As part of National Public Health Week 2022, CSTE is highlighting the work of our members in applied epidemiology. Today is Part 2 of a spotlight of CSTE President Dr. Ruth Lynfield.

CSTE President Dr. Ruth Lynfield coped with the early stages of the COVID-19 pandemic like many of us did.

She went outside.

“Every weekend I could, I’d go to a different state park and hike,” Dr. Lynfield said. “I loved being with my family, my dog and to just be out in nature.”

As the weeks turned into years, Dr. Lynfield, the State Epidemiologist for Minnesota, understands even more how she and her public health colleagues must take care of themselves.

“Because if you don’t, you’re not going to be able to work at your best,” she said. “And you’re not going to be able to take care of your staff, your colleagues and your family.”

With that outlook, it’s easy to see how building a sustainable and resilient public workforce is one of Dr. Lynfield’s presidential priorities. Her efforts on this front include helping to produce and execute a training series allowing individuals to navigate their experiences of burnout, learn skills to support resilience, and cultivate and sustain new self-care habits. The series is for both State Epidemiologists and Deputy State Epidemiologists with a goal to expand to other CSTE members. 

Another one of Dr. Lynfield’s presidential priorities is also today’s National Public Health Week theme: Health Disparities. i.e., a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Lynfield says inequities exposed during the COVID-19 pandemic has spurred her passion towards this subject even more.

“There’s been a lot of work during this pandemic to dig into the risk factors for contracting COVID and having severe COVID,” she said. “Health disparities have come through as a really important issue. Especially understanding the role that structural racism has played and how that may impact a person’s decision if they want to get vaccinated or receive healthcare. There’s a lot of work that needs to be done.”

Much of that work, according to Dr. Lynfield, involves going directly out to the community to talk with individuals in different areas and trying to understand what the barriers are.

“Certainly, if someone is suspicious about a new vaccine, hearing about it from someone in their own community is more likely to result in having more confidence in it,” she said. “That’s what we need to do. It's difficult work and multi-layered. But we need to see where the gaps are and understand them.”

Another aspect of reaching out into the community, according to Dr. Lynfield, is accepting it is a two-way street. In other words, paying attention to what individuals have to say and being open to their ideas on how to best keep their community as healthy as possible.

“We need to listen; we can’t just say ‘oh we know how to fix this’ – we need to also ask people: how do you think we should fix this,” Lynfield said “It’s going to take time. But we must do it. There are astonishing inequities, so we must start including it in everything we do and understanding where the successes are and being able to apply those successes in other areas.”

Despite a full plate of priorities and the day to day works as a State Epidemiologist, Dr. Lynfield finds it vital to still keep her commitment to mitigating stress and burnout through the activity she enjoys the most.

“When I’m out hiking in nature, it gives me perspective,” she said. “It helps me balance things.”

Ruth Lynfield, MD, is State Epidemiologist from Minnesota and CSTE President for the 2021-22 term. More information on Dr. Lynfield's current work on LEIFE and other presidential priorities can be found at https://www.cste.org/page/presidential-priorities-award.

As part of National Public Health Week 2022, CSTE is highlighting the work of our members in different areas of applied epidemiology. Today’s focus is on recent CSTE Fellow Hannah Collins.

As a public health epidemiologist in Seattle, Hannah Collins had a unique, front row view of the early stages of the COVID-19 pandemic. However, Ms. Collins dealt with the stress of those uncertain months in Spring 2020 like many Americans did.

She adopted a “pandemic puppy” – a labradoodle named Coco.

As this National Public Health Week continues with today’s theme of “Public Health Workforce: Essential to our Future,” Ms. Collins’ story encapsulates the next generation of young epidemiologists at the forefront of their field.

Hannah’s journey to applied epidemiology began after college. She worked on a program evaluation to understand the impact of a community-based parenting program and how it could be implemented in Head Start Preschools.

“I became really invested in how to make data more accessible to communities,” she said.

Ms. Collins then earned her master’s degree in at the University of California – Berkeley’s School of Public Health in Maternal, Child, and Adolescent Health. While working during a summer internship at the Ohio Department of Health, she learned about the CSTE Applied Epidemiology Fellowship (AEF) program, submitted an application and was accepted.

She is now completing CSTE’s AEF and working as an Epidemiologist II at Public Health – Seattle & King County in Washington State. In both her fellowship and current job, Ms. Collins has worked in three different areas: Overdose and Substance Use Surveillance, Injury and Violence Prevention and Climate Change Impacts.

Recently, she’s been evaluating an algorithm to help identify opioid overdoses in emergency medical services data to improve overdose surveillance, detect clusters, and form outreach programs.  One of those outreach programs included some tech-savvy techniques.

“Over the past year, I’ve worked on a pilot program that texts people who have survived an overdose to see if we can connect them to a range of services or if there is any support we can provide for them,” she said.

Ms. Collins’ day-to-day activities vary depending on the most pressing issue. She updates data on King County’s public health dashboards, collaborates with partners at Emergency Medical Services and the Medical Examiner’s Office, as well as Washington State’s syndromic surveillance program (Rapid Health Information Network). Her time is also spent writing and thinking about how best to communicate the most recent data to the public.

Her work in Injury and Violence Prevention has recently included a CDC-funded evaluation of the social economic and overall health impacts of COVID 19 and associated mitigation strategies.

“We’ve been monitoring things like unemployment, family violence, behavioral health data, traffic patterns and several other topics,” she said.

In addition to the general population dealing with the stresses of a major pandemic, Ms. Collins acknowledges that she and her fellow public health workers who were thrust into an ‘all hands-on deck at all times’ situation has taken its toll. However, the staff camaraderie and setting some much needed personal boundaries has helped.

“People continue to get burned out and there’s no quick, easy fix,” she said.

Despite the challenges of the last two years, Hannah is proud of her work and her team’s accomplishments. Particularly their capacity to modify and shift when a strategy or plan wasn’t working.

“I’m most proud of our ability to adapt and be innovative,” she said. “For example, if we’ve tried something that’s not getting a lot of response, we adapted and made very quick changes in real time.”

Ms. Collins referred to CSTE’s AEF program as an important bridge between her education and career and credits her mentors for helping to shape her views on applied epidemiology.

“The two epidemiologists who were my mentors for this program helped me realize the possibilities of epidemiological data at the local level to make change,” she said. “They were very influential.”

What does the future hold for Hannah Collins? She’s excited to continue working as an epidemiologist in King County and advance the use of data to improve the health of those in her area. And given that she was born and raised in Seattle & King County, having a personal connection to her work.

“I’m grateful to work in the community I grew up in,” she said. “I’m excited to have the chance to make an impact here.”

Hannah’s story represents countless young professionals working in public health today: Strong community ties, and an emphasis on updating the decades old data and technology structures in their jurisdictions. This next generation of applied epidemiologists will certainly face more obstacles and personal hardships. Supplying them with the empathy and support they need is crucial to keeping all of us healthy.

And for Hannah, when times get tough, she can always take a long stress-relieving walk with Coco.

Hannah Collins, MPH is an Epidemiologist II at Public Health – Seattle & King County. Hannah recently completed CSTE’s Applied Epidemiology Fellowship (AEF) and will graduate in Class XVIII. 

*Update: On February 8, the House of Representatives passed a continuing resolution to fund the federal government at current levels until March 11. The Senate passed the bill on February 17 and President Biden signed it, averting a government shutdown. House and Senate appropriators have negotiated a framework to fund the government for the remainder of Fiscal Year 2022 and are currently working to craft formal legislation.

Federal Funding Update

CSTE reported in June 2021 that President Biden released his Fiscal Year (FY) 2022 budget, calling for historic increases in funding for the Centers for Disease Control and Prevention (CDC), including resources to carry out public health efforts at the state and local levels. While the president’s budget was groundbreaking, it is not binding. Congress sets federal spending, and though FY 2022 began on October 1, 2021, the FY 2022 congressional appropriations process is still underway. Republicans and Democrats are working to bridge their differences and come to an agreement before temporary funding expires February 18, 2022.

Along with our partners in the Data: Elemental to Health campaign, CSTE has led advocacy efforts to secure robust, long-term, sustainable funding for CDC’s public health Data Modernization Initiative (DMI) to upgrade our nation’s antiquated public health data infrastructure. We were pleased to share last spring that, thanks to our efforts, President Biden’s budget proposed a $100 million increase—or tripling—in funding for DMI at $150 million. And last July, the House Appropriations Committee recommended the same level of funding, which was included in a larger package of appropriations legislation that passed the full House of Representatives.

Across the Capitol, the Senate has taken no formal action on appropriations legislation to fund public health. However, the Chairman of the Senate Appropriations Committee introduced draft legislation last fall that would also fund DMI at $150 million. While these numbers match, they are not yet set in stone as overall funding levels still face pressures that could ultimately drive CDC and other health agency funding down. However, the consistent bipartisan commitment across Congress and the Administration to provide increased funding for DMI demonstrates that policymakers understand and agree with the dire need to invest in the modernization of our deficient public health data systems. The COVID-19 pandemic illustrated just how severe the need is and CSTE and our partners continue to advocate for robust, sustained funding that keeps pace with technology and will facilitate the immediate response to any emerging public health threat.

The fiscal year ended on September 30, 2021 with no funding agreement in place. Since then, Congress has passed two consecutive continuing resolutions (CR) extending federal funding at current levels while negotiations continue. At the same time, Congress will soon begin preparing for the FY 2023 appropriations process. We will be meeting with key congressional offices to request further increased funding for DMI in FY 2023 and will share more detail in the coming weeks.

Federal funding is critical for public health. CRs of any duration damage our public health infrastructure and impede our ability to respond. CSTE has prepared talking points that can be used as you speak to colleagues and policymakers about the need for increased investment in public health.

A Call for Long-Term Investment in Public Health Data Modernization

Incremental investments through the annual appropriations process and supplemental COVID-19 relief funding have been critical and have begun to improve public health data systems, particularly at the federal level. However, we cannot realize the potential of data modernization without also providing significant resources dedicated to modernizing foundational state and local public health data systems.

Data: Elemental to Health has estimated that a modern and secure public health information system will require a federal investment of at least $7.84 billion over five years. The COVID-19 pandemic has highlighted the egregious gaps in our system, and it also taught us that modernization cannot wait. The next public health crisis will always be looming. If we do not take the necessary steps to equip our public health system for the next emergency, we will face the same devastating inadequacies we have experienced in responding to COVID-19.

Meghan Riley is vice president at Cavarocchi Ruscio Dennis Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC

After months of failed negotiations, in December Congress finally passed a federal funding bill that included much-needed COVID-19 relief for struggling communities across the nation. The Consolidated Appropriations Act for Fiscal Year 2021 (Omnibus) was signed by the President on December 27, 2020. The Omnibus allocated critical funding for COVID-19 vaccines and therapeutics, vaccine distribution and administration, and contact tracing and testing, with specific funds designated for high-risk and underserved populations, including communities of color.

The Omnibus allocated $50 million to the Data Modernization Initiative at the Centers for Disease Control and Prevention (CDC), a key CSTE priority. Importantly, this legislation also included language to authorize activities to improve the public health data systems at the CDC. This provision will ensure that critical investments in our nation’s public health infrastructure go toward the most necessary updates. It remains essential that funds be appropriated annually to CDC to meet the $100 million authorization level this program needs to ensure its ongoing implementation and success. CSTE was at the forefront of advocating for this critical provision and will continue to urge Congress to prioritize funding for our public health data infrastructure to improve our response to COVID-19 and help state and local health departments prepare for the inevitable next public health crisis.

Meanwhile, President Joe Biden was sworn into office on January 20, 2021. Prior to the Inauguration, Biden released his American Rescue Plan, a proposal for yet another critical round of pandemic relief funding. The American Rescue Plan contains many essential investments to boost our nation’s pandemic response, such as $20 billion for a national vaccination plan; $50 billion for diagnostic tests and screening; and critically, a strong commitment to expand the public health workforce. As the presidential transition ramped up, CSTE held numerous conversations with transition officials, and later, White House staff. During these conversations, CSTE emphasized the need for additional funding for the DMI and shared specific activities that could be undertaken immediately to help to address data modernizations needs. One of these key recommendations was to include CSTE members and leadership in the COVID-19 taskforce meetings. As a result of our outreach and ongoing communications with key officials, the American Rescue Plan contains a request for $700 million to address data modernization needs at the state, local, and federal levels. CSTE strongly supports this investment and has begun conversations with leaders on Capitol Hill to bring it to fruition.

Now the Biden Administration must work with Congress to appropriate these essential funds—and CSTE is working to ensure they go to DMI. The slim margin in the Senate will make it difficult for the new Democratic majority to push the funding proposal forward. While Congress attempts to find a bipartisan agreement, Democratic leaders in the Senate and House are also considering moving the proposal through a process called budget reconciliation, which only requires a simple majority in the Senate for passage, but may not allow for inclusion of every priority.

When President Biden took office, he also quickly released a National Strategy for the COVID-19 Response and Pandemic Preparedness. This plan represents both a comprehensive attack on COVID-19 and an approach to better equip the U.S. to respond to future threats. As part of this national strategy, President Biden issued an Executive Order Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats. This executive order acknowledges that a strengthened public health infrastructure will make it possible for the U.S. to better prevent, detect, and respond to future diseases and other public health crises. Under this executive order relevant federal agencies will coordinate to advance and upgrade our public health data infrastructure.

As our members work on the ground to respond to the COVID-19 pandemic, CSTE will continue to press Congress and the Administration to follow through with the funding and policy priorities that will best position our public health workforce to succeed against COVID-19 and the threats of the future.

Meghan Riley is vice president at Cavarocchi Ruscio Dennis Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC.