2025 is a year of extraordinary change in the United States. We are engaged in a national debate about the role of government, particularly the federal government, in providing the resources that communities need to protect health and promote well-being. Within this context, public health leaders are asking: what does this mean for public health, for my organization, for my program and, most important of all, for the health of people in our communities? How do we communicate better with our elected officials? Who in our community can advocate for our basic public health policies, including childhood immunizations, clean air, and health care coverage?

Whether you’re worried about child health or Medicaid coverage for low-income adults, there is a new advocacy tool available. In our recent JPHMP column, we highlight the newly published 50-State Scan of Public Health Advocacy Capacity. The 50-State Scan is a guide to the advocacy landscape in each state: the demographics, political composition of the state legislature, and the key organizations advocating on health issues in the state.

When you look across several state profiles, it is a reminder that in our federalist system, every state is different. But from Massachusetts to Montana, state and community leaders are finding ways to navigate their state legislatures to advocate for the policies and programs that protect health.

National public health leaders often lament that the US Constitution does not directly address health, which means that, according to the 10^th Amendment, many of the powers to protect health “are reserved to the States respectively or to the people.” Supreme Court Justice Louis Brandeis noted that “a single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.”

In public health, we have great examples of advocates in states leading the way.  In 1978, through the efforts of Dr. Robert Sanders, a Murfreesboro pediatrician, Tennessee became the first state to pass a law requiring child safety seats, eventually leading to laws in every state and federal regulations protecting children from injuries in motor vehicles. We have seen similar waves of change in tobacco control, health care coverage, and marriage equality. Conversely, we also witnessed organized efforts after the COVID-19 pandemic by the American Legislative Exchange Council (ALEC) and others to limit public health authority in states and localities.

Read Our Article in the May Issue of JPHMP

Our 2022 and 2023 reports on how to strengthen advocacy for the public’s health highlighted the urgent need to strengthen state public health advocacy organizations. These are the “boots on the ground” – people with sharp skills in advocacy, communications, and lobbying. With State legislatures throughout the country debating laws, from immunization protections to Medicaid coverage, that affect the health of our communities, we need strong advocates for health. Effective advocates for health must be in the halls of our state capitols talking with legislators, in boardrooms working with business leaders, in community meetings building coalitions with other advocates, and on street corners engaging people in our communities. As we said in our May column, we can’t afford NOT to advocate for the public’s health. Our lives and our well-being depend on it.

Acknowledgements

The authors express their deep appreciation to Edward L. Baker MD, MPH, and Quang Dang, JD for their contributions to the JPHMP article and to Quang Dang, Manel Kappagoda, Emma Waugh, and Leslie Zellers for their great work on the 50-State Scan of Public Health Advocacy Capacity.

About the Authors

Martha Katz, MPA, is a health policy leader committed to improving health and access to health care for all.  She was CDC Deputy Director for Policy/Legislation and held leadership positions at the CDC Foundation and Healthcare Georgia Foundation.  She chairs the Board of the James F. and Sarah T. Fries Foundation.

Gene W. Matthews, JD, is a public health law consultant and part-time adjunct faculty at the UNC Gillings School of Global Public Health in Chapel Hill, NC. His many roles in developing the field of public health law include his 25-year tenure as chief legal advisor for CDC in Atlanta.

Maddy Frey, MPH, is a public health evaluation consultant working with nonprofits, foundations and hospitals to transform the root causes of health inequities.