Washington’s FPHS System is, at its core, a collaborative effort intended to fully fund and provide essential public health services across the state. FPHS are delivered by the four sectors of Washington’s governmental public health system: local health jurisdictions (LHJs), sovereign Tribal nations, the State Board of Health, and the State Department of Health.
When we talk about FPHS, the term can be used in several ways:
Foundational Public Health Services funds are benefiting communities across the state. These stories represent some of the impacts of systemwide collaboration and funding for governmental public health. You can look up stories by topic and location at the FPHS In Action page.
Thanks to FPHS Immunization Outreach and FPHS Reinforcing Capacity funds, Spokane’s Immunization Assessment & Promotion (IAP) team was able to implement two successful vaccine campaigns, create community-specific resources, provide educational opportunities for vaccine advocates, develop and maintain partnerships, and provide access to vaccines for uninsured adults.
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Skagit County Public Health has been able to provide STI testing, treatment, and outreach to communities living in remote areas, experiencing homeless, or facing other barriers to accessing care.
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Families who have a child with an elevated blood lead level tell us how grateful they are for the education and assistance the Lead Prevention program provides. Overwhelmed staff at medical clinics also express gratitude for our lead prevention program and the support we provide to families. Lead poisoning is preventable, and with FPHS dollars, we are making a difference for families in Pierce County.
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Washington law (RCW 43.70.515) identifies the seven limited statewide sets of defined public health service areas that make up “foundational public health services.”
What makes a public health services “foundational”?
In practice, these guidelines needed to be translated into workable areas that can translate across the governmental public health system. To do this, the FPHS Steering Committee developed a set of definitions to clarify which among public health services are considered to be foundational.
They ended up creating two primary categories for FPHS: Foundational Program Areas and Foundational Capabilities. Foundational Program Areas are those specific subject-based activities done by the governmental public health system. Foundational Capabilities represent infrastructure and activities that affect and influence all Foundational Program Areas.
It is important to remember that FPHS does not represent all public health services. What is shared on this website and its dashboard is limited specifically to FPHS. There are many other additional public health services being done in Washington by nonprofits, healthcare providers and others. While important, they are not considered Foundational.
The FPHS Steering Committee (SC) is the decision-making body for FPHS and how funds are allocated across the state. It is composed of representatives from all four quadrants of Washington’s governmental public health system and convenes monthly (or as needed) to achieve concurrence through consensus-based decision making. The Steering Committee is supported by several operational and advisory teams.
DOH programs and services, implemented in collaboration with local health departments and state, federal and private partners, touch the lives of all Washingtonians and visitors to the state. DOH provides comprehensive public health services and programs to the community through a workforce of approximately 2,000 public health professionals– all dedicated to improving the health and well- being of Washingtonians and the communities in which they live, learn, work, worship, and play.
SBOH provides leadership and advances public health practices that protect and improve the public’s health. Their work focuses on analyzing policies, developing rules, promoting partnerships, and encouraging public engagement in the public health system.
FPHS
Steering Committee
LHJs are represented and convened in the FPHS System through the Washington State Association of Local Public Health Officials (WSALPHO). WSALPHO collaborates with other public health agencies to advance public health, educate and inform policymakers on local health issues, advocates for public health policy, and empowers local health departments.
The American Indian Health Commission (AIHC) serves as the FPHS liaison organization for the 29 federally recognized Indian Tribes whose traditional lands and territories included parts of Washington, and two Urban Indian Health Organizations.
Each sector designates staff to work together to support the operations and management of the system. These individuals collaborate in communications across the state, facilitation of meetings, liaising with their home sectors, facilitating advisory groups, developing and refining policy, quality improvement, and fiscal management.
The Project Management Team is composed of FPHS System Staff and several Steering Committee members. They set agendas for SC meetings and oversee high-level operational decisions and communications between them.
SME Workgroups exist to advise the SC on specific subject matter areas, providing a connection to the realities of current trends and challenges. They are comprised of working professionals in each of the subject matter areas from across the system, and co-lead positions for each of these groups are reserved for one person from each sector. Between the six workgroups, all program and capability areas are covered.
Communicable Disease works to prevent and control communicable diseases and other notifiable conditions. Examples of services in this area include disease investigations in response to outbreaks, promotion of vaccines as a measure of protection, data collection to inform planning for policies and programs, and diagnostic testing for infectious, communicable, genetic, and chronic diseases, as well as environmental health concerns, through the state's Public Health Lab.
Environmental Public Health includes services that protect the public's health by preventing and reducing exposure to environmental health hazards. Examples of services in this area include food, water, and waste inspections; data collection to inform planning for policies and programs; and efforts that help prevent exposure to harmful substances like lead, mold, and dangerous chemicals.
Maternal, Child, and Family Health services support healthy pregnancies, safe births, and strong starts for children. It is one of the three program areas that comprise the “Lifecourse” set of services.
Access to/Linkage with Care efforts ensure people know how to access clinical care and health coverage, while also working with local providers to improve care coordination. It is one of the three program areas that comprise the “Lifecourse” set of services.
Chronic Disease, Injury, and Violence Prevention uses data to identify risks and promote healthy habits to help people live longer, healthier lives. It is one of the three program areas that comprise the “Lifecourse” set of services.
Vital Records document life events like births and deaths to provide insight into birth and mortality trends and can inform public health decision-making.
Assessment capabilities ensure public health entities can collect, maintain, access, analyze, and interpret public health data for planning and decision making, including the development of health assessments and health improvement plans.
Business Competencies are basic infrastructure needs that support the system, including leadership and governance, information technology, workforce development, and fiscal management.
Communications capabilities ensure people have access to accurate, timely health information in a way they can understand.
Community Partnerships work focuses on building relationships with diverse partners across different levels of government, business, and community to address health challenges.
Emergency Preparedness and Response capabilities mean public health entities are ready to respond to disasters, outbreaks, and other emergencies with a focus on protecting those most at risk and keeping the public informed to help communities stay safe.
Policy Development includes creating evidence-based recommendations to improve community health and ensuring solutions are put into action effectively.
The governmental public health system has been delivering FPHS since before there was funding for it -- but has never been sufficiently funded for these essential services to be complete and statewide.
An Agenda for Change was produced by local and state public health officials in WA calling for a reshaping of public health to protect people from threats, build communities of prevention and promotion, and improve access to care. One of the key elements of this reform was long-term predictable funding.
A FPHS framework for Washington was developed, laying the groundwork for what the system would become, including criteria for defining foundational public health services.
The 2012 Public Health Improvement Plan included the Agenda for Change Action Plan which describes FPHS as services that should be available everywhere, and introduced the foundational programs and capabilities.
The FPHS Preliminary Cost Estimation Model was published. In it, an initial cost estimate to fully fund FPHS in local and state public health in Washington was presented. This was $327,990,000 biennially across the governmental public health system (in 2013 dollars).
An FPHS Phase 2 white paper was published. Included in the document was a revised cost estimate, discussion about a framework for service delivery, alignment of funding, determining effective models, and funding options.
The FPHS Policy Committee published A New Vision for Washington State and made funding and policy recommendations to the legislature. The report stated that public health is a basic responsibility of government, Washington state should fund FPHS, and FPHS fund allocation should be a collaborative process between locals and state.
Washington became an inaugural member state of the Public Health Accreditation Board’s (PHAB’s) 21st Century Learning Community (21C) States, where they led in developing the FPHS National Model.
A Plan to Rebuild and Modernize Washington’s Public Health System was presented to the Washington State Legislature. The plan defined the problem of public health funding and proposed the solution as Foundational Public Health Services – modernizing and adequately funding the public health system.
A request for $30 million per year for the 2017-19 biennium was submitted as a decision package to the Governor and State Legislature.
A baseline assessment was initiated to determine how much funding would be needed to fully implement FPHS statewide.
The State appropriated $6M per year for FPHS
Via a legislative budget proviso, Rebuilding and Transforming Washington’s Public Health System: Preliminary Report was submitted to the Legislature. The report included the first description of how FPHS funds had been allocated and utilized.
The baseline assessment was completed, identifying a need of $225M annually to fully fund FPHS
The State appropriated $3M/year more for FPHS, to a $9M total (4% of 2018 need)
April 3rd – Gov. Inslee signed the Foundational Public Health Services bill into law (2SHB 1497)
Tribes joined the FPHS System
The State appropriated $5M/year more for FPHS, to a $14M total (6% of 2018 need)
The State appropriated nothing more for FPHS, maintaining $14M total (6% of 2018 need)
Onset of the COVID-19 pandemic.
A FPHS System staff team began to be assembled with FPHS funds.
The FPHS System updated annual reporting process for fund recipients.
The State appropriated $52M/year more for FPHS, to a $63M total (28% of 2018 need)
A proposal process was implemented across governmental public health agencies and organizations to guide funding across the system.
The State appropriated $49M/year more for FPHS, to a $112M total (50% of 2018 need)
SC convened three Technical Workgroups to focus on updating the FPHS Definitions, revising how the FPHS System evaluates itself, and centering health equity.
The State appropriated $50M/year more for FPHS, to a $162M total (72% of 2018 need)
The State appropriated no new funds for FPHS, and reduced FPHS funding by $12M/year due to economic outlook and state budget cuts. (Down to 67% of 2018 need, at $150M total)
The FPHS System updated annual reporting process for fund recipients.
