Now Is the Time for the Foundational Public Health Services

The conversation about the FPHS requires consideration of how they align with public health accreditation and how both can be used in transformation efforts.

In a post-COVID-19 pandemic world, have you wondered what governmental public health will look like, how public health departments and practitioners can be best prepared to combat the next crisis, and how the field can continue to grapple with ongoing public health issues? Fortunately, the concept of the Foundational Public Health Services (FPHS) has gained new prominence as policymakers are using the framework to focus on and invest in public health infrastructure, advance equity, and address emerging threats to our livelihoods. Additionally, the FPHS have been and continue to be implemented to transform and modernize public health systems from the ground up, which we posit has resulted in improved outcomes, the creation of new service delivery models, and dedicated funding for the FPHS. The momentum around the FPHS is strong, and we must seize these opportunities now to meet the evolving needs of the field at all levels to create equitable and modern public health systems. Additionally, PHAB accreditation continues to be a way for health departments to advance quality, performance and to transform. Both the FPHS and accreditation will be essential to building back public health systems better into the future – truly building 21st Century Public Health.

Brief Overview of the FPHS

The FPHS framework outlines the unique responsibilities of governmental public health and defines a minimum set of services that must be available in every community. Additionally, to best serve their communities, Tribal, territorial, state, and local health departments provide additional services specific to their community’s needs and may require additional capacity in different areas. Click here to learn more about the FPHS framework.

The Importance of the FPHS Today

Health departments need sustainable, long-term funding towards cross-cutting capabilities to transform. Health departments are at the ready 24/7 to serve their communities. That requires access to a wide range of critical data sources, robust laboratory capacity, preparedness and policy planning capacity, and expert staff to leverage in support of public health protections. To best provide the FPHS, health departments need a workforce that can provide the Foundational Capabilities. Evidence suggests many public health departments do not have the dedicated funding needed to implement and sustain the Foundational Capabilities nor the workforce needed to provide those capabilities[1]. Without these key components, public health departments simply can’t deliver seamless, high-quality protections the public expects. Public health departments prevent and respond to the spread of infectious and chronic diseases and other public health issues, bring people together to help communities stay healthy, and are deepening efforts to confront and dismantle unjust systems and structures. To continue these activities and respond to new threats, the governmental public health system needs an ongoing commitment to fund the foundational public health infrastructure from federal, Tribal, territorial, state, and local governments. The FPHS framework provides value in transformation and modernization efforts by:

  • Creating a common language and national understanding of governmental public health’s vital role in a thriving community.
  • Serving as a framework against which capacity and resource gaps can be determined, as can the cost for assuring foundational activities to understand and justify funding needs.
  • Providing opportunity for standardization across jurisdictions, but with the flexibility to adapt to specific needs.
  • Aligning with national initiatives, such as public health accreditation.

Across the country, several states are working to transform their governmental public health system by adopting and implementing the FPHS framework. PHNCI supports the 21st Century (21C) Learning Community, a group of states in various stages of adopting the FPHS framework, from initial conceptualization to implementation. PHNCI has collected materials generated by learning community members, and they have been categorized as those that have helped set the stage for FPHS, FPHS frameworks that define core services, models to deliver FPHS, assessments of existing and needed capacity to fully implement FPHS, financing and implementation strategies, and accountability metrics.

Additionally, the Bipartisan Policy Center recently called for gradually allocating $4.5 billion annually for a new public health infrastructure account to support state, Tribal, local, and territorial public health capabilities, and $4 billion annually for the Prevention and Public Health Fund to bolster public health programs and local needs. This funding would be paid for by a public health excise tax on products that have an adverse effect on health such as alcohol, tobacco, nicotine in vaping, and sugar-sweetened beverages. This type of tax can lead to direct and indirect savings through discouraging behavior that may cause disease[2].

Lastly, several pieces of legislation that provide direct investments into foundational activities are making their way through Congress. Two key acts include:

  • American Rescue Plan Act (H.R.1319) provides funding for state and local governments to bolster the public health workforce.
  • Build Back Better Act (H.R.5376) would provide funding to support core public health infrastructure, largely aligned with the Foundational Capabilities, for state, territorial, local, and Tribal health departments, and encourages progress towards accreditation.

The FPHS and Accreditation

The conversation about the FPHS requires consideration of how they align with public health accreditation and how both can be used in transformation efforts. The Foundational Capabilities represent the public health infrastructure needed to support basic public health protections and other programs and activities that are key to ensuring the community’s health and achieving equitable health outcomes. Version 2022 of the Public Health Accreditation Board (PHAB) Standards & Measures (to be released in spring 2022) will designate and emphasize Foundational Capability measures, thus raising their necessity and importance for a high-performing health department. These measures will also be featured in PHAB’s Pathways Recognition Program, which serves as a steppingstone for health departments to assist them as they progress in their performance improvement journeys.

As Foundational Capabilities are being addressed and met at these varying levels, this increased visibility of the connection between the FPHS and accreditation helps strengthen accountability of health department performance to the public, ensures Foundational Capabilities are underlying services provided within communities, and builds up the public health infrastructure that makes our country a healthier and safer place to live and work.

As the FPHS framework is being adopted and embraced in many states, it is guiding investment in transformation and modernization efforts, it is grounding the process and field in equity, and it is building momentum around learning from states who are using it. We now have an opportunity to strengthen our public health system and keep moving forward to build on the FPHS work. We hope you will join us on this journey as we ramp up our 21C efforts to further expand our reach and showcase the transformation work that is happening across the country.

[1] Developing a Financing System to Support Public Health Infrastructure, The Public Health Leadership Forum, November 2018.

[2] Positioning America’s Public Health System for the Next Pandemic, Bipartisan Policy Center, June 2021.

Author Profile

Travis Parker Lee
Travis Parker Lee, MBA, is a Program Specialist at PHAB, where he provides programmatic support to the Public Health National Center for Innovations. Prior to joining PHAB in 2009, Travis was the Program Assistant for Accreditation and Quality Improvement at the National Association of County and City Health Officials. He holds a Master of Business Administration degree from the University of Maryland Global Campus and a Bachelor of Science degree in Public Health Education from James Madison University.