964: MAHA Report, Subrecipient Monitoring

SUMMER JOHNSON: 

This is the award-winning Public Health Review Morning Edition for Thursday, August 7, 2025. I'm Summer Johnson. Now, today's news from the Association of State and Territorial Health Officials.

Today, we start off with an interview with ASTHO's Chief Medical Officer, Dr. Susan Kansagra, focused on this summer's Make America Healthy Again report. She checked in with us to talk about a new blog she and other ASTHO experts wrote, which highlights how the work state and territorial health departments are doing intersects with themes in the MAHA report. Here's that interview.

SUSAN KANSAGRA: 

This blog post is an attempt to look at what those evidence-based practices and efforts that state health departments have been doing that support chronic disease prevention. We know one of the priorities that has emerged from this administration is around chronic disease prevention. We saw the MAHA Commission, that Make America Healthy Again Commission, put out a report around chronic disease prevention and outlined some themes, including nutrition, physical activity, and environmental exposures that lead to chronic disease. And so our goal with this blog post was to identify those intersections between the key themes in the MAHA Commission report, which focused on chronic disease prevention, particularly in children, and the work that state and health departments have already been doing to support chronic disease prevention. So, there were a few key themes in that report, for example, supporting nutrition, decreasing consumption of sugary beverages, supporting physical activity, and then reducing exposure to environmental contaminants. Those were some of the overarching themes in the report. So, our blog post took those themes and looked at what state health departments are already doing, state and territorial health departments are already doing in that area, and then picked out a few concrete actions.

JOHNSON: 

So, you mentioned there are high-level themes, but there are also some concrete actions that you've laid out. What are some examples of those tactics that states are already doing to prevent chronic disease in their communities?

KANSAGRA: 

So, to go through what some of those things are in the realm of supporting nutrition, we know that state and territorial health departments have worked on things like food procurement standards for government agencies ensuring that schools, as well as other agencies in- within local government and state government are serving foods that meet nutrition criteria to help prevent chronic disease. And that's something that has been ongoing for a long time, and there's more opportunities there in that space as well. So, that's some of the things that we touch on. We certainly know that there is also a lot of work that's happening now with SNAP programs. We're seeing states propose SNAP waivers that align SNAP purchasing with some standards, for example, removing sugary drink purchases. And at the same time, other states have implemented incentive programs around fruit and vegetable purchases. So, that's another example of policy changes that states have made in the past to support healthier eating. Physical activity is another great example where there's a lot of community-level work that has been done by state and territorial health departments. For example, working on complete streets that enable pedestrians and bicyclists and motorists all to be on that street and reduce injuries and support physical activity. Or, for example, safe routes to school that help promote physical activity for children on their way to school. Those are some other examples of work that have been happening across state and territorial local health departments that support some of the themes in that report, and we give a few examples. And then lastly, opportunities to reduce exposure to environmental contaminants that we know are harmful to health. So, one example of this is lead. We know lead exposure in youth is a problem because lead causes many long-term health outcomes, and there's no safe level exposure to lead. So, for example, lead exposure in early childhood and lead poisoning can lead to brain damage, it can lead to difficulty learning, speech and hearing impairment. And so, there is a large body of work that state and health departments are doing to increase lead screening, decrease the number of children exposed to lead contaminants, and to support home and environmental investigations when they do find a child with elevated lead.

JOHNSON: 

Why is this piece that you put out so important right now to the conversation that's happening?

KANSAGRA: 

Obviously, chronic disease prevention is not a new activity. State and territorial local health departments have been doing this work for a long time. They've created incredible partnerships, and have a lot of expertise in doing that type of systems and environmental change work to support healthy living, whether that's through activities that support built environment or help promote healthier eating. But the reason for this is because we are seeing you now emotional interest in momentum. Of course, we've seen the MAHA Commission report and the themes that that report outlines around nutrition, physical activity, and environmental contaminants and how that contributes to chronic disease, particularly in children. So, our goal was to take some of those broader themes and really look at the intersection of what state and territorial health departments are equipped to do, and have been doing for a while, and identify those specific actions that intersect between the two. So, that was the impetus for this and why we chose to put this out. Now, of course, we're also hearing that the MAHA commission will be putting out some more concrete strategies and action steps as well, and so we'll be looking to see what those are once that is released as well.

JOHNSON: 

That blog article is called, "Levers for Preventing Chronic Disease that Intersect with Key MAHA Report Themes," and it's online now. You can head to the link in the show notes to read it.

The Nebraska Department of Health and Human Services recently went through a significant undertaking to develop a standardized process for department-wide subrecipient monitoring, saving millions of dollars each year and reducing the large amounts of time spent on appeals. Ryan Daly is the deputy director of finance and operations for the Nebraska Department of Health and Human Services, and describes the risk of operating without systemic oversight.

RYAN DALY: 

We ended up being a position where we had to repay the federal government several million dollars for decade-old audit findings that had been subsequently repeated over and over and over. And beyond that, we were spending too much time in the audit space instead of being able to actually focus on public health work that needed to get done.

JOHNSON: 

Daly says his department turned to ASTHO's, CFO and Financial Leaders Peer Network, or CFOPN.

DALY: 

One of the first things that we didn't outright steal, but very nearly, was an invoice framework that Washington State makes use of and adapted those, built upon that, developed an entire manual and suite of tools and resources for our teams.

JOHNSON: 

Daly adds that the framework made a big difference.

DALY: 

What we really found is that when we standardize, there are some areas where the monitoring level of effort could actually go down some, and others where it would have to rise. And so, it wasn't overall as much of an increase in work for our teams or even for our subrecipient partners.

JOHNSON: 

You can read more about Nebraska's subrecipient monitoring system in an online resource. There's a link in the show notes.

Also, ASTHO's framework for addressing ethical considerations in public health wastewater surveillance was recently published in the Journal of Public Health Management and Practice Direct. To read more about best practices for implementation, you can head to the link in the show notes.

And in other ASTHO resources that you should check out, a new blog article describes the valuable public health insights that can come from immunization information systems that cross jurisdictions. Head to the link in the show notes to learn how ASTHO is making immunization data exchange a reality.

And finally, today, ASTHO extends a hearty welcome to new member Dennis Worsham, secretary of health for the Washington State Department of Health. Worsham brings a deep commitment to collaborative work with all parts of the public health system to the role. You can read more about this work in his bio. There's a link to that in the show notes.

That'll do it for today. We're back tomorrow morning with more ASTHO news and information. I'm Summer Johnson, you're listening to the award-winning Public Health Review Morning Edition. Have a great day.