Press Room

Top State and Territorial Public Health Issues Revealed in New Building a Healthier Nation Report

ARLINGTON, VA (March 15, 2018)—The Association of State and Territorial Health Officials (ASTHO) released a new report today that highlights the top five public health issues facing state and territorial health agencies in 2018. The report, Building a Healthier Nation: The State of State and Territorial Public Health, calls on policymakers to fund the nation’s fragile public health infrastructure and demonstrates how public health affects our daily lives.

“The top five issues identified by state and territorial health officers represent some of today’s greatest threats to public health nationwide. However, if we act now, they also present tremendous opportunities to protect and promote health,” says Michael Fraser, executive director of ASTHO. “The work of public health spans many communicable and non-communicable diseases, and capacity to support this work requires a skilled workforce and a well-resourced public health infrastructure.”

“It is through preparedness, health promotion, and disease prevention activities—the core work of state and territorial health agencies—that we will truly improve our nation’s health and realize savings in our healthcare system. It is far more effective to prevent illness than to treat it. Congress and the Administration must work together to provide states and territories with predictable, sustained funding for these population health efforts if we are to see long-term improvements in health and reduced spending on healthcare,” says John Wiesman, ASTHO President and secretary of health at the Washington State Department of Health.

The top five priorities featured in ASTHO’s report include:

  • Addressing the Opioid Crisis and Preventing Substance Misuse and Addiction: Overdose deaths have reached epidemic proportions: in 2016, the United States saw over 60,000 drug overdose deaths—more than 100 deaths daily. Health agencies are working around the clock to end this epidemic; however, more funding is needed to support CDC and health agency prevention activities.
  • Reducing Illnesses and Deaths from Preventable Chronic Diseases: Injuries and illness from chronic diseases such as cancer, heart disease, stroke, diabetes, and substance misuse are the most common, costly, and preventable health conditions facing America today. State and territorial public health agencies rely on federal dollars to bolster their chronic disease prevention efforts.
  • Preventing Infectious Disease Outbreaks: Largely preventable infectious diseases are posing a grave threat to the nation’s health. Sexually transmitted diseases are rising at an alarming rate. In 2016, reported cases of gonorrhea, syphilis, and chlamydia increased for the third consecutive year. Furthermore, healthcare-associated infections, including antimicrobial resistant pathogens, cause hundreds of thousands of illnesses and deaths among U.S. patients each year. Many of these infections could be prevented with increased investments in public health agencies.
  • Managing Public Health Emergencies: Preparation, Response, and Recovery: Three major hurricanes, several wildfires and mudslides, floods, as well as record-setting cold temperatures across the nation challenged both public health and state and local governments in 2017 and 2018. In 2017, the overall cost of weather-related disasters exceeded $300 billion, making it the costliest year on record. Unfortunately, critical federal investments in state and territorial public health preparedness have declined over the last several years, despite increasingly severe natural disasters and other threats.
  • Protecting Our Drinking Water from Environmental Health Threats: The United States has one of the safest drinking water supplies in the world and public health agencies rely on sustained federal funding to maintain excellence in drinking water safety. Existing and emerging challenges must be addressed, including improvements to an aging infrastructure, addressing chemical and microbial contaminants, nutrient overloading, as well as harmful algal blooms.


Building a Healthier Nation is an overview of state and territorial public health agency priorities intended to help policymakers understand the current capacity of the public health system. Each year, the report frames the opportunities and challenges facing state and territorial governmental public health leaders.

ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories and freely-associated states, and the District of Columbia, as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in public health practice.