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If there is any word to describe 2020 it is “unprecedented,” with the work of health agencies front and center since COVID-19 emerged in the U.S. But as we approach Public Health Thank You Day and the Thanksgiving season, ASTHO wants to send a special appreciation to our entire state and territorial public health workforce. We have been so impressed by your tireless work to address COVID-19 in your jurisdictions and you have wowed us all with your dedication and commitment to the work of health protection and improvement. Thank you all for all you do to keep your communities healthy!

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This ASTHOBrief addresses the importance of developing robust, culturally competent risk-appropriate care systems for American Indian and Alaska Native communities.

Danny Staley (alumni-NC) discusses his role as ASTHO’s Chief of Caribbean Operations and how his time as North Carolina's state health official helped him prepare for his current position.

Harris plans to focus presidency on building public trust in our work and advancing collaboration between state and territorial public health agencies

Readout of CDC/ASTHO/CSTE/APHL Call Regarding Avian Influenza Preparedness ARLINGTON, VA—On Friday, Nirav D. Shah, CDC’s Principal Deputy Director, Dr. Demetre Daskalakis, Director of CDC’s National Center for Immunization and Respiratory Diseases, and Dr. Vivien Dugan, Director of CDC’s Influenza Division, met with members of the Association of State and Territorial Health Officials (ASTHO), the Council of State and Territorial Epidemiologists (CSTE), and the Association of Public Health Laboratories (APHL) to discuss avian influenza planning. CDC officials emphasized that, although the risk to the public remains low, the agency wants state public health officials to be prepared to respond. CDC recommended that state public health officials engage with their state veterinarians and agriculture department officials to ensure that they have up-to-date operational plans to respond to avian influenza at the state level. For example, CDC emphasized the importance of having plans in place to quickly test and provide treatment to potentially impacted farm workers following positive results among cattle herds. CDC also encouraged state health officials to communicate about any challenges they are facing. ASTHO, CSTE, and APHL members support CDC’s recommendations and look forward to continuing their partnership with their state agriculture counterparts, as well as CDC and other federal agencies, as part of their preparedness efforts. ASTHO Press Release Boilerplate website yes

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.

On July 13, 2021, ASTHO issued a statement of support for President Joe Biden’s nomination of Rahul Gupta, MD, MPH, MBA, FACP, to serve as the Director of the Office of National Drug Control Policy.

On Jan. 19, 2021, ASTHO released a statement commending President-Elect Joe Biden's nomination of Rachel Levine, MD, to serve as Assistant Secretary for Health at the United States Department of Health and Human Services.

On July 27, 2022, Nicole Alexander-Scott, MD, MPH, joined ASTHO as a senior executive consultant. Alexander-Scott is a former Rhode Island Department of Health Director and former ASTHO President, she will support states and territories in capacity building focused on health equity.

On Dec. 10, 2020, ASTHO president and Pennsylvania secretary of health Rachel Levine, MD, testified about the COVID-19 vaccine before a Senate subcommittee.

On July 16, 2020, ASTHO announced that Pennsylvania Secretary of Health Rachel Levine, MD, has been appointed to the position of ASTHO President.

On Jan. 14, 2020, ASTHO members from Rhode Island and Massachusetts testified before a House subcommittee on state efforts to address the opioid epidemic.

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

The ASTHO-Mason Collaborative for Applied Public Health Practice will increase access to public health education and training through student fellowships, innovative curriculum, applied practice and policy research, and academic and continuing education programs for public health students and professionals.

Health Officials Seek to Prevent Adverse Childhood Experiences ARLINGTON, VA—At least five of the top 10 leading causes of death are associated with adverse childhood experiences (ACEs), according to a new report released yesterday by the Centers for Disease Control and Prevention (CDC). ACEs, such as abuse, neglect, and witnessing violence or substance misuse in the home, can lead to increases in chronic disease, mental health issues, and socioeconomic hardship later in life. The Association of State and Territorial Health Officials (ASTHO) and its members are committed to helping prevent ACEs to improve long-term health, access to life opportunities, and the overall health of Americans. According to CDC’s report, 61 percent of adults have at least one ACE and 16 percent of adults have four or more ACEs. Preventing ACEs before they occur could prevent up to 21 million cases of depression, up to 1.9 million cases of heart disease, and up to 2.5 million cases of obesity. State and territorial health departments can lead prevention efforts, including, improving health equity, and reducing health disparities among children and families, by bolstering protective factors. Focusing on community solutions, reducing stigma, and providing access to preventive services can reduce the risk of future ACEs from occurring and mitigate the impact of ACEs that have already transpired. "Childhood experiences can have a powerful and enduring impact on health and opportunity well into adulthood," says Nate Smith, ASTHO president and secretary of health at the Arkansas Department of Health. "We all know that children are our future. Fortunately, our communities can come together to prevent ACEs. We can provide to families the proper economic and social support to create safe and nurturing environments for society's most vulnerable. Protecting against violence and trauma and fostering secure and supportive relationships is how we build a strong foundation for our children and adults." For more information about ACES, access  ASTHO’s issue brief, Adverse Childhood Experiences: Primary Prevention. ASTHO Press Release Boilerplate website yes

Connecticut Health Official Renée Coleman-Mitchell Testifies on Vaping Illnesses ARLINGTON, VA—Renée Coleman-Mitchell, MPH, commissioner of the Connecticut Department of Public Health, testified today on the threats of e-cigarette use before the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. The hearing, “E-cigarettes: An Emerging Threat to Public Health,” featured two panels that conveyed the magnitude of the current vaping-related lung disease epidemic from e-cigarette use. “Vaping of nicotine and marijuana related products has continued to rise in Connecticut and nationally – especially among young people,” says Coleman-Mitchell. “Vaping is now super easy and convenient and doesn’t smell like cigarettes. This means it’s really easy to hide it from parents. And now, vaping is endangering the lives of our citizens.” “Providing states with the necessary resources for a structure to help us cope with both our lung injury reporting and our youth epidemic is key. We cannot afford to wait another 50 years to combat the vaping epidemic, we need to take action now.” The Association of State and Territorial Health Officials (ASTHO) is pleased that Congress continues to investigate the national outbreak and learn from state public health officials about the severity tobacco use has on our health. Coleman-Mitchell is the sixth ASTHO member to testify this year on the vaping-related lung disease epidemic. Visit the committee’s website for more information and to read Coleman-Mitchell’s testimony. ASTHO Press Release Boilerplate website yes

Nation’s Public Health Officials Urge Americans to Stop Vaping ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) issued the following statement in response to the pulmonary illnesses associated with vaping. “We are alarmed by the current outbreak of severe pulmonary illnesses and deaths associated with vaping. This is a public health emergency with serious consequences. Until we know precisely what substances are causing these illnesses, we strongly urge all Americans to stop vaping immediately,” says Nathaniel Smith, MD, MPH, ASTHO president and secretary of health at the Arkansas Department of Health. “E-cigarettes are unsafe and unregulated. The FDA has never approved these devices for tobacco cessation. Given the highly addictive nature of these products, members of the public should discuss with their physicians the various FDA approved methods to assist with nicotine withdrawal symptoms. Some states have already acted by temporarily banning the sale of vaping products or banning the sale of flavored e-cigarettes. “We’re very concerned by the rapidly increasing rates of e-cigarette use by young people. This dramatic increase in youth vaping is being driven by fraudulent marketing practices that target young people with kid-friendly flavors. Federal, state, and local governments should take immediate action to address this epidemic by banning flavors, restricting marketing practices, raising taxes on tobacco products including e-cigarettes, supporting tobacco free air policies, expanding cessation programs, and raising the minimum age for tobacco purchases to 21.” ASTHO Press Release Boilerplate website yes

ASTHO Awards Public Health Leaders and Agencies for Service BETHESDA, MD—The Association of State and Territorial Health Officials (ASTHO) presented several awards during its 2019 Annual Meeting and Policy Summit this week to commend public health leaders and agencies for their service and dedication to improving our nation’s health. “We’re pleased to recognize this distinguished group of health professionals and agencies,” says Elke Shaw-Tulloch, state health officer at the Idaho Department of Health and Welfare, past ASTHO president, and chair of ASTHO's Nominations, Awards, and Membership Committee. “The excellence we highlight today touches millions of lives and represents just a small sample of our nation’s dedicated public health professionals, who continuously strive to promote the public’s health and well-being.” The 2019 ASTHO awardees include: John Wiesman, DrPH, MPH, Secretary of Health, Washington State Department of Health Arthur T. McCormack Award Dr. Wiesman has served as Washington state’s health official since 2013 and currently co-chairs the Presidential Advisory Council on HIV/AIDS. Under his leadership, the Washington State Department of Health is spearheading the End AIDS Washington program, developing the Healthiest Next Generation initiative, identifying and funding foundational public health services, implementing the governor’s executive order to reduce suicide and prevent firearm injuries and deaths, and addressing the public health impacts of climate change. Stephanie C. Williams, RNP, MPH, Senior Deputy, Arkansas Department of Health Noble J. Swearingen Award As deputy director for public health programs at the Arkansas Department of Health, Ms. Williams oversees and guides the work of the agency’s four operational centers: Health Advancement, Health Protection, Local Public Health and Public Health Practice. She also oversees the state public health laboratory and the state offices of Health Communication and Minority Health. Ms. Williams also advises and assists the state health official in setting policy and programmatic direction for the department and serves as state health official in his absence. Janae Price, MPH, Senior Epidemiologist, Illinois Department of Public Health State/Territorial Excellence in Public Health Award Ms. Price served the Illinois Department of Public Health from April 2016 to March 2019 as a member of the U.S. Public Health Service Commissioned Corps. She led or co-led more than five nationally-funded statewide projects, ten committees or workgroups, and numerous complex multi-year projects. Price’s contributions led the health agency to strengthen its chronic disease epidemiology capacity by integrating evaluation and performance monitoring for chronic disease programs, developing critical partnerships, improving data collection and reporting quality, and using innovative methods to assess public health needs. Paul K. Halverson, DrPH ASTHO Alumni Award Dr. Halverson served as the state health official for the Arkansas Department of Health from 2005-2013. He oversaw the development of Arkansas’ statewide trauma system, which has become a model for other states, and he greatly enhanced the effectiveness of the Arkansas Public Health Preparedness Program and the Arkansas Public Health Laboratory. As a state health official, Dr. Halverson was a mentor to many new state health officials and a trusted colleague to his peers. After transitioning to his position as founding dean of the Indiana University Richard M. Fairbanks School of Public Health, he has remained active as an ASTHO alumnus, serving as president of the ASTHO Alumni Society. Increasing Immunization Capacity in Texas Emergency Responder Facilities—Texas Department of State Health Services ASTHO Vision Award, First Place, Category A (Programs ≥ $250,000) ASTHO recognizes Texas Department of State Health Services for its work raising immunization rates for Texas emergency responders. Implementation of the New York State Prevention Agenda 2013-2018—New York State Department of Health ASTHO Vision Award, Second Place, Category A (Programs ≥ $250,000) ASTHO recognizes New York State Department of Health’s for its work developing a six-year state health improvement plan, which aims to make New York the healthiest state. Developed in collaboration with the Ad Hoc Committee to Lead the Prevention Agenda and more than 140 statewide organizations, the plan identifies New York’s most urgent health concerns and recommends ways statewide organizations and local health departments, hospitals, and partners from the health, business, education, and nonprofit sectors can work together to address them. Office of Grants Management—Northern Mariana Islands Commonwealth Healthcare Corporation ASTHO Vision Award, First Place, Category B (Programs less than $250,000) ASTHO recognizes the Northern Mariana Islands Commonwealth Healthcare Corporation for establishing the Office of Grants Management to improve coordination of the administration of all of the health agency’s federal programs and external funds. The office was created to oversee the financial and record keeping aspects of the annual grant-making process for the corporation and its divisions for all grants received or awarded. It also collaborates closely with all program managers to streamline and improve grant applications, implementation, administration, compliance, performance, and reporting requirements on all grants. Local and Tribal Public Health System Improvement Program—Montana Department of Public Health and Human Services ASTHO Vision Award, Second Place, Category B (Programs less than $250,000) ASTHO recognizes Montana Department of Public Health and Human Services for its efforts to improve Montana’s local and tribal public health infrastructure. As part of this work, the health agency has strengthened partnerships between the healthcare sector and public health agencies; accelerated the use of the Public Health Accreditation Board’s national standards for public health practice by state, local, and tribal public health agencies; and strengthened local boards of health. ASTHO Press Release Boilerplate website yes

Panel of State Public Health Officials Testify on Lung Disease Outbreak WASHINGTON—Today, four state health officials are testifying on a panel before the House Energy and Commerce Subcommittee on Oversight and Investigations about the public health impacts of youth e-cigarette use and the current lung disease outbreak. The panel includes: Joneigh Khaldun, chief deputy director for health and chief medical executive, Michigan Department of Health and Human Services Elizabeth Tilson, state health director and chief medical officer, North Carolina Department of Health and Human Services Lee Norman, secretary, Kansas Department of Health and Environment Monica Bharel, commissioner, Massachusetts Department of Public Health The hearing, “Sounding the Alarm: The Public Health Threats of E-Cigarettes,” will provide members of Congress the opportunity to examine causes of the ongoing vaporizer-linked lung disease outbreak. “State and territorial public health agencies are taking a leading role in implementing strong action to protect consumers from the harms of e-cigarette use,” says Michael Fraser, CEO of ASTHO. “We are pleased that Congress highlighted their critical work today. We strongly urge Congress and the administration to take steps to strengthen oversight of e-cigarettes, increase investments in research and prevention, and to better understand health effects associated with their use, and provide increased funding for tobacco education and cessation programs.” For more information and to read the state health officials’ testimony, visit the committee’s website. ASTHO Press Release Boilerplate website yes