1055: Healthy Choices, Healthy Places: State Strategies for Population Health

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This is Public Health Review
MORNING Edition for Wednesday,

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January 21st, 2026.
I'm John Sheehan for the

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Association of State and
Territorial Health Officials.

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Today, how states turn public
health messaging into real

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behavior change.
We'll hear from Doctor Steven

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Stack, Secretary of Kentucky's
Cabinet for Health and Family

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Services, about the Our Healthy
Kentucky Home campaign.

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Doctor Stack is an ASTO member
and former ASTO president, and

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we'll share how Kentucky is
using simple, achievable goals

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with clear calls to action to
build long term sustainable

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health improvements.
Later, we'll hear about healthy

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community design and public
health from Clint Grant, Asto's

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Director of Healthy Community
Design, Chronic Disease and

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Health Improvement.
From transportation and road

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safety to green space and
mobility, Clint will explain how

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decisions about streets,
sidewalks, and transit are some

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of the most powerful and often
overlooked public health choices

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States and communities make.
But first Doctor Steven Stack.

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I asked him about the Our
Healthy Kentucky Home campaign,

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which by late last year had
racked up 28,000 website visits

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and 54,000,000 social media
hits.

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I wanted to know if that was
translating to behavioral

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changes in Kentucky.
So the Our Healthy Kentucky Home

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campaign is an attempt to have
simple, actionable steps people

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can take to lead healthier,
happier lives.

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So of course, trying to change
and improve the health of four

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and a half million Kentuckians
is no small undertaking.

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But we we do look for signs of
engagement.

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We have good traffic on our
website and social media posts.

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We're monitoring increases in
participation in our programs.

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The services that we refer
people to, we're looking at

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resource downloads, time spent
on health topic pages on our

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website, hotline calls.
We're trying to see if we're

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getting increased engagement for
people calling our, our phone

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numbers and click through rates
on seeking services on our

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online and social media links.
And then we're getting feedback

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from partners and we are seeing
a number of partners who are

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trying to incorporate the RLP
Kentucky home campaign and its

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themes into their own work and
creating derivative products.

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So a variety of ways we look for
this, but but of course it's

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it's imperfect.
And this is year two of the

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initiative.
Do you see the need to adjust

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your approach or or are you
staying the course?

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Well, yes, both.
So part of it is staying the

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course.
So it's eat, exercise and

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engage.
That's the shortest way to say

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the foundation of the campaign.
More detail is eat at least two

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servings or fruits or vegetables
every day, exercise at least 30

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minutes three times per week,
and remain socially engaged to

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be socially connected.
And so those things are really

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foundational and they're also
modest.

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That's not the number of fruits
and vegetables or the minutes of

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exercise that are national
guidelines, but we know from our

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own data, our own surveys in the
state that people are so far

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from reaching those national
guidelines that we need to make

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the initial goals more
attainable.

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And so we're going to continue
to emphasize that in the whole

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second year.
And if we do a third year, we'll

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do it in the third year because
the goal is to try to get the

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folks who are doing the least to
start doing more, not to get the

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people already doing lots to do
even more beyond that.

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But then we're also going to
focus.

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We learned from the first year,
the posts that we made on social

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media that got the most
circulation were very concrete

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resource based posts.
When we gave people a call to

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action, a phone number they
could call, a website they could

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visit, a place they could go to
get resources or help, those

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were shared and people hopefully
therefore were making better use

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of that.
Yeah.

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What are some other examples of
strategies for residents that

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you're using to sort of get
those resources out there?

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So we work real hard to make
sure that the website provides

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really clear and plain language,
breaks things down into short

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steps that lead directly to
resources or programs or tools

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that we offer.
The social media post links

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straight to the R Healthy
Kentucky Home website, and we

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try to drive everything to the R
Healthy Kentucky Home website as

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much as possible.
So it's a central hub.

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We do use a variety of short
videos to try to engage people's

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attention and break it down into
just a couple minutes of

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digestible information and and
we continue to use the same core

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themes over and over.
I think we underestimate

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sometimes that it requires a lot
of repetition for a simple

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message to get through the the
noise and chaos of all the

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things we're exposed to social
media and other communication

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channels.
Sure.

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Given that it's only a year 2,
do you think you have lessons

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learned that might be helpful
for other health agencies?

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Yeah.
So for other states you might

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want to do this, we'd say keep
navigation simple.

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Reduce steps for people to
engage resources wherever

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possible.
Use trusted local partners.

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Our residents, our citizens,
rely on familiar faces to have

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trust and confidence and the
information.

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Track what pathways people use
and refine quickly.

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If you're learning that certain
types of posts or certain

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avenues of of sharing are better
taken up by your population,

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then highlight those and
diminish the other ones.

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An awareness alone isn't enough.
People need a clear, easy next

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step and a trusted outlet to
learn more.

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So be concrete and point them
somewhere where they can take

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action themselves.
Make it as simple as possible.

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I think those things help
improve the likelihood of

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uptake.
Each month has been around a

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different theme in the program.
How do you track if those

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thematic elements are working?
Sure.

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So we track theme specific web
visits, downloads, and time

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spent on the resources we
provide.

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We monitor our social engagement
tied to each month's topics, and

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we can see which posts really
take off much more than others

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and then try to give more of the
type of content that resonated

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with people.
We try to collect partner

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reports from local events or
screenings or community outreach

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efforts that they do that align
with these themes and in here

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what they're doing on the ground
from our local partners.

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We also review referral and
program utilization data to see

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if more Kentuckians are perhaps
accessing resources.

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So if we highlight tobacco
cessation resources or we

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highlight diabetes prevention
resources or we highlight food

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insecurity resources, do we see
an uptick in calls to our call

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lines or website access?
And then we're trying to plan

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for long term growth so that we
can build out those programs

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where we have the resources that
people most need and want in

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order to provide for meaningful
support for meaningful health

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change over time because it
takes time and consistency to

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achieve better population health
that's durable.

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Yeah, absolutely.
Talk a little more about how you

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plan for making a sustained long
term approach like this and what

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other states could learn.
Well, I think our healthy

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Kentucky home aligns with
Governor Beshear's overall

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message of our new Kentucky
home.

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And so it is intentionally
harmonizing so that those

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reinforcing the messages that
the goals I've mentioned before

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is very simple, eat healthier,
exercise more and be socially

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engaged and meaningfully
socially engaged, not on

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smartphones or other technology
devices in person with people,

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which really is a much more
engaging and fulfilling

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experience.
And then staying consistent with

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that over a longer period of
time.

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So we've already done one full
year.

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This is the second year and the
governor's got almost a third

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year left in his term.
And so hopefully we'll continue

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this over a longer arc and see
if we can't drive change and

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make this more ingrained in our
our thoughts and our behaviors

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and meet people where they are.
Doctor.

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Steven Stack is secretary of
Kentucky's Cabinet for Health

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and Family Services and ASTO
member and former ASTO

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president.
Now, for a different perspective

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on influencing population health
and behavior, let's go to Clint

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Grant, director of Healthy
Community Design, Chronic

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Disease and Health Improvement
at ASTO.

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I wanted to know what was meant
by healthy community design.

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At its core, Healthy Community
Design recognizes that health

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isn't created in a doctor's
office or hospital.

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It's really shaped by the
environments we move through

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every day.
You know, the way I look at

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Healthy Community Design is that
it brings together public health

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and transportation, for example,
as well as community voices to

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ensure our communities are
livable, safe, as well as

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accessible.
You know, one of the great

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things about healthy community
design is states can play a

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critical role here when it comes
to helping to set design

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standards and policies and
funding priorities that can

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really shape how our communities
look for generations.

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Yeah, and there's a lot to
unpack there.

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I feel like you touched on not
just sort of infrastructure, but

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the way communities are laid
out, green space, the existence

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of of power lines, all these
kind of things that maybe you

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don't think of on your
day-to-day, but they do.

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They do factor into how a
community is planned and and the

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the health of its residents.
Yeah, absolutely.

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So, you know, just the simple
presence of of a park space has

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shown to improve mental health
conditions for community

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members.
You know, the existence of

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barriers such as roadways or
power lines, as you mentioned,

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that can restrict movement and,
and freedom of movement also

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goes a long ways to whether or
not communities and individuals

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are able to, to safely be
physically active or want to be

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physically active and connecting
with one another.

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And the pandemic really showed
that's the impacts of social

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isolation and how we develop our
communities can really play a

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big role in in the sense that
someone has with being connected

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to their community, whatever
that may look like.

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And today we're talking
specifically about

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transportation.
Can you connect the dots for us

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between transportation
infrastructure or, you know,

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access to transportation and how
that connects to public health?

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Yeah, absolutely.
So transportation decisions are

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some of the most powerful and
often overlooked public health

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decisions that we make.
Transportation can impact the

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risk of injury, you know,
whether or not an individual is

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physically active, are the air
we breathe, the water we drink,

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whether or not we have access to
care or to jobs or economic

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opportunity and even social
connection.

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And so when we're looking
specifically at transportation,

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you know, spaces like our
streets, whether or not they

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have sidewalks, are school
zones, you know, are they at a

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safe speed?
You know, your transit stops,

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your bus stops, you know, metro
access, they all influence

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whether people feel safe being
active.

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And as a parent, whether or not,
you know, I'm comfortable

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letting my kids walk or bike to
school.

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So when it comes to Rd. safety,
states are really starting to

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focus on vulnerable road users,
which are your pedestrians and

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cyclists and people with
disabilities, children, older

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adults.
And this is really exciting

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because vulnerable road users
face much higher risk because

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they are they have less physical
protection as well as visibility

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on the roadway, which is why
there's been an epidemic of

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sorts of serious injury and
death related to traffic

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incidences.
Yeah, 100%.

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And there's so much complexity
there from not just sort of

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access to modes of
transportation, but also, you

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know, increasingly lanes for
electric scooters or electric

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bikes or shared bikes or just
bicycles in general.

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I know a lot of cities are sort
of taking that up, but, you

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know, the infrastructure
originally just wasn't designed

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for it.
So there's a there's a big hill

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to climb there.
Yeah, absolutely.

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When we're looking at shared
use, that's, that's a tremendous

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area of, of growth over the past
decade plus looking at

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reimagining our streets for
being for people, not just for

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cars.
You know, also we look at the,

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the cost of owning a motor
vehicle, owning a personal car,

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those costs continue to grow.
So there's an equity piece to it

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as well.
And if we're making decisions

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that are strictly based off of
the availability of a personal

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vehicle, we're cutting out
opportunity for so many others.

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Yeah, These are all choices
we're making, whether to put it

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to add a parking space or to add
a sidewalk, whether to create a

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green that is no vehicles or to
add another, you know, access

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point communities make those
decisions.

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Yeah, yeah, communities
absolutely make those decisions

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and, and they have a voice to to
be able to speak up.

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And, and you know, that's one of
the great things about many of

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the planners that I engage with
and have talked with over the

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years.
Whether it's you, your municipal

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planners or state based planners
or, or folks in nonprofits, the

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voice of the community is very
important.

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And as public health
practitioners, often times we,

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we are, you know, we go to these
quote, UN quote tables where

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these planning decisions are
made.

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And it's really important that
we bring the data to be able to

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support decisions that may not
be popular.

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You know, when we look at adding
a additional lane of traffic,

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you know, adding, you know, one
more lane to an Interstate or a

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highway on the efficiency scale
that ranks very high.

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But when we look at the health
impacts there, there are clear

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impacts.
And that's where public health

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professionals can come in to
really elevate that and

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highlight that point.
What advice would you have for

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state officials that you know,
see this need in their

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communities that want to get
involved in in those kind of

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planning decisions?
The advice I would, I would give

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is be yourself, be a public
health professional.

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Don't try to be a transportation
engineer or urban planner or

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rural planner.
Stick to what you know and, and

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be able to, to speak in, in a
sense that that conveys that

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message.
Whether you know, as public

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health professionals, we may be
stepping in as the person that

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advocates for a community in
public health.

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We are fantastic conveners.
We are asked to be chief health

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strategist all the time.
And so use that, that ability

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and lean into it, be able to
pull different groups together.

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If, if there are any plans that
are, you know, being discussed,

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if there are community events,
you know, take 1015 minutes out

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of your day to go in to listen
and learn from what the planners

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are saying.
Well, so also the community is

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saying.
And then bring your public

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health knowledge to the table
and be be willing to speak out

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for the public that we love and
serve.

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Are there any examples from
states that are doing anything

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innovative or different, or that
have had particular successes?

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So there are a couple states
that come to mind, first being

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California.
So California recently put in

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place a policy that lowers
schools own speed limits to 20

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mph.
It may not sound like a lot, but

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that's that's actually a pretty
huge accomplishment because it's

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creating safer environments for
once again, our our vulnerable

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road users, our children.
This also has a ripple effect of

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reducing the need for school
buses.

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You know, Hawaii, they've
adopted a policy recently that

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addresses intersection day
lighting.

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So these walls focus on parked
cars near crosswalks.

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We know that if a car is parked
directly in front of a

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crosswalk, it's limited
visibility of pedestrians.

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And a lot of our conflicts
between pedestrians and motor

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vehicles are at intersections.
And one of the really neat

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things that they're also doing
is if if a, if they find a car

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that is in violation of this new
law, those funds are being

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directly sent to the Safe Routes
to School program.

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Another strong example is New
Jersey's Target 0 Commission.

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This commission's working
towards eliminating all traffic

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fatalities and serious injury by
2040.

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It's going to be a hard goal,
but it's a goal that's

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definitely doable.
And by pulling together

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different industries,
transportation, public health,

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community based organizations,
nonprofits, advocacy groups, by

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pulling all these folks
together, you're getting diverse

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thoughts, different opinions on
how to address this issue.

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That's I'm really excited to
watch over the the next few

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years as they continue to grow.
Clint Grant is Asto's director

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of Healthy community design,
chronic disease and health

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improvement.
Earlier we heard from Doctor

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Steven Stack, Secretary of
Kentucky's Cabinet for Health

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and Family Services, an ASTO
member and former ASTO

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president.
Dialysis related infections

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remain a serious and preventable
threat to patient safety.

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Each year, thousands of patients
experience bloodstream

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infections that can lead to
hospitalization or worse.

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New insights from CD CS Making
Dialysis Safer for Patients

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Coalition highlight what works,
creating a strong culture of

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safety, empowering frontline
staff with practical role

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specific training, and ensuring
visible, engaged leadership.

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Health departments play a
critical role in bringing these

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strategies to life through
collaboration, technical

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assistance, and support for
dialysis facilities nationwide.

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Learn more and visit the link in
the show notes.

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Public health data is evolving
and interoperability is the next

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frontier.
Join us Thursday, January 22nd

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for a webinar, The Next Frontier
of Public Health

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Interoperability, TEFCAHDUS, and
what comes Next.

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Experts from state and local
public health, health

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00:18:03,200 --> 00:18:06,080
information exchanges and data
networks will explore how

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intermediaries like HI, ES and
health data utilities are making

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real world data exchange
possible and what it means for

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public health action.
This has been Public health

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review MORNING Edition.
I'm John Sheehan for the

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Association of State and
Territorial Health Officials.