In the early days of March, CSTE’s leadership and several Board Members set out for Washington, D.C. for our annual Capitol Hill Day. Being back on the Hill in person for the first time since 2019 was exciting and presented an important opportunity to advocate for a future in which CSTE members and all public health officials have the resources needed to respond swiftly and effectively to public health threats.

Amidst the usual hustle and bustle of policymakers, CSTE’s delegation brought a unique element to the table: real stories from the trenches of public health. These accounts represented the profound impact that federal public health funding has on efforts at the state level—in our legislators’ communities. The experiences shared by epidemiologists highlighted their daily endeavors to combat diseases and protect public health. The annual Hill Day also provided an opportunity for CSTE to showcase amazing jurisdictional work on data and epidemiology, Stories from the Field, which has proven to be a great resource for Congressional staffers and leaders.

Central to the discussions was the need to appropriate at least $340 million annually for Public Health Data Modernization. CSTE emphasized the importance of a robust public health data infrastructure. The ask was clear:  continued and increased investment to ensure that our systems can keep pace with rapid advancements in technology and having the trained staff to use and manage the technology to ensure it effectively supports the science and work of applied epidemiologists whose central mission is to collect data to drive public health actions and ultimately save lives. CSTE highlighted how such funding would not only streamline processes but also enhance the nation’s ability to rapidly identify health threats, conduct rapid case investigations and halt the spread of illnesses.

Another key focus was the Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity Program (ELC). CSTE leaders asked Congress to appropriate at least $120 million for ELC, to support this crucial program, which stands as a pillar of the CDC’s efforts to monitor and protect public health. They underscored the fact that the ELC program’s support for nimble response ready epidemiologists makes it a swift and effective mechanism for new and emerging threats—a necessity in the unpredictable landscape of public health.

Reflecting on Hill Day, the message to Congress was clear: funding for Public Health Data Modernization and the ELC program must be strong and sustained. The nation’s health and safety depend on these investments. CSTE’s advocacy efforts marked a significant step towards securing a future where public health funding is not merely sufficient but exceptional, equipping epidemiologists and other public health professionals with the necessary tools and resources to safeguard the nation’s health.

Victoria Barahona is a policy associate at CRD Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC.>

Today’s NPHW daily theme is “Healthy Neighborhoods.” From Ethiopia to New York City to Washington State, AEF fellow Hannah Gorman is always focused on the health of the neighborhood she’s currently in.

It’s easy to draw a connection between Hannah Gorman’s favorite childhood book series, “Harriet the Spy,” and her eventual career in epidemiology. In those stories, Harriet observes her neighborhood, writes down what she sees and takes action based on the data she collects.

Sound familiar, fellow epis?

Gorman uses these same techniques daily as a CSTE Applied Epidemiology Fellow (AEF) at the Washington State Department of Health.

Her journey to public health and epidemiology is an interesting one. It started when Gorman took a “gap year” after high school and worked for a program for children in Ethiopia whose parents had either passed away or were unable to care for them, mostly due to HIV/AIDS.

It was this experience that led her to have a different view of what the word “health” means.

“[In Ethiopia] the kids themselves did not have HIV,” she said. “But they needed to go to a good school, they needed a house, they needed a place to live, they needed a parent that could care for them -- things that are very much a part of health, but we don't always think of as health. That opened my eyes.”

This “eye opening” kicked off Gorman’s mission to improve health within communities through a focus on the social determinants of health. Work that resonates strongly with today’s National Public Health Week theme, “Healthy Neighborhoods.”

Gorman studied Anthropology as an undergrad, but when choosing her next steps, she wanted something more on-the-ground and practical than purely academic.

“[Anthropology] helped give me a scholarly way to look at it, but I didn't feel like I had very concrete tools to practice it,” she said.

This realization led to her pursuing first teaching, and then a master’s in public health degree, where she was soon bitten by the epi bug.

“I was studying social and behavioral sciences, but I took one epidemiology class my first year and said, ‘I'm done. This is it. This is what I want to do.’”

While working a summer internship at the New York City Department of Health and Mental Hygiene during graduate school, Gorman connected with a former AEF fellow through her mentor. After learning about the program, she immediately applied.

“It just sounded like exactly what I wanted.”

As an official AEF fellow at the Washington State Department of Health, Gorman focused on two important areas of work: maternal and child health evaluation work and a Healthy Youth Survey designed to gather data on trends in youth health.

“That data we collect is used by our state to inform us about risk and protective factors for youth health behavior,” she said.

Gorman lists multiple highlights of her time as an AEF fellow, including presenting at the 2023 CSTE Annual Conference on her work studying multiple different ways of categorizing transgender youth. She is also helping to create guidance on how best to deal with sexual orientation and gender identity data.

“Essentially we're trying to create a best practice guide for the whole agency, to standardize how we deal with SOGI (Sexual Orientation and Gender Identity) data,” Gorman said. “So, for any data relating to sexual orientation, gender identity, or any other concepts, we're literally writing a guide for how people should handle that data.”

Gorman’s AEF journey has recently ended, but she looks forward to a full and productive career in public health. She recently began a new position as Healthy Youth Survey Epidemiologist & Coordinator. She credits AEF for the professional experience and something even more important: confidence.

“I just accepted a full-time position [as Healthy Youth Survey Epidemiologist & Coordinator at Washington State Health Department] and I feel much more assured going into that,” she said. “Because I've had this time to make mistakes and learn from them in a protected environment.”

Harriet would be proud.

Get involved! Learn more about CSTE’s Maternal and Child Health subcommittee and how to join. Interested in the CSTE AEF fellowship? Start here.

Public health is facing a serious and recurring threat: the potential loss of a vital source of funding, the Prevention and Public Health Fund (prevention fund). The prevention fund is a dedicated funding stream created by the Affordable Care Act in 2010 to improve the nation’s public health system by supporting activities such as chronic disease prevention, immunization, tobacco control, lead poisoning prevention, and infectious disease response. It was originally intended to help improve health outcomes and reduce long-term health care costs, by preventing diseases and conditions that are costly to treat and that reduce the quality of life for millions of Americans. However, the prevention fund now also makes up a significant portion of CDC’s budget as it has been used to fund core CDC activities when base funding increases were not possible.

Unfortunately, the prevention fund has been reduced by Congress several times in recent years and is vulnerable to further budget cuts and transfers as it is seen by some policymakers as an available pot of money. Trust for America’s Health has numerous resources on their website, like this chart below:

The prevention fund provides essential resources to state, territorial, local, and tribal (STLT) health departments to protect communities from infectious diseases and many other public health threats. Any cuts to the fund would jeopardize our already-underfunded public health infrastructure.

The latest proposed cut to the prevention fund comes from a provision included in H.R. 485 , the Protecting Health Care for All Patients Act, which passed the House in a 211-208 vote on February 7. The Senate has not acted on the bill. H.R. 485 uses the prevention fund as a pay-for to address unrelated changes to federal health care programs. The cuts would result in $1.19 billion in cuts over Fiscal Years 2025-2029, which is about a 13% reduction over that period. CSTE joined more than 170 organizations in sending a letter to Congress opposing these wrongheaded proposed cuts.

Importantly, one of the programs funded by the prevention fund is the foundational Epidemiology and Laboratory Capacity (ELC) funding line, which provides flexible resources to STLT health departments to enhance their capacity to prevent and control infectious diseases. This flexible ELC funding is crucial for the public health system’s ability to detect, investigate, and respond to outbreaks that may not be addressed by disease-specific funding. However, the ELC funding line could be at risk if the latest proposed cuts to the PPHF are enacted. This would have negative consequences for public health and the health and well-being of our nation. While CSTE continues to advocate for increased funding for ELC, some voices in Congress are threatening to reduce critical prevention fund resources that aid public health in their own communities.

The prevention fund affects every state—including yours! Check out the details by visiting Trust for America’s Health’s (TFAH) prevention fund page , which shows how many grants are funded in each state through the various programs supported by the prevention fund.

The prevention fund is under constant threat and needs your advocacy to ensure their continuation. That’s why we urge you to act today and call on your legislators to protect the prevention fund. Now is the time to speak up for the health and safety of our communities. Together, we can make a difference for public health.

Victoria Barahona is policy associate at CRD Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC.

As the year comes to an end, let’s look at where the appropriations process stands and what we can expect when Congress returns to Washington, DC in January.

Last month, just before the November 17 deadline, the House and Senate passed a “laddered” continuing resolution (CR), successfully averting a government shutdown. The CR (H.R. 6363) extends government funding to January 19, 2024 for four of twelve appropriations bills. The remaining 8 bills, including the Labor HHS, Education and Related Agencies Appropriations bill last until February 2, 2024. Congress will have its work cut out for it next month with two deadlines that could spell a partial or full government shutdown if bipartisan negotiations break down.

Below you’ll find topline agency numbers from the CR as they compare to current funding levels for FY 2023:

 Centers for Disease Control and Prevention

• Final FY23: $9,217,590,000
• Senate FY24: $9,197,590,000
• House FY24: $7,591,566,000

 Epidemiology and Laboratory Capacity (ELC)

• Final FY23: $40,000,000
• Senate FY24: $40,000,000
• House FY24: $40,000,000

 DMI/Public Health Data Modernization

• Final FY23: $175,000,000 
• Senate FY24: $160,000,000
• House FY24: $75,000,000

 Center for Forecasting and Outbreak Analytics

• Final FY23: $50,000,000
• Senate FY24: $45,000,000
• House FY24: $0

Major cuts have been proposed by the House, as you can see above. However, the federal budget for the full fiscal year is still undecided, as different parties in Congress have different views on how to allocate the funds. Cuts to federal programs are on the table, alongside the possibility of a long-term CR, which will decimate public health funding. Make no mistake, these cuts will impact STLT epidemiologists who rely on sustained federal investments.

February will be here before we know it. CSTE reminds you that you can take action and urge your representatives and senators to fund vital public health programs at the highest levels possible. Anybody can advocate to their legislators.

Here are some steps you can take:

1. Advocate for public health in your jurisdiction. You can write an email in your personal capacity or share your stories on social media. Your voice matters! Find your representative here and reach out through their website or by phone.

    

2. Educate and share materials on DMI with your colleagues. You can send them CSTE’s DMI report, which provides a snapshot of the state of the public health data infrastructure. Or share this infographic for a short update. And, remember to review this one-pager reflecting CSTE’s estimates on the actual cost of DMI at the STLT level.

    

3. Encourage your colleagues, friends, and family to act today. Ask them to contact their legislators and tell them that public health is at risk without adequate and sustained funding. The current FY24 funding deadline is February 2, 2024. Don’t wait, act now!

Anyone can get involved. The clock is ticking for lawmakers to reach a lasting budget deal or approve another short-term funding extension by February 2. CSTE will keep pushing for adequate funding and will keep you informed as the appropriations process unfolds in the new year.

Victoria Barahona is policy associate at CRD Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC.

15 Years and running...

In 2008, CSTE and CDC collaborated to create the first set of Applied Epidemiology Competencies (AECs). The goal was simple: Improve the practice of epidemiology within the Public Health system. The first step? Define the role of an epidemiologist and determine what skills are needed for each step in their career.

Of course, the world has changed drastically since 2008, so CSTE and CDC have partnered once again to update the AECs and ensure relevancy in 2023. If you’re hungry to get started, read the full report here. But if you’re short on time, here are five fast (digestible) facts about the update:

1. We Heard You! – As part of the 2023 revisions, CSTE gathered feedback on the AECs from a diverse audience. We convened a 20-member expert panel, hosted six town halls with more than 200 participants, and distributed an online survey. In all, 43 states provided feedback.
2. New and Improved Structure – The updated AECs now have an easier, more intuitive flow that builds in skill complexity as the tiers progress. This allows for a more practical and useful document that’s simple to understand. The competency format also includes a straightforward skill statement with examples, similar to the Core Competencies for Public Health Professionals
3. Diversity, Equity, and Inclusion Infused in All Domains – Principles of health equity have been infused throughout the AECs. This includes emphasizing the application of diversity, equity, inclusion, and accessibility (DEIA) principles for identifying populations, designing, analyzing, and interpreting epidemiologic surveillance data, and implementing public health actions to ensure health equity is at the forefront of epidemiology.
4. AECs Can Help You Today! – The AECs are a great resource for recruitment and retention efforts in your health department. They can be used to create job descriptions, identify professional development opportunities, craft training plans, and more—tools that are more important than ever in this modern era of public health funding.
5. More Resources are Coming! – The 2023 AEC rollout is just beginning. CSTE plans to create an accompanying toolkit that will include evaluation tools, templates for creating job descriptions, career portfolios and training plans, interview questions, and much more!

One thing that hasn’t changed since 2008 is CSTE’s commitment to a healthy, engaged, and informed applied epidemiology workforce. We are proud to present these updated AECs—which you can read in full here—and we look forward to releasing even more companion resources soon.

To read the full AEC report, please click here. For additional questions, please contact WFResources@cste.org.