A separate department of health in Washington State: four years before the mast

This paper reviews the recent experience in Washington State which resulted in creation of a separate state Department of Health. Until the 1989 legislation was passed, Washington was one of 19 states in which public health was organizationally housed in a superagency. The Institute of Medicine, in its 1988 report on The Future of Public Health, recommended that states organize core functions under a separate department of health. The effort in Washington State was led by local public health officials. Success followed four years of hard work during which mistakes were made, coalitions were built, and legislative process was learned.