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Learn how states are leveraging transportation policy to improve health outcomes in this Health Policy Update.

A One Health approach can give health agencies the connections they need to address climate and health.

Learn how state health and transportation agencies are partnering to improve physical access to healthcare.

This brief highlights how both states are using the Health in All Policies framework to address systemic racism and social inequity between populations of different racial and ethnic groups.

Applying Healthy Aging Practices and Policies to Advance Brain Health and Caregiving Advancing Brain Health & Caregiving with Healthy Aging Practices Kellie Waugh, Tyrone Bethune Learn how to advance brain health and caregiving through healthy aging practices and policies, including paid family leave, healthy community design, and more. Public health departments nationwide are implementing policies, interventions, and partnerships to support health throughout the life course. Actions across ASTHO’s five Healthy Aging and Older Adult Health Technical Package objectives also serve as pathways for supporting brain health and caregiving at the state level. Consider using the following objectives, resources, and examples as you work for positive change in your jurisdiction. 1. Expand Paid Family and Sick Leave Paid leave policies support working caregivers in maintaining their economic well-being while providing care, including for those living with dementia. Inclusive leave policies help reduce employment-related stress among caregivers and allow greater focus on caring for their loved ones as well as themselves. Health departments may influence the development of flexible paid family and sick leave policies that support caregiving responsibilities, and provide evidence of the positive economic, physical, and mental health benefits. Additionally, health agencies can collaborate with multi-sector partners (i.e., labor and workforce agencies, aging services, health care providers, caregiver coalitions, and community organizations) to develop, share, and promote strategies that better support working caregivers through: Resources like those from Minnesota’s Board on Aging. Toolkits (e.g., Massachusetts Employer Toolkit to Support Working Caregivers). Public education efforts (e.g., New York’s working caregivers’ initiative). 2. Support Healthy Community Design Designing communities for lifelong health helps individuals navigate streets and community spaces, prevents chronic disease and injury, and keeps people socially connected. These measures make it easier for people of all ages to thrive, and especially support those living with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers. Public health champions have the skills and data needed to apply built environment core competencies, actively participate in planning discussions, and identify and address community needs. Transportation policies promote physical activity and reduce environmental pollutants, which support chronic disease prevention and dementia risk reduction. Similarly, efforts for affordable and adaptable housing assist individuals living with ADRD and their caregivers to safely live and age in place. Public health can: Increase awareness of the link between housing and health. Influence policies for affordable housing development and universal design. Embed safety assessments into existing home-based programming. Together, accessible communities, safe housing, and reliable transportation ensure access to essential care and services that support independence for people living with ADRD and their caregivers. 3. Promote Fall Prevention and Mobility Among the older adult population, those living with ADRD may experience higher risk for falls. Jurisdictions are strengthening policies and engaging partners in coalitions to prevent falls among older adults. These collaborative networks bring together organizations, multi-sector champions, and community members to address falls through coordinated strategies and shared resources. Fall prevention coalitions align public health, health care, and community-based efforts, and translate evidence-based strategies into sustainable action. With these coalitions, health agencies strengthen community-clinical linkages, elevate falls prevention as a public health priority, and identify initiatives that intersect brain health and caregiving. ASTHO’s guide for expanding falls prevention outlines how health departments can implement CDC’s Stopping Elderly Accidents, Deaths & Injuries framework by enhancing surveillance, care coordination, and community-based pathways to assess risk and prevent falls among older adults. These efforts reinforce the aging in place movement, providing older adults and caregivers with the necessary tools to live independently. 4. Increase Telehealth Access Expanding telehealth services is a key public health approach to improve access to care, especially for people living with ADRD and in rural communities. Telehealth services facilitate early brain health assessment and remote monitoring of chronic conditions such as ADRD, while reducing isolation among those living with dementia and their caregivers. Ensuring access to telehealth services for urban and rural communities often depends on Medicaid reimbursement. Public health can partner with state Medicaid programs to strengthen coverage for telehealth services, and health agencies may also be able to support provider regulation or related policies that improve telehealth access in the state. Additionally, data collected or utilized by health departments can shed light on the communities and programs that may benefit from having a virtual care component. Public health is focusing on patient and provider education as another avenue to increase telehealth access. Collaboration with academic medical centers, state Medicaid programs, and reliable internet providers are all promising opportunities to leverage digital care technologies. Health agencies can support provider workforce strategies (e.g., Project ECHO) to equip professionals with dementia-specific training, especially in areas that are rural or have a shortage of providers. And they should continue to monitor the evolving state and federal policy landscape to identify changes related to telehealth access and minimize potential barriers to care. 5. Strengthen the Health Care, Long-Term Care, and Public Health Workforce Public health encourages workforce readiness to support healthy aging, ADRD, and caregivers. The National Healthy Brain Initiative State and Local Road Map’s Workforce domain is a key pillar for advancing brain health and reducing dementia risk at scale. In 2025, 32 health departments reported working on at least one Workforce domain action. Agency-led activities such as training, technical assistance, and capacity building equip cross-sector professionals with evidence-based implementation strategies. Trust for America's Health has established the Age-Friendly Public Health Systems Recognition Program recognizing public health agencies for advancing workforce capacity and system-level improvements that naturally address the intersection between brain health. To date, six state health departments have achieved recognition, and Tennessee was the first to earn it across the state health agency and every local health department. Visit ASTHO’s Healthy Aging and Brain Health webpage for additional resources, and reach out to healthyaging@astho.org for technical assistance requests. article yes

Health in All Policies Evaluation Tool for State and Local Health Departments ASTHO, Association of State and Territorial Health Officials, social determinants of health, promote health equity, highest level of health, united states, health inequities, improved health, health outcomes, influence health, health in all policies task force, national association of county and city health officials, department of public health, achieve health equity, advance health equity, local public health, health care system, local health departments, public health institute, public health professionals, community health workers, health including, health in all policies (hiap), evaluation tool, state and local health departments, health equity, public health practice This tool provides several strategies for health agencies to incorporate Health in All Policies into their programs. State and local health departments are investing in Health in All Policies (HiAP) as a strategy to incorporate health equity into local decision-making processes. HiAP encourages engaging partners from diverse backgrounds—such as transportation, housing, education, and environment, and other sectors—to address the root causes of health disparities that are deeply intertwined with social, economic, and environmental factors. Many health departments are seeking to evaluate the benefits of investing in integrating HiAP into their public health practice. To support the development of robust evaluations, ASTHO—in partnership with the National Association of County and City Health Officials (NACCHO) and with funding provided by CDC's National Center for Environmental Health—developed this HiAP Evaluation Tool for local and state health department to provide structure and guidance for evaluating HiAP initiatives. Get the Resource (PDF) website yes

Environmental Health Policy Guides Environmental health is concerned with how interactions between humans and their environments impact human health. The field emerged to protect people from chemical or biological threats in their environment like air pollution and waterborne diseases. More recently, the field focuses on creating health promoting environments, such as homes, workplaces, schools, neighborhoods and communities. Human-environment interactions are complex, and issues are often under the jurisdiction of multiple agencies or organizations. For example, environmental agencies may be responsible for air and water quality and natural resource agencies for energy creation. Therefore, improving overall population health necessitates cross-sectoral collaboration on policies, programs, and projects. Health in All Policies (HiAP) provides a framework for working with other sectors to address these multifaceted issues. In order to promote the cross-sector collaborations taking place at the local, state and federal levels, ASTHO is developing a series of topic-specific, evidence-based policy guides. The guides catalogue policies and programs that link environmental issues that have benefited from a health perspective. These guides are developed with feedback from a range of subject matter experts, CDC, as well as ASTHO’s HiAP Steering Committee and Advisory Groups. website yes

Evidence-Based Approaches to Promoting Health Equity in Retail Food Safety ASTHO, Association of State and Territorial Health Officials, health equity, food safety, health in all policies, foodborne illness, public health, food code, food service employees, food safety resources, safety standards, barriers to food safety, retail food safety, communication barriers, diversity of language, understand and implement, educational resources, culturally respectful, food science, impacted populations, equitable enforcement, best practices, food safety training, community health, conduct inspections, control measures, jurisdiction demographics Heather Tomlinson ASTHO | Public health agencies can incorporate health equity into their food safety work by tailoring their messages and strategies to their communities. Foodborne illness is costly, preventable, and all too common. Public health agencies are responsible for food safety and reducing foodborne illness by educating and inspecting retail food establishments. Several studies have found that independent ethnic restaurants—those that serve food originating from a culture or heritage of certain ethnic groups—had more violations and, as a result, were inspected more frequently than the average. Some of these violations may be related to a misunderstanding of the food code and/or language barriers. Currently, more than one in four food service employees speaks a language other than English at home and 22% of employees have less than a high school diploma. It is crucial that food safety resources and messaging provided by public health agencies be made available to reflect varying languages and literacy proficiencies to ensure accessibility and comprehensibility for all. Achieving health equity, in which everyone has a fair and just opportunity to attain their highest level of health, requires health agencies to evaluate their approaches to food safety so all food establishments can meet retail food safety standards. Addressing Communication Barriers Health agencies should be familiar with the diversity of languages and cultures in their jurisdiction so materials can be tailored to each community’s differing needs. Providing food safety training courses, regulations, and other materials in languages spoken by local restaurant staff can reduce barriers so restaurant operators and workers who don’t speak or read English fluently have access. Having interpreters or multilingual inspectors can drastically improve communication between inspectors and restaurant staff. For health agencies without these resources, inspectors can utilize photos or translation services, such as Google Translate or language lines, to communicate effectively with restaurant operators. Demonstrating proper practices in person or through videos can also help communicate through observation. With more than half of U.S. adults aged 16 to 74 years old reading below the equivalent of a sixth-grade level, food safety educational resources should be developed so that all populations have access to documents written at educational levels tailored for their community. Educational materials should meet plain language accessibility requirements, including limited text in the appropriate language and simple cultural appropriate imagery. Food safety inspectors can carry materials in multiple languages or have online resources they can share with the retail food facility, such as Washington’s Food Worker Manual or FDA’s Educational Posters that provide flyers on common food safety topics. Finally, newly developed resources should include the target audience in development and pilot testing to ensure they are achieving the desired impact. Designing Materials to Support Your Audience Being familiar with cultural norms and communicating in a culturally sensitive way can enhance the delivery of food safety messaging. One study found that produce safety education materials developed for produce growers in the U.S. Virgin Islands were not seen as culturally appropriate. After redesigning the materials based on community feedback, the managers saw improvements in food safety knowledge and hygiene practices among produce growers. These results and similar studies suggest that educators should partner with impacted populations to evaluate the utility of potential interventions before implementation and ensure they are interpreted as intended. In addition to culturally appropriate food safety education materials, agencies can ensure that they meet the practical needs of the retail environment. For example, materials targeted for mobile facilities (i.e., food trucks) may need to be durable and waterproof to withstand operation and transportation. Ensuring Equitable Enforcement at Your Health Agency Health agencies can incorporate concepts such as equitable enforcement and health equity into their staff’s annual training curriculum. Equitable enforcement promotes compliance with law and policy that considers and minimizes harm to people affected by health inequities. ChangeLab Solutions’ guide on Equitable Enforcement to Achieve Health Equity educates policymakers, advocates, and enforcement officials on best practices in the design and development of enforcement provisions to avoid inequitable impacts and promote community health. A study from Michigan State University found that food safety professionals throughout the United States, especially at the local level, encountered a variety of ethnic food establishments and ethnic foods for which they lacked relevant food safety training. The smartphone application, Cultural Food Safety App, offers searchable information on food safety issues and control measures associated with specific culturally based foods. This app can help regulators better understand cultural foods and their production to ensure foods are being safely prepared and be more familiar with what to look for when conducting inspections. Lastly, health agencies can incorporate a Health in All Policies framework into their food safety practices through ASTHO’s Food Safety Guides. ASTHO strongly supports health agencies in promoting a diverse and culturally competent food safety workforce. By assessing jurisdiction demographics, addressing communication barriers, tailoring resources to fit the audience, and building a culturally competent workforce, health agencies can improve equity in their jurisdiction’s food safety programs. 5U18FD007739-02 website yes

Wisconsin is leaning into teamwork to address homelessness and safe housing in the state.

Policymakers seek to prevent the spread of COVID-19 by focusing on non-congregate sheltering and alternative housing for unhoused populations.

This report explores how the seven strategies for HiAP directly relate to the actions involved in developing State Health Improvement Plans, as both are collaborative by nature and seek to improve health and equity.

There is no one-size-fits-all approach to using a Health in All Policies (HiAP) strategy to address lead poisoning prevention. ASTHO held key informant interviews with staff from four state health agencies to learn more about their state childhood lead poisoning prevention programs and better understand how each agency employs a HiAP approach in its programmatic work. The key themes pulled from the discussions can be found in this report.

Health in All Policies can be a successful strategy to expand collaboration between state and territorial agencies and other partners, but the terminology used in programs focused on these efforts can differ. While equity is often a prominent part of these efforts, it is not always included in the program title. ASTHO partnered with the Kansas Health Institute to host listening sessions to better understand how these efforts are framed and deployed.

Leveraging Healthy People 2030 to Build Non-Traditional Multisector Partnerships multisector partnerships, healthy people 2030, health equity, health outcomes, social services, health disparities, preventable disease, premature death, health literacy, economic stability, social determinants of health, department of health, improving the health, united states, long term, life expectancies, population health, chronic diseases, prevention and health promotion, health care system, disease prevention and health, health systems, healthy people 2030 objective, subject matter experts, office of disease prevention, personal health literacy, achieving health equity, health problem, population groups, astho, association of state and territorial health officials Corinne Gillenwater, Megan DeNubila-Griffin ASTHO | This toolkit helps public health build and maintain relationships with non-traditional partners across a multitude of sectors. The goal of this toolkit is to help state and territorial health agencies (S/THAs) build non-traditional, non-public health sector partnerships to improve health outcomes and advance health equity. The Healthy People 2030 objectives, aligned closely with the Social Determinants of Health (SDOH) framework and Health in All Policies (HiAP) lens, can serve as the cornerstone of these collaborations. This toolkit is implementation-focused, providing partnership-building and -sustaining skills that are rooted in Healthy People 2030 tools and success stories and can be operationalized for community needs. Overall, this toolkit encourages S/THAs to implement these described strategies in their own public health practice to: Establish and maintain partnerships within and across sectors at the state and territorial level to create a shared vision of health. Respond to public health priorities collaboratively and strategically. On This Page Using Healthy People 2030 in Non-Traditional Partnerships to Improve Public Health Types of Non-Public Health Sector and Non-Traditional Partnerships for Consideration Foundations of Strong Partnerships Sustainability of Partnerships 10 Steps for Strong Public Health Multisector Partnerships Conclusion Additional Resources website yes

Interview with Gina M. Raimondo, former governor of Rhode Island, to learn more about a Rhode Island Department of Corrections initiative that helps prevent and treat addiction among incarcerated individuals and other statewide efforts to combat the opioid epidemic.