Background:

Structure of the Public Health System.

"Public health" is defined by statute as the activities that society does collectively to assure the conditions in which people can be healthy. The public health system in Washington includes the Department of Health (DOH), the State Board of Health (Board), 35 local health jurisdictions, and tribal governments. The DOH is charged with: performing duties related to vital statistics; studying factors related to health improvement, the causes of morbidity and mortality, and the effects of the environment on public health; investigating and advising local health officers; performing health inspections; regulating public water systems; and maintaining a public health laboratory. The 10-member Board provides a public forum for the development of public health policy. Rules adopted by the Board cover issues such as newborn screening, childhood immunizations, disease prevention and control, cleanliness of facilities, drinking water quality, food service, and vital statistics. Local health jurisdictions (county health departments, multi-county health districts, and city-county health departments) enforce public health statutes, as well as rules adopted by the Board, the DOH, and local governments.

The state, tribes, and urban Indian health clinics address public health issues through a government-to-government relationship. Protecting the public's health across the state is recognized in statute as a fundamental responsibility of the state. Distributions to local health jurisdictions must deliver certain outcomes, such as a reduction in vaccine preventable diseases and creation of a disease response system capable of responding at all times.

Public Health Services Improvement Plan.

The DOH is required to submit a biennial public health services improvement plan developed in coordination with the Board, local health jurisdictions, and others. The plan addresses minimum standards for public health protection, strategies and a schedule for improving public health programs throughout the state, and a recommended level of dedicated funding.

Core Public Health Functions of Statewide Significance.

In 2008 the DOH was required to develop a prioritized list of activities and services performed by local health jurisdictions that qualify as "core public health functions of statewide significance" and to adopt performance measures. The DOH and local health jurisdictions must abide by the list and performance measures.

The DOH provides local jurisdictions with financial incentives to encourage local investments in core public health functions. Local jurisdictions may not supplant existing local funding with those state resources. "Core public health functions of statewide significance" are health services that: (1) promote uniformity in public health activities, increase the system's strength, or apply to broad public health efforts; (2) if inadequately addressed, are likely to have a significant adverse impact beyond the borders of the local health jurisdiction; and (3) address communicable diseases, public health emergencies, chronic diseases and disabilities, promotion of healthy families and the development of children, environmental health concerns, and assessment of local health risks and trends.

Funding for Foundational Public Health.

The 2016 Supplemental Operating Budget directed the DOH and local health jurisdictions to provide a proposal outlining a plan for implementing foundational public health services statewide to modernize, streamline, and fund a 21st century public health system. In the 2017-2019 Operating Budget, the Legislature appropriated one-time funding of $12 million for foundational public health services.

Summary:

Foundational Public Health Services Funding.

Funding for foundational public health services must be appropriated to the Office of Financial Management (OFM). The OFM may only allocate funding to the Department of Health (DOH) if the DOH, after consultation with federally recognized Indian tribes pursuant to the statutory consultation process, jointly certifies, with a state association representing local health jurisdictions and the State Board of Health (Board), to the OFM that there has been an agreement on the distribution and uses of state foundational public health services funding. If joint certification is provided, the DOH must distribute the funding according to the agreed-upon distribution and uses. If joint certification is not provided, the appropriation for foundational public health services lapses.

By October 1, 2020, the DOH, in partnership with local health jurisdictions, sovereign tribal nations, and the Board must report on:

service delivery models, and a plan for further implementation of successful models;
changes in capacity of the governmental public health system; and
progress made to improve health outcomes.

Foundational Public Health Services.

"Foundational public health services" means a limited statewide set of defined public health services within the following areas: control of communicable diseases and other notifiable conditions; chronic disease and injury prevention; environmental public health; maternal, child, and family health; access to and linkage with medical, oral, and behavioral health services; vital records; and cross-cutting capabilities including assessing the health of populations, public health emergency planning, communications, policy development and support, community partnership development, and business competencies.

"Governmental public health system" means the state DOH, Board, local health jurisdictions, sovereign tribal nations, and Indian health programs located in Washington. "Service delivery models" means a systematic sharing of resources and function among state and local governmental public health entities, sovereign tribal nations, and Indian health programs to increase capacity and improve efficiency and effectiveness.

The definitions of "core public health functions of statewide significance" and "local health jurisdictions" are repealed. The statutory provisions related to the public health services improvement plan are repealed.

House	94	4
Senate	44	1