The spotlight on public health has never been so prominent in everyday news than it has been since the COVID-19 pandemic began, and health departments have proved that they are vital to the health and safety of local communities. However, they have been underfunded, insufficiently staffed, and forced to operate with outdated systems that are not sufficient. There are opportunities now to transform the governmental public health system to work for all communities by centering equity, modernizing data systems, and equipping health departments with the necessary infrastructure to provide foundational services. The Public Health Accreditation Board (PHAB) and its innovation center, the Public Health National Center for Innovations (PHNCI), are leading the way to transform public health practice.

It has become evident that public health systems nationwide are deeply inadequate – the infrastructure, workforce, and systems needed to provide essential functions are outdated, insufficient, and in dire need of modernization. Since health departments serve their communities 24/7, they require the necessary infrastructure to access a wide range of critical data sources, robust laboratory capacity, and preparedness and policy planning capacity, as well as the expert staff to leverage them in support of public health protections. This important public health infrastructure requires an investment from and at all levels for transformation to work and to support basic public health protections, programs, and activities key to ensuring community health, well-being, and achieving equitable outcomes.

For more than a decade, PHAB, a non-profit organization dedicated to advancing and transforming public health practice through public health accreditation and innovation, has implemented programs and activities that drive transformation efforts at all levels within the public health system. These not only include the national accreditation program for governmental public health, which strengthens public health infrastructure, but initiatives through PHNCI that focus on innovation, transformation, and empowering health departments to drive change.

PHAB and PHNCI have engaged with health departments and collaboratives to identify, implement, and replicate innovations in communities, and align efforts across sectors and advance health equity. PHNCI has expanded the 21st Century (21C) Learning Community to focus on building and strengthening governmental public health infrastructure and systems to create change through centering equity, modernizing data systems, and equipping health departments with Foundational Capabilities and workforce needed to serve, rebuild trust, and be accountable to their communities.

Many states have been positively impacted by these transformation efforts, which are often led by health departments, system partners, and communities themselves. 

• In Washington, a 21C Learning Community participant, the state legislature enacted statutes that defined the governmental public health system, provided definitions for foundational services, and distribution processes for resources. Recently, the state successfully allocated a $147 million investment in the 2021-2023 biennium, as well as a $148 million per year ongoing investment starting in FY2024. These dollars fund the infrastructure to provide foundational services statewide (including local health department capacity and Tribal assessment processes) and new service delivery models that will provide foundational services more efficiently and effectively. Their success and lessons learned have been disseminated to other 21C states who strive to build similar support governmental public health at the state and local levels.
• In neighboring 21C state, Oregon, the legislature codified foundational services in statute as the framework for governmental public health. Recently, the state allocated a $60 million investment to strengthen leadership and governance/regional infrastructures and embed health equity and cultural responsiveness across the state. Additionally, this investment helps conduct Tribal modernization assessments and develop and implement modernization plans. The goal of this activity is to bring Tribes that would like to be a part of public health modernization to the point of implementation by the end of the biennium.
• In Missouri, the public health community has had robust conversations about the need for modernization, which have been focused on foundational services and accreditation. Recently, the state has identified several statewide gaps and deficiencies, and key opportunities for policy and system changes needed at the state level. Such changes would support a stronger public health system across the state and incentivize modernization of local health departments that are committed to enhancing their foundational services.
• As a result of the National Commission to Transform Public Health Data Systems, efforts to support states in modernizing their data systems as part of larger transformation activities is underway now. Through the 21C Learning Community, PHAB will engage several 21C states to serve as a Learning Lab in implementing the recommendations for data modernization practices, including stakeholder and power mapping, developing a plan to prioritize and begin implementation of the recommendations, and documenting lessons learned, challenges, and leading practices for advancing data systems transformation that centers equity.

PHAB has supported transformation efforts like those above to ensure that governmental public health can continue to serve as the backbone of the larger public health system and work collaboratively with other sectors and communities to respond to evolving community needs. This essential work drives future directions for public health and enhances the possibilities for everyone to have a fair and just opportunity to be as healthy as possible.