Just like our Covid-19 response, transformation of the governmental public health system takes grit and grace among partners.


21C states are embedding a variety of innovative strategies into their transformation efforts, with a focus on health equity, Foundational Capabilities and workforce, and accreditation. Examples of each are shared below:

Health Equity

Many states have incorporated and specifically called out health equity in their state FPHS models, which serves as a lens through which all public health services should be assured.

The Minnesota Legislature provided funding for local and Tribal public health projects to build public health capacity and pilot new organizational models in health equity. The state is providing training and technical assistance to build knowledge, skills, and abilities across the state, and is also working to increase racial/ethnic diversity in workforce.

Missouri has developed a facilitated workshop that walks public health professionals through a deeper self-assessment of health equity practices within their agencies. Using a step-by-step workbook, participants will develop action plans to build individual and organizational capacity to assure foundational public health services grounded in health equity.

Foundational Capabilities and Workforce

North Carolina has a Community Health Worker initiative across all 100 counties, as well as a public-private partnership with community-based organizations, to reach underserved populations. The state also recruits external advisors from historically marginalized populations to contribute to the State Health Improvement Plan and Healthy North Carolina 2030 goals.

Ohio has used federal and state workforce development dollars to add dedicated communications and regional support staff across the state. These positions help coordinate shared planning and implementation efforts between the state and local governments.


Nebraska’s strategy to transform and modernize public health includes a commitment to meeting national standards and measures for public health departments. This commitment continues with a vision to have every health department on a pathway to meeting national accreditation standards, which may include at a minimum engaging in regular community health assessment and health improvement planning activities or achieving and maintaining accreditation status.

Nevada is leveraging accreditation to transform its public health system. Through its commitment and investment in accreditation, Nevada plans to use accreditation as a means to achieve lasting, systemic changes, develop a culture of continuous quality improvement, and enhance performance management to better promote and protect the health of all Nevadans.