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Surveillance is the act of systematically collecting, collating, and analyzing health-related information that can be communicated on a timely basis to guide action.1 Sentinel surveillance is one form of surveillance that can serve as an early warning system in efforts to identify health threats that require rapid action.2 Sentinel surveillance systems, such as the Centers for Disease Control and Prevention's US Outpatient Influenza-like Illness Surveillance Network,3 provide the early red flag, the proverbial canary in the mine, that alerts public health to a threat requiring action. A diverse group of local and state-level public health officials were invited by AJPH Associate Editor Paul Erwin to participate in the sentinel surveillance system. Aspects of geography, population demographics and density, public health agency organizational structure and reach, and recent political context were the primary characteristics explored in considering whom to invite to participate. President Trump has promised to make fundamental policy changes that are vitally important to the public's health, from repealing the Affordable Care Act, to environmental deregulation, to issues pertaining to women's health. What we will report on through this sentinel practitioner surveillance system is what a handful of committed public health professionals are experiencing first-hand-good or bad-as an early indication that the fact ofchange, not the fear of change, needs further light. The author wishes to acknowledge the commitment, dedication, and input ofthe public health practitioners who are participating in this surveillance network, and to AJPHEditor-in-ChiefAlfredo Morabia and Associate Editor Mark Rothstein for their helpful suggestions and guidance on...

[...]guided by a framework of national laws, the EPA has led national progress in improving air quality, cleaning up our waterways, reducing harmful pesticide exposures and industrial emissions, and providing support for states and communities to advance environmental health. EPA scientists work with other federal programs and agencies, including the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Department of Agriculture, the Department of Defense, the Department of Energy, the Department of the Interior, and NASA (the National Aeronautics and Space Administration). The EPA Office of Research and Development has also built partnerships with the American Public Health Association, the Association of State and Territorial Health Officials, the Environmental Council of the States, the National Association of County and City Health Officials, the National Environmental Health Association, and the Association of Public Health Laboratories. Working with NASA, EPA scientists track harmful algal blooms to protect our recreational and drinking water resources. [...]together with the Department of Defense and the National Institutes of Health, EPA toxicologists are working with the Cancer Moon Shot initiative to understand and prevent risk factors for cancer in our troops. HEALTHY ENVIRONMENT Amid the current zeal for less regulation as justification for attacks on the EPA, it is important to emphasize that a healthy environment, healthy communities, and a healthy economy go hand in hand. Since the inception of the EPA 46 years ago, the United States has enjoyed significant progress in reducing public health effects from...

Back then, a popular onslaught swept out Jim Crow laws, McCarthyism, and racist immigration quotas, ushering in legislation that protected civil rights, voting rights, and women's rights; aided public schools and college students; opened the border to Jews, Italians, and people of color; implemented the National Endowment for the Arts, food subsidies, and Head Start; sharply increased Social Security benefits; and created Medicare, Medicaid, and community health centers. [...]it offered little help to 90% of the population, perpetuated a dysfunctional health care financing system, left 26 million uninsured, saddled covered families with unaffordable deductibles and narrow provider networks, and enriched drug firms, medical conglomerates, and insurers. Richard Nixon's 1971 plan- offered to counter Ted Kennedy's single-payer proposal-was eerily similar to the ACA: a requirement that employers cover their workers, Medicaid managed care-like coverage for the poor with sliding-scale subsidies for the near-poor, and insurance exchanges for individual purchasers (http://cbsn.ws/2lLKhnn). AFFORDABLE CARE ACT REPLACEMENTS Not surprisingly, the ACA replacements floated by Republicans such as House Speaker Paul Ryan and Department of Health and Human Services Secretary Tom Price amount to rebranded, meaner versions of the ACA. The ACA's contraception-coverage mandate would likely fall victim to the law's repeal; Republicans are edging closer to banning Medicaid and Title X reimbursement to Planned Parenthood and criminalizing abortion; and a new executive order bans foreign-aid funding to groups that even mention abortion. [...]the pro-corporate agenda carries other health hazards: a diminished Environmental Protection Agency and boost for coal and other fossil fuels, oil pipelines...

BUDGET CUTS The ACA included authorization of the Prevention and Public Health Fund \"to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs\" (https:// www.cdc.gov/funding/pphf). Of the $1 billion authorized annually for this, more than $892 million was to be transferred to the Centers for Disease Control and Prevention for activities to address heart disease, tobacco control, diabetes prevention, and other critical public health priorities. The Prevention and Public Health Fund funds have already been used to pay for an offset to a scheduled cut to Medicare physician payments1 and more recently to help pay for an increase in the National Institutes of Health budget authorized in the 21st Century Cures Act.2 If the ACA is repealed, including the Prevention and Public Health Fund, it could be disastrous for public health programs at the federal and state levels. In addition to the benefits to individual health when people have health insurance, Medicaid has been an important source of support to many public health initiatives, as documented in a report of the Medicaid and CHIP Payment and Access Commission in June 2014, \"Medicaid and Population Health.\" Would our country's already embarrassingly low international ranking in infant mortality, 27th among Organisation for Economic Co-operation and Development countries, slip even further if this coverage is reduced? BLOCK GRANTING MEDICAID The use of block grants has been a longstanding policy of conservative Republicans,...

The untreated, corrosive water wrought havoc: discolored and distasteful water, bacterial contamination and water-boiling advisories, rashes and skin irritation, water main breaks and leaks, one of the largest outbreaks of Legionnaire's disease, an uptick in pneumonia deaths, and-as proven to a dismissive government- lead exposure. Reinvesting in Flint and in our kids, long-standing partners Michigan State University, a land grant university, and Hurley Medical Center, a public hospital, both with footprints in Flint for more than a century, launched a model public health program: the Pediatric Public Health Initiative. Through community and clinical programs, childhood health policy and advocacy, and robust evaluation, the Pediatric Public Health Initiative works with many partners, including our heroic parents and kids, as a center of excellence, with the primary goal of mitigating the impact of the Flint water crisis and serving as a national resource for best practices. A blend of governmental and philanthropic sources now supports expanded maternal-infant support programs, universal home-based early intervention, a new highquality early education center with another opening in a year, family and parenting support programs, massive investment in early literacy and two-generation literacy initiatives, universal preschool, school health services, mindfulness programming, breastfeeding support, nutrition prescriptions, WIC (Special Supplemental Nutrition Program for Women, Infants and Children) colocation with primary care, mobile grocery stores, traumainformed care, health care expansion via Medicaid waiver, and more. Flint has awoken the nation to the ongoing issues of early adversity, lead contamination, water quality, inadequate public health regulations, deteriorating infrastructure, public health disinvestment,...