Stories from the Field

Creating Healthy, Vibrant Main Streets in North Dakota

The Main Street Initiative in North Dakota brings together state and local representatives across sectors, including health departments, to grow communities primed for economic growth.



The Main Street Initiative, launched in 2017 and housed within the North Dakota Department of Commerce, is built on three interrelated pillars: a skilled workforce; smart, efficient infrastructure; and healthy, vibrant communities.


Once a community signs on to the initiative, state officials schedule an onsite “listening tour” and then provide resource referrals to support local priorities. State-wide programming is a further tool for addressing shared challenges. Among those who may join each listening tour – representatives from the Departments of Commerce, Health, and Transportation, North Dakota Fish and Game, and non-governmental agencies. Sometimes, the Governor attends as well.


Local public health officials are tapped to underscore the link between health and economic development, distributing detailed community health profiles prior to each listening session and discussing community health improvement plans. Community leaders initially knew little about the role of health in the Main Street Initiative, but this information helped build knowledge.


The North Dakota Department of Health supports the initiative by providing community health data, such as the rates of obesity and tobacco use, and information on resources to the Main Street Community Dashboard. This online resource aggregates public data to help communities understand local conditions and to inform the development of the ground-up, cross-disciplinary partnerships that are key to the initiative’s success.

If we have great health, but a terrible economic outlook for our communities, things will not work out. If we have challenging health but a great economy, the same thing. All of these pieces fit into a much larger puzzle. Jace Beehler, North Dakota Office of the Governor

Deeper Dive

The Main Street Initiative (MSI) in North Dakota supports communities to identify local priorities and develop tailored strategies to address them, while driving towards a shared goal of statewide economic growth. State resources are available to strengthen the three pillars of MSI — a skilled workforce; smart, efficient infrastructure; and healthy, vibrant communities. This cross-disciplinary effort promotes collaboration among state and local representatives in the public, private and not-for-profit sectors, with a role for public health that continues to evolve and grow.

The Opportunity

With just 755,000 people sprawled across 71,000 square miles, North Dakota ranks as the 47th most dense state in the union. And its cruel winters are legendary – on average, the temperature drops below 00F 50 days of the year, perhaps contributing to rates of obesity and excess drinking that are substantially over US averages.

But scattered across the landscape are regions of extraordinary natural beauty, hunting and fishing grounds teeming with wildlife, and small cities that are finding their way into national profiles. “Can We Talk About How Cool Fargo is?” asks one blogger on the Livability web page. Bismarck has been ranked the “second least stressed city in America,” according to WalletHub. North Dakota also has one of the lowest unemployment rates in the country. And its air is pure – only Wyoming has less air pollution. (See America’s Health Rankings for more data).

Clearly, the state has a lot going for it and the Main Street Initiative, launched in 2017 under the leadership of Governor Douglas Burgum, is trying to capitalize on that. By identifying community assets and challenges, and bringing together custom-tailored teams of people to promote the first and overcome the second, MSI helps position North Dakota to compete in the global economy of the 21st century. State and local health departments are among the collaborators often at the table.

Linking Public Health and Business

The Main Street Initiative is built on three pillars that North Dakota officials recognize as interrelated drivers of economic success: a skilled workforce; smart, efficient infrastructure; and healthy, vibrant communities. “Each one of these pieces plays an important role in developing communities,” explained Jace Beehler, MPA, policy advisor to the governor’s office. “If we have great health, but a terrible economic outlook for our communities, things will not work out. If we have challenging health but a great economy, the same thing. All of these pieces fit into a much larger puzzle.”

Within the three-pillar framework, local communities select issues of greatest concern to them, and the state connects them to supportive services and resources. “The governor has made clear that the Main Street Initiative is to be driven by local communities,” Beehler emphasizes.

“We’re trying to create a very localized approach, providing services from the state level to each community for the issues they would like to focus on.” – Jace Beehler, Governor’s Office

Listening tour:  Once a community signs on to participate in the Main Street Initiative, state officials schedule an on-site “listening tour.” The visitors vary, but often include representatives from the state Department of Commerce, where MSI is housed, the Departments of Health and Transportation, and North Dakota Game and Fish. Other partners with a statewide presence may join as well, including individuals from small business development centers, the rural electric cooperative, agricultural extension offices, arts organizations, and historical societies. Often, the governor himself attends the meeting, and always someone from his office is there.

Each community invites its own players – the Mayor, members of the City Council and the Chamber of Commerce, municipal commissioners, including from parks and recreation, educators, and health systems executives are typically in the room. High school and college students often join the discussions as well. “We are out there to hear what is important to them,” says Sara Otte Coleman, who directs the Tourism Division within the Commerce Department. “It can’t be top-down. It is about hearing from them where their needs are and where they see their potential.”

Local public health officials are often, but not always, included. “Early on, health was not at the forefront,” acknowledges Kelly Nagel, MS, LRD, director of the Office of Public Health Systems and Performance at the health department. “Community leaders were having a hard time figuring out how health would be integrated into the Main Street Initiative.”

That began to change when detailed community health profiles were included in the information packets distributed prior to each listening session. Discussions about community health improvement plans have also become part of the conversation, underscoring the links between health and economic development. In another step to help local leaders recognize the potential contributions of public health, Nagel encourages local public health folks to invite themselves to MSI gatherings and showcase their field.

“We give public health officials a heads-up that their community will be visited at a certain day and they are reaching out to city commissioners and Mayors to ask if they can be at the table. There is a structure in place for them to do that.” – Kelly Nagel, North Dakota Department of Health

Scheduled listening sessions typically last at least three hours. Following a walking tour through town, everyone gathers to hear state representative describe the Main Street Initiative in detail and allow community members to explore their own priorities. One town might be interested in transforming a vacant building into a center of cultural activity while another might consider how to attract a mixed-use development or residential construction that emphasizes walkability. Creative uses of tax credits and new strategies for growing the workforce are other common areas of discussion. “The best meetings end up with the community somewhat taking over,” Beehler emphasizes. “We always want to be sure we are in a supporting role, but not driving the decisions.”

State support:  After the initial convening, liaisons from the Department of Commerce put together a “swab analysis” summarizing what they heard, and then stay in close contact with local leaders to help them activate state-level resources. Periodic conference calls allow all of the MSI communities, “to check in, talk about how things are going, share success stories and frustrations, and talk about best practices,” says Emily Brown, community engagement manager for the initiative.

Other state-level activities are designed to draw attention to shared challenges, such as substance use and suicide. Recovery Reinvented, developed in tandem with the behavioral health division of the Department of Human Services, was part of one effort to complement and inform local work. More than 1,200 attendees attended a day-long event focused on advocacy, accessing resources, and eliminating the stigma of addiction.

The Office of the Governor, the state Department of Commerce and the North Dakota League of Cities also designate Main Street Award winners to honor local efforts. In 2018, a Mobilizer Award went to Jamestown for its Get Fit & Explore initiative, designed to increase physical activity, while Watford City earned a Vibrancy Award for fundraising efforts that turned a farmer’s market into a weekly community cultural event.

Community dashboard: The cloud-based Main Street Community Dashboard, which aggregates volumes of public data on an easy-to-access web site, is a key MSI tool for helping communities understand local conditions. Core demographic information comes from the US Census, while the federal Bureau of Labor Statistics and Job Service North Dakota paint a detailed employment and wage picture. The Office of the Tax Commissioner, the state Department of Commerce and various utility companies incorporate a package of revenue and cost-of-living data, while still more information comes from state educational departments and the North Dakota Council on the Arts.

Dashboard data with direct health implications include rates of obesity and tobacco usage from the North Dakota Department of Health, crime statistics from the Office of the Attorney General, access to farmer’s markets from the state Department of Agriculture, recreation and leisure data from the Tourism Division, and walk and bike scores. The Dashboard also allows communities to overlay their own metrics, such as what they learn from community health assessments.

The power of the Dashboard, created through a collaboration with state government, local universities and a private sector partner, has been recognized with a national Government Experience Award from the Center for Digital Government.

Public Health and the Main St. Initiative: Although health ingredients strengthen all three pillars of the Main Street Initiative, they are especially emphasized as part of the drive towards healthy, vibrant communities. At the state level, the Health and Wellness Steering Committee is one of the administrative structures charged with advancing that agenda.

Health systems, health provider associations, legislators, and health department staff are represented on that committee, as are partners from many other sectors. Representatives from the Department of Transportation help keep Vision Zero, with its goal of eliminating traffic fatalities, on the agenda while tourism officials are there to highlight recreational activities, such as mountain biking, hiking, and hunting, which draw visitors while also providing fitness opportunities for residents.

“If a community has the right ingredients to attract a visitor, it is probably going to be healthy for residents as well. They go hand in hand.” – Sarah Otte Coleman, Tourism Division

For Coleman, the opportunity to work more closely with public health was an eye-opener. “Prior to the Main Street initiative, I had very little engagement with public health,” she says, acknowledging that she had once thought the field focused primarily on policy and providing last-resort medical services. “Now, I’ve learned how many resources and programs they have.”

Raising that kind of awareness is one of the real strengths of MSI. “What is so motivating for me is when steering committee members who don’t typically work together can make connections, and then use those connections to further their work,” says Mylynn Tufte, MBS, MSIM, BSN, a state health officer with the North Dakota Department of Health, who helps guide the committee.

The Future Is Collaborative

Although the Main Street Initiative is still in its infancy, the enthusiasm for the idea is evident in the many requests that state has received from communities who want to be part of it. “We have unlimited promise and potential,” declared Governor Douglas Burgum in a keynote address at the February 2018 Main Street ND Summit, which brought together local and national community development experts and advocates to help envision the state’s future.

Partnerships and ground-up participation are the way forward, he said. “The only thing that is keeping us from having an incredible future is our ability to work collaboratively together to solve problems, and our ability to learn and understand that the things that we have done in the past will not necessarily help us in the future. We need new approaches and ideas to help us move forward.”

“We only reach our unlimited promise and potential as a state if every community reaches its potential.”  — North Dakota Governor Doug Burgum

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