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  4. ARCHIVED FROM CURRENT SITE Doing Business as Usual When Nothing is Usual: Managing Public Health Priorities During a Pandemic

Doing Business as Usual When Nothing is Usual: Managing Public Health Priorities During a Pandemic

August 16, 2021 | Alannah Kittle; Kristi Meadows; Cara Person

As state and territorial health agencies (S/THAs) continue to focus on the COVID-19 pandemic response, leaders must also find time to reflect on broader public health challenges and the changes needed to address them. Many preexisting public health needs have been exacerbated over the last 18 months, and we must create stronger, more agile systems to avoid repeating the mistakes of the past.

To aid in this cause, ASTHO performs an annual environmental scan that identifies S/THAs’ top infrastructure and programmatic priorities. The priorities reflected in this environmental scan then inform ASTHO’s organizational strategic plan, our capacity building services, and our advocacy strategy. Data collection and surveying for this year’s environmental scan occurred between July 2020 and May 2021. During this time, ASTHO’s research team collected data from a variety of S/THA sources, including:

  • State and territorial health improvement plans and strategic plans.
  • ASTHO calls with state and territorial health officials (S/THOs).
  • Technical assistance requests from S/THOs and agency staff.
  • ASTHO staff key informant interviews.
  • The Insular Areas workgroup and committee notes.

The information was analyzed to identify public health priorities among S/THAs, and the priorities were then broken down into the following priority groups:

  • Infrastructure priorities: public health agency administrative operations such as finance and performance management.
  • Programmatic priorities: core services provided by public health agencies (e.g., chronic disease and environmental health).

Below is a high-level overview of state infrastructure and programmatic priorities identified in this year’s scan. Additional information on each priority is included below with specific examples of how these issues present in the daily work of S/THAs.

Infrastructure Priorities

Workforce Development, Capacity, and Retention

  • Fostering improvement of employee engagement and resilience.
  • Ensuring sustainability of the workforce if pandemic funding is depleted.
  • Preparing for an increase in post-pandemic retirements.
  • Developing training programs for providers and public health professionals on behavioral health and health communications.
  • Implementing certification curricula for environmental health workers, clinical staff, and others.

Funding and Financial Management

  • Properly managing current funding and distribution of funding across programs.
  • Utilizing the recent influx of federal funding.
  • Increasing opportunities for flexible funding and improvement to mechanisms for blending and braiding funds.
  • Strengthening financial expertise, accounting, and financial programs at S/THAs.
  • Learning how other S/THAs finance health equity activities, community health worker services, and related programs.

Policy Development and Support

  • Developing COVID-19 mitigation measures and public health disaster statutes and definitions.
  • Assessing the impact of changes to state laws that restrict the authority of public health agencies.
  • Analyzing the evolution in public health authority and seizing the opportunity to rethink agency identity.
  • Examining upcoming state legislation on vaccination mandates and exemptions, health equity, criminal justice reforms, expansion of interstate telehealth compacts, addressing the opioid crisis, and reform packages for long-term care.

Collaboration and Partnership Development

  • Creating partnerships among S/THAs to share best practices and strategies for addressing COVID-19.
  • Collaborating on the expansion of public health’s role to address systemic racism and social determinants of health.
  • Building community connections to address outbreak management and vaccine hesitancy.
  • Fostering collaboration with unique partners such as law enforcement to address the opioid epidemic, and Medicaid partners to increase data sharing and vaccination rates.

Assessment and Surveillance Efforts

  • Enhancing data systems and surveillance capacity to assess trends, identify emerging threats, and evaluate impacts of policies and programs.
  • Strengthening COVID-19 mitigation efforts and surveillance capacity.
  • Modernizing data collecting and surveillance of adverse childhood experiences (ACEs) and comprehensive suicide and opioid overdose programs.
  • Ensuring the availability of reliable, timely, and trusted public health data.
  • Collecting appropriate socio-demographic data in data systems.

Programmatic Priorities

COVID-19 Response

  • Creating affordable options for vaccine uptake and disseminating best practices for vaccine promotion, equitable vaccine distribution (including risk communications strategies), and vaccination protocols.
  • Strengthening best practices for COVID-19 surveillance activities, mitigation efforts, and data management and reporting.
  • Building flexible telehealth systems to supplement in-person services.
  • Addressing data modernization, information gathering and reporting, and data integration challenges.

Health Equity

  • Prioritizing vulnerable populations in pandemic response activities, including vaccine distribution equity, Medicaid coverage, vaccine roll-out to rural communities, and telehealth policies.
  • Ensuring infrastructure exists to address equity and access to care, especially in rural and agricultural communities.
  • Strengthening coverage of services that address the social determinants of health.
  • Prioritizing environmental justice programs.
  • Standardizing metrics and reporting on progress of efforts.
  • Scaling up internal agency work on health and racial equity, including integration of health equity into all trainings, policies, and programs.

Behavioral Health and Substance Misuse

  • Minimizing disruptions to care and prevention efforts as resources and manpower are diverted to the COVID-19 response.
  • Ensuring focus on opioid preparedness, overdose prevention, and suicide and ACEs prevention efforts.
  • Optimizing overdose reporting and Neonatal Abstinence Syndrome (NAS) prevention and treatment programs.

Access to and Linkage With Care

  • Guaranteeing affordable care for COVID-19 services, including insurance for COVID-related illnesses and vaccinations, and linkages to care for COVID testing.
  • Implementing and expanding more flexible telehealth policies, including interstate compacts.
  • Identifying opportunities to fund and utilize community health workers to build vaccine confidence and assist with equitable recovery.
  • Adapting service and screening provisions to a digital environment due to the COVID-19 pandemic.

Priorities in the U.S. Territories and Freely Associated States

The U.S. territories and freely associated states face distinct challenges with limited public health infrastructure and resources. Below are the top infrastructure and programmatic priorities identified across these jurisdictions.

Infrastructure Priorities

  • Prioritizing hiring and retention of professionals, especially individuals with expertise in financial management, policy development, and behavioral health.
  • Improving grants and financial management by updating systems, increasing expertise, and improving collaboration among departments.
  • Advocating for additional funding through long-term sustainable Medicaid funding and the renewal of the Compacts of Free Association Agreement to ensure access to affordable healthcare services.
  • Strategically planning, implementing, and advocating for improvements to the data infrastructure including data governance plans, increased availability of electronic health records, and improvements to data modernization and interoperability of systems.
  • Improving surveillance capacity and advocating for inclusion of their data in national datasets.
  • Collaborating and partnering with other S/THAs to build expertise and learn best practices across programmatic areas.

Programmatic Priorities

  • Addressing COVID-19 challenges and impacts on public health infrastructure, including the need for administrative capacity building within territorial health agencies.
  • Ensuring equitable and affordable primary care and preventive services for all populations, including veterans and individuals who have migrated from insular areas to the mainland United States.
  • Strengthening behavioral health prevention and services for NAS, ACEs and opioids, and mental health concerns.
  • Increasing access to telehealth to improve access to healthcare, public education, and training for providers.
  • Addressing social determinants of health and community revitalization through housing, food, parental supports, and other strategies.
  • Monitoring of environmental health concerns, including vector-borne diseases and climate change issues.

Identifying primary S/THA priorities is the first step in ensuring that ASTHO’s work is timely, relevant, and reflective of our members' needs. Ultimately, these priorities will inform ASTHO’s strategic plan, our capacity building efforts, and our legislative strategies to effectively advocate for and partner with S/THAs. In many ways, this is our initial step in promoting programs and enacting policies that create healthier communities nationwide.