Our History

The Association of State and Territorial Health Officials was established in 1942—however, ASTHO can trace its origins back even farther.

In 1879, the Sanitary Council of the Mississippi Valley met to discuss measures to prevent and control epidemics, such as a devastating cholera outbreak that occurred six years prior. It was during this meeting that a national association of health officials was first suggested.

Four years later, officers from state boards of health met again—this time in Michigan—to discuss forming that national organization. The following year, in 1884, representatives from 19 states met in Washington, D.C., and established the first National Conference of State Boards of Health. In 1897, the conference expanded its membership to include representatives from Canada and Mexico.

By the turn of the 20th century, the U.S. Surgeon General and state and territorial health officials were meeting annually to discuss medical and scientific aspects of controlling diseases prevalent at the time and developing other public health endeavors.  

With the passing of the Social Security Act of 1935, S/THOs recognized the need for an organization that would help them navigate rapidly expanding state and territorial public health policies and programs and represent them on matters concerning federal health grants.

The Association of State and Territorial Health Officials was incorporated on March 23, 1942. For 80 years, ASTHO has continued to support its members and other public health officers across America. Some of the work ASTHO has conducted over the years includes improving the collection and utilization of public health data, expanding access to care and treatment, and creating new preparedness frameworks to respond to crises.

In the last 20 years, ASTHO has been at the forefront of crises such as 9/11 and the 2001 anthrax attacks, the H1N1 influenza pandemic, environmental disasters like the Deepwater Horizon Spill, and the COVID-19 pandemic.



ASTHO can trace its origins back to a cholera outbreak in the United States in 1873. This outbreak spread from its point of origins in New Orleans and killed hundreds.


Six years later, the Sanitary Council of the Mississippi Valley met and, with the 1873 epidemic in mind, first raised the idea of assembling an association of local health officials in order to head off future health crises.


19 health officials gathered in Washington, D.C. to form the National Conference of State Boards of Health, an entity established to organize health organizations across the nation to give each other aid and share expertise.


By the turn of the century, state and territorial health officials began meeting annually with the Surgeon General in order to discuss ongoing health issues across America and its territories. 


After the passing of the Social Security Act, these officials realized the need for a more formal organization to address these public health needs.


On March 23, 1942, the Association of State and Territorial Health Officials was incorporated and has now served public health officials for over 75 years. ASTHO works in partnership with officials at all levels of government, the CDC, and 21 affiliate public health organizations to support public health across the nation.


ASTHO created the National Public Health Program Reporting System in order to collect data on how states spend their federally-provided public health funding.


ASTHO was incorporated as the ASTHO Foundation, an entity that used grants to support ASTHO’s work.


The ASTHO Foundation stopped operating the National Public Health Program Reporting System after federal funding for the system ended.


During the AIDS crisis, ASTHO supported measures such as the Ryan White CARE Act and the AIDS Drug Assistance Program, both of which are efforts focused on expanding access to HIV/AIDS treatment.


The ASTHO Foundation renamed itself as the Public Health Foundation, now focused on promoting quality improvement across the entire public health field.


ASTHO launched the inaugural class of the State Health Leadership Institute.


9/11 and the 2001 anthrax attacks spurred the nation to develop preparedness plans for bioterrorism and other homeland security threats. During the aftermath of these events, ASTHO worked to put public health in the spotlight, meeting with federal law enforcement agencies, engaging with White House staff, and creating what would become our Preparedness Policy Committee.


After the Bioterrorism Act of 2002 was passed, ASTHO worked closely with CDC and HHS to help direct public health funding to local health departments and bolster state and local public health infrastructure.


Together with the National Association of County and City Health Officials (NACCHO), the American Public Health Association (APHA), and the National Association of the Local Boards of Health (NALBOH), ASTHO helped to establish the Public Health Accreditation Board (PHAB), an organization dedicated to establishing and maintaining standards for public health departments.


The experience of 2001’s large-scale crises came to inform ASTHO’s response to the 2009 H1N1 influenza pandemic. The White House reached out to ASTHO to take part in formulation of the national emergency response and went on to serve a key role in that response by coordinating with local health officials and other healthcare and public health associations.


ASTHO provided support to Gulf Coast state health officials in response to the Deepwater Horizon oil spill, also referred to as the BP oil spill, in 2010. These officials came together with ASTHO to coordinate strategies to address the impacts that this crisis had on the Gulf Coast states and those emergency crews who responded to the spill.


During the COVID-19 pandemic, ASTHO and its partners worked in collaboration to facilitate public health communication and assist S/THOs in coordinating their pandemic response.