partner profile

in their tenures. More generally we are working on a First 100 Days paper( available in early 2017) that highlights five priority areas ASTHO sees as crucialtotheCongressandnewadministration. OurworkwithCongress isongoing, butournextbigeventwillbeourkeyleadershipmeetingthe first weekofMarch. Ithink allofus engagedin public healthhaveaduty to educate our policymakers on the impact of our work and the need to sustain andstrengthenthat work. Ilike tosaythateveryminuteweare not on the Hill advocating for public health, someone else is filling that voidwiththeirownprogramadvocacy.

What do youconsider tobe thetop challengesfacingtheUSpublic healthsystemin2017?

Wehavealotofchallenges! First, akeyissuewillbecontinuedefforts to tellthepublichealthstorytoanewadministrationandCongressto sustaincurrentpublichealthinvestments. Second, Ithinkwemustdoa betterjobthinkingaboutalternativestrategiestoaddresshealthreform andaccesstohealthcareiftheAffordableCareActgoesaway. Whatare we suggesting as essential elements of a new health coverage plan?

WhileIknowthereisabigdifferencebetweenpublichealthand healthcare delivery, we cannot ignore that most of the“ action” is in healthcaredelivery. Howarewepositioninghealthagenciestoaddress population health and to take part in discussions of healthcare access, delivery and, importantly, upstream prevention? What are we doing to link public health and healthcare in the states? Of course, there are continued challenges related to public health workforce development and retention and pressure to cut governmental public health funding even whenthereisgreatneed. Iaminterestedinhowweadvanceourworkon health equity— an issue often incorrectly perceived as partisan. Finally, Iwouldsayachallengeisourcontinuedneedtorespondtopublichealth emergencies. Naturaldisastersandinfectiousdiseasesposechallenges as well as opportunities to build support for the critical role public health plays in states and territories.

Is current public health funding sufficient to address these challenges?

No. Next question?

But seriously, there is tremendous need. As we spend more and more on healthcare delivery we have to make the case that investments in prevention are highly cost-effective and sometimes even cost-saving. If we cannot quantify that, we are sunk. We must get better at advocating forsustainedandincreasedinvestmentsusingeconomiclanguage, as wellascompelling storiesaboutthe impact of ourwork. Itisnotokay that many states do not benefit from core public health programs funded by CDC because funding is not available for all states. It is not okay that we are cutting staff in our health departments at the very time we need to strengthen our health system to address public health threats like Zikavirus, environmentalhazardsandstubbornlyhighratesofchronic disease. Wehavetobetterlinkourworktothehealthcaredeliverysystem where the bulk of our health dollars are spent and show the return on investmentthatpublichealthpayswhenproperlyresourced. Letmejust add that we must stop talking to ourselves about this— the wringing of handsandgnashingofteethmaybefamiliartous, butweneedtoengage policymakers and others who can impact health agencies’ bottom lines. Thereisalotto do inthisarea for sure. And no oneisgoingto do itfor us.

Howcanweexpeditefederalfundingforresponsetofuture publichealthemergenciesinthewakeofdelayedfundingfor

Zika response?

We should work more closely with our elected representatives to demonstrate the urgent need for these funds and move public health appropriations for emergency response into a more accessible mechanism. ASTHO supports an adequately resourced Public Health Emergency Fund that jurisdictions can tap after reaching certain epidemic thresholds or experiencing public health emergencies. Thereisnoreason Zikafundingshouldbe heldhostage in political fights about other issues. Preventing the deleterious effects of an infectionlikeZikaisclearlynonpartisan. Let’ screateafundand assure accountability for it while simultaneously getting it outside the political process. I think we have a lot to learn from the Federal Emergency Management Agency on this one.

How can we strengthen connections within state health programs, e. g., emergency response, epidemiology and lab? Are there states

that serve as models in this regard?

OnethingIhaverealizedoverthecourseofmanyyearsworkingin public health and healthcare is that we are truly tribal. We love our silos, where we have our funding, our expertise, our professional identity. But the challenges of today and tomorrow are multi-sectorial anddonotpresentinsilos. TakeZika, forexample: itimpacted infectious disease control, epidemiology, maternal and child health, laboratory practice, vector control, public health preparedness and other public health programs. Can we use the Zika crisis as a model for cross-agency collaboration in the future? I hope so.

How can APHL and ASTHO work more closely together?

IappreciatewhatAPHLmembersbringtostateandterritorialpublic health and the core function they play in the public health enterprise. We start there. I have deep respect for APHL’ s staff and leadership andagoodworkingrelationship. Thatrelationshipallowsustobuild trust andmove quicklywhen weneedtoact together. Certainly, state andterritorialhealthofficialshavevariedlevelsofknowledgeof governmental laboratories and the highly technical work they do. I think APHL and ASTHO can work more closely together on orientations for new state and territorial health officials, using APHL resources to bringASTHOmembersuptospeedonlaboratoryfunctions, challenges andopportunities. Ofcourse, Iwouldliketoseeusdomoretogether ontheadvocacyside. Anotherareaforcontinuedexplorationishow weworktogetherontechnologyprojects, suchasourelectroniccase reportingprojectand“ DigitalBridge.” IwouldalsoliketoseeASTHO work more closely with APHL on global issues, such as working with ministriesofhealthinresource-limitedcountries. Thereismuchtodo, andIamexcitedtodoitwithAPHL.