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Although suicide was a critical public health issue in the U.S. long before the COVID-19 pandemic began, Americans are now reporting increased mental health challenges like depression, anxiety, and suicidal behaviors. In addition, millions have experienced financial hardships, social isolation and loneliness, and increased stress—all of which are shared risk factors for mental health conditions, suicidal behaviors, and substance misuse. State public health officials have taken bold action over the past 12 months to mitigate the physical impacts of COVID-19, and the same swift action should be applied to mitigate the acute and potential long-term mental health, suicide, and substance use impacts. The National Response’s "An Action Plan for Strengthening Mental Health and Prevention of Suicide in the Aftermath of COVID-19" provides a roadmap for addressing the mental health, suicide prevention, and substance misuse prevention needs spurred by COVID-19.

Each year, ASTHO tracks and analyzes key legislation that impacts public health, and highlights the emerging trends for our members. While the bulk of the tracked legislation arises in state legislatures, ASTHO also follows legislation from the territories and Freely Associated States, jurisdictions collectively referred to as the insular areas. The insular areas often face different challenges than the states, while also sharing many common concerns. This post contains a brief look at some of the public health related legislation introduced in the insular areas during their current legislative sessions.

Every year in mid-July is National Youth Sports Week—in 2021 it falls on July 19-23. It’s an important health observance because youth sports create strong connections with peers and caring adults, as well as promote socio-emotional skills and positive well-being. The Office of Disease Prevention and Health Promotion’s National Youth Sports Strategy outlines policies and strategies that support access to youth sports. NYSS Champions, including ASTHO, work to promote participation and recognize the positive health outcomes sports can have on youth, such as limiting the impacts of adverse childhood experiences and building resiliency.

Though now an illegal practice, government contracts, policies, and practices have generally excluded women, and Black, Indigenous, and people of color. Still, practices and existing structures continue the inequitable distribution of all contracts. Governmental and non-governmental grants and funding should benefit the communities they serve while being proportionate to the communities' demographics. This is where inclusive contracting comes in.

One in three individuals who contract COVID-19 will experience lasting mental health impacts, according to a recent study. This startling discovery underscores the reality facing our nation: the challenges of this last year—the public health and economic ramifications of COVID-19, coupled with the longstanding racial and ethnic inequities that it highlighted—will be felt for years, if not decades, to come.

Flavored tobacco policy has changed rapidly over the past few months. In April, FDA announced their intention to implement rules prohibiting the sale of menthol e-cigarettes and flavored cigars, though it may take years until they implement a final rule. And in 2021, 15 states and Washington, D.C. considered legislation prohibiting the sale of some or all flavored tobacco products. However the tobacco industry has seen success recently in obstructing the legislative efforts of states in this area.

In this episode, two maternal healthcare veterans share approaches for bringing providers into the process, as well as how state health officials can promote risk appropriate care strategies and address challenges in achieving equitable risk appropriate care.

ASTHO Launches National Campaign to Support Healthy Communities, Aligning with NACCHO and the U.S. Surgeon General ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) announced this week the launch of a multi-year initiative to build healthier and more resilient communities across the country. The challenge, “Building Healthy and Resilient Communities,” will be led by ASTHO’s president and director of the Rhode Island Department of Health, Nicole Alexander-Scott, MD, MPH, in partnership with the National Association of County and City Health Officials (NACCHO) and aligned with the U.S. Surgeon General’s focus on community health and economic prosperity. The challenge calls on state, territorial, local, and tribal health officials to align strategic investments and promote community-driven, place-based solutions to empower communities to be as healthy as possible, reduce health disparities, and stimulate economic development. Examples of such initiatives include Rhode Island’s Health Equity Zones, Purpose Built Communities in Georgia, the Fort Worth Blue Zones Project, and Live Well San Diego. Activities to support the challenge will center on creating opportunities for health officials to mobilize community advocates and partners towards making lasting systems and policy changes that improve living conditions at the community level. Using this platform, ASTHO and its partners, along with NACCHO and the U.S. Surgeon General, will connect public health officials with business leaders, policymakers, and other cross-sector stakeholders to shift investments to promote sustainable, equitable community development. “Health officials have a critical role to play ensuring that everyone in every community has an equal opportunity to be as healthy as they can be, regardless of their zip code,” says Dr. Alexander-Scott. “My vision is for ASTHO, along with NACCHO and the U.S. Surgeon General, to empower all public health leaders to build stronger, more connected communities that have the assets and resources they need to create the conditions for success to be as healthy as possible. By funding and implementing sustainable strategies that are tailor-made for each community, we can amplify the community’s voice and transform public health for generations to come.” “America’s greatest assets are its communities, so we should turn to them more often,” says VADM Jerome Adams, MD, MPH. “We have the best healthcare system in the world, yet life expectancy in the United States is lower than in many other high-income countries. State and local health officials know their communities best and should be inspired to change the community environment to make sure that healthy behaviors are easy behaviors that are available to everyone.” “We’re pleased to lead this challenge with ASTHO and recognize there are great synergies between state and local health officials that will allow us to be successful in equipping and encouraging communities to think more strategically about health at the community level,” says Kevin Sumner, MPH, NACCHO president and health officer for the Middle-Brook Regional Health Commission in New Jersey. View ASTHO’s President’s Challenge for more information. ASTHO Press Release Boilerplate website yes

This episode emphasizes the importance of addressing heart disease and stroke prevention through approaches that center on health equity, including systems-level changes, quality improvement, and community development. CDC’s Division for Heart Disease and Stroke Prevention is partnering with ASTHO to support jurisdictions in successfully integrating efforts with healthcare and community partners and implementing best practices and evidence-based policies to identify, control, and improve blood pressure.

This episode highlights ASTHO’s President’s Challenge, “Building Health and Resilient Communities,” which is a multi-year campaign that calls on state, territorial, local, and tribal health officials to align strategic investments and promote community-driven, place-based solutions to empower communities to be as healthy as possible, reduce health disparities, and stimulate economic development. The challenge is aligned with the National Association of County and City Health Officials (NACCHO) and the U.S. Surgeon General’s focus on community health and economic prosperity.

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

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.

Forming Partnerships to Increase Rural Immunization Rates ASTHO, Association of State and Territorial Health Officials, national immunization awareness month, farmworker communities, vaccine equity project, increase rural immunization, immunization rates, healthcare access, community action agencies, barriers to vaccine uptake, community partnerships, underlying medical conditions, back-to-school vaccinations, national community action partnership, vaccination strategies, vaccination importance, farmworker communities, challenges to healthcare access, vaccination rates, national center for farmworker health, rural immunization, preventable disease Shalini Nair, Heather Tomlinson ASTHO | Learn how public health partners with community organizations to bring vaccines to rural communities that otherwise would have difficulty accessing care in this blog. Rural communities face many challenges in accessing health care, like limited provider availability, gaps in insurance coverage, transportation issues, language barriers, and limited internet access. Additionally, rural populations are more likely to have underlying medical conditions, less likely to have insurance, and live farther from medical facilities. During the COVID-19 pandemic, overall routine vaccination coverage remained stable; however, there was a notable 4–5% drop in vaccination rates among young children living below the federal poverty level and in rural areas. In response, CDC developed the Let’s Rise initiative and a back-to-school campaign to provide actionable strategies and resources for getting Americans back on schedule with their routine vaccines. This month is National Immunization Awareness Month, highlighting the importance of vaccination for people of all ages. Boosting vaccine access and confidence is crucial to limit the spread of vaccine-preventable diseases. Barriers to Vaccine Uptake While they only account for 14% of Americans, rural communities represent nearly two-thirds of primary health care shortage areas. Due to the lack of providers, rural Americans often live over 10 miles from their closest health care facility and do not always have access to reliable transportation. Additionally, rural communities also have a larger proportion of people who are uninsured and underinsured. Studies have shown that primary care visits and strong provider recommendations can greatly enhance utilization of preventative health measures, such as vaccination, while limited access to these aspects can reduce health outcomes. The COVID-19 pandemic exacerbated this disparity as many rural hospitals closed and the country faced national workforce shortages. Rural communities were significantly impacted, with 76% of rural adults knowing someone who had COVID-19 and 38% contracting COVID-19 themselves. Despite this impact, the majority of those polled reported this did not change their intent to get vaccinated. Furthermore, the gap in COVID-19 vaccination coverage between urban and rural areas more than doubled between April 2021 and January 2022, despite rural communities having disproportionately higher COVID-19 disease incidence and mortality. The digital divide also limits access to accurate information on the safety and efficacy of vaccines. States and community groups have taken various actions to address these barriers. Successful Strategies to Address Low Vaccination Rates in Rural Communities With support from CDC, ASTHO is working with the National Community Action Partnership and five community action agencies (CAAs) on the Partnering for Vaccine Equity project. A recent blog showcases some of the work the CAAs have implemented to improve vaccine acceptance and uptake and to customize evidence-based strategies to their own communities and neighborhoods. Two project partners, Pickens County Community Action and Enrichment Services Program, are working to build trust and increase vaccine uptake in rural Alabama by leveraging existing networks and taking a whole-health approach to outreach efforts. In Russell County, Enrichment Services deployed a highly successful paper- and social media-based messaging campaign centered around messages that emphasized three points: Vaccines are Safe, Vaccines Save Lives, and Vaccines Save Money. By reaching out to local churches, Enrichment Services was able to greatly expand the reach of their health promotion messages. In addition, to increase the number of available access points for vaccination, Enrichment Services co-located outreach at schools and engaged local EMT representatives from the National Association of Emergency Medical Technicians for their first-hand knowledge of the community. Sample graphics from Enrichment Services' vaccine equity messaging campaign. In Pickens County, Pickens Community Action relied on existing partnerships with over 30 community organizations to kickstart their vaccine equity efforts. To address access-related barriers, Pickens sponsored rides to and from their vaccine clinics and partnered with local physicians to provide personalized counseling to individuals receiving vaccinations. Notably, they established both a faith-based and a disability services advisory committee to further assist their outreach efforts. Some of their existing partners in the community include the local National Association for the Advancement of Colored People (NAACP), the Black Belt Community Foundation, Whatley Health System, Hill Hospital of Sumter County, The University of Alabama, and elected officials. Left: A food table being set up for Pickens’ Community Health Fair at the Tom Bevill Lock and Dam in Pickensville, AL. Right: A mobile outreach van from partner the University of Alabama rolls in to assist at Pickens’ Community Health Fair. For both agencies, offering services that address the social determinants of health greatly increased engagement. Both sites found success in offering incentives—such as food or gas gift cards and free food giveaways—but their greatest success has been from co-locating vaccine events with service offerings that address essential needs such as housing, utility assistance, or education. This model has proven highly successful not only for COVID-19 vaccines, but also as a sustainable strategy for general vaccine outreach. Increasing Vaccination Rates in Farmworker Communities Numerous successful strategies have been implemented in rural communities largely comprised of immigrants—with a special focus on migrant farmworkers, who labored throughout the pandemic due to the critical nature of their work. In addition to facing barriers related to transportation, health insurance, and language access, many farmworkers are not able to visit a clinic or pharmacy due to their long working hours. The National Center for Farmworker Health, in collaboration with CDC and over 40 different organizations, worked to diffuse funding, trainings, and tools for building capacity to act during the public health emergency. This network generated over 1.3 million COVID-19 related educational interactions with farmworkers and supported the distribution of over 108,000 COVID-19 vaccine doses during 2020 and 2021. The network also documented effective practices undertaken by community-based organizations and agricultural employers to distribute vaccines, dispel myths, and build vaccine confidence. Photos courtesy of the Guatemalan-Maya Center (left) and National Center for Farmworker Health (right). State Considerations for Implementation Collaboration with trusted community groups can amplify state efforts to vaccinate communities, particularly in those with low vaccination rates. Working with CAAs and organizations that understand their communities and utilize innovative outreach strategies can help states expand the reach of their messaging. Communications should be tailored to include multilingual messaging and images that resonate with targeted communities. The National Governors Association developed a guide that provides valuable strategies for states to increase vaccine uptake in their rural communities. To help address the digital divide in their communities, several states have made investments in their digital infrastructure. Partnering with local pharmacies, federally qualified health centers, and emergency medical services to offer alternative vaccination sites in communities has been integral in improving awareness and access. Holding mobile vaccine clinics with after-hours availability or offering transportation to and from vaccine clinics can help address transportation issues and make vaccines accessible in communities with limited health care facilities. Addressing immunizationinequities in rural communities requires understanding the community and implementing innovative strategies tailored to these populations. Partnering with community-based organizations can help states reach critical audiences and ensure that vaccine efforts are addressing relevant barriers. article yes

ASTHO spoke with Palina Louangketh about her history as a refugee to the United States, her extensive work in expanding health equity in Idaho, and how her past has influenced her present.

States Support Postpartum Health with Medicaid Expansions astho, association of state and territorial health officials, 2023 state legislative session, medicaid expansions, postpartum health, the consolidated appropriations act, national women s health week, postpartum coverage, affordable care act, premium tax credits, affordable care, 12 weeks, united states, extended postpartum coverage, health a priority, medicaid program, national women s health, mother s day, 2023 legislative, vaginal birth, physical activity, women s health week, postpartum care, coverage for 12 months, 60 days, state plan amendment, care act, postpartum depression, health care Sowmya Kuruganti National Women’s Health Week reminds us that postpartum care is critical for the long-term health of the birthing parent and baby. National Women’s Health Week’s 2023 theme—Women’s Health, Whole Health: Prevention, Care and Wellbeing—is a reminder that postpartum care is critical for the long-term health of the birthing parent and baby. The first year after pregnancy can be full of physical, emotional, and mental health challenges that have long-term or even life-threatening health impacts without timely diagnosis and treatment. In September 2022 CDC reported that 23% of pregnancy-related deaths occur from seven to 42 days postpartum, and 30% of deaths occur 43-365 days postpartum. Among all pregnancy-related deaths occurring from 2017 to 2019, approximately 84% were deemed preventable. Black and American Indian and Alaskan Native <!--(AI/AN)--> women have two to three times higher rates of pregnancy-related death compared to white women. These disparities, like others, are driven by social and economic factors that are rooted in structural and systemic racism and discrimination. Health insurance coverage is one such factor that supports positive maternal health outcomes by facilitating access to care before, during, and after pregnancy. In the United States, 40% of births are covered by Medicaid, which is the primary source of health coverage and access to care for those of low income. Organizations like ASTHO and the Association of Maternal and Child Health Programs support extending Medicaid coverage through one-year postpartum to combat disparities in maternal health outcomes. Federal Legislation for Postpartum Coverage under Medicaid For the majority of states that have adopted Medicaid expansion under the Affordable Care Act (ACA), all people with income up to 138% of the federal poverty level (FPL) are eligible for Medicaid. In states without Medicaid expansion, pregnant people can be eligible for coverage during pregnancy and up to 60 days postpartum under federal law. After 60 days postpartum, these people may lose coverage for the rest of the year-long postpartum period based on general state Medicaid eligibility requirements. Prior to 2021, states could extend Medicaid coverage to postpartum people through a section 1115 demonstration waiver or through state funds. The enactment of the 2021 American Rescue Plan Act, gave states another option to extend Medicaid coverage to 12 months postpartum via state plan amendment for five years. So far in 2023, CMS has approved the State Plan Amendments for five states (Alabama, Arizona, Colorado, Oklahoma, and Rhode Island) implementing a 12-month postpartum expansion. To date, a total of 33 states have expanded Medicaid coverage to 12 months postpartum via Section 1115 demonstration waiver or state plan amendment. 2023 State Legislative Session Depending on states rules for modifying Medicaid coverage the legislature may need to direct the health department to submit a state plan amendment. So far in 2023, three states enacted legislation related to expanding coverage to 12 months postpartum. In Mississippi, SB 2212 authorizes the state’s Division of Medicaid to provide 12 months continuous postpartum coverage to people who qualify. Utah’s SB 133 extends coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. In Wyoming, HB 4 temporarily extends Medicaid coverage for qualifying pregnant women for 12 months postpartum, ending March 31, 2027. Other states introduced bills to extend postpartum coverage during this session. The Alaska Legislature passed legislation (SB 58) directing the Department of Health to submit a state plan amendment extending postpartum coverage to 12 months, and to raise the household income level for eligibility to 225% of the FPL. The bill is currently awaiting action by the governor. Iowa introduced legislation (SF 57) to enact postpartum coverage for 12 months postpartum by Medicaid State Plan Amendment. This would extend the current 60-day postpartum coverage for Medicaid beneficiaries. The Missouri legislature passed (SB 45) that would extend MO HealthNet postpartum coverage from 60 days to 12 months postpartum for women who are either currently receiving or eligible to receive aid to families with dependent children, or eligible to receive benefits via the income eligibility standard. Pregnant women eligible for MO HealthNet and receiving mental health treatment for postpartum depression, related mental health conditions, or substance abuse treatment within sixty days of giving birth would remain eligible for benefits for those services for an additional 12 months. The bill is currently awaiting action by the governor. Nebraska introduced legislation (LB 419) to extend postpartum coverage for 12 months postpartum that would extend the current 60 day postpartum coverage. Texas introduced legislation (HB 12) to extend postpartum coverage to 12 months; it has passed in the House and is now pending in the Senate. Its passage would significantly change the current coverage structure, which uses state funds to provide postpartum people a limited package of postpartum services through the Healthy Texas Women program under HB 133, and subsequently submitted 1115 waivers to draw down federal funds for the program and extend coverage to six months postpartum. Wisconsin introduced companion bills (AB 114/SB 110) extending postpartum coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. This action would extend coverage from the current 60 days and amend the previous 90-day Section 1115 Waiver submitted in 2021. Studies have demonstrated numerous benefits of extending Medicaid coverage for postpartum people and, given these positive impacts, ASTHO expects that more states will take action to extend Medicaid to 12 months postpartum. ASTHO will continue to monitor and report on this essential maternal public health issue. website yes

In February 2023, ASTHO staff traveled to Koror, Palau for a four-day health equity summit and held workshops to identify, select, and prioritize measures for Palau’s health equity work.

Looking to the future, states are improving access to care, providing subsidies for tuition costs, expanding hours of licensed facilities, increasing access, and meeting the needs of both parents and children.

Supporting policies that reduce HIV stigma and promote health equity is an important public health issue.

Partnering with Community Action Agencies Can Improve Trust in Vaccines astho, association of state and territorial health officials, association of state and territorial health officials astho, state health official, public health official, territorial health official, island jurisdictions, state health, health department, public health, state and territorial health, social determinants of health, johns hopkins, advance health equity, socially determined, health inequities, race ethnicity, covid-19 vaccines, health disparities, vaccine supply, high income countries, vaccine equity, vaccine distribution, vaccine hesitancy, immunization, centers for disease control, community action agencies, covid19 pandemic, at-risk populations, healthy equity Geetika Nadkarni Learn how community action teams are working to improve COVID-19 vaccine acceptance and uptake in their own communities. In the current climate surrounding vaccinations and other large-scale public health measures, it’s more important than ever for public health to engage communities. One way to do this is through working with community action agencies (CAAs), local entities that work to reduce poverty and reduce disparities among the populations they serve. Funded through the Community Services Block Grant (CSBG), CAAs are an ideal complement to public health’s mission to address the social determinants of health and achieve greater equity. With support from CDC, ASTHO is working with the National Community Action Partnership and five CAAs in the Partnering for Vaccine Equity project, which aims to increase acceptance and uptake of vaccines among racial and ethnic minority groups and in rural communities. ASTHO chose to partner with CAAs as trusted community agents for this project because of their existing relationships within communities through programs such as Head Start, food banks, federal nutrition programs, and employment and housing assistance. Through their internal and external partnerships, they can reach people who may be concerned about vaccine safety and/or lack access to vaccination sites. Through this project, CAAs are partnering with residents, faith-based organizations, local schools and universities, state and local public health departments, and non-profits active in the community. They are also engaging a range of local providers, such as federally qualified health centers (FQHCs), physicians, community health workers, medical and nursing students, and emergency medical technicians (EMTs). These community action teams are working together to improve vaccine acceptance and uptake and to customize evidence-based strategies to their own communities and neighborhoods. article yes

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