UAB’s Live HealthSmart Alabama aims to remedy state’s low health rankings

 Is it possible to lift Alabama’s health rankings from the bottom tier of states?

Dr. Mona Fouad, a researcher at the University of Alabama at Birmingham, thinks so. And she plans to do something about it through a multi-faceted project that seeks to improve the health and well-being of all Alabamians over the next decade.

Dr. Fouad is leading Live HealthSmart Alabama, an ambitious UAB initiative to raise Alabama’s rock-bottom health rankings, which include those for high blood pressure (No. 49 among the states), diabetes (No. 48) and obesity (No. 46). Her goal is to elevate these rankings into the 30s by 2030.

The Live HealthSmart project received $2.7 million in funding as the winner of UAB’s inaugural Grand Challenge, a competition created in 2019 to target major societal hurdles in the state. Additional external funding is expected to drive the project toward its bold objectives.

“These problems touch everyone in Alabama,” Dr. Fouad said. “If you talk to business owners, they say these problems affect them. If you talk to school principals, they say it affects them. It you talk to pastors at churches, they say this affects their congregations.

“This resonates with everyone,” she emphasized.

While Dr. Fouad recognizes that reaching Live HealthSmart’s goals will be difficult, she is used to tackling daunting challenges.

As the founding director of the UAB Minority Health & Health Disparities Research Center (MHRC), Dr. Fouad led a project that dramatically shrank the difference in cancer screening rates between white and African American women in the Alabama Black Belt.

Dr. Fouad’s Center also boosted African American participation in UAB cancer clinical trials and helped more than 1,400 Birmingham children improve their nutrition and increase physical activity levels.

This time, Dr. Fouad and her team decided to set the bar high and go for maximum impact.

“All the efforts to change these problems in Alabama have been made on an individual level,” she explained. “If you try to do this on an individual level, it’s very hard to bring change. You need to be bolder. We need to affect change on policies, systems and the built environment.”

UAB Live HealthSmart Fouad
UAB President Dr. Ray Watts, center, joined Dr. Mona Fouad and the rest of the Live HealthSmart Alabama team for a kick-off ceremony for the program that aims to improve the state’s poor health rankings. (Image: UAB)


Dr. Fouad’s team began work on the initial phases of the project last year, holding a series of community town hall meetings that yielded valuable input. The team developed a brand for the project and guidelines for a Live HealthSmart designation for schools, restaurants and businesses.

The team also set about to build broad-based support for the program. Partnerships have been forged with more than 90 community organizations and businesses that include Blue Cross Blue Shield of Alabama and VIVA, as well as agencies such as the Alabama Department of Public Health and the Alabama Hospital Association.

“I have never had this kind of support where so many people are saying, ‘Let’s do this.’

The Grand Challenge is bringing a lot of people and organizations together to get behind one vision and work toward one goal,” Dr. Fouad said. “We didn’t have that before.”

Critically, UAB threw its funding — and full support — behind the Live HealthSmart project as the winner of its Grand Challenge.

“The extraordinary coalition Dr. Fouad and her team have assembled, working in conjunction with communities across Birmingham and Alabama, will find the solutions needed to improve the health of our state. We want to concentrate enough resources around this project to really move the needle,” UAB President Dr. Ray L. Watts said.

(Read his letter about the project.)

 “Like America’s goal to put a man on the moon, Grand Challenges have a history of catalyzing innovation for the benefit of society,” said Dr. Christopher Brown, vice president for Research at UAB. “When we announced this endeavor, we said it would unite university activities — teaching, research, scholarship, commercialization, patient care and service — along with the capabilities of partnering organizations to solve large-scale problems affecting Alabama.

“Our rankings indicate the health of our state is a large-scale problem. The team Dr. Fouad has assembled will find the solutions needed to positively impact those numbers, which will help our citizens achieve better health and propel our state forward,” he added.

Live HealthSmart Alabama
UAB President Dr. Ray Watts stands with Dr. Mona Fouad, who is leading the Live HealthSmart Alabama project to improve Alabama’s health rankings. Live HealthSmart is the winner of UAB’s inaugural Grand Challenge. (Image: UAB)


Following the town hall meetings, Dr. Fouad’s team developed insights that came to underpin the Live HealthSmart game plan. These include advocating for changes in policies, systems and environments to advance prevention and wellness, healthy eating and increased physical activity across Alabama.

They decided to target the root causes of Alabama’s health problems.

“We didn’t just want to focus on high blood pressure or diabetes, because we won’t get anywhere,” Dr. Fouad said. “We found that if we focus on access to healthy food, access to physical activity and prevention and wellness, we cut across all these chronic diseases.

“If you improve these things, you can improve much more,” she added.

To get the project rolling, Live HealthSmart “Demonstration Zones” were named. These areas – Bush Hills, Titusville, East Lake, Kingston and the UAB campus – are the initiative’s proving grounds over the next two to three years.


The first stop was Kingston, a neighborhood of about 2,300 residents in east Birmingham.

What’s going on there illustrates Live HealthSmart’s comprehensive approach to spurring change.

Dr. Fouad’s team brought in the UAB School of Public Health for an environmental scan of the neighborhood and asked the UAB School of Engineering to conduct walking audits and drone surveys to assess the area’s built environment.

After the assessment, plans were drawn up to build new sidewalks and repair existing ones in Kingston’s priority pedestrian corridors. The goal is to provide safer walking routes to the local elementary school and improve access to public parks and bus stops.

Cost estimates have been prepared for new crosswalks and crossing signs at key intersections, along with three new bus shelters to encourage transit use and enhance security.

Dr. Fouad’s team has engaged with the City of Birmingham, Alabama Power and major construction companies to create community-driven development plans based on identified priorities.

In addition, the team is looking to make improvements at the Stockham and W.C. Patton parks. They have teamed with Blight Free Birmingham, a group that encourages investment in neighborhoods, to find solutions to the area’s large number of vacant homes.

Other priorities include providing additional resources to increase access to healthy funds in the neighborhood. Dr. Fouad also wants to expand a teaching farm that she established there.

Intervention strategies will be essential. The Live HealthSmart team can look to existing partnerships with UAB and organizations such as the Jefferson County Health Department to improve wellness.

All these steps are necessary to bring about lasting change, she said.

“It’s not enough to tell people to exercise and eat healthy and get screened. You have to make it possible. That’s the idea behind the Grand Challenge,” she added.


Once the Live HealthSmart team completes its work in the Demonstration Zones, plans call for developing a model program for rural areas and expanding the effort into other parts of Alabama.

“Our plan is to scale it up across the state, but this is going to take several years. Success brings success, and when people see how we turned around a community, everybody is going to want to be part of it,” Dr. Fouad said.

The key, she said, is to make sure the program is precisely targeted and customized for each area. Another must: developing partnerships with key players in these communities – hospitals, schools, civic organizations, and others that can play a leading role at the local level.

“Then we can do what we did here, bring the people together as a coalition. We can give them the tools and tactics and the know-how. Then they can take action for their region,” Dr. Fouad said.

Technology is expected to play a role through the development of smartphone apps that could, for example, let residents know when a food truck loaded with fresh vegetables is arriving in the neighborhood.


Down the road, the Live HealthSmart team will be able to measure progress against milestones identified in the plan.

In five years, for instance, one goal is to reduce the percentage of Alabamians who report no physical activity or exercise in 30 days from 32 percent to 29 percent, raising Alabama’s ranking from 45th to 35th. Reducing smoking from 20.9 percent to 17.5 percent would elevate Alabama from 41st to 30th nationally.

Final 10-year targets for Live HealthSmart include:

  • Cutting the obesity rate from 36.3 percent to 33 percent, lifting Alabama from 46th to 37th
  • Reducing high blood pressure statistics from 41.9 percent to 34.7 percent, propelling Alabama from No. 49 to No. 38 among the states.
  • Lowering Alabama’s obesity rate from 36.3 percent to 33 percent, lifting the state from 46th to 37th
  • Reducing high cholesterol from 37.2 percent to 35.4 percent, improving Alabama’s ranking from No. 45 to No. 38.

“The Grand Challenge is not just focused on improving the health of people. It can impact a lot of other things. It’s not just health care costs, it impacts every sector of the economy,” Dr. Fouad said.