Public Health Transformation is not only important but necessary in redefining public health’s role to acknowledge the social determinants of health and work collaboratively to remove barriers so individuals, families and communities can achieve optimal health.

Public health transformation is a journey; it is important to acknowledge and celebrate successes and share details across states so that efforts may be replicated.

The following examples of legislation, funding, and assessments in 21C states demonstrate the impact of transformation work:

In 2020, House Bill 129 made public health transformation law. The state determined that 3 full-time equivalents (FTEs) per 15,000 population (with an additional FTE per 5,000 population) were needed to do this work, and the current cost per FTE to be $109,000. This cost must be recalculated for each two-year state budget cycle.

In 2020, passed the original SAPHE Act, statute 72 of the Acts of 2020, entitled An Act Relative to Strengthening the Local and Regional Public Health System. Additional details on the SAPHE program are outlined here.

In 2021, received $15 million annual increase, a historic investment to increase support of their public health system

  • $7 million increase to local public health (LPH) grants; this is an annual increase to the base of the LPH grant. The increase to each community health board is based on a percentage increase to the current award.
  • $500,000 increase to Tribal Health Grants; an increase to the base of the Grant. View bill language on page 450.21.
  • $6 million to New Public Infrastructure Funds; new funds for community health boards and Tribal governments to support their ability to build Foundational Capabilities and meet national public health standards. Minnesota Department of Health (MDG) will work with State CHS Advisory Committee to determine the process for distributing funds. View bill language on page 159.1.
  • $1.5 million to new MDH funding public health system and oversight; funds will be used to assess the capacity of the public health system, estimate costs, and oversee transformation. View bill language on page 451.1.

  •  In 2022, they completed a joint Ohio Department of Health and Association of Ohio Health Commissioners (AOHC) Modernization Project. This resulted in an environmental scan and recommendations for the legislature.
  • In 2022, they received $6 million for feasibility studies for smaller city health districts.
  • During COVID response, they used their gap analysis data to identify the gap between the existing contact tracing staff levels at the local level compared to the needed number, resulting in a $37 million investment for LHDs to conduct case investigation and contact tracing.
  • 2017-2019 state budget allocated $3.5 million to address accreditation fees and coordination, as well as infrastructure costs for mergers.
  • The State’s Regents Program allocated $5 million to help local health departments become accreditation ready and support specific research projects.
  • In 2020, they issued a report on the second Costing of FPHS tool and Annual Financial Report.
  • In 2019, they issued a report on the first rollout of the Costing of FPHS tool and Annual Financial Report.
  • In 2012, the AOHC released the Public Health Futures Report.

  •  In the current biennium, the legislature invested $60.6 million, with the majority of funds allocated to the state’s 32 local public health authorities and some funds allocated to federally recognized Tribes.
  • In 2020, they created a new community engagement team that funds and supports a network of community-based organizations across the state to lessen the impact of the COVID-19 pandemic on black, indigenous, tribal, and people of color, as well as other groups experiencing health inequities.

  • In the 2021-2023 legislative cycle, they requested $285M for communicable disease, environmental health, assessment, and a portion of the cross-cutting capabilities; appropriated a total of $175M and in the subsequent biennium promised a total of $324M (72% of the need), ongoing.
  • In 2021, Engrossed Second Substitute House Bill 1152 was passed to diversify local boards of health to include more voices from the scientific community and community members to address equity as a part of its transformation process and establish a Public Health Advisory Board.
  • In the 2019-2021 legislative cycle, they requested $296M for communicable disease, environmental health, assessment, and a portion of the cross-cutting capabilities; appropriated $28M per biennium ongoing.
  • In 2019, the governmental public health system, Foundational Public Health Services, the State’s role, and shared decision-making process for allocations were codified in state law (RCW 43.70.512 & 43.70.515).
  • A 2018 baseline assessment revealed that an additional $450M per biennium is needed to fully implement the FPHS in Washington.
  • In the 2017-2019 legislative cycle, they requested $60M for communicable disease; appropriated $15M one-time funding.