An issue brief by ASTHO and the Duke University Margolis Center for Health Policy that highlights considerations for state health officials as they look to maximize the benefits of COVID-19 therapeutics.
Over the years evidence has expanded on community health workers (CHWs) improving outcomes and even reducing disparities in heart disease and many other public health priority areas. However, their presence in state and local public health workforce is still modest. A number of efforts have sought to expand the role of CHWs in medical care settings by developing reimbursement through third party payers, along with including them in managed care contracts and incorporating them in state Medicaid plans. The experience and lessons of the COVID-19 pandemic could substantially change the way we practice public health in the future, and provides opportunities to expand the role and presence of CHWs in the state and local public health workforce.
As public health officials lead the pandemic response, clear direction-setting in every state and territories is vital to assure our planning and implementation is fair and focused on those most at need. These are not entirely unprecedented times—1918 pandemic flu killed almost 700,000 Americans. Even then, despite increasing understanding of respiratory disease transmission, many leaders—including public health leaders—downplayed the pandemic and refused to take effective steps to limit large gatherings and encourage mask wearing. Changing behavior, or introducing new social norms, was as difficult then as it is now. We have to learn from history if we are to effectively respond to our present reality.
Public health officials have a significant opportunity to provide leadership on the issue of Long COVID, through their own authorities, and by capitalizing on their influence in the public health and healthcare sectors.
We can prepare for the future of health equity and data by ensuring the equitable collection of data and building systems that are flexible enough to account for forward progress.
Braiding and layering funding allows state health departments to leverage diverse fundings sources and amplify their impact. Learn more about this strategy and its importance.
From the Chief Medical Officer: Key Takeaways from ASTHO’s HPAI Scientific Symposium hpai scientific symposium, highly pathogenic avian influenza, one health, public health, state and local public health officials, wild birds, human health, infectious diseases, disease control and prevention, centers for disease control, infected with avian influenza, symptoms of illness, domestic animals, working closely, united states, health department, food safety, public health practice, domestic poultry, contact with infected, health official, health risks, infect humans, dairy cattle, exposure to infected Marcus Plescia, Jessica Baggett, Meredith Allen A recap of ASTHO's Scientific Symposium on Highly Pathogenic Avian Influenza While only one human case of Highly Pathogenic Avian Influenza (HPAI) has been reported in the United States this year, the discovery of transmission of HPAI in cattle has led to an increase in the need for federal, state, and local public health agencies to enter a heightened phase of readiness. The risk to the general population remains low but this change signals the need for an increase in collaboration, research, and communication. Last week, ASTHO hosted a virtual symposium in partnership with the Infectious Diseases Society of America and the Council for State and Territorial Epidemiologists that featured public health leaders and scientists driving the U.S. government’s response to HPAI. Experts outlined potential actions for managing further spread and identified areas requiring additional investigation and guidance. Using a One Health Approach is Critical One Health recognizes that the health of people is closely connected to the health of animals and our shared environment. This is not a new concept but has become more important in recent years. The disciplines of public health and agriculture are inextricably linked. The symposium emphasized the importance of building and maintaining partnerships between CDC, USDA, FDA, ASPR, NIAID, and state and local public health departments. Recognizing the interconnectedness of these domains is essential for effective disease prevention and control. Public Health Recommendations will Evolve with the Science A key insight from the symposium was the dynamic nature of the situation. While we know a great deal about pandemic flu response, spread through dairy cattle is new. More in-depth epidemiologic studies will call out changes in transmission between cattle, people and cattle, and the potential for person-to-person spread. Collaboration between public health, agriculture, and farm owners will allow public health to gather epidemiologic data that can be translated into clear and data-supported recommendations to prevent continued transmission. As scientific understanding evolves and new evidence emerges, so must our public health response. As always, the public health community will commit to continuous learning, flexibility, and readiness to adjust strategies accordingly to ensure that interventions remain evidence-based and effective. Assessing the Current State of Readiness The supporting federal government response to HPAI appears to be well positioned; our federal partners don’t anticipate challenges with the commercial supply chain for personal protective equipment (PPE), vaccine, or therapeutics. The commercial system continues to be the primary source for PPE, but there are federal stockpiles available from ASPR, and the Food Safety and Inspection Service (FSIS) national veterinary stockpile. There is no indication of viral resistance to existing antiviral treatments and, in addition to commercial supplies, "tens of millions of courses" of Tamiflu area available through the strategic national stockpile should they be needed. CDC is providing ongoing surveillance of emerging flu strains and anticipates rapid availability of vaccine should infection begin to occur in workers in high-risk settings. State and Local Public Health Officials are Increasing Planning and Coordination The interface between public health agencies and state or local agriculture departments is critical. A public health response includes rapid situational awareness, laboratory testing, implementing public health recommendations around screening/isolation, and providing appropriate care (medications). Questions and planning scenarios specific to health officials may include the following: How will your team determine whether people are exposed and, importantly, symptomatic? Who will you dispatch to the farm to obtain testing for those symptomatic individuals? What is your approach to case investigations? How will you engage in symptom monitoring in this population? On the laboratory side, how will specimens be transported to the public health lab? Are your laboratories ready to receive/run those specimens, even if they are, for example, conjunctival? If positive, how will that specimen be sent to CDC for confirmatory testing? If positive, how will you communicate the result to the individual and counsel them on isolation? How will Tamiflu be provided (if indicated)? From what cache? What is your communications plan if positive? ASTHO will continue to work closely with our partners to monitor this situation and provide updates as they become available. website yes
Heart Disease and Stroke Prevention in the Pacific Territories heart disease, stroke prevention, american heart month, cardiovascular health, chronic disease, pacific territories, environmental infrastructure, disease epidemic, tobacco use, mental health, united states, physical activity, health problems, leading cause of death, health conditions, american heart, cardiovascular disease, chest pain, type of heart disease, coronary heart disease, heart health, flow to the heart, risk of heart disease, heart disease and stroke, prevent heart disease, astho, association of state and territorial health officials Marcus Plescia Heart disease and stroke prevention in the pacific territories. Each February, American Heart Month raises awareness for heart disease and cardiovascular health—a matter that warrants attention year-round. In ASTHO’s 2023 Environmental Scan, territorial health officials highlighted chronic disease prevention and treatment as top current public health program and service priorities, emphasizing heart disease and stroke as key focus areas. As such, I want to highlight heart disease as a public health issue in the U.S. territories, which have played an important role in ASTHO’s chronic disease prevention efforts. Several years ago, ASTHO CEO Mike Fraser pointed out Mark Durand’s work in the Pacific territories. Durand developed a list of prioritized chronic disease-related health policies and a matrix to map progress across six jurisdictions. This ultimately provided the basis for ASTHO’s Essential Policies for Chronic Disease Prevention and Control—which served as a foundation for ASTHO’s Heart Disease and Stroke Prevention (HDSP) Learning Collaborative—and led to the launch of ASTHO’s technical packages in all program areas. Heart Disease and Stroke Prevalence in the Pacific In the United States, heart disease is the first leading cause of death and stroke is the fifth. Disparities exist across several demographic lines, including race, ethnicity, and nationality. U.S.-Affiliated Pacific Islands (USAPIs) adults have the second-highest death rate from cardiovascular disease in the country. Additionally, in all USAPIs involved in ASTHO’s HDSP Learning Collaborative—Commonwealth of Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), Guam, and Republic of Palau—heart disease and stroke are in the top three leading causes of death, with cases soaring in recent years. The U.S. territories are home to small and diverse populations with rich history, cultural practices, and languages. Unfortunately, the long-lasting impacts of colonialism have weakened the social, cultural, and environmental infrastructure that has historically protected the health of USAPIs communities. In recent decades, health threats have shifted from infectious diseases to preventable chronic diseases; the Pacific Island Health Officers Association even declared a Regional State of Emergency in 2010 because of their non-communicable disease epidemic. Since this declaration, there has been increased interest in and efforts toward policy and health system interventions in USAPIs, which ASTHO has been proud to support through our learning collaborative. Heart Disease and Stroke Prevention Learning Collaborative: Key Accomplishments Since 2013, ASTHO has partnered with CDC to develop and sustain the HDSP Learning Collaborative, focused on improving rates of hypertension. In all, 36 participating states, territories, and freely associated states have implemented innovative strategies through systems, policy, and quality improvement processes. Historically, this learning collaborative—open to both states and islands—has focused on the design and implementation of hypertension control programs. In USAPIs, program efforts evolved to address and improve cardiovascular health more broadly. Although USAPIs workplans differ from each other, they all have advanced health equity by understanding community needs and adapting to health system capacity. Table-CMO Heart Disease Stroke Prevention in the Pacific Tools for Change/Spotlight-CMO Heart Disease Stroke Prevention in the Pacific website yes
Tobacco control has been a public health success in states across the nation, but there is still work to be done, especially surrounding the popularity of menthol and other types of flavored tobacco.
Reflections on ASTHO's time at the National Menthol Conference.
The disparities experienced during the COVID pandemic have brought a national focus to health equity in our nation. The attention and resources currently being provided to help address health inequities provide an opportunity that I have never experienced in my public health career. There are still challenges, but we have an opportunity to build momentum for the first time in decades if we can focus on implementing evidence-based strategies, demonstrating change and documenting our progress.
Every year on Nov. 22, ASTHO—and countless other agencies and organizations worldwide—take a moment to acknowledge the public health workforce on Public Health Thank You Day. Like so many other days of recognition, it has become a blip on our yearly calendar. And, simply put, that’s just not enough. This year, ASTHO leadership took pen to paper to share some of our feelings, fears, and—yes, our thanks—for everything the public health workforce has always done to protect us.
As we anticipate the likely approval of COVID-19 vaccination for children, our nation faces the final step to bring the COVID-19 pandemic under control. If approved for children ages 5-11, the COVID-19 vaccine will dramatically improve our efforts to resume in-person learning in our nation’s schools and will help break the cycle of transmission from children to adults.
The rise of seriously ill COVID-19 patients is a reminder of the primary role that public health departments play in responding to any outbreak: preventing community-wide transmission of disease.
Tobacco use is the leading preventable cause of heart disease, particularly in adults aged 35 to 64. This blog post breaks down ways the Surgeon General's report on smoking cessation may be helpful to state health officials.
A New Normal for Public Health Agencies Association of state and territorial health officials, astho, states and territories, covid-19, covid-19 pandemic, immunization, vaccination, influenza vaccination, chronic disease, opioid epidemic, behavioral health, public health, public health agency Marcus Plescia Public health agencies have had to face the challenge of managing the COVID-19 pandemic while also continuing to conduct their normal duties in maintaining the public’s well-being. As states and territories prepare to reopen many of the functions of their economies and communities, it is also time to pivot to a new normal at health departments nationwide. COVID-19 has been the most substantive threat facing public health in decades and required an urgent mobilization and redirection of resources for all public health programs. A crisis of this proportion would stress any agency, but following a steady decrease in workforce over the past decade, public health has been hit particularly hard. We cannot expect health departments to continue pre-COVID work and continue to sustain the COVID-19 response without adequately scaling up our resources. Many vital public health functions such as immunizations, chronic disease prevention, STI/HIV prevention, and the opioid overdose response have had to be scaled back in response to COVID-19. If this continues, it will soon have profound effects on the public’s health, even in areas where we have previously been successful, such as tobacco cessation and childhood immunizations. The new normal in public health must be an adaptation to the need to contain and control COVID-19 while simultaneously addressing the many other public health needs in a jurisdiction. We need to adapt to the new normal, but we cannot continue to do more with less. Scale Up Vaccination Campaigns The threat of other infectious disease outbreaks is an immediate concern for public health. As we desperately seek a vaccination for COVID-19, it should remind us of the important function of health departments in assuring access to existing vaccination schedules. Under current "stay at home" orders, many families have not participated in well-child visits. According to the Association of Immunization Managers, activities involving going out in the field have been suspended in most health departments. As a result, studies have estimated that the administration of the MMR vaccine has dropped substantially. The new normal means we must address this issue prior to the likely resumption of the school season this fall. Adult and child influenza vaccinations will also be far more important. If a predicted second wave of COVID-19 this fall is accompanied by a serious flu outbreak, the impact on the medical system could be catastrophic. Our vaccination efforts need to resume soon and go beyond traditional public health campaigns—like increased opportunities for large-scale immunization in non-clinical settings like parking lots, summer camps and workplaces. Prevent a Resurgence of Other Chronic Diseases It is never useful to pit one public health problem against another. But it is important to recognize that despite the substantial death toll of COVID-19 over a short period, heart disease and cancer continue to be the top killers in America. Last year there were 269,000 cancer deaths and 525,000 deaths from heart disease. State and local tobacco control programs have had a profound effect on reducing the incidence of these diseases, but tobacco-use trends that were concerning prior to the pandemic have worsened. COVID-19 has shifted public health’s attention from the concerning implications of the EVALI outbreak, and efforts to address e-cigarette use have been undermined in the last three months. The Food and Drug Administration (FDA) has now delayed the premarket review deadline for e-cigarettes because of COVID-19, and significant reductions in charitable giving have diminished the capacity of important tobacco control advocacy groups. Refocus on Diseases of Despair This pandemic came during an existing epidemic of addiction and opioid misuse that provided many indications of the strains on the fabric of our society that have now become so evident with COVID-19. Often referred to as "diseases of despair," the opioid epidemic, suicide, alcohol addiction, and domestic violence continue to rage across our society, and have worsened as a result of the stress and hardship of COVID-19. Some efforts to address behavioral health have been hampered by the challenges of continuing effective interventions and therapy during a pandemic. Recent reports of suicides among medical providers treating COVID-19 patients and soaring rates of calls to mental health crisis lines highlight the alarming national suicide trends we continue to experience, and addressing stigma and providing mental health first aid programs are important now more than ever. Protect the Most Vulnerable As we think about a new normal in public health, the core work of promoting and protecting the health of those at risk is particularly acute given the devastating toll of COVID-19 among the elderly and people of color. Social distancing rules have exacerbated social isolation among those who are physically debilitated or suffer cognitive impairment, a situation that will not improve as our plans to reopen America place significant emphasis on the need for continued mitigation strategies for groups at greatest risk. Mitigation strategies must shift from "social" isolation to physical isolation, and public health should help pursue policy and environmental interventions that provide resources and stimulation for those who have been "shut in" by the pandemic. In this new normal, public health needs to continue to look for ways to partner with clinical providers to encourage different forms of preventive services that address a wide range of both medical and social problems. Create a New Normal Public health plays an important role as a convener in addressing many population, medical and social issues. That role is critically important moving forward. The recently updated Healthy People 2030 objectives, which will launch in August are a way to reset our efforts and lead the new normal. They provide a shared vision for public health across sectors and regions, and the developmental and research objectives which are designed to address areas of substantial disparity between populations are particularly important to our experience with COVID-19. It is a challenging time in public health. COVID-19 has made it difficult to meet needs and still attend to longstanding issues. After decades of neglect, public health has little surge capacity. While public health practitioners are good at finding ways to do two things at once, this is not a sustainable model for health improvement. New funding streams are emerging for public health through testing and contact tracing that may provide resources for agency expansion. We must insist that this expansion of the public health workforce is long overdue and must be sustained. Once the pandemic is controlled, these contact tracers should stay in the workforce and expand public health capacity to control core infectious diseases like HIV and other STIs. Their focus should be expanded to engage creatively in other issues like violence prevention and better control of chronic disease risk factors like diabetes, hypertension, and tobacco use—all highly relevant to COVID-19 outcomes. Good leadership requires the ability to look ahead and get creative. That future will be with us before we know it, and if we are not attentive to it, the implications of the COVID-19 pandemic could ultimately be overshadowed by a resurgence of the public health issues that have plagued us in the past. The new normal means adjusting to the threat of COVID-19 while also sustaining the core work of public health. We can do two things at once, and always have, but sustained resources that will expand public health agency capacity have to be part of the high expectations of governmental public health to protect and promote the nation’s health. The new normal does not mean doing more with less. It means doing more with more. The success of our nation’s reopening depends on it. website yes
On Aug. 11, 2022, ASTHO's Chief Medical Officer issued a statement of support for CDC's new COVID-19 guidelines.
On Feb. 26, 2024, ASTHO's CMO issued a statement in response to several measles outbreaks currently occurring in the United States.
The refrain from the popular Police song “Don’t Stand So Close to Me” takes on new meaning in the current era of COVID-19 infection and control. Remember to isolate, quarantine, and social distance.
ASTHO Statement on FDA’s Announcement to Reduce Nicotine in Cigarettes ARLINGTON, VA—ASTHO’s chief medical officer, Marcus Plescia, issued the following statement on FDA’s announcement to reduce nicotine in cigarettes: “We are pleased that FDA is seeking public comment on a potential product standard to lower nicotine in cigarettes to make them less addictive. This is an important and aggressive intervention to address the tragic burden of tobacco use in this country. The highly addictive qualities of nicotine have led to the premature death and suffering of millions of Americans by making cigarettes hard to quit. The Association of State and Territorial Health Officials (ASTHO) looks forward to commenting on the proposed rule and we hope FDA will move forward with regulating the nicotine content of combustible cigarettes to prevent disease and save lives attributed to tobacco use.” ASTHO Press Release Boilerplate website yes