Setting the Stage

Transforming public health is a multi-year effort that requires commitment and buy-in from individuals who work within the system and others who are critical to achieving this far-reaching goal. At the outset it is important to articulate the problems that need to be addressed and to convene all those needed for a successful change process. On this page you will find reports that describe work done at the outset of the 21C learning community states’ efforts to modernize their public health systems.

State and local governmental public health department staff began working hand-in-hand to modernize and fund public health in 2018. The foundational product of their effort is a brief that reviews the state of public health, goals for transformation, and next steps.

In 2015, the Kansas Association of Local Health Departments held a retreat for a group of its members and other key stakeholders to develop a unified vision for the state’s public health system. The retreat summary includes an initial vision statement and several implementation strategies to bring it to reality.

The Kentucky Health Departments Association (KHDA) has been working since 2014 to transform public health. Their efforts resulted in a proposal “to build a strong equitable infrastructure to enable local public health professionals to identify population health needs and apply appropriate responses within a comprehensive public health system.”

Minnesota’s nationally recognized state-local public health partnership has served Minnesotans well since established in 1976, but as Minnesota changes, health inequities persist, and the issues facing communities across the state become more complex, the public health system must evolve. “What” governmental public health must do is becoming clear as public health leaders and technical experts across Minnesota develop a set of Foundational Public Health Responsibilities. “How” Minnesota’s state, local and tribal health departments best carry out those responsibilities is yet to be determined. The Commissioner of Health convened a bold, creative group of leaders to reimagine Minnesota’s public health system and chart a course forward to ensure public health responsibilities are effectively and efficiently carried out in every corner and every community across Minnesota.

Every Missourian deserves access to foundational public health programs and services in their own community — services that protect families, promote healthy choices and prevent the spread of disease. FPHS are a minimum set of fundamental services and capabilities that must be available in every community in order to have a functional public health system. Additional services can be added to this framework, in order to achieve state or national accreditation or meet specific local needs. The overall goal is effective and efficient population health management with health equity and social determinants of health as a lens through which services are provided.

The Association of Ohio Health Commissioners appointed an ad hoc steering committee of its members in 2012 to consider and make recommendations on the functions, fiscal requirements and organization of local health districts in the state. The resultant report provides a summary of the current state of local public health, recommendations for the future, and a picture of significant disparities in funding and service capacity among local health districts throughout Ohio.

Oregon House Bill 2348 (2013) created the Task Force on the Future of Public Health Services to study the future of public health services in Oregon, and to make recommendations for legislation. The 15 members appointed to the Task Force included representation from state and local governmental public health agencies, academia, health care, social services, labor relations, non-profits and the state legislature. The report’s recommendations address basic public health services, as well as their delivery, funding and performance measurement.

Two years after the Task Force report was released, the Oregon Health Authority released a report on the economics of public health investments, with estimates on the ongoing cost of selected preventable conditions to the population, examples of recommended funding levels to close gaps in services currently not reaching all Oregonians, and calculations of the very small decreases in preventable conditions needed to offset the investments.

In 2017 the Coalition of Local Health Officials published the Oregon Public Health Modernization Roadmap, which provides steps to implementing successful system change initiatives for FPHS.

In Washington, the state department of health, state board of health, and local health jurisdictions collaborated on a proposal to rebuild, modernize and fund a 21^st century public health system. Directed by a proviso in the 2016 supplemental state budget, the report reviews the state of public health and provides a blueprint for modernization.