My Profile e-Learning Center my.ASTHO Contact Us

2023 Environmental Scan of Current and Emerging Public Health Priorities

December 04, 2023

ASTHO’s annual Environmental Scan of Current and Emerging Public Health Priorities (referred to simply as “the Scan” throughout this report) tracks U.S. public health concerns and trends. Through qualitative analyses of select health agency materials and health official feedback, the Scan identifies state, territorial, and freely associated state health agencies’ (S/THAs) top current and emerging priorities across public health programs, infrastructure, and health equity domains, as well as S/THAS’ strategies to address them.

Current State Public Health Program and Service Priorities

Findings in this section are based on an analysis of 32 state health improvement plans (SHIPs), 32 state health agency (SHA) strategic plans, and 32 sets of results from a survey of state health officials (SHOs) conducted between March-July 2023. The included documents were active within a defined period (e.g., 2020 – 2025) or, in the absence of a defined active period, created in or after 2019 by the jurisdictional health agency. ASTHO administered the 2023 Environmental Scan survey to SHOs between April and June 2023. In total, 42 states and Washington, D.C. have at least one plan included in the findings for this section of the report.

Maternal, child, and family health is a priority area in 60% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health program and service priority area by 84% of SHOs who responded to the Environmental Scan Survey.

Youth and adolescent physical and mental well-being is a focus issue in 42% of SHIPs and strategic plans.
Early childhood development and health promotion is a focus issue in 40% of plans.
Prenatal and perinatal care is a focus issue in 38% of plans.
Maternal and infant mortality is a focus issue in 36% of plans.

Behavioral health and substance use is a priority area in 63% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health program and service priority area by 69% of SHOs who responded to the Environmental Scan Survey.

Mental health is a focus issue in 44% of SHIPs and strategic plans; suicide prevention, a related issue, is a focus in 30% of plans.
Substance misuse prevention and harm reduction is a focus in 42% of plans; substance use harm-reduction, a related issue, is a focus in 34% of plans.
Treatment and recovery services is a focus issue in 39% of plans.
Opioid use is a focus issue in 23% of plans.

Access to and linkage with care is a priority area in 81% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health program and service priority area by 38% of SHOs who responded to the Environmental Scan Survey.

Primary and preventive care is a focus issue in 47% of SHIPs and strategic plans.
Health insurance coverage and care affordability is a focus issue in 39% of plans; economic barriers to healthcare access, a related issue, is a focus issue in 27% of plans.
Quality of care is a focus issue in 38% of plans; inequities in healthcare outcomes, a related issue, is a focus in 36% of plans.
Coordination and continuity of care is a focus issue in 38% of plans.

Communicable disease control is a priority area in 28% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health program and service priority area by 63% of SHOs who responded to the Environmental Scan Survey.

Immunization and vaccination is a focus issue in 31% of SHIPs and strategic plans.
Sexually transmitted infections and diseases are focus issues in 16% of plans; HIV and AIDS, related issues, are a focus in 14% of plans.
Building capacity for communicable disease laboratory testing and monitoring is a focus issue in 17% of plans.

Chronic disease prevention is a priority area in 65% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health program and service priority area by 16% of SHOs who responded to the Environmental Scan Survey.

Nutrition, physical activity, and other modifiable personal health behaviors are focus issues in 50% of SHIPs and strategic plans.
Tobacco and vape use is a focus issue in 41% of plans.
Healthy weight (obesity prevention) is a focus issue in 39% of plans.

Current Island Jurisdiction Public Health Program and Service Priorities

Findings in this section are based on an analysis of information expressed by territorial and freely associated state health officials (denoted as “THOs” for the purposes of this report) in ASTHO surveys (e.g., the 2022 ASTHO Profile survey and 2023 ASTHO Environmental Scan survey), forums (e.g., the Insular Affairs Committee to the ASTHO Board), individual conversations between health officials and ASTHO staff, and current strategic documents as available from the Atlantic island jurisdictions and the Republic of the Marshall Islands. ASTHO administered the 2022 Profile Survey between April and December 2022 and the THO Environmental Scan survey between April and June 2023, garnering completed responses from THOs representing six of the eight island territories and freely associated states (a 75% response rate) for both.

Communicable disease control was listed as a top-three current public health program and service priority area by four THOs (66%) who responded to the Environmental Scan Survey and was listed as a top-five population health priority by all six THOs (100%) who completed the 2022 ASTHO Profile Survey. Focus issues in this area include vaccine-preventable diseases, including COVID-19; regional lab testing services; dengue and other tropical diseases; tuberculosis (TB), including multi-drug resistant TB; sexually transmitted diseases, including HIV; and safe drinking water.
Access to and linkage with care was listed as a top-three current public health program and service priority area by four THOs (66%) who responded to the Environmental Scan Survey and a top-five population health priority by all six THOs (100%) who completed the 2022 ASTHO Profile Survey. Focus issues in this area include telehealth; mental and behavioral health service options; substance use prevention and treatment; maternal, infant, child, and older adult healthcare; community-based public health and partnerships; health equity; and access to care supports for underserved communities.
Chronic disease prevention (and treatment) was listed as a top-three current public health program and service priority area by one THO (17%) who responded to the Environmental Scan Survey and was a top-five population health priority for five THOs (83%) who completed the 2022 ASTHO Profile Survey. Focus issues in this area include prevention and treatment for cancer, respiratory disease, heart disease, stroke, and diabetes; risk factors for chronic disease; and nutrition and physical activity.

Current State Public Health Infrastructure and Capacity-Building Priorities

Findings in this section are based on an analysis of the same materials used to identify SHAs’ program and service priorities above.

Workforce development is a priority area in 51% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health infrastructure and capacity-building priority area by 75% of SHOs who responded to the Environmental Scan Survey.

Training and education is a focus issue in 52% of SHIPs and strategic plans.
Recruitment and retention is a focus issue in 39% of plans.
(Re-)Building clinical and laboratory workforce capacity is a focus issue in 38% of plans.

Organizational competencies include functions related to organizational finances, human resources, culture, leadership, IT systems, and general capacity to carry out core public health work. They are a priority area in 63% of states with a SHIP and/or strategic plan included in the Scan and this category was listed as a top-three current public health infrastructure and capacity-building priority area by 38% of SHOs who responded to the Environmental Scan Survey.

Funding strategies and grant writing are a focus issues in 41% of SHIPs and strategic plans.
Funding and resource management are focus issues in 41% of plans.
Organizational culture and leadership are focus issues in 28% of plans.

Accountability, performance management, and quality improvement is a priority area in 67% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health infrastructure and capacity-building priority area by 28% of SHOs who responded to the Environmental Scan Survey.

Quality improvement and accreditation are focus issues in 36% of SHIPs and strategic plans.
Performance measurement and evaluation is a focus issue in 34% of plans.
Performance improvement planning is a focus issue in 27% of plans.

Data modernization and informatics is a priority area in 33% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health infrastructure and capacity-building priority area by 59% of SHOs who responded to the Environmental Scan Survey.

Public health data sharing and coordination is a focus issue in 34% of SHIPs and strategic plans.
Public health data standards and interoperability are focus issues in 25% of plans.
Building organizational capacity for data-driven decision-making is a focus issue in 19% of plans.

Organizational equity is a priority area in 49% of states with a SHIP and/or strategic plan included in the Scan and was listed as a top-three current public health infrastructure and capacity-building priority area by 31% of SHOs who responded to the Environmental Scan Survey.

Organizational health literacy is a focus issue in 42% of SHIPs and strategic plans and 47% of states’ health equity plans or goals.
Equity-centered processes and policies is a focus issue in 25% of SHIPs and 58% of states’ health equity plans or goals.
Equity-focused public health interventions and programs is a focus in 31% of SHIPs and 33% of states’ health equity plans or goals.
Diversity, equity, inclusion, accessibility, and belonging are focus issues in 23% of SHIPs and strategic plans and 36% of states’ health equity plans or goals.

Current Island Jurisdiction Public Health Infrastructure Priorities

Findings in this section are based on an analysis of the same materials used to identify THAs’ program and service priorities above.

Organizational competencies, including performance management and quality improvement, were listed as top-three current public health infrastructure and capacity-building priority areas by four THOs (66%) who responded to the Environmental Scan Survey and four THOs (66%) who responded to the 2022 ASTHO Profile Survey. Focus issues in this area include financial infrastructure; financial sustainability of staff, structures, and service; business processes, including procurement, recruitment, and grants management; performance management and quality improvement; policy development; and public health governance structures.
Emergency preparedness and response was listed as a top-three current public health infrastructure and capacity-building priority area by four THOs (66%) who responded to the Environmental Scan Survey and two THOs (33%) who responded to the 2022 ASTHO Profile Survey. Focus issues in this area include emergency preparedness response and recovery networks and lessening the impact of climate change.
Data modernization and informatics was listed as a top-three current public health infrastructure and capacity-building priority area by three THOs (50%) who responded to the Environmental Scan Survey and three THOs (50%) who responded to the 2022 ASTHO Profile Survey. Focus issues in this area include data collection, analysis, and clinical and applied research; data-driven decision-making; data representation in federal datasets; interoperability across government systems; and the modernization of electronic health records and telehealth systems.
Workforce development was listed as a top-three current public health infrastructure and capacity-building priority area by the one THO (17%) who responded to the Environmental Scan Survey and the four THOs (66%) who responded to the 2022 ASTHO Profile Survey. Focus issues in this area include recruitment and retention, local academic pipelines and training opportunities; staff compensation; and staff salary gaps.

Health Official Survey: Recent Impacts on Public Health Priorities

We asked state and territorial health officials THOs, “In the past 6 months, what events or trends have impacted your agency’s priorities, and how?” The events and trends most frequently mentioned across 32 SHO and 6 THO responses include:

Newly passed laws and legislation.
Ending of the COVID-19 public health emergency.
Health workforce shortages.
New infectious diseases and communicable disease outbreaks.
Reduced public confidence in vaccines.
Environmental trends and climate-related events.
Ongoing mental health, opioid, and maternal health crises.
New federal funding to support health agency work in specific areas (such as health equity and public health infrastructure).

Health Official Survey: Emerging Public Health Priorities

We asked S/THOs, “In the next 6 months, what new or emerging issues do you anticipate will become bigger priorities for state health agency leaders?” The emerging priorities most frequently mentioned across 32 SHO and six THO responses include:

Emerging Public Health Program and Service Priorities

Mental and behavioral health.
Medical autonomy and access to care issues.
Environmental issues and climate change.
Emerging or resurging infectious diseases.

Emerging Public Health Infrastructure and Capacity-Building Priorities

Health workforce shortages.
Public health data modernization.
Combatting misinformation.
Emergency and extreme weather preparedness.

Health Official Survey: Strategies to Advance Health Equity

We asked S/THOs, “In the past 6 months, which 3 key strategies or initiatives has your agency engaged in to advance health equity?” The most frequently mentioned strategies across 32 SHO and six THO responses include:

Developing workforces and organizations to increase capacity for health equity work.
Promoting internal organizational literacy in health equity topics.
Offering staff education and training on topics related to diversity, equity, inclusion, accessibility, and belonging.
Increasing workforce diversity.
Engaging and supporting communities to improve. health outcomes.
Bringing more high-value, low-cost health services to communities.
Emphasizing equity in all policies and advocacy work.
Improving and utilizing data to better understand and address health inequities.
Focusing on the equitable distribution of resources.

Cross-Cutting State Health Equity Focus Areas and Key Strategies

While health equity is a core focus across all state public health policy and practice, the Scan highlights three key cross-cutting health equity focus areas: personal health literacy, the social determinants of health, and access to and linkage with care. Findings in this section are based on an analysis of 32 SHIPs, 32 SHA strategic plans, 36 SHA health equity plans or list of health equity goals, and 32 SHO survey responses. In total, 48 states and Washington, D.C. have at least one plan or goal statement included in this section of the report’s findings.

Cross-Cutting State Health Equity Focus Area: Personal Health Literacy

Personal health literacy is a priority area in 60% of states and 39% of all plans included in the Scan, and was discussed in the context of understanding or addressing population health inequities in 53% of all plans.

Culturally and linguistically appropriate health information, education, and services are focus issues in 52% of all SHA plans.
Health and safety information that is accurate, accessible, and actionable is a focus issue in 37% of plans.
Healthcare system changes to improve personal health literacy is a focus issue in 21% of plans.

Cross-Cutting State Health Equity Focus Area: Social Determinants of Health

Social determinants of health (SDOH) is a priority area in 72% of states and 59% of all SHA plans included in the Scan. This was discussed in the context of understanding or addressing population health inequities in 47% of all plans.

Community capacity-building and resilience to health threats is a focus issue in 38% of all SHA plans.
Service environment is a focus issue in 38% of plans.
Social and community connectivity is a focus issue in 35% of plans.
Built and natural environment is a focus issue in 31% of plans; environmental justice, a related issue, is a focus in 9% of plans.

Cross-Cutting State Health Equity Focus Area: Access to and Linkage with Care

Access to and linkage with care, a priority area in 70% of states and 48% of all SHA plans, was discussed in the context of understanding or addressing population health inequities in 44% of all plans, more than any other public health program and service area. The Scan found that the population groups most disproportionately impacted by the following inequities in access to the following services include BIPOC communities, rural communities, people experiencing poverty, people living with and disabilities, and LGBTQI+ communities.

Access to maternal and infant care: ”Maternal, Child, and Family Health” was discussed in the context of understanding or addressing population health inequities in 30% of all SHA plans, ”prenatal and perinatal care” was discussed in 13% of plans, “infant mortality” was discussed in 13% of plans, and "maternal mortality” was discussed in 10% of plans.
Access to mental health and substance use care: “behavioral health and substance use” was discussed in the context of understanding or addressing population health inequities in 22% of all SHA plans. “mental health” was discussed in 12% of plans, “substance use harm reduction” was discussed in 10% of plans, and “treatment and recovery services” was discussed in 9% of plans.
Access to chronic disease prevention and management services: “chronic disease prevention” was discussed in the context of understanding or addressing population health inequities in 21% of all SHA plans. “Healthy weight (obesity prevention)” was discussed in 9% of plans, and “nutrition, physical activity, and other modifiable personal health behaviors’ was discussed in 9% of plans.
Access to health insurance and affordable care: “Health insurance coverage” was discussed in the context of understanding or addressing population health inequities in 21% of all SHA plans and “affordability of care” was discussed in 16% of plans.
Access to care in rural and geographically isolated communities: “Rural or geographically isolated communities” was discussed in the context of understanding or addressing population health inequities in 13% of all SHA plans.