In the Public Health Review podcast debut, host Robert Johnson speaks with public health officials from Alaska, Kentucky, and West Virginia about the ongoing opioid epidemic in the U.S. and its intersections with other epidemics like neonatal alcohol syndrome and hepatitis C.
State Health Officials Commend Public Health Emergency Declaration to Address Opioid Epidemic ARLINGTON, VA—Members of the Association of State and Territorial Health Officials (ASTHO) joined President Donald Trump and First Lady Melania Trump today at the White House for a meeting declaring the nation’s opioid crisis a public health emergency. “While emergency declarations are normally reserved for natural disasters or infectious disease outbreaks, the President’s announcement recognizes the work that states and territories are already undertaking to address the crisis and will allow for increased collaboration and coordination of regional and federal assets across the country for an even more effective response,” says John Wiesman, ASTHO president and secretary of health at the Washington State Department of Health. “We hope the public health emergency declaration, combined with future additional federal investments in substance abuse treatment and prevention, will lead to fewer deaths and better health for all Americans.” State and territorial health officials have been at the frontlines of this crisis working to address the many facets of the epidemic. Six states have already declared emergencies in their jurisdictions: Alaska Arizona, Florida, Maryland, Massachusetts, and Virginia. “While federal leadership has been working hard in partnership with states to address this crisis, many states have taken executive and legislative action to address the epidemic including implementing new laws and regulations around prescribing and providing additional funding for treatment services and evidence-based public health interventions to prevent substance misuse in the first place,” says Michael Fraser, ASTHO’s executive director. “The federal emergency adds to the work that states and territories have been doing in many different ways across the country.” Treating and preventing substance use disorders and addiction is very complex. “Opioid addiction is challenging because many people first become addicted when receiving the medications through the healthcare system. Addiction is not a moral failing on the part of the individual; it is a health condition we must address in healthcare and across all sectors as a society at the national, state, and community levels,” says Jay Butler, ASTHO’s immediate past president and chief medical officer for the Alaska Department of Health and Social Services. “Addiction is treatable and, more importantly, preventable with appropriate evidence-based interventions. The declaration today will help us respond even more effectively to the loss of life and devastating impact of substance misuse and addiction.” ASTHO, in partnership with the National Association of State Alcohol and Drug Abuse Directors (NASADAD), recently released a framework on public health responses to the opioid crisis that was developed to assist health officials in combating the epidemic. As federal agencies and Congress look to implement their response to this public health emergency, ASTHO urges national leaders to provide additional resources focusing on both treatment and prevention of addiction. “This is a crisis we ultimately are not going to arrest—or treat—our way out of; instead, we have to prevent our way out of this,” adds Fraser. “Like any public health emergency, addressing this problem calls for important steps to prevent the disease in the first place. We hope that the President and First Lady’s attention to the opioid epidemic will help us focus on both treatment and prevention. That is the work of public health, and states and territories are committed to mustering all resources available to end this epidemic.” ASTHO Press Release Boilerplate website yes
State and Territorial Health Leaders Commend Selection of Dr. Brenda Fitzgerald for CDC Director ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) commends the Administration for nominating Dr. Brenda Fitzgerald to serve as director of Centers for Disease Control and Prevention. Fitzgerald has served as commissioner and state health officer of the Georgia Department of Public Health since 2011, directing the state’s 18 public health districts and 159 county health departments and overseeing various state public health programs. “Brenda comes to the job with experiences as a successful leader in public health and healthcare” says Dr. Jay Butler, ASTHO president and chief medical officer for the Alaska Department of Health and Social Services. “Her accomplishments in Georgia and her many contributions to ASTHO are a testament to her commitment to promote, protect, and improve the health of all Americans. Her perspectives gained from clinical practice as well as serving as chief of a state public health agency will be crucial to her success as director of our nation’s premiere public health agency.” Fitzgerald currently serves as president-elect of ASTHO, is a board-certified Obstetrician-Gynecologist, and has practiced medicine for more than three decades. She was in private practice before being tapped by Gov. Nathan Deal in 2010 to be part of his transition team, and then was ultimately selected to lead the Georgia Department of Public Health in 2011. As state health official, Fitzgerald has undertaken many state public health initiatives including launching the “Talk with me Baby” initiative to encourage increased language development among Georgia babies; leading a statewide, multi-faceted childhood obesity initiative, called the Georgia Student Health and Physical Education (SHAPE) Initiative, which took Georgia’s childhood obesity rate from second highest in the nation to 17th in just five years; and coordinating efforts across the state during the Ebola virus disease epidemic and protecting Georgia residents from the Zika virus through a Zika Awareness Campaign. “Dr. Fitzgerald’s first-hand experience working at the frontlines of public health and dealing with real-time health emergencies make her an ideal leader for the Centers for Disease Control and Prevention,” says Dr. Michael Fraser, executive director of ASTHO. “Her collaborative approach to addressing both infectious disease and chronic health issues will serve the CDC well. We look forward to supporting her in this new role and working with CDC leadership well into the future to protect all Americans from health threats and promote optimal health for all.” Fitzgerald holds a Bachelor of Science degree in Microbiology from Georgia State University and a Doctor of Medicine degree from Emory University School of Medicine. She completed post-graduate training at the Emory-Grady Hospital in Atlanta and held an assistant clinical professorship at Emory Medical Center. As a Major in the U.S. Air Force, Fitzgerald served at the Wurtsmith Air Force Strategic Air Command Base in Michigan and at the Andrews Air Force Base in Washington, D.C. ASTHO Press Release Boilerplate website yes
State and Territorial Health Leaders Commend Nomination of Dr. Jerome Adams for U.S. Surgeon General ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) commends the Administration for nominating Indiana State Health Commissioner Dr. Jerome Adams to the position of U.S. Surgeon General. Adams has served as commissioner of the Indiana State Department of Health since 2014, where he oversees the public health protection and laboratory services, health and human services, healthcare quality and regulatory, and tobacco prevention and cessation commissions. “The Administration has nominated a true public health leader to serve as U.S. Surgeon General,” says Dr. Michael Fraser, executive director of ASTHO. “Dr. Adams understands the healthcare landscape, has first-hand experience dealing with serious public health issues, and will be a strong advocate for state public health, bringing a unique and valuable set of skills to the nation’s healthcare system. His knowledge of public health challenges and opportunities as Indiana State Health Commissioner will serve our nation well in the months and years ahead.” As a member of ASTHO, Adams has worked nationwide to address public health issues, including the challenges presented by the current opioid crisis. His clinical acumen combined with strong clinical and community-based experience make him a uniquely qualified candidate for the nation’s top physician. “Our nation needs a strong, experienced, and articulate public health champion, and Jerome is the right person at the right time to serve as our Surgeon General,” says Dr. Jay Butler, ASTHO president and chief medical officer for the Alaska Department of Health and Social Services. “This nomination recognizes his state and national leadership experience, his broad perspective, and his clinical expertise—he brings all this to the very important job of Surgeon General.” Adams earned a B.S. in biochemistry and a B.A. in biopsychology at the University of Maryland, Baltimore County. He has been a researcher at medical schools in both the Netherlands and Zimbabwe and has worked under Nobel Prize winner Dr. Tom Cech. He earned his Medical Doctorate at the Indiana University School of Medicine, and his Masters of Public Health at the University of California, Berkeley. He has been an active member of ASTHO, including representing ASTHO at the American Medical Society House of Delegates and participating in national initiatives to address significant public health challenges. ASTHO Press Release Boilerplate website yes
State and Territorial Health Leaders Praise Surgeon General’s Report on E-Cigarettes ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) praises U.S. Surgeon General Vivek Murthy for issuing a first ever report on e-cigarette use among youth and young adults, and calls on local, state, and national partners to redouble efforts to prevent tobacco use and support tobacco cessation efforts nationwide. The new report indicates a dramatic rise in e-cigarette use among youth and young adults. E-cigarettes are now the most commonly used tobacco product among youth, surpassing conventional cigarettes in 2014. Emerging data suggests that youth who use e-cigarettes are more likely to use combustible tobacco products. ASTHO members have a strong history of supporting programs that improve tobacco prevention and control efforts in their states, and this new report reiterates that tobacco use, in any form and at any age, is harmful to our health. “The report’s main message, that there is no acceptable level of nicotine when it comes to our children, is a strong one and one that I support as a physician, father, and champion for health in my state. That's why in Vermont we added e-cigarettes to the tobacco products restricted under our Clean Indoor Air Act,” says Harry Chen, MD, chair of ASTHO’s Prevention Policy Committee and commissioner of the Vermont Department of Health. “While there is still a lot we do not know about e-cigarettes, we do know that vaping products contain chemicals that could cause harm, especially in young people. Our research on the health effects of smoking clearly shows that nicotine, regardless of how it is delivered, is addictive and can harm the developing brain.” ASTHO President and Chief Medical Officer for the Alaska Department of Health and Social Services, Jay Butler, MD, states that “our nation’s state and territorial health leaders are committed to aggressive efforts to reduce all tobacco use and address the issues posed by electronic cigarettes. This is an area where health, policy, and science can converge to prevent harm and potentially prevent addiction and substance misuse among our youth.” While all state and territorial public health agencies have experience addressing tobacco control and prevention, e-cigarettes pose new challenges to health leaders. “We are concerned about tobacco-attributable health disparities, tobacco-related morbidity and mortality, and the limited regulation and lack of definitive research on e-cigarettes and their components,” says ASTHO’s Executive Director Michael Fraser, PhD. “To this end, we support further investment in prevention efforts and research to inform local, state, and national policymakers. I think the surgeon general’s report is going to focus more attention on the unique issues raised by e-cigarettes and the need for additional policy work and investment at the state and national level to promote healthy behaviors among our nation’s young people.” ASTHO is currently updating its position statement on tobacco prevention and control to include the public health consequences of e-cigarettes and related vaping devices. ASTHO Press Release Boilerplate website yes
ASTHO’s Leadership Trailblazers series shares outstanding public health leaders’ inspirations, motivations, and accomplishments. This post features Jay C. Butler (alumni–AK), Deputy Director for Infectious Disease at CDC.
On this episode, we examine opportunities for bipartisanship and forecast what the public health landscape may look like in the wake of the 2018 midterm elections.
State and Territorial Health Officials Applaud Surgeon General’s First Ever Report on Alcohol, Drugs, and Health ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) commends U.S. Surgeon General Vivek H. Murthy for issuing a landmark report on alcohol, drugs, and health, and remains committed to helping state and territorial health departments enhance prevention efforts, expand access to treatment, and ensure that recovery is possible for everyone struggling with substance use disorders and addiction. “Substance misuse and addictions must be recognized as public health issues, and not just a concern of the criminal justice system,” says Dr. Jay Butler, ASTHO president and chief medical officer for the Alaska Department of Health and Social Services. “We now know that addictions are chronic conditions involving brain function, and substance misuse is often deeply rooted in early life events and social factors. To truly make an impact, we must make these connections to create and implement effective, science-based responses.” Launched in September 2016, ASTHO’s President’s Challenge, led by Dr. Butler, centers around public health approaches to preventing substance misuse and addictions. Through the challenge, ASTHO hopes to further unite and rally state health officials, affiliates, and partners to take action over the next year on this critical and urgent public health issue within states and communities. Since 2012, ASTHO has convened state agencies, healthcare and mental health professionals, third-party payers, researchers, and community-based partners to identify actionable steps to better understand and address prescription drug abuse. “This report marks an important turning point in our nation’s response to substance use disorders and addiction, and further exemplifies the need to support health departments in taking steps to address substance misuse through a comprehensive approach,” says Dr. Michael Fraser, ASTHO Executive Director. “We look forward to continued partnership with our members, federal agencies, local health departments, and other organizations working to address the many issues we face related to misuse and abuse of drugs and alcohol.” Substance misuse and addictions to alcohol, prescription drugs, and illicit substances are long-standing but growing problems in the United States. Over 20 million people have substance use disorders, and 12.5 million Americans reported misusing prescription pain relievers in the past year, according to HHS. Addressing drug and alcohol misuse has been a top priority for health officials across the nation. The Surgeon General’s report includes many ways that all Americans can get involved in preventing drug and alcohol misuse. Specific actions that state health leaders can take include: Providing leadership, guidance, and vision in supporting a science-based approach to addressing substance use-related health issues. Improving coordination between social service systems and the health care system to address the social and environmental factors that contribute to the risk for substance use disorders. Implementing criminal justice reforms to transition to a less punitive and more health-focused approach. “We aren’t going to treat our way out of this problem of misuse and addiction, nor are we going to arrest our way out of it,” says Fraser. “Instead, we have to focus on preventing misuse in the first place. The Surgeon General’s report is a great way for all Americans to get engaged on this issue and promote healthy behaviors at home, at work, in our communities, and in our states.” For more information about ASTHO’s 2017 President’s Challenge, visit www.astho.org/addictions. ASTHO Press Release Boilerplate website yes
Health Officials and Attorneys General Convene to Discuss Legal and Public Health Solutions to Opioid Epidemic ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) and the National Attorneys General Training and Research Institute, a branch of the National Association of Attorneys General, held an inaugural three-day summit with health officials and attorneys general on Nov. 14-16 to promote coordination across public health, law enforcement, and medical professionals to address opioid abuse and misuse, an epidemic that claims the lives of 78 people each day and has now become one of the nation’s most urgent public health threats. At the meeting, health officials and attorneys general discussed the importance of working together to change the conversation about people with substance use disorders, and the need to move from punitive approaches toward compassionate, evidence-based treatment. Health and law enforcement officials are intensifying efforts to improve prescribing practices, apply effective regulatory and enforcement measures, and eliminate stigma and misconceptions about individuals who seek addiction treatment. “We need to reframe the conversation about addiction, from one about bad choices and moral failings to one about chronic health conditions that affect the brain,” says Jay Butler, ASTHO president and chief medical officer for the Alaska Department of Health and Social Services. “Together, public health and law enforcement officials have a critical role to play in ending this epidemic that continues to devastate our families and communities.” ASTHO’s 2017 President’s Challenge, led by Butler, centers around public health approaches to preventing substance misuse and addictions. Through the challenge, ASTHO will unite and rally state health officials, affiliates, and other cross-sector partners to take action on this critical and urgent public health issue within states and communities. State health officials will work to expand primary prevention efforts in their states to educate consumers, prescribers, families, policymakers, and other partners about opioid use, and address risk factors in communities to reduce demand for drugs and other addictive substances. U.S. Surgeon General Vivek Murthy and Office of National Drug Control Policy Director Michael Botticelli also delivered remarks on Monday, calling for greater integration of substance use disorder services into the healthcare system so that addiction can be treated with the same precision and urgency as other health conditions like diabetes, heart disease, or cancer. Nationally recognized experts and thought leaders from the National Institute on Drug Abuse, CDC’s National Center for Injury Prevention and Control, the Substance Abuse and Mental Health Services Administration, the American Medical Association, and the Johns Hopkins Bloomberg School of Public Health also described federal and state policy options, strategies for engaging medical professionals, and promising community-based prevention initiatives. ASTHO Press Release Boilerplate website yes
Association of State and Territorial Health Officials Announces New Leadership Appointments SALT LAKE CITY—Edward Ehlinger, commissioner of the Minnesota Department of Health, was elected president of the Association of State and Territorial Health Officials (ASTHO) during the association’s annual meeting. Brenda Fitzgerald, commissioner for the Georgia Department of Public Health, was elected as secretary-treasurer at the same meeting. Jay Butler, chief medical officer and director of the Division of Public Health at Alaska Department of Health and Social Services, became president-elect. All appointments take effect immediately. Ehlinger has served as Minnesota’s health commissioner since January 2011. Previously, he was the director and chief health officer for Boynton Health Service at the University of Minnesota, as well as director of personal health services for the Minneapolis Health Department. He has been honored with the Albert Justus Chesley Award from the Minnesota Public Health Association, the Advancement of Justice Award from the Hennepin County Bar Association, the first Ed Ehlinger Award from CityMatCH, and the Physician Communicator Award from the Minnesota Medical Association. In Minnesota, he is famous for his “Pitch the Commissioner” tours, where he travels to different counties and invites their citizens to join him in a game of horseshoes as they share ideas about what their communities need to be healthy. Fitzgerald is a board-certified obstetrician-gynecologist and a fellow in anti-aging medicine. Prior to her current role as George’s health commissioner, Fitzgerald served on the Georgia OB-GYN Society’s board and as its president. She also worked as a healthcare policy adviser with House Speaker Newt Gingrich and Sen. Paul Coverdell. As a major in the U.S. Air Force, Fitzgerald served at the Wurtsmith Air Force Base in Michigan and the Andrews Air Force Base in Washington, D.C. In 2012, Fitzgerald led the launch of Georgia SHAPE, a childhood fitness and obesity reduction program that received formal commendation from the President’s Council on Fitness, Sports & Nutrition in 2014. Butler was appointed chief medical officer and director of the Division of Public Health at Alaska Department of Health and Social Services in 2014. Previously, he was senior director for community health services at the Alaska Native Tribal Health Consortium in Anchorage, where he was also a clinical infectious diseases consultant and medical director for infection control and employee health. Butler served as a U.S. Public Health Service medical officer for more than 23 years, and participated in a number of emergency deployments, such as heading the H1N1 Vaccine Task Force at CDC and being a team co-leader during the CDC responses to the SARS outbreak of 2003, avian influenza in 2004, and Hurricanes Katrina and Rita in 2005. In 2010, he received ASTHO’s National Excellence in Public Health Award. Jewel Mullen, commissioner of the Connecticut Department of Public Health, became immediate past president; and Terry Cline, commissioner of the Oklahoma State Department of Health, became past president. All ASTHO offices are one-year positions. ASTHO Press Release Boilerplate website yes
State and Territorial Health Officials Gather in Washington, D.C. to Make the Case for Prevention and Public Health Programs WASHINGTON, DC—State and territorial health officials from across the country gathered in Washington, D.C. this week to ask Congress to sustain investments in public health and prevention programs regardless of actions to repeal and replace the Affordable Care Act (ACA). During a Capitol Hill briefing today and meetings with key White House and congressional leaders this week, members of the Association of State and Territorial Health Officials (ASTHO) said that the nation’s health is at risk if proposals to eliminate the Prevention and Public Health Fund do not specify a viable replacement. “Federal funding for core state prevention and public health programs and services has existed for decades. Since its creation in 2010, the Prevention and Public Health Fund has invested $6 billion in preventive health services and core public health programs at the local, state, and federal levels,” says ASTHO Executive Director Michael Fraser. “Eliminating public health programs for community health needs, maternal and child health, cancer screenings, chronic disease prevention, and immunizations without a clear plan for replacement will seriously undermine our ability to effectively protect and promote health programs and guard against emerging public health threats.” “We commonly associate roads and bridges, railways and airports with infrastructure, but public health is also part of our nation’s critical infrastructure,” adds Jay Butler, MD, ASTHO President and Chief Medical Officer at the Alaska Department of Health and Social Services. “Just as the federal interstate highway system promotes commerce between the states, a strong public health infrastructure assures a healthy and productive workforce across the nation. As Congress looks to reinforce our nation’s aging transportation infrastructure, we urge similar efforts to improve and upgrade our nation’s public health system.” ASTHO’s health care infrastructure concerns stem from the fact that many local water systems are rapidly deteriorating and environmental contamination threatens the availability of safe drinking water for millions of Americans. State and territorial public health agencies monitor the air and water safety and work across government to remediate environmental hazards. Critical public health laboratory, public health information systems, and epidemiology capacity are also part of our nation’s public health infrastructure. In addition to making the case for prevention, state and territorial health officials discussed last year’s public health response to the Zika outbreak and plans for this year’s response, the need for continued support to address the opioid epidemic, and the nation’s need to include public health in proposals to improve the nation’s aging infrastructure. In fiscal year 2016, Congress allocated $932 million from the Prevention and Public Health Fund to programs across multiple federal health agencies, providing the bulk of funding for health programs affecting millions of Americans. ASTHO Press Release Boilerplate website yes
ASTHO Provides Recommendations to President’s Commission on Opioids ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) appreciates recent actions taken by Congress and President Trump to address opioid misuse, including last week’s meeting of the President's Commission on Combating Drug Addiction and the Opioid Crisis. ASTHO and its members stand ready to work with the commission, chaired by Gov. Chris Christie, as it prepares to make recommendations to the president later this year for improving our nation’s response to the opioid epidemic. “Collectively, states and territories recognize the opioid crisis as a public health emergency and now, as with any emergency, we must respond with the resources necessary to sustain a full continuum of care and ensure that proven prevention, treatment, and recovery services are used consistently,” says ASTHO President Jay Butler. “To do that, we need to work with other government agencies, healthcare providers, law enforcement, and local, state, and national organizations to counteract stigma and view addiction as a chronic health condition that affects the brain. Just like asthma or diabetes, if we apply appropriate, evidence-based strategies, addiction is both preventable and treatable.” State and territorial health officials play an important role in promoting multipronged, government-wide solutions to prevent and intervene in this public health crisis that affects virtually every community in America. On June 16, ASTHO sent a letter to Gov. Christie outlining five recommendations for the commission’s consideration, emphasizing the vital work of state and territorial health agencies, including: Expanding and strengthening primary prevention and education strategies. Reducing and controlling access to prescription and illicit opioids. Improving monitoring and surveillance of drug addiction and opioid misuse and overdose. Promoting multi-program, government-wide approaches to combatting opioid misuse. Improving access to and use of effective treatment and recovery support. These recommendations are integral to the 2017 ASTHO President’s Challenge, a national effort to unite public health leaders and foster public and private commitment to prevent substance misuse, addictions, and the related consequences. In addition, ASTHO is identifying strategies for state and territorial health officials to address the opioid crisis across jurisdictions using a comprehensive approach, building on other initiatives and tools, such as the CDC’s prescribing guidelines, the Surgeon General’s report on addiction, and National Governors Association’s Road Map for States. ASTHO Press Release Boilerplate website yes
State Health Officials Strongly Encourage Influenza Vaccinations Among Pregnant Women ARLINGTON, VA—Jay Butler, MD, ASTHO president and chief medical officer for the Alaska Department of Health and Social Services, released the following statement today regarding the importance of influenza vaccinations for pregnant women: “As we enter flu season, state and territorial health officials strongly encourage all individuals six months or older to receive an annual influenza vaccination, including pregnant women and older adults. Each year, millions of Americans are affected by the flu and influenza vaccines are vital to reduce the chances of getting sick. Illness from influenza infection can be particularly dangerous for pregnant women and their developing babies. A recent report from the ongoing Vaccine Safety Datalink project found that there may be a possible link between miscarriage early in pregnancy and the flu vaccine in women who received a certain version of the vaccine two years in a row. ASTHO and its members are concerned about this potential risk when weighed against other risks, including the risks posed by influenza during pregnancy, and continue to work with national healthcare organizations, including the American College of Obstetricians and Gynecologists and CDC, to determine whether these new findings should lead to any changes in national recommendations. Given the large volume of data indicating the safety of influenza vaccination during pregnancy, ASTHO and its members support current recommendations for use of vaccines during pregnancy. This study raises an important question about risk, and an ongoing investigation to study this issue further is recommended. It is also important to note that this study does not prove that flu vaccine was the cause of the miscarriage. Earlier studies have not found a link between flu vaccination and miscarriage. CDC continues to recommend that pregnant women get an influenza vaccine during any trimester of their pregnancy because flu poses a danger to pregnant women, and a flu vaccine can prevent influenza in pregnant women which also protects their baby after birth. State and territorial health departments continue to encourage pregnant women to get vaccinated to be protected from influenza during pregnancy. Immunizations are a vital public health tool and one of the most cost-effective means of public health promotion and disease prevention. Vaccines prevent disease, disability, and death in children and adults.” ASTHO Press Release Boilerplate website yes