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This brief examines the ways states can support certification for community health workers.

This resource highlights state-based program initiatives tailored to improving hypertensive disorders of pregnancy outcomes.

Thousands have been diagnosed with cyclosporiasis, which can cause explosive diarrhea and be tough to track. Learn the latest outbreak and investigation details.

Ripple Effect: What USPSTF Recommendations Mean for State and Territorial Health Law What USPSTF Recommendations Mean for State and Territorial Health Law Andy Baker-White This Health Policy Update highlights how U.S. states and territories are using policy to codify important public health recommendations. The United States Preventive Services Task Force (USPSTF) is a volunteer panel of national experts that issues evidence-based letter-grade recommendations on clinical preventive services. Under the Affordable Care Act, services with an A or B grade must be covered by most private health insurance plans without cost-sharing, with similar requirements for Medicaid enrollees and Medicare beneficiaries. An estimate by the Department of Health and Human Services concluded that in 2020, these services reached approximately 264 million Americans. States and territories implement these recommendations through statutes and rules. ASTHO identified over 200 state and territorial laws referencing the USPSTF, including in insurance statutes, Medicaid rules, disease-specific laws, and state employee health plan requirements. Over the past year, the stability of USPSTF recommendations has come into question. The U.S. Supreme Court's June 2025 ruling in Kennedy v. Braidwood confirmed the HHS Secretary’s authority to block USPSTF recommendations and remove task force members. News reports in July 2025 indicated that HHS Secretary Kennedy intended to remove all USPSTF members, and in May 2026 fired the chair and vice-chair of the task force. Questions are being raised about whether USPSTF recommendations will be rescinded or downgraded and, if so, what the impact would be on states and territories. In addition, if the USPSTF fails to convene in the future, it cannot review newer data on preventive services, meaning existing recommendations could become outdated and USPSTF can’t make recommendations for new services. To meet these challenges, states and territories are taking steps to ensure the continued scientific basis for preventive health services within their own law. Dynamic References to USPSTF Recommendations States and territories often use dynamic references to USPSTF recommendations in regulating health plan coverage of preventive services. This allows the jurisdiction to automatically require coverage for the most current USPSTF recommendations. Laws in West Virginia (state employee health plans), Oregon (regulated health plans), Hawaii (health director standing orders), and Alaska (adult Medicaid enrollees) use this approach. While dynamic references allow jurisdictions to stay up to date with the recommendations, if the task force withdraws any guidance, then those preventive services would no longer require no-cost coverage without additional action from those jurisdictions. Some jurisdictions address this by specifying that certain USPSTF guidance changes will not apply. For example, Guam’s law requires continued no-cost coverage for colorectal cancer screenings and authorizes the health director to adjust diabetes screening recommendations if USPSTF recommendations cease. Illinois specifies that the 2009 USPSTF recommendations for breast cancer screening and mammography are not to be considered current because national medical bodies created differing recommendations for screening. Another way jurisdictions avoid the unpredictability of using dynamic references is locking in the date of the USPSTF recommendations that are used for coverage requirements. For example, Massachusetts requires its state employee health plan to cover USPSTF A and B recommendations that were in effect by July 1, 2023. Using a version of USPSTF recommendations from a specific date maintains a base level of coverage regardless of future changes, though adopting new recommendations or removing outdated recommendations would require separate action. During this year’s legislative sessions, several states enacted or proposed legislation to remove dynamic USPSTF references. For example, Maryland passed legislation (HB 637 and SB 385) to lock in the USPSTF A and B recommendations that were in effect on December 31, 2024. Washington enacted HB 2242 requiring coverage of USPSTF A and B recommendations in effect on June 30, 2025, as well as recommendations adopted by the state insurance commissioner. A bill passed in Delaware, HB 338, would require the use of the USPSTF recommendations from January 1, 2025. Overall, however, neither dynamic nor fixed references to USPSTF recommendations address how jurisdictions can keep up with new scientific data and advances in preventive services in the absence of ongoing USPSTF review and recommendations. To fill this need, some states have enacted legislation that creates processes for reviewing data and establishing recommendations. For example, the new Maryland law mentioned above also authorizes the state’s health secretary to adopt preventive service recommendations that have not been recommended by or that differ from USPSTF. The new process requires notice and a 30-day comment period, an analysis by the Maryland Health Care Commission, and citations to the authoritative medical body upon which the recommendation is based. Disease-Specific Statutes: USPSTF Grades as Care Standards and Thresholds Many states also use USPSTF grades as thresholds for specific preventive services, establishing the standard of care, or issuing standing orders. For example, Arkansas law defines "follow-up colonoscopy" by reference to a colorectal screening assigned an A or B grade by the USPSTF, while Nevada’s law directs primary care providers to use criteria set out in USPSTF recommendations to screen adult women for BRCA mutations. In Hawaii, the state health director is authorized to issue public health standing orders for current USPSTF A and B recommended services, and in Idaho the law uses USPSTF guidance for applying ocular antibiotic prophylaxis to newborns as the standard for medical practice in the state. Some states are considering legislation to distance preventive service coverage requirements from USPSTF recommendations. For example, while New Jersey's current law requires no-cost coverage for colorectal cancer screenings in accordance with the method and frequency recommended by the USPSTF, introduced legislation (A4916 and S4254) would remove the reference to USPSTF recommendations and instead authorize one screening per year for persons aged 33 or older. More broadly, Hawaii considered legislation (HB 1898 and SB 3133) that would have authorized the state’s health department to “make recommendations relating to clinical preventive service recommendations of the [USPSTF] Force that have been assigned a grade of A or B as of July 1, 2025” and require no-cost coverage for the department’s recommendations. However, this legislation did not pass. State Employee Benefit Plans USPSTF recommendations may also be used to establish preventive health services covered by state employee health plans. A West Virginia statute requires the state’s employee health plans to cover mammograms consistent with "current guidelines from the United States Preventive Services Task Force," while the health plan document further states that preventive services are "subject to change as USPSTF…recommendations are updated.” In Ohio, a regulation requires state employee health benefits include all USPSTF-recommended tobacco cessation services and authorizes the state health director to update covered services if USPSTF guidance changes. Missouri law requires full coverage of USPSTF graded A and B recommended prescription and prescribed over-the-counter drugs for state plan members. The Path Forward USPSTF recommendations have helped millions of Americans receive critical health services at no cost, and states and territories have built practices, programs, and standards on that foundation. From adopting fixed-date references to establishing state-level recommendation authority to creating new state review bodies, legislative activity this year reflects a broad effort to address ripple effects from potential future changes to or lack of USPSTF guidance. Health officials may be asked to assess their jurisdiction’s laws and their use of USPSTF recommendations, and coordinate with insurance commissioners, Medicaid directors, and employee benefits administrators to confirm consistent agency interpretation and identify where action is needed. ASTHO will continue to monitor these policies as they develop. article yes

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

Establishing an Office of Health Equity or Minority Health Learn how to establish, structure, and fund a health equity or minority health office. A dedicated office of health equity or minority health can provide a focus on cross-cutting efforts and strategies that help to improve services, outreach, and engagement with marginalized communities. This report delves into the typical scope for setting up a health equity or minority health office, including how to establish, structure, and fund it—providing a blueprint to island areas working to build one or considering establishing one in the future. In addition, it explores lessons learned from state offices of health equity or minority health, including California, Michigan, Nebraska, Nevada, New Jersey, New York, Ohio, Vermont, and Washington. Get the Report (PDF) website yes

Breastfeeding is considered the gold standard in postnatal care for both birthing persons and infants. Yet racial disparities in breastfeeding initiation and duration rates continue to persist. Effective intervention strategies require a multi-level approach that includes comprehensive legal, policy, and programmatic efforts.

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.

In 2020, the COVID-19 pandemic exacerbated barriers to care and treatment for individuals experiencing opioid use disorder. Experts estimate a record-setting 90,000 people died of a drug overdose in 2020. Additionally, as the pandemic continues, it has understandably diverted attention, funds, and personnel usually focused on the opioid crisis. State and local public health departments are experiencing an all-time low in staffing, especially among Maternal and Child Health programs.

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

May is Mental Health Awareness Month and the importance of continued mental health promotion and suicide prevention efforts during the COVID-19 pandemic. As we address the physical effects of COVID-19 through social distancing, mask wearing, and vaccination, we still need to prioritize mental health and well-being during and after the pandemic. A recent Morbidity and Mortality Weekly Report found increases in adults reporting symptoms of anxiety or depression (36.4% to 41.5%) and unmet mental health care need (9.2% to 11.7%) between Aug. 2020 to Feb. 2021.

Mejorando el Manejo de Desempeño en las Operaciones de Salud Ambiental del Condado de Licking, Ohio Colton Anderson El manejo de desempeño es crucial para garantizar la efectividad y eficiencia de las operaciones de un departamento de salud. En salud ambiental, donde las regulaciones, los estándares y las preocupaciones de salud pública son primordiales, un manejo de desempeño efectivo asegura que tareas como la supervisión de la calidad del aire y del agua, la inspección de instalaciones para el cumplimiento de normas y la respuesta a emergencias ambientales se realicen con precisión y puntualidad. Además, permite que un departamento de salud identifique áreas de mejora, asigne recursos de manera eficiente y se adapte a las condiciones ambientales cambiantes o a los requisitos regulatorios. El Departamento de Salud Ambiental del Condado de Licking, Ohio, no solo está implementando prácticas de manejo de desempeño, sino que también las está alineando con los Estándares y Medidas de Reacreditación de Salud Pública, mientras rastrea diligentemente los datos para facilitar la mejora continua, que compartieron durante un seminario web sobre el Manejo de Desempeño en Salud Ambiental para fortalecer la capacidad de los beneficiarios de la subvención para la Infraestructura de Salud Pública. Optimizando el seguimiento de desempeño Mejorar el seguimiento del desempeño puede variar desde utilizar una hoja de cálculo de Excel bien estructurada con gráficos de líneas claros hasta emplear un software sofisticado de manejo de desempeño. Al desarrollar y seguir consistentemente medidas que se adapten a las necesidades del departamento de salud ambiental, el proceso no solo se vuelve claro, sino también sostenible, fomentando la toma de decisiones informadas. El Departamento de Salud Ambiental del Condado de Licking ha implementado un enfoque exhaustivo para organizar su sistema de seguimiento, segmentándolo por área de programa y adaptando las medidas para satisfacer las necesidades y objetivos específicos de cada dominio. Se han logrado éxitos notables al integrar sin problemas las medidas de desempeño en el sistema general de manejo de desempeño del condado, un logro alcanzado tras exhaustivos esfuerzos de mejora de calidad en su programa de plomería y operaciones de servicios fiscales. Entre estas iniciativas, se lanzó un proyecto notable para abordar problemas relacionados con los permisos de plomería a punto de expirar y la falta de un mecanismo de seguimiento confiable para las fechas de vencimiento. A través de mejoras estratégicas en los procedimientos de almacenamiento y seguimiento de permisos, el condado ahora cuenta con la capacidad de evaluar con precisión la tasa de vencimiento mensual de los permisos de plomería. De manera similar, se inició otro proyecto para reducir la emisión excesiva de reembolsos dentro del departamento. Al investigar las causas raíz de las solicitudes de reembolso, esta iniciativa facilitó el establecimiento de una medida de desempeño destinada a monitorear los montos mensuales de reembolso, asegurando así la adhesión a la asignación presupuestaria anual para reembolsos. Comunicando las medidas de desempeño Comunicar de manera efectiva las medidas de desempeño es esencial para la transparencia, la responsabilidad y la alineación con los objetivos organizacionales. Comunicar claramente y de manera regular los datos de desempeño permiten a los interesados comprender el progreso del departamento, identificar áreas de mejora y celebrar los éxitos. Un aspecto crucial de la comunicación de las medidas de desempeño es el uso de formatos accesibles y comprensibles. El departamento utiliza diversos canales de comunicación (por ejemplo, reuniones de personal, boletines departamentales, portales de intranet) para difundir los datos de desempeño de manera efectiva. Los recursos visuales, incluidos gráficos, tablas y tableros, presentan información compleja en un formato comprensible, facilitando la comprensión y el compromiso del personal. Estrategias de Manejo de Desempeño Equitativas En la búsqueda de la equidad dentro del manejo de desempeño, el Departamento de Salud Ambiental del Condado de Licking ha establecido vínculos transparentes entre los objetivos de los empleados y las prioridades organizacionales, apoyando la flexibilidad para acomodar diversas necesidades. Reconociendo el papel fundamental de los gerentes, el departamento invierte en mejorar sus habilidades de coaching para garantizar una toma de decisiones justa en las operaciones diarias. Además, el departamento implementa un enfoque matizado para la evaluación del desempeño, recompensando efectivamente el desempeño sobresaliente en ciertos roles mientras aborda y mejora el desempeño en otros. Como parte de su compromiso con la salud pública y la equidad, el departamento también opera un Programa de Cumplimiento Mejorado, ofreciendo inspecciones adicionales de seguridad alimentaria a las instalaciones que no cumplen con el Código de Seguridad Alimentaria de Ohio. Las inspecciones mensuales proporcionan apoyo continuo a estas instalaciones en la implementación de procedimientos adecuados de seguridad alimentaria, complementadas con sesiones de capacitación gratuitas en el sitio para capacitar a los operadores de alimentos con el conocimiento y las habilidades esenciales. A través de estos esfuerzos concertados, el departamento se esfuerza por fomentar la equidad en las prácticas de salud ambiental dentro de la comunidad Lecciones aprendidas y direcciones futuras A partir de la experiencia del Condado de Licking, es fundamental establecer un ritmo adecuado para integrar el manejo de desempeño en las operaciones del departamento. Comenzar con pocas medidas nuevas y monitorearlas regularmente para establecer pequeñas victorias al principio es clave para una implementación sostenible a largo plazo. Por ejemplo, documentar las fuentes de datos o los informes utilizados para actualizar sus tableros hizo que mantener las medidas de desempeño actualizadas fuera mucho más sencillo, especialmente para el personal nuevo. El Condado de Licking cree que su departamento de salud local debe esforzarse por operar todos sus programas de manera óptima. Tienen un gran número de medidas de desempeño vinculadas a las operaciones para garantizar una entrega óptima de los programas. Si bien las tareas programáticas se ejecutan a un alto estándar, si no logran mejoras en los resultados de salud o equidad, esto sirve como un catalizador para discutir posibles ajustes en el modelo de entrega del programa. A medida que el Condado de Licking continúa refinando su enfoque, busca activamente mejorar su sistema de manejo de desempeño alineando más estrechamente las medidas con los resultados de salud, enfatizando el impacto y la equidad. En última instancia, como indicó el Subcomisionado de Salud del Condado de Licking, Greg Chumney, "el manejo de desempeño se ve diferente para todos". A través de la dedicación, la innovación y la colaboración, el manejo de desempeño continuará siendo un pilar fundamental para avanzar en la salud ambiental y el bienestar público. article yes

The COVID-19 pandemic has presented many challenges for breastfeeding families and state breastfeeding initiatives. This brief discusses these challenges and how states in ASTHO’s Breastfeeding Learning Community are overcoming COVID-19 challenges 

This brief highlights how the Georgia Department of Public Health and the Ohio Department of Health developed robust opioid overdose surveillance systems.

The opioid crisis continues to claim the lives of thousands across the United States and has cost the economy billions in health care, mortality, and criminal justice costs. In 2018, it’s estimated that 67,367 people died of overdose, with opioids (prescription opioids, heroin, and other synthetic opioids other than methadone) made up almost 70% of overdose deaths. Provisional data for the twelve-month period ending December 2019 shows that there were 71,130 overdose deaths, with 50,178 overdose deaths attributed to opioids. The COVID-19 pandemic has also exacerbated the drug overdose crisis. Data shows that in the time of continued lockdowns and social distancing that overdose rates have increased, indicating a sustained need to support people with substance use disorder.

Responsible for planting, growing, harvesting, processing, and preparing the food we eat, agricultural workers are essential workers during the COVID-19 response to keep the U.S. food supply chain operating efficiently. But farmworkers are particularly vulnerable to COVID-19 due to lack of physical distancing, lack of access to health insurance and sick leave, and poor access to clean water for handwashing throughout the work day.

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

This Health Policy Update is an overview of state legislative activity to increase financial stability for families during the COVID-19 pandemic which may help to prevent adverse childhood experiences.

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

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.