1072: From Rural Dollars to Dinner Plates: Turning Big Federal Policy Into Real Health Gains

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Thursday, February 19, 2026. I'm John Sheehan, with news from the Association of State and Territorial Health Officials.

Today, we look at two sweeping developments and the on-the-ground work required to make them matter. First, Chris Salyers, director of programs and evaluation at the National Organization of State Offices of Rural Health, explains the Rural Health Transformation Program, RHTP, a $50 billion, 5-year investment aimed at strengthening rural communities. And later, Shannon Vance, director of family and child health at ASTHO, breaks down the newly released 2025-2030 Dietary Guidelines for Americans and their wide-ranging implications. But let's start with Chris Salyers and an explanation of the Rural Health Transformation Program.

CHRIS SALYERS: 

So the RHTP, or the Rural Health Transformation Program, is a $50 billion investment in a five-year period into rural communities across America.

SHEEHAN: 

And has it just started? What's the current status of the program?

SALYERS: 

Yeah, so all states were required to submit a hypothetical budget of about $200 million for the first year. This was due back at the end of the calendar year 2025. Awards have been made. We're seeing the first-year awards ranging from $147 million to $281 million. And right now, states are diligently working on revising those budgets. But it's also important to note that while budget revisions might be accepted, additional steps are still required to release the funds to states.

SHEEHAN: 

And so, could you give us some sense of how states are beginning to sort of ramp up and what the role of external stakeholders is?

SALYERS: 

Yeah, that's a great question. So several states are establishing advisory groups that include key external stakeholders. For example, in Michigan, an open call has been issued for individuals and organizations to serve on the Rural Health Transformation advisory council. So this open call specifically identifies the types of parties and stakeholders it intends to engage with, and it outlines its plan to directly engage with rural communities and rural experts.

SHEEHAN: 

So, it's really sort of, we're still in the preliminary stages of sort of mapping out, mapping out this process.

SALYERS: 

Absolutely, and I think all states are really currently just trying to make sure they get it right. We have some lessons learned from the past, but there really is no blueprint on procurement or contracting in an instance like this, and so states must balance federal requirements with state requirements before they ever try getting money out the door. And meanwhile, the communities are kind of over here wondering if they'll see a piece of anything, right? It feels to them like this isn't a transparent process, but we know that there are so many other layers to this than just the projects that were submitted in the plans.

SHEEHAN: 

And so, in addition to sort of transparency and just sort of like the logistical hurdles of funding, what should states be thinking about in terms of challenges or things to keep an eye on?

SALYERS: 

Yeah, so I would say we're going to see a variety of challenges pop up, right? And they're not going to be the same in each individual state. There's going to be some things that are regional issues. And so as we're going into this for a five-year period, I would say, lean into your peer learning collaboratives that are supported by your national organizations. I think we could all use a little peer support right now, even if it's just a safe space to get something off our chest. So, what a note that we'll be launching along with ASTHO and the National Academy of State Health Policy, a series on getting money out the door is going to be looking at procurement and contracting strategies that your state might consider an opportunity to share with one another. This series is going to be limited to the RHTP leadership in each state, so that we can keep that conversation small and manageable. But meanwhile, groups like ASTHO, and NOSORH, and NASHP will continue to provide peer learning opportunities for our networks. So really, the thing is, make sure that you're plugging in where it makes most sense for you.

SHEEHAN: 

So, gathering information, collaborating where possible, listening where possible, getting your ground game set, as opposed to instead of worrying about where those funds are going to go, necessarily

SALYERS: 

Right, there's not a lot you can have total control over right now, and so leaning into the. Those places where you can build infrastructure and get things teed up while you're waiting to know exactly which direction you can go, will make for a much more successful effort long term, ensuring that the dollars that were invested actually end up in rural communities. That is one of the biggest concerns that we have, is making sure that this doesn't get absorbed by an outside entity and never finding its way back down into a rural community. So using this time to stand up procurement and lean into contracting is so beneficial to rural communities who usually don't have the resources or the capacity to compete for state dollars, right? They're smaller nonprofits. They're smaller organizations, or maybe they're a network of organizations working together collaboratively, but taking time in this procurement and contracting space to look at how you're moving money out the door is one key way of making sure it does end up in rural communities.

SHEEHAN: 

Chris Salyers is director of programs and evaluation at the National Organization of State Offices of Rural Health.

Now let's hear from Shannon Vance, director of family and child health at ASTHO, about the newly released 2025-2030 Dietary Guidelines for Americans and the wide-ranging implications.

SHANNON VANCE: 

Yeah, the dietary guidelines, they're foundational when we think about addressing nutritional deficiencies in our diets and the increasing number of chronic diseases that we're seeing in our communities. These new guidelines come as chronic conditions affect more than 75% of us, adults, nearly 30% of children and adolescents under 25, which is especially concerning when you realize that nearly 90% of US healthcare spending is devoted to treating chronic disease, much of which can be connected back to diet and lifestyle, yeah.

SHEEHAN: 

And just for reference, part of that is the sort of food pyramid that we all grew up learning about in school, that's been flipped on its head.

VANCE: 

Yeah, we had the food pyramid, and then we had a plate for a while, My Plate, and now we've got an upside-down food pyramid, yeah.

SHEEHAN: 

Can you give us some of the big takeaways from the most recent guidance?

VANCE: 

Yeah, so when we think about the emphasis on protein and full-fat dairy, those are probably the biggest changes that we see in these new guidelines, which are great for portions of public health. And when we think about the guidelines, kind of on a whole, there are potential wins across the board of the guidelines, especially when we think about the zero sugar rule for young children, or the continued encouragement of nutrient-dense foods, really across the life cycle. It's really important when we think about the new guidelines, to keep in mind that nutrition is highly individualized, very, very specific to one's age, gender, health risk, and physical activity levels, so how each individual interacts with the guidelines will be very different.

SHEEHAN: 

Yeah, that's something that actually was one of my first thoughts. I'm a vegetarian, and I felt a little left out.

VANCE: 

There are some specific call-outs for vegetarians and vegans, but yeah, the focus on full-fat dairy, more red meat consumption, does leave vegetarians and vegans in a little bit of a lurch.

SHEEHAN: 

Of these new updates, do any strike you as particularly impactful?

VANCE: 

Yeah, I think one of the big ones for public health is the changes around 'no sugar added' or 'no amount of added sugars' being considered part of a healthy diet. Previously, the guidelines were that, recommended that less than 10% of your daily calories come from added sugars, but the new guidelines really take it one step further and state that no amount of added sugar is recommended as part of a healthy diet, but that at a minimum, no one meal should contain more than 10 grams of added sugars, which I think is a huge win across the board, given how pervasive added sugars are in our food supply. Individual behavior change will likely be very difficult. Total elimination of added sugars will be extremely difficult for most Americans, particularly for those who have limited access to fresh foods, whole foods, those sorts of things. And ultimately, the food industry will need to reformulate a lot of their products to remove added sugars to align with these new guidelines, while maintaining the same taste, texture, stability that consumers have come to know, which, as I'm sure you can understand, would take some time. But I think when, when we think about the guidelines, and while we wait for the food industry to catch up, it's really important to focus on ways to increase access to fresh and whole foods, to make the healthy choice the easiest choice, which in some cases it's not these days.

SHEEHAN: 

Yeah, I think a lot of people would very wholeheartedly agree that, yes, try not to eat sugar. It's just a better idea just to try and not eat sugar. But it's so hard. The food industry is very, very large, and there's been decades and decades of foods, high processed foods with a lot of sugar in them being created. And it's a culture shift as well as an industrial shift.

VANCE: 

It is. And I mean whole foods, fresh foods, healthy foods, they taste good, but sometimes added sugars taste better. And so it is really hard when you're short on time, when you are battling, you know, work, kids, keeping a healthy exercise schedule, all those sorts of things. It can be hard to have time to prioritize eating those fresh, whole foods, and added sugars just kind of make things easier. So like I said, the behavior change piece of it will be really integral here, but will take some time.

SHEEHAN: 

Another update to the guidelines has to do with recommendations for different ages. It treats infants differently than than adults, and it treats young adults different than older adults. Can you explain the significance of that and the importance?

VANCE: 

Yeah, every stage of life comes with different nutritional needs, health risks, eating habits and physical activity levels. So when thinking about your nutrition and good nutrition, it's really important to think about it across your life as this dynamic framework, and having that mindset is incredibly valuable. And so the guidelines calling out specific age groups is wonderful because it helps individuals kind of keep in mind, okay, this is where I am in my life. Here are the things that I should prioritize we think about in our youngest years and throughout our adolescence, prioritizing a diverse range of nutrient dense foods, including fruits and vegetables and whole grains, is really key to ensuring proper development. And then at that same stage, instilling healthy eating behaviors that can be aligned with your activity levels, they can set you up for a lifetime of proper nutrition, and then can reduce your likelihood of developing a chronic disease as you enter adulthood. And then, when you think about as an adult, as we continue to age, it remains important for us to eat this balanced diet that aligns with our unique lifestyles and health concerns, but also this ensures that we can maintain functionality and prevent decline as we get into our older years, the life course perspective, when we think about nutrition, recognizes that establishing healthy eating patterns early can create this really, really, really strong foundation for lifelong health and chronic disease prevention, while also having some flexibility to meet every individual's nutritional needs, and having that spelled out in the guidelines is really helpful.

SHEEHAN: 

Yeah, and a big win for sort of early life nutrition.

VANCE: 

Definitely, yeah, definitely. It's really wonderful to see. Like I mentioned, the 'no sugar added' early on, that's a huge, huge win for nutrition.

SHEEHAN: 

And you touched on this a little bit earlier. How you know these guidelines are, you know, there for for all Americans to, you know, adhere to or not, but they also have very concrete impacts on federal programs that deal with funding or subsidizing nutrition, thinking of school lunches, thinking of SNAP programs. What will be the impacts on some of these programs and some of the challenges of implementing them?

VANCE: 

Yeah, the new guidelines will likely trigger operational and policy shifts across the federal nutrition assistance program spectrum, and each program brings their own challenges when we think about SNAP. SNAP programs may be expected to tighten their eligibility around things like sugar-sweetened beverages and candy. The good news is with that, many states and jurisdictions were already making steps to do that prior to the release of the new guidelines. So this is really aligned with some of those changes that were already happening WIC programs will more than likely need to adjust their food packages to align with the new recommendation changes, especially when we think about the full fat dairy butter and saturated fat recommendations. This could pose a challenge as some WIC programs are just now beginning to roll out their food packages that align with the 2020-2025 guidelines, USDA is required to review WIC food packages every 10 years, but they have yet to indicate when they'll do their next review or when they'll update WIC nutrition education materials, so we might see some delays in implementation there, as well as for school meals. The impacts of the new guidelines, I think, are even more up in the air. The new school nutrition standards will need to be rolled out to align with the new dietary guidelines. But the most recent changes to school nutrition standards was in mid-2024, so not that long ago, and that included a gradual phase-in of changes between Fall 2025 and Fall 2027, so we're solidly in the middle of that and the new guidance, any new guidance that comes out, we'll need to find a way to align with the current rollout. This is coupled with the administration's priority on restricting ultra-processed foods in school meals, and the changes that that itself will bring to school districts. And these school districts already operate on razor-thin margins. They have limited staff and often face supply issues. So what happens for school meals with these new dietary guidelines is anyone's guess at this point.

SHEEHAN: 

Yeah, and that's just sort of one example, a very, a very crystal clear example of change upon change upon change, and then certain organizations having to catch up to it, and it brings up a very salient point of, well, you're making all these rules, but how can we help address people being able to accommodate the financial challenges that come along with those new rules?

VANCE: 

Yeah, the new guidelines themselves are much shorter than previous years' guidelines, and so I'm hopeful that the administration will come out with additional guidance around more specifics when rolling out these types of changes. But the new guidelines themselves stop short of addressing some of the primary drivers that kind of impact, accessibility, affordability, of foods, those sorts of things. We know that the solutions to these barriers are not and cannot be solved in a silo. So really, really great opportunity for state health departments to engage with cross-sector partners. Nutrition guidelines matter. These, these guidelines and these dietary guidelines are very, very important, but they work best when the broader conditions surrounding those guidelines support people's ability to follow them. So what we really need is a systems based approach to improve availability of real food by dismantling the economic and structural barriers that prevent access to nutritious food for all and state health departments are well positioned to champion these efforts to help ensure that all of the people within their population that fall under their umbrella can access fresh whole foods that help them align with the dietary guidelines and have healthier lives.

SHEEHAN: 

Shannon Vance, director of family and child health at ASTHO.

Earlier, we heard from Chris Salyers, director of programs and evaluation at the National Organization of State Offices of Rural Health.

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This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.