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SUBJECTS › HEALTH › Local Government Public Health Administration
Updated 09/08

Local Government Public Health Administration

Contents

About Public Health Administration in Washington

In Washington State, responsibility for public health protection is shared among the the State Board of Health, Washington State Department of Health, and the 34 local government 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, it 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. More on Washington State public health system can be found on  About the Washington State Department of Health.

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Funding for Local Government 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.  The 2007 state operating budget provided $20 million for local public health jurisdictions (in addition to continued backfill) distributed by formula. 

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 - Public Health Improvement Plan

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.

Local Government Health Boards

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, determines terms of office, compensation or reimbursement, 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.

Local Health Officer

Each local board of health must appoint a health officer who must be a licensed, experienced physician and 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 - Local Board of Health

Health Departments

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

Single County Health Departments

Health Districts (Chapter 70.46 RCW)

A health district is all the territory consisting of one or more counties organized pursuant to the provisions of chapters 70.05 and 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).

By way of historical background, counties were authorized in 1939 to levy .4 mills on assessed valuation or thirty cents per capital based on the population of the county, exclusive of any first class city in the county, which ever was less. In 1945 legislation to create health districts was enacted. Ch. 183 Laws of 1945 provided for the creation of health districts consisting of two or more counties, to include all cities and towns except those with population over 20,000. Other cities between 20,000 and 100,000 could join by a petition from the legislative body. Cities over 100,000 were excluded. Chapter 46, Law of 1945 permitted any county, first class city or health district to pool facilities and finances. The original legislation defined health district as "all territory consisting of one or more counties and all cities with a population of 100,000 or less, and towns therein."

Accreditation of Public Health Departments

Organizations and Agencies

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