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Learn about the importance of exploring intermediaries that work alongside existing data platforms in addressing ongoing public health challenges.

States Amending Policies to Slow Congenital Syphilis Increases States Trying Policies that Increase Syphilis Testing Amelia Poulin State are exploring ways to slow the rapid increase of congenital syphilis cases by strengthening policies to require testing at key points during pregnancy. Syphilis among newborns, or congenital syphilis, is preventable. Yet the latest CDC data show that congenital syphilis cases have more than doubled (106%) from 2019-2023. In 2023 alone, there were nearly 4,000 cases of congenital syphilis resulting in 279 stillbirths and infant deaths. Timely testing and adequate treatment during pregnancy might have prevented up to 80% of these cases. Increases in congenital syphilis often mirror increases in syphilis among reproductive-aged women. From 2022 to 2023, the rate of syphilis (all stages) increased 6.8% among women aged 15–44 years; rates also increased in 39 states and Washington, D.C. CDC recommends testing pregnant women for syphilis at the first prenatal visit, as well as at 28 weeks gestation and delivery if they are at increased risk of infection. Syphilis testing recommendations extend to asymptomatic women who are at increased risk for infection as they may face additional barriers to health care. ASTHO’s policy-level interventions for states and territories suggest universal syphilis testing for pregnant women. Additionally, states have been taking action to increase access to syphilis testing for people, including those who are pregnant. The Syndemic Perspective A history of incarceration, sex work, drug use, and geography can all significantly increase risk for sexually transmitted infections (STIs), HIV, tuberculosis (TB), and more. Structural barriers, including housing instability, economic insecurity, stigma, and restricted health care access, create conditions that heighten vulnerability to multiple infections. These conditions do not occur in isolation but rather as part of a syndemic, where overlapping epidemics interact with and exacerbate one another. Health agencies may be positioned to address upstream and root cause issues recognizing and addressing the intersections of these disease areas and related structural and social issues (e.g., drug use and poverty). Health agencies carry a wealth of interdisciplinary expertise, with staff leading efforts around data collection and surveillance, policy, community mitigation, and more, all of which support capacity to identify root causes and design an evidence-based, multifaceted response. Policies that prioritize housing stability, harm reduction services, and access to comprehensive health care, including STI screening, can help mitigate these risks and improve health outcomes. Geography can also increase the chances of syphilis transmission. Some regions with limited health care infrastructure, provider shortages, and limited STI prevention program funding and capacity may have higher rates of infection. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Social and economic differences across different geographic locations contribute to varying levels of disease burden. By adopting a syndemic framework, states can move beyond disease-specific interventions and implement comprehensive strategies that address upstream factors contributing to disease transmission. State Actions Several states have introduced or passed legislation to expand syphilis testing access, with a focus on increasing screening opportunities, mandating insurance coverage, and ensuring appropriate prenatal testing protocols. Syphilis Testing In 2024, Colorado enacted HB 24-1456, which gave the state’s Board of Health rulemaking authority over syphilis testing. This flexibility allows the state to adapt its public health response based on emerging epidemiological trends as new data on syphilis transmission and congenital infections become available. The 2025 legislative sessions have highlighted additional approaches to expanding access to syphilis testing. The New York legislature introduced S 2704, which would require health insurance coverage for certain approved STI home test kits. This policy would provide individuals who face barriers to in-person care a convenient and private way to get tested and stay healthy. Oregon is also addressing testing accessibility through HB 2943, which would require hospitals to test people for HIV and syphilis when they have blood tests done in the emergency department (ED). Since EDs often serve populations who do not routinely access preventive health care (e.g., people experiencing homelessness or struggling with substance use disorders), this legislation would strengthen the role of emergency settings in STI prevention and intervention. Perinatal Syphilis Testing Recognizing the importance of perinatal screening, several states have introduced legislation to add requirements for syphilis testing at key points in pregnancy. Tennessee recently enacted SB 1283, which requires that health care providers take a blood sample to screen for syphilis, hepatitis B, and hepatitis C at the first prenatal examination, ten days after the examination, and at delivery. This approach aligns with CDC recommendations and ensures infections are identified and treated in time to prevent congenital transmission. Similarly, Nebraska LB 41 would require testing for syphilis at the first examination, in the third trimester, and at birth (with the mother’s consent), reinforcing a multi-point screening strategy to detect and treat infections that may develop later in pregnancy. Missouri’s SB 178 would take a comprehensive approach to syphilis prevention during pregnancy by requiring an additional test at 28 weeks, a critical point for intervention. The legislation would also require treatment for mothers who test positive for an STI, reducing the risk of congenital infections. Additionally, it would expand Expedited Partner Therapy by allowing any health care professional authorized to prescribe medications to administer Expedited Partner Therapy as well as include other STIs in the treatment, enabling faster treatment for sexual partners who might otherwise go untreated and continue the cycle of transmission. Policy Considerations Expanding both syphilis and perinatal syphilis testing policies demonstrate a growing recognition of the need for proactive, evidence-based strategies to address the increasing rates of syphilis and congenital syphilis. However, the ability of policies to affect public health outcomes may depend on continued resource allocation, workforce training, and public awareness campaigns. State and territorial health agencies can consider additional measures, such as integrating syphilis screening into routine primary care visits and providing funding for community-based outreach. Conclusion These legislative actions represent various approaches states are taking to addressing syphilis. Implementing screening protocols aligned with current evidence may contribute to efforts to address syphilis and congenital syphilis. By leveraging legislative action and evidence-based interventions, states can improve health outcomes and reduce disparities in syphilis and other STIs. A comprehensive approach that includes additional testing, expanded health care access, and targeted interventions for populations at higher risk for infection or severe disease may ensure better health outcomes for parents and infants alike. ASTHO will continue to monitor and report on this important public health issue. article yes

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.

Explore how states are enacting legislation to help justice-involved people avoid overdose illness and death and foster a smooth transition after release.

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.

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

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.

These states are connecting public health and transportation to improve access to healthcare—learn how in this report.

This brief outlines some of the barriers that pregnant and postpartum women with opioid use disorder face, as well as examples of state legislation passed to address recovery program implementation, treatment funding and insurance coverage, and provider education.

This report analyzes way that public health officials can mitigate the impact of disasters on pregnant people, neonates, and infants through a variety of policies, including policies related to preparing for, responding to, and recovering from a public health emergency.

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 ASTHOReport serves as a primer for state and territorial health agencies seeking to assess the public health impacts of lead exposure in drinking water.

This blog from ASTHO’s PH-HERO team touches on the importance of trauma-responsive leadership in the public health workforce.

State and federal actions to expand the doula workforce and improve maternal health.

While communities transition from emergency response to long-term monitoring and recovery, the federal government and states are taking legislative action to improve emergency preparedness capabilities.

Following disruptions to daily life caused by the COVID-19 pandemic, emergency departments saw an increase of mental health-related visits. A June 2021 study showed a significant increase of mental health-related visits among 12–17-year-olds compared to the previous year. States and territories that implement a comprehensive public health approach to suicide prevention across all domains of life—an approach known as the socio-ecological model—can reduce contributing risk factors.

States are preparing to keep their communities safe during severe storms and low temperatures this winter.

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

Centering the Community’s Voice in State-Led Health Equity Initiatives health equity, public health departments, health outcomes, michigan public health institute, health disparities, underserved populations, marginalized communities, people of color, indigenous people, premature deaths, minority health, cultural competency, public health, life expectancy, improving health, american indians, health service, african american, native american, social determinants of health, sexual orientation, mortality rate, socioeconomic status, covid-19 pandemic, higher rates, alaska natives, group of people, racial groups, social economic, population health, department of health, astho, association of state and territorial health officials Lana McKinney, Jessica Fepelstein Establishing the community voice in health policy discussions. Over the past two years, ASTHO has worked directly with state public health departments and their communities to build capacity for improving health outcomes. These public health departments are building a culture of health equity through policies, practices, and quality improvement measures. This includes the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative—a 10-state learning community hosted by ASTHO, the CDC Foundation, and the Michigan Public Health Institute. STRETCH supports states in operationalizing health equity and preventing the constant pressures caused by negative health outcomes on their communities. For example, poverty can create constant pressures just as water pushes against a dam, which can build to the point of breaking and push people into poverty. Additionally, ASTHO supports state and territorial recipients of CDC’s COVID-19 Health Disparities grant to improve the health of high-risk and underserved populations disproportionately impacted by the COVID-19 pandemic. Health disparities impact the quality-of-life and financial well-being of communities, with the economic burden of health disparities increasing from $320 billion in 2014 to $451 billion in 2018. This includes associated costs of excess premature deaths, lost labor market productivity, and excess medical care for Americans of color as compared to their white counterparts. Events in recent years, such as the COVID-19 pandemic, revealed the pressures that Black, Indigenous, People of Color (BIPOC) and other marginalized communities experience because of health disparities. Aligned with the technical assistance received by public health departments, several states have taken concrete steps to achieve optimal health for all by supporting training of public health staff and increasing engagement of under-represented and underserved communities in the policy process. Promoting Staff Health Equity Training Ensuring that public health staff and other leaders are equipped with the knowledge, skills, and attitudes necessary to provide culturally competent and equitable care to all patients, regardless of their social background or identity can improve health outcomes. In recent years, states have worked to expand access to cultural competency and humility training for health system workers. Nevada enacted legislation (AB 267) requiring the state Board of Health to establish the frequency for medical facilities and dependent care facilities to conduct cultural competency training for employees who have direct patient contact. It also (1) requires the Office of Minority Health and Equity and Department of Health and Human Services to establish and maintain a public-facing list of approved courses for cultural competency training, and (2) require nurses, psychologists, marriage and family therapists, counselors, social workers, and behavioral analysts to complete a minimum of three hours of cultural competency training to successfully renew their license. At least four other states—Illinois (SB 2427), Massachusetts (S 1413), Virginia (SB 1440), and Vermont (H 512)—considered bills expanding access to cultural competency training for health care professionals. Vermont’s bill would implement the recommendations of the Health Equity Advisory Commission to provide training and continuing education for health care providers to improve cultural competency, cultural humility, and antiracism in Vermont’s health care system. Public health agencies can also promote health equity training by allocating funding and providing training. For example, the Arizona Department of Health Services leveraged funding from CDC’s COVID-19 Health Disparities grant to establish the Advancing Health Equity, Addressing Disparities (AHEAD AZ) program with the University of Arizona Center for Rural Health, which supports the health care and public health workforce, including support for Arizona’s 17 Critical Access Hospitals health equity strategic plans, and implementing a COVID-19 testing program that provided testing to communities most in need regardless of socioeconomic or immigration status, including those living in correctional facilities and unhoused people. Health Equity Commissions Health equity commissions play a critical role in advancing optimal health for all by bringing together experts, stakeholders, and policymakers to draw on evidence-based approaches that address the root causes of health disparities and to develop strategies to prevent them. At least two states proposed legislation related to health equity commissions in 2023. Colorado passed a law (SB 23-151) extending its Health Equity Commission through 2029. New Jersey is considering S 3136, which would establish and require a Commission on Health Equity to, among other things, recommend implicit bias training requirements for health care providers. Empowering Community Members to Engage in the Policy Process Hearing directly from community members, particularly those with lived experience, provides health agencies with unique insights into the community’s needs and daily life, and helps gain support from those most affected by the policy. There can be several barriers to holistic community engagement, particularly for community members who have fewer resources. Policymakers can take steps to lower these barriers by providing access to childcare, supporting transportation costs to a meeting, and/or compensating community members for their time and effort supporting the policy development process. In 2022, Washington enacted SB 5793 to compensate community members with lived experience for their time and expertise when serving on boards, commissions, councils, committees and other similar policymaking groups. The law directed the state’s Office of Equity to develop equity-driven compensation guidelines for all state agencies, which Washington’s Department of Health used to create and implement its Community Compensation Guidelines. These compensation guidelines outline how and when community members can be paid for their time and expenses when engaging in the policy process. Such methods are particularly valuable because the communities facing the most inequity are also the ones most systemically marginalized. Similarly, in 2023 Oregon’s legislature considered SB 694 to create a Task Force and Work Group Stipend Fund. The fund would provide for providing members who do not otherwise receive compensation for their participation to be compensated for their time and travel for task force or workgroup related work. ASTHO will continue to monitor policy developments supporting health equity programs and initiatives, providing relevant updates. Special thanks to Maggie Davis, JD, ASTHO’s director of state health policy, for her contributions to this blog. Additional Resources to Help Public Health Leaders Increase Community Engagement ASTHO’s Programmatic Health Initiatives and Strategies Georgia Health Policy Center’s Guide to Funding Navigation to help communities design and sustain equity-advancing investment. <!-- Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative framework. --> website yes

Addressing the impact of substance use disorder on pregnant and postpartum individuals: a critical analysis of SUD policy, access to care, and lessons from the field.