Top Nine Public Health Highlights of 2019

December 19, 2019 | Michael Fraser

Working with state and territorial public health leaders is always exciting and incredibly rewarding: every day there’s a new development, a new solution, a new headline that impacts the health of all Americans. Of course, that also has its downside—some of those things that make public health challenging come at a tremendous cost to our nation’s health: measles outbreaks, rising STD rates, growing burden of chronic diseases, and illnesses like EVALI. And that’s just scratching the surface.

However, as I look back on this year, I’m overwhelmed at all the work public health officials and ASTHO staff have accomplished this year. We’ve had some major public health wins—and ended the year on a very high note with Congress’s fiscal year 2020 budget that prioritized increases in public health funding we worked so hard to achieve. I am extremely proud to say that we are on track to meet our “22 by 22” goal, a 22% overall increase to the CDC’s budget by the FY2022. The Omnibus Appropriations Bill passed by Congress just this week gets us there with over $600 million new dollars for CDC programs that support the entire governmental public health system. ASTHO President Nate Smith (SHO-AR) joined in the star power advocating for increases for public health funding by testifying before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and Related Agencies followed by none other than Kathy Bates!

So, as we look back on 2019 and welcome 2020, here’s a brief year end listing of nine of many amazing public health moments from 2019.

1. Responding to the nation’s measles outbreaks

The measles outbreaks of 2019 were front-page news. From Jan. 1 – Dec. 5, over 1,276 measles cases were recorded across 31 states—an outbreak so large that the United States was on the verge of losing its measles elimination status. ASTHO, our members, and our partners jumped into action. John Wiesman (SHO-WA) testified to the Senate HELP Committee on the importance of vaccine education; our members penned op-eds and published measles awareness videos on social media; we held sessions at our annual meeting on advocating for science-based vaccine laws, and followed that up with leader-to-leader roundtables on the unique challenges measles outbreaks pose. ASTHO and our members played an integral role in curbing this budding public health crisis, and ultimately the nation’s measles elimination status was preserved.

2. Working to end the HIV epidemic

Ending the HIV epidemic was a major public health focus this year, reflected both in the President’s State of the Union speech and in FY20 federal public health budgets. In 2019, ASTHO played a key role in supporting state and territorial health agencies as the Ending the Epidemic initiative rolled out. We kicked off our efforts by hosting a conversation between federal partners, relevant public health associations, and the HIV/AIDS advocate community. This convening aligned our focus for short- and long-term goals over the next decade. With federal support, ASTHO has been tasked with developing a learning community for the seven priority states identified in HHS’s three-tiered plan to end this epidemic. There is much work to be done—and none of it easy—but ASTHO is poised to play a leading role in this once-in-a-generation public health opportunity.

3. State leadership in the EVALI response

The nation’s burgeoning vape epidemic became front page news this year as youth vaping rates skyrocketed, and thousands of Americans were hospitalized after using vaporizer products. Despite the outbreaks and associated deaths, ASTHO’s leadership on the issue was a bright spot of 2019. Six of our members—Ngozi Ezike (SHO-IL), Joneigh Khaldun (SHO-MI), Elizabeth Tilson (SHO-NC), Lee Norman (SHO-KS), Monica Bharel (SHO-MA), and Renee Coleman Mitchell (SHO-CT) —delivered expert testimonies to the House of Representatives detailing the latest vape research and trends in their states. Behind the scenes, ASTHO staff worked tirelessly creating databases of e-cigarette legislation, advising members ahead of meetings with state legislatures, and creating content summarizing recommendations to reduce vape use. This epidemic is challenging and multi-faceted, but was proud that states led the way with policy solutions to protect the public’s health.

4. ASTHO profile survey receives 100% participation rate

To plot the best course forward, you first must know where you stand. In 2019, ASTHO fielded the survey component of the ASTHO Profile, a project that paints a comprehensive picture of the landscape of state and territorial public health systems. This year, the survey achieved a 100% response rate from health agencies in all 50 states and Washington, D.C. as well as responses from seven U.S. territories and Freely Associated States. This high level of engagement is a huge success for multiple reasons: it allows us to represent the breadth of work overseen by health agencies to diverse audiences, and it enhances our understanding of public health infrastructure. This data will be at the heart of our strategies as we work to advance state public health in 2020.

5. ASTHO launches Right from the Start series for new health officials

As the organization representing the heads of state and territorial health agencies, leadership is at the core of ASTHO’s mission. Our Right from the Start video series, produced and debuted in 2019, is an exciting addition to our leadership development offerings. This digital content suite features insights from ASTHO alumni, leadership experts, federal leaders, and others with one purpose in mind: to help state health officials do their job better. Its digital format represents an important shift towards the future, as well—in-person convenings will always have their place but meeting our S/THOs in their daily lives with digital content will be a huge part of ASTHO’s work moving forward.

6. Building support for our territorial members and freely associated states

We formed an Insular Affairs Subcommittee to identify the unique policy needs and priorities of our Pacific and Atlantic jurisdictions, along with states with large populations of island residents. As a result, the ASTHO Government Affairs team focused on funding improved population health data collection in our Insular Areas, and on addressing inequities in the way territories are reimbursed under Medicaid. ASTHO members Esther Muña (THO-CNMI) and Linda Denourcey (THO-GU) made the days-long journey to Washington to meet with federal officials and members of Congress considering solutions to the Medicaid “cliff” and Esther testified at a congressional hearing to consider fix options. ASTHO’s work culminated in a potential two-year fix to these issues in the year-end budget deal, which continues increased funding and federal matching funds. Though the Medicaid funding for the territories expired during negotiations, we continued pushing for:

  1. A longer-term fix.
  2. Support to the territories’ Medicaid programs during the negotiations.

The funding cliff would have led to drastic cuts to their health care systems, causing years of investments in infrastructure and expanded access to care, and progress to backslide.

7. Climate and health policy statement

After a multiyear effort, our Assembly of Members approved moving forward to craft a policy on climate and health and the Board of Directors unanimously approved our Climate and Extreme Weather Events Health Policy Statement in December. This statement indicates our support in building and sustaining healthy communities that are climate-resilient and prepared for extreme weather events. This milestone caps the hard work of a consensus-focused drafting committee of state and territorial health officials. We wish to recognize the efforts of the members, past and present, who contributed to and worked to get us to this statement. Our policy now charts a clear path forward in our advocacy and program efforts to increase capacity to prevent, protect, and respond to the human health impacts of climate and extreme weather.

8. Washington Week partnership with NACCHO

Our Washington Week convening is always one of the most impactful events we host all year—it’s always exciting to go to Capitol Hill and share the importance of governmental public health directly to the Congress. This year we teamed with the National Association of County and City Health Officials (NACCHO) for a joint public health advocacy day on March 11. ASTHO and NACCHO share many public health goals, and we’re stronger when we advocate our needs to Congress together.

9. Continued work on the opioid epidemic

While the opioid epidemic continues to be a challenge for states, I’m very proud of the work we’ve done providing technical assistance for states. We’ve published extensive guidance on prescription drug monitoring programs, hosted webinars on the best practices for pregnant and postpartum women struggling with substance use disorders and continued to advocate for federal funding to combat the crisis. Karyl Ratty (SHO-DE) testified on the issue at a Congressional hearing and spoke about how her state was responding to the crisis, and highlighted the role of state and territorial public health agencies in the response. ASTHO will continue to stay on top of this issue as it shifts in the years to come. Personally, I’m also very excited about a book I co-wrote with Jay Butler, MD, an ASTHO alumni (alumni-AK) and current deputy director for infectious diseases at the CDC. A Public Health Guide to Ending the Opioid Epidemic offers a deep look at comprehensive, practical, scalable models for public health approaches on opioids. The opioid epidemic is challenging, but we have the data on what works. We just need to use it.

What a year it has been. Thanks for all your support and engagement with ASTHO—it makes all the difference. And as we prepare for 2020, we welcome you to continue to be part of a strong and effective ASTHO, an organization I am proud to lead and an organization that truly helps state and territorial health leaders promote and protect the health of our nation.