Public Health Review

In 2017, nearly 64,000 children under six had elevated blood levels as defined by the CDC. There is no safe blood lead level in children, and even low levels of lead have been shown to affect IQ, ability to pay attention, and academic achievement. To decrease maternal and child morbidity and mortality associated with lead exposure, families need access to systems of coordinated care in order to address their needs related to lead exposure. This episode will discuss how Louisiana and Iowa have used quality improvement strategies and innovative partnerships to improve systems of care related to maternal and child lead exposure. Our guests also discuss the racial disparities that exist in populations with high lead exposure, and how addressing this is critical to achieving overall health equity.   Guests: Alexander Billioux, MD, DPhil, Assistant Secretary of Health, Louisiana Department of Health Trina Evans-Williams, ScD, MPH, State Program Coordinator, Louisiana Healthy Homes and Childhood Lead Poisoning Prev

Initially started after the 1979 Surgeon General’s Report, Healthy People began as a way achieve health improvement through a national commitment to disease prevention and health promotion. Now in its fifth iteration, which kicked off last week, Healthy People 2030 charts the course for public health over the next decade. In this episode, public health leaders share their perspectives about where state and territorial health agencies intersect with Healthy People 2030 and why it should be treated as a ‘North Star’ in public health. Guests: Paul Halverson, DrPH, Founding Dean and Professor at Indiana University Richard M. Fairbanks School of Public Health Former Secretary, Arkansas Department of Health Jill Hunsaker Ryan, MPH, Executive Director of Colorado Department of Public Health and Environment  Resources: Preparing for Healthy People 2030 (ASTHO) Healthy People 2020 and 2030: Conversation and Cup of Joe ASTHOConnects webinar (ASTHO) From Healthy People 2020 to Healthy People 2030 ASTHOBrief  (ASTHO)

In the past decade, 120 rural hospitals have closed—leaving many vulnerable Americans without care. As communities age, medical care is becoming harder to find due to the shortage of physicians in rural areas. On top of that, the COVID-19 pandemic is shining even more of a light on the growing health disparities faced by rural communities and the emerging needs of the rural health workforce. On this episode, speakers will discuss the impact of COVID-19 on rural health infrastructure and workforce, and how to improve these conditions in rural communities. We hear from three leaders who work in states with high rural healthcare needs and vast provider shortages to learn how to increase access to quality healthcare in rural areas, barriers that exist, and innovative strategies for rural health workforce recruitment and retention. Guests: Lee Norman, MD, MHS, MBA, Secretary, Kansas Department of Health & Environment Benjamin Anderson, MBA, MHCDS, Vice President, Rural Health and Hospitals of the Colorado Hos

COVID-19 is amplifying why systemic racism in America is a public health issue. Communities of color are being disproportionately burdened by this pandemic due to persistent inequities that increase their risk to more severe bouts of COVID-19 and death. America is currently engaged in dual crises to stop the spread of COVID-19 and to advance racial justice. On this episode, speakers will address both issues and highlight the importance of public health agencies leading with and integrating equity in their COVID-19 response. We hear from three leaders managing their COVID-19 response by prioritizing areas with the greatest need and supporting community-led decision-making to ensure the most socially vulnerable populations have increased access to treatment, testing, isolation options, and resources. Speakers: Joneigh Khaldun, MD, Chief Medical Executive and Chief Deputy Director for Department of the Michigan Department Health and Human Services Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island D

Increasing and maintaining vaccine coverage is an important way to prevent the spread of disease and keep communities healthy.  Efforts to reduce COVID-19 transmission, such as social distancing, led to fewer people seeking non-urgent medical care and receiving routine vaccinations.  Recent studies demonstrate that childhood vaccine uptake has decreased since the onset of COVID-19, leaving many children under or unvaccinated.  Ensuring routine vaccination services during the COVID-19 pandemic is an important way to prevent the spread of serious illness, hospitalizations, and further strain on the healthcare system.  This fall it will be vital for individuals to get vaccinated for the flu to reduce the overall burden of respiratory illness, protect vulnerable populations, and decrease the burden on the healthcare system. In this episode, our guests give the national and state-level perspective of what to expect this upcoming flu season, and why it’s so important to adhere to a vaccination schedule. Speakers: N

Leading a governmental health department is a complex job during the best of times, but particularly so during a pandemic when leaders must navigate every step carefully.  In this episode, our guests introduce and discuss a concept called ‘polarity thinking,’ which invites leaders to embrace situations or problems from the opposing perspectives, or ‘poles.’ As public health leaders have to communicate messaging that many people may not want to hear – like wearing a mask in public or urging the public to get a flu shot this fall – embracing ‘polarity thinking’ can strengthen their arguments and earn them more credibility with the people they serve. Learn more about this leadership strategy in the episode. PROGRAMMING NOTE: At several points in the interview, the host and guests refer to the word ‘STHO,’ which stands for “state (territorial) health officials.” Guests: Abigail Dunne-Moses, Senior Faculty, Center for Creative Leadership Paul Halverson, DrPH, Founding Dean and Professor at Indiana University Richa

For people with substance use disorders or those who rely on opioids to manage chronic pain, the COVID-19 pandemic has highlighted gaps in these systems of care. Access to services has been severely impacted in areas around the country, and some states and territories are experiencing increases of fatal and nonfatal overdose. In some places, overdose deaths have outpaced COVID-19 deaths.     State and territorial health leaders are thinking long-term about how policy changes made as a response to the pandemic might be continued to support vulnerable populations. During this episode, public health experts discuss how states and territories can better support communities by addressing barriers to pain management and substance use treatment services, along with establishing wraparound services to mitigate the societal and economic impacts of COVID-19.   Guests: Lisa Piercey, MD, MBA, Commissioner, Tennessee Department of Health Kelly J. Clark, MD, MBA, DFAPA, DFASAM, Immediate Past President of the American Soc

May is Mental Health Month, and this year, health officials are tasked with navigating the impact of COVID-19 on the behavioral health system. The rates of depression, suicide, and substance use are expected to surge as communities continue to struggle with COVID-19 cases — along with the fear, isolation and unemployment that comes with the pandemic. It’s essential that policymakers ensure that communities have continued access to mental health and substance use disorder services not only during, but also in the aftermath of this pandemic. During this episode, public health leaders discuss gearing up for a surge of mental health needs, and strategies states could take to mitigate the impacts. Experts also discuss why it is especially critical to examine the behavioral health infrastructure for rural communities and the impact of historical trauma exacerbated by the pandemic.   Guests: Joe Parks, MD, Medical Director and Vice President of Practice improvement, National Council for Behavioral Health Saul Levi

The current COVID-19 pandemic serves as a case example that highlights the fundamental need to more aggressively use the Shared Risk and Protective Factors (SRPF) Framework to address Adverse Childhood Experiences (ACEs), suicide, and opioid misuse. This episode explains what the SRPF framework is, and how states and territories can collaborate with a broader range of partners to implement research-based programs, policies, practices, and strategies that will improve the existing fractured and unstable systems. This framework ultimately works to nurture the safe and stable communities that youth and families need to thrive.   During this episode, two public health practitioners join us to discuss their unique perspectives on the SRPF Framework through a state/federal government and academic lens. Our guests explain how leveraging the SRPF Framework ultimately achieves better outcomes more efficiently—and how the pandemic underscores the urgency of using more upstream approaches. Guests: Jewel Mullen, MD, MPH

If there’s anyone who has spent their career preparing for a global pandemic, it’s Anne Schuchat, MD. Currently, she serves as the principal deputy director of the Centers for Disease Control and Prevention (CDC). She served as acting CDC director from January-July 2017 and February-March 2018.  In the past 15 years, Dr. Schuchat worked on CDC emergency responses for the 2009 H1N1 pandemic influenza response, the 2003 SARS outbreak in Beijing, and the 2001 bioterrorist anthrax response. She’s worked at the CDC since 1988 on immunization, respiratory and infectious disease. Kate Winslet’s character in the 2011 film ‘Contagion’ was even modeled after Schuchat. She sat down with ASTHO for a 1-on-1 to discuss her reaction to the COVID-19 response, what policymakers should be thinking about next, and what keeps her up at night. “The virus hasn’t gone through the entire population. We don’t know whether the months ahead will bring a much worse illness, but I think we need to be ready for that. We need to have our s

In just a matter of weeks, the situation around COVID-19 in the United States altered dramatically. Now, dozens of states have called for non-essential businesses to close and for residents to stay at home. It’s an evolving situation that’s testing many aspects of American life. On this episode, we speak with two public health veterans who led state health departments during times of public health uncertainty--like H1N1 and Ebola. Our guests discuss the lessons they learned during trying times, the advice they’d give the public health workforce, and their thoughts on the situation surrounding COVID-19. Guests: Josh Sharfstein, MD, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins University, former state health official of Maryland Leah Devlin, DDS, MPH, Professor of Health Policy and Management at the University of North Carolina, former state health official of North Carolina Resources: H1N1 Alumni(ASTHO) The Public Health Crisis Survival Guide: Leadership and Management in Tr

State, territorial, and local governments continue to grapple with substance misuse and addictions. Today’s episode discusses why there needs to be a comprehensive response in public health surveillance, in particular around the opioid epidemic. After all, without thorough data, it’s tough for lawmakers to drive action that will reduce the prevalence and incidence of drug overdoses. This episode also explores states that are considering novel initiatives to address non-fatal drug overdoses. Today, we highlight Rhode Island and Vermont, where officials are looking at the substance misuse epidemic through a global lens to hold themselves accountable. Guests: Ewa King, Ph.D., Associate Director of Health, Rhode Island Department of Health Mark A. Levine, M.D., Commissioner, Vermont Department of Health Resources: Preventing Opioid Misuse and Overdose in the States and Territories(ASTHO) Rx -Innovative Approaches for Overdose Prevention(ASTHO) Improve Monitoring and Surveillance(ASTHO) About Public Health Labo

Every year, state and territorial health officials descend on the Nation's capital to educate lawmakers on the importance of increased funding for public health. This year is no different, though there is a shadow hanging over this year's events: COVID-19, an infectious disease that's been spreading across the globe. On the first day of ASTHO's "Washington Week," the organization formally requested emergency supplemental money with the National Association of County and City Health Officials (NACCHO), Council of State and Territorial Epidemiologists (CSTE), and Association of Public Health Laboratories (APHL) in order to adequately respond to COVID-19. Though the risk to Americans remains low, this episode highlights why it's important for Congress and the Trump administration to support state, territorial, tribal, and local public health workforces as they respond to this possible pandemic. Guests: Nirav Shah, MD, JD, Director of the Maine Center for Disease Control and Prevention Jim Blumenstock, Chief of

Blink and you might have missed it: In December, the federal government passed a bill that raises the legal age to buy tobacco to 21, now in effect. On top of that, the federal government also issued enforcement guidance that will remove some flavored e-cigarette products from the shelves. These laws are in response to the epidemic of youth e-cigarette use, with 27.5 percent of high schoolers reportedly using them. This podcast investigates what these federal policies might mean for youth e-cigarette use and discusses what states can do on their own to make tobacco products less available and attractive to youth and young adult consumers. Speakers: David Dobbins, JD, MPH, Chief Operating Officer, Truth Initiative Joneigh Khaldun, MD, MPH, FACEP, Chief Medical Executive and Chief Deputy Director for Health, Michigan Department of Health and Human Services Marcus Plescia, MD, MPH, Chief Medical Officer, ASTHO Resources: Newly Signed Legislation Raises Federal Minimum Age of Sale of Tobacco Products to 21 (F

Since 2016, 30 states have experienced hepatitis A outbreaks, primarily among individuals experiencing homelessness and/or those struggling with substance abuse. State health departments, with support from the CDC, have mounted a robust public health response, with vaccination as a cornerstone for prevention. Hear from our experts about the national perspective and on-the-ground action to stop the spread of hepatitis A—as well as challenges that remain with these complex populations. Guests: Cathy Slemp, MD, MPH, Commissioner and State Health Officer, West Virginia Bureau for Public Health Neil Gupta, MD, MPH, Chief of the Epidemiology and Surveillance Branch in the Division of Viral Hepatitis, Centers for Disease Control and Prevention Resources: CDC: Widespread outbreaks of hepatitis A across the United States ASTHOExperts blog: State Legislation Aimed at Preventing Hepatitis A Outbreaks Linked to Illicit Drug Use ASTHOExperts blog: Health Departments are Key to Eliminating Hepatitis in the United States

Sepsis is a life-threatening condition caused by the body’s extreme response to an infection and can rapidly lead to tissue damage, organ failure, and death. Sepsis can be caused by a wide range of infections but is most commonly linked to infections of the lungs, kidneys, skin, and gut. Based on CDC estimates, at least 1.7 million American adults developed sepsis in 2014 and nearly 270,000 died as a result of sepsis. CDC investigations showed that sepsis begins outside of the hospital for four out of every five patients. While preventing infections and illness is critical to reduce the risk of sepsis, early detection and immediate treatment is often the difference between life and death. Many opportunities exist to improve sepsis prevention, detection, and treatment and improve patient outcomes. Our experts discuss the national burden and epidemiology of sepsis, the importance of raising awareness among healthcare personnel and the community, and case examples of state efforts to promote policy changes relat

Pregnant women are particularly vulnerable to behavioral health issues, including depression and substance misuse. According to American Congress of Obstetricians and Gynecologists (ACOG), depression is the most common mental health disorder experienced during pregnancy, with estimates that 14% to 23% of women experience perinatal depression. Leaders in Louisiana discuss how they’re providing more support for women across the span of their reproductive life, and the challenges they still face on this episode. The National Council for Behavioral Health also outlines how states can provide integrated systems of care for pregnant women. Guests:  Brie Reimann, MPA, Assistant Vice President, Integrated Health Solutions, National Council for Behavioral Health Rebekah Gee, MD, Secretary, Louisiana Department of Health Amy Zapata, MPH, Director, Bureau of Family Health, Louisiana Department of Health   Resources: ASTHOBrief: State Approaches for Promoting Family-Centered Care for Pregnant and Postpartum Women wit

It’s that time of year again…flu season. Each year, the United States battles seasonal influenza, leaving thousands of people sick, hospitalized, or worse. Public health professionals across the nation are on the front lines, doing their best to prepare for and respond to seasonal flu in the hopes of reducing the likelihood of a pandemic event. This episode will focus on the burden of seasonal and pandemic flu, and highlight key planning activities and strategies that federal, state, and local public health agencies are doing to combat flu and keep communities healthy.   Guests: Cara M. Christ, M.D., M.S.  Director for the Arizona Department of Health Services Daniel B. Jernigan, M.D., M.P.H.  Director of the Influenza Division in the National Center for Immunization and Respiratory Diseases (NCIRD), CDC Christopher Shields  Assistant Commissioner at City of Chicago

In the United States, three main types of fungi—coccidioidomycosis, histoplasmosis, and blastomycosis—can cause lung infections like pneumonia when people breathe in fungal spores from the air. Depending on where you live, you may be more likely to come in contact with one of these fungi. Some fungal diseases go undiagnosed and cause serious infections in people in the United States and around the world, leading to illness and death. Increased awareness about fungal diseases is one of the most important ways we can improve early recognition and reduce delays in diagnosis and treatment. In this episode, in honor of Fungal Disease Awareness Week, Tom Chiller from CDC’s Mycotic Diseases Branch, and Kristen Ehresmann, director at the Minnesota Department of Health’s Infectious Disease Epidemiology department, talk about the risks of endemic fungal diseases.   Guests: Tom Chiller, MD, MPHTM, chief of the mycotic diseases branch, CDC Kristen Ehresmann, director of the infectious disease epidemiology, prevention, a

Nearly 34 million U.S. adults smoke cigarettes. About two out of every three of them want to quit and more than half will try to quit each year. Quitting can be difficult, but if we come together and double down on our efforts, we can help people who smoke make 2019 the year they quit—and quit for good. CDC’s Office on Smoking and Health (OSH) has designated 2019 the Year of Cessation, providing a coordinated opportunity across state and territory public health agencies to enhance their capacity to address tobacco cessation efforts. In this episode, hear about the policy implications and implementation efforts from the Tobacco Control Network and state public health executive leadership. Guests: Corinne Graffunder, DrPH, MPH, director of the Office on Smoking and Health, CDC Patti Henley, MEd, director of the Massachusetts Department of Public Health Tobacco Cessation and Prevention Program Luci Longoria, MPH, Tobacco Control Network Chair and manager for Community Mobilization for Policy at the Oregon He