Lawmakers in Olympia are considering an overhaul of Washington state’s public health system to increase access to basic services.

A number of changes are expected as the bill works its way through committee. The basic idea is that areas of the state will pool their public health departments until the number of people they serve reaches a certain population. It would also clarify which basic, or foundational, services public health agencies statewide would be required to provide. Across the state, there are 35 local health jurisdictions, each governed by a local health board.

The legislation (HB 1152) was proposed by Rep. Marcus Riccelli, a Democrat representing Spokane. Currently, the target number for pooling resources is 250,000 people, but Riccelli said that’s likely to change based on feedback from counties and local health officers. Counties with large populations such as King, Snohomish and Pierce counties will likely be allowed to use their existing public health departments.

Other areas of the state where counties have already partnered together to provide health services could also see carve-outs in the bill. Riccelli said the goal of the legislation is to create a health system in Washington that’s state-supported with adequate funding, locally implemented and coordinated regionally.

“The pandemic has shown that we need stronger state support, so we need public health that’s state-supported,” he said.

Over the last year, politics has crept into discourse around public health, Riccelli said. Statewide, there have been instances of key public health leadership being ousted by health boards. In October, the Spokane County Board of Health fired its top health officer, Dr. Bob Lutz.

To help address that, Riccelli introduced a related bill (HB 1110) that will require health boards to include medical experts, stakeholders and people with lived experience, instead of allowing only politicians to serve, as is the case in some areas of the state. These stakeholders and experts must make up at least half of the boards under the bill.

“Really what the intent is to bring balance to our public health boards,” Riccelli said.

King County details

In King County, there are eight health board members and three additional alternate representatives from the county, Seattle and suburban cities. Health professionals and Seattle & King County Public Health have five seats.

The restructuring of health districts would be informed by the board composition. And in King County, lawmakers see other benefits.

Rep. Gerry Pollet, a Democrat representing the 46th Legislative District, said HB 1152 strengthens the definition of what foundational health services are and how to fund them. These include controlling communicable diseases, environmental public health and and child health.

Pollet and Riccelli both said public health funding from the state has been gutted in recent decades. To help make up funding, Pollet has proposed a bill (HB 1345) that would create a manufacturing license for nicotine vaping products and add a 45% excise tax and a surcharge on vaping products. This would go to fund public health and the Andy Hill Cancer Research Endowment Fund.

Pollet said this, combined with the other bills, could help build a more equitable and healthier state.

“For Seattle, King County, I think it would strengthen the overall ability to investigate and respond to public health threats whether it’s communicable diseases or sexually transmitted disease, drug epidemic, youth nicotine addiction. And it would enable a strong integrated Seattle-King County public health agency to really do more to look at the social determinants of health, which is how you tackle the racial disparities that we see in COVID,” Pollet said.

However, there have been concerns raised since the legislation was proposed. Officials in Clallam and Jefferson counties in the north Olympic Peninsula told the Forks Forum in January they were worried that restructuring could harm their health district. If no exceptions were made for their district, they may have to partner with neighboring counties that may not share their values or commitment to services they currently provide like needle exchanges or providing birth control for teens.