Foundational Public Health Services

This week, the Governor signed a state budget that makes significant investments in the governmental public health system.

This system, and public health generally, has long been underfunded, resulting in gaps in the ability to equitably protect and improve the health of everyone, everywhere in our state.

With public health funding, it’s feast or famine. Right now there is a lot of attention and funding directed at public health, to help us get out of the COVID pandemic and into recovery. This is the typical course of events – an emergency happens, generous funding comes to states to address the emergency, and then funding goes away.

To get us out of this cycle, the State Department of Health, State Board of Health, local health jurisdictions and tribal public health partners have been working together for years to secure adequate, sustainable, predictable resources for this system. In order to be successful, we have:

  • Defined a limited set of core public health services, uniquely provided solely or primarily by government everywhere, that are population-based and frequently mandated by law;
  • Produced system results that demonstrated a $450M/biennium gap in our ability to deliver Foundational Public Health Services (FPHS) equitably across the state;
  • Focused first on requesting funding for areas that best meet these characteristics, including communicable disease control, environmental public health, and assessment (surveillance and epidemiology);
  • Relied on committees of subject matter experts from across the system to design and prioritize funding requests that make best use of technology and professional skill sets; leverage federal match dollars; and explore new service delivery models;
  • Presented to legislators as a system, and asked partners such as those from the health care delivery system to support our requests;
  • Reported to legislators on investments and outcomes.

The infusion of new money into the governmental public health system amounts to $147M in the current 21-23 biennium and $296M in future biennia ongoing. Over time, the resources will be used to strengthen and develop work in specific programmatic areas like communicable disease control, environmental public health, maternal and child health, chronic disease and injury prevention, and access to care. Resources will also help with infrastructure to support information systems and laboratory capacity, and capabilities like assessment, communications, emergency planning, policy and planning, community partnership development, and leadership development. We will continue to convene cross-system groups of subject matter experts to design service delivery models and prioritize funding requests.

Governmental public health system partners make decisions about allocations of funding through the work of the Foundational Public Health Services Steering Committee, as described in state law (RCW 43.70.515). To learn more about FPHS, go to

What is remarkable about the investment that our state leaders are making right now in the governmental public health system is that they are doing so with an eye to the future. They understand that post-COVID, our system needs to be robust and modern and well-staffed if we are to address future emergencies and 21st century public health issues like behavioral health, chronic disease, racism, social determinants of health, and an aging population.

And that is taking the long view.


Maria Courogen is the Systems Transformation Director at the Washington State Department of Health. The Systems Transformation team members serve as connectors, working to elevate and align agency efforts with governmental public health, and other health and wellness system partners. The team helps facilitate collaborative engagement strategies, and leverage information and opportunities to advance transformation efforts systemwide.