This e-study explores the complexities of implementing, county-by-county, a statewide initiative to improve citizens’ health and reduce healthcare costs to the state. Building on a renewed and nationwide momentum for increasing individuals’ movement and decreasing access to unhealthy foods and tobacco, Minnesota’s State Health Improvement Plan or SHIP, seeks to apply broad policy goals aimed at better health. The program relies on decentralized implementation structure that is activated at the local level through individual county health agencies.