On Oct. 4, 2023, ASTHO responded to a Request for Information from the U.S. House of Representatives' Ways and Means Committee on the subject of improving access to healthcare and rural and underserved areas, including the island jurisdictions.
The bill provides $27.1 million to address shortfalls in Medicaid funding in the Northern Mariana Islands and extends critical autism-related programs.
After years of advocacy, ASTHO and our partners are celebrating the recently signed Consolidated Appropriations Act.
While COVID-19 is still present and ever-changing, public health professionals must also grapple with new challenges such as monkeypox, increasing firearm homicide, and widespread heat waves. In the wake of such emergencies, public health preparedness is more critical than ever.
Strengthening Public Health Workforce Capacity in Island Jurisdictions Strengthening Public Health Workforce Capacity in Island Jurisdictions A.C. Rothenbuecher, Allison Budzinski, Marta McMillion, Melissa Sever Guam and CNMI leveraged support from ASTHO to improve their public health workforce planning — learn more in this blog post. Strategic workforce planning helps public health agencies stay prepared, attract and retain the right talent, and build flexible systems that can handle change. When done well, it leads to better services, stronger performance, and a healthier work environment. It also saves money by reducing turnover and helps agencies respond to health emergencies or challenges as they arise. A Learning Collaborative Approach For U.S territories and freely associated states, where geography, connectivity, and resources pose unique challenges, strategic planning is especially important. With support from the Public Health Infrastructure Grant (PHIG), the Association of State and Territorial Health Officials (ASTHO) and the Public Health Accreditation Board (PHAB) launched a nine-month Island-Centric Workforce Planning Learning Collaborative to offer support as island health departments strengthen their workforce planning efforts. This pilot included workforce teams from Guam’s Department of Public Health and Social Services and the Commonwealth of the Northern Mariana Island’s (CNMI) Commonwealth Healthcare Corporation, Division of Public Health Services. The learning collaborative gave participating island health departments a chance to build on their strengths while getting tailored support for workforce planning. Through expert guidance, peer sharing, and coaching — both online and in person — participants worked through each step of ASTHO’s Workforce Planning Guide and explored essential workforce components aligned with PHAB’s Standards and Measures for Accreditation. The collaborative took a “start with what you have” approach, building on previous workforce planning efforts, existing data, and plans in both Guam and CNMI while leveraging resources from several national partners in the process. From Resources to Results: Putting Workforce Tools to Work Before the learning collaborative began, ASTHO, PHAB, and the University of Nebraska Medical Center (UNMC) teamed up to streamline and align their workforce planning resources. Early coordination ensured the tools complemented each other and avoided duplication. The ASTHO Workforce Planning Guide served as the foundation, while PHAB’s Workforce Plan Template gave health departments a clear structure to build upon. UNMC’s Public Health Workforce Planning: A Practical Guide and workforce data from the de Beaumont Foundation’s Public Health Workforce Interests and Needs Survey (PH WINS) helped ground planning efforts with practical guidance for facilitators and up-to-date data reflecting current needs and priorities. Callout 1 - Blog - Strengthening Public Health Workforce Capacity in Island Jurisdictions Collaboration Across Islands: Sharing Challenges and Solutions Over the course of the learning collaborative, Guam and CNMI’s public health teams built strong relationships by sharing challenges, exchanging ideas, and celebrating progress. Common issues like limited workforce capacity helped them relate to one another, while differences in structure and resources sparked creative solutions. The peer relationships and connections that were built and strengthened during the collaborative continue. On-Site Support ASTHO visited both jurisdictions to meet with leaders, review progress, and plan next steps — reinforcing the value of ongoing partnerships in workforce development. During the visits, participants revisited the Workforce Planning Cycle, layered in the latest PH WINS data, refined draft plan sections, clarified alignment with PHAB workforce standards, and considered the sustainability of their work beyond the collaborative. The hands-on sessions blended facilitation, coaching, and dedicated writing time, allowing participants to make measurable progress on their plans. What Guam and CNMI Achieved Through the learning collaborative, Guam and CNMI made meaningful progress in their strategic workforce planning efforts. Some near-term successes include: Active Workforce Committees: Both jurisdictions formed or maintained dedicated teams to lead workforce planning efforts. Steps Toward Accreditation: Each agency advanced efforts towards PHAB recognition related to a core domain, “Maintain a Competent Public Health Workforce.” Smart Use of Data: Each agency used human resource, workforce, and PH WINS data to guide decisions and improve planning. Stronger Capacity: Teams gained valuable skills and knowledge to support long-term workforce efforts. Customized Action Plans: Each agency created tailored plans aligned with their unique goals and needs. While Guam and CNMI achieved many similar milestones, each jurisdiction brought its own strengths and strategies to the table. Their different approaches offer valuable lessons for tailoring workforce planning and technical assistance to local needs. Guam emphasized structural development and broad departmental engagement, while CNMI leaned into data-driven decision-making and sustained leadership support. Callout 2 - Blog - Strengthening Public Health Workforce Capacity in Island Jurisdictions What Other Jurisdictions Can Learn The Island-Centric Workforce Learning Collaborative offers practical lessons for other jurisdictions focusing on workforce planning: Start with leadership support and clear roles across teams. Utilize and adapt existing tools and frameworks, like the PHAB Workforce Planning Template, the ASTHO Workforce Planning Guide, and UNMC’s Public Health Workforce Planning: A Practical Guide to jumpstart planning. Request tailored coaching and technical assistance through national organizations such as ASTHO and PHAB. Leverage workforce data, such as PH WINS, to inform decisions and progress. Collaborate across partners to benefit from diverse expertise. Celebrate your wins to build momentum and morale. What’s Next for Workforce Development in CNMI and Guam The success of the Island-Centric Workforce Learning Collaborative highlights what’s possible when public health agencies are supported with the right tools, partnerships, and local context. Guam and CNMI’s progress show that even in resource-limited settings, meaningful change is achievable. Special Thanks - Blog - Strengthening Public Health Workforce Capacity in Island Jurisdictions OE22-2203 PHIG article yes
In February 2023, ASTHO staff traveled to Koror, Palau for a four-day health equity summit and held workshops to identify, select, and prioritize measures for Palau’s health equity work.
This blog explains ASTHO’s Islands Health Equity Framework, which outlines a culturally resonant approach to health equity in the island areas.
Hearing the Hill astho, association of state and territorial health officials, opioid crisis, covid-19 funds, public health, public health data and workforce, american rescue plan, promoting health, drug overdose death, coronavirus preparedness and response supplemental appropriations act 2020, de beaumont foundation, infectious diseases, substance use disorder, health equity, drug overdoses, january 2022, state local, opioid epidemic, opioid use disorder, workforce development, synthetic opioids, overdose deaths, prescription opioids, cares act, health departments, covid-19 pandemic Devon Page ASTHO | Takeaways from congressional meetings on leading public health topics. CSPAN is no Netflix. But that’s not to say this endless stream of content fails to entertain. In one short month, the new Congress has held several richly informative—and sometimes lively—hearings regarding the nation’s most pressing public health topics. The debates over COVID-19 funding, government oversight, and substance control—to name a few—illuminate the multiplicity of party agendas, how members of Congress are grappling with different issues, and opportunities for bipartisan collaboration. Since assuming the majority, House Republicans have been dutifully fulfilling their promise to scrutinize the origins of, funding for, and agency response to COVID-19. Three hearings were held in the first two weeks of February alone. The House Committee on Oversight and Accountability held a Feb. 2 hearing to discuss what Chair James Comer (R-KY) called “the greatest theft of taxpayer dollars in American history,” namely the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. The hearing spotlighted the tradeoff between urgency and accountability: essentially, getting loans out the door quickly created vulnerabilities for fraud. To make matters worse, agencies were slow to implement modernization policies, such as data sharing between agencies, which only exacerbated the problem. While politicking reared its face in some cross-aisle imputations, committee members on the whole recognized that the issue warranted attention and demonstrated a willingness to work together to produce solutions to avoid similar instances of fraud in the future. Just down the hall, the House Committee on Energy and Commerce was holding a hearing titled, “Challenges and Opportunities to Investigating the Origins of Pandemics and Other Biological Events.” Here again, agreement penetrated party lines. Proactively addressing pandemics seemed a unanimous priority, albeit with some caveats: House Republicans focused chiefly on identifying the origin of the COVID-19 pandemic to help the U.S. better prepare for the next pandemic, where House Democrats tied this into preparedness and infrastructure. The blockbuster event of the COVID-19 hearings occurred a week later, featuring Lawrence Tabak of NIH, FDA Commissioner Robert Califf, and CDC Director Rochelle Walensky. Representatives, with a markedly more partisan fervor, explored a myriad of topics—from the impact of CDC guidance on declining public trust to NIH laggard interventional clinical trials for long COVID research—and expressed a mix of dissatisfaction and approval. Amid criticism from largely the conservative members, Walensky was steadfast in requesting broader public health data and workforce authority, as well as robust funding for public health core capacities. Rep. Diana DeGette (D-CO) echoed the director, calling for updated agency data infrastructure. The strong partisanship and serrated critiques of the agencies made clear the canyon-sized gap separating Democrats and Republicans on the federal COVID-19 response. In each of these hearings, at least one representative made mention of a different priority of this Congress: the fentanyl crisis. On Feb. 1, a House Energy and Commerce Health Subcommittee hearing was devoted entirely to the subject. And while Chair Brett Guthrie (R-KY) and Ranking Member Anna Eshoo (D-CA) appear postured to produce bipartisan legislation, differences in how the parties want to approach the issue are not insignificant. Republicans, on the one hand, favor classifying fentanyl as a Schedule 1 drug and cracking down on smuggling across the United States-Mexico border, while some Democrats strongly resist such measures. These points will likely be hashed out in future debates concerning H.R. 467, the Halt Fentanyl Act, and similar legislation. The committee also touched on the importance of investing in mental health. Rep. Tony Cárdenas (D-CA) emphasized the value of the 988 Hotline, and introduced H.R 498, the 988 Lifeline Cybersecurity Responsibility Act, to protect the hotline from cybersecurity incidents. Additionally, Rep. John Sarbanes (D-MD) requested that SAMHA’s Chief Medical Officer Neerja Gandotra, one of the hearing’s witnesses, explain why continued investment in mental health programs is paramount. Gandotra noted that the investments, specifically in youth, lead to decreased criminal justice involvement, fewer hospitalizations, and improved performance in school. There was also a Feb. 9 Senate hearing examining the state of the U.S. territories, which included testimony from the governors of the U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and Commonwealth of the Northern Mariana Islands. Both parties were resolute in supporting the governments. Several senators, including Ranking Member John Barrasso (R-WY) and Senator Mazie Hirono (D-HI), emphasized the importance of supporting Compacts of Free Association (COFA) citizens’ health and social safety nets. With just about 90% of this Congress’s session ahead of them, these issues, among others, will certainly be probed further as the object of congressional concern. Regarding public health, much remains to be said and—hopefully—done. Bipartisanship, no doubt to the surprise of many commentators, seems to be the reigning attitude: a sign of things to come or merely pretense? Only time will tell. website yes
Learn more about current and upcoming public health trends through ASTHO's annual Environmental Scan.
Technical assistance for procuring software to support data dashboard development.
About Public Health in the U.S. Territories and Freely Associated States Public Health in the U.S. Territories and Freely Associated States Learn about public health needs in the U.S. territories and freely associated states, and ASTHO’s work to support them. The U.S. territories and freely associated states are home to unique populations, rich with history and culture. Their customs, geography, and history contribute to their many strengths — but also add nuance and complexity to the public health landscape. ASTHO works closely with island public health officials to understand, increase awareness about, and champion their needs. The team’s efforts help secure island voices at the table and representation in essential U.S. public health programs. What Are the U.S. Affiliated Territories and Freely Associated States? There are eight U.S. territories and freely associated states, consisting of six Pacific islands and two Caribbean territories. The six islands in the Pacific include three territories — Guam, America Samoa, and the Commonwealth of the Northern Mariana Islands (CNMI) — and three freely associated states: the Republic of the Marshall Islands (RMI), the Federated States of Micronesia (FSM), and the Republic of Palau. Meanwhile, Puerto Rico and the U.S. Virgin Islands (USVI) make up the two territories in the Caribbean. The U.S. territories and freely associated states are often left out of the family picture. However, residents of the territories are U.S. citizens or nationals, and residents of the freely associated states can live, work, and travel in the United States without a visa. Moreover, they have some of the highest per capita rates of U.S. military enlistment. Importantly, these island health systems are also eligible for many domestic health programs, but they may differ from the states (e.g., Medicaid in the territories is capped, and freely associated states do not have Medicaid). Public Health Challenges in the Islands Island issues are state issues. Like many states, the U.S. territories and freely associated states have high rates of chronic diseases and must contend with caring for aging populations. That said, there are important differences — such as ineligibility for certain federal programs, available data, existing workforce, and local infrastructure — requiring care in tailoring public health response and prevention strategies. Given some of these limitations, people from the U.S. territories and freely associated states often travel to the states for health care services and some must move to Hawaii or the continental U.S. Still, they have a dedicated public health and health care workforce, tight-knit communities, and regional partnerships lending to their success addressing certain public health challenges (e.g., COVID-19). Karl Ensign - Page - About T/FAS How Is Public Health Unique in the U.S. Territories and Freely Associated States? Disease, geography, and demographics are unique parts of public health in the U.S. territories and freely associated states. Disease Oceans do not protect these areas from the public health challenges that the states contend with, like infectious disease. Infectious disease is one of the main issues across all island jurisdictions, including diseases that the continental U.S. does not often see (e.g., tuberculosis, leprosy, Zika). In addition, the introduction of canned foods and spam in the Pacific and Caribbean islands have disrupted the indigenous diets of fish and fruit, contributing to a significant chronic disease problem — with the Pacific experiencing some of the highest obesity rates in the world. Chronic diseases are the leading causes of morbidity and mortality across both states and territories. However, the prevalence and incidence of key chronic diseases can be orders of magnitude higher in the territories. For example, an estimated 8.5% of adults in the states have diabetes, while the prevalence is more than four times that (34% in 2018) in American Samoa. Geography and Demographics Further, differences in geography and demographics bring novel public health challenges. Most of the U.S. territories and freely associated states are made up of multiple islands, with small island masses, which means delivering public health care might require multiple modes of transportation (e.g., a ferry, boat, ship and/or small plane) and significant costs and staff time to provide services to outlying islands. Many of the Pacific islands are across the international dateline as well, making it difficult to join calls based on stateside working hours. The geography in territories and freely associated states also leaves them at increased risk for severe weather events (e.g., hurricanes and typhoons) and the resulting immediate and long-term public health impacts. Their tropical climate also raises health risks that are less common in the mainland (e.g., dengue). In addition, many of the territories and freely associated states consist of small population sizes and residents who speak different languages (e.g., Spanish, Haitian, Creole, Marshallese, Filipino, Chuukese, Palauan). Therefore, meaningful, locally-based public health work often looks different than it does in the continental U.S., even if it follows the same principles. How Does ASTHO Support Public Health in the U.S. Territories and Freely Associated States? ASTHO’s Island Support team dedicates its time and work to advancing public health in the U.S. territories and freely associated states — working closely with these jurisdictions’ health leaders and their teams to tell their story, serve their needs, and ensure their access to the vital public health programs available to states. Policy The team supports island policy priorities, targeting legislative and administrative change: The Insular Affairs Committee to ASTHO’s Board of Directors highlights islands’ unique legislative policy needs and engages key stakeholders on Capitol Hill. The ASTHO-led Island Areas Workgroup works to address the key administrative challenges affecting health outcomes in the territories and freely associated states through collaboration across health agencies, federal agencies, and partners. Including Island Area Data Sets - Page - About T/FAS Partnership The Island Support team also works cross-functionally across the organization and with external regional and national partners to best serve the islands, including: Engagement across ASTHO teams to increase awareness of the islands and how to work more effectively with these populations. Collaboration with partners to increase awareness of and effectively address islands’ priority public health needs. Technical Assistance and Capacity Building In addition, the Island Support team provides health officials from the territories and freely associated states with direct, specialized support for their public health efforts: Technical assistance supporting the implementation of new systems, processes, and skills. Development of resources (i.e., reports, briefs, etc.) to support health officials in the territories and freely associated states in addressing their priority issues and to advocate to their peers and Congressional leaders. Alex Wheatley - Page - About T/FAS Get in Touch Are you a public health leader in the Caribbean or the Pacific looking for assistance? Or perhaps you’re stateside working to include island needs and views in your programs. In any case, if you’d like to connect with ASTHO’s Island Support team, we’d love to hear from you and are here to help. Email the Island Support team at islandsupport@astho.org. Padding Block - Medium article
Explore ASTHO’s policy support for U.S. territories and freely associated states, helping address health challenges and advance equity through strategic partnerships.
Island Areas Glossary Use this guide as a quick reference for unique terminology related to the U.S. territories and freely associated states. The U.S. territories and freely associated states (T/FAS) come with their own unique terminology. This page is designed as a quick reference to get new readers up to speed or give old hands a referesher. All entries are alphabetical. If you are looking for something specific, hit "Control+F" to open a search box in your browser's window. <!-- --> website False
U.S. Territories and Freely Associated States Supporting U.S. Territories and Freely Associated States Association of state and territorial health officials, astho, us territories, improve population and community health, freely associated states, territorial support, public health territorial support, insular areas, island jurisdictions, pacific and Atlantic jurisdictions, population health needs, public health services, territorial health officials, Medicaid in the territories, Medicaid financing for us territories, public health topics, insular areas, health equity, freely associated states, federated states of micronesia, guam behavioral health and wellness center, free association with the united states, united states territories, world health organization, public health services, guam behavioral health, american samoa, advance health equity, united states, compacts of free, republic of palau, marshall islands, pacific islands, permanently inhabited, northern mariana islands, health disparities, health services, public health system, virgin islands, free association with the united states, wake island, public health, health and wellness center, 50 states, federated states of micronesia fsm Find tools designed to support U.S. territories and freely associated states in addressing their unique public health needs. ASTHO supports public health leaders across the U.S. territories and freely associated states — including the chief health officials (ASTHO members) — in their efforts to improve the health and well-being of their communities. The territories are under the jurisdiction of the U.S. government, while the freely associated states are independent nations that have entered into Compacts of Free Association with the United States. Note: ASTHO collectively refers to these eight jurisdictions as the territories and freely associated states, T/FAS, island areas, or island jurisdictions. article
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On March 2, 2023, ASTHO announced that during the 2023 spring meeting, island health officials will also meet with Congress and the administration to urge them to strengthen island health systems and infrastructure.
The COVID-19 pandemic presented an opportunity for an existing behavioral health resource—the Guam Behavioral Health and Wellness Center’s Crisis Hotline—to become a household name. During the pandemic, the hotline became a lifeline for a community in crisis greatly in need of information.
Spanish language version of "Embedded: Puerto Rico’s Public Health Emergency Preparedness Academy" blog post.
In the late fall of 2021, ASTHO leadership visited select jurisdictions in the Pacific and the Atlantic for the first time since COVID-19 curtailed travel to these regions. It was a fantastic to reconnect with our leadership and dedicated staff. Unsurprisingly, we heard about the jurisdictions’ challenges, including chronic ones related to funding and infrastructure, as well as new challenges resulting from the global pandemic.
A groundbreaking “all-of-government” approach is getting underway in the U.S. Virgin Islands to more efficiently manage and expend federal grant funding for social determinants of health and overall population health improvement. The initiative follows findings that public health agencies encounter redundant, multi-layered review and approval processes that hamper their ability to efficiently procure needed goods and services that address long standing and emerging public health needs. Moreover, such processes hinder the ability to quickly stand up critical programs and respond to public health emergencies.