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This toolkit is designed to support public health leaders in leveraging the policy development process to achieve health equity in their jurisdiction.

Collecting and sharing data are crucially important to improving health equity, because those datasets inform effective policymaking. Despite having some of the most challenging population health outcomes, the U.S. island areas are often absent within federal public health datasets.Federal, island, and nonprofit partners should prioritize efforts to increase their inclusion.

Health agencies play a key role in preparing for and responding to hurricanes and other severe weather events.

This blog explains ASTHO’s Islands Health Equity Framework, which outlines a culturally resonant approach to health equity in the island areas.

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

This blog describes public health legislation introduced during the Island Areas’ 2024 legislative sessions.

Each year, ASTHO tracks and analyzes key legislation that impacts public health, and highlights the emerging trends for our members. While the bulk of the tracked legislation arises in state legislatures, ASTHO also follows legislation from the territories and Freely Associated States, jurisdictions collectively referred to as the insular areas. The insular areas often face different challenges than the states, while also sharing many common concerns. This post contains a brief look at some of the public health related legislation introduced in the insular areas during their current legislative sessions.

ASTHO has several members from the territories and Freely Associated States—jurisdictions with unique challenges, and do not fall under the category of a state or federal district. This post is a brief look at some of the public health related legislation introduced during recent legislative sessions.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

This how-to guide provides steps, tips, and templates for developing and maintaining effective partnerships within island health agencies.

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

This blog shares key takeaways from the first Island Areas COVID-19 Health Equity Action Institutes.

Navigating Public Health Planning with Precision and Purpose Discover examples and best practices for developing strategic plans that enhance community health outcomes. Embarking on the journey of public health planning demands more than good intentions. It requires a meticulous blueprint that encompasses budgetary considerations and strategic timelines, and effectively leverages external support. Across a landscape in which every decision has the potential to uplift entire communities, there are a world of opportunities and details to explore. Included among them are the critical components of crafting a robust plan, the value of engaging contractors, and strategies for optimizing resources. Mining Existing Plans for Insight and Inspiration Organizational strategic plans, Community Health Assessments (CHAs), and Community Health Improvement Plans (CHIPs) can supply guidance and inspiration for comprehensive public health planning. These documents offer both valuable insights into public health initiatives and tangible examples of effective planning frameworks. There are multiple examples of existing plans within health agencies across jurisdictions; when seeking them out, consider various criteria (e.g., population characteristics, geographic location, and specific health priorities). By examining plans tailored to communities with similar demographics or facing comparable health challenges, planners can apply approaches that resonate in their own context. Additionally, understanding the distinctions between strategic plans, CHAs, and CHIPs is essential, particularly for agencies aspiring towards PHAB Pathways Recognition Program or PHAB Accreditation. These plans are separate entities within the PHAB framework, each playing a vital role in shaping public health strategies and fostering community well-being. Strategic Plans Strategic plans outline organizational goals, plans to achieve them, and how to measure success. They drive resource allocation, decision-making, and other priorities organization wide. Examples U.S. Virgin Islands Hawaii Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Community Health Assessments Community health assessments offer a complete view of risks, resources, and factors influencing outcomes. Supported by diverse environmental and socio-economic data, CHAs inform health policy, staff protocols, partnerships, program development, funding, resource allocation, and health improvement planning. Examples U.S. Virgin Islands Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* Community Health Improvement Plans Community Health Improvement Plans are strategic, collaborative roadmaps derived from CHAs. They outline how health agencies, partners, and communities will unite to enhance overall health. They guide priorities, resource allocation, and steer project, program, and policy implementation. Examples U.S. Virgin Islands Hawaii Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* *PHAB Accredited Health Department Plan Components, Timeline, and Budget Agencies considering planning processes and examples from other jurisdictions should recognize the diversity in approaches across different agencies and jurisdictions. There truly isn’t a singular “right” way to undertake public health planning. Instead, it’s about tailoring the process to suit the jurisdiction’s unique needs and circumstances. Examples to Guide Plan Development The Kansas Institute of Health’s Strategic Planning in the Public Health Sector Handbook offers a comprehensive breakdown of planning elements and timeframes based on a six-month plan development calendar. Explore Minnesota Department of Health’s Community Health Assessment and Planning Toolkit, a rich resource for navigating the CHA-CHIP process and timeline. Their template includes a detailed approach that considers capacity to accomplish each step within a desired timeline. Given the variation in the depth and breadth of jurisdiction planning processes, it is challenging to pinpoint a specific dollar amount to cover a planning endeavor. NACCHO’s MAPP Budget Template (part of their downloadable MAPP 2.0 process) can help systematically think through the resources necessary for planning processes. Outsourcing Key Support External support—in the form of facilitators, contractors, or other specialized professionals—can play a pivotal role in enhancing public health planning by offering fresh insights, innovative strategies, and diverse perspectives. Such support also allows for full, active organizational participation in the planning process. Moreover, they can provide valuable technical assistance, helping to navigate complex challenges and identify best practices from other contexts. By harnessing external support, organizations can optimize their decision-making processes, foster collaboration, and enhance the delivery of services to communities, thereby promoting better health outcomes for all. Conducting a SWOT Analysis: Contractors can assist in facilitating a thorough analysis of the organization's strengths, weaknesses, opportunities, and threats (SWOT). This structured assessment helps identify internal factors that impact the organization's ability to achieve its objectives and external factors that may affect its operations. Proposing Strategic Priorities: Based on the SWOT analysis and input from stakeholders, contractors can help planning teams crystallize priorities aligned with the organization's mission and vision. These priorities serve as the foundation for developing the plan. Facilitating Steering Committee Meetings: Steering committee meetings are crucial for decision-making and guiding the strategic planning process. External facilitators can lead these meetings, ensuring productive discussions, consensus-building, and alignment with organizational goals. Developing Components of the Strategic Plan: Contractors can support in drafting or reviewing various components of the plan, including vision and mission statements, goals, objectives, and action plans. They may ensure these components are clear, concise, and aligned with the overarching strategic direction. Developing a Draft Implementation Plan: An implementation plan outlines how to achieve strategic goals, including timelines, responsible parties, and resource allocation. Contractors can support an organization to develop a draft implementation plan that outlines actionable steps to translate the strategic plan into reality. Developing Quality Improvement Metrics: Contractors can assist in guiding the development of metrics to measure the effectiveness of the strategic plan. These metrics should be specific, measurable, achievable, relevant, and time-bound (SMART), providing a framework for monitoring progress and making data-driven decisions. Conducting Training Among Organization Staff: To ensure buy-in and understanding of the strategic plan and process itself, contractors can help develop and co-facilitate training sessions for staff members. These sessions may cover strategic objectives, action plans, and their roles in achieving organizational goals. Developing a Communication Plan: Effective communication is an essential key for keeping any strategic plan off the shelf. Contractors can support an organization in developing a comprehensive communication plan that outlines key messages, target audiences, communication channels, and timelines to ensure consistent and transparent communication throughout the organization and with partners. Developing Process Logs, Templates, and Meeting Notes: Contractors can create documentation tools such as process logs, templates for strategic planning documents, and detailed meeting notes. These resources streamline the planning process, capture important discussions and decisions, and serve as valuable references when considering sustainability. In summary, external support brings valuable expertise and resources to public health planning processes, enabling organizations to navigate complexities, engage partners effectively, and develop actionable strategic plans that drive positive health outcomes for communities. OE22-2203 PHIG website yes

A Blueprint for Establishing a Health Equity or Minority Health Office 30:37 minutes Learn how to form and manage an office of health equity or minority health, based on several firsthand experiences. Listen to the podcast episode now. <!-- Podcast Embed ep 93 --> There are many considerations when forming and managing an office of health equity or minority health. The National Association of State Offices of Minority Health shares how agencies across the United States have overcome common challenges and benefited from having a dedicated health equity office. In addition, the United States Virgin Islands Department of Health discusses initial successes and challenges experienced while establishing their office. Finally, the California Department of Public Health, with a well-established office of health equity, shares how their office utilized health equity liaisons and supported rural/tribal communities. This podcast episode complements the recently published ASTHOReport “Establishing an Office of Health Equity or Minority Health,” which examines different approaches to sustainability. Show Notes Guests Rohan Radhakrishna, MD, MPH, MS, Former Deputy Director and Chief Equity Officer, California Department of Public Health Justa Encarnacion, RN, MBA, HCM, Health Commissioner and Chief Public Health Officer, United States Virgin Islands Department of Health Veronica Halloway, Executive Director, National Association of State Offices of Minority Health Resources Establishing an Office of Health Equity or Minority Health | ASTHO Islands Health Equity Framework | ASTHO Office of Health Equity | California Department of Public Health United States Virgin Islands Department of Health National Association of State Offices of Minority Health Podcast Transcript ep 93 website yes

Medicaid plays a critical role in providing access to health services for low-income U.S. citizens in the five U.S. territories. However, Medicaid financing in the territories has been underfunded compared to states. In this episode, guests discuss the urgent need for a permanent Medicaid solution, drawing attention to the need for equitable health financing for the U.S territories. This funding is necessary to support comprehensive public health and healthcare within these jurisdictions that include expanded prevention, testing, and treatment programs and capabilities.

This blog describes the island areas COVID-19 successes and their cultural and historical context.

Over the past several years, states and jurisdictions have continued to implement important policies to reduce tobacco and nicotine use, including increasing tobacco prices, expanding areas deemed “smoke-free,” limiting the sale of flavored tobacco products, and supporting tobacco cessation programs.

How the U.S. Virgin Islands is Improving Federal Grants Management astho, association of state and territorial health officials, public health, grant programs, grant management, overall health, health system, improving health, social determinants of health sdoh, grant funding, health outcomes, united states virgin islands, territory of the united states, health community, long term, quality of life, health care, grants management system, u.s. virgin islands. social determinants of health, population health, federal grants, federal grants management, federal grant planning, electronic grants management system Kristin Sullivan Learn about new grants management practices in the United States Virgin Islands. The United States Virgin Islands (USVI) continues to lead the way, making headway on improving key business processes. Last year, ASTHO reported on the beginning of a new "all-of-government" approach in the USVI to more efficiently manage and expend federal grant funding to identify territory-wide social determinants of health and in turn yield population health improvement. Under the leadership of Governor Albert Bryan, Jr., cabinet members from four administrative agencies (Offices of Management and Budget; Property and Procurement; Personnel; and Finance), four programmatic agencies (Health; Education; Human Services; and Justice), and the Governor’s Office comprised a Cross Agency Leadership Team (CALT). After evaluation of the federal grants' life cycle value stream, the team prioritized improving the Federal Grant Planning and Set Up process to prevent bottlenecks and other issues that occur throughout the rest of federal grant lifecycle. During this planning phase, the CALT—along with a project team comprised of key staff in each agency— were oriented to performance improvement basics and participated in Boundary Spanning Leadership workshops where they discussed a unified vision of collaboration to modernize business processes for the benefit of their community. In addition to the benefits to the community they serve, participants envisioned becoming better stewards of funds, increasing respect and trust with funders, increased cross-agency collaboration and communication, and improved job satisfaction due to less rework and urgent requests. "As we promote health equity in our diverse communities, we must recognize operational efficiency as a key driver including our ability to move resources to those most in need. This initiative creates an intentional focus through cross-agency dialogue on saving time, reducing duplication, and building workforce capacity to continuously improve." - Justa Encarnacion, Commissioner, USVI Department of Health Through a series of virtual and in-person workshops, each agency identified the steps in their current process revealing significant commonalities and supporting the feasibility of process standardization across agencies. The full project team worked to uncover the root causes behind process inefficiencies and identified and prioritized solutions. The workshops culminated in a set of recommendations for improvement, which was presented to and vetted by the CALT:   Create one standard process for all agencies documented in a standard operating procedure (SOP). Electronically enable the process (i.e., no paper or emails) using the existing grants management system to track information, facilitate workflow visibility and approvals, and store all information in one common location. Enhance quality and reduce errors through mistake-proof templates and checklists. Work toward removing redundant data entry across financial and grant systems. Streamline information sharing of notice of awards via the creation of general email inboxes. Establish Federal Grants oversight responsibilities in programmatic agencies. Establish Federal Grants Community of Practice (COP) among participating agencies to ensure continual effectiveness and efficiency.   Since then, the project team—with leadership support—has made significant progress developing the recommended improvements, working through challenges, and monitoring progress. To date, one standard process and SOP for all agencies was developed, and four workflows were created to automate the new process within their electronic grants management system, eCivis. Collaboration among programmatic, administrative agencies, and the eCivis vendor resulted in resolution of access issues, better-defined field entries for the automated workflows, and enhanced buy-in on broader system use. 100% of project team evaluation respondents reported improved communication and customer service among participating agencies. Additionally, the COP was established and alternates leading biweekly meetings allowing for the necessary time and space to develop emerging leaders, build capacity of the team, and prepare to sustain collaboration and improvement.  Options to establish federal grant oversight responsibilities in programmatic agencies is under discussion by a subgroup of leadership and COP members. Similar challenges that can be found in other jurisdictions, such as limited staffing capacity and turnover, changes in leadership, and managing daily priorities, affects the speed of which improvements are developed and implemented. These disruptions as well as individual agency process changes that occur over time, will need to be managed with attention given to momentum or resistance experienced, as well as to empowering the project team to adjust. Collaboration and decision making across multiple agencies is not easy. Success lies in engaging all agencies that play key roles in the grants process and strong executive leadership.  These keys to success can be replicated by other jurisdictions similarly interested in improving their ability to procure needed goods and services in a timely manner, efficiently recruit and on-board staff, and effectively manage grants and contracts.  Next Phase and Future Actions There are several critical actions USVI is working to execute prior to moving to full implementation of the new, improved process. Each agency will need to test the new workflows and prepare to roll out training to programmatic and administrative staff beyond the project team. Once completed, the new process will be in place and the COP will monitor process performance including speed and quality, and support ongoing process and system improvements. With reaffirmed commitment and prioritization from Governor Albert Bryan, Jr. and the U.S. Department of the Interior, ASTHO was recently awarded additional funding to continue supporting USVI on its journey to improve its federal grants management. Continual Impact thank you website yes