Programs aim to get rural North Dakotans moving, eating healthier

Chronic disease and metabolic dysfunction affect large numbers of North Dakotans. 

Several new programs coming soon to rural areas aim to reverse that by getting people moving and making healthy, whole foods more accessible. 

“What I want people to know is that moving is the most important thing we can do to stave off chronic disease, and to change the trajectory of it if you’re starting to experience it,” said Pat Traynor, interim commissioner at ND Health and Human Services. 

“That is a huge, huge problem for us as humans, and there’s a huge cost to it over time,” Traynor said. 

Of the $199 million in Rural Health Transformation Program (RHTP) grants coming to the state over the next year, a total of $3.5 million is dedicated to three programs encouraging movement, healthy eating and community cohesiveness. 

That includes $2.5 million for rural areas to establish community walking programs, $700,000 for piloting before-school physical education programs at schools, and another $300,000 for establishing or scaling up community garden programs. 

These address two pillars of the Make North Dakota Healthy Again program, ND Moves Together and ND Eats Well. 

“We want to make it contagious, making walking and eating well contagious,” Traynor said. “And let’s do it together, so we’re socially connected, because we have a crisis of friendship, a crisis of loneliness, we have anxiety and depression. The number one preventer of all these things is social connection.” 

Poor lifestyle choices, including an overreliance on cheap, convenient ultra processed food, largely sedentary lifestyles, bad sleep habits, and a lack of activity outside in the sunlight, are considered leading culprits in the rise of these diseases. 

Total personal healthcare costs amounted to around $8.6 billion dollars in North Dakota in 2020, the last year with the most complete data. 

Just 30 minutes of walking per day and as little as two strength sessions per week can reduce the prevalence of some of these chronic diseases by between 30-50%, Traynor said. 

Trending in the wrong direction

A look at the numbers shows how unhealthy many have become. 

A total of 9.8% in North Dakota have diabetes, and another 32.2% have prediabetes, according to American Diabetes Association numbers. 

Around 31% of the adult population in the state is obese, a rate that could reach 54% by 2030, the New England Journal of Medicine projected in 2023. 

Cardiovascular disease is the leading cause of death in the state and around 30% of all North Dakotans have high blood pressure, North Dakota Health and Human Services figures show.

The second leading cause of death is cancer, which accounts for 17% of all deaths in the state in the most recent data. 

On the mental health side, 18% reported their mental health was “not good” eight or more days in a month, data from 2025 shows. Around 25% reported some form of mental illness over the past year including depression, anxiety and hopelessness. 

Walking together 

A total of 35 applications for community walking programs were submitted, Traynor said, with around 20 expected to be selected. 

One hopeful applicant is First District Health Unit, which serves seven counties in the north-central part of the state. 

Holly Brekhus, Minot-based executive director of the unit, said their proposal centers on finding a coordinator who will then utilize the public health nurses in each community to create walking programs across the area. 

“In those small communities, everyone knows the county nurse, so they’re familiar, they know who lives there, they know what other organizations are in the community, so they would be our team leaders in each of these communities,” Brekhus said. 

Proposals must include at least one community walk once per week and another two that can be individually done and logged, she said, with nurses also able to provide nutrition guidance and ensure people are getting their normal health screenings. 

“It would kind of vary by community,” Brekhus said. “If it’s a tight-knit group, and they want to walk together three times a week, great.” 

Communities, no matter where they are, will likely need to collaborate with schools and other organizations that have indoor space that could be utilized for walking programs, particularly in deep winter or during other inclement weather periods, she said. 

Gardening together 

For the community garden program, 45 applications have come into  HHS, with around 10 to be selected as pilots. 

Gina McKee, who runs Prairie Wild Garden Company, has submitted a grant request. Earlier in the year McKeee had been contracted to set up the Towner Community Garden project through a grant from the local soil conservation district to use a vacant lot in the town. 

Now that this has been established, a RHTP grant could help cover some operational costs and double the amount of raised beds, potentially add a high tunnel to allow a prolonged growing season, expand a pollinator section of the garden, and increase the ability to raise awareness in the community about the garden, McKee said. 

She’s hopeful the grant will come through, particularly since the grant materials requested already established plots of outlines for programs that could be scaled up soon. 

“It was excellent timing with the grant availability,” McKee said. “Had we not started yet, and already had some funding, it probably wouldn’t have worked for us this year.” 

McKee said she hopes to work with NDSU Extension, which could hold educational workshops and training at the site, and sees potential collaboration with other groups like 4H. 

Julie Garden-Robinson, a nutrition and food safety professor at NDSU Extension, was already selected for an RHTP grant for just over $500,000 as part of the ND Eats Well Together pillar. 

Garden-Robinson is already familiar with many in rural communities across the state for the weekly column Prairie Fare that often runs in newspapers she’s been penning for 28 years. 

The grant will help NDSU Extension expand on existing outreach programs about nutrition and healthy eating and increase the ability to collaborate on projects across the state, like the community garden program. 

This will be done by holding events and training from the Pre-K level to college age, public health officials, teachers, other adults all the way through retirees, she said. 

Recent changes to the federal dietary guidelines require updates to curriculum, she said, which is another part of what the grant will help facilitate. 

“We're excited to have this funding because there's a lot of things that we never could do because we have limited funding,” Garden-Robinson said. 

Zero-hour PE programs 

Another grant will support around 10 pilot programs for establishing “Zero-hour PE” initiatives at schools. 

This would allow for the creation of structured 30-45 minutes of physical activity before school for middle and high school students with a component for tracking that activity through fitness tracking wearable devices. 

So far, 23 applications have been submitted, Traynor said. 

“We know physical activity improves academic performance as well as gets people hooked on activity that otherwise wouldn’t have this opportunity, because they might not be in a sport,” Traynor said. “It’s for everyone, but it also gets kids that otherwise wouldn’t be in an organized thing.” 

One question that naturally arises is how this would conflict with busing or other transportation for kids going to school. 

Traynor said funding for these programs will be available to ensure kids in rural areas can get to the sessions outside of the normal busing operations. 

Recently hired to oversee the granting process and build out the Make North Dakota Healthy Again programs over the next five years is Nicole Benson, a Grand Forks native who helped get a segment of her city certified as a “Blue Zone” last year. 

Blue Zones are areas around the world where people have been found to avoid some of the chronic diseases plaguing other parts of the world and where they have higher lifespans and healthspans. This includes parts of Sardinian, Okinawa, Greece, Costa Rica, and Loma Linda in California where healthy eating, movement and social connectedness are built into the lives of residents.

“We’ll really be focusing on nutrition, movement, building resiliency, and a lot of that has to do with social connection and mental health,” Benson said. 

Benson said over the course of the five years the types of grants will likely morph as innovative ideas come in from communities across the state about how they’d like to use the funding. 

“I think we’re just scratching the surface of what’s to come,” Benson said. 

She sees deeper collaboration with school districts and potentially early childhood centers, both for increasing wellness of students and staff, as well as partnering with faith organizations to support well-being and elevate what’s already being done. 

“One of the lessons I learned from the Blue Zones project in Grand Forks is that people were already doing amazing things,” Benson said. “So part of it is understanding what is already happening and to support those initiatives, to amplify and build upon those things.”