1154: Public Health Leadership and Innovation in the Islands

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Friday, June 26, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

 

Today, public health leadership and innovation in the islands. ASTHO CEO Dr. Joseph Kanter reflects on key themes emerging from the Executive Leadership Forum, where public health leaders from across the country are navigating funding uncertainty, workforce challenges, and an increasingly complex operating environment. Later, ASTHO Senior Director for State Health Policy, Andy Baker-White, discusses how U.S. Island jurisdictions are advancing public health through legislative action, the focus of a recent Health Policy Update. But let's start with Dr. Kanter and his reflections from ASTHO's Executive Leadership Forum.

 

JOSEPH KANTER: 

This is an incredible opportunity to bring together folks that make health departments run across the country, from the people that help support the commissioners to people that lead teams, people that do really important and life-saving work, we're talking about leadership development, how to execute, how to lead teams effectively, and how to do your job to the best of your ability in constantly changing and challenging conditions. It's been a really inspiring experience. My main takeaway at the moment is just how incredible these public health professionals are. The job is really hard right now. We talk a lot about the challenges, and they come from all angles, but the folks that are here are indicative of how deeply committed and devoted people are improving other people's lives, to making their communities healthier, to improving the health of other people, and that's evident when you step into the room. Here, I've had the chance to talk to a number of folks from different health departments, and learning about what drives them, what gets them up in the morning, and why they do the work that they do. It's not for the pay, we know that is really inspiring. So, I'm just so happy to be here, and I'm so proud of all the folks that we have gathered here.

 

SHEEHAN: 

Yeah, you mentioned some of the shifting challenges. Are there any challenges in particular that seem to be pretty salient this year?

 

KANTER: 

Funding uncertainty is always a challenge. It's particularly acute this year, because most of health department funding, or at least 50% if not greater, typically comes from federal grants. When those grants are uncertain or complicated, it adds real complexity to the work that health departments across the country do, because the activities, important activities, are tied to these grants. It makes it hard to plan. It makes it hard for health departments to invest proactively in issues or programs that they feel are important. There are things that might be coming down the road. It's hard for them to be proactive in that type of funding environment, but you know that's also nothing new for public health. We always have funding challenges. I think it's always challenging when public health is in the news and politicized. We've seen that since COVID, and that certainly hasn't died down at all. That creates stress for folks. On the flip side, it's an incredible field right now to be able to go to work with the sole purpose of making other people's lives better is a real gift, and you know, talking to the leaders that we have gathered here, you know, with this Executive Leadership Forum that we're conducting now, we're bringing together a number of groups. We're bringing together our DELPH cohort, the Developing Executive Leaders in Public Health. We're bringing together our ASTHO Leadership Institute, we're bringing together individual peer groups, different folks from health departments across the country. So, including the chief financial officers, we're bringing together informatics, data modernization leads, we're bringing together legislative liaisons, public health communicators, public health lawyers, senior deputies, HR, and workforce directors. When you talk to these folks, they're so resilient and creative at how they go about challenges, and for anyone that has worked in government before, you know it's not uncommon to have to put out four or five fires before lunch every day. That's the nature of this work. So, it takes incredibly strong, committed people, and it's just been so impressive to talk to folks here and hear their background and watch them connect with one another.

 

SHEEHAN: 

Yeah, and conversely, on the wins side, have there been any high-profile or frequently mentioned public health wins recently?

 

KANTER: 

Oh, every day, every day. I think one of our challenges in public health is they're always not high-profile, but every day, in the background, health departments are saving lives in ways that people don't know, but are better for it. Let me give you one example. Last month, the California Department of Public Health identified an outbreak of botulism in infant formula. Botulism is an infectious disease that, particularly in infants, can cause paralysis, respiratory suppression, and death if untreated. They picked this up from three cases scattered across three different states of infants that had they identified consumed the same brand of formula, one was in California, one was in Washington, and one was in Pennsylvania, to pick up that small of the signal of all the cases out there, of all the babies out there across three different states, and tie it back to one supply of botulism is incredible public health work, incredible disease detective work that led to collaboration with the FDA and led to a recall of that formula. The manufacturer voluntarily complied and voluntarily recalled that batch of formula that saved lives, that saved infant lives. That type of work happens every day, and I think it's important for us in public health to continue to work to elevate those stories, because the more that people know of the life-saving work, the important work, the easier I think it will be to fix our funding challenges and everything else.

 

SHEEHAN: 

That was ASTHO CEO Dr. Joseph Kanter reflecting on this week's Executive Leadership Forum. Now let's switch gears and hear from ASTHO Senior Director for State Health Policy Andy Baker-White on how U.S Island jurisdictions are advancing public health through legislative action.

 

ANDY BAKER-WHITE: 

What we're seeing are strategies that really focus on structural and foundational reforms and not just narrow programmatic fixes. So, you know, what we're seeing are island jurisdictions, they're building the scaffolding for their public health systems and not just adding services onto what's already there, in this, you know, we're seeing in the areas of financing and data, you know that's through Guam's Medicaid reimbursement restructuring and also with the Virgin Islands with their proposed health data utility framework. And what this is really showing is that you can't really fix delivery without also fixing how providers get paid, as well as how the data flows to those providers, and between the providers, we're also seeing. You know, within this set of legislation, you know, looking at the whole continuum, this is legislation that spans the lifetime, you know, from immunization requirements for children to long-term care licensing and elder abuse prevention policy. So, this is just really suggesting that in island jurisdictions, what's really being thought about is public health policy as a continuum rather than just addressing different isolated crises. Also, you know what we're seeing through this legislation are really culturally-specific public health threats that are getting conventional regulatory treatment. We see this with the Betel Nut regulation in CNMI, you know, requiring warning labels, excise taxes, and retail tracking. This is really policies that mirror the proven tobacco control policies, so we're seeing again, kind of like a structure using conventional regulatory provisions for island-specific threats as well.

 

SHEEHAN: 

Yeah, another theme you've noted running throughout this legislation has been around workforce, what kinds of actions are you seeing taken towards improving workforce and working with, you know, restricted supply in the islands?

 

BAKER-WHITE: 

Yeah, what we're seeing here, you know, jurisdictions are really trying to thread a narrow needle when it comes to workforce, and what that is, is that's the need to have more providers, but not really abandoning the quality guarantees the safety standards for having more providers. And these policies really reflect almost a structured flexibility approach where they're opening new pathways for the workforce while also building in safeguards, conditions, and oversight, and this is really brought on by the geographic need, and the geographic realities that the islands find themselves in are really leading to this logic within this policy here in the states, one state orders another. State workforce can easily move between states, but with island jurisdictions, it's just that geography really makes them need to kind of look at different types of policies. So, we see this in one of Guam's policies, which just doesn't open the door to foreign-trained physicians, but it also creates a provisional pathway. So, again, kind of like first having a provisional pathway before any sort of permanent licensure, and also in Puerto Rico, we're seeing how, you know, the recruitment policies, it's modifying an existing policy, but you know, kind of really seeing what works, and trying to just modify what they already have.

 

SHEEHAN: 

Gotcha, data modernization, another challenge, certainly for the island jurisdictions, what role does policy play in improving data modernization?

 

BAKER-WHITE: 

Yeah, policy really sets the framework for data infrastructure and data sharing, and what the framework does is it really sets up the trust that one can put into the data sharing. So, the policies really define who can access the data under what governance and with what accountability. So, this allows jurisdictions to modernize without creating new privacy or security risk in the USVI with the new policy that would establish a data health data utility. What it does is it's creating an entity with its own board, its own accountability, and arguably more insulation from political turnover while still being tied to government oversight.

 

SHEEHAN: 

Andy, you've mentioned a couple of times now that the policies are working towards a care continuum that sort of embraces different pieces of legislation. How do they all work together in sort of a cohesive structure within these jurisdictions?

 

BAKER-WHITE: 

Yeah, well, cohesion a lot of times can be a little more aspirational than fully achieved, but I think what this shows, you know, what we're highlighting in the blog is really showing how policymakers can build toward coherence by anchoring each piece of policy to a recognizable point on that care continuum and layering oversight consistently across these pieces. I mean, it's something that we see in the blog, you know, no matter kind of where on the continuum the policies are, there's oversight, there's accountability, there's transparency to build trust. So, I think also, you know, kind of with, you know, how you get coherence is by just using the same, again, using the same regulatory tools that licensing frameworks, so that even though that these are addressing different issues, different services, there's a consistency within the mechanism that the jurisdictions are using to bring these changes about. Also, you know, just interagency coordination can bring about cohesion. So, having, requiring the Department of Health to also work with the Department of Education and other mental health services can help bring cohesion to the policies.

 

SHEEHAN: 

Yeah, and as you've also mentioned in the blog, you know that these policies are being enacted shows that public health policy can grow, can evolve. Why should readers, you know, pay close attention to how these legislative actions are, you know, taking root?

 

BAKER-WHITE: 

I think for readers, you know, it's important because it really shows how the island jurisdictions are acting as policy innovators, how they're really, how they're solving real structural problems within workforce financing oversight with creative approaches. You know, we're seeing with with this blog and these policy examples, active policymaking across these areas, and while, while you know, kind of individually, there's nothing earth-shattering, you know, in the aggregate, what this shows is comprehensive policy activity across the public health and health system, really. You know, kind of the breadth of the policies should be the headline here, and also, you know, there are things that rural and frontier states, who are also facing workforce shortages and underdeveloped data infrastructures, could also learn from the approaches that the island jurisdictions are taking. We recently had a state reach out for information about how to license foreign-born health care providers, and we connected them with their colleagues in the island jurisdictions, because we knew the island jurisdictions are really innovating in this area. It was something exciting to watch.

 

SHEEHAN: 

Andy Baker-White is ASTHO,'s senior director for state health policy. Earlier we heard from Dr. Joseph Kanter, ASTHO's CEO.

 

Join ASTHO on July 13 for the final Lunch and Learn series webinar focused on preserving institutional knowledge during workforce transitions in public health agencies and the implications for STI and infectious disease programs. As part of ASTHO's Policy Institute, this session will examine the challenges health departments face when staff retire, change roles, or leave organizations, and how these transitions can affect program effectiveness and continuity. Learn more at the link in the show notes.

 

Join ASTHO on July 9 for a webinar launching a new suite of resources designed to help state, territorial, and freely associated state health agencies advance shared strategies for addressing the intersection of adverse childhood experiences, suicide, overdose, and mental health concerns. This session will introduce a roadmap for this work and highlight practical tools to support the implementation of strategies related to economic and foundational supports, the built environment, and trauma response efforts. Register at the link in the show notes.

 

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.