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In-depth analysis on state health policy surrounding the public health workforce. This is part of ASTHO's annual legislative prospectus series.

ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on data modernization and privacy.

ASTHO Legislative Prospectus | Prevention 2025 state legislative action on infectious disease control and prevention.

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

Opportunities for Public Health Agencies to Advance Sustainable Financing of Community Health Worker Programs Advancing Sustainable Financing of Community Health Workers Explore how health officials can play key roles as funders, administrators, and policy designers to advance sustainable financing of community health workers. Many states face upcoming funding gaps for community health worker (CHW) positions, with COVID-19 related grant funding streams expiring. Concurrently, many states are rapidly beginning to cover CHW services under Medicaid. In addition, Medicare launched a new reimbursement opportunity for CHWs in January 2024. These factors create an opportunity for state and territorial health agencies to develop or contribute to equitable reimbursement and robust implementation. This report details how health officials can play key roles as funders, administrators, and policy design champions to ultimately advance sustainable financing of CHW services. Get the Report (PDF) website yes

Supporting Resilience in Rural Areas Through Cross-Sector Partnerships ASTHO, Association of State and Territorial Health Officials, rural health, public health, public health partnerships, health in all policies, government agencies, community organizations, academic institutions, rural populations, infrastructure improvement, healthcare systems, environmental determinants, climate change, sustainable practices, environmental challenges, extreme weather, environmental health risks, protective factors, engaging rural partners, building trust, idaho department of health and welfare, michigan department of health, health equity, austin climate equity plan, healthy start oregon, kansas department of commerce, wisconsin broadband access, chesapeake housing mission Ali Aslam The key to making rural communities more resilient is for public health to partner with community organizations, governmental agencies, and other critical partners. Working across sectors of government agencies, community organizations, businesses, and academic institutions is critical to address public health challenges in rural communities. Using a Health in All Policies (HiAP) approach helps public health agencies better address the interconnected social, economic, and environmental determinants of health impacting rural communities and improve community well-being. HiAP brings together a multitude of perspectives to develop holistic strategies that can support infrastructure improvements, sustainable land use practices, diversified economic opportunities, safer and healthier home environments, and robust health care systems in rural communities. Through community leadership and collaboration, this cross-sector approach can enhance the capacity of rural communities to build resilience, adapt to climate change, and foster long-term sustainability to improve public health outcomes. Learn how states are implementing HiAP strategies to improve health in their rural communities in this report. Get the Report (PDF) website yes

This report, based on findings from ASTHO’s 2022 Environmental Scan, dives into how Health in All Policies strategies can promote health equity.

States Partner Across Sectors to Address Lead Poisoning Kayley Humm, Kerry Wyss, Ali Aslam Learn in this brief how three states are using partnerships to improve lead testing and reduce cases of lead poisoning. ASTHO partnered with the National Center for Healthy Housing (NCHH) to provide technical assistance and capacity-building support for lead poisoning prevention efforts in three state health agencies: Maryland Department of Health, North Dakota Department of Health and Human Services, and Arkansas Department of Health. This brief highlights each agency’s strategies for collaborating across sectors along with accomplishments for strengthening lead poisoning prevention capacity in each jurisdiction. Many of these strategies align with those used in a health in all polices (HiAP) approach to lead poisoning prevention. State Examples Maryland Department of Health Maryland adopted a collaborative approach to prevent lead poisoning. The Maryland Department of Health (MDH) has an established lead poisoning prevention program that partners with the Maryland Department of the Environment. The Department of the Environment oversees the childhood lead registry and case management, while MDH focuses on lead testing regulations and Medicaid services. This partnership has been implemented across the 24 local health departments in the state. Maryland enhanced lead case management by providing staff support and tackling complex cases that require additional assistance. In addition to supporting an increase in lead case management activities and lead awareness, ASTHO funding also helped strengthen collaboration and coordination among local health departments, state agencies, and local health care providers. The MDH Environmental Health Bureau also improved efficiency by moving data from the lead registry to MDH for lead surveillance and case management. They also developed and launched sub-county lead testing data as part of their Environmental Public Health Tracking public portal. These activities align with HiAP strategies of developing and structuring cross-sector relationships, coordinating funding and investments, and synchronizing communications. North Dakota Department of Health and Human Services The North Dakota Department of Health and Human Services (NDHHS) made significant strides in building up the state lead program, which recently transitioned from the department of environmental quality to NDHHS. With support from ASTHO and NCHH, NDHHS developed a lead prevention website with a data dashboard, developed a lead screening questionnaire, and built collaborative partnerships. The activities in North Dakota align with the HiAP strategies of developing and structuring cross-sector relationships, synchronizing communications, and integrating research, evaluation, and data systems. Building collaborative partnerships is a key initiative for the NDHHS lead program. Already developed partnerships include stakeholders such as Health Tracks and WIC. Health Tracks developed a newsletter article for their provider network so physicians can stay up to date and aware of the lead program transition and lead testing changes, and WIC will host informational lunch and learns to raise awareness about lead testing within their network. North Dakota is also prioritizing building partnerships with tribal communities. A tribal communications plan was developed with the goal of establishing an effective communication plan between the state of North Dakota and each tribal government for lead-related events. Anticipated outcomes from the communication plan include testing for blood lead levels, conducting environmental assessments on tribal lands, and seeing if a tribal member or government is interested in hosting a lead screening event. Progress has been made with the Standing Rock Sioux Tribe, Turtle Mountain band of Chippewa, and NDHHS is hopeful to establish intertribal meetings with all four governmental tribal representatives. Arkansas Department of Health The Arkansas Department of Health established its lead program in 2011 to support abatement of lead-based paint in residential and commercial properties. With support from ASTHO and NCHH, Arkansas has been using a data-driven approach to gain a more comprehensive understanding of lead exposure burden in the state. These activities align with the HiAP strategy of incorporating health data into decision-making and integrating research, evaluation, and data systems. The Arkansas Department of Health conducts periodic audits on its data system to support access to timely and accurate data. To improve data quality and frequency of blood lead testing reports, the health department is establishing incentive programs to encourage facilities to report cases of elevated blood lead. In addition to conducting outreach to its partners, the Arkansas Department of Health has been working to improve lead case data access and data quality through data mining efforts, case report matching, and migration to a new lead surveillance system. Arkansas has been working to modernize the current reporting system to facilitate automation and promote overall efficiency of data analysis and case identification. Conclusion The collaborative efforts of Maryland, North Dakota, and Arkansas highlight the importance of multi-sector partnerships and data sharing in addressing lead poisoning prevention and align with many of the strategies used in a HiAP approach. Each state implemented tailored strategies that sought to grow collaboration in its unique context. These initiatives highlight the importance of cross-sector collaboration in public health initiatives and may serve as valuable models for other jurisdictions. article yes

This toolkit is designed to support public health leaders in leveraging the policy development process to achieve health equity in their jurisdiction.

Learn how the Maryland Department of Health leveled up their strategic planning process to improve their critical public health work in this blog post.

Good news and bad news on tobacco use: smoking rates are down but e-cigarette use continuing rapid rise among youth. Read how states are combating the problem.

Cases of sepsis and septic shock can be prevented with strong health policies as shown in New York. Several states have taken action to enact mandatory early detection and treatment protocols.

Public Health Approaches to Preventing Suicide and Promoting Mental Well-Being Public Health Approaches to Preventing Suicide Caitlin Langhorne Griffith, Arnelle Toffey Learn how to execute public health approaches to preventing suicide, which requires understanding the dynamics of policymaking and implementation. Despite ongoing prevention efforts, suicide remains a leading cause of death and disability among Americans of all ages, racial and ethnic groups, geographic regions, and socioeconomic statuses. While suicide affects populations at all levels, it continues to be the second leading cause of death in individuals under 44 and disproportionately impacts veterans, individuals with lower income and educational attainment, and residents in rural areas, among other groups. Approximately 6% of the U.S. population has a Serious Mental Illness (SMI) (e.g., bipolar disorder, major depressive disorder, and schizophrenia), and a 2022 study found that almost 10% of people who die by suicide had a known SMI. In addition, individuals with or without SMI can experience suicidal ideation or attempts. Factors such as adverse childhood experiences, limited access to health care, and economic instability can contribute to suicide risk. Public health approaches that expand treatment access and address the drivers of suicide risk can help foster mental well-being in communities and reduce the risk of individuals dying by suicide, including those with SMI. However, executing these approaches requires understanding the dynamics of evidence-based strategies in policymaking and implementation. Population-Based Approaches Expanding access to mental health care is critical for reducing risk and managing symptoms of mental illness, as only 50% of young adults (18 to 25 years old) and 53% of adults (26 to 49 years old) with any mental illness received treatment in 2024. However, barriers to mental health care — such as availability of providers, access to telehealth, cost, and other systemic factors — can prevent individuals from receiving treatment, especially during serious declines in mental health. Population-based approaches can fill this gap by focusing on non-clinical interventions and activities that address chronic stressors and other factors contributing to mental health declines, improving mental health outcomes. Examples of these policies include: Addressing structural determinants of suicide risk (e.g., economic security). Promoting access to clinical services (e.g., Medicaid expansion and state mental health parity laws). Limiting access to lethal means for suicide (e.g., child access prevention laws and access to high-risk medications). 988 Suicide & Crisis Lifeline State health agencies can also consider approaches that provide and enhance direct crisis support. The 988 Suicide & Crisis Lifeline is a nationwide hotline that provides emotional support to individuals experiencing suicide, mental health, or substance use crises. Since its launch in July 2022, call volumes have steadily risen in all states, and the Lifeline has been shown to improve callers' mental well-being as well as reduce suicide risk. Implementation of the 988 Lifeline occurs at both the state and local levels, resulting in variations in funding and infrastructure across communities. In the most recent legislative session, jurisdictions enacted legislation to fund and sustain 988, ensuring consistency in quality and access across all communities. For example, North Dakota SB 2200 allocates funding for 988 operations from a community health trust fund, while Texas HB 5342 established a trust fund outside of the state treasury to support the 988 Lifeline. States also enacted legislation either consolidating (Colorado SB 236) or ensuring interoperability with 988 and 911 emergency lines (Nebraska LB 362), streamlining services and accessibility for those in need of mental health support. In addition, 12 states have adopted a 988 telecom fee — similar to fees that support 911 infrastructure in every state — to create a sustainable financing source for 988. Adolescent Mental Health Support at School Schools are a critical setting to support adolescent mental health, particularly for children with serious emotional disturbances who are at elevated risk of suicide. Several states have mandated suicide prevention training requirements for school personnel as part of ongoing professional certification requirements. Federal funding — such as the Suicide Training and Awareness Nationally Delivered for Universal Prevention Act, which focuses on evidence-based programs for students — can help states and tribes establish/expand training for school staff and equip them with the education to recognize warning signs and connect students to resources, alongside student-directed programs that increase mental health literacy and foster peer support. In the 2025 legislative session, at least three states enacted legislation focused on preventing youth student suicide. Kentucky (HB 48) and Montana (SB 369) mandate training for school staff on suicide awareness and prevention, while Virginia HB 2055 requires school staff to provide materials to parents on suicide prevention (including the safe storage of firearms) if they believe a student is at imminent risk. At least three additional states enacted legislation that requires student identification cards to include mental health information and suicide crisis resources, including the 988 Lifeline (Colorado SB 326, Illinois HB 3000, New Jersey A 4897). Georgia HB 268 requires public schools to provide at least one hour of suicide awareness prevention and training to students in grades 6-12. Conversely, an Idaho bill (SB 1199) that would amend a 2024 law to allow minors to access medical treatment when calling the 988 Lifeline without parental consent passed the Senate but did not advance in the House. Jurisdictions have also incorporated policies that provide additional safeguards for adolescents and their use of the internet: Utah recently enacted SB 98, which requires the state Board of Education to create a video presentation for parents outlining the safety and legal issues students may encounter while using technology. Maryland's SB 310 expands the state's Youth Suicide Prevention School Program to include instruction to students on the relationship between gambling and youth suicide. At the federal level, Congress is considering the Kids Online Safety Act, which requires platforms, applications, and streaming services that connect to the internet to exercise care in creating and implementing design features to prevent and mitigate harm to minors. Looking Forward It is important to understand suicide prevention approaches nationwide, including how jurisdictions formalize and strengthen suicide prevention infrastructure as well as promote healthier environments. Strategies for policymakers include the following: Analyzing and comparing suicide prevention infrastructure laws nationwide to identify gaps and guide jurisdictional changes. Building protective environments that address upstream social and structural risk factors (e.g., access to clinical services and food insecurity), while advancing policies that reduce access to lethal means. Strengthening school-based prevention efforts by leveraging available funding to expand evidence-based programs, train school staff, establish student-directed programs, and connect students to needed resources. Promoting safer online spaces for youth with policies that limit harmful design features, strengthen parent engagement, and increase online platform transparency. Continuing investments in crisis services to expand and sustain programs like the 988 Lifeline. Prioritizing economic support policies to strengthen families and reduce ACEs, supporting healthier development and well-being. Leveraging these legal and policy frameworks can reduce suicide risk, support mental well-being, and build a stronger public health system for all. article yes

Learn about how five jurisdictions approached self-measured blood pressure monitoring programs to reduce hypertension and uncover systemic barriers to care.

PrEP is a powerful tool to reduce new HIV infections; expanding access to PrEP is a priority within the federal Ending the HIV Epidemic in the U.S. initiative. One way to increase access to PrEP is by allowing pharmacists to prescribe and dispense it.

This ASTHOBrief contains three key recommendations for improving the 2013 CDC/CSTE Cancer Cluster Investigation Guidelines.

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.

ASTHO’s guidebook, Leading Public Health Practice Through Health Informatics and Technology, provides additional information on achieving bidirectional data exchange and preparing for electronic case reporting adoption and implementation.

Social determinants of healthcare are the conditions in which people are born, live, work, play, worship, and age. Read how these issues affect population health.

This infographic highlights 10 high-level strategies to advance work in school behavioral health.