ASTHO Unveils Top 10 State Public Health Policy Issues to Watch in 2024

December 11, 2023

ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) today released its top 10 state public health policy issues that state legislatures will focus on in 2024. The list provides an overview of anticipated policies and potential evidence-based interventions for policymakers, public health professionals, and others preparing for the upcoming legislative sessions.

“Our prospectus series is a vital resource for state health officials and their teams preparing for their upcoming legislative sessions,” says ASTHO CEO Michael Fraser, PhD. “While issues like overdose prevention and tobacco control persist, we forecast renewed focus on increasing and supporting the public health workforce and curbing infectious diseases including persistently increasing sexually transmitted infections.”

The top 10 state public health policy issues for 2024 identified by ASTHO are:

Workforce: Looking ahead in 2024, ASTHO anticipates legislatures will prioritize strengthening the public health and healthcare workforce, which has experienced significant shortages in recent years. This will be achieved through funding initiatives, modifying licensing requirements, streamlining hiring processes, and investing in workforce pathway programs.

Mental Health: Policymakers are taking steps to improve mental health nationwide through greater investments in suicide prevention efforts (such as the national 988 crisis helpline and firearm injury prevention), support for youth mental health needs, and research on psychedelic substances to treat post-traumatic stress disorder and other mental health disorders.

Overdose Prevention and Substance Misuse: Lawmakers are expected address the dramatic increase of fatal overdoses by supporting harm reduction efforts like the legalization and dissemination of fentanyl and xylazine test strips, expanding access to peer support specialists to support recovery, and strengthening regulation of substances with potential for misuse or abuse.

Sexually Transmitted Infections (STI) Prevention: ASTHO expects policymakers to adopt laws to reduce STI rates, increase syphilis testing for pregnant people, expand preexposure prophylaxis (PrEP) and post exposure prophylaxis treatments (PEP) for HIV, and improve sex education requirements best equip young people to prevent contracting an STI.

Data Systems Modernization and Privacy: Policymakers are expected to consider legislation that will improve privacy protections for identifiable health data, expand public health access to data via Health Information Exchanges, and require updates to public health data collection systems to increase interoperability.

Preventing the Spread of Infectious Disease: ASTHO anticipates legislation on public health legal authorities for infectious disease control (e.g., isolation and quarantine), combating misinformation and disinformation through improved literacy, and improving vaccine access.

Access to Evidence-Based Reproductive Health Services and Family and Child Health: Legislatures are likely to consider bills improving access to contraceptives and increasing availability of perinatal providers such as doulas and midwives. Legislators are also likely to see policies to prevent maternal mortality and morbidity.

Optimal Health for All: ASTHO anticipates legislation to address health inequities by optimizing health disparity data collection and sharing, improving rural healthcare access, and investing in climate adaptation planning.

Environmental Health: ASTHO anticipates policymakers will consider legislation aimed at protecting environmental health, including bills to reduce and remove lead exposure, regulate per- and polyfluoroalkyl substances (PFAS) levels, and support strengthening food safety measures.

Tobacco and Nicotine: ASTHO expects policymakers to adopt laws and policies that prohibit flavored tobacco products, promote smoke-free environments, and decrease youth access to tobacco and nicotine products (including synthetic nicotine).

ASTHO tracks emerging and current policy trends every year analyzing their impact on state and territorial public health. For more information on these trends, visit ASTHO’s legislative prospectus series.


ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories and freely associated states, and Washington, D.C., as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in public health practice.