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Investing in Indiana’s Public Health Infrastructure Through Community-Driven Policy Change public health infrastructure, community driven policy, indiana state health commissioner, public health system, indiana department of health, outpatient facilities, technical assistance, data and information integration, emergency preparedness, child and adolescent health, legislative action, state and local elected officials, health problems, health care, health system, health departments, federal agencies, essential public health services, centers for disease control, state and local levels, health outcomes, health organization, covid-19 pandemic, health infrastructure, promoting health, public health organizations, states public health, federal funding, astho, association of state and territorial health officials Maggie Davis, Keith Coleman Indiana enacts historic public health funding through community engagement and legislative support. In April 2023, Indiana passed bill SB 4, which was a historic investment in the state's public health funding and restructuring its public health system. This case study shares how the Governor's Public Health Commission and the Indiana Department of Health approached community listening sessions, formulated recommendations, and successfully built legislative support to reform the public health system in the state. Get the Report (PDF) website yes

Sandra Powell, deputy director of Rhode Island Department of Health, how her department was able to increase the number of permanent positions to meet critical public health needs.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—we are focusing this week on mental and behavioral health as well as supporting the public health workforce.

Accompanying an infusion of federal funding, states are considering several policy changes to strengthen the public health workforce and address challenges within the health care workforce.

Likely Public Health Legislative Trends for 2025 Prospective Public Health Legislative Trends for 2025 Maggie Davis Get an inside look at prospective public health legislative trends for 2025, based on ASTHO's legislative tracking efforts and member feedback. Drawing from member feedback and ASTHO’s legislative tracking efforts, ASTHO identified five key issues state and island legislatures are likely to work on for the upcoming legislative sessions for the annual 2025 Legislative Prospectus Series. Each brief provides public health leaders and policymakers with a synopsis of the topics, recent legislative trends, and anticipated legislation in upcoming sessions. Public Health and Health Care Workforce States are continuing to address workforce shortages within public health and the health care systems. ASTHO’s prospectus outlines strategies that legislatures are considering, from bolstering state public health funding to legislative efforts addressing nationwide workforce shortages through recruitment incentives, workforce commissions, and pipeline programs. Containing Spread of Infectious Disease State and territorial public health agencies are responsible for protecting the health and safety of their residents and have legal authorities to fulfill those responsibilities. In recent years, many legislatures have revisited the scope of these legal authorities, with states like Washington (SB 6095) expanding the health official’s authority to issue standing orders for a range of disease interventions. Similarly, legislatures may continue considering vaccine-related legislation. While many bills in recent years aim to weaken vaccine policy, state leaders have listened to medical leaders within their state who advocate for strong vaccine policies. In 2024, West Virginia’s governor vetoed HB 5105 that would have weakened school enrollment requirements, informed by strong opposition from the state’s medical community and evidence that the existing vaccine policy had prevented disease outbreaks. Data Modernization and Privacy Modernizing public health and health care data systems have taken big steps forward, including federal initiatives like the Trusted Exchange Framework and Common Agreement (TEFCA), which establishes guiding interoperability principles and standards for health data exchange. Nevada enacted AB 7 in 2023 requiring new regulations governing health information exchanges (HIEs) and granting certain liability protections to providers using them. In the proposed rules published in August 2024, the Nevada Department of Health and Human Services intends to require that participating HIEs are TEFCA members. ASTHO anticipates more jurisdictions will allow public health agencies access to a wider range of privacy-protected health data through secure platforms like HIEs. Maternal and Child Health Public health supports mothers and children throughout their development. There are three emerging issues that legislatures are likely to work on in the next year: maternal morbidity and mortality, fetal and infant mortality, and youth mental health. One strategy to address youth mental health is using laws to regulate social media companies, requiring them to implement safeguards for minors who use their services. For example, California enacted SB 976 in 2024, which requires “addictive internet-based” services to gain parental consent before minors could use the service and limit the hours in which minors could use an application. Technology industry groups are challenging these efforts in court, with one suit asserting that California’s measure is unlawful governmental interference with First Amendment rights of minors. Substance Misuse and Overdose Prevention Although there was a significant decrease in overdose deaths in 2023, there are still legislative actions to help reduce substance misuse and prevent overdose likely to be considered in 2025. During the 2024 sessions at least 24 state legislatures considered bills to regulate products like kratom and hemp derived products (e.g., Delta-8). Additionally, at least 18 legislatures considered bills to decriminalize drug checking equipment like fentanyl and xylazine testing streps. ASTHO anticipates states legislators will continue implementing harm reduction efforts, policies to connect people with substance use disorders to care, and efforts to regulate products with potential for abuse or misuse in the next session. What We Know So Far The majority of states will convene their legislative sessions in January 2025, with at least 15 states scheduled to conclude their session by the end of April; there will likely be a flurry of legislative activity in the first quarter of the year. Already the Texas legislature has prefiled more than 1,200 bills for their 2025 session, covering topics including a health commissioner’s authority to establish routine childhood immunization requirements (HB 468) and making changes to the state’s maternal mortality and morbidity review committee reporting requirements (HB 713). Additionally, Virginia’s General Assembly convened its two year session in January 2024 and has a number of bills carrying forward into 2025 including bills related to suicide prevention (HB 80) and improving maternal health data quality (HB 286). ASTHO will monitor legislation related to these topics and more during the 2025 sessions and will provide relevant updates. 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ASTHO's 2024 Legislative Session Update: Part Two Beth Giambrone, Maggie Davis, Christina Severin ASTHO's Public Health Legislative Update on Tobacco, Mental Health, Environmental Health, Workforce, and Containing Infectious Disease By the end of April, at least 36 states will have concluded their regularly scheduled 2024 sessions, with several states passing laws on important public health issues. Earlier this month, ASTHO provided a brief update on five of the top 10 public health state policy issues to watch during the 2024 state and territorial legislative sessions; this update examines the remaining five. Containing the Spread of Infectious Disease Public health agencies have a responsibility to keep their communities safe and healthy by maintaining foundational public health services including identifying, containing, and preventing the spread of communicable disease. ASTHO supports maintaining and guaranteeing robust public health legal authorities allowing public health leaders to meet their responsibilities for containing the spread of infectious disease. Following the COVID-19 pandemic, state and territorial legislatures considered many bills to change public health agency’s legal authorities to meet their responsibility, a trend that ASTHO anticipated continuing into 2024. So far, at least 28 states have considered, and at least two legislatures passed, bills relating to public health authority to address the spread of infectious disease in 2024. For example, the Hawaii legislature passed SB 3122, expanding public health authority by providing the state health official broad authority to issue standing orders for people 18 years and older to receive evidence-based services recommended by the U.S. Preventative Services Task Force. In March, however, Utah enacted HB 405, which limits local public health official’s authority to issue an isolation or quarantine order to specific conditions unless the local legislative body agrees that a new, drug resistant, or reemerging pathogen likely to cause high mortality or morbidity needs containment. Environmental Health Under the Safe Drinking Water Act, the EPA has the authority to set national standards for public drinking water. These standards establish legally enforceable Maximum Contaminant Levels (MCLs) and non-enforceable Maximum Contaminant Level Goals for public water systems. In April 2024, EPA released a final rule establishing legally enforceable MCLs for six PFAS compounds that occur in drinking water. Public water systems have until 2027 to complete initial monitoring and inform residents of the levels of PFAS in their water, and until 2029 to act if their drinking water levels exceed the MCLs. To date in 2024, at least four states have enacted or are considering legislation that would aid in monitoring and remediating PFAS in drinking water. Virginia recently enacted HB 1085/SB 243, which requires that the Department of Health notify the Department of Environmental Quality (DEQ) of any results from their monitoring of public water systems that show MCL exceedances, at which time requires DEQ to implement a plan to prioritize and conduct assessments of the public water system's raw water source(s). The Rhode Island House of Representatives passed H 7439, which would require the Department of Environmental Management to determine the maximum number of PFAS detectable by standard laboratory methods, and specifies the types of water systems that will be required to monitor untreated drinking water for those PFAS by June 1, 2025. Massachusetts is considering H 853, which would require the Department of Environmental Protection to maintain a list of municipalities where PFAS levels exceed the MCL and provide vouchers to homes in those municipalities to purchase home water filtration equipment. Strengthening the Public Health Workforce With several successes in 2023, ASTHO anticipated legislatures to continue considering legislation to strengthen the public health and health care workforces that represent the communities they serve during the 2024 legislative sessions. One strategy is establishing career pathway programs that provide students training and support to pursue public health careers. At least six states have considered, and three have passed, bills creating or strengthening a career pathway program during the current legislative sessions. At least two states have enacted programs to address health care provider shortages in April. Maine’s legislature passed LD 2268, which would allow internationally trained physicians to receive a limited license to practice medicine and address provider shortages in rural areas of the state. Washington enacted SB 5582, directing community and technical colleges to develop a plan in consultation with local workforce development councils and health care employers to train more nurses over the next four years. In May, Hawaii’s legislature passed HB 1827 appropriating funds to support public high school health care workforce certificate programs to support graduates seeking entry-level positions in the health care industry. Supporting Mental Health Children and adolescents continue to experience mental health issues, with teen girls reporting significant challenges. Schools can play an important role in supporting the mental health of all students through direct services or policies that address prevention, education or coordination. In 2024, a number of jurisdictions considered legislation related to youth mental health, through training requirements for staff and students, and support for treatment flexibility in the school setting. At least six jurisdictions considered bills related to mental health education for students, including specific suicide and violence prevention content. Virigina enacted HB 603, which requires school health instruction to include information about common mental health challenges, helpful coping strategies, the importance of seeking help from a professional or other adult, and available school resources. Several jurisdictions, including Virginia (HB 224), Minnesota (HF 4363) and Missouri (HB 2471), also considered establishing or amending suicide prevention and related mental health training programs for teachers and other school staff. Finally, several jurisdictions considered legislation to explore or otherwise support using telehealth services in schools for mental health services. Minnesota is considering legislation that would create a pilot program to determine whether the availability of telehealth services in schools increases mental health access (SF 4236) as well as a requirement to provide space at secondary schools for students to receive telehealth mental health services (HF 3542). New York is currently considering S 8976, which would authorize telehealth services in schools to be delivered by licensed providers, while Maryland enacted HB 522 in April, which requires school districts to develop guidelines to allow telehealth appointments at schools starting in the 2025-26 school year. Tobacco and Nicotine Products According to the American Lung Association, 22 states do not have comprehensive smoke-free laws that help protect against the dangers of second-hand smoke in a variety of settings (e.g., multi-family homes, public spaces, restaurants), or reduce the number of people who start smoking. At least 16 states have introduced legislation aimed at creating, promoting, or expanding smoke-free environments. Connecticut recently enacted SB 132, which expands their clean indoor air act to prohibit vaping at dog race tracks. The Maryland legislature passed HB 238/SB 244, which would update their Clean Indoor Air Act to prohibit vaping in public indoor areas, indoor places of employment, and mass transportation. In addition, the Alabama Senate recently passed SB 37, which would prohibit vaping in public places. In addition, at least 14 states have introduced legislation to either prohibit or further restrict the sale of flavored tobacco products, including menthol products. For example, bills introduced in Hawaii (HB 2441/SB 3130), Minnesota (HF 2177/SF 2123), and New Jersey (S 1947) would prohibit the sale of flavored tobacco products, including menthol, within their jurisdiction. In addition, a bill in New York (A 699/S4477) would ban the sale of flavored smokeless tobacco products within five hundred feet of a public or private school. ASTHO’s state health policy team continues to monitor these important public health issues and will provide relevant updates. website yes

This blog post discusses mitigating risks of AI use in government agencies, emphasizing privacy, transparency, and ethical concerns.

As the U.S. continues to undertake the largest vaccination campaign in almost a century, it has required government at all levels to surge workforce capacity. The federal government, states, territories, and local jurisdictions are acting to meet the immediate demand for vaccination as well as expand the long-term vaccination workforce. Looking ahead, expansion of the vaccination workforce long-term will help support potential COVID-19 booster shots and expand vaccine access broadly.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: public health authority, immunization, data privacy and modernization, public health workforce, and health equity.

ASTHO has identified health equity and rural health as issues that policymakers across the country will consider in 2022.