Public Health Administration
In Washington State, responsibility for public health protection is shared among the State Board of Health, Washington State Department of Health, and the 37 local health jurisdictions covering the 39 counties. The State Board of Health provides a citizen forum for the development of public health policy in Washington State, and is responsible for outlining the state’s priority health goals and recommended strategies for use in preparing budgets and requesting legislation. The Board also exercises regulatory authority in a variety of public health areas, including drinking water, immunizations, school safety, and food handling.
The state Department of Health is responsible for the preservation of public health, monitoring health care costs, maintaining minimal standards for quality in health care delivery, and the general oversight and planning for all the state's activities.
The local health board has supervision over all matters pertaining to the preservation of life and the health of people within its jurisdiction. Responsibility for governance of local public health boards is placed solely with counties or groups of counties which may form health districts.
Funding for Public Health
The Health Reform Act of 1993 changed public health governance at the local level. The act, which became effective on July 1, 1995, removed cities from the statutory responsibility of providing public health services and rested it solely with the counties. Counties became responsible for public health administration and for the expenses of public health. City and town payments for health care services, previously based on cost allocation formulas, were replaced by motor vehicle excise tax funds (MVET). A percentage of the motor vehicle excise tax distributed to cities and towns was redirected to the county health departments based on population. However Initiative 695 and the subsequent repeal of the motor vehicle excise tax by the legislature in 2000 eliminated the funding source for local public health. The legislature has backfilled the lost revenue. Funding for local public health jurisdictions in the 2009-2011 biennium is provided at $80 million, reflecting a slight deduction from last biennium.
Any county, combined city-county health department, or health district is authorized and empowered to create a "public health pooling fund" for the efficient management and control of all moneys coming to such county, combined department, or district for public health purposes (RCW 70.12.030). Into any such fund so established may be paid: (1) All grants from any state fund for county public health work; (2) Any county current expense funds appropriated for the health department; (3) Any other money appropriated by the county for health work; (4) City funds appropriated for the health department; (5) All moneys received from any governmental agency, local, state or federal which may contribute to the local health department; and (6) Any contributions from any charitable or voluntary agency or contributions from any individual or estate. Any school district may contract in writing for health services with the health department of the county, health district, or county-city health district and place such funds in the public health pooling fund in accordance with the contract.
Public Health Service Standards, Improvement Plan, and Indicators
The 1993 Health Services Act required the state department of health to develop a public health improvement plan for consideration by the 1995 legislature. The initial plan contained 88 capacity standards intended to measure state and local health jurisdictions' infrastructure adequacy and 29 health outcome measures. Among the plan's recommendations was that state and local health department contractual relations contain specific service delivery capacity objectives and health outcome objectives to be used as a basis for accountability.
The Public Health Improvement Act of 1995 required that the state develop "performance-based contracts" with each local agency based on "the core functions of public health." Basic standards for public health are part of the biennial public health improvement plan. A single standard was proposed for the public health system, with separate state and local measures that demonstrate whether a standard is met. This set of standards is limited to the responsibilities of state and local government. The contributions of non-government health providers and community-based organizations are essential, but they are separate from the specific accountability expected of government agencies.
Community Health Indicators and Reports
The Health Services Act of 1993 restructured governance of health departments by transferring authority to counties and removing city representation from local boards of health, except by appointment.
The local board of health is to:
- Enforce through the local health officer or the administrative officer the public health statutes of the state and rules;
- Supervise the maintenance of all health and sanitary measures for the protection of the public health within its jurisdiction;
- Enact such local rules and regulations as are necessary in order to preserve, promote and improve the public health and provide for the enforcement thereof;
- Provide for the control and prevention of any dangerous, contagious or infectious disease within the jurisdiction of the local health department;
- Provide for the prevention, control and abatement of nuisances detrimental to the public health;
- Make such reports to the state board of health through the local health officer or the administrative officer as the state board of health may require; and
- Establish fee schedules for issuing or renewing licenses or permits or for such other services as are authorized by the law and the rules of the state board of health: fees for services cannot not exceed the actual cost of providing any such services
Unless the county is part of a health district, the board of county commissioners constitutes the board of health in counties without a home rule charter. In counties with a home rule charter, the county legislative authority establishes the local board of health, and determines terms of office, compensation or reimbursement, and membership criteria. The county legislative authority may appoint elected officials from cities and towns and persons other than elected officials so long as persons other than elected officials do not constitute a majority.
Each local board of health must appoint a licensed, experienced physician who is qualified, or is provisionally qualified, in accordance with the standard prescribed in RCW 70.05.051. The local health officer is the executive secretary to, and administrative officer for the local board of health. See also RCW 70.46.090; a health department is not deemed to provide adequate public health service unless there is at least one full time professionally trained and qualified physician as set out in RCW 70.05.050.
Charter Counties - Board of Health
Health Departments and Health Districts
Combined City-County Health Department
Any city with a population of 100,000 or more and the county in which it is located may form a combined city and county health department and appoint a director of public health. Any other city, other governmental agency, or any charitable health agency may contract with the agency to receive public health services.
A health district is all the territory consisting of one or more counties organized pursuant to the provisions of Ch. 70.05 RCW and Ch. 70.46 RCW. The district board of health shall constitute the local board of health for all the territory included in the health district, and shall supersede and exercise all the powers and perform all the duties by law vested in the county board of health of any county included in the health district (RCW 70.46.060). The expense of providing public health services shall be borne by each county within the health district (RCW 70.46.085).
Organizations and Agencies
- American Public Health Association (APHA)
- Association of State and Territorial Health Officials (ASTHO)
- Centers for Disease Control and Prevention (CDC)
- Family Policy Council of Washington State
- Health Resources and Services Administration (HRSA)
- National Association of County and City Health Officials (NACCHO)
- National Institutes of Health
- Northwest Center for Public Health Practice (NWCPHP) - Provides training, research, evaluation, and communications services to support public health organizations. An outreach program of the University of Washington School of Public Health.
- Partners in Information Access for Public Health Professionals - A collaboration of U.S. government agencies, public health organizations and health sciences libraries
- Public Health Foundation (PHF) - The Public Health Foundation (PHF) is dedicated to achieving healthy communities through research, training, and technical assistance
- United States Department of Health and Human Services
- Washington State Department of Health
- Washington State Department of Social and Health Services
- Washington State Health Care Authority - Oversees 8 programs: Basic Health, Health Technology Assessment, Medicaid and Medical Assistance Programs, Prescription Drug Program, Public Employees Benefits Board, Uniform Medical Plan, Washington Health Program, Washington Wellness