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As COVID-19 emerged and spread in the U.S., people working and residing in long-term care facilities have experienced a significant burden of COVID-19 cases and deaths. As of Oct. 8, deaths associated with these facilities account for 40% of total COVID-19 deaths in the U.S. Health officials have taken measures to improve their funding and capacity.

As we celebrate National Rural Health Day this year, we are reminded of how important telehealth can be for public health and healthcare. Telehealth can minimize challenges faced by rural patients and communities—such as transportation, provider shortages, etc.—manage volume, increase the quality of healthcare, and lower overall costs by reducing readmissions and avoidable emergency department visits. However, the COVID-19 pandemic has shown that access to reliable broadband is still a challenge and is a key social determinant of health for rural Americans.

Many pharmaceutical companies urgently began developing a COVID-19 vaccine earlier this year to reduce the spread of the virus as the threat of a pandemic loomed. Fast forward several months and millions of COVID-19 cases later, states and territories are preparing to distribute a potential vaccine with preliminary plans for distributing a COVID-19 vaccine due to the CDC in October.

Anticipating a rapid deployment of COVID-19 vaccines as they are authorized, the CDC developed COVID-19 Vaccination Program Operational Guidance in collaboration with state and local jurisdictions to outline how each jurisdiction will make an authorized vaccine widely available. In addition to the operational plans, there is a legal framework of federal and state laws supporting the distribution and administration of the FDA-authorized vaccines.

As the country prepares for the inauguration of President-Elect Joseph R. Biden, Jr. on Wednesday, the incoming administration has highlighted several priorities over the next four years. This post is a summary of priorities that are closely aligned with the work and interests of state and territorial public health, including continued COVID-19 recovery and response, and climate change.

As a truly historic year comes to an end, many public health policy issues received a considerable amount of attention in 2020. Subjects such as the pandemic that will live on in infamy, racial health disparities, and the future of the Affordable Care Act, are just a few of the major health issues that took center stage on Capitol Hill this year.

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On Dec. 3, the International Day of People with Disabilities commemorates disability rights and brings awareness to essential issues for those with disabilities by promoting the “well-being of persons with disabilities in all spheres of society.” While the ADA laid a critical foundation for disability rights, the work to ensure equitable access to services and needs continues, including access to state and local emergency preparedness and response activities like crisis communication, access to resources, allocation of vaccine and other medical countermeasures, and transportation.

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 COVID-19 pandemic has exasperated challenges around access to nutritious and affordable foods. In response, the federal government has taken action to increase funding and access to programs to strengthen food security.

To enhance social distancing and reduce healthcare worker and patient exposure to COVID-19, there have been unprecedented expansions in the use of telehealth, supported by both federal and state policy.

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

On Jan. 30, 2023, ASTHO released a statement commending the FDA on a new proposal to conduct individual risk assessments for blood donors, a policy that reflects the best available science while not promoting stigma and discrimination against historically excluded groups.

On Sept. 28, 2022 ASTHO CEO Michael Fraser, PhD, attended the White House Conference on Hunger, Nutrition, and Health, a unique convening of advocates, lawmakers, and experts to end hunger, improve nutrition and physical activity, and reduce disparities.

ASTHO President Scott Harris, MD, MPH, Testifies to Congress Advocating for Sustainable and Predictable Public Health Funding ARLINGTON, VA — Scott Harris, MD, MPH, president of the Association of State and Territorial Health Officials (ASTHO) and state health officer for the Alabama Department of Public Health, testified today before the House Committee on Appropriations Subcommittee on Labor, U.S. Department of Health and Human Services (HHS), Education and Related Agencies. Harris emphasized the importance of providing sustainable and predictable federal funding for key programs and initiatives at the Centers for Disease Control and Prevention, Health Resources and Services Administration, and other federal health agencies that enhance our nation’s public health. In addition, he mentioned the challenges associated with the recent cancellation of COVID-19 grants by HHS. “Governmental public health agencies are on the front line protecting our nation and improving the health and well-being of the entire U.S. population. Our country continues to face many public health challenges, deaths associated with chronic diseases, the re-emergence of vaccine-preventable diseases, and opioid misuse,” says Harris. “To build long-term resilience, public health funding must be consistent, forward-looking, and rooted in community-driven initiatives that address the needs of people where they live.” ASTHO calls on Congress to provide stable and long-term financial support for public health agencies. Without consistent investment state, local, tribal and territorial health agencies will struggle to strengthen their infrastructure, build public trust and protect the health and safety of all Americans. We must have a firm commitment to lasting resources that ensure a healthier future for our communities. For more information about the hearing, please visit the committee YouTube channel and read Harris’s full testimony. ASTHO Press Release Boilerplate website yes

State and Territorial Health Leaders Convene on Capitol Hill to Advocate for Sustained Funding ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) leadership and public health officials will gather in Washington, D.C. from March 10-13 for the annual Spring Leadership Forum. Attendees will gather to discuss key policy issues, attend peer learning sessions, and advocate for critical funding on Capitol Hill. Health officials are expected to highlight the value of federal funding to public health agencies as well as infrastructure needs, with the looming expiration of federal funding on March 14. Specifically, ASTHO requests Congress provide $365 million in FY25 and invest $1 billion, which equates to about $3 per person in the United States, in FY26 for vital public health infrastructure. “This week, ASTHO members are meeting with Congress to advocate for adequate resources to sustain vital, life-saving public health operations,” says Joseph Kanter, MD, MPH, ASTHO CEO. “In-person meetings allow health officials to shed light on the impact of legislation on state-level health systems. Our goal is to foster bipartisan collaboration and advocate for Americans across the country who rely on federally funded programs to stay healthy.” Additionally, senior leadership from the five U.S. territories and three freely associated states (T/FAS) will participate in an island-tailored set of meetings with Congressional and federal agency partners. On Capitol Hill, ASTHO’s T/FAS members will discuss the impact of the recently renegotiated Compacts of Free Association, as well as emphasize the importance of territorial Medicaid funding and the challenges associated with the Section 1108b cap on territorial Medicaid funding. "ASTHO’s Spring Leadership Forum is a critical opportunity for U.S. territorial and freely associated state health officials to make our voices heard in Washington, D.C. We look forward to working with members of Congress and federal agencies on emerging federal and island public health priorities," says Dr. Esther Muña, CEO of the Commonwealth of the Northern Mariana Islands’ Commonwealth Healthcare Corporation, chair of the ASTHO Insular Affairs Committee, and Director on the ASTHO Board. ASTHO Press Release Boilerplate website yes

Federal funding that supports public healthy emergency preparedness is critical. Read the latest on PAHPA and more in the Health Policy Update.

Learn about public health strategies for preventing chronic disease that intersect with themes in MAHA report including nutrition and physical activity.

HHS Budget Hearings Chart New Direction for Public Health Budget Hearings Chart New Direction for Public Health Catherine Jones Learn about the key policy/funding themes that emerged from HHS Secretary Robert F. Kennedy’s testimony during the May 2025 budget hearings. In May 2025, HHS Secretary Robert F. Kennedy Jr. appeared before the House and Senate Appropriations Committees as well as the Senate Health, Education, Labor, and Pensions (HELP) Committee to discuss the Trump Administration's proposed FY26 HHS budget. On May 2, President Trump released his “Skinny Budget,” which formed the basis of much of the questioning Sec. Kennedy received from members of both parties. These hearings illuminated a sweeping reorganization of HHS and other federal agencies, signaling a dramatic shift in public health priorities and funding. Seven key themes emerged from the testimony, highlighting how these priorities are being advanced through the Make America Healthy Again (MAHA) initiative and the newly proposed Administration for a Healthy America (AHA). The President’s Budget Appendix, released in late May, reaffirms these policy and funding proposals. Reorganizing HHS and CDC The blueprint for HHS calls for consolidating various agencies under the new AHA, including HRSA, SAMHSA, and parts of CDC. In the hearings, Republicans broadly supported MAHA and AHA initiatives, mentioning the need to disrupt bureaucratic inefficiencies, reduce regulatory hurdles, and improve health care delivery. Democrats expressed concerns about program disruptions, layoffs, and FY25 appropriated funds that remain undisbursed. A handful of Democrats pressed Sec. Kennedy on whether he would spend FY26 funds, as appropriated by Congress; he responded affirmatively. When asked who authorized the staff layoffs, Sec. Kennedy gave inconsistent responses claiming ownership in one hearing and later attributing decisions to the Department of Government Efficiency. Public Health Preparedness and Prevention Preparedness and prevention were central topics, especially in the HELP Committee hearing. The proposed elimination of the Hospital Preparedness Program and cuts to the Public Health Emergency Preparedness Program would result in a net loss of hundreds of millions of dollars in federal support. HELP Committee Chair Sen. Bill Cassidy (R-LA) voiced concerns about the implications for under-resourced and rural states. Sec. Kennedy emphasized CDC’s legal responsibility for national pandemic response and called for reauthorization of the Pandemic and All-Hazards Preparedness Act. In the House hearing, he also addressed topics such as supply chain independence from China for critical medicines, and adequate funding for the Strategic National Stockpile and Biomedical Advanced Research and Development Authority. Vaccines Sec. Kennedy's past vaccine skepticism drew bipartisan scrutiny. Lawmakers pressed him to affirm support for routine immunizations, particularly amid a measles resurgence. When asked about pediatric vaccinations in the House hearing, Sec. Kennedy demurred wanting to refrain from giving medical advice. In the HELP hearing, he confirmed that funding appropriated for vaccines would be used accordingly and stated that vaccine recommendations would continue to be made by CDC’s Advisory Committee on Immunization Practices (ACIP). However, on May 27, he contradicted that assurance by directing CDC to remove COVID-19 as a recommended vaccine for pregnant women and children — reportedly without ACIP input. It should be noted that on June 9, a directive from Sec. Kennedy offered formal notice of the immediate termination of the current 17 ACIP voting board members. Injury and Violence Prevention Substance use, suicide, and overdose prevention were major topics around injury and violence. The FY26 budget proposes transferring CDC’s National Center for Injury Prevention and Control to AHA but still eliminates a majority of its programs. These programs have driven progress on opioid surveillance and community-based interventions, and reduced rates of overdose. When asked about preserving the SAMHSA State Opioid Response Grant, Sec. Kennedy said he supported harm reduction tools such as naloxone and community care programs but needed to review the specific grant. He acknowledged overdose as a public health crisis and stated that HHS will maintain 500 addiction treatment centers nationwide. He mentioned his commitment to addiction programs and the administration’s keen attention on preventing fentanyl from entering the United States. Additional questions were raised about high alcoholism rates on reservations, general funding for Indian Health Services, and elimination of LGBTQ+ services in the suicide prevention hotline; Sec. Kennedy promised to follow up on these topics. Chronic Disease, Cancer, and Food Safety Throughout the hearings, Sec. Kennedy underscored his steadfast commitment to reducing rates of heart disease, diabetes, cancers, Alzheimer’s and dementia, and other chronic conditions. He also wants to focus on the challenges of rural health care and rural hospital closures, as well as improved access to care for vulnerable populations, such as older Americans, veterans, and people with disabilities. In his testimony, Sec. Kennedy repeated his commitment to address nutrition and physical activity and to prioritize healthy eating in the Head Start program. He is working closely with FDA to phase out harmful dyes. FDA has fast-tracked approval for vegetable substitute dyes for the food industry. Sec. Kennedy is also focused on combating ultra-processed foods stating that “nutrition reform will address the root causes of diseases,” such as cancer. CDC’s Center for Chronic Disease Prevention is proposed for elimination in the budget, and the Diabetes Prevention Program Outcome Study is paused. Children’s and Women’s Health Lawmakers from both parties voiced concern over misinformation leading to declining vaccination rates and a growing measles threat. Youth mental health and social media harms were emphasized. Senators also raised bipartisan objections to the proposed elimination of CDC’s Childhood Lead Poisoning Prevention Program, which is being revisited. He expressed interest in researching environmental causes of autism and not solely focusing on genetics. In the House hearing, he acknowledged racial disparities in maternal care. Despite proposed cuts to programs like the National Breast and Cervical Cancer Early Detection Program, Sec. Kennedy voiced support for women’s health research. He also said he supports dental care, though he offered limited assurance on fluoride access. The budget proposes to close CDC’s Division of Oral Health. Tobacco Control In the House hearing, Ranking Member DeLauro (D-CT) criticized the proposed elimination of CDC’s Office on Smoking and Health. Senators in the HELP hearing emphasized tobacco’s status as the leading preventable cause of death and warned that staffing cuts would undermine decades of progress. Sec. Kennedy acknowledged the concerns but said he needed to review the specifics. He was also asked about FDA’s inaction on regulating illicit Chinese-made vapes targeting U.S. youth. While Sec. Kennedy presented the FY26 budget as a framework for streamlining government and cutting costs, critics argued that it undermines core public health capacities. As Congress enters markup season and prepares to negotiate final programs and funding levels, the outcome of this year’s budget debate will have long-term implications for the U.S. public health system. article yes

State and territorial health officials gathered on Capitol Hill to meet with lawmakers and discuss public health priorities—learn more about Hill Day in this blog post.