From Dec. 4-5, teams from Arizona, California, Idaho, Maine, Nevada, Oregon, Texas, and Wyoming gathered for the Healthy Brain Initiative (HBI) Planning Lab in Orlando, FL. This 2-day intensive workshop is the first of its kind to support participating states in action planning from the HBI Road Map. By the end of the session, each team developed a mission statement, two goals, and several related strategies to build a public health infrastructure supportive of people living with dementia and their caregivers. The teams were accompanied by CDC, Alzheimer’s Association, and Emory Train Centers. Interested in participating in a workshop like this? Look out for the HBI Action Institutes, coming soon to a region near you.

Members of ASTHO’s senior deputy and chief financial officer committee met with CDC leaders this week, including John Dreyzehner (alum-TN, director, CDC Center for Preparedness and Response), to discuss strategies to strengthen public health funding and address emerging health threats. The group also discussed tactics to support a coordinated effort to strengthen skills for senior leaders in health agencies. Across conversations, leaders focused on creating a shared vision between CDC and state and territorial health leaders.

On Nov. 19, ASTHO CMO Marcus Plescia and Chief of Caribbean Operations Danny Staley attended a CDC Grand Rounds session titled “PFAS and Protecting Your Health.” The session focused on research and program needs to address the many health risks associated with PFAS, and also detailed the history of PFAS contamination in the United States. Presenters discussed Michigan’s PFAS response efforts, a new CDC supported multi-site health study, and a community perspective on PFAS contamination.

On Nov. 18, ASTHO and NACCHO held a joint telebriefing for congressional staff to provide an update on electronic cigarette or vaping product use-associated lung injuries (EVALI). Dr. Monica Bharel (SHO-MA) and Dr. Susan Palchik (Hennepin County, MN director of public health) spoke on the rapid responses state and local health departments rolled out in response to the outbreak.

From Nov. 11-18, Mike Fraser (CEO, ASTHO) and Karl Ensign (chief, performance improvement, research, and evaluation) visited members from three Pacific island territories-- Guam, the Commonwealth of the Northern Marianas Islands, and Chuuk State in the Federated States of Micronesia. They were accompanied by Center for State, Tribal, Local, and Territorial Support (CSTLTS) Director Dr. Jose Montero and Bill Gallo from the CSTLTS Office of Insular Affairs. The goal of the trip was to hear more about territorial priority areas, share thoughts with CDC on capacity building activities, and connect with partners in the Pacific who are working on our shared goal of developing strong and healthy Pacific islands. A great deal of the trip focused on addressing significant chronic disease challenges in the region, especially obesity and diabetes, meeting with staff delivering and administering services, and touring a wide range of facilities.

On Nov. 13, Jay Butler (alum-AK) spoke at a briefing hosted by the Urgent Care Association and the American College of Cardiology about preparation efforts for the 2019-2020 influenza season. The panel discussed the burden of seasonal flu in relation to illness, hospitalizations, and absenteeism, and also shared effective responses to misconceptions about the flu vaccine. Panelists emphasized the importance of flu vaccination to prevent illness, the importance of urgent care centers in providing access to the vaccine, and the effect of flu on those with underlying chronic diseases. Other panel members included Dr. Richard Park (founder and chief executive officer, City MD) and Dr. Andrew Choi (assistant professor of cardiology, George Washington University).

On Nov. 5, ASTHO’s Data Analytics and Public Health Informatics team, in partnership with CDC, hosted and facilitated a Neurological Conditions Surveillance Summit at CDC headquarters in Atlanta. ASTHO invited and engaged over 30 stakeholders in the neurological conditions space to discuss data needs around prevalence/incidence, improved data collection efforts, and advocacy for neurological conditions. CDC also provided an update on their National Neurological Conditions Surveillance System. Several stakeholders noted the existence of neurological disease specific registries or mandated reporting in their county or state, but many agreed that this data wasn’t routinely collected at the state or national level, and that current estimates still contain gaps. ASTHO plans to distill actionable information from the meeting to S/THOs to encourage better data capture for neurological conditions.

On Nov. 7, Karyl Rattay (SHO-DE) spoke at the 2019 March of Dimes Report Card briefing panel on Capitol Hill. The panel was moderated by Rahul Gupta (alum-WV), Senior Vice President and CMO of March of Dimes, and educated members of Congress and their staff about the impact of preterm births and the organization’s 2019 report card, which highlights progress and actions to improve the health of moms and babies in the United States. Other members of the panel included Tiffany Spina (patient advocate), Dr. Zsakeba Henderson (Medical Officer, Maternal and Infant Health Branch, Division of Reproductive Health, CDC) and Dr. Andrew Bremer (Acting Chief, Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Development, NIH).

From Nov. 2-6, ASTHO colleagues, leaders, members, and alumnus attended the American Public Health Association (APHA) 2019 annual meeting. The theme of this year’s meeting was "Creating the Healthiest Nation: For science. For action. For health." The convening looks to further the practice of public health by sharing the latest research and information, promoting best practices, and advocating for public health issues and policies grounded in research. In addition to attending presentations and meet-ups, ASTHO staff shared their expertise as speakers on a number of panels throughout the conference. Next year’s meeting will take place in San Francisco, CA.

On Oct. 31, ASTHO's Performance Improvement team visited with Mark Benton (SHO-NC) and his leadership team at the North Carolina Division of Public Health (NC DPH) to kick off the division's strategic planning process. ASTHO facilitated a session that included 25 division staff with the goal of identifying the agency's strategic priorities. Participants heard from Beth Lovette (Deputy Director, NCDPH) on the results of an environmental scan that identified emerging public health trends and challenges in North Carolina. The scan also identified the agency's strengths and weaknesses, as well as opportunities and threats to consider when formulating its strategic priorities.

On Oct. 30, ASTHO held an organization-wide training on advancing health equity. The session, presented by Human Impact Partners, shared insight on what health equity is, how we can advance it in our immediate work, and we how can work towards transformative, systems-level change for the future. In addition to viewing presentations, staff participated in exercises to deepen understanding of equity as a concept and to explore how our individual backgrounds shape the way we think about equity issues. A second training is scheduled for January.

From Oct. 21-24, ASTHO hosted the 15th Annual ASTHO Directors of Public Health Preparedness Meeting in Minneapolis, MN. The meeting brought together the directors of the 62 Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) recipients, federal leaders, and partner organizations to discuss emerging domestic and global public health threats, state and local practices to improve preparedness and response capabilities, and new developments in federal policies and cooperative agreements. Joe Henderson from Harvard University’s National Preparedness Leadership Initiative facilitated a Preparedness Leadership Summit, and Dr. Robert Kadlec, Dr. Stephen Redd, and Dr. John Dreyzehner (alum – TN) provided keynote addresses. Members participated in peer-to-peer panels, while ASPR and CDC shared their visions for the future of the HPP and PHEP programs.

On Oct. 23, ASTHO alumni Jose Montero (NH) and Jay Buter (AK) and CEO Michael Fraser participated in a “Dialogue with Leaders” panel hosted by CDC’s Office of the Associate Director of Policy. The discussion was co-hosted by a number of ASTHO partners, including the National Governor’s Association, the National Conference of State Legislatures, and the National Academy of State Policy. The event was attended by CDC staff interested in policy work at the state and territorial levels and highlighted state needs and priorities.

On Oct. 10, ASTHO’s environmental health team participated in Children’s Environmental Health Day hosted by the Children’s Environmental Health Network (CEHN). As an official sponsor of the event, ASTHO participated in a Twitter chat focused on environmental health hazards and interventions in early learning and childcare environments. CEHN also hosted an awards ceremony at the Milken Institute School of Public Health at George Washington University , where child health advocates were recognized for contributions in the fields of science, community, advocacy, business, and youth leadership.

On Oct. 16 and 17, ASTHO and CDC leadership convened with USVI Department of Health leadership, community partners, and data stewards to kick off a yearlong health planning process that will lead to a comprehensive health assessment and strategic plan. The assessment and plan will guide the work of USVI DOH for years to come and will begin to fulfill Public Health Accreditation Board requirements. Staff articulated core values, a vision, opportunities, and threats related to this work. Additionally, community partners discussed the importance of community input and how to collectively facilitate engagement and communication. The planning coalition will reconvene in winter 2020 to review population and health system data.

From Oct. 8-10, ASTHO was in Puerto Rico assisting the Puerto Rico Department of Health (PRDOH) as the agency continues its journey towards accreditation. Secretary of Health Rafael Rodriguez Mercado provided opening remarks to over 40 staff across various secretariats. ASTHO’s Performance Improvement team then facilitated 12 domain workshops to assess and analyze documentation for accreditation. PRDOH Assistant Secretary and ASTHO member Catherine DeLa Cruz joined staff in examining how the agency’s programs, policies, and practices are aligned with PHAB requirements.

Mike Fraser (CEO, ASTHO) and Danny Staley (Chief of Caribbean Operations, ASTHO) visited with Justa Encarnacion (THO-USVI) and her leadership team last week in St. Thomas, U.S. Virgin Islands. They spent the day reviewing current agency structure and function, sharing ways to get engaged with ASTHO peer groups and policy committees, and learning about the priorities and opportunities for health improvement in the USVI. Among the many items discussed were health information technology support, behavioral health, and linking clinical and community care.

On Sept. 28, Lisa Peterson (Director of Health and Homeland Security, ASTHO) presented at an event in Prince George’s County, MD titled “Creating Resilient Communities.” Lisa’s presentation to the community described the role of public health in an emergency. She also described science-backed steps that people can take before, during, and after emergencies.

From Sept. 23-25, ASTHO hosted its 2019 Annual Meeting and Policy Summit in Bethesda, MD. The meeting brought together our members, federal and local leaders, experts across industries, and ASTHO staff for three days of learning and collaboration. Attendees participated in small group discussions, networking sessions, Q&A sessions with expert panels, and more. In addition to the record 40 state health officials present, the meeting was attended by U.S. Surgeon General Jerome Adams (ASTHO alum – IL) and leadership from CDC and HHS. View a full recap of the meeting here.

From Sept. 24-25, five health officials testified before two Congressional committees to discuss the public health impacts of e-cigarette use and the current vaporizer-linked lung disease outbreak. Illinois State Health Official Ngozi Ezike testified to the House Committee on Oversight and Reform Subcommittee on Economic and Consumer Policy, and state health officials from Michigan, North Carolina, Kansas, and Massachusetts testified to the House Committee on Energy and Commerce Subcommittee on Oversight and Reform. Below is the full list of members who delivered testimonies:

• Joneigh Khaldun, chief deputy director for health and chief medical executive, Michigan Department of Health and Human Services
• Elizabeth Tilson, state health director and chief medical officer, North Carolina Department of Health and Human Services
• Lee Norman, secretary, Kansas Department of Health and Environment
• Monica Bharel, commissioner, Massachusetts Department of Public Health
• Ngozi Ezike, director, Illinois Department of Health

On Sept. 17-20, ASTHO’s Performance Improvement team hosted the second of three business process improvement workshops with the U.S. Virgin Islands Department of Health (USVI DOH). Over 30 USVI DOH staff helped create and finalize process maps for recruitment, procurement, and expenditure reviews. The workshop enabled participants to challenge current health department processes and gain a deeper understanding of the process improvement cycle. Participants were encouraged to innovate and make hands-on contributions to improve the organization’s workflows. A third and final workshop is planned for early November, at which we will finalize plans developed in the first two meetings.

On Sept. 24, a group of 27 ASTHO alumni gathered to discuss the future of public health and the influence they carry in their current roles to improve health outcomes. ASTHO thanks this group for their continued dedication to the field. We also congratulate Paul Halverson (former SHO – AR) as the recipient of the 2019 ASTHO Alumni Award. The expertise of ASTHO alumni continues to add great value to ASTHO staff, affiliates, and current state and territorial health officials.

From Sept. 18-19, ASTHO staff participated in the Council to Improve Foodborne Outbreak Response (CIFOR) meeting in St. Paul, Minnesota to finalize the third edition of CIFOR’s Guidelines for Foodborne Disease Outbreak Response. CIFOR is a collaboration of national associations and federal agencies that has worked together since 2006 to improve methods to detect, investigate, control, and prevent foodborne disease outbreaks. Council members include experts in epidemiology, environmental health, public health laboratory activities, and food regulation at the local, state, and federal levels.

On Sept. 11-13, ASTHO staff attended and presented at the 2019 Legionella Conference, hosted by NSF International and the National Environmental Health Association. The conference focused on how water systems industries, public health, and other stakeholders in water management can align water and energy sustainability goals with public health priorities. Staff presented on how health officials are changing their responses to disease outbreaks in light of the criminal charges handed to government leaders in the Flint, Michigan water crisis. Staff also presented on the results of an environmental scan and gap analysis led by ASTHO that looked at S/THA approaches for the surveillance, testing, response, and notification of Legionnaires’ disease outbreaks.

On Sept. 12, ASTHO and NACCHO represented state, territorial, local, and tribal governmental public health on Capitol Hill at the Coalition for Health Funding’s Public Health Fair. The fair offered members of Congress, congressional staff, and the community an opportunity to interact with ASTHO and NACCHO staff, participate in our interactive trivia game, and learn more about the importance of partnership between health stakeholders at all levels of government. The fair was also attended by representatives from non-profit organizations, private companies, federal government agencies, and others that are working to improve the nation’s health.

On Sept. 10, ASTHO provided a federal and state health update during a meeting with Delaware Governor John Carney, State Health Official Karyl Rattay, representatives from the offices of Senator Tom Carper, Senator Chris Coons, and Congresswoman Blunt Rochester, the Delaware Division of Public Health, and other partners. The purpose of this meeting was to celebrate state accomplishments of the Delaware Contraceptive Access Now (DE CAN) program. DE CAN, a partnership between Upstream and the state of Delaware since 2014, worked collaboratively to reduce the rate of unintended pregnancy by providing access for all women in the state to the full range of contraceptive methods. From 2013 through 2017, there was a 24% decrease in unintended pregnancies among family planning clients, while the US saw only a 3% decrease over the same time period.

ASTHO was one of many public health and federal organizations who participated in the Public Health Accreditation Board (PHAB) Data Surveillance and Informatics Think Tank from Sept. 10-11, 2019. ASTHO contributed to the discussion by sharing the current state and capacity of informatics for state health agencies and participating in brainstorming around updating the accreditation measures for informatics and data surveillance. Other participants included our partners NACCHO, CSTE, the Public Health Informatics Institute, and several state and local health department staff.

On Sept. 9-10, Randall Williams (SHO - Missouri), Mike Fraser (CEO, ASTHO), and Marcus Plescia (CMO, ASTHO) attended the CDC Hypertension Control meeting in Atlanta, Georgia. The meeting focused on best practices and public-private partnerships to help move the rate of blood pressure control in individuals with hypertension from 50 to 80 percent.

On Aug. 21-23, ASTHO’s Performance Improvement team facilitated a business process improvement workshop with the U.S. Virgin Islands Department of Health (USVI DOH). Over 40 staff from USVI DOH and cross-governmental agencies participated in this detailed mapping of the department’s recruitment, procurement, and grants management processes. As part of ASTHO’s capacity building efforts in the U.S. territories, a representative of the Puerto Rico Department of Health participated and shared lessons learned from similar work being done in Puerto Rico. A follow-up workshop will take place in September.

On Aug. 29, ASTHO hosted a panel of national public health leaders to develop a shared strategy for HHS’s Ending the HIV Epidemic: A Plan for America initiative. Represented organizations include HHS, HRSA, CDC, NACCHO, NASTAD, NMAC, the National Coalition of STD Directors, Big Cities Health Coalition, AIDS United, and the AIDS Institute. The meeting focused on how federal, state, local, and cross-sector health partners can work together to maximize the impact of HIV treatment and prevention programs.

On Aug. 26-29, ASTHO staff attended the National Conference on Tobacco or Health in Minneapolis, MN. Over the course of the conference, staff convened an executive committee meeting of the Tobacco Control Network, gave poster presentations on ASTHO’s chronic disease prevention work, and co-facilitated a health equity training workshop. The conference’s opening session featured keynote remarks from Surgeon General Jerome Adams (alum-IN).

On Aug. 19-23, ASTHO hosted the ASTHO Leadership Summit, Cohort 3, in Colorado Springs. During the week, Mylynn Tufte shared perspectives on leading a state agency and how she incorporated the agency values in her leadership practice. Samantha Scotti from NCSL spoke about working with state delegations and provided an overview of the 2020 races. ASTHO Chief of Government Relations Carolyn Mullen shared ASTHO’s federal policy priorities, resources ASTHO offers, and how the policy statement process works. On Wednesday, ASTHO hosted a dinner discussion with Alaska Gov. Bill Walker and Jay Butler (alumnus-AK) on how they worked together to align priority initiatives and communicate health messages. ASTHO CEO Michael Fraser shared information from the Public Health Workforce Interest and Needs Survey, with recommendations for state and territorial agency workforce development.

On Aug. 20-22, ASTHO’s Maternal and Child Health team hosted the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI) Learning Community Year Two Expansion Meeting in Arlington, VA. The three-day gathering convened to support the learning community’s participants in developing and amending action plans to support policy implementation related to opioid use disorder among pregnant and postpartum women and infants prenatally exposed to opioids, including infants born with neonatal abstinence syndrome. State health officials in attendance included Ali Harrist (SHO-WY) and Kristina Box (SHO-IN).

On Aug. 12-16, Karl Ensign, ASTHO’s Chief of Performance Improvement, Research and Evaluation, and Heidi Westermann, Director of Public Health Systems and Planning, met with leadership from the Pacific Islands Health Officers’ Association (PIHOA) at ASTHO’s headquarters in Arlington, VA. This month, PIHOA Executive Director Emi Chutaro, Deputy Director Janet Camacho, and other senior PIHOA staff are meeting with key partners, including officials from HRSA, HHS, and the U.S. Department of the Interior. ASTHO has a long and successful partnership with PIHOA, having collaborated on many initiatives and projects. Discussion included ongoing collaborative efforts, as well as policy and program strategies for the coming year. ASTHO CEO Michael Fraser will attend PIHOA’s Executive Board Meeting in November.

On Aug. 13-16, ASTHO participated in a four-day pandemic influenza exercise directed by the assistant secretary for preparedness and response (ASPR). As part of this activity, ASTHO activated an emergency operations center (EOC) staffed by several teams. On the second day, staff from NACCHO and APHL joined ASTHO in the EOC (CSTE joined virtually) to engage in collaborative work and information sharing. Activities included requests for assistance from states, federal agencies, and other partners. Simultaneously, the EOC worked on methods to support ASTHO, such as critical staff shortages. States representing each region of the country participated, including Massachusetts, Connecticut, New Hampshire, New York, Pennsylvania, South Carolina, Illinois, New Mexico, Nebraska, Colorado, Arizona, Idaho, and the city of Chicago. Participating federal agencies included ASPR, CDC, FEMA, the Department of Homeland Security, the Department of Energy, and many others.

On Aug. 15-16, ASTHO and the Arkansas Department of Health hosted the Regions IV and VI State Health Officials’ meeting in Little Rock, AR. Topics discussed included: public health challenges for states along the U.S.-Mexico border, preparedness related to the Ebola crisis in the Democratic Republic of Congo, as well as clinical services offered by county health departments. State health officials in attendance included: Rick Toomey (SHO-SC), Scott Harris (SHO-AL), Lisa Piercey (SHO-TN), Thomas Bates (SHO-OK), Nathaniel Smith (SHO-AR), Alex Billioux (SHO-LA), Mark Benton (SHO-NC), Abinash Achrekar (SHO-NM), John Hellerstedt (SHO-TX), and Thomas Dobbs (SHO-MS). Also in attendance were senior leadership from state health agencies and HHS Region IV and VI regional health administrators.

On Aug. 8, ASTHO’s preparedness and social and behavioral health teams joined colleagues from the Georgia Department of Public Health to plan, develop, and execute a tabletop exercise. The exercise centered around a simulated opioid overdose cluster spike and included representatives from state and local public health, law enforcement, and CDC. The primary objective was to pilot a new ASTHO Opioid Rapid Response Team Guidebook for developing a team to augment a state’s incident management structure. Preliminary evaluation responses indicate that the guidebook was a useful and effective tool. A special thanks to Georgia Department of Public Health planning partners.

On Aug. 1, Randall Williams (SHO-MO) and Kristina Box (SHO-IN), along with representatives from ASTHO’s directors of public health preparedness peer group, participated in a semi-annual joint policy workgroup meeting in Louisville. The workgroup is hosted by ASTHO in collaboration with the Governors Homeland Security Advisors Council (GHSAC) and the National Emergency Management Association (NEMA). The group brings together public health, homeland security, and emergency management to address cross-cutting issues. Topics included migrant border health, Ebola preparedness, cyber attacks on the public health system, and combating vaccination misinformation. This partnership is now completing its tenth year and remains a cornerstone activity of ASTHO’s preparedness portfolio.

ASTHO’s Maternal and Child Health team hosted the ASTHO Breastfeeding and Early Life Nutrition Innovation Sustainability Training on July 30-31, 2019 in Asheville, North Carolina. This two-day gathering brought together State Physical Activity and Nutrition (SPAN) recipients and their partners to form a cohesive partnership between physical activity, nutrition and obesity prevention, early life nutrition and breastfeeding support. Participants collaborated on boundary spanning techniques for achieving success and maximum impact and explored innovative and equity focused breastfeeding interventions and implementation approaches.

Last week, Nate Smith (SHO-AR) participated in the first bipartisan “Rural and Underserved Communities Health Task Force” meeting hosted by the House Ways and Means Committee. Smith was part of a panel of outside experts who discussed the challenges of delivering health care in rural and underserved areas, and explored holistic bipartisan policy options that could improve outcomes and care in these communities.

On July 22-26, ASTHO hosted its third ASTHO Week. As a teleworking organization, ASTHO Week brings together all staff in ASTHO’s headquarters in Arlington, VA, for a week of collaboration, discussion, teambuilding, and organizational strategy. A highlight from the week included a Public Health Leader Roundtable on July 25 hosted by Nate Smith (SHO-AR) at Cornerstone Government Affairs’ offices in Washington, D.C. ASTHO convenes this informal gathering of about 50 top leaders in public health to inform state and territorial governmental public health and partner on current issues, activities, and advocacy efforts. During the meeting, participants received updates on congressional activities and shared the top public health issues their organizations are currently facing. Smith also addressed ASTHO’s staff, speaking about his career path, his work as a physician and its impact on his public health practice, priorities for his upcoming term as ASTHO’s president, and more. Later that afternoon, Smith joined David Lakey (alumnus-TX) and ASTHO leadership for a deskside media briefing on actions U.S. public health officials can take to prevent a domestic Ebola outbreak like the one currently occurring in the Democratic Republic of the Congo.

On July 9-10, ASTHO’s performance improvement team facilitated a second business process improvement workshop at the Puerto Rico Department of Health (PRDOH). During the workshop, over 20 PRDOH staff came together to validate current processes and build standard operating procedures for procurement, property, and travel processes. As part of ASTHO’s capacity building efforts in the U.S. territories, Tatia Monell-Hewitt, chief financial officer of the U.S. Virgin Islands Department of Health, participated to share expertise and lessons learned. This work is part of crisis funding to assess and enhance administrative processes that support public health infrastructure and funding.

On July 17, ASTHO Region VI Director John Hellerstedt (SHO-TX) hosted CDC Director Robert Redfield and CSTLTS Director Jose Montero (alumnus-NH) at the Texas Department of Health to discuss the Administration’s plan for Ending the HIV Epidemic in America.

On July 16, Carolyn Mullen, ASTHO’s chief of government affairs and public relations attended a briefing and tour of the Philadelphia Curran Fromhold Correctional Facility along with Rob Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors, and other behavioral health leaders to learn more about the facility’s medication-assisted treatment (MAT) program. This briefing was led by Dr. Bruce Herdman, Chief of Medical Operations for the facility. In recent years the program has expanded to offer all forms of MAT and continuity of treatment following release of the inmates. This approach was recently featured in a SAMHSA publication titled, “The Use of MAT for Opioid Use Disorder in Criminal Justice Settings.”

On July 17, Region III held their regional priorities summit. Attendees included several state health officials, behavioral health officials, federal government staff, and leadership staff from ASTHO, the National Association of State Alcohol and Drug Abuse Directors, and the National Association of State Mental Health Program Directors. Topics discussed during the summit included the judicial opioid care continuum, polysubstance regional trends, harm reduction programs, ending the HIV epidemic, vaccine hesitancy, and Lyme disease.

ASTHO’s preparedness and social and behavioral health teams joined with colleagues from the Utah Department of Health to plan, develop, and execute a tabletop exercise. The exercise was conducted on July 17 in Salt Lake City and centered around a simulated law enforcement closure of three pain clinics in the area, resulting in the loss of critical services for 2000 patients and clients. This loss of pain management support led to an overwhelming surge on other members of the healthcare community and an increase in the misuse of opioids with resultant overdoses and deaths. The exercise included representatives of state and local public health, law enforcement, corporate healthcare, and CDC. The primary objective was to evaluate a new ASTHO Opioid Rapid Response Team Guidebook constructed for use in developing a team to augment a state’s incident management structure. Preliminary reports indicate that the guidebook was a useful and effective tool for states and territories. A special thanks to ASTHO and Utah Department of Health planning partners.

On July 10-12, ASTHO, CDC, and the National Conference of State Legislatures (NCSL) hosted a Winnable Battles meeting convening state policymakers and state health leadership to address key public health issues. State teams from Alabama, Georgia, Kentucky, Mississippi, and West Virginia worked together to tackle issues including HIV and infectious consequences of opioid use, hypertension, and adverse childhood experiences. During the meeting, Scott Harris (SHO-AL), Jay Butler (alumnus-AK), and Danny Staley (alumnus-NC), ASTHO’s chief of Caribbean operations, discussed their experience as state health officials working with legislators to address priority public health topics.

On July 10, Amandeep Kaur, ASTHO’s health improvement analyst, attended a briefing on President Trump’s Advancing American Kidney Health Initiative. President Trump signed an executive order to direct HHS to focus on three main goals: preventing kidney failure, increasing treatment affordability and options, and increasing access to kidney transplants. President Trump highlighted the importance of home dialysis, as it would lower kidney disease treatment expenditure. He also presented policy options such as reimbursing organ donors and improving organ procurement regulation. Over 30 million people are living with chronic kidney disease; it is currently the ninth leading cause of death in America. The briefing included an opportunity to hear stories of kidney disease patients. HHS Secretary Alex Azar also revealed a plan to work with Congress to eliminate the 36-month limit on Medicare coverage of post-transplant medication coverage.

On July 8, ASTHO CEO Michael Fraser attended the NACCHO 2019 Annual Conference in Orlando. At the conference, Fraser briefed the NACCHO board on current ASTHO priorities and opportunities for collaboration between ASTHO and NACCHO. ASTHO members, partners, and alumni featured prominently on the NACCHO meeting agenda including Scott Rivkees (SHO-FL), who participated in the opening plenary session, CSTLTS Director Jose Montero (alumnus-NH), who presented on CDC’s priorities, followed by U.S. Surgeon General Jerome Adams (alumnus-IN) and John Dreyzehner (alumnus-TN), who moderated a session on public health messaging and the de Beaumont Foundation’s PHRASES project. ASTHO Immediate Past President John Wiesman (SHO-WA) was also in attendance.

On July 10-11, the executive committee of the Tobacco Control Network (TCN), an ASTHO peer network, convened in ASTHO’s Atlanta regional office with ASTHO staff and the CDC Office on Smoking and Health for a two-day strategic planning and business planning meeting. The executive committee discussed the strategic direction and top priorities of the network for the next three years. The group also celebrated 2019 as the 25th anniversary of TCN and their support of state and territorial tobacco control programs. ASTHO recently published a blog post highlighting TCN’s role in tobacco control successes over the last 25 years, featuring remarks from ASTHO Chief Medical Officer Marcus Plescia and TCN Chair Luci Longoria.

On July 9-10, ASTHO hosted the National Viral Hepatitis Program Planning Meeting, a convening of state, local, federal, and nonprofit partners in a national dialogue on viral hepatitis program planning to move forward on the path to elimination. Alex Billioux (SHO-LA) presented on the Louisiana Hepatitis C elimination program, including their innovative drug pricing model for hepatitis C treatment. Additional presentations included topics such as improving prevention and surveillance, decreasing barriers to treatment, and engaging people affected by viral hepatitis in elimination planning.

On June 27, ASTHO held a second Project ECHO session on HPV at the CDC Foundation in Atlanta. CDC Foundation CEO and President Judy Monroe presented an engaging session on public-private partnerships. Members of the Texas Department of Health participated as the session’s case presenters. The session provided feedback and advice for Texas around choosing influencers and keeping volunteers on HPV projects engaged and excited about the work. The third Project ECHO session on HPV is scheduled for July 23 from 4-5 p.m. at ASTHO’s headquarters in Arlington, VA. The focus will be communications.

On June 18-19, ASTHO’s environmental health team hosted a two-day GIS workshop for state health agency staff in Providence, RI. The workshop provided vector-borne disease surveillance training to health agency staff working on vector management activities. Using case studies with state data, the workshop examined how to address the spread of vector-borne diseases such as Dengue fever, West Nile, and Zika viruses using spatial analysis and data visualization techniques. This was the second training delivered through a partnership between ASTHO and the National Library of Medicine’s Community Health Maps Initiative.

On June 25, Karen Smith (SHO-CA) welcomed attendees to the 2019 National Opioid Leadership Summit. The summit focused on the challenges the United States continues to face with the opioid epidemic, including equity and stigma, collective impact, economic impact, and integral partnership with the criminal justice system. Monica Bharel (SHO-MA) discussed cross-sectoral solutions, including work among partners in criminal justice, public health, behavioral health, higher education, and healthcare sectors. Bharel provided a recent example of cross-sector collaboration between the Massachusetts Department of Health and all four medical schools in Massachusetts to mandate Medical Education Core Competencies for the Prevention and Management of Prescription Drug Misuse.

On June 20-21, ASTHO’s state health policy team hosted its annual State Legislative Liaison (SLL) meeting in Atlanta. The SLL meeting provided an opportunity to share successes and challenges, discuss emerging public health policy issues, and identify legislative priorities for 2020. The meeting also included a training on public health economics led by Glen Mays, Professor and Chair, Department of Health Systems, Management and Policy at the Colorado School of Public Health. The training featured tools and strategies to determine and communicate the economic value of public health policy. In addition, federal partners from CDC’s National Center for Immunization and Respiratory Disease and CDC’s Public Health Law Program as well as the legislative liaison from Washington state participated on an expert panel discussing communication and policy strategies to improve vaccine coverage.

June 17-20, ASTHO hosted its Leadership and Communications Summit and Board Meeting in Atlanta. A few highlights from the week include:

On June 17, ASTHO and the Emory Rollins School of Public Health hosted a welcome reception for newly appointed state and territorial health officials, as well as local health officials attending CDC’s New Health Officer Orientation. The reception provided an opportunity for state and territorial health officials and big city health officers to engage and network with CDC leaders, ASTHO executive leadership, as well as ASTHO alumni. Kathleen Toomey (SHO-GA) offered welcoming remarks.

On June 18, ASTHO hosted a networking dinner at the Emory Conference Center. Twenty-eight state and territorial health officials were present, including: Nate Smith (SHO-AR), Ngozi Ezike (SHO-IL), Lee Norman (SHO-KS), Amy Acton (SHO-OH), Jeanna Ayers (SHO-WI), Alexander Billioux (SHO-LA), John Wiesman (SHO-WA), Greg Holzman (SHO Designee-MO), Norm Oliver (SHO-VA), LaQuandra Nesbitt (SHO-DC), Catherine Slemp (SHO-WV), Mark Levine (SHO-VT), Mylynn Tufte (SHO-ND), Lily Lou (SHO-AK), Thomas Dobbs (SHO-MS), Abinash Achrekar (SHO-NM), Esther Muna (THO-CNMI), Renee Coleman-Mitchell (SHO-CT), Linda Unpingco-DeNorcey (THO-Guam), Catherine De La Cruz-Duran (THO-PR), Jill Hunsaker Ryan (SHO-CO), Rachel Levine (SHO-PA), Beth Lovette (SHO-NC), Lisa Morris (SHO-NH), Lisa Piercey (SHO-TN), Kathleen Toomey (SHO-GA), and Randall Williams (SHO-MO). The dinner provided an opportunity to introduce newly appointed state and territorial health officials and overview ASTHO’s engagement with members.

On June 19, ASTHO and Washington Media Group hosted a media and communications training workshop to help equip both new and seasoned state and territorial health officials with the tools and skills necessary to effectively communicate public health priorities and issues. The workshop focused on how to tell powerful and meaningful stories, strategies to engage the media, as well as how to effectively communicate in challenging political environments and during times of crisis. In addition to ASTHO and Washington Media Group, Katherine Lyon Daniel, CDC’s associate director for communications, and Lynn Sokler, CDC’s senior communications advisor, joined the media training to share strategies and CDC resources for effective crisis communications.

On June 18-20, ASTHO’s environmental health team hosted its annual State Environmental Health Directors (SEHD) meeting and a GIS workshop for state health agency staff in Providence, RI. The SEHD meeting provided colleagues with an opportunity to set priorities, share best practices, and identify opportunities and strategies for successful interagency collaboration. The meeting also included a training on Advancing Environmental Health Priorities Through Health in All Policies facilitated by the Kansas Health Institute. The training featured presentations on state environmental health priorities such as food and water safety, as well as PFAS biomonitoring investigations. Federal partners from CDC, EPA, and FDA also participated. Meanwhile, the GIS workshop provided vector-borne disease surveillance training to health agency staff. The workshop, led by Kurt Menke from the National Library of Medicine’s Community Health Maps Initiative, was the second training delivered through a partnership between ASTHO and the initiative.

On June 11-12 ASTHO facilitated a Boundary Spanning Leadership workshop with the North Dakota Department of Health and their leadership team. During the meeting, Mylynn Tufte (SHO-ND) pointed out alignment between work the department is undertaking through its braiding and layering project and the state’s Mainstreet Initiative. CSTLTS leadership also participated. The workshop empowered the team with the tools and knowledge to effectively identify and span existing boundaries in order to support and fund infrastructure, activities, and services aimed at addressing the social determinants of health.

Last week, ASTHO’s performance improvement team hosted a “Business Process Improvement Kick-Off” meeting with Danny Staley (alumnus-NC), ASTHO’s chief of Caribbean operations, as well as leadership from the U.S. Virgin Islands Department of Health. ASTHO led a cross-agency meeting with directors and commissioners from USVI’s Office of Management and Budget, the department of finance, department of property and procurement, and as well the department of health. Leadership from CDC and CSTLTS were also present. Broad agreement on direction and scope was achieved within the department of health and related agencies, with reforms directly aligning with the new government’s vision and priorities around reforming procurement and recruitment.

This week, ASTHO CEO Michael Fraser, as well as Jim Blumenstock, ASTHO’s chief of health security and members of the environmental health team hosted ASTHO’s Climate and Health Summit in Honolulu, HI. The meeting convened territorial health leaders and staff to discuss agency priorities related to the impacts of climate on health. Also in attendance were partners from PIHOA and the East-West Center, as well as leadership from CDC’s National Center of Environmental Health and the Hawaii State Department of Health. A two-day vector borne disease GIS surveillance workshop directly followed the meeting led by an instructor from the National Library of Medicine’s Community Health Maps initiative.

On June 3-4, ASTHO and CDC hosted the ASTHO/CDC Heart Disease and Stroke Prevention Learning Collaborative in Guam. The meeting provided an opportunity for project teams from CNMI, Guam, and Palau to refine action plans and strategies to implement rapid hypertension management and control initiatives with support from ASTHO and CDC. Esther Muña (THO-CNMI), Linda DeNorcey (THO-Guam), and Emais Roberts (THO-Palau) discussed leadership and systems change on a panel moderated by ASTHO CEO Michael Fraser.

On May 30, ASTHO hosted a leadership summit on adverse childhood experiences (ACEs) at its headquarters in Arlington, VA. During the summit, participants discussed strategies for using ACEs data to inform programmatic and policy work at the state level. Chris Jones, CDC’s senior advisor and director of strategy and innovation, spoke about the intersection between ACEs, substance misuse, suicide, and the importance of primary prevention. Ana Novais, deputy director for the Rhode Island Department of Health, described the state’s Health Equity Zones and explained how this initiative promotes social and community connectedness to mitigate stress and trauma among youth. Attendees representing health departments in Arkansas, Oklahoma, Washington, Wisconsin, and Virginia also presented on how their states are using ACEs data collected from the Behavioral Risk Factor Surveillance System to address substance use disorders and other behavioral health conditions.

On May 23, Esther Muña (THO-CNMI) and territorial health leaders from Guam, Puerto Rico, America Samoa, and the U.S. Virgin Islands testified before the U.S. House Committee on Natural Resources. Their testimonies focused on the need for increased federal Medicaid contributions in the territories, as well as the health consequences that would result without these contributions. “Low federal contributions, coupled with exhaustion of the Patient Protection and Affordable Care Act funds this year, creates a fiscal cliff for our Medicaid program,” Muña said. “This fiscal cliff threatens to unweave our substantial improvements over the past ten years in the delivery of healthcare, further erodes our economy, and threatens the health and well-being of our people.”

On May 15-16, ASTHO’s Performance Improvement team facilitated the first of three in-person business process improvement workshops at the Puerto Rico Department of Health (PRDOH). Over 20 PRDOH staff and external government stakeholders participated in the development of three key PRDOH business processes maps: property, procurement, and travel. These maps will be essential to the agency in developing standard operating procedures for key financial processes and implementation throughout the agency. This work is a collaborative effort involving ASTHO, CDC, and PRDOH.

On May 21, Elke Shaw-Tulloch (SHO-ID) and the Idaho Department of Health hosted an ASTHO Boundary Spanning Leadership workshop, with leaders from each bureau within the department participating. The purpose of the workshop was to look at how the bureaus could work together to adopt the 2019 ASTHO President’s Challenge, “Building Healthy and Resilient Communities,” by expanding their vision for “Get Healthy Idaho.” This workshop was conducted with support from CDC for a pilot project looking at braiding and layering funding sources to address social determinants of health and foundational public health capabilities.

On May 21-24, Guam's senior leadership and quality improvement council worked with ASTHO staff to strategize efforts to improve Guam's culture of quality. This included facilitating a self-assessment activity to identify gaps and opportunities to strengthen Guam's quality improvement plan and implement a performance management system. The discussions have been valuable in identifying opportunities and challenges. The team is looking forward to process mapping current and future performance management system components with QI council members and other programmatic staff.

On May 21, staff from ASTHO’s regional office in Atlanta attended CDC’s Grand Rounds, “Turning the Tide: The Role of Water Management to Prevent Legionnaires’ Disease.” Jay Butler (alumnus-AK), ASTHO past-president and current deputy director for infectious diseases at CDC, introduced the panel, which included perspectives from the Colorado Department of Public Health and Environment and the U.S. Department of Veteran Affairs. Panelists discussed the burden Legionnaires’ disease places on the public health and healthcare systems, environmental health’s role in preventing Legionnaires’ disease, as well as the importance of building public health capacity around this important issue.

On May 5-8, ASTHO convened the 26th Senior Deputies Annual Meeting in San Juan, Puerto Rico, providing an opportunity to strengthen relationships between state, territorial, and federal partners, as well as share programmatic priorities and best practices in public health. Senior deputies from over 25 state and territorial health agencies, CDC, and the de Beaumont Foundation, came together to discuss the public health challenges impacting states and territories, emerging trends, as well as strategies and tools to advance the public’s health and well-being. On May 5, new senior deputies attended several orientation sessions providing resources to equip them for their new positions. Rafael Rodríguez Mercado (THO-PR) and Catherine de la Cruz Duran (THO Designee-PR) provided welcoming remarks. Participants then heard from peers and partners about experiences engaging the business community, strategies on implementing national data standards to advance information exchange, as well as building and strengthening the public health workforce. CDC deputies led round table discussions on key programs, with participants asking questions and sharing successes and challenges. Additionally, colleagues from Puerto Rico shared firsthand perspectives on response and recovery efforts following hurricanes Irma and Maria. Before finishing the annual meeting, senior deputies along with chief financial officers attended a workshop on positive change leadership and appreciative inquiry.

On May 9, ASTHO’s Center for Population Health Strategies hosted a site visit with the Montana Department of Health in Helena as part of the clinical to community connections team’s Telehealth Learning Community. The meeting included stakeholders working together toward advancing behavioral telehealth, including Sheila Hogan (SHO-MO). The meeting featured two panels on telehealth programs and reimbursement, a presentation from Mei Kwong, executive director of the Center for Connected Health Policy, as well as a brainstorming session.

On May 13-15, ASTHO and CDC hosted the 2019 Prevention for States (PfS)/Data-Driven Prevention Initiative (DDPI) Awardee Meeting in Atlanta. The week began with a pre-meeting workshop for state health officials. ASTHO CEO Michael Fraser introduced the meeting, along with Grant Baldwin CDC’s director of the Division of Unintentional Injury Prevention, and Sarah Bacon, CDC’s lead behavioral scientist on the Opioid Overdose Prevention Programs Team. State health officials in attendance included Jeanne Ayers (SHO-WI), Scott Harris (SHO-AL), Gregory Holzman (SHO Designee-MO), Kathy Kunkel (SHO-NM), Mark Levine (SHO-VT), LaQuandra Nesbitt (SHO-DC), and Lisa Piercy (SHO-TN). During the pre-meeting, conversation centered around assessing the purpose and utility of state opioid data dashboards, understanding the potential need for and benefits of standardization of dashboard data elements, building consensus around which dashboard elements could feasibly be standardized, as well as discussion on the future of such dashboards and how they might be leveraged to respond to other substance use crises. The broader meeting comprised breakout sessions showcasing the efforts of PfS/DDPI awardees and partners as they move beyond implementation to achieve impact. Sessions highlighted state accomplishments, innovative strategies, and key collaborations in the fight against the opioid overdose epidemic.

On May 15-16, ASTHO’s environmental health team, with support from CDC’s National Center for Emerging and Zoonotic Infectious Diseases, helped facilitate the 2019 National Association of Vector-Borne Disease Control Officials (NAVCO) Annual Meeting in Fort Collins, CO. The meeting featured a variety of speakers discussing various vector-borne disease topics, including emerging and re-emerging arboviral diseases, technical aspects of tick surveillance, and state perspectives on insecticide resistance testing. The NAVCO board also convened for a meeting to discuss future priorities and activities for the association. Additionally, ASTHO’s state health policy and environmental health teams discussed their ongoing vector-borne disease work.

On May 8-9, ASTHO convened a CFO Annual Meeting in San Juan, Puerto Rico, to discuss the financial management of public health emergencies. Participants heard about experiences responding to and recovering from natural disasters and public health threats, as well as innovative funding strategies. Esther Muna (THO-CNMI) and Catherine de la Cruz-Duran (THO-PR), as well as Tatia Monell-Hewitt, CFO for the U.S. Virgin Islands Department of Health, and Derek Sasamoto, CFO for the Northern Mariana Islands Commonwealth Health Corporation, discussed post-typhoon and post-hurricane financial recovery and sustainability for CNMI and Puerto Rico, with an emphasis on what health departments can learn from these experiences.

In addition, CFOs shared how administrative processes can delay receiving and spending critical emergency public health dollars, as well as how they successfully navigated these challenges. Anna Novais, senior deputy of the Rhode Island Department of Health, and Amy Ferris, Chief Financial Officer of the Washington State Department of Health, also shared current efforts to fund foundational services and prevention activities in the absence of dedicated funding. CDC deputy directors joined CFOs to discuss opportunities to further collaborate on communication, grants, and financial competency. The CFO meeting was preceded by a joint training with participants from the ASTHO Senior Deputy Annual Meeting, which focused on strengthening management through positive change leadership.

On May 1, ASTHO launched a new learning community based on Project ECHO (Extension for Community Healthcare Outcomes), an education and collaboration model. This initiative aims to establish multidisciplinary state teams and create knowledge networks for sharing evidence-based strategies and promising practices related to HPV, with the goal of ultimately improving HPV vaccination rates across the nation.

On Apr. 29-May 2, ASTHO hosted its second ASTHO Week. As a teleworking organization, ASTHO Week brings together all staff in ASTHO’s headquarters in Arlington, VA, for a week of collaboration, discussion, teambuilding, and organizational strategy. A few highlights from the week include:

On Apr. 29, the DC Central Kitchen welcomed ASTHO volunteers to help cut, chop, peel, and prep food in the community kitchen. ASTHO enjoyed learning about the organization and its commitment to building a more equitable, healthy food system.

On April 30, the Chris Atwood Foundation hosted a training with ASTHO staff about how to recognize an opioid overdose and administer lifesaving naloxone, sparking an important conversation about stigma, medication-assisted treatment, and recovery.

On April 30, Shereef Elnahal (SHO-NJ) and Saanie Sulley, data analyst for the Alliance for Innovation on Maternal Health, discussed health equity and solutions to address racial disparities in infant and maternal mortality.

On May 1, Jerry Rhodes, ASTHO’s director of crisis response preparedness, and Alex Seifert, ASTHO’s senior analyst of preparedness and epidemiology, hosted a COOP Presentation to discuss ASTHO’s emergency response plans. Following the presentation, staff gathered to sample wings and eat ice cream.

On April 22-25, ASTHO’s social and behavioral team attended the Rx Drug Abuse and Heroin Summit in Atlanta, a national collaboration of professionals from local, state, and federal agencies, treatment providers, and other sectors impacted by prescription drug abuse and heroin use. President Trump headlined the event, delivering the keynote address, in which he discussed the Administration’s plans to address the ongoing national opioid epidemic. It is the event for decision makers and allied professionals working to address this public health emergency. John Dreyzehner (alumnus-TN) also presented at the summit, moderating a panel focused on improving outcomes for pregnant women with opioid use disorder, and their infants.

On April 23, Josh Berry, ASTHO’s senior analyst of chronic disease prevention, visited Charleston, West Virginia, with members of the West Virginia Breast and Cervical Cancer Screening Program and other community and clinical stakeholders as part of the breast cancer disparities in-person/virtual meeting organized with NACDD. Facilitators from ASTHO and NACDD joined health agency and external stakeholder teams in Mississippi, Pennsylvania, Tennessee, and Wisconsin. Participants engaged in learning and information sharing as a large group, as well as action plan brainstorming to support state health agencies in addressing breast cancer disparities with data-driven action steps.

On April 17, Kelsey Donnellan, ASTHO’s senior analyst of health improvement, presented at the Aging in America Conference in New Orleans. The session, entitled “Starting Conversations About Dementia in Indian Country: A Public Health Road Map,” included a panel discussion with experts from the Alzheimer’s Association, CDC, the International Association for Indigenous Aging, and Splaine Consulting. ASTHO’s presentation focused on the recently released resource, “Communicating in Indian Country: Healthy Heart, Healthy Brain.” Donnellan reviewed the role of ASTHO in state public health, outlined the participatory process used to develop the communication materials, and discussed how they can be used. State and tribal partnerships are important to supporting American Indian and Alaska Native people living with, or at risk for, dementia, as many live off reservation and in urban cities. The full resources can be found on ASTHO’s website.

Last week, ASTHO’s Performance Improvement, Research and Evaluation team led business process improvement work in the Marshall Islands. A memorandum of understanding and three accompanying standard operating procedures (SOPs) in grants management, procurement, and recruitment were developed and reviewed with the participation of the five cabinet-level agencies charged with implementation. Pictured during the signing of the SOPs are (from left to right): the Public Service Commission, the Attorney General’s Office, the Ministry of Health, the Ministry of Finance, and the Office of the Chief Secretary. The work is a collaborative effort involving ASTHO, CDC, PIHOA, the Republic of the Marshall Islands’ Ministry of Health. Additionally, ASTHO facilitated cross-agency conversations to helped broker agreements to work on the following:

• Reducing the number of signatures required for relatively small-cost requisitions.
• Establishing standing orders for pharmaceuticals and lab supplied that will be (re)completed on a yearly or bi-yearly basis.
• Expedited procurement procedures for outbreaks and other public health events that do not yet rise to the level of national emergencies covered by the National Disaster Act.

On April 15, ASTHO CEO Michael Fraser presented to CDC, CSTLTS, and technical monitors in Atlanta. CSTLTS Director Jose Montero (alumnus-NH) introduced and then turned discussion over to Fraser. During the presentation, Fraser laid out ASTHO’s strategic plan to improve capacity at state and territorial public health departments. A focus of the presentations was ASTHO’s capacity building and technical assistance framework, which aims to further support state and territorial public health through capacity building, technical assistance, and thought leadership. Throughout the presentation, Fraser emphasized ASTHO’s focus on strategic foresight when assessing state priorities, as well the importance of being precise and predictive. ASTHO thanks CDC, CSTLTS, and CSTLTS Director Jose Montero for hosting the presentation.

On April 17, the Nebraska Department of Health and Human Services Office of Health Disparities and Health Equity hosted Deborah Fournier, ASTHO’s senior director of clinical to community connections, and Priyanka Surio, ASTHO’s director of data analytics and public health informatics. Fournier and Surio led several sessions during the department’s Minority Health Conference, with a focus on uniting practice and partnerships to achieve health equity. Fournier led the morning keynote session on how cross-sector initiatives, such as the Accountable Health Communities model, can improve health outcomes for low-income and minority communities to advance health equity. Surio led a breakout session on building an informatics-savvy public health infrastructure to explore the skills, technologies, and strategies necessary for capturing and displaying social determinants of health data. Fournier also led a breakout session highlighting ASTHO’s 2019 President’s Challenge, “Building Healthy and Resilient Communities.”

On April 16-17, ASTHO and the National Organization of State Offices of Rural Health hosted a meeting with Primary Care Office (PCO) directors and HRSA at ASTHO’s headquarters in Arlington, VA. The meeting familiarized participants with major components of PCO work and also served to build working relationships between PCO directors who are able to consult and strategize with one another. In addition, the meeting provided new PCO directors with an opportunity to seek mentorship and expert advice from colleagues.

On April 9, ASTHO’s Center for Population Health Strategies hosted a site visit with the Florida Department of Health in Tallahassee, FL. The site visit was part of the Clinical to Community Connections team’s Telehealth Learning Community. The half-day meeting included stakeholders working toward advancing behavioral health services in school settings. The meeting featured a presentation from Mei Kwong, executive director of the Center for Connected Health Policy. Lloyd Sirmons, director of the Southeastern Telehealth Resource Center, provided a telehealth demonstration.

Last week, Abe Kulungara, ASTHO’s senior director of environmental health, attended the Council to Improve Foodborne Outbreak Response (CIFOR) meeting in Dallas. CIFOR is a multidisciplinary collaboration of national associations and federal agencies working together since 2006 to improve methods to detect, investigate, control and prevent foodborne disease outbreaks. CIFOR members met in Dallas to finalize the third edition of CIFOR’s Guidelines for Foodborne Disease Outbreak Response, a comprehensive resource for federal, state, and local agencies involved in investigating foodborne outbreaks.

On April 4, ASTHO co-sponsored and supported a congressional briefing entitled “Emerging Threats to Mothers and Babies: Protecting Vulnerable Populations During and After Public Health Emergencies.” Over 100 congressional staffers and stakeholders attended the session, which covered issues impacting mothers and babies such as Zika and how lessons learned can help inform tracking, detection, and care in future public health emergencies. Speakers included Margaret (Peggy) Honein, director of CDC’s Division of Congenital and Developmental Disorders at the National Center on Birth Defects and Developmental Disabilities. Honein emphasized preparedness: “We don’t want to repeat history,” she said. “We want to stop the next Zika.” Lacy M. Fehrenbach, assistant secretary of prevention and community health at the Washington State Department of Health, described how Washington state uses data from home visiting to plan and support vulnerable communities during emergencies. “We don’t know what the next Zika is,” Fehrenbach said, “but we do have the ability to find it more quickly.”

During the week of April 1, ASTHO’s performance improvement team convened a public health systems improvement workshop with eight states and two territories: Alaska, Arizona, CNMI, Connecticut, Kansas, Maine, Montana, New Jersey, Puerto Rico, and Wisconsin. This was part of the state and territorial Public Health Systems Improvement CBTA Project. The workshop focused on change management, engaging leadership, and leading and facilitating teams in support of planning, performance management, and accreditation. ASTHO staff and consultants helped participants build connections, discover existing resources, brainstorm, and problem solve. Over the next four months, these states and territories will implement public health improvement in their health agencies through systems thinking and pragmatic planning.

Last week, ASTHO’s preparedness and infectious disease teams attended the Public Health Preparedness Summit in St. Louis. ASTHO led or co-led several activities, including the PHEP-HPP awardee meeting, a town hall on repatriating U.S. citizens following an international disaster, as well as meetings of the directors of public health preparedness, medical countermeasures coordinators, territorial representatives, and directly funded cities. In addition, Randall Williams (SHO-MO), Nate Smith (SHO-AR), Cathy Slemp (SHO-WV), and Marissa Levine (alumna-VA) participated in a tabletop exercise focused on difficult policy issues and solutions arising from an evolving pandemic. Jim Blumenstock, ASTHO’s chief of health security, led the National Academies workshop on exploring medical and public health preparedness for a nuclear incident. Randall Williams delivered a welcome speech during the opening session of the summit, which brought together more than 1,900 public health preparedness professionals.

On March 28, ASTHO President Nicole Alexander-Scott (SHO-RI) spoke during a plenary session at the Open Forum for Quality Improvement and Innovation in Public Health conference, hosted by the National Network of Public Health Institutes. The dialogue focused on framing community resilience as a public health strategy. Dr. Alexander-Scott described Rhode Island’s first set of statewide health equity indicators, which offer a look at civic engagement, social vulnerability, and equitable housing policies. She was joined by several other panelists to discuss community cohesion, engagement, and health equity, including NACCHO President Kevin Sumner, John Auerbach (alumnus-MA), president and CEO of Trust for America’s Health, and Alonzo Plough, vice president for research-evaluation-learning and chief science officer at the Robert Wood Johnson Foundation.

The past week has been busy for ASTHO’s environmental health team. See below for highlights from the week!

On March 19, ASTHO CEO Michael Fraser, along with Jim Blumenstock, ASTHO’s chief of health security, and Abe Kulungara, ASTHO’s senior director of environmental health, met with Donald Welsh, the new executive director of the Environmental Council of States (ECOS) and Carolyn Hanson, the deputy director at ECOS. EPA, ECOS, and ASTHO have a Memorandum of Agreement on public health and environmental collaboration that will advance the parties’ mutually shared mission of protecting the public’s health from environmental threats and hazards. At the meeting in Washington D.C., ASTHO and ECOS underlined the need to collaborate in enhancing communication and developing resources around contaminants like Per- and polyfluoroalkyl substances (PFAS).

Also on March 19, Kathy Dolan, ASTHO’s director of environmental health, and Nicholas Porter, ASTHO’s senior analyst for environmental health, along with leadership from CDC’s National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry (ATSDR), attended presentations from the New York State Department of Health (NYSDOH) and the Pennsylvania Department of Health (PADOH) on their recently completed PFAS biomonitoring projects. The presentations took place at CDC’s Chamblee campus in Atlanta. The projects implemented and evaluated CDC/ATSDR’s PFAS Exposure Assessment Technical Tools (PEATT), a step-by-step protocol for assessing a community’s exposures to PFAS in affected communities in both states.

On March 14-15, ASTHO brought several state health officials and other members of the environmental health and infectious disease policy committees to Washington, D.C. to discuss policy implications around new and emerging methods to detect foodborne disease, capacity building for foodborne outbreak response, and the identification of opportunities and strategies for successful interagency collaboration. The meeting featured presentations on whole genome sequencing and culture independent diagnostic testing, One Health, and cannabidiol (CBD) infused foods. Officials from CDC, the National Association of State Departments of Agriculture, FDA, and USDA provided updates on food safety priorities and initiatives.

On March 20, Danny Staley, ASTHO’s chief of Caribbean operations, and Joya Coffman, ASTHO’s senior director of performance improvement, presented an update on crisis funding and ongoing work in the Caribbean at the Public Health Accreditation Board (PHAB) meeting. Staley began the presentation with an overview of the devastation caused by hurricanes Irma and Maria, highlighting the response ASTHO is leading as part of its crisis work with CDC. This work includes supplemental staffing, equipment purchases, and contracting for impactful public health system improvements. One important area ASTHO highlighted to the board is business processes improvement technical assistance and training that ASTHO is providing to expand public health capacity to implement streamlined and standardized processes in financial management, procurement, and human resources. PHAB board members and federal partners underscored the critical role of public health departments and national partner organizations in crisis recovery efforts from the lens of both immediate workforce and resource deployment, as well as executive leader mentorship and support.

On March 14-15, John Wiesman (SHO-WA) co-chaired the 63rd Presidential Advisory Council on HIV/AIDS (PACHA) Meeting in Washington, D.C. In his opening remarks, Wiesman called for bold action to defeat HIV/AIDS in America. He highlighted the importance of working across sectors to deploy effective prevention and treatment interventions, provide timely access to affordable healthcare services, and tackle stigma. He emphasized that discrimination of all kinds and social determinants of heath must be addressed to end the epidemic. “As one state who has had an initiative to end AIDS, we look forward to working with each other and learning more from each other to pull together best practices,” said Wiesman. HHS Assistant Secretary for Health Brett Giroir, CDC Director Robert Redfield, and leadership from HRSA, NIH, SAMHSA, and IHS discussed the initiative to end HIV and PACHA’s critical role in influencing and impacting this historic effort.

From March 11-15, ASTHO hosted its annual Washington Week. See below for highlights from the week!

To kick off the week, ASTHO hosted an in-person training for its inaugural Policy Academy on March 11-12. The ASTHO Policy Academy, designed and conducted with the assistance of CDC’s Office of the Associate Director for Policy, helps state health agency leaders develop and strengthen their policy skills. Teams from three state health agencies attended, representing the Arkansas Department of Health, the Idaho Department of Health and Welfare, and the New Hampshire Department of Health and Human Services. Each team was made up of health officials, senior deputies, legislative liaisons, legal counsel, and program staff. During the Policy Academy, they received training on key steps in the policy development process, including policy analysis, policy communication, engaging stakeholders, and policy development.

Esther Muña (THO-CNMI) chaired the Insular Affairs Subcommittee meeting on March 11. The subcommittee provides a forum for ASTHO’s members to exchange information on policy challenges and solutions within the Pacific and Atlantic jurisdictions. The subcommittee identified policy priorities for consideration by the full government relations committee and ASTHO board. It is believed that this is the first time that jurisdictions in the Pacific and the Atlantic have collaborated on a shared public health policy agenda along with states with relatively large numbers of island populations.

On March 12, ASTHO facilitated a workshop in partnership with the Georgetown Law Center. Attendees were joined by John Monahan, senior advisor for global health at Georgetown University, and Howard Koh (alumnus-MA), professor of public health leadership at Harvard’s T.H. Chan School of Public Health and the Harvard Kennedy School. The workshop covered a wide range of topics and offered practical tips on meeting with members of Congress, engaging governors’ offices, leveraging state Medicaid dollars for public health programs, and overcoming regulatory obstacles in state government.

On Tuesday evening, March 12, ASTHO, NACCHO, NALBOH, and the Big Cities Health Coalition attended a combined dinner at the Washington Marriott Georgetown to illuminate the important public health work done across states, territories, and localities. The group heard a presentation from Marc Garufi, chief of the public health branch at the Office of Management and Budget, about the current budget environment.

The following morning, on March 13, ASTHO and NACCHO sponsored a “meet and greet” breakfast reception before their annual Hill Day. State and local health officials assembled in the historic Kennedy Caucus Room to network and prepare for the day ahead. Sen. Sheldon Whitehouse (D-RI) shared opening remarks reinforcing the value of public health work and caught up with Rhode Island’s health official, ASTHO President Nicole Alexander-Scott.

On March 13, ASTHO and NACCHO members took to Capitol Hill to share a unified message about the critical need to sustain investments in public health agencies that protect and promote the health of all Americans and prevent sequester cuts in the FY20 budget. The day consisted of meetings with members of Congress. Health officials discussed public health issues and priorities impacting their constituents, encouraging Congress to work in a bipartisan manner to support funding levels for CDC and other important public health programs. Check out #PublicHealthOnTheHill on Twitter for more coverage and photos from the day!

 

Following Wednesday’s meetings on Capitol Hill, health officials met with several HHS leaders, including Assistant Secretary for Health Brett Giroir, Assistant Secretary for Preparedness and Response Robert Kadlec, and Nafisa Jiwani, Deputy Senior Advisor for Value-Based Care at HHS. Giroir invited ideas and feedback on ways the Office of the Assistant Secretary for Health can support work at the state level around several key priorities, including efforts to address the opioid epidemic, eliminate HIV, and counter anti-vaccine rhetoric. Kadlec spoke about the importance of maintaining a robust public health preparedness infrastructure to respond to a variety of incidents and threats, including measles, Ebola, and natural disasters. Jiwani outlined several of the HHS Secretary’s initiatives to transform healthcare into a more value-oriented system, citing opportunities related to health IT, interoperability, and data sharing.

On March 15, ASTHO members convened with SAMHSA and HRSA leadership for a discussion on substance abuse trends, budgeting, and collaboration between state and federal agencies. Elinore McCance-Katz, SAMHSA’s assistant secretary for mental health and substance use, started the morning with a presentation on the latest national substance use and mental health data. HRSA Administrator George Sigounas followed with a discussion on how state and federal agencies can work together to stretch their budgets and maximize programmatic impact. Sigounas held a Q&A session, during which ASTHO members presented the needs of their states and inquired about the role federal agencies can play in solutions.

On March 14, the ASTHO Board of Directors convened in Washington, D.C. The board heard a presentation from Steven Reynolds, MPH, deputy director of CSTLTS, and discussed several important operational items.

On March 9, ASTHO’s maternal and child health team, in partnership with the Association of Maternal and Child Health Programs (AMCHP), convened the Promoting Innovation in State and Territorial MCH Policymaking (PRISM) Learning Community Policy Academy. Six states and territories participated in cohort 1 of PRISM, including Arkansas, the Commonwealth of the Northern Mariana Islands, Iowa, New Mexico, South Carolina, and Washington state. Gerd Clabaugh (SHO-IA) attended and provided invaluable guidance to the Iowa state team. Presenters included HRSA, the National Association of State Alcohol and Drug Abuse Directors, and the San Antonio Metropolitan Health District. The National Conference of State Legislatures presented on their new MCH database tool which tracks enacted state laws on fourteen different topics. Through facilitated sessions, teams identified priorities and drafted action plans they will use during the PRISM Learning Community to support public health policy implementation related to MCH mental health and substance misuse and addiction.

On March 6, the House Subcommittee on Environment held a hearing on PFAS chemicals and their risks to human health. The hearing featured testimony from Rep. Brian Fitzpatrick, Rep. Daniel Kildee, EPA’s Assistant Administrator for the Office of Water, Dave Ross, as well as the Department of Defense (DoD) Deputy Assistant Secretary of Defense for Environment, Maureen Sullivan. Both Rep. Fitzpatrick and Rep. Kildee focused their testimony on the urgent need for DoD, EPA, and other federal public health agencies to address PFAS contamination in drinking water and protect the public from future exposures. Rep. Kildee underscored the need to focus on contaminated site cleanup, while Rep. Fitzpatrick urged EPA to set legally enforceable Maximum Contaminant Levels (MCLs) and designate PFOA and PFOS as hazardous substances under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), also known as the Superfund Act. Ross discussed EPA’s newly released PFAS Action Plan, noting that designating PFOA and PFOS as hazardous substances under CERCLA and moving forward with the MCL process as outlined under the Safe Drinking Water Act are both included in the plan. EPA will soon release interim groundwater clean-up recommendations. Sullivan outlined DoD’s actions to reduce exposures to PFOA and PFOS in drinking water at the 24 DoD installations that tested above EPA’s Lifetime Health Advisory level of 70 parts per trillion combined for PFOA and PFOS, as well as their efforts to clean up contamination at the 401 military installation sites with known or suspected releases of PFOA or PFOS into the environment. More information on the hearing, including a video archive and links to written witness testimonies, can be found here.

On March 6-7, ASTHO, in partnership with CDC, hosted a convening that showcased examples of successful and innovative collaborations between healthcare and community-based partners to address health-related social needs, with a particular focus on transportation and food insecurity. Public health officials, Medicaid directors, CMS Accountable Health Communities bridge organizations, federal partners, philanthropies, and private insurance providers discussed their roles in strengthening multi-sector partnerships. Pictured below is Anne Schuchat, principal deputy director of CDC, who spoke at the meeting.

On Feb. 27-28, ASTHO, in partnership with CDC’s National Center for Injury Prevention and Control, convened the Enhanced State Opioid Overdose (ESOOS) Partner Meeting in Atlanta. The meeting featured presentations on CDC’s response to the opioid epidemic, as well as an in-depth look into the ESOOS program and upcoming funding. The meeting focused on how CDC ESOOS strategies interact with and complement other organizations’ current opioid work and how information might be used synergistically to achieve goals. Attendees discussed challenges faced related to mortality and morbidity surveillance data and brainstormed solutions.

On Feb. 27-28, Nate Smith (SHO-AR) attended ACIP in Atlanta as a representative on behalf of ASTHO. ACIP develops vaccine recommendations for children and adults in the United States. Recommendations include the age when the vaccine should be given, the number of doses needed, the amount of time between doses, precautions, and contraindications. Before recommending a vaccine, ACIP considers many factors, including vaccine safety and efficacy. During the session, ACIP voted on recommendations for Japanese Encephalitis and anthrax vaccines. There were also several informational sessions on influenza, human papillomavirus, pneumococcal, meningococcal, zoster, and hepatitis vaccines.

On Feb. 26, ASTHO CEO Michael Fraser spoke to students at Harvard’s T.H. Chan School of Public Health, providing an overview on state and territorial public health, then presented at an all-school lecture on “Threats and Opportunities to State and Territorial Public Health.” The presentation focused on the people, programs, policies, and priorities of ASTHO members and ASTHO’s work in Washington, D.C. Both lectures were opportunities for students to learn more about the work of state and territorial public health and consider careers in government in the future.

On Feb. 13, ASTHO, with funding from CDC’s Opioid Crisis Jurisdictional Support program and in collaboration with the Texas Department of State Health Services, hosted a regional workshop in Austin, TX, to discuss access and analysis around state and local opioid-related data. Thirty-six participants attended from state, local, and tribal governmental agencies, along with healthcare organizations and providers. Participants were trained on how to analyze data from a public health perspective, access and use the state’s data visualization website, and how to use the state’s syndromic surveillance reporting system.

On Feb. 14, ASTHO convened the first meeting of the Public Health Leadership Roundtable at ASTHO’s headquarters in Arlington, VA. The roundtable, which included 40 partner organizations with an interest in state and territorial public health, discussed common concerns and challenges around national and federal policy for public health agencies. The assembled organizations shared legislative agendas, with the goal of strengthening communication and coordination around state and territorial public health leadership and policy.

On Feb. 11-15, ASTHO attended the Health Information Management and Systems Society (HIMSS) 2019 Global Conference in Orlando. State health officials in attendance included Mylynn Tufte (SHO-ND), Gerd Clabaugh (SHO-IA), and Shereef Elnahal (SHO-NJ), all of whom participated on several educational sessions, learning labs, and roundtable events. On Feb. 12, ASTHO CEO Michael Fraser delivered the keynote address during the HIMSS State and Local Policy Luncheon, describing how to build a national public health informatics and IT infrastructure through people and processes. On Feb. 13, ASTHO hosted an ignite session and lunch to learn more about burning issues, success stories, and key priorities from state health officials, informatics directors, national partners, and federal representatives. ASTHO’s presence at HIMSS represents a great leap forward in elevating the role of public health, as we continue to communicate public health’s role in connecting systems and data across multiple sectors.