STate Activation and Response (STAR): An Evidence-Based, Practice-Informed Approach to Public Health System Improvement

This article summarizes the development and refinement of the ST ate A ctivation and R esponse (STAR) technical assistance program. STAR is an evidence-based, practice-informed approach to supporting state and territorial health departments with developing, implementing, and evaluating chronic disease prevention and health promotion programs. The National Association of Chronic Disease Directors developed the first version of this program during 2008 and has iteratively updated the program based on organizational effectiveness literature, evidence-based public health practice, and state and territorial health department feedback. The current version of STAR was implemented during 2019; through the end of 2023, 15 states, and 1 territory participated in the program using the revised framework. This new iteration of STAR has been well-received by state and territorial health department participants, who have reported improvements to public health infrastructure and operations, workforce training and wellbeing, application of evidence-based practice and communication, and commitment to a shared mission.