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Policy Trends Shaping Healthy Food and Chronic Disease in 2026 Policy Trends Shaping Healthy Food & Chronic Disease in 2026 Learn about policy trends shaping healthy food and chronic disease in 2026, such as regulating ingredients and modifying SNAP. A growing focus on links between nutrition and public health outcomes is driving legislative efforts across the country, with states actively responding to rising rates and the cost of chronic disease. As state legislatures consider ways to combat chronic diseases, they are also implementing policies aimed at addressing the food environment by introducing and enacting bills that regulate ultra-processed foods (UPFs), adjust SNAP benefits, and improve access to healthy food. Regulating Food Ingredients and Ultra-Processed Foods While efforts to define and regulate UPFs are still in development at the federal level, several states have decided to move forward with legislation targeting the use of specific artificial dyes and chemical preservatives in food products. West Virginia enacted HB 2354, prohibiting the sale or manufacturing of any food containing a list of specified dyes and certain preservatives. Similarly, Vermont is considering H 260, and New York is considering companion bills S 1239/A 1556. These bills aim to ban the manufacture, sale, or distribution of food containing a core group of chemicals (e.g., potassium bromate, propylparaben, and Red 3). Meanwhile, North Carolina introduced HB 440, which would prohibit additional color additives and ban the sale of food products containing nine specific dyes and chemicals. Pennsylvania introduced HB 1134, which focused on warning labels and would require foods with dyes Blue 1, Blue 2, Green 3, Red 40, Yellow 5, or Yellow 6 to include a label that states, “This product contains synthetic colors, which may have an adverse effect on activity and attention in children.” Leg Prospectus-2026 - CD - CA Restricting Ingredients in School Meals While previous years have focused on access to school meals, a growing wave of recent state legislation aims to eliminate UPFs, synthetic dyes, and chemical preservatives from children's diets. Several states have enacted or advanced bans on specific chemical additives in school meals: Utah’s HB 402 and Virginia’s HB 1910 prohibit schools from offering food containing common food dyes (Blue 1, Blue 2, Green 3, Red 3, Red 40, Yellow 5, and Yellow 6) or certain preservatives like potassium bromate and propylparaben. Similarly, Texas enacted SB 314 prohibiting specific additives in free or reduced-price school meals and SB 25, which mandates warning labels and expands state nutrition curriculum. In addition, other jurisdictions have introduced but not passed numerous bills proposing similar restrictions including South Carolina's HB 4339, which would prohibit certain additives in school meals. Modifying SNAP SNAP is the nation's largest federal food assistance program, providing benefits to low-income households. While the program is federally funded and administered by USDA through its Food and Nutrition Service, individual state agencies operate and manage eligibility and distribution. Since SNAP is governed by federal law, states must obtain a USDA waiver to implement changes that deviate from the federal rules. Several states are exploring waivers to limit the use of SNAP funds for purchasing candy and sweetened beverages or soft drinks, with Arkansas (SB 217), Idaho (HB 109), and Texas (SB 379) having passed legislation. Arkansas's new law requires the Department of Human Services to request a waiver to exclude candy and soft drinks, and reapply annually if denied. This dual ban was also the subject of bills introduced in Wyoming (HB 323) and South Carolina (HB 4061). Indiana (HB 1486) considered broader restrictions on “accessory foods,” aiming to prohibit the use of SNAP benefits for items like chips, energy drinks, sweetened beverages, soft drinks, and prepared desserts while New Jersey (A 5697/S 4348) introduced a narrower set of proposed restrictions, focused on soft drinks (including soda and sugary/sweetened beverages). Expanding Detection and Coverage for Chronic Diseases In response to high chronic disease rates — including diabetes, cardiovascular disease, cancer, and respiratory illnesses — states are enacting and proposing legislation focused on treatment coverage, awareness, and prevention. Several states are directly addressing obesity and pre-diabetes by mandating insurance coverage. Colorado (SB 25-048) enacted legislation requiring large group health plans to cover treatment for obesity and pre-diabetes, including medical nutrition therapy and metabolic/bariatric surgery. In Nevada, AB 555 caps patient cost-sharing for a 30-day supply of insulin for people with state-regulated commercial health plans. To aid early detection of diabetes, New Hampshire (SB 102), Louisiana (SB 26), and Florida (SB 958) enacted new laws requiring the creation of informational materials on Type 1 diabetes risk factors, warning signs, and screening available to students and parents. To reduce financial barriers to necessary cancer screenings, several states have enacted bills to mandate insurance coverage and/or lower the cost of diagnostic breast exams and supplemental testing. Virginia (HB 1828), Florida (SB 158), and Oklahoma (HB 1389) have enacted bills to limit or lower the cost of such breast imaging. Meanwhile, Colorado enacted HB 25-296, clarifying that health insurers cover medically necessary diagnostic and supplemental breast imaging that goes beyond routine screening. Looking Ahead ASTHO expects state and territories to continue advancing legislative proposals that focus on the prevention of chronic diseases and access to healthy foods in 2026. Future legislative action may include: Establishing policies to address food insecurity and promote access to nutritional foods by targeting food deserts. Exploring policy and leadership options to discourage the consumption of high-sugar drinks. Developing and adopting standards for healthy food procurement policies for state agencies and public institutions to increase the demand for nutritious products. Continuing to enact insurance coverage mandates for comprehensive chronic disease screenings and treatment. OE22-2203 PHIG article yes

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: tobacco, HIV, mental health, PFAS, and opioids.

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

States Continue to Address PFAS in U.S. Food and Water Supply States Continue Addressing PFAS in Food and Water Supplies Heather Tomlinson, Beth Giambrone Read how federal and state actions aim to tighten regulations to reduce PFAS exposure in the U.S. food and water supply. Use of per- and polyfluoroalkyl substances (PFAS), manufactured chemicals that resist water and heat, has steadily increased since they were first developed in the 1940s. PFAS are present in a wide variety of consumer products. PFAS do not degrade easily and can result in increasing concentrations of contamination in water and soil. PFAS exposure has been linked to a variety of health impacts, causing state and federal governments to enact legislation and create policies that reduce their presence in consumer products. States are also working on ways to address and communicate about PFAS contamination and elimination. PFAS in Food and Food Packaging FDA has been evaluating potential dietary exposure by testing foods most commonly eaten by the U.S. public for PFAS through the Total Diet Study (TDS). The initial findings indicate that the vast majority do not — 97% of the 810 fresh and processed foods samples, to be precise. Nevertheless, some specific food subtypes have shown a higher prevalence, with over half of TDS seafood samples detecting at least one type of PFAS. As part of their technical assistance to states, FDA can test foods produced in areas with known environmental contamination to evaluate potential contamination of human and animal food. One recent example came from two dairy farms in New Mexico with known PFAS groundwater contamination; this sampling resulted in milk samples from one farm showing PFAS levels at a potential health concern threshold and lead to them being discarded prior to entering the food supply. Consumers can also be exposed to PFAS through food packaging. As of February 2024, FDA announced that grease-proofing materials containing PFAS are no longer sold for food packaging in the United States, eliminating the primary source of dietary exposure from food contact surfaces. At least 17 states have introduced legislation in their 2025 sessions to prohibit selling food packaging that contains PFAS, with bills in seven states seeing significant movement. In April 2025, New Mexico enacted HB 212, which prohibits selling food packaging and other products containing PFAS starting January 1, 2027. Bills in California SB 682, Illinois SB 1531, and New York S 187 that would prohibit manufacturing, distributing, and/or selling products containing PFAS (including food packaging) advanced in the first chamber. Regulating Drinking Water In April 2024, EPA used their authority under the Safe Drinking Water Act to establish Maximum Contaminant Levels (MCLs) for PFAS found in drinking water. This National Drinking Water Regulation (NPDWR) established individual MCLs for PFOA,PFOS, PFNA, PFHxS, and GenX and a Hazard Index MCL for mixtures of two or more PFAS (specifically PFHxS, PFNA, GenX Chemicals, and PFBS). Under the rule, public water systems must complete initial monitoring for PFAS by 2027 and continuously monitor thereafter. In addition, they must inform the public about PFAS levels in their drinking water and, beginning in 2029, any public water system that exceeds one or more of the MCLs must reduce the PFAS levels and notify the public of the violation. A recent announcement from EPA stated that while they intend to retain the current MCLs for PFOA and PFOS at four parts per trillion (ppt), they will “rescind the regulations and reconsider the regulatory determinations for PFHxS, PFNA, HFPO-DA (commonly known as GenX), and the Hazard Index mixture of these three plus PFBS.” The agency will also propose to give drinking water systems until 2031 to come into compliance with the PFAS rule. A proposed rule is planned for a fall release, with finalization in the spring of 2026. Finally, EPA plans to establish a framework for exemptions and provide assistance to drinking water systems through the PFAS OUTReach Initiative. EPA delegates responsibility for enforcing regulations for public water systems to states that meet certain requirements. Under the current federal rule, states have two years to establish regulations that are at least as stringent as current EPA standards. At least 20 states currently have regulatory standards for at least one PFAS in drinking water, and so far in the 2025 sessions, at least six states introduced legislation to establish new or updated MCLs: Indiana (HB 1366), North Carolina (SB 384), and West Virginia (HB 3475) introduced bills directing their health departments to establish MCLs for certain PFAS contaminants. North Carolina’s bill also requires the Commission on Public Health to consider adopting MCLs for PFAS contaminants not listed in their legislation if at least two other states have set MCLs or issued guidance. The New York state Senate recently passed S 3207, which would tighten MCLs for PFOS and PFOA from 10 ppt to 4 ppt, and establish MCLs of 10 ppt for PFNA, PFHxS, and HFPO-DA. The measure is currently in the Assembly for consideration. Pennsylvania HB 578 would establish MCLs for PFAS at 10 ppt, and would allow MCLs established by the Environmental Quality Board or executive order of the governor to supersede current MCLs. Vermont H 286 would establish MCLs for PFOS, PFOA, PFHxS, PFNA, perfluoroheptanoic acid (PFHPA), and perfluorodecanoic acid (PFDA) at zero ppt, and MCLs for any other testable PFAS at 20 ppt. Two states also introduced legislation modifying requirements for monitoring or reporting PFAS. Maine recently enacted LD 1326, which codifies the requirements to monitor and report PFAS compounds in accordance with EPA’s final rule and requires public notification of the type and level of PFAS in drinking water if they exceed the federal standard. Delaware SB 72 would require the Department of Health and Social Services to create a website where residents can access information related to the level(s) of PFAS in public drinking water systems, and require water utility companies to provide notice of excess PFAS levels to residents who receive water from that system. The measure passed the Senate in May and is currently in the House for consideration. PFAS is a cross-cutting issue, impacting health departments, agricultural agencies, environmental agencies, and the public. State and territorial health agencies can collaborate with community groups to create a broad coalition that can work together across their respective areas to address PFAS contamination. Many states have created internal cross-agency workgroups to evaluate and address PFAS exposures. ASTHO will continue to provide updates on PFAS elimination and MCL implementation. article yes

Learn how states are regulating kratom, a plant-derived substance growing in popularity, in this Health Policy Update.

How the Emergence of Xylazine Impacts Overdose Prevention Policy overdose prevention policy, overdose crisis, fatal overdoses, emergence of xylazine, illicit drug supply, toxicological testing, withdrawal symptoms, xylazine test strips, drug paraphernalia laws, drug checking, legislative action, drug supply, substance use disorders, controlled substance, opioid use disorder, centers for disease control, health care, harm reduction services, psychoactive substances, department of public health, illegal drug, type of drug, opioid crisis, prescription opioid, astho, association of state and territorial health officials JoAnne McClure, Victoria Pless How states are considering overdose policy changes as xylazine continues to emerge in the illicit drug market. Developing and adopting policies to reduce fatal overdoses can help public health leaders address the ever evolving and complex national overdose crisis. More than 109,000 fatal overdoses occurred in 2022, with the majority involving illicitly manufactured fentanyl. Adding to the overdose challenge is the emergence of xylazine, a non-opioid tranquilizer (i.e., sedative), that is being increasingly mixed with fentanyl in the illicit drug supply. As of November 2022, xylazine was found in the illicit drug supply in 48 of 50 states and Puerto Rico. Xylazine is currently associated with one in ten fatal fentanyl (11%) overdoses, a near-threefold increase from 2.9% in 2019. Toxicological testing for xylazine is not uniform and, as a result, its involvement in fatal overdoses may be underestimated. Some states have taken initiatives such as Indiana (HB 1286) and South Carolina, to improve the consistency of toxicological testing for xylazine. With xylazine’s addition to the overdose crisis, states are beginning to adopt laws to better regulate the supply of xylazine and detect its presence in the illicit drug supply. What is Xylazine? Xylazine, also known as “tranq” or “tranq dope,” is a central nervous system depressant causing drowsiness, slowed breathing, reduced heart rate, and hypotension, which can increase the risk of a fatal overdose. Xylazine is approved for veterinary use in the United States but is not FDA-approved for human medicine. Xylazine, can be added to substances that are ingested orally, snorted, sniffed, or—mostly commonly—injected intravenously, and has been added to or used to cut heroin and fentanyl to prolong their effects. People who use drugs may be unaware of xylazine’s presence, which can put them at a higher risk of fatal overdose. Xylazine use is associated with skin ulcers, lesions, abscesses that left untreated, can lead to amputation. People who develop a physical dependency on xylazine may develop severe withdrawal symptoms. Although symptoms of xylazine use and opioid use are similar—making it difficult to differentiate whether someone has used one or both substances—overdose reversal agents (e.g., naloxone) do not counteract the effects of xylazine. Public health leaders still recommend that naloxone be administered for a suspected opioid overdose because xylazine has been detected in substances alongside fentanyl. For a person experiencing a xylazine-involved overdose, public health leaders emphasize the need to seek treatment beyond naloxone. In addition to public health’s work to address xylazine in the illicit drug supply, some state and territorial legislatures are expanding or protecting access to xylazine test strips as well as steps to limit access to xylazine through the state drug schedule. Legalizing Drug-Checking Equipment Drug-checking equipment, such as fentanyl test strips, are evidence-based interventions that allow a person who uses drugs to test their supply for an adulterated substance. State drug paraphernalia laws historically prohibited drug checking equipment, limiting the possession, distribution and use of items like fentanyl test strips. To make fentanyl test strips more widely available to prevent overdose, legislatures rapidly changed their laws to either explicitly legalize fentanyl test strips or generally legalize drug checking equipment. As of July 5, 2023 more than 33 jurisdictions legally authorize the use of fentanyl test strips, 12 of which (Alaska, Colorado, Guam, Maine, Maryland, Nebraska, New York, the Commonwealth of the Northern Mariana Islands, Pennsylvania, South Carolina, Utah, and Vermont) generally authorize the possession and use of drug-checking equipment. Similar to fentanyl, people may not know whether they are exposed to xylazine when using other substances, increasing the risk for harm. New test strips can detect the presence of xylazine, however state drug paraphernalia laws that criminalize drug checking equipment may limit the accessibility of xylazine test strips to prevent overdose. In 2023, at least three states—Illinois (HB 3203), New Hampshire (HB 287), and Utah (SB 86)—enacted legislation to authorize or decriminalize use of drug-checking equipment for fentanyl and xylazine, ensuring that xylazine test strips are lawful and able to be distributed. Additionally, states that previously passed legislation to allow for fentanyl-specific drug checking are amending their statutes to include all drug checking to ensure the legal possession of xylazine test strips. For example, Delaware enacted (SB 189) that specifically legalized xylazine test strips. Two other states—Vermont (H 222) and New Jersey (SB 3957)—enacted laws expanding the authorization of fentanyl test strips to allow for all harm reduction supplies, including drug checking equipment, which would permit the use of xylazine test strips. The Question of Scheduling Drugs are scheduled based on their acceptable medical use and potential for misuse and severe psychological and/or physical dependence, with drugs in Schedule I being the most tightly regulated. Xylazine is not a controlled substance under the federal Controlled Substance Act so it is not DEA scheduled or controlled. Nevertheless, xylazine is subject to FDA regulation under the federal Food, Drug, and Cosmetic Act and state law. Prior to 2023, only two states directly or indirectly scheduled xylazine. Florida codified xylazine as a Schedule I substance in 2016, and xylazine could fall under Massachusetts’ Schedule VI designation, which applies to prescription drugs. As state and territorial leaders take steps to schedule xylazine, policymakers should consider whether scheduling or other criminal penalties will deter people from seeking care if they fear being arrested for unknowingly testing positive for exposure or xylazine use. Another consideration for leaders before scheduling xylazine is whether scheduling will also make possession of test strips illegal under the jurisdiction's drug paraphernalia law. In 2023 at least nine states–Delaware (SB 189), Illinois (HB 3873), Louisiana (HB 106), Michigan (HB 4913), New Jersey (A 5448), New York (A 5914), Oklahoma (SB 668), Rhode Island (HB 5922), and West Virginia (SB 546)—considered legislation to schedule xylazine as a controlled substance. Of those, Delaware, Rhode Island, and West Virginia enacted laws scheduling xylazine in 2023. In addition to legislative action, at least two governors (Ohio and Pennsylvania) took executive action to schedule xylazine. ASTHO’s overdose prevention and state health policy teams continue to monitor these important public health issues. website yes

Earth Day is a natural time to examine current and future climate change policies that impact human health, including clean air, safe drinking water, access to food, and secure shelter.

Restrictions on flavored tobacco and nicotine products, including menthol, may reduce sales and reduce the number of new users.

Recent legislation at both the state and federal levels has significantly affected the ability of health care providers to serve patients virtually and across state lines.

A pressing public health issue before the COVID-19 pandemic hit, the need for public health interventions to reduce tobacco use is heightened with a strong association between tobacco use, in all forms, with severe COVID-19 outcomes. Additionally, tobacco use remains the leading cause of preventable death in the U.S., claiming approximately 480,000 deaths each year. Evidence-based policies to reduce tobacco use like raising the age of sale to 21, increasing tobacco pricing, and prohibiting the sale of flavored tobacco products are common public health strategies enacted through state legislation. As anticipated in ASTHO’s 2021 Legislative Prospectus on E-Cigarettes, states are considering many of these evidenced-based tobacco reduction strategies during the 2021 legislative sessions.