partner profile of the Affordable Care Act— that provides about 12 % of CDC’ s annual budget and a good portion of the funding for CDC’ s Epidemiology and Laboratory Capacity grants to states. We’ re a vocal public health advocate and strive to make sure policymakers, the media and the public understand how crucial public health is to saving lives.

With a new federal administration in place, what do you foresee for public health over the next four years? And what are TFAH’ s priorities

during this time?

We will continue to see many proposals from the new administration that will impact health. As I’ ve mentioned, some of those relate to legislation, such as healthcare reform. But we’ ll also be paying attention to the budget deliberations, as well as administrative decisions and regulations that can impact health. Because health is affected by many services outside the healthcare arena, we also pay close attention to policies such as housing, food security, clean air and clean water.

Another TFAH priority is modernizing the public health system and optimizing federal funding for that system. Over the past several years, a public health model has been put forth that describes the modern public health agency as“ chief health strategist.” That role requires a health department to have the most up-to-date information about the demographics and health concerns of the communities it serves, the evidence-based interventions that can be applied to address those concerns, and real-time, granular data to guide that work, along with all relevant partners from both health and non-health sectors. In general, disease prevention is about moving upstream to create conditions in peoples’ lives that foster health and wellbeing, rather than focusing on treating health problems after they arise. We need to make the healthier behavior the easier choice. Some specific issues we’ re focusing on at the moment are obesity, emergency preparedness and behavioral health.

You have had opportunity to interface with US public health laboratories in a few of your previous positions. What were some notable

experiences?

I was public health commissioner in Boston during the 9 / 11 tragedy, and among my responsibilities was overseeing the city’ s emergency medical services. For a period of time after 9 / 11, there was great fear about the possibility of bioterrorism and anthrax exposure to the public. In a single month, we received over 1,000 calls from the general public related to white powders that might be anthrax. If we got a call like that, the EMTs and paramedics had to treat it very seriously. And we brought every single sample to the state public health laboratory. Despite the high volume, the public health laboratory was extraordinarily professional, effective and cooperative in working with the city and assuring the public was safe.

Later, as a state health commissioner, my department oversaw the Massachusetts state public health laboratory during the 2009 H1N1 influenza pandemic when, again, there was great fear among the public and laboratory tests were needed to assess exposure. There was a lot of pressure and a lot of urgency to turn those tests around quickly and to provide accurate information. The laboratory staff did an extraordinary job under difficult circumstances.

At the federal level, one of my CDC jobs was overseeing the office of State, Tribal, Local and Territorial Support. We spoke often with the health officials involved in Zika testing at regional or state laboratories. As with H1N1, Zika was a new test for the labs; they had a lot of pressure to develop expertise quickly, and they did a phenomenal job for public health.

As a non-laboratorian, what is your perspective on( a) what public health laboratories are doing well in their interactions with other public health leaders, and( b) what they could do better to increase their visibility and resources?

I think they’ re doing a terrific job interacting with public health leaders. A key need for health officials is accurate and up-to-date test data— no easy feat. It requires continually training people, getting the latest equipment and producing state-of-the art work. My experiences at CDC around new technologies— such as whole genome sequencing to investigate foodborne disease outbreaks— reinforced for me how central it is to have confidence in test data.

With regard to the second question, this is a problem because laboratories are often not visible to the public unless there’ s a crisis, and that can lead to underfunding and a lack of appreciation for the effort required to maintain preparedness. I think public health laboratories are doing their best to make their case from the commissioner level to the grassroots level. Yet, I think we can do better. We need to highlight the importance of laboratories across all the disciplines of public health and make more effective use of communication tools, including social media.

What can APHL and its member laboratories do to enhance their partnership with TFAH?

I think we have a strong partnership already. We work well together. Perhaps we can pay more attention to proposed policies that may affect the laboratory and make sure we’ re unified in sending the right message to policymakers. TFAH’ s most recent preparedness report, released in December, assesses whether states have met ten key preparedness indicators. Two of the ten come from APHL’ s annual member survey, namely, providing biosafety training or information about training to sentinel clinical labs and having a biosafety professional on the staff of the state public health laboratory. Fortyfour states met the first goal, and 47 the second. This is a way for TFAH to contribute to the pressure on states to meet these goals.

The feature article in this issue of Lab Matters is devoted to cannabis. What is TFAH’ s view of cannabis legalization?

TFAH doesn’ t have a formal position on that. We do think it’ s important to pay attention to the experiences of states that have legalized cannabis. And clearly the labs have a role to make sure legal cannabis products are safe for consumers. TFAH will have a formal position once there is more data on the public health impacts of legalization.