President’s Challenge, additional federal resources will help equip health officials to mobilize community-led, place-based collectives to improve the way we live, work, and play.” “In the decade since the Great Recession, public health departments have lost about a fifth of their workforce due to funding issues and recovery has been slow at best. We see the impact of these resource losses on the health and well-being of our communities every day. In so many areas of public health, we know what works, but we don’t have the resources to ensure that all Americans, no matter where they live, have access to the same basic public health infrastructure, services, and protections,” says Kevin Sumner, NACCHO president and health officer/director for the Middle-Brook Regional Health Commission. “So much of our public health system operates silently in the background. By joining together on Capitol Hill, we will amplify our voice and spread the message of the importance of governmental public health in all sectors.” For more information on ASTHO’s advocacy priorities, visit http://www.astho.org/Advocacy-Materials. For more information about the President’s Challenge, visit http://www.astho.org/ASTHO-Presidents-Challenge/2019. For more information on NACCHO’s advocacy priorities, visit https://www.naccho.org/uploads/downloadable-resources/flyer_legislativeagenda_2019.pdf. ASTHO Press Release Boilerplate NACCHO Boilerplate website yes

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On March 23, 2023, ASTHO President Anne Zink testified before the U.S. House of Representatives Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

Scott Harris Testimony Regarding Sustainable and Predictable Public Health Funding Testimony Title Scott Harris 20250409 On behalf of the Association of State and Territorial Health Officials (ASTHO), I respectfully submit this testimony on FY26 appropriations for the U.S. Department of Health and Human Services (HHS). ASTHO is the national nonprofit representing state and territorial public health agencies. ASTHO's members — the chief public health officials of these agencies — are dedicated to formulating and influencing sound public health policy and assuring excellence in public health practice. We respectfully request that Congress provide sustained and predictable federal funding from the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the Administration for Strategic Preparedness and Response (ASPR) for state and territorial health departments. The funding requests mentioned below are illustrative of the ongoing needs of our jurisdictions; we acknowledge that these levels may not be achievable in the next fiscal year. I am sincerely grateful to Congress for providing resources in FY25 to support and maintain investments in public health, ensuring our nation’s preparedness for current and emerging health threats. As a former state health official once eloquently stated, “The U.S. public health system is not a singular entity but a decentralized, uneven patchwork of federal agencies and state, local, tribal, and territorial public health authorities. As a result, the collaborative endeavor for public health is only as strong as the weakest link.” State health department budgets are a mix of state and federal funding streams. For some states, up to 80% of all funding comes from federal sources, with CDC being the single largest funder. Any disruption or decrease in federal funding will result in a significant impact on the ability of state and territorial health departments to protect and promote the health and safety of our population. Public health officials remain deeply concerned that our country faces significant challenges, including, but not limited to, the ongoing opioid overdose epidemic, chronic disease, preventing the spread of infectious diseases, rising health debt, access to health care in rural areas, and mental health crises. Furthermore, the recent abrupt cancellation of grants totaling as much as $11 billion caught state and territorial health departments by surprise; unfortunately, these actions will significantly impact our public health preparedness and response activities. Although the majority of this funding had already been spent, it was appropriated by Congress and obligated to health departments with work plans, budgets, and timelines approved by federal agencies for ongoing activities. These funds were intended not only for pandemic response, but also for mitigating key health security vulnerabilities that became apparent during the pandemic as well as strengthening our preparedness and response framework for the future. With congressional and executive branch support, these funds were being used to modernize data systems, bolster laboratory capacity, improve electronic case reporting of time-sensitive infectious disease outbreaks, improve H5N1 avian influenza and measles testing, and enhance biomedical terrorism preparedness, to name just a few examples. To meet not only the next public health emergency threat but also address our current challenges, it is critical that Congress invest in a stronger public health system by providing sustained and flexible funding that meets the needs of state, territorial, and local public health departments. America’s state and territorial public health departments work in partnership with CDC toward this goal. CDC plays a vital role in supporting communities to expand the capacity of our nation’s frontline of public health defense: our country’s state, tribal, territorial, and local public health departments. Regardless of the politics in our individual jurisdictions, state and territorial health officials are united in our mission to protect the health of our country. As the committee and incoming administration consider modernizing the federal government infrastructure, we respectfully request the following: Congress must work to sustain investments to state and territorial health departments: As Congress grapples with reducing our nation’s debt and deficit, the savings or return on investment generated by investing in public health has long been documented. Moreover, our membership relies on federal funding to address a myriad of illnesses through targeted interventions with the shared goal of preventing injury and disease. For example, in the fall of 2023, the North Carolina Department of Health and Human Services identified apple cinnamon fruit puree as the likely source of elevated blood lead levels in children. Even low levels of lead exposure in children can have long-lasting health effects, including potential brain damage and permanent reduction of IQ. Following their assessment, FDA issued a safety alert advising parents not to buy or feed the identified brand of fruit puree. Consultation: As the boots on the ground who put federal policy into action on the front lines, it is vital to consult with state and territorial health leaders about the potential impacts of funding reductions and/or administrative changes. Pausing or preventing money from going to states and territories, especially when done with little or no notice, creates disruptions and further harms our ability to rebuild trust with the public. As the recipients of numerous grant programs, we have first-hand knowledge of administrative changes that may actually benefit the system and could help reduce redundancies in the federal government. Flexibility: Federal funding mechanisms are often focused on specific programs, such as lead poisoning or food safety, and cannot be used flexibly to accomplish broad programmatic goals. We are grateful for the subcommittee’s ongoing support for public health infrastructure and capacity by funding this line at $350 million and we respectfully request $1 billion for this program at CDC in FY26. This disease-agnostic, flexible, and sustainable funding will support efforts within agencies that build capacity to detect and respond to threats both domestic and global, while improving and supporting activities in core public health capabilities, including assessment, policy, preparedness and response, community partnership, communications, equity, accountability, and performance management. Moreover, this funding will build a highly trained workforce that can be rapidly scaled to meet local, regional, or national threats. We strongly encourage Congress to prioritize flexibility in programmatic funding wherever possible to ensure the needs of the population can be met. Along with partner organizations, ASTHO supports the Data: Elemental to Health Campaign. Previously, we called on Congress to provide the first-ever dedicated funding for public health data systems and build a 21st-century public health data superhighway. Thanks to the work of this Subcommittee, Congress answered the call and provided annual funding for CDC's Public Health Data Modernization Initiative (DMI). For FY26, we request $340 million for data modernization efforts at CDC, which includes funding for the Center for Forecasting and Outbreak Analytics and the Response Ready Enterprise Data Integration platform. DMI is necessary for building a world-class data workforce and data systems to ensure we can meet the next public health emergency at full capacity. Our state and territorial health departments need robust, sustained, yearly funding to complete the foundational investment in DMI and ensure we are providing resources for public health systems and infrastructure, including at state and local health departments, to keep pace with evolving technology. States use the Preventive Health and Health Services Block Grant (Prevent Block Grant) to offset funding gaps in programs that address leading causes of death and disability. In some cases, this grant serves as seed funding for crucial, innovative projects so a state or territorial health department can meet otherwise unfunded community health goals. ASTHO respectfully requests $175 million for this program. For more than 30 years, the Prevent Block Grant has served as an essential funding source for state and territorial health agencies. CDC’s Public Health Emergency Preparedness Cooperative Agreement (PHEP) provides vital support for public health preparedness and response. ASTHO requests $1 billion for PHEP to sustain and improve governmental public health programs. Established in the aftermath of the September 11 terrorist attacks, PHEP has been a core public health preparedness program that supports 62 state, local, and territorial public health departments. The pandemic response demonstrated the need to invest in these programs to rebuild and bolster the nation’s preparedness capabilities. CDC has refreshed its strategy with critical lessons learned from COVID-19 to support public health jurisdictions with an updated response framework that prioritizes essential areas for the public to prepare for, respond to, and recover from health threats in the next five-year funding cycle that begins in the current fiscal year. Under ASPR, ASTHO is requesting $500 million for Health Care Readiness and Recovery, which includes the Hospital Preparedness Program (HPP) Cooperative Agreement. This includes developing mechanisms for effective patient movement, communicating situational awareness, and providing resource sharing across disparate health care entities. HPP allows individual health care facilities and coalitions to access a truly national response network, enabling the system to save lives and protect Americans from 21st-century health security threats.

Hill Day Advocacy at ASTHO’s 2026 Spring Leadership Forum Hill Day Advocacy at 2026 Spring Leadership Forum Catherine Jones Learn about key topics from Hill Day at ASTHO's 2026 Spring Leadership Forum, including crucial public health funding and access to care. While spring brings many familiar rites of passage, ASTHO’s Spring Leadership Forum stands out as a defining moment each year. For one week, ASTHO Board Members convene with health officials from states and the U.S. territories and freely associated states (FAS) in Washington, D.C., to examine pressing public health policy issues, participate in leadership and policy training, and align cross-jurisdictional priorities. This year’s forum saw a record number of more than 40 health officials. It included discussions with federal agency experts, meetings with congressional offices during Hill Day, and specialized sessions (e.g., Rural Health Academy and public health communications in the AI Era). Federal Agency Meetings ASTHO’s Board of Directors met with leadership from HHS, including representatives from the Office of the Assistant Secretary for Health, CMS, Administration for Strategic Preparedness and Response, SAMHSA, and HRSA. Discussions focused on: Strategic priorities for each agency. How to strengthen federal-state collaboration. Sustaining public health infrastructure. Addressing emerging health priorities. Hill Day Meetings About Public Health Funding ASTHO organized meetings with members of Congress and their staff to highlight the importance of sustained, stable, and robust public health funding — specifically, the Public Health Infrastructure Grant (PHIG) and Rural Health Transformation Program (RHTP). PHIG A central priority was advocating for a $1 billion allocation for PHIG in FY27 to strengthen the public health workforce, data systems, and foundational capabilities health departments rely on. Officials noted the impactful use of PHIG dollars in their states, how this funding directly supports local health departments, and emphasized that public health funding has historically followed a boom-and-bust cycle tied to emergencies — leaving federal agencies and state and local health departments to respond to major crises without consistent infrastructure and workforce support between events. RHTP Conversations also addressed the Rural Health Transformation Program and the challenges of deploying large federal investments quickly and effectively. Participants discussed an innovative pilot that allows Medicare reimbursement for emergency medical services responding to calls that do not result in hospital transport. Additional topics included: Clinical workforce shortages. Measles outbreaks. Vaccine access and insurance coverage. Emergency preparedness (i.e., the Strategic National Stockpile). Adequate lab capacity. Impacts of delays in federal grant funding. Workforce. Broader efforts to redesign health care systems to prioritize prevention and keep patients out of emergency rooms. Hill Day Discussions with U.S. Territories and Freely Associated States Meetings with congressional committees focused on issues facing the U.S. territories and FAS, such as those surrounding Medicaid funding and access to care for veterans. Medicaid Funding Territorial health leaders emphasized the critical role Medicaid plays in sustaining island healthcare systems, where the program serves as a backbone of coverage for many residents. Congressional action has helped stabilize territorial Medicaid funding by establishing a permanent 83 percent Federal Medical Assistance Percentage (FMAP) for the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa, and a temporary 76 percent FMAP for Puerto Rico. However, leaders stressed that Medicaid funding remains vulnerable to statutory caps that are too low and future policy changes. They also emphasized Puerto Rico’s current FMAP will expire in 2027. Access to Care for Veterans Representatives from FAS (the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau) raised concerns about access to health care and mental health services for veterans. While veterans from these nations are eligible for certain benefits through the Department of Veterans Affairs, many must travel long distances to receive care in Guam or U.S. states — creating significant financial and logistical barriers. Leaders emphasized solutions to improve access, including: Expanding telehealth services. Mail-order pharmacy options. Beneficiary travel programs. Leveraging existing on-island hospitals and clinics. Ensuring veterans can receive care and age in place in their home communities supports their health, strengthens local health systems, and reinforces longstanding partnerships between U.S. states and critical Pacific Island allies. Looking Ahead ASTHO extends its sincere appreciation to the members of Congress, congressional staff, committee staff, and federal agency leaders who met with state and island delegations and engaged in thoughtful dialogue on strengthening public health systems. In the months ahead, ASTHO’s Government Affairs team will continue working closely with congressional offices to provide timely data and perspectives, and to advocate for sustained federal investment in public health programs and territorial and FAS health care issues. ASTHO remains committed to advancing solutions to ensure health agencies have the resources and flexibility needed to address today’s public health challenges and prepare for those ahead. Reviewed by - Carolyn Mullen article yes

ASTHO Urges Congress to Increase Funding for Public Health Programs ARLINGTON, VA—Today, John Wiesman, ASTHO president and secretary of health at the Washington State Department of Health, submitted written testimony to the House Labor, Health and Human Services and Education Appropriations Subcommittee urging Congress to provide increased funding to support public health programs in FY19. This funding would allow federal agencies that support state, local, and territorial public health departments to improve the health of the population by addressing the opioid epidemic, enhancing preparedness programs, and continuing services through the Preventive Health and Health Services Block Grant. “Our federal partners, including CDC and HRSA, provide a level of financial support to health departments that state budgets simply cannot fulfill on their own. We are pleased Congress recently provided the most significant increase for public health in over a decade, however, we must build upon this momentum and provide states and territories with sustained, predictable, and hopefully increased funding in FY19 and beyond. State and territorial health officials are saving lives every day and health departments rely heavily on these federal funds to achieve broad impact and sustain high levels of success. The health of our nation is a matter of national security. ASTHO and our members stand ready to assist Congress and the Administration in our shared work of protecting and promoting the public’s health.” ASTHO Press Release Boilerplate website yes

ASTHO Applauds Bipartisan Budget Deal ASTHO Applauds 2018 Bipartisan Budget Deal ARLINGTON, VA—Today, President Trump signed the Bipartisan Budget Act of 2018 into law ending the very brief government shutdown. John Wiesman, ASTHO’s president and secretary of health at the Washington State Department of Health, issued the following statement in response: “We applaud Congress and the Administration for their approval of the Bipartisan Budget Act of 2018. This bi-partisan law will greatly assist state and territorial public health in promoting and protecting the health of all Americans. Specifically, this law provides the necessary resources for states and territories recovering from the recent natural disasters, and ensures stable funding for the Maternal, Infant, and Early Childhood Home Visiting Program. During negotiations of the bill, Congress also promised to provide $6 billion to help address the ongoing opioid crisis. Given the current public health emergency declaration, ASTHO strongly urges Congress to allocate a portion of this funding to the Centers for Disease Control and Prevention and states and territories so they can scale up evidence-based public health prevention programs. The deal does restore funding to the prevention and public health fund for FY19-FY21, which we greatly appreciate. These funds support core work detecting and responding to outbreaks, preventing tobacco use, and immunizing our children. However, ASTHO remains very concerned about cuts to the fund after 2022 and the core public health programs that these funds support. It urges Congress and the Administration to reconsider that decision in the out years. Health promotion and disease prevention activities require robust and sustained federal funding. The Bipartisan Budget Act is an important step in the right direction and we look forward to working with Congress to develop the FY18 omnibus appropriations bill to ensure additional resources are allocated to public health so we can continue our mission to improve the health and wellbeing for all.” ASTHO Press Release Boilerplate website yes

State and Territorial Health Officials Gather in Washington, D.C. to Make the Case for Prevention and Public Health Programs WASHINGTON, DC—State and territorial health officials from across the country gathered in Washington, D.C. this week to ask Congress to sustain investments in public health and prevention programs regardless of actions to repeal and replace the Affordable Care Act (ACA). During a Capitol Hill briefing today and meetings with key White House and congressional leaders this week, members of the Association of State and Territorial Health Officials (ASTHO) said that the nation’s health is at risk if proposals to eliminate the Prevention and Public Health Fund do not specify a viable replacement. “Federal funding for core state prevention and public health programs and services has existed for decades. Since its creation in 2010, the Prevention and Public Health Fund has invested $6 billion in preventive health services and core public health programs at the local, state, and federal levels,” says ASTHO Executive Director Michael Fraser. “Eliminating public health programs for community health needs, maternal and child health, cancer screenings, chronic disease prevention, and immunizations without a clear plan for replacement will seriously undermine our ability to effectively protect and promote health programs and guard against emerging public health threats.” “We commonly associate roads and bridges, railways and airports with infrastructure, but public health is also part of our nation’s critical infrastructure,” adds Jay Butler, MD, ASTHO President and Chief Medical Officer at the Alaska Department of Health and Social Services. “Just as the federal interstate highway system promotes commerce between the states, a strong public health infrastructure assures a healthy and productive workforce across the nation. As Congress looks to reinforce our nation’s aging transportation infrastructure, we urge similar efforts to improve and upgrade our nation’s public health system.” ASTHO’s health care infrastructure concerns stem from the fact that many local water systems are rapidly deteriorating and environmental contamination threatens the availability of safe drinking water for millions of Americans. State and territorial public health agencies monitor the air and water safety and work across government to remediate environmental hazards. Critical public health laboratory, public health information systems, and epidemiology capacity are also part of our nation’s public health infrastructure.  In addition to making the case for prevention, state and territorial health officials discussed last year’s public health response to the Zika outbreak and plans for this year’s response, the need for continued support to address the opioid epidemic, and the nation’s need to include public health in proposals to improve the nation’s aging infrastructure. In fiscal year 2016, Congress allocated $932 million from the Prevention and Public Health Fund to programs across multiple federal health agencies, providing the bulk of funding for health programs affecting millions of Americans. ASTHO Press Release Boilerplate website yes

State Health Officials to Congress: Act on Zika Funding Now ARLINGTON, VA—While Congress debates the future of federal funding for Zika preparedness and response, the Zika virus continues to spread. Rising case numbers and new information about long-term consequences of the infection highlight the urgency of mounting a major response. For the sake of our nation’s health, our representatives in Washington must come together and approve a bill to fund needed Zika preparedness response efforts and keep our nation’s public health infrastructure strong and secure. This national and state public health emergency requires a coordinated and properly resourced effort at the federal, state, and local levels. The nation’s state and territorial health officials stand ready to be part of that effort.   Zika virus is likely to continue to spread and is here to stay. While there is still much to learn about the virus and its health impacts, what we know already justifies an aggressive response. The virus has a potentially devastating impact on fetal development, and we are learning more about the risk of long-term health impacts for adults who become infected. We also know that federal agencies and state and territorial health departments are inadequately funded to respond to this crisis. There is an urgent need for additional resources to shore up mosquito control efforts, educate the public, increase public laboratory capacity, provide help to families with infants exposed to Zika, and follow up with pregnant women who may have been exposed to Zika at home or abroad. Due to the urgency of this threat, state and federal health agencies have been forced to divert resources from other critical public health programs to pay for Zika response. We agree that this robbing-Peter-to-pay-Paul approach, described by Centers for Disease Control and Prevention Director Dr. Tom Frieden and National Institute of Allergy and Infectious Diseases Director Dr. Anthony S. Fauci in their August 31 Washington Post editorial, is the wrong way to fight the Zika epidemic. We need a focused, coordinated, and adequately funded response to Zika while continuing to support the other essential work health agencies do to protect the public. For this to happen, Congress must act now. “We urge Congress to recognize that this is a serious, nonpartisan threat and to come together to pass emergency funding so that the public health system can effectively respond to Zika while simultaneously preparing for myriad other health threats like Ebola, natural disasters, and the upcoming influenza season,” said ASTHO President and Minnesota Commissioner of Health Edward P. Ehlinger, MD, MSPH. In the absence of dedicated funding for Zika response, public health officials must fund Zika efforts by redirecting funds away from other important functions such as the all-hazards preparedness efforts of state and territorial health agencies that enable them to rapidly respond to public health emergencies of all kinds. This approach leaves us in a precarious position as Zika will not be the only public health emergency that state and territorial health agencies face. States are tasked with minimizing and mitigating the health effects of hurricanes, tornadoes, terrorist attacks, chemical spills, and all kinds of other manmade and natural emergencies. Preparation and response to Zika is a massive undertaking, and Congressional inaction is handcuffing states, limiting their ability to prepare and respond to emergency situations. It has been months since public health officials first began calling for Zika funding, and Congressional delay lays bare the inadequacy of America’s piecemeal approach to funding public health emergency responses. In addition to properly funding a Zika response, we also need to create a permanent, FEMA-style Public Health Emergency Fund to facilitate an immediate response to public health emergencies. Public health crises arise independent of the Congressional calendar, and such a fund would allow for a rapid response rather than redirecting public health funding from other critical priorities. Federal and state health agencies are obligated to protect health and wellness nationwide. We believe Congress is similarly obligated to support the critical health protection efforts in partnership with the states. As Drs. Frieden and Fauci stated, we should be working tirelessly to respond to and slow the spread of Zika infections and support those families whose newborns have been affected by this virus. We are ready to do that, but we need support from Congress now to make it happen. ASTHO Press Release Boilerplate website yes

ASTHO Members Advocate for $1 Billion Investment in Public Health Infrastructure During Annual Spring Leadership Forum ARLINGTON, VA — The Association of State and Territorial Health Officials (ASTHO) will convene state, territorial and freely associated state health leaders in Washington, D.C., March 2-5 for its annual Spring Leadership Forum. Attendees will meet with members of Congress and federal partners to advocate for sustained funding and long-term investments in the nation’s public health infrastructure. During meetings, ASTHO members will stress the importance of a strong, resilient public health system. ASTHO urges Congress to invest $1 billion in FY27 in public health infrastructure — or about $3 per person nationwide — to ensure health agencies can maintain core capabilities such as disease surveillance, laboratory capacity, data modernization and workforce development. “This week, ASTHO members will meet with Congress to highlight the essential role federal funding plays in protecting the health of communities in every state and territory as well as the impact of grant pauses and terminations,” says Joseph Kanter, MD, MPH, ASTHO CEO. “Sustained, predictable investments allow health agencies to maintain the workforce, laboratories and data systems that keep the public healthy and safe.” As part of this convening, senior leadership from the U.S. territories and freely associated states (T/FAS) will participate in island-focused meetings. On Capitol Hill, ASTHO’s T/FAS members will discuss the impact of the recently renegotiated Compacts of Free Association, as well as emphasize the importance of territorial Medicaid funding and the challenges associated with the Section 1108b cap on territorial Medicaid funding. With federal agency partners, T/FAS members will discuss emerging and priority public health issues, including veterans' access to care. "ASTHO’s Spring Leadership Forum offers an invaluable platform for T/FAS health leaders to engage directly with decisionmakers in Washington, D.C. We welcome the opportunity to share island perspectives and collaborate with Congress and federal agencies on shared public health priorities," says Justa Encarnacion, RN, MBA, HCM, the commissioner of health in the U.S. Virgin Islands and director on the ASTHO Board. ASTHO Press Release Boilerplate website yes

In this episode of Public Health Review learn how different states maximize federal and state programs for improved housing, transportation, and other social determinants of health.