Why State Leadership Matters More Than Ever in Public Health
By: Geran Tarr, Former Alaska State Representative, SiX consultant
In December 2024, a month after the presidential election and in conjunction with the SiX National Conference, SiX took 15 state legislators to visit the National Centers for Disease Control and Prevention (CDC) in Atlanta. Fifteen months of the second Trump Administration later and looking towards National Public Health Week April 6-10, it is hard to process how much has changed.
The nation’s public health infrastructure has been gutted, with disastrous effects that will take decades to fully understand. Staff have departed key health agencies, including the CDC and Department of Health and Human Services, over questionable public health decisions not grounded in scientific evidence, and the public is now left wondering what and who to believe.
During our 2024 visit, we learned from public health experts about the critical role the CDC plays in protecting public health, from securing talented advisors to establish evidence-based vaccine policy (all of whom have now been dismissed and replaced) to preventing mass outbreaks of illness through intricate surveillance programs and so much more. We learned that 90% of CDC funds are returned to states for public health needs. The CDC is just one federal public health agency under attack from the current administration. Given all of this, state legislators' role in public health has shifted, giving them more responsibility in protecting their constituents.
Across the country, state legislators and the communities they represent are feeling the deep impacts of the federal budget cuts and dismantling of critical public health infrastructure, particularly in rural areas. For National Public Health Week, we’re highlighting some of the ways that legislators are organizing, strategizing and stepping up to protect public health through policy that brings together agriculture, food, rural, and health issues including on toxics and pesticides policy, food access policy, and infrastructure and rural health access policy.
Pesticides and Toxics
For three sessions running, Midwestern and Southern states have been battlegrounds for a controversial pesticide immunity bill. The so-called Bayer bill (also known as “Cancer-Gag” or “Failure to Warn”) would prevent farmers, workers, and families from taking legal action if they suspected an illness like cancer was the result of pesticide use.
Why are these deeply unpopular bills being pushed in states? In a David vs. Goliath scenario unfolding in courtrooms across the country, farmers and rural residents with cancer have been successfully suing chemical giants like Bayer and Syngenta for making them sick. A great deal of evidence points to links between Bayer’s Roundup herbicide (with the active ingredient glyphosate) and cancer and Syngenta’s paraquat and Parkinson’s disease. After paying millions of dollars in lawsuits, these companies have taken a different tack: passing state legislation to prohibit lawsuits. State legislators are stopping these bad corporate actors and holding them accountable for making farmers sick. In Iowa, for example, SiX's Cohort for Rural Opportunity and Prosperity (CROP) member State Representative Megan Srinivas, a physician, held cancer listening sessions to surface community health concerns from rural Iowans, including concerns about the Bayer bill. Other toxics and pesticides policy where state legislators are leading includes addressing PFAS contamination, removing toxic metals in baby foods, and bans on chemicals in foods, personal care products, and agriculture, including proposed bans on paraquat due to its links with Parkinson’s.
Hunger and Food Access
As the federal government took a hatchet to federal SNAP funding and food programming in 2025, state legislators across the country worked hard to fill the “SNAP gaps” created by federal actions, food price inflation, and program changes that will limit access, like instating a work requirement for SNAP benefits. Food is a basic need and without proper nutrition our communities suffer. State legislators recognize the critical importance of food access in building and maintaining health communities, which is why policymakers are creating new and innovative programs to fund free and reduced school lunch programs, expanding access to fresh, healthy foods, and partnering with farmers to expand their reach. These state-funded programs can operate independently of the federal government, securing food access for their neighbors. With recent estimates showing the cuts to SNAP could lead to 70,000 avoidable deaths and the current federal government showdown resulting in delays in receiving food benefits, these are just the most recent examples of how critical state actions are in protecting communities from the impacts of federal actions.
Infrastructure and Rural Health Access
Even prior to the second Trump administration, rural communities struggled with access to affordable, convenient, and quality health care due to limited investment in public health infrastructure in rural communities. This has only worsened with the scaling back of federal funding for rural infrastructure. Though this administration has chosen to abandon communities, state legislators are showing up and bringing a listening ear, willingness to try new ideas, and respect for the needs of rural communities so desperately needed at this time. In her role as chair of the Committee on Health, Minnesota Representative and CROP member Kristi Pursell has also hosted listening sessions across rural communities to hear and understand what is happening with their health. Across the country, policymakers are finding ways to expand access and create new partnerships to overcome barriers. For example, in New Mexico, they are funding infrastructure to overcome maternity deserts, ensuring women don’t have to travel unreasonable distances for important health care appointments while other states are making investments to address the rural grocery store crisis.
Systemic disinvestment in rural America has been happening over decades, aided by inadequate state and federal policy that leaves rural communities behind, and won't be fixed overnight. However, with state legislators leading the way and creating a proactive and positive vision for rural public health through co-governance based rural organizing, we know that positive change can be lasting.
The theme for this year’s National Public Health Week is Ready. Set. Action! and state legislators are showing they are ready to lead on public health and already are taking action. Let’s applaud and uplift the important public health work of our state legislators! Happy National Public Health Week 2026!