Displaying 15 results for

Under the Tenth Amendment, states have the power to protect the health and welfare of their populations, including the authority to implement isolation and quarantine orders to limit the spread of disease. This post is an examination of state public health authority for isolation and quarantine.

States and territories have broad powers to protect public health and safety, including powers to prevent and control the spread of communicable disease typically exercised by state and territorial health departments. This authority is an essential tool in the fight to keep the public safe and healthy.

Reconciling the tension between public health and civil liberties is one of the most significant challenges of public health law and ethics. The Supreme Court of the United States historically upheld state authority to enact and enforce public health laws that temporarily limit a person’s civil liberties, such as quarantine and isolation powers that restrict a person’s freedom of assembly in order to prevent the spread of contagious disease. There have been many legal challenges to the public health orders issued to slow the spread of COVID-19—many of the claims asserting violations of First Amendment rights of assembly, association, and expression—but they’ve largely been rejected by the courts. However, courts have treated claims asserting violations of the free exercise of religion more favorably, which may indicate an impending shift in how courts analyze the impact state and territorial actions may have on religious organizations.

Initial estimates from 2020 suggest that annual drug overdose deaths in the United States reached a record high of 93,000. Fortunately EMS strategies are being put in place to combat this nation-wide issue.

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.

Environmental health and public health preparedness staff work closely together to respond to natural disasters and climate change—learn how in this report.

Conditioning school attendance on student vaccinations is an evidence-based way of maintaining and increasing vaccine coverage. State law establishes school vaccination requirements which apply not only to public schools but often to private schools and childcare facilities as well. All states allow an exemption for those where a vaccine poses a medical risk. Several states also allow non-medical exemptions, often based on an asserted religious, philosophical, or personal belief of the parents or child opposing vaccinations. However, a few states have recently abolished all non-medical exemptions.

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

This week might have marked the beginning of summer, but many policymakers and health officials have their eye on the upcoming school year and what that might mean in terms of getting students vaccinated against COVID-19. According to a recent MMWR, COVID-19 related hospitalizations among adolescents increased in March and April 2021, potentially related to increased circulation of new COVID-19 variants, changes in physical distancing, and a larger number of children returning to school or other in-person indoor activities. This increase indicates an urgent need for vaccination against COVID-19, which is currently authorized for use in youth as young as 12.

The need for food and nutritional assistance is growing. Based on Feeding America’s food insecurity projections released in March, it is anticipated that 42 million people may experience food insecurity this year—up from 35 million pre-pandemic. The job loss in communities as businesses had to shut down or reduce capacity has left many families across the country relying on food banks. In fact, food banks in the Feeding America network distributed 6.1 billion meals to individuals and families during this pandemic, an increase of 43% from 2019. Many of the people who have fallen into food insecurity are experiencing it for the first time in their lives, as our food pantry partners across the country report that 35% or more of the people they’re serving today had never received charitable food prior to the pandemic.

As the number of COVID-19 vaccinations grows, some states are looking at their vaccination rates to determine when to loosen measures that mitigate the spread of COVID-19, such as venue capacity limits, business closure times, and masking requirements. As vaccinations allow businesses to reopen and customers to return, questions have arisen about whether venues or services—especially those that bring people in close contact for long periods of times—such as retail stores, concert venues, entertainment venues, air travel, cruise ships, etc., can require patrons or customers to verify that they received a COVID-19 vaccine. So far, state policy makers have had mixed views on the issue.

Ohio Department of Health Using Partnerships to Improve Public Health Data and Emergency Preparedness Margaux Haviland Learn how Ohio leverages partnerships to promote data modernization and improve public health emergency preparedness. In a public health emergency, it’s crucial to quickly and strategically deploy supplies such as personal protective equipment and medical countermeasures (MCM). This requires coordinated efforts among local, state, and federal partners to assess and address community needs. Timely access to actionable data about MCMs and other essential public health supplies is vital for this process. State health agencies need up-to-date information on available public health supplies to make informed decisions and respond effectively to evolving situations. In order to explore opportunities to improve data sharing for public health response, in March 2024 ASTHO, with support from the Administration for Strategic Preparedness and Response (ASPR) and HHS Coordination Operations and Response Element, selected three state health agencies—Ohio, Massachusetts, and Washington—to identify and pilot scalable solutions for enabling bidirectional information sharing regarding ASPR-deployed assets across all levels of public health. The Ohio Department of Health (ODH) proposed a highly collaborative approach to their data readiness proposal that encompassed ongoing strategic planning, which included MCM plan revisions, broadening coalitions, data modernization through standardizing systems, and last-mile delivery using equity-based allocations. Incorporating Local Perspectives As a home rule state, where public health authority is decentralized, the ODH team worked to ensure that local health department perspectives were included in the ODH data readiness project work. The ODH project team collaborated with the Association of Ohio Health Commissioners (AOHC) as well as Ohio’s seven regional health care coordinators to solicit feedback on barriers to sharing MCM inventory data, challenges with data reporting, and operational changes that could improve bidirectional MCM data sharing. ODH engaged directly with long-standing partner AOHC, a nonprofit organization representing Ohio’s local health districts, to capture the local health department perspectives by establishing a diverse focus group, facilitating surveys, and gathering feedback. With AOHC support, ODH was able to successfully field its first survey with responses from 111 public health leaders and emergency response coordinators. Survey results indicated consistent responses when considering challenges experienced or expected with reporting MCM data, with three clear themes emerging: A lack of continuity between systems and compatibility (i.e., the duplication of efforts due to having both local and centralized data solutions). Staffing constraints, including time, money, and personnel. Issues with data accuracy and efficiency, having no standard nomenclature for reporting resources and allocation. The survey also captured proposed solutions for enhancing bidirectional MCM data sharing, with a centralized system being the top-ranked theme as the most relevant to respondents. A state-wide system would allow for state and local health agencies' visibility and real-time documentation that could be easily reported for state and federal requests. Another recurring theme was the importance of collaboration and diversifying partnerships, which will only aid in furthering MCM efforts within Ohio. MCM Summit To further collaborate with local public health and health care stakeholders, ODH held a one-day summit—Medical Countermeasures for a More Prepared Ohio—focused on enhancing MCM preparedness and response through improved integration with public health partners. The summit offered an opportunity for participants to develop local and regional relationships, initiate discussions, and increase awareness and collaboration through operational data sharing. The presentations and workshop included speakers from Ohio State University, Columbus Public Health, Cardinal Health, MMCAP Infuse, the Department of Health and Human Services, and the Ohio Department of Health. The sessions centered around developing a unified operational view, the equitable and timely distribution of MCMs, better integration of the health care supply chain into public health preparedness, and medical surge response during public health emergencies. The workshop then allowed attendees to work through a developing medical surge scenario, including steady-state situational awareness and the transition into initial response decisions and subsequent MCM distribution and logistics. Feedback from the event has been extremely positive, with participants sharing takeaways that could be leveraged in their jurisdictional planning: “How we may be able to better plan for shortages by leveraging private sector opportunities.” “We have a strong working relationship with our partners that needs to be protected and promoted.” “Showing the importance of MCM and keeping better inventory along with learning more about MCM supply chain process, how my organization uses it, and who they order from.” “Overall, I enjoyed the event. I felt the morning speakers were strong and informative. I really took away a lot regarding supply chain dynamics.” Opportunities to Improve Data Readiness and Response During the data readiness project, ODH identified critical opportunities for local, state, and federal partners to bolster data modernization efforts and improve efficiencies, mainly through standardization and interoperability. Currently, MCM distribution and reporting are largely directed by two federal agencies, CDC and ASPR, which use different processes as well as reporting and tracking systems. Improving the alignment of requesting and reporting processes for local agencies would reduce administrative burden during an emergency response. The standardization of data elements across agencies, as well as the reporting requirements, would reduce duplication of effort and improve jurisdictional capacity to respond to public health emergencies where MCMs are deployed. The next phase for Ohio includes leveraging the relationships developed during the project to continue to improve state responsiveness and effective through planning, exercising, and determining a feasible data solution that supports the goals of the state’s evolving MCM strategy. article yes

The Ohio Department of Health implemented a project to engage Ohioans with disabilities to identify opportunities to create public health preparedness plans that better meet the needs of people with access and functional needs.

States Stay Prepared by Supporting the Public Health Workforce Margaret Nilz, Christina Severin Learn how states use policy to support emergency preparedness and bolster the public health workforce. Public health — particularly public health preparedness — continues to experience workforce shortages, driven by longstanding systemic challenges such as chronic underfunding, high turnover, limited recruitment, and an aging workforce. While some jurisdictions report increased capacity to hire and train public health staff in recent years, they often rely on short-term or temporary funding streams, which limit long-term sustainability. State, local, tribal, and territorial health agencies have varying capacities to respond to public health emergencies, particularly in rural and underserved communities. Because a limited workforce can inhibit emergency preparedness efforts, jurisdictions recognize the importance of cultivating a resilient public health preparedness workforce to respond to future emergencies. In recent years, jurisdictions have pursued several policy interventions to bolster the public health preparedness workforce such as legislation supporting front-line clinical staff and first responders, and rulemaking and other executive powers to provide structural and financial support to critical personnel. Legislative Efforts Legislative efforts to increase benefits and support for health care and public health workers can help address the root causes of workforce challenges and lay the groundwork for sustainable, long-term investment in public health preparedness. Laws that establish standards and expectations for the preparedness workforce, including expansions of benefits or additional training, support workforce growth and retention. Since 2024, several jurisdictions expanded mental health benefits and related support for first responders and other preparedness personnel. Both Alaska (SB 103) and California (AB 2859) enacted legislation that allows peer support programs for emergency service personnel. In Alaska, the bill creates programs for entities such as law enforcement agencies, firefighters, and emergency dispatchers, while California’s bill creates programs to serve a variety of health care providers involved in emergency medical care, including physicians, nurses, paramedics, and emergency medical technicians (EMTs). Utah enacted HB 378, which requires the Department of Public Safety to annually distribute information about its critical incident stress management program to first responder agencies. The bill also requires first responder agencies to annually notify employees about the availability of mental health resources, including periodic screenings for employees and continued support for retired or separated first responders and their spouses. On a broader scale, Hawaii SB 3279 recently established a well-being project tasked with mental health trainings and support for several community organizations, including first responders, hospitals, and medical staff. In Washington, HB 2311 directs the state’s Criminal Justice Training Commission to develop resources for first responder wellness, including a peer support network for active and retired first responders and their families. States have also enacted legislation expanding traditional employment-related benefits, including Colorado (HB 24-1219), which expanded certain health benefits for firefighters to include part-time and volunteer firefighters, and Idaho HB 55, which allows retired public employees to volunteer with public employers without it being considered reemployment. In addition, Georgia HB 451 requires state and local entities to provide disability benefits for first responders who experience occupational or volunteer-related post-traumatic stress disorder. Finally, several jurisdictions enacted legislation to support education and training for their public health and health care workforce. For example, Kentucky HB 484 established an emergency medical service education grant program that provides tuition support for students pursuing paramedic certification, wage reimbursement to ambulance providers whose employees pursue certification, and funding for institutions planning to offer EMT, advanced EMT, and paramedic programs. Oklahoma HB 1696 expands eligibility for the Oklahoma Medical Loan Repayment program to include certified nurse practitioners. Two new laws in Puerto Rico require police officers with the Puerto Rico Police Bureau to be certified in first aid or immediate rescue (PC 0859) and adds seminars on sign language, suicide prevention, and conflict mediation to the Bureau’s continuing education training (PC 0543). Other Policy Levers: Beyond the Legislature Jurisdictions can also use non-legislative policy tools to enhance workforce capacity in public health preparedness. This includes rulemaking, where executive agencies use existing legal authority to adopt or amend regulations. Regulations have the force of law and can help support the public health workforce by establishing licensure standards, training requirements, and operational protocols. Wisconsin, following the enactment of AB 576 in 2024, is developing rules to establish a program for peer support and critical stress management teams in the state. And Utah recently adopted rules for its first responder mental health services grant, which helps these professionals pursue a degree or certification as a mental health provider. Government agencies can also leverage grants and contracts to fund and otherwise direct workforce development initiatives, support training programs, and expand capacity in targeted areas. Jurisdictions can strategically direct funds to address skill gaps and assist local, state, tribal, and territorial agencies build a more resilient workforce. One example of this is in Michigan, where in 2024 the state health agency issued a request for grant proposals to award up to $9 million in EMS workforce grants, building on similar awards to address EMS shortages in 2023. Executive orders are another policy option for jurisdictions to consider as they explore different pathways to workforce sustainability. Executive orders are issued by a jurisdiction’s chief executive (often the governor) and direct certain policy actions or activities. Generally, the power to issue an executive order comes from existing law or a jurisdiction’s constitution and, in most cases, does not require legislative approval or review. Several states have leveraged executive orders to advance the public health workforce and support preparedness activities more specifically. For example, Vermont and New Jersey have recently used executive orders to create or extend advisory councils on issues pertinent to public health preparedness. In 2024, Virginia’s governor issued an executive order formalizing the Office of First Responder Wellness, which provides training, counseling, and other resources to first responders in Virginia. In 2023, the governor of Maryland issued an executive order establishing a State of Preparedness directive if there is a risk of public emergency, and the actions state agencies must undertake to promote improved coordination and hazard planning. Key Takeaways Addressing public health emergency preparedness workforce challenges demands strategic, long-term policy solutions, but several implementation options are available. Health agencies can pursue a variety of policy interventions to support and prepare their public health workforce for future emergencies. ASTHO will continue to monitor this important issue and provide updates as appropriate. article yes

Toxic stress contributes to a variety of negative outcomes for children. And unfortunately, COVID-19 has increased the likelihood of children experiencing childhood trauma, adverse childhood experiences (ACEs), and toxic stress. States and territories should have programmatic, and policy mechanisms to both prevent and mitigate the lifelong effects. A CDC Vital Signs Report found that preventing or mitigating ACEs could reduce depressive disorder by 44%, smoking by 33%, and unemployment by 15%.