Beyond the Status Quo: 5 Strategic Moves to Position State and Territorial Public Health Agencies for an Uncertain Future

The 75th anniversary of the Association of State and Territorial Health Officials (ASTHO) presents an opportunity to celebrate the past accomplishments of state and territorial health agencies (SHAs) and consider their potential future. Several authors have examined the current and future needs of the governmental public health workforce and future trends impacting the governmental public health system. The Institute for Alternative Future’s Public Health 2030 Scenarios aptly describe 4 potential futures that public health agencies may face (Table 1), and several of these scenarios would have negative impact on SHA capacity to address public health challenges and improve population health. Brownson and Kreuter described future trends impacting public health in the new millennium in 1997. Their forecast was updated and elaborated upon 20 years later by Erwin and Brownson, who provide an excellent summary of the macrotrends and “forces of change” facing public health today (see Table 2). When these trends are combined with increasing political partisanship, declining support for government, disdain for science, and popular debates over what constitutes fact