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Defining Disease Forecasting and Modeling Disease forecasting, generated by disease models, helps the public health workforce understand potential future outbreaks. Learn more about disease forecasts and models. Disease forecasting is important in describing potential future outbreaks that will affect the population and demand for health services in a given geographic area. Forecasts pull input from various sources (e.g., disease models, demographic, mobility, and intervention impact data). Individual forecasts can also be part of an ensemble forecast to improve accuracy. Forecasts can cover any length of time, but most target a window of several weeks to a few months. A subset of forecasts, known as nowcasts, seek to estimate present conditions, or those expected to occur imminently. Disease models are mathematical tools that are foundational components of disease forecasts. They estimate quantifiable factors that are impossible or impractical to directly measure, (e.g., future hospitalizations from a given disease, or its infection count in a population). Although models can be useful for specific questions, they do not give as complete a picture as a forecast. There are four major disease model types: Mechanistic. Attempts to simulate biological and/or social processes of transmission based on assumptions from prior or experimental data. Statistical. Relies on past data (such as infections or death) to predict future trends and can incorporate some assumptions about intervention application and uptake. Quality and quantity of past data can be a major limitation, and some models may suggest biological improbabilities. Agent. Simulates individual risks and behaviors in a population. These are highly complex, computationally very expensive to develop and run and require vast amounts of data and strong assumptions. Ensemble. Like their forecasting counterparts, they compile models and outputs, mitigating the risk of relying on one data point. While raising the overall confidence in output, they require coordination of many models to be built and simulated, which can be complex and costly unless the models already exist (such as for COVID-19 case counts). Forecasts and Models Work Together While disease forecasts and models are often conflated, they are discrete concepts. Forecasts offer a general prediction, whereas models are the mathematical pieces forecasters use to create them. Weather forecasts are commonplace, and their weekly predictions are often reasonably accurate. In contrast, predicting a big storm’s individual factors (e.g., rainfall, wind speed, lightning strikes) fall to the job of models. Together, those models help meteorologists better understand the weather and generate a forecast. In a public health context, disease forecasting informs public health officials, health care providers, and policymakers about potential risks and guide decision-making regarding preventive measures, resource allocation, and response strategies. Meanwhile, disease models aim to simulate the behavior of infectious diseases under different scenarios, allowing researchers to explore and evaluate various factors that influence disease transmission. Considerations for Decision-Making Decision-makers should consider scope and limitations of forecasts and models. They may consider adding inputs—such as projections for economic and long-term impacts. Examples include economic impacts of school closures, costs of more staffing ahead of an outbreak, and supply chain shortage forecasts for personal protective equipment (PPE). Decision-makers at all levels should consider using modeling to answer more specific, practical questions rather than predicting overall trends. Forecasts can cover different geographic scales. Public health leaders will need granular, local data to most effectively inform decision-making and communications. Novel conditions and pathogens may not have readily available data to inform models or forecasts, which will affect their predictive ability. Health officials must effectively communicate these limitations to decision-makers and the public. Examples of Forecasts and Models CDC’s COVID-19 Forecast for Hospitalizations (ensemble forecast) shows the number of daily COVID-19 hospitalizations reported in the United States from the prior two months and projected daily COVID-19 hospitalizations over the coming four weeks. Information sources are independent teams meeting submission and data quality requirements. CDC’s FluSight (ensemble forecast) has many contributing teams and models that predicts the upcoming weekly laboratory confirmed influenza hospital admissions both nationally and by state. Johns Hopkins University’s Center for Systems Science and Engineering county-level risk model for COVID-19 in the United States. This model leverages epidemiological data, mobile phone data, demographic and socioeconomic information, and behavioral metrics. The Global Epidemic and Mobility Framework simulates the global spread of infectious diseases by mathematically representing infection dynamics, population geographies, and population mobility patterns. Additional Resources Disease modeling for public health: added value, challenges, and institutional constraints Predictive Models for Forecasting Public Health Scenarios: Practical Experiences Applied during the First Wave of the COVID-19 Pandemic Applying infectious disease forecasting to public health: a path forward using influenza forecasting examples Technology to advance infectious disease forecasting for outbreak management CDC-RFA-OT18-1802 2018-2024 article yes

Learn how health departments can focus their infectious disease prevention efforts in this brief.

Disease Forecasting and Modeling Data for Public Health Action Disease Forecasting Benefits Public Health Planning Disease forecasting and modeling help prepare public health departments for future infectious disease outbreaks and epidemics. Disease forecasting and modeling data can be powerful tools for state and local health agencies (S/THAs) that respond to outbreaks, develop appropriate policies, and ensure interventions have maximum impact. Actions for which decision-makers can leverage such data include: Surveillance. Forecasts and modeling help public health agencies anticipate the spread of disease or outbreaks. This advance warning allows public health officials to inform public health recommendations, preparation, and response. Communication. Disease forecasts help relate the risk of disease outbreaks to various audiences accurately and quickly, which, in turn, can inform messages on important preventive measures and encourages compliance with recommended interventions. Resource allocation. Modeling data can help decision-makers better allocate resources by predicting where and when disease outbreaks are likely to intensify and create the greatest need. Evaluation. Forecasts and modeling can help make evaluating the effectiveness of public health policies and interventions more efficient by comparing predicted outcomes with observed data and adjusting as needed. Considerations Informed by S/THA Forecasting Jurisdictions with forecasting experience identified key indicators to monitor as part of outbreak forecasting, which fall into three main categories: Epidemic spread indicators (e.g., symptom monitoring, morbidity and mortality data, percent positivity, regional pictures of transmission). Health care system capacity (e.g., essential and/or surge personnel, available beds, ventilator usage, and supply of personal protective equipment. Public health capacity for testing capacity and contact tracing. Further considerations for S/THAs: Know your strengths. Identify the unique skillsets among partners in public health, academia, and the private sector and consider how they foster reciprocal relationships. Recognize capacity/expertise gaps. Consider leveraging partnerships for specific types of analytics expertise while exploring internal capacity building opportunities (e.g., job shadowing and resource-sharing programs on workflows and methodologies). Engage legal and compliance teams. Ensure policy and practice are aligned among partners. Explore data access/sharing pipelines. Connect public, private, academic partners, and their audiences. Start small. Identify discrete forecasting and modeling projects to demonstrate success. Identify decision-makers’ needs. Provide quick access to analyses, metrics, dashboards. Michigan Used Models and Forecasting for Hep C Cases In response to Hepatitis C virus (HCV) in young adults from 2010-2018, the Michigan Department of Health and Human Services (MDHHS) simulated how HCV treatment could significantly reduce HCV prevalence among young people who inject drugs, especially for those both previously or currently injecting drugs. MDHHS used several novel predictors to paint a local picture of probable HCV diagnoses among residents up to age 40. These predictors included measures related to a variety of population characteristics (e.g., access to transportation, college education, presence of non-family households) and public health indicators (e.g., heroin treatment admissions, newborns with neonatal abstinence syndrome, and sexually-transmitted infections). MDHHS also leveraged county-level assessments of HCV vulnerability to identify locations for new syringe services programs in the state. MDHHS has recognized several modeling and analytics use cases that benefitted their work during responses to HCV and COVID-19: Short-term forecasts (i.e., weeks) helped predict likely transmission patterns and potential ranges of projections. Longer-term forecasts (i.e., months) explored scenarios based on new recommendations and policy changes. Retrospective counterfactuals evaluated the impact of policies or other changes by examining “what-if” situations. MDHHS is considering using forecasts and models for COVID-19, influenza epidemics, tuberculosis vulnerability, and C. auris spread. Resource constraints require decision-makers and public health practitioners to consider how they are using available resources for the highest return on investment. Models generated momentum to respond to threats and evaluate whether interventions were successful. CDC-RFA-OT18-1802 2018-2024 article yes

Partnering with Legislative Staff to Improve Long COVID Outcomes Partner with Legislators to Improve Long COVID Outcomes Amelia Poulin and Sidnie Christian Learn how health departments can secure legislative understanding and support for Long COVID recovery efforts. Long COVID challenges public health systems, impacting individuals’ health, workforce participation, and community well-being. State and territorial health departments are leading efforts to track, understand, and mitigate the health and economic effects through surveillance, education, and coordinated care initiatives.  To maintain and expand these efforts, health department programs can secure legislative understanding and support. This requires cultivating longstanding, trust-based relationships with legislators and their staff. Strategic engagement helps legislators view health departments as indispensable partners in addressing complex public health issues with broad social and economic implications. Build Longstanding Relationships with Legislative Staff Legislative staff are often the most consistent points of contact in a lawmaker’s office and play a central role in shaping policy advice. Regular engagement strengthens trust and visibility, helps maintain productive relationships, and ensures consistent communication with legislative offices. Health agencies can achieve this by: Engaging early and often: Identify key legislative staff for health department programs to brief on emerging Long COVID data, evolving needs, and program outcomes throughout the year. These conversations provide context and set the stage for trust before policy requests. Over time, they can lead to invitations for health department representatives to provide expert input. Positioning the program as a trusted, nonpartisan source: Health department leaders can provide timely, objective information about Long COVID’s impact on local hospitals, schools, and employers. Demonstrating responsiveness: Following up on constituent inquiries related to Long COVID testing or benefits shows legislators that the health department is directly addressing concerns in their districts.   Program staff can play a key role by developing briefing materials, success stories, and district-level data to share internally with leadership or policy offices for dissemination to legislators.   Note: Health department staff should align engagement with internal communication protocols. They may centralize outreach through a legislative or government affairs office that coordinates messaging and ensures compliance with statutes and lobbying restrictions. Identify Objectives and Tailoring Asks Before reaching out to legislative staff, health department leaders should clearly define their goals (e.g., funding for post-COVID clinics, data infrastructure, or research partnerships). When health departments align requests with legislative priorities, those proposals may seem more feasible or be more likely to gain support. Keys to doing so include: Understanding legislator priorities: Review voting history, public statements, and committee membership (e.g., health, workforce, budget). Identify shared interests such as workforce participation, economic productivity, or small business resilience. Choosing the right messenger: Personal narratives from constituents affected by Long COVID related to the sub-issue (e.g., a small business owner struggling to return to work, a teacher navigating disability benefits, or a parent managing caregiving responsibilities) can be effective. Consider pairing stories with district-specific data to illustrate scope. State health departments can also amplify impact by working with local health jurisdictions to paint a larger picture of how Long COVID impacts communities in the region. For example, drawing connections between workforce impacts across multiple counties can demonstrate to legislators that Long COVID affects the state’s overall economic resilience, not just isolated communities. This approach can help legislative staff see statewide trends and understand how targeted investments could yield system-wide benefits. Crafting the message: Use plain, non-technical language to describe Long COVID (e.g., “lingering symptoms after COVID infection” rather than “post-acute sequelae”). Consider emphasizing economic impacts (e.g., missed work or school days, productivity losses, and long-term disability claims) and framing the health department as a problem solver that helps businesses/families recover and navigate challenges, rather than a requester for resources. Communicate Effectively Legislators are often time constrained. Clear, concise, and locally relevant messages are most effective. To build an effective ask of a legislator’s office, health department staff can: Use their language: Translate public health concepts into legislative priorities (e.g., “economic competitiveness,” “community stability,” “health care access”). Incorporate local data: Share district-level statistics on Long COVID cases or workforce absences, as data allows (e.g., “in your district, an estimated 5,000 workers have missed more than two weeks of work due to Long COVID”). Combine data with moral resonance: Pair values-based appeals (e.g., “every resident and their family deserve the chance to live and work at their full potential”) with supporting evidence (“yet one in four adults in this district continue to experience symptoms six months after infection, limiting their ability to contribute to the workforce and community”). Leave behind resources: Provide one-page infographics or briefing sheets summarizing data and program activities. Follow up to reinforce conversations with updates, success stories, and progress metrics. Anticipate Policy Dynamics and Counterarguments Legislative discussions may surface alternative policy ideas or misconceptions about Long COVID and health agency program roles. Consider preparing for opportunities to: Answer questions: Public health leaders should be prepared to clearly explain the department’s legal authority, the evidence base for Long COVID programs, and the partnerships that support implementation. Consider explaining how scientific research, emerging epidemiologic data, and best practices inform Long Covid programs and how partnerships with hospitals, clinics, and community organizations help ensure effective service delivery. Clear, concise explanations help legislators understand the health department’s scope and role, build credibility, and preempt misconceptions that could undermine support for program priorities. Acknowledge unintended consequences: Demonstrate awareness of policy trade-offs and propose pragmatic solutions. For example: A proposal to expand Long COVID benefits might raise concerns about budget constraints. Health department leaders could suggest phased implementation or pilot programs in high burden areas. Understand alternatives: Be prepared to discuss other proposed interventions and show how the health department’s approach complements them. For example: If a legislator suggests employer-led sick leave policies as the primary solution to Long COVID, the health department could explain that monitoring Long COVID prevalence and providing patient support can help ensure workers’ safe return to their jobs, complementing workplace policies. Leverage rulemaking: When statutory change is limited, use administrative rulemaking and public comment to align implementation with public health intent.   Conclusion Building lasting, credible relationships with legislative staff allows health departments to move from reactive engagement to a proactive strategy. By pairing constituent stories with district-specific data, aligning messages with economic and moral values, and maintaining year-round communication, public health leaders can secure sustained support for Long COVID initiatives. These strategies not only advance Long COVID priorities but also strengthen the overall policy capacity and visibility of public health agencies, positioning them as trusted, solutions-oriented partners in state governance.   article yes

Strengthen your knowledge of wastewater surveillance ethics, with firsthand insights on key challenges and considerations from state health agencies and partners.

As part of ASTHO’s Public Health - Hope, Equity, Resilience, and Opportunity initiative, we are using this post to highlight some acts of thanks for organization leaders and supervisors to consider.

Following a hurricane, the risk of exposure to infectious disease increases due, in part, to the presence of floodwater and debris. Hurricanes may contribute to population displacement and overcrowding—further heightening risk factors for respiratory diseases—as well as cause damage to healthcare facilities. In this post, see how jurisdictions respond to the biggest post-hurricane threats, from water-borne diseases to severe disruptions in the healthcare system.

Tips for public health leaders to improve crisis communications.

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

Geographic Information Systems and other data visualization tools have become integral parts of public health decision-making workflows and provide crucial support to topic areas such as environmental health, the COVID-19 pandemic response, and chronic disease investigation and prevention.

Deaf people—especially sign language users—are one community that is often overlooked and forgotten in public health communications, which are almost always caused by miscommunication or exclusivity. COVID-19 has shined a light on these inequities.

ASTHO spoke with Greg Endler, and Michele Roberts of the Washington State Department of Health as they share reflections on working to improve vaccine confidence in their jurisdiction both prior to and after the COVID-19 pandemic.

Public health officials from all levels of government are working to respond to the existing outbreak of monkeypox, while preparing for the potential of more widespread transmission.

Building a Culture of Care: Leadership in Public Health Agencies 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, centers for disease control, creating a culture of care, public health workers, health equity, physical health, building a culture of care, health departments, public health professionals, training program, school of public health, mental health problems, public health leaders, public health workforce, mental well-being, culture of care, mental health, workforce development Chris Taylor ASHTO | A blog post highlighting three simple actions agencies can take to strengthen a culture of care. Throughout the COVID-19 pandemic response, many of us have witnessed or experienced increased feelings of exhaustion, mental distance from our work, negativism or cynicism related to our jobs, and reduced professional efficacy. The World Health Organization classifies these symptoms of burnout as an occupational phenomenon, rather than as a medical condition. For governmental public health agencies to successfully promote and protect the health of their communities, it is imperative that they support their staff to remain healthy and resilient. This blog provides information and considerations for state, territorial, tribal, and local health departments to identify and address work related causes of burnout, as well as build and maintain the health and mental wellbeing of their staff. Governmental public health continues to play a central role in the COVID-19 response, which for more than two years has created unprecedented and prolonged demands on staff. Beyond the COVID-19 response, there continue to be massive changes in how and where we do business, as well as how we interact with one another, contributing to additional organizational stress. In 2021, CDC surveyed state, territorial, tribal, and local public health staff to assess symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and suicidal ideation. Among 26,174 public health staff who participated: 53.0% reported symptoms of at least one mental health condition in the preceding two weeks, including anxiety (30.3%), depression (32.0%), PTSD (36.8%), or suicidal ideation (8.4%). The highest prevalence of symptoms was among respondents 29 years or younger, as well as transgender or nonbinary persons (i.e., those who identified as neither male nor female) of all ages. Public health staff who reported being unable to take time off work were more likely to report adverse mental health symptoms. Severity of symptoms increased with increasing weekly work hours and percentage of work time dedicated to COVID-19 response activities. In a 2022 follow up survey, 75.5% of respondents did not think their employer had increased mental health support. Additionally, other recent surveys have indicated a trend of rising stress and burnout in the public health workforce, leading many to resign and more to consider leaving their agencies. While some support to the workforce may be available in government agencies, staff may feel they don’t have time, or feel supported to utilize these programs. This blog series will explore strategies that health department leadership may consider to strengthen a culture of care in their organization. Three Simple Actions You Can Take Today to Strengthen a Culture of Care Health department leaders can have a major impact on the behaviors and health of their workforce. Consider taking these actions: Practice and offer a model of your own commitment to self-care Self-care, which includes a healthy diet, adequate sleep, and regular exercise, are critically important for leaders in maintaining productivity and effectiveness, particularly during stressful periods. Other ways to practice self-care can include meditation or mindfulness practices, journaling, expressing gratitude or acts of kindness, or connecting with friends and loved ones. Send a message to your entire department discussing the importance of self-care and sharing examples of how you practice self-care. This not only demonstrates that your organization values and supports self-care, but also gives practical examples for staff to consider implementing. This would also be an excellent opportunity to highlight the availability of an employee assistance program (EAP) or employee wellness programs and benefits. Acknowledge the mental health effects of the COVID-19 response Share an example of how you (or someone you care about) has been impacted emotionally or psychologically by the COVID-19 pandemic. Your example can normalize the burnout and moral injury that some of your staff may be experiencing, as well as build trust and connectedness. Talking about mental health at work is important to reduce the stigma and create an environment that is more open and understanding about anxiety, depression, and other mental health issues that might show up in the workplace. This is also an opportunity to discuss mental health coverage in your health insurance plan(s), as well as resources available in the community, some which may be funded by your department. Exercise at the office or on the office grounds One well-proven approach to addressing stress and improving mental health is exercise. As a leader, you can model the importance of exercise to your agency. This can be as simple as taking the stairs rather than the elevator, incorporating stretching throughout the day, or walking during phone calls. Invite staff of all abilities to join you in a stretch, movement, or walk break. Consider a standing desk, replacing your chair with a stability ball, or keeping exercise equipment in the office for use during breaks. By prioritizing and modeling physical activity, you are sending a message that self-care is important. What Does a Culture of Care Mean for You? Has your organization prioritized a culture of health and well-being? Are there lessons learned for your organization’s support of staff during the COVID-19 response? How is your organization ensuring a manageable workload, particularly during times of emergency response? Speak with your employee wellness, workforce development, human resources, and/or professional development teams to ensure the organization is best meeting the health and wellness needs of employees. Based on the alarming findings of the CDC surveys, special emphasis should be placed on ensuring employees have additional information about, and are aware of, services/referrals to treat anxiety, depression, PTSD, and suicidal ideation. What’s to Come? Many employers and leaders have been creative in strengthening a culture of care in their organization. Over the coming months, ASTHO will highlight specific strategies to increase a culture of care in your organization. We’ll also share examples employed by health officials and other senior leaders within health organizations. Finally, we plan to curate a list of resources for executives, supervisors, and employees for creating a culture of care, stress reduction, self-care, and burnout prevention. Conclusion For public health systems to serve their communities most effectively, it is imperative that their staff are healthy, both physically and mentally. State, territorial, tribal, and local health departments should consider policies and programs that support the health and mental well-being of their staff – particularly in high stress emergency responses. We look forward to additional opportunities to discuss these important issues, hear how health department leaders are strengthening a culture of care, and learning how ASTHO can support your efforts. website yes

Accurate and timely communication from health officials during a public health emergency is critical to ensure people can reduce their risk of illness or death. Karen Smith (alumni-CA) talks about her experiences communicating policy changes, as well as key strategies for maintaining public trust.

On the 32nd anniversary of the ADA, this blog post explores state legislation around the country that supports people living with disabilities.

The COVID-19 pandemic presented an opportunity for an existing behavioral health resource—the Guam Behavioral Health and Wellness Center’s Crisis Hotline—to become a household name. During the pandemic, the hotline became a lifeline for a community in crisis greatly in need of information.

During the 2022 state legislative sessions, at least 20 states considered bills that would require a religious exemption to a vaccine requirement. As state legislatures continue considering vaccine protocols for COVID-19, HPV, and other diseases—along with what types of exemptions should be given—courts are reconsidering what type of vaccine requirements are constitutional.

This video highlights specific administrative strategies, partnerships, and metrics used by the North Carolina Division of Public Health to support efficient and effective spending of federal funding.

Under the Tenth Amendment, states have the power to protect the health and welfare of their populations, including the authority to implement isolation and quarantine orders to limit the spread of disease. This post is an examination of state public health authority for isolation and quarantine.