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See schedule oinfectious disease:in 2023-2024, CSTE continued to emphasize the effective use of forecasts and analytic tools by public health decision makers during infectious disease outbreaks. Along with the association of state and territorial health officials (astho) and cfa, CSTE hosted four regional forecasting meetings, inviting state epidemiologists and state health officials from all 50 states, washington, d.c., territorial health agencies, tecs, and the five large local health departments funded through CDC's elc program.the goals for each meeting were to build relationships between cfa and public health decision makers, assess the utility of specific cfa products, promote the effective use of cfa products to improve future outbreak responses, and increase collaboration between state epidemiologists and state health officials. Several themes and discussion points repeatedly arose during the meetings, mostly involving communication, public health data policies, and promoting cfa products. These included: - communications: attendees expressed the need for more cohesive messaging related to forecasts, especially when it is released at the national level, and that better coordinated communication will lead to a more cohesive message being released by all partners. - public health data policies: attendees discussed how data sharing policies and access between tribes, states, and the federal government continue to be problematic. Ensuring access to public health data and having effective public health data policies in place are critical to supporting successful infectious disease forecasting efforts. - promoting cfa products: attendees also discussed a low awareness of cfa products among participants. Health agency leaders described being unprepared for the release of forecasting and analytic products by the federal government and other entities.meeting feedback was positive, with one attendee saying, "overall, the meeting was very effective and i really enjoyed being part of the discussions. I enjoyed the in-person workshop as it elicits more comments and discussion than virtual settings." the four regional meetings were well attended by CSTE and astho members, and the regional model was well received. In conclusion, several recommendations were brought forth after the discussions and meetings. These include developing a unified communications strategy for the release of new cfa products, seeking pre-release feedback for new products from health agency leaders, communications training for all levels of the public health workforce, and producing and distributing a written overview of new products to support their use in public health decision making.this was a unique opportunity for regional engagement between senior health agency leaders, as well as tec representatives. It will help health officials across the country be better prepared to respond to future outbreaks and protect the health of their communities.other portfolio highlights: - managed 17 funded projects across many id areas, including hai/AR, zoonotic diseases, and forecasting - reorganized the id steering committee to include zoonotic diseases in the VBD subcommittee, expand the influenza subcommittee to include covid and viral respiratory diseases, and elevate the amd workgroup to a subcommittee with a wastewater surveillance workgroup - released multiple new resources, including an enteric disease capacity assessment, a legionella water management program evaluation tool, and a zoonotic influenza reference guide

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See schedule oenvironmental health / occupational health:as climate-related events such as wildfires, extreme or prolonged heat, and floods become more common, the potential for direct and indirect effects on the health and well-being of workers increases as well. To address emerging health risks, public health must improve methods for tracking and monitoring health outcomes among workers who may be exposed to such hazards on the job.CSTE's occupational health and climate change workgroup, which was an ad hoc group under the occupational health subcommittee, launched a new resource in april 2024 to help occupational health professionals accelerate and tailor their approach to this. Occupational health surveillance for tracking climate related health impacts on workers: heat, wildfires & floods provides guidance to jurisdictions on integrating climate-related factors into occupational health surveillance. By doing so, health departments can gain insight into the risks faced by workers and identify activities to mitigate health impacts.understanding which workers will be most affected is essential for preparedness and response, but that can be complicated. Exposures to climate-related hazards differ by industry, occupation, and region. Workers can be affected by hazards of incremental climate change and by acute disasters. And there is no single data source that can identify all work-related injuries and illnesses, so multiple sources are often needed to access data relevant to climate outcomes.the new surveillance document includes descriptions of and links to select data sources that contain exposure data relevant to climate, specifically for heat, wildfires, and floods. It also has information on potential health outcomes and environmental exposures, related measurement options, and situational examples from jurisdictions implementing surveillance to address the impacts created by these issues.health departments can use these resources to develop and adapt their own processes for monitoring climate-related health outcomes among workers based on the industries and vulnerabilities of their regions. The resulting surveillance efforts will provide information needed to create interventions and make decisions about response activities, recommendations to workers, and other targeted outreach. Some jurisdictions have already gained broader recognition of events that can impact their regions.all workers deserve to return home at the end of their day or shift without being harmed while on the job. By implementing occupational health surveillance on climate-related health impacts, public health departments will be better prepared to protect their working populations and enable their communities to thrive.

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See schedule osurveillance / informatics:in 2023-2024, CSTE continued its longstanding partnership with CDC and other relevant stakeholders supporting syndromic surveillance via the national syndromic surveillance program (NSSP). CSTE began its formal role as the NSSP community of practice (cop) convening body in 2019. The NSSP cop comprises over 1,500 syndromic surveillance practitioners across the country working at the STLT and federal levels. In addition to monthly NSSP cop webinars that include all cop members, the NSSP cop convenes webinars and working meetings of five subcommittees, two user groups, and three workgroups. CSTE has hosted four annual syndromic surveillance symposia since 2020. The annual symposium has evolved over time in both scope and attendance. Early symposium themes focused on expanding the use of syndromic surveillance; recent symposium themes have focused more on the application of syndromic surveillance practice. Attendance has grown from approximately 500 attendees in 2020 to over 1,000 attendees in 2023. A post-event evaluation found that attendees valued the diverse range of topics, as well as the practical application of the symposium content. One respondent said, "being new to the topic, there was a large variety of topics that i could attend. I also really appreciated the virtual setup allowing easy navigation of the topics, times, and days. It was by far the best virtual symposium i have attended to date." CSTE has played a pivotal role in fostering engagement between the NSSP cop and the wider audience of applied epidemiologists across CSTE's steering committees and the state epidemiologists. CSTE worked closely with CDC to develop data visualizations for respiratory virus response during the 2023-2024 season, which leveraged syndromic data and were displayed on the CDC website. The NSSP cop also worked closely with several CSTE steering and subcommittees on various projects, including with the non-infectious disease program on an outbreak response related to the consumption of diamond shruumz brand chocolate mushroom edibles. The NSSP cop also worked with CSTE's injury epidemiology and surveillance subcommittee on the best practices compendium, a collection of recommendations on how to collect, manage, and use syndromic surveillance data for public health action. The ability to work across various programmatic disciplines of applied epidemiologists has become increasingly important as the NSSP cop membership has grown exponentially and is more diverse in terms of program areas supported.other portfolio highlights: - increased ecr capacity with 213 conditions available in the reportable conditions knowledge management system; 70 stlts are actively using the portal to enhance disease surveillance - conducted a case surveillance and notification assessment of 64 jurisdictions - launched the CSTE stories from the field website, with over 180 stories from stlts highlighting innovative data modernization solutions

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Workforce:data is at the foundation of public health response. But it's more than just numbers managing data, improving data exchange, and building the workforce's data skills are all essential for responding effectively to emerging threats. The entire public health data system must work together. CSTE's applied public health informatics fellowship (aphif) is ensuring that it can. Aphif works to build informatics capacity at STLT health departments while training recent master's or doctoral graduates and early career professionals in applied public health practice. It provides on-the-job training in public health informatics, communication skills, and public health practice and policy, preparing participants for long-term career placement at the state and local level. Eliza ramsey worked with the alaska department of health (doh) as part of aphif class 6 (2022-2024). "i picked the informatics fellowship because throughout prior work experiences and my training, i was running into data walls left and right," she said. "i realized i needed to think about going upstream and equipping myself with some of the tools about how we get better data in the first place." ramsey's placement resulted in a full-time position with alaska doh as a medicaid program specialist, where she still works on data strategy and analytics, carrying over many of the projects from her fellowship. Aphif is important now more than ever. The covid-19 pandemic underscored the urgent need for data modernization and increased data analysis capacity in public health. CDC launched the data modernization initiative (dmi) in 2019 and the public health data strategy (PHDS) in 2023 to spearhead ongoing data modernization, reduction of gaps in data, streamlining of data processes, and other related efforts. By applying the experience they've gained, fellows can advance data modernization and PHDS goals while helping their host sites. Fellows have jumpstarted stagnant projects, worked across programmatic silos on cross-cutting topics, and implemented new methodologies. In addition, they offer invaluable informatics expertise as public health departments modernize data systems, implement new technologies, and meet the evolving data needs of public health. Aphif graduates can pull actionable insights from data that enable efficient decision making and response. They understand that in public health, data isn't just numbers - it's the basis of our ability to sustain thriving and healthy communities everywhere.other portfolio highlights: - hosted the largest cohort ever of the data science team training (DSTT) program (40 teams, 180 participants) and expanded aphif to class 7 - supported future public health leaders in the largest cohort ever of the early career professionals mentorship program (173 mentors, 256 mentees) and cohort 4 of the leading epidemiologists, advancing data (lead) program (28 participants) - placed 56 members of aef class 21 in health departments for two years of on-the-job training (10 in local, 27 in state, and 1 in territorial departments)

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Public health law:in january 2023, laurie forlano (state epidemiologist, virginia) joined CSTE staff in the 2023-2024 legal epidemiology learning cohort through changelab solutions and the CDC public health law program. The team examined state laws and regulations that govern public health data sharing with tribes in six states.the team researched and analyzed whether laws in alaska, california, florida, new mexico, oklahoma, and south dakota enable or prohibit the sharing of identifiable health information between state health departments and tribal public health authorities, including tribal nations and tribal epidemiology centers (tecs).in developing their research focus, CSTE highlighted the authority of tribal nations and tecs to take action to protect public health through inherent rights and federal law. They also emphasized how access to identifiable health information and other data can affect such entities' ability to fulfill their public health responsibilities. The team aimed to understand what laws exist that define and address public health authority status, identifiable health data, and data sharing for public health purposes.by examining relevant public health laws, the CSTE team developed a better understanding of legal epidemiology methods and whether the laws of the six states included in the legal dataset enable or prohibit sharing of identifiable health information between state health departments and overlapping tribal public health. CSTE senior program analyst taylor pinsent was part of the team and found value in studying more about legal epidemiology, especially as her role often includes reviewing reports from partner associations and national institutions. The team presented its findings at the 2024 CSTE annual conference and provided attendees with information on how to use legal epidemiology methods (especially as non-attorneys) to track the work they're doing. The sessions received positive feedback and were well attended, especially as a significant number of abstracts submitted to the conference featured the topic. CSTE continues to build its legal epidemiology knowledge, and it remains an emerging field with major interest from our members and the public health workforce at large.other portfolio highlights: - managed nine funded projects on topics including disaster epidemiology, notification protocols for ill travelers, and preparing for concurrent disasters - conducted 14 close-hold reviews to ensure state and large city epidemiologist pre-decisional input on draft federal guidance and activities for rapidly evolving response activities - established the health security, policy & law steering committee with disaster epidemiology, readiness & response (new), and public health law subcommittees

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Chronic disease:often when we think of data modernization, infectious diseases spring to mind, especially in our post-pandemic environment. However, chronic diseases represent one of the nation's leading causes of disability, affecting six in 10 adults in the u.s. Chronic conditions including heart disease, cancer, stroke, diabetes, and chronic kidney disease dominate the leading causes of death. And despite data modernization efforts throughout the public health system as a whole, there are still large gaps and vulnerabilities in the surveillance needed to monitor and address chronic diseases effectively. To narrow these gaps and improve chronic disease surveillance nationwide, CDC's national center for chronic disease prevention and health promotion (nccdphp) awarded CSTE $1 million to develop a comprehensive, multi-year national strategic plan for chronic disease surveillance modernization to guide public health decisions and strengthen data systems. The plan will include a roadmap for STLT health departments to reference based on their jurisdictions' current or desired chronic disease modernization capacity. In november 2023, CSTE convened the chronic disease surveillance modernization partners' network to develop the plan and roadmap. Through july 2024, public health and healthcare partners including STLT chronic disease programs, national organizations like the national association of chronic disease directors and the national association of county and city health officials, CDC staff and others assessed the strengths, challenges, and opportunities for chronic disease surveillance modernization. Partner activities included bimonthly virtual meetings, two in-person meetings, focus groups with tribal and territorial epidemiologists, and a landscape assessment collecting feedback from over 250 public health practitioners.CSTE and a team of consultants developed the national strategic plan composed of a vision statement, goals, and a series of strategies and objectives to advance chronic disease data, technology, processes, policies, and workforce. Data system improvements will ultimately lead to timelier chronic disease insights to guide public health decision making and resources and improve health outcomes.

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Injury epidemiology & surveillance:to thoroughly understand something, it's often helpful even necessary to define it. As applied epidemiologists in stlts working to protect the health of communities across the nation, CSTE members know how critical it is not only that all jurisdictions use a definition for a particular public health issue, but that they all use the same definition. One of the important functions CSTE serves is establishing such definitions for public health conditions and threats. Members, staff, and other experts create position statements that provide detailed, standardized information and definitions for all public health departments to use in their tracking and response efforts. These statements are voted on by the CSTE council each year. In 2023-2024, members of CSTE's injury, substance use & mental health steering committee developed the position statement, "standardized public health case definition for injuries related to firearms," which was approved at the 2024 annual conference. CSTE member dagen wright of the oregon health authority worked as lead author in collaboration with members from five other jurisdictions, additional subject matter experts, and partners to create the statement, which addresses the urgent public health problem of injuries related to firearms.the committee determined that developing this standardized public health case definition was necessary "to fully understand the prevalence, risk and protective factors, and long-term consequences" of fatal and nonfatal injuries related to firearms and to identify priority areas for prevention and response. Previously, data sources in this area were "narrow, disordered, and delayed," according to a 2019 expert panel that conducted a comprehensive evaluation of available sources. And most sources only included data related to fatal injuries, although there are twice as many nonfatal injuries, on average, each year.the newly adopted case definition provides a framework for consistently classifying fatal and nonfatal cases across states where firearm-related injuries are reportable at the jurisdiction level, as well as in jurisdictions that may be interested in making them reportable. Applying the case definition will allow public health departments nationwide to estimate and understand the burden, trends, and geographic distribution of fatal and nonfatal injuries related to firearms. Then they can determine the best response for their communities, tailor prevention strategies specific to their jurisdictions, and monitor the effectiveness of their approach.like all position statements CSTE and our members develop, the standardized public health case definition for injuries related to firearms and all CSTE's worksupports STLT applied epidemiologists in their vital day-to-day work creating and sustaining healthy, thriving communities.

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Tribal epidemiology:an update to CSTE's tribal epidemiology toolkit was one of many efforts under the organization's new vision statement (see p. 4). First published in 2014, the toolkit provides information to help CSTE members and STLT agencies improve relationships with tribal nations and indigenous peoples. It is a starting point for learning more about the challenges tribes and tecs face in protecting and promoting the health of their people, including lack of access to timely, comprehensive data and misunderstanding of tribal authority. This underlying idea is expanded upon in the toolkit: "by improving the working relationships between tribal and non-tribal public health agencies, we can begin to better address the health disparities experienced by american indian and alaska native people and to achieve health equity for all americans." CSTE collaborated with the great plains tribal leaders health board on the update, working to center the voices of tribal people and ensure the new iteration of the toolkit reflected their lived experience and expertise. In addition to high-quality resources, the toolkit includes sections on tribal background, cultural humility, and sovereignty & health authority to provide background information and best practices for CSTE members working with tribal nations and tecs. This update includes current issues in tribal epidemiology and folds in new resources published by state, tribal, and federal partners. Tribes have inherent authority as sovereign nations to provide public health services as they determine what is best to protect their citizens' health. While each tribe is different and has different capacities, they can provide a range of robust public health services to their members and communities. CSTE hopes the new tribal epidemiology toolkit will help members improve relationships with tribal nations and health organizations to address some of the greatest health challenges facing indian country. The original goal of the toolkit remains the same: to improve the health of american indian and alaska native people through epidemiology. By improving the working relationships between tribal and non-tribal public health agencies, we can begin to better address the health disparities experienced by american indian and alaska native people and to achieve health equity for all americans.other portfolio highlights: - the tribal epidemiology subcommittee drafted its first-ever policy brief, "enhancing data access to improve AI/an health: a framework for state & local public health officials," to support improving tribal access to public health data - increased tribal epidemiology subcommittee membership by 50% since 2022 - sponsored the first-ever health equity & tribal epidemiology track at the 2024 CSTE annual conference