What do school meals, housing, paid leave, and pre-K have to do with public health? According to Trust for America’s Health: everything. In this episode, Breanca Merritt, Director of Policy at Trust for America’s Health, breaks down a new report titled Promoting Health and Cost Control in States (PHACS), which tracks how states are adopting 13 evidence-based policies that improve health, reduce long-term costs, and deliver a return on investment, many of them outside traditional healthcare. But this isn’t happening in easy conditions. With federal funding shifts, post–public health emergency rollbacks, workforce strain, and growing political pressure, states are being asked to do more with less. The report serves as both a reality check and a playbook, highlighting strategies that are working across very different political and fiscal environments. The takeaway: even in a tough moment, there are practical, evidence-based ways to move policies that improve health and strengthen communities, if sectors work together.
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Leadership Power Hour: Your Launchpad for Impact | ASTHO
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This is Public Health Review,
MORNING Edition.
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For Thursday.
February 12th, 2026 I'm John
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Sheehan with news for the
Association of State and
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Territorial Health Officials.
Today we'll hear about a new
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report which tracks how states
are adopting 13 evidence based
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policies that improve health,
reduce long term costs and
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deliver a return on investment.
Many of them.
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Outside traditional healthcare,
our guest is Bianca Merritt,
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director of policy at Trust for
America's Health, which created
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the report titled Promoting
Health and Cost Control in
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States.
So Trust for America's Health
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has an initiative that's been
around since about 2018 called
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Promoting Health and Cost
Control in States initiative,
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also known as FACTS.
And so this work has identified
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13 evidence based policies that
states can pursue to promote
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health and well-being and
produce a cost cost savings and
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have an economic return on
investment.
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So in the past several years,
our organization had identified
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those policies and kind of
checked out, you know, how
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effective they are and how
they're working.
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And so this iteration of the
work that resulted in our report
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focused on how states are doing
in those areas.
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We identified these policies.
How are states actually
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implementing or adopting some of
these to make a difference where
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they are?
So the report primarily looks at
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three different things.
One, well, first of all, say who
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the audience really is for this
work.
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Anyone who's working in state
government, including state
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health officials, folks who are
working in state agencies, but
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also folks who are working at
the advocacy level on the
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ground, really moving some of
these different policies
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forward.
The second group of folks
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includes legislators who are,
you know, responsible for of
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course, implementing these
things through legislative
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action and also folks who are
interested in these topics in
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all those roles but outside of
traditional health and public
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health areas.
And these policies really span
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not just kind of traditional
health and public health, but
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also things that we consider to
be in non medical driver spaces.
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So things related to housing,
paid leave, universal pre-K, and
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other things that are that
public health recognizes the
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whole is important, but that
aren't typically consistently in
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our purview as in governmental
public health or even outside of
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government.
And the report is sort of set in
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the context of a changing
federal funding landscape.
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And so the report makes makes
clear that it's identifying both
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funding challenges.
But also opportunities.
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That states.
Have have sort of come up with
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right?
Yes, we do set up how we would
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like the audience to engage in a
few different ways.
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So to your .1 thinking through
what the federal landscape looks
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like, we know there's been a lot
of shift happening both in terms
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of certainly the funding
environment federally that
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federal agencies provide to
states to implement some of
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these policies, but also the
infrastructure related to
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advancing that work.
So we do take some time to
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highlight first what are the
federal changes that have
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happened, especially in the post
COVID public health emergency
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environment where we saw a lot
of investment in some of these
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strategies that have since been
pulled back.
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So just highlighting generally
what that environment looks like
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and how states have adjusted.
Secondly, we worked directly
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with state advocates, state
government leaders to hear about
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what that processes look like
for them both before and since
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the post COVID public health
emergency environment, but also
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in the post 2024 election season
to get a sense of what
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strategies they've employed to
move this work forward as well
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as some of the challenges that
they faced in moving this work
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forward.
And then lastly, we highlighted
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the status of each of these 13
areas in terms of what the
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federal fiscal environment looks
like for advancing some of this
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work and also highlighting
opportunities that states could
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pursue advancing the work absent
federal support.
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So it's a good mix of strategy,
innovation, cross sector
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partnerships and also the
reality of what it looks like to
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navigate this more challenging
time in public health policy.
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Absolutely.
And let's drill down into a
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couple of those areas.
What are some takeaways from the
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report?
Sure.
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I think one major take away is
that, yes, this is a challenging
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time, but states more than ever
have really had to be incredibly
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creative and insightful about
not just what can be used to
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advance the public's health, but
also to think about how we're
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centering in communicating
effectively the needs of folks
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on the ground in our States and
communities to make sure that
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that is the priority.
And really making sure that all
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the support fiscally,
infrastructure rise really
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centers those needs.
And that's been really good to
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see, but also understanding the
challenges that it, it sounds
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great, but it's not as simple as
I'm saying at the complexity of
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not just working in state
government, but folks who are
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also on the ground doing the
grass roots work are also facing
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a ton of challenges fiscally and
structurally as well.
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Another thing we really try to
lift up in the report is the
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diverse ways in which states are
trying to advance some of these
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efforts.
And so there's no
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one-size-fits-all is I'm sure
folks know if you work within
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one state, a lot of it works in
that state, works there, maybe
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not elsewhere.
But what we tried to do is lift
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up strategies that are working
across all kinds of different
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States and political
environments and so also giving
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folks some, I think some hope.
I think often at the national
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level things might look bleak in
terms of just the numerous, you
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know, hits that public health in
particular is taking.
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But understanding the cross
sector strategies that that
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states are employing are
critical.
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So in addition to thinking about
community and other types of
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infrastructure opportunities, I
also want to lift up the fact
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that states are really clear to
us about the importance of
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communicating how important
issues are both to the lay
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public and also to legislators
to advance some of this work and
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also the need for local and
community evidence.
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And when they have those
stories, they have the numbers
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and they could present that to
legislators, advocates,
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whomever.
It really helps advance some
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really complex policies that
they know have a higher return
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on investment even been in our
current environment.
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I think another thing that's
important here is that a lot of
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what we've seen has been
bipartisan in nature and to
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understand that that's happening
at the state level where state
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legislative environments have
been increasingly politicized.
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It's also positive when we're
thinking about some of these
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specific topical areas that
require that bipartisan support
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to move them across the finish
line.
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What are some examples of of
state innovations or or this
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diversity of strategies?
I think one example is universal
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school meals.
We've seen across a number of
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states who are pursuing this
work and also doing it in a
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bipartisan way.
So we lift up in our report the
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case of Arkansas.
We spoke with some advocates
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there as well to understand how
they were able to advance a
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universal school breakfast
policy using, you know, a lot of
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tax revenue, including from a
variety of different sources.
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Working with a new governor to
really spearhead that work after
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working closely with the state
legislature for years, getting
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folks on board over time.
And then really this most recent
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year, leaning into data showing,
you know, increases in rates of
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kids with more hunger, less
access to food, and kind of all
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those things culminating in an
opportunity to really advance
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something that's needed by a lot
of kids across the state,
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regardless of income.
And so I think sometimes we we
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want to paint a broad brush
about the types of states that
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can advance some of these
policies and the types of
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political environments that
exist.
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But ultimately, folks have told
us across the board that it's
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really about just kind of
meeting the moment and also
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finding those key allies and
being able to communicate very
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clearly and with evidence
stories.
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A lot of strategies that we know
are tried and true, but I think,
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importantly that a lot of those
strategies still work even in a
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time where things feel hyper
politicized and really
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intransigent.
And could you give us an example
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of?
Sort of the type.
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Of creative thinking that goes
into sort of navigating these
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funding challenges.
Sure.
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I think some of it is well, one,
I think just facing the reality
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of what's going to happen and I
think at the state level,
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particularly in government,
folks have looked for a while
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recognizing that with the
decrease in COVID era funding
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that it was just the writing has
been on the wall for a while.
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I think what's expedited some of
the challenges that knowing that
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the cuts that have come have not
just been within public health,
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but also across other sectors.
And so we're thinking about what
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it looks like to navigate the
fiscal environment.
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The first step is just the
reality of understanding where
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all the cuts are going to be and
also understanding that the full
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effects of those cuts had not
yet been seen.
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So I think just the gravity and
reality of it and grappling with
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that is a is a critical step.
But as I alluded to, I think
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we're seeing so many more states
leaning into community
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partnerships, even when they've
existed before, doing the best
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they can to lesson.
I think in public health in
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particular, there's been more of
a push to acknowledge maybe
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missteps in the past where we
haven't always been in touch
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with community and integrated
into what folks are needing.
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And so really highlighting some
of those opportunities about
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what could be from the ground up
is definitely something that
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we're seeing states not
necessarily investing more time
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and money into, but just the
desire to and the willingness to
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and really leveraging the
opportunities that exist to be
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as in tune as possible to what
focusing on the ground, which
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enables them to make a stronger
argument about where the gaps
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exist and where the investment
should go.
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So I think for us, that was
something that consistently
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stood out.
So, Priyanka, the report is
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certainly a combination of
opportunities, but very much
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couched in the challenges of the
moment.
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Could you talk a little bit more
about, you know, the nature of
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the challenges and how great it
is?
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To sort of.
Think positively and creatively
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with opportunities but taking a
clear eyed.
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Look at where we are.
Sure.
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I think we definitely highlight
in the report just the creative
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and unique ways that states are
advancing some of these frankly,
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often costly and upfront costs
with some of these policies, but
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also being able to, you know, be
strategic around that work.
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That's certainly a key theme
here.
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But we also lean into the fact
that these are significant,
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unprecedented reductions in
federal funding and
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infrastructure and workforce.
And so when you're combining
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those federal cuts with the
anticipated state budget cuts
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and federal increasing
requirements on things like SNAP
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and Medicaid reporting, it's
really straining our system.
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And so certainly state
government advocates can be as
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creative as they want, but we
really do want to recognize that
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these reductions are
substantial.
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And it's unfair in a lot of ways
to have states bear the burden
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of creativity and cost sharing
and savings to make some of not
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just these policies
recommendations work, but also
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just core public health
infrastructure.
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I also want to add that then in
addition to states having to
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strategize around this work,
that they're also navigating a
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lot of false planes and
skepticism even in some of these
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spaces.
So we talk about public health,
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but this report also talks about
areas outside of public health
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and traditional public health
infrastructure like housing,
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education, etcetera.
And So what we have also learned
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is that it's really important
for states in public health
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roles to lean even more into our
partners and other sectors
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because they're really in the
same boat in terms of facing
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these massive cuts.
And so that cross sector
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collaboration that's often
really hard to achieve even the
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best of times is really
something that's going to be
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critical to advance the public's
health, especially beyond
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traditional public health
infrastructure.
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00:12:04,640 --> 00:12:09,800
And does the report touch on
sort of non medical intervention
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00:12:09,800 --> 00:12:13,080
policy suggestions, things you
know?
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00:12:13,080 --> 00:12:16,880
Related to child.
Nutrition, things that sort of
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00:12:16,880 --> 00:12:19,160
can take place before
intervention.
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00:12:20,040 --> 00:12:22,200
Absolutely.
So the premise of this entire
231
00:12:22,200 --> 00:12:25,400
initiative, including this
report is really to think about
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00:12:25,560 --> 00:12:29,960
those community and structural
drivers related to health, non
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00:12:29,960 --> 00:12:32,520
medical drivers of health.
And so historically, public
234
00:12:32,520 --> 00:12:37,040
health is really focused on, you
know, in practice, a lot of
235
00:12:37,040 --> 00:12:39,840
emphasis has been on kind of
these health related social
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00:12:39,840 --> 00:12:43,560
needs efforts and doing more
direct service or thinking about
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00:12:43,560 --> 00:12:46,000
social drivers and recognizing
their importance.
238
00:12:46,000 --> 00:12:49,040
But a lot of these policy areas
being kind of outside of the
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00:12:49,040 --> 00:12:51,720
traditional purview of a public
health or Health and Human
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00:12:51,720 --> 00:12:54,680
services department.
So it's critical that these
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00:12:54,680 --> 00:12:57,600
topics are seen as a part of
public health, while recognizing
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00:12:57,600 --> 00:12:59,880
the public health in its current
form doesn't really have the
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00:12:59,880 --> 00:13:01,800
capacity to pursue all these
those things.
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00:13:01,800 --> 00:13:04,880
So it's again kind of leading to
the importance of these kind of
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00:13:04,880 --> 00:13:09,160
cross sector opportunities to
advance the public's health and
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00:13:09,160 --> 00:13:11,880
knowing that they're critical.
And also knowing that working
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00:13:11,880 --> 00:13:15,200
together is going to be so
important to advancing public
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00:13:15,200 --> 00:13:18,600
health, knowing that all of our
sectors are challenged fiscally
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00:13:18,600 --> 00:13:21,640
and structurally to do this work
in a vacuum.
250
00:13:21,640 --> 00:13:24,640
So thinking about this
opportunistically, I think will
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00:13:24,640 --> 00:13:29,080
help advance these policies that
are again a mix of kind of
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00:13:29,080 --> 00:13:32,200
traditional policies in public
health such as smoke free
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00:13:32,200 --> 00:13:36,640
environments, walkability, but
also things with experts who are
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00:13:36,640 --> 00:13:39,080
not in our field, but who are
definitely facing the same
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00:13:39,080 --> 00:13:43,480
fiscal, structural and other
community challenges that we do
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00:13:43,480 --> 00:13:47,480
in in public health.
Brianna Merritt is director of
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00:13:47,480 --> 00:13:49,480
policy at Trust for America's
Health.
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00:13:50,920 --> 00:13:53,560
Want more public health insights
beyond the podcast?
259
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Follow ASTO on social media for
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263
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developments, and stories from
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264
00:14:11,840 --> 00:14:14,920
country.
Follow ASTO wherever you scroll
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and find those links in the show
notes.
266
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For more details or to register,
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check out the link in the show
notes.
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This has been Public Health
Review MORNING Edition.
282
00:15:08,280 --> 00:15:11,040
I'm John Sheehan for the
Association of State and
283
00:15:11,040 --> 00:15:12,360
Territorial Health Officials.
00:00:00,840 --> 00:00:02,760
This is Public Health Review,
MORNING Edition.
2
00:00:02,760 --> 00:00:05,960
For Thursday.
February 12th, 2026 I'm John
3
00:00:05,960 --> 00:00:08,480
Sheehan with news for the
Association of State and
4
00:00:08,480 --> 00:00:11,520
Territorial Health Officials.
Today we'll hear about a new
5
00:00:11,520 --> 00:00:15,160
report which tracks how states
are adopting 13 evidence based
6
00:00:15,160 --> 00:00:18,840
policies that improve health,
reduce long term costs and
7
00:00:18,840 --> 00:00:21,600
deliver a return on investment.
Many of them.
8
00:00:21,640 --> 00:00:25,120
Outside traditional healthcare,
our guest is Bianca Merritt,
9
00:00:25,480 --> 00:00:28,520
director of policy at Trust for
America's Health, which created
10
00:00:28,520 --> 00:00:31,920
the report titled Promoting
Health and Cost Control in
11
00:00:31,920 --> 00:00:34,720
States.
So Trust for America's Health
12
00:00:34,720 --> 00:00:37,720
has an initiative that's been
around since about 2018 called
13
00:00:37,720 --> 00:00:40,280
Promoting Health and Cost
Control in States initiative,
14
00:00:40,280 --> 00:00:43,520
also known as FACTS.
And so this work has identified
15
00:00:43,520 --> 00:00:47,320
13 evidence based policies that
states can pursue to promote
16
00:00:47,320 --> 00:00:52,640
health and well-being and
produce a cost cost savings and
17
00:00:52,640 --> 00:00:54,280
have an economic return on
investment.
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00:00:54,520 --> 00:00:58,480
So in the past several years,
our organization had identified
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00:00:58,480 --> 00:01:01,080
those policies and kind of
checked out, you know, how
20
00:01:01,080 --> 00:01:02,560
effective they are and how
they're working.
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00:01:02,760 --> 00:01:06,560
And so this iteration of the
work that resulted in our report
22
00:01:07,080 --> 00:01:10,400
focused on how states are doing
in those areas.
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00:01:10,400 --> 00:01:13,240
We identified these policies.
How are states actually
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00:01:13,240 --> 00:01:17,160
implementing or adopting some of
these to make a difference where
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00:01:17,160 --> 00:01:20,320
they are?
So the report primarily looks at
26
00:01:20,360 --> 00:01:23,920
three different things.
One, well, first of all, say who
27
00:01:23,920 --> 00:01:25,440
the audience really is for this
work.
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00:01:26,480 --> 00:01:29,120
Anyone who's working in state
government, including state
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00:01:29,120 --> 00:01:32,840
health officials, folks who are
working in state agencies, but
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00:01:32,840 --> 00:01:35,520
also folks who are working at
the advocacy level on the
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00:01:35,520 --> 00:01:38,400
ground, really moving some of
these different policies
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00:01:38,400 --> 00:01:40,800
forward.
The second group of folks
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00:01:40,800 --> 00:01:44,920
includes legislators who are,
you know, responsible for of
34
00:01:44,920 --> 00:01:47,320
course, implementing these
things through legislative
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00:01:47,320 --> 00:01:51,440
action and also folks who are
interested in these topics in
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00:01:51,440 --> 00:01:54,680
all those roles but outside of
traditional health and public
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00:01:54,680 --> 00:01:57,400
health areas.
And these policies really span
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00:01:57,400 --> 00:01:59,840
not just kind of traditional
health and public health, but
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00:01:59,840 --> 00:02:04,120
also things that we consider to
be in non medical driver spaces.
40
00:02:04,120 --> 00:02:08,520
So things related to housing,
paid leave, universal pre-K, and
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00:02:08,520 --> 00:02:11,039
other things that are that
public health recognizes the
42
00:02:11,039 --> 00:02:14,920
whole is important, but that
aren't typically consistently in
43
00:02:14,920 --> 00:02:19,640
our purview as in governmental
public health or even outside of
44
00:02:19,640 --> 00:02:23,160
government.
And the report is sort of set in
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00:02:23,160 --> 00:02:27,440
the context of a changing
federal funding landscape.
46
00:02:28,360 --> 00:02:32,800
And so the report makes makes
clear that it's identifying both
47
00:02:33,280 --> 00:02:35,960
funding challenges.
But also opportunities.
48
00:02:36,240 --> 00:02:38,160
That states.
Have have sort of come up with
49
00:02:38,160 --> 00:02:41,720
right?
Yes, we do set up how we would
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00:02:41,720 --> 00:02:44,400
like the audience to engage in a
few different ways.
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00:02:44,400 --> 00:02:48,760
So to your .1 thinking through
what the federal landscape looks
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00:02:48,760 --> 00:02:52,120
like, we know there's been a lot
of shift happening both in terms
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00:02:52,160 --> 00:02:54,920
of certainly the funding
environment federally that
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00:02:54,920 --> 00:02:57,400
federal agencies provide to
states to implement some of
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00:02:57,400 --> 00:03:00,600
these policies, but also the
infrastructure related to
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00:03:00,600 --> 00:03:02,520
advancing that work.
So we do take some time to
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00:03:02,520 --> 00:03:05,040
highlight first what are the
federal changes that have
58
00:03:05,040 --> 00:03:08,200
happened, especially in the post
COVID public health emergency
59
00:03:08,200 --> 00:03:10,720
environment where we saw a lot
of investment in some of these
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00:03:10,760 --> 00:03:12,920
strategies that have since been
pulled back.
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00:03:12,920 --> 00:03:16,080
So just highlighting generally
what that environment looks like
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00:03:16,080 --> 00:03:20,320
and how states have adjusted.
Secondly, we worked directly
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with state advocates, state
government leaders to hear about
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00:03:25,040 --> 00:03:28,800
what that processes look like
for them both before and since
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00:03:29,480 --> 00:03:34,000
the post COVID public health
emergency environment, but also
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00:03:34,000 --> 00:03:38,600
in the post 2024 election season
to get a sense of what
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00:03:38,600 --> 00:03:40,840
strategies they've employed to
move this work forward as well
68
00:03:40,840 --> 00:03:43,320
as some of the challenges that
they faced in moving this work
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00:03:43,320 --> 00:03:45,880
forward.
And then lastly, we highlighted
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00:03:46,080 --> 00:03:49,560
the status of each of these 13
areas in terms of what the
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00:03:49,880 --> 00:03:52,960
federal fiscal environment looks
like for advancing some of this
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00:03:52,960 --> 00:03:56,440
work and also highlighting
opportunities that states could
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00:03:56,440 --> 00:03:59,720
pursue advancing the work absent
federal support.
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00:03:59,720 --> 00:04:03,000
So it's a good mix of strategy,
innovation, cross sector
75
00:04:03,000 --> 00:04:05,800
partnerships and also the
reality of what it looks like to
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00:04:05,800 --> 00:04:09,000
navigate this more challenging
time in public health policy.
77
00:04:09,640 --> 00:04:11,680
Absolutely.
And let's drill down into a
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00:04:11,680 --> 00:04:14,400
couple of those areas.
What are some takeaways from the
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00:04:14,400 --> 00:04:15,320
report?
Sure.
80
00:04:15,560 --> 00:04:19,560
I think one major take away is
that, yes, this is a challenging
81
00:04:19,560 --> 00:04:23,800
time, but states more than ever
have really had to be incredibly
82
00:04:23,800 --> 00:04:27,800
creative and insightful about
not just what can be used to
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00:04:27,800 --> 00:04:32,120
advance the public's health, but
also to think about how we're
84
00:04:32,120 --> 00:04:36,600
centering in communicating
effectively the needs of folks
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00:04:36,600 --> 00:04:40,160
on the ground in our States and
communities to make sure that
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00:04:40,280 --> 00:04:43,080
that is the priority.
And really making sure that all
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00:04:43,080 --> 00:04:45,480
the support fiscally,
infrastructure rise really
88
00:04:45,600 --> 00:04:49,120
centers those needs.
And that's been really good to
89
00:04:49,120 --> 00:04:52,080
see, but also understanding the
challenges that it, it sounds
90
00:04:52,080 --> 00:04:55,400
great, but it's not as simple as
I'm saying at the complexity of
91
00:04:55,480 --> 00:04:57,520
not just working in state
government, but folks who are
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00:04:57,520 --> 00:05:01,080
also on the ground doing the
grass roots work are also facing
93
00:05:01,080 --> 00:05:04,120
a ton of challenges fiscally and
structurally as well.
94
00:05:04,960 --> 00:05:07,800
Another thing we really try to
lift up in the report is the
95
00:05:07,800 --> 00:05:12,320
diverse ways in which states are
trying to advance some of these
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00:05:12,680 --> 00:05:14,880
efforts.
And so there's no
97
00:05:14,880 --> 00:05:19,320
one-size-fits-all is I'm sure
folks know if you work within
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00:05:19,320 --> 00:05:22,280
one state, a lot of it works in
that state, works there, maybe
99
00:05:22,280 --> 00:05:24,720
not elsewhere.
But what we tried to do is lift
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00:05:24,720 --> 00:05:28,080
up strategies that are working
across all kinds of different
101
00:05:28,080 --> 00:05:31,720
States and political
environments and so also giving
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00:05:31,720 --> 00:05:35,120
folks some, I think some hope.
I think often at the national
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00:05:35,120 --> 00:05:39,880
level things might look bleak in
terms of just the numerous, you
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00:05:39,880 --> 00:05:42,520
know, hits that public health in
particular is taking.
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00:05:42,720 --> 00:05:45,480
But understanding the cross
sector strategies that that
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00:05:45,480 --> 00:05:46,840
states are employing are
critical.
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00:05:47,600 --> 00:05:50,520
So in addition to thinking about
community and other types of
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00:05:50,520 --> 00:05:52,960
infrastructure opportunities, I
also want to lift up the fact
109
00:05:52,960 --> 00:05:55,840
that states are really clear to
us about the importance of
110
00:05:55,840 --> 00:05:58,680
communicating how important
issues are both to the lay
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00:05:58,680 --> 00:06:02,520
public and also to legislators
to advance some of this work and
112
00:06:02,520 --> 00:06:05,640
also the need for local and
community evidence.
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00:06:05,640 --> 00:06:08,000
And when they have those
stories, they have the numbers
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00:06:08,200 --> 00:06:10,400
and they could present that to
legislators, advocates,
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00:06:10,400 --> 00:06:13,280
whomever.
It really helps advance some
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00:06:13,280 --> 00:06:16,800
really complex policies that
they know have a higher return
117
00:06:16,800 --> 00:06:19,440
on investment even been in our
current environment.
118
00:06:19,480 --> 00:06:21,360
I think another thing that's
important here is that a lot of
119
00:06:21,360 --> 00:06:24,600
what we've seen has been
bipartisan in nature and to
120
00:06:24,600 --> 00:06:27,520
understand that that's happening
at the state level where state
121
00:06:27,520 --> 00:06:30,640
legislative environments have
been increasingly politicized.
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00:06:30,760 --> 00:06:32,840
It's also positive when we're
thinking about some of these
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00:06:32,840 --> 00:06:37,080
specific topical areas that
require that bipartisan support
124
00:06:37,080 --> 00:06:38,720
to move them across the finish
line.
125
00:06:39,360 --> 00:06:44,880
What are some examples of of
state innovations or or this
126
00:06:44,880 --> 00:06:51,080
diversity of strategies?
I think one example is universal
127
00:06:51,080 --> 00:06:54,000
school meals.
We've seen across a number of
128
00:06:54,000 --> 00:06:57,280
states who are pursuing this
work and also doing it in a
129
00:06:57,280 --> 00:06:59,880
bipartisan way.
So we lift up in our report the
130
00:06:59,880 --> 00:07:02,400
case of Arkansas.
We spoke with some advocates
131
00:07:02,400 --> 00:07:05,280
there as well to understand how
they were able to advance a
132
00:07:05,280 --> 00:07:09,360
universal school breakfast
policy using, you know, a lot of
133
00:07:09,640 --> 00:07:12,800
tax revenue, including from a
variety of different sources.
134
00:07:13,120 --> 00:07:18,120
Working with a new governor to
really spearhead that work after
135
00:07:18,360 --> 00:07:22,240
working closely with the state
legislature for years, getting
136
00:07:22,240 --> 00:07:25,360
folks on board over time.
And then really this most recent
137
00:07:25,360 --> 00:07:29,520
year, leaning into data showing,
you know, increases in rates of
138
00:07:29,800 --> 00:07:33,080
kids with more hunger, less
access to food, and kind of all
139
00:07:33,080 --> 00:07:36,400
those things culminating in an
opportunity to really advance
140
00:07:37,200 --> 00:07:39,360
something that's needed by a lot
of kids across the state,
141
00:07:39,360 --> 00:07:42,960
regardless of income.
And so I think sometimes we we
142
00:07:42,960 --> 00:07:45,080
want to paint a broad brush
about the types of states that
143
00:07:45,080 --> 00:07:46,840
can advance some of these
policies and the types of
144
00:07:46,840 --> 00:07:48,360
political environments that
exist.
145
00:07:48,760 --> 00:07:51,720
But ultimately, folks have told
us across the board that it's
146
00:07:51,720 --> 00:07:54,160
really about just kind of
meeting the moment and also
147
00:07:54,160 --> 00:07:58,200
finding those key allies and
being able to communicate very
148
00:07:58,200 --> 00:08:01,640
clearly and with evidence
stories.
149
00:08:02,080 --> 00:08:04,280
A lot of strategies that we know
are tried and true, but I think,
150
00:08:04,280 --> 00:08:06,560
importantly that a lot of those
strategies still work even in a
151
00:08:06,560 --> 00:08:09,120
time where things feel hyper
politicized and really
152
00:08:09,120 --> 00:08:13,040
intransigent.
And could you give us an example
153
00:08:13,120 --> 00:08:15,360
of?
Sort of the type.
154
00:08:15,960 --> 00:08:19,240
Of creative thinking that goes
into sort of navigating these
155
00:08:19,240 --> 00:08:21,040
funding challenges.
Sure.
156
00:08:21,040 --> 00:08:26,160
I think some of it is well, one,
I think just facing the reality
157
00:08:26,160 --> 00:08:28,840
of what's going to happen and I
think at the state level,
158
00:08:29,000 --> 00:08:31,200
particularly in government,
folks have looked for a while
159
00:08:31,200 --> 00:08:36,080
recognizing that with the
decrease in COVID era funding
160
00:08:36,280 --> 00:08:38,960
that it was just the writing has
been on the wall for a while.
161
00:08:38,960 --> 00:08:42,640
I think what's expedited some of
the challenges that knowing that
162
00:08:42,640 --> 00:08:45,880
the cuts that have come have not
just been within public health,
163
00:08:45,880 --> 00:08:49,760
but also across other sectors.
And so we're thinking about what
164
00:08:49,760 --> 00:08:52,280
it looks like to navigate the
fiscal environment.
165
00:08:52,280 --> 00:08:54,920
The first step is just the
reality of understanding where
166
00:08:54,920 --> 00:08:59,320
all the cuts are going to be and
also understanding that the full
167
00:08:59,320 --> 00:09:01,720
effects of those cuts had not
yet been seen.
168
00:09:01,720 --> 00:09:04,080
So I think just the gravity and
reality of it and grappling with
169
00:09:04,080 --> 00:09:06,880
that is a is a critical step.
But as I alluded to, I think
170
00:09:06,880 --> 00:09:11,280
we're seeing so many more states
leaning into community
171
00:09:11,280 --> 00:09:14,280
partnerships, even when they've
existed before, doing the best
172
00:09:14,280 --> 00:09:16,320
they can to lesson.
I think in public health in
173
00:09:16,320 --> 00:09:20,960
particular, there's been more of
a push to acknowledge maybe
174
00:09:20,960 --> 00:09:25,120
missteps in the past where we
haven't always been in touch
175
00:09:25,120 --> 00:09:28,360
with community and integrated
into what folks are needing.
176
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And so really highlighting some
of those opportunities about
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what could be from the ground up
is definitely something that
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we're seeing states not
necessarily investing more time
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and money into, but just the
desire to and the willingness to
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and really leveraging the
opportunities that exist to be
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as in tune as possible to what
focusing on the ground, which
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enables them to make a stronger
argument about where the gaps
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exist and where the investment
should go.
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So I think for us, that was
something that consistently
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stood out.
So, Priyanka, the report is
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certainly a combination of
opportunities, but very much
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couched in the challenges of the
moment.
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Could you talk a little bit more
about, you know, the nature of
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the challenges and how great it
is?
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To sort of.
Think positively and creatively
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with opportunities but taking a
clear eyed.
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Look at where we are.
Sure.
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I think we definitely highlight
in the report just the creative
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and unique ways that states are
advancing some of these frankly,
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often costly and upfront costs
with some of these policies, but
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also being able to, you know, be
strategic around that work.
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That's certainly a key theme
here.
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But we also lean into the fact
that these are significant,
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unprecedented reductions in
federal funding and
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infrastructure and workforce.
And so when you're combining
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those federal cuts with the
anticipated state budget cuts
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and federal increasing
requirements on things like SNAP
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and Medicaid reporting, it's
really straining our system.
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00:10:51,760 --> 00:10:56,360
And so certainly state
government advocates can be as
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creative as they want, but we
really do want to recognize that
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these reductions are
substantial.
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00:11:01,800 --> 00:11:06,280
And it's unfair in a lot of ways
to have states bear the burden
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of creativity and cost sharing
and savings to make some of not
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00:11:10,280 --> 00:11:13,360
just these policies
recommendations work, but also
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just core public health
infrastructure.
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I also want to add that then in
addition to states having to
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strategize around this work,
that they're also navigating a
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00:11:23,880 --> 00:11:27,240
lot of false planes and
skepticism even in some of these
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spaces.
So we talk about public health,
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00:11:29,160 --> 00:11:32,720
but this report also talks about
areas outside of public health
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and traditional public health
infrastructure like housing,
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education, etcetera.
And So what we have also learned
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00:11:38,800 --> 00:11:42,840
is that it's really important
for states in public health
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roles to lean even more into our
partners and other sectors
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because they're really in the
same boat in terms of facing
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00:11:48,400 --> 00:11:52,160
these massive cuts.
And so that cross sector
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00:11:52,160 --> 00:11:55,840
collaboration that's often
really hard to achieve even the
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00:11:55,840 --> 00:11:57,800
best of times is really
something that's going to be
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critical to advance the public's
health, especially beyond
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00:12:02,320 --> 00:12:04,120
traditional public health
infrastructure.
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00:12:04,640 --> 00:12:09,800
And does the report touch on
sort of non medical intervention
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00:12:09,800 --> 00:12:13,080
policy suggestions, things you
know?
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00:12:13,080 --> 00:12:16,880
Related to child.
Nutrition, things that sort of
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can take place before
intervention.
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00:12:20,040 --> 00:12:22,200
Absolutely.
So the premise of this entire
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00:12:22,200 --> 00:12:25,400
initiative, including this
report is really to think about
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those community and structural
drivers related to health, non
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medical drivers of health.
And so historically, public
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00:12:32,520 --> 00:12:37,040
health is really focused on, you
know, in practice, a lot of
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00:12:37,040 --> 00:12:39,840
emphasis has been on kind of
these health related social
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00:12:39,840 --> 00:12:43,560
needs efforts and doing more
direct service or thinking about
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social drivers and recognizing
their importance.
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00:12:46,000 --> 00:12:49,040
But a lot of these policy areas
being kind of outside of the
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00:12:49,040 --> 00:12:51,720
traditional purview of a public
health or Health and Human
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00:12:51,720 --> 00:12:54,680
services department.
So it's critical that these
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00:12:54,680 --> 00:12:57,600
topics are seen as a part of
public health, while recognizing
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00:12:57,600 --> 00:12:59,880
the public health in its current
form doesn't really have the
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00:12:59,880 --> 00:13:01,800
capacity to pursue all these
those things.
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00:13:01,800 --> 00:13:04,880
So it's again kind of leading to
the importance of these kind of
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00:13:04,880 --> 00:13:09,160
cross sector opportunities to
advance the public's health and
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00:13:09,160 --> 00:13:11,880
knowing that they're critical.
And also knowing that working
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00:13:11,880 --> 00:13:15,200
together is going to be so
important to advancing public
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00:13:15,200 --> 00:13:18,600
health, knowing that all of our
sectors are challenged fiscally
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00:13:18,600 --> 00:13:21,640
and structurally to do this work
in a vacuum.
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00:13:21,640 --> 00:13:24,640
So thinking about this
opportunistically, I think will
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00:13:24,640 --> 00:13:29,080
help advance these policies that
are again a mix of kind of
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00:13:29,080 --> 00:13:32,200
traditional policies in public
health such as smoke free
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00:13:32,200 --> 00:13:36,640
environments, walkability, but
also things with experts who are
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00:13:36,640 --> 00:13:39,080
not in our field, but who are
definitely facing the same
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00:13:39,080 --> 00:13:43,480
fiscal, structural and other
community challenges that we do
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00:13:43,480 --> 00:13:47,480
in in public health.
Brianna Merritt is director of
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00:13:47,480 --> 00:13:49,480
policy at Trust for America's
Health.
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00:13:50,920 --> 00:13:53,560
Want more public health insights
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259
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264
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Follow ASTO wherever you scroll
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and find those links in the show
notes.
266
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This has been Public Health
Review MORNING Edition.
282
00:15:08,280 --> 00:15:11,040
I'm John Sheehan for the
Association of State and
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00:15:11,040 --> 00:15:12,360
Territorial Health Officials.