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Supporting Health Department Decision Makers with Disease Forecasting and Outbreak Analytics Disease Forecasting and Outbreak Analytics Amelia Poulin, Chris Taylor ASTHO and CDC surveyed states and territories about disease forecasting and outbreak analytics—learn more about the results. ASTHO, with support from CDC Center for Forecasting and Outbreak Analytics, conducted a survey to assess state and territorial health agencies' expertise and needs in using infectious disease forecasts and analytic techniques. Senior deputies from 28 jurisdictions submitted responses, which will help to inform health agency communications and decision-making efforts. The information in this report, fielded from March – May 2023, provides a comprehensive overview of the needs assessment results as well as key takeaways. Get the Report article yes

How Mississippi Prioritizes Environmental Justice During Disaster Response Association of state and territorial health officials, astho, environmental health, environmental justice, public health, cross sector partnerships, emergency preparedness, natural disaster response, emergency response, health equity, social determinants of health, missisippi state department of health, office of environmental health, office of health equity, covid 19 pandemic, emergency planning and response Ali Aslam, Yaryna Onufrey, Beth Giambrone This case study dives into the Mississippi State Department of Health’s environmental justice initiatives, conducted using cross-sector partnerships. Environmental justice is defined as all people enjoying the same degree of access and protection from environmental and health hazards. This happens by intentionally involving all people—regardless of race, color, national origin, or income—while developing, implementing, and enforcing environmental laws and policies. The Mississippi State Department of Health incorporates environmental justice principles into their disaster response and emergency preparedness efforts. Mississippi's environmental justice work has been community-based and equity-driven. This case study dives into Mississippi’s cross-sector partnerships, community health initiatives, and health equity work as the state has worked to address environmental health concerns. Get the Report (PDF) website yes

Medicaid analysis project assesses COVID-19's impact on adults with intellectual and developmental disabilities.

Implementing Health in All Policies in the Climate Space ASTHO, Association of State and Territorial Health Officials, HiAP lens, Health in all policies, climate change, climate space, flooding and rain, extreme weather, extreme heat, wildfire damage, seven strategies, Texas workgroup, national disaster operational workgroup, Washington state department of health, emergency preparedness and response, hiap implementation, Wisconsin department of health services, new mexico taskforce, interagency climate change taskforce, climate action teams, Climate and Health Capacity Survey, HiAP Task Force; Climate Change Commission, Resilience Initiative Kerry Wyss, Ali Aslam ASTHO | A Health in All Policies approach can help public health agencies better address the impact of climate change on population health and well-being. Each year, we face hurricanes, floods, extreme heat events, destructive wildfires, as well as other natural disasters and homeland security threats that test the resiliency of state, territorial, and freely associated state agencies and the communities they serve. To address the health threats posed by natural disasters and by climate change, more health agencies are integrating a Health in All Policies (HiAP) approach. This cross-sector approach can make these climate efforts more effective and impactful, and help promote health equity and optimal health. This report outlines strategies for health agencies to apply the HiAP lens and utilize cross-sector collaboration to optimize their climate and health responses. Get the Report (PDF) website yes

ASTHO convened focus groups of state environmental health directors and designated representatives from 11 states to talk about their agencies’ ventilation guidance for school districts. The discussions focused on recommendations for filtration and air cleaning technologies in schools, layered mitigation techniques, partner engagement, and challenges moving forward.

The opioid epidemic has exacerbated the shortage of board-certified forensic pathologists, presenting a major workforce challenge for public health systems.

This report analyzes way that public health officials can mitigate the impact of disasters on pregnant people, neonates, and infants through a variety of policies, including policies related to preparing for, responding to, and recovering from a public health emergency.

This brief dives into the impact of the COVID-19 pandemic on the ability of people with disabilities to access vital health care services during the public health emergency.

This brief from ASTHO discusses the results of standing up virtual and hybrid emergency operations centers during the covid-19 pandemic.

ASTHO engaged Oklahoma public health officials, members of the Oklahoma Harm Reduction Alliance, Health Minds Policy Initiative, and representatives of the Southern Plains Tribal Health Board, and others in a Boundary Spanning Leadership workshop.

About Infectious Disease Prevention About Infectious Disease Prevention Learn about infectious disease prevention and ASTHO’s role in supporting health agencies' efforts to protect communities from communicable diseases. Infectious disease prevention and control is a core responsibility of state and territorial public health agencies. These agencies implement interventions, policies, and programs to protect individuals, communities, and even the economy. Infectious disease prevention protects communities from communicable diseases, such as measles, tuberculosis, influenza, sexually transmitted infections (STIs), and emerging pathogens. Through surveillance, policy, outbreak response, and communication, state and territorial health departments safeguard not only health, but economic and workforce stability as well as community resilience through coordination at local, state, national, and global levels. ASTHO is committed to supporting the infectious disease prevention efforts of its members and other public health and healthcare professionals with expert insights on the latest information and innovations in the field. What Is Infectious Disease Prevention and Control? Infectious disease prevention and control encompass measures and interventions to limit the spread of communicable diseases. Transmission modes vary, but public health interventions focus on identifying and breaking the chains of transmission to: Prevent further spread of disease. Mitigate individual and community impacts. State and territorial health agencies are responsible for monitoring disease trends, implementing control measures, coordinating with federal and local partners, and ensuring compliance with health regulations. Tools to ensure effective detection, investigation, and response to communicable disease outbreaks include: Legal authority. Strong, coordinated data infrastructure. A well-trained workforce. Effective public health policy. Ericka McGowan - Page - About Infectious Disease How to Prevent Infectious Diseases Many factors contribute to preventing and controlling infectious diseases and protecting populations. Prevention measures help people stay healthy, and infectious disease prevention ultimately relies on individuals to take small but important actions that can influence individual, community, and population health. Individual measures may include staying current with vaccinations, proper hygiene, and handwashing. In addition, systems-level prevention strategies that state and territorial public health agencies may implement include: Immunization programs and vaccine policy implementation. Laboratory capacity. Epidemiologic investigation. Workforce capacity in disease intervention and contact tracing. Healthcare-associated infection prevention programs. Emergency preparedness and response coordination. Public and provider engagement and education. Policies and Programs Infectious disease policies are designed to prevent the spread of illness in places like school, childcare, work, community and religious organizations, and healthcare settings, providing guidance for: Hygiene: Standing up expectations for handwashing, cleaning surfaces, and other disease prevention behaviors. Sick leave: Outlining policies and expectations for reporting illness, staying home when sick, and safely returning to work. Vaccination: Requiring or recommending immunizations (i.e., vaccine requirements for healthcare, school, or childcare entry). Public Health Surveillance and Monitoring State, territorial, and local health departments, along with partners in healthcare, look for signals in the community that may indicate a potential increase in an infectious disease — also known as public health surveillance and monitoring. This is a tool that helps public health departments identify where, when, and how to prevent, control, or stop infectious disease outbreaks. Surveillance can include disease reporting by healthcare providers and laboratories, wastewater monitoring, and cross-jurisdictional data sharing. This data is collected and used to help identify cases and populations at risk for exposure or disease transmission. Communication and Education Communicating about new and emerging or re-emerging infectious disease threats and educating the public, healthcare providers, and policymakers are vital roles for state and territorial health agencies. Additionally, health agencies must work with medical professionals, the media, and community partners to raise awareness about infectious disease outbreaks in their communities. Why Is Infectious Disease Prevention and Control Important? Infectious disease prevention and control is an important function of public health agencies to preserve individual and community well-being, as many infectious diseases spread quickly and can have varying (but sometimes debilitating) impacts. Infants, the elderly, immunocompromised individuals, and other high-risk groups may be disproportionately vulnerable to infectious disease and suffer more severe complications if they contract an infectious disease. Infectious diseases can also have downstream social and economic impacts. For example, measles outbreaks lead to missed time at school for children infected with or exposed to the disease, which results in caregiver time, loss of productivity, and reduced income and spending. There are also financial and other associated costs to public health — with recent research estimating an average cost of $766,013.80 for public health agencies per measles outbreak (including the resources required to initiate an investigation and mobilize a response). Further, certain infectious diseases, such as those with the potential to become a pandemic, have global impacts that drive an even higher cost, in lives, money, and resources to control them. Fortunately, state and territorial public health efforts to prevent infectious disease result in huge savings across the board. Kate Petersen - Page - About Infectious Disease How Does ASTHO Support Infectious Disease Prevention and Control? ASTHO serves as a national voice representing state and territorial public health, ensuring federal policy, funding decisions, and national strategies reflect infectious disease priorities. It has multiple teams dedicated to supporting infectious disease prevention and control. Together, they play a crucial role in helping state and territorial health agencies track and respond to emerging infectious diseases, implement effective infectious disease infrastructure and policy, and more. Key activities include: Providing strategic guidance on emergency policy and programmatic issues affecting state and territorial public health infectious disease efforts, through ASTHO’s Infectious Disease Policy Committee, which: Evaluates federal, state, and territorial policy impacting national infectious disease programs. Elevates state and territorial perspectives in national policy discussions. Provides subject matter expertise and strategic insight on surveillance, outbreak response, immunization policy, workforce, and infrastructure. Offers perspectives from the field about emerging infectious disease topics. Maintaining crucial partnerships with the Association of Immunization Managers, the Council of State and Territorial Epidemiologists, and others in the field, to: Share situational awareness. Align and coordinate policy approaches. Enhance outbreak response capacity nationwide. Serve as a bridge between state public health and national funders/stakeholders. Co-leading and facilitating The Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant Pathogens to improve practices and policies related to outbreaks of these pathogens. Supplying technical assistance and producing capacity building resources (e.g., INSPIRE: Readiness) around infectious disease prevention and control. Get in Touch Working to enhance your health department’s capacity to prevent and control infectious disease? ASTHO’s Infectious Disease unit is here to support your efforts. Take a look at ASTHO’s infectious disease prevention resources, and reach out for direct assistance by emailing infectiousdisease@astho.org. article

Disease Forecasting ASTHO was an active partner in the creation of CDC’s Center for Forecasting and Outbreak Analytics (CFA), including early calls for the federal government to create a center charged with improving response capabilities to emerging public health threats through disease modeling and forecasting. ASTHO leadership was involved in advisory roles as CFA was initiated. Consultation and engagement on how the work of CFA can be most effectively used in the field continues with state and territorial health officials, health department, and ASTHO staff. Since 2022, ASTHO has received funding from CFA to support health department decision-makers with disease forecasting. This project includes a needs assessment which outlines knowledge of and capacity for disease forecasting activities throughout the nation’s state and territorial public health system. ASTHO also convened monthly sessions with partner organizations—the Council of State and Territorial Epidemiologists, National Association of County and City Health Officials, and the National Conference of State Legislatures—to share updates on disease forecasting related programming, identify opportunities for coordination and collaboration between the organizations and our respective members, and work in partnership with CFA as they continued to develop and implement programming. ASTHO works with existing peer networking groups, learning communities, and policy committees to seek input on disease forecasting topics. Updates from CFA are regularly shared with various ASTHO work groups and newsletters reaching health officials, senior deputies, epidemiologists, infectious disease directors, public health preparedness directors, informatics directors, public health attorneys, legislative liaisons, public information officers, and others. This included a five-session disease forecasting learning series in the spring of 2024. Disease Forecasting Learning Series In response to capacity needs identified through a needs assessment and regional meetings, ASTHO held a five-session disease forecasting learning series in the spring of 2024. Topics included Disease Forecasting Basics Part 1 and 2, Workforce Challenges and Opportunities, Communicating about Disease Forecasting, and Communicating with Policymakers about Disease Forecasting. Presenters included subject matter experts from ASTHO, CDC, partner organizations, academia, and health departments who provided important context and real-world application of the topic from experiences in their jurisdictions. Latest Webinar Communicating with Policymakers July 18, 2024 Overview of key considerations when developing documents and talking points that will be used to brief health department leaders, policymakers, and elected officials. Adam Brush, MSW, MPH, Associate Director for Policy and Communication, Center for Forecasting and Outbreak Analytics, CDC Shannon Kolman, MBA, Senior Policy Specialist, Health Program, National Conference of State Legislatures Maggie Davis, JD, MA, Director, State Health Policy, ASTHO article False

#MaskUp Campaign ASTHO and the Big Cities Health Coalition produced a public service announcement to encourage people across the country to express their compassion for others and #MaskUp. Please download, share, and encourage others to do their part to protect the community from the pandemic. website no

The COVID-19 pandemic spotlighted health inequities at national, state, and local levels. This report details the role immunization can play in reducing these disparities, informed directly by conversations ASTHO held with state equity and immunization leaders from March-July 2021. These conversations have been distilled into 20 key actions health agencies can take to make an impact.

This report analyzes the results from a survey of state and territorial health agency staff to collect information regarding health agency efforts to address climate change and extreme weather.

State Strategies for Advancing Viral Hepatitis Elimination astho, association of state and territorial health officials, public health officials, state health officials, territorial health officials, state health department, population health, health care systems, distribution of such outcomes, triple aim, defined group, individuals including the distribution, health system, outcomes within the group, save lives, group of individuals including, health outcomes, health improvement, community health, health and health, institute of medicine Cases of viral hepatitis are on the rise across the United States. There are many barriers on the road to progress. See what's being done about it. Cases of viral hepatitis are on the rise across the United States. Current barriers to progress include recent increases in rates of injection drug use, lack of awareness, limitations on testing and diagnostic capacity, access to treatment, and availability of data. ASTHO strives to support states and territories as they work to solidify comprehensive approaches to viral hepatitis elimination. This report synthesizes key actions and proven strategies for public health leaders to consider as they approach elimination planning within their own jurisdictions. Get the Report (PDF) website

Building Core Policy Skills: A Discussion Guide for STI Prevention Efforts Building Core Policy Skills for STI Prevention Efforts JoAnne Deehr, Lana McKinney Get insight into the ASTHO Policy Academy On Demand training, with practical examples and reflection questions focused on real-world STI prevention challenges. This discussion guide provides insight into and builds on the ASTHO Policy Academy On Demand training — deepening participant engagement through practical examples and reflection questions focused on real-world STI prevention challenges. While the training provides foundational understanding of the policy development process and how it supports programmatic work across health departments, this guide helps translate those concepts into practice by: (1) prompting discussion, (2) exploring implementation scenarios, and (3) connecting policy tools to day-to-day decision-making in STI prevention efforts. Module 1 – What Is Policy? This module provides a foundation for understanding how policy serves as a tool for public health intervention and establishes a foundational understanding of the policy development process. It covers the spectrum of policy actions, from formal state laws to agency-level protocols. Question 1: How can internal policy tools (e.g., updated clinical protocols or statewide guidance for universal prenatal syphilis screening) help to create near-term protection while considering broader legislative or payer policy changes, and how do these different policy levers compare in speed and impact? Question 2: When you think about a change, like expanding prenatal syphilis screening or covering at-home STI test kits, what parts do legislation drive versus internal agency policy or payer rules? Which decisions occur at the federal, state, and local levels, and how do those layers of authority influence what can be changed through legislation versus agency or payer policy? Module 2 – Problem Identification Effective policy begins with using data to understand and define a public health problem and its impact on specific communities. This module focuses on using surveillance to explore the problem that you can use policy to address and tools you can use to analyze the root causes of the problem. Question 1: When confronted with rising STI rates or screening gaps, how do you integrate quantitative data (surveillance, claims, lab metrics) with qualitative input (provider or community feedback) to define the problem? And what additional information would strengthen your analysis? Question 2: If you apply a root-cause method like the "5 Whys" to rising STI rates or missed prenatal screening, what are underlying drivers that might emerge? How would you determine whether the root cause is workflow, funding, access, or policy structure? Module 3 – Interested Parties Engagement and Education Policy development is a team sport. This module focuses on identifying internal and external partners, from community-based organizations to legislative leaders needed to move a policy forward. Question 1: When advancing policies related to STI testing access, congenital syphilis prevention, confidentiality protections, or Medicaid coverage, which interested parties must be engaged for approval, implementation, and community uptake? How do responsibilities differ between those who make policy decisions (e.g., legislators, Medicaid leadership) and those who operationalize them (e.g., clinics, maternal and child health programs, community partners)? Where might you find champions on the issue, coordination challenges, competing priorities, or confidentiality concerns that create friction? Question 2: In a medication shortage where prioritization decisions are required, how would you include perspectives of highest-risk patients and frontline providers? How might priorities differ among payers, clinicians, and community organizations? Module 4 – Policy Analysis This module examines the legal frameworks that empower health departments to act. It introduces methods for evaluating which policy options are legally sound within a specific jurisdiction. Question 1: When using an impact matrix to compare policy options — such as screening requirements, coverage mandates, or partner services expansion — why is it important to include the “status quo” as a baseline? How does that help you weigh feasibility, cost, impact, and potential unintended consequences? Question 2: When weighing the status quo against a proposal, such as at-home STI testing coverage, how would you assess long-term health impact, tradeoffs, operational feasibility (e.g., provider capacity, lab processing, reimbursement workflows) and possible unintended consequences? What sources of evidence would guide your decision-making? Module 5 – Policy Strategy and Design Translating data into a compelling narrative is key to building support for a policy. This module covers how to tailor messages for different audiences, including the media and policymakers. Question 1: When developing and thinking of pitching a policy like at-home STI testing coverage, which partners could help sell the proposal, and how would you address real world implementation constraints? Question 2: When communicating urgency around medication prioritization during a national shortage, which messaging strategies are most effective? What supporting policy elements (e.g., provider guidance, prioritization protocols, or reporting expectations) should be built in from the start to make the strategy workable? Module 6 – Policy Authorization and Enactment This module focuses on the formal process of moving a policy from a proposal to an official law or regulation. It includes navigating the legislative calendar and understanding the rulemaking process. Question 1: What concerns might arise when proposing coverage mandates or new screening requirements, and how would you address them proactively? Question 2: If you were advancing a policy such as expanded prenatal screening requirements or broader congenital syphilis prevention efforts (i.e., closing gaps between screening, treatment, and postpartum follow-up), which key decision-makers would need to be engaged? At what level of government (federal, state, or local) do they operate, and how would that distribution of authority shape your strategy and cross-program collaboration (e.g. maternal and child health, Medicaid, community organizations)? Module 7 – Policy Implementation Enactment is only the first step; implementation involves turning policies and/or laws into functional programs. This module covers the creation of guidance documents and the training of staff to ensure a policy’s success. Question 1: After a policy like expedited partner therapy is approved, what operational steps (i.e., training, workflow updates, and coordination) are required for successful rollout? Question 2: What behind-the-scenes barriers — such as low provider awareness of new requirements (e.g., expedited partner therapy authorization or prenatal screening mandates) or limited public awareness of benefits like at-home STI test coverage — most often undermine implementation and how can early coordination, promotion, and targeted communication address them? Module 8 – Developing the Evaluation Process Plan The final module focuses on measuring whether a policy achieved its intended health goals. It emphasizes using data to refine and improve policies over time. Question 1: Following implementation of policies related to screening access, congenital syphilis prevention, confidentiality, or Medicaid continuity, what indicators would signal success? What frontline feedback would inform policy refinement? Question 2: What indicators would show at-home testing policies are reaching the high-need groups, and how would you respond if the impact differs from what is expected? article yes

Learn how to best prioritize emerging infectious disease cases and contacts for follow-up, with this five-step framework.

Defining Disease Forecasting and Modeling Disease forecasting, generated by disease models, helps the public health workforce understand potential future outbreaks. Learn more about disease forecasts and models. Disease forecasting is important in describing potential future outbreaks that will affect the population and demand for health services in a given geographic area. Forecasts pull input from various sources (e.g., disease models, demographic, mobility, and intervention impact data). Individual forecasts can also be part of an ensemble forecast to improve accuracy. Forecasts can cover any length of time, but most target a window of several weeks to a few months. A subset of forecasts, known as nowcasts, seek to estimate present conditions, or those expected to occur imminently. Disease models are mathematical tools that are foundational components of disease forecasts. They estimate quantifiable factors that are impossible or impractical to directly measure, (e.g., future hospitalizations from a given disease, or its infection count in a population). Although models can be useful for specific questions, they do not give as complete a picture as a forecast. There are four major disease model types: Mechanistic. Attempts to simulate biological and/or social processes of transmission based on assumptions from prior or experimental data. Statistical. Relies on past data (such as infections or death) to predict future trends and can incorporate some assumptions about intervention application and uptake. Quality and quantity of past data can be a major limitation, and some models may suggest biological improbabilities. Agent. Simulates individual risks and behaviors in a population. These are highly complex, computationally very expensive to develop and run and require vast amounts of data and strong assumptions. Ensemble. Like their forecasting counterparts, they compile models and outputs, mitigating the risk of relying on one data point. While raising the overall confidence in output, they require coordination of many models to be built and simulated, which can be complex and costly unless the models already exist (such as for COVID-19 case counts). Forecasts and Models Work Together While disease forecasts and models are often conflated, they are discrete concepts. Forecasts offer a general prediction, whereas models are the mathematical pieces forecasters use to create them. Weather forecasts are commonplace, and their weekly predictions are often reasonably accurate. In contrast, predicting a big storm’s individual factors (e.g., rainfall, wind speed, lightning strikes) fall to the job of models. Together, those models help meteorologists better understand the weather and generate a forecast. In a public health context, disease forecasting informs public health officials, health care providers, and policymakers about potential risks and guide decision-making regarding preventive measures, resource allocation, and response strategies. Meanwhile, disease models aim to simulate the behavior of infectious diseases under different scenarios, allowing researchers to explore and evaluate various factors that influence disease transmission. Considerations for Decision-Making Decision-makers should consider scope and limitations of forecasts and models. They may consider adding inputs—such as projections for economic and long-term impacts. Examples include economic impacts of school closures, costs of more staffing ahead of an outbreak, and supply chain shortage forecasts for personal protective equipment (PPE). Decision-makers at all levels should consider using modeling to answer more specific, practical questions rather than predicting overall trends. Forecasts can cover different geographic scales. Public health leaders will need granular, local data to most effectively inform decision-making and communications. Novel conditions and pathogens may not have readily available data to inform models or forecasts, which will affect their predictive ability. Health officials must effectively communicate these limitations to decision-makers and the public. Examples of Forecasts and Models CDC’s COVID-19 Forecast for Hospitalizations (ensemble forecast) shows the number of daily COVID-19 hospitalizations reported in the United States from the prior two months and projected daily COVID-19 hospitalizations over the coming four weeks. Information sources are independent teams meeting submission and data quality requirements. CDC’s FluSight (ensemble forecast) has many contributing teams and models that predicts the upcoming weekly laboratory confirmed influenza hospital admissions both nationally and by state. Johns Hopkins University’s Center for Systems Science and Engineering county-level risk model for COVID-19 in the United States. This model leverages epidemiological data, mobile phone data, demographic and socioeconomic information, and behavioral metrics. The Global Epidemic and Mobility Framework simulates the global spread of infectious diseases by mathematically representing infection dynamics, population geographies, and population mobility patterns. Additional Resources Disease modeling for public health: added value, challenges, and institutional constraints Predictive Models for Forecasting Public Health Scenarios: Practical Experiences Applied during the First Wave of the COVID-19 Pandemic Applying infectious disease forecasting to public health: a path forward using influenza forecasting examples Technology to advance infectious disease forecasting for outbreak management CDC-RFA-OT18-1802 2018-2024 article yes

Learn how health departments can focus their infectious disease prevention efforts in this brief.