Resetting the Course for Foundational Public Health Services (FPHS) During COVID-19

Underfunding of the governmental public health system in the United States has been a problem for many years, and the COVID-19 pandemic revealed the significant gaps in public health infrastructure that have resulted from this inadequate funding.

The states of Ohio, Oregon, and Washington received funding in 2016 to define, measure, and advocate for the foundational public health services (FPHS) delivered by the governmental public health system. They have taken unique but related approaches to strengthening work in the areas of categorical public health programs and the underlying infrastructure and capabilities that support the programmatic work.

All 3 states conducted assessments of gaps and funding needs that have allowed them to advocate for, and receive, limited resources for the governmental public health system. These resources were used to strengthen the public health system in ways that assisted with pandemic response. The pandemic also provided many opportunities for the states to demonstrate the importance of the foundational capabilities (assessment, communications, partnership development, policy, leadership, quality improvement, emergency response planning) and public health infrastructure in the areas of information technology and laboratory capacity. These opportunities allowed states to make progress in obtaining funding for FPHS.

While heavily focused on the program area of communicable disease control, the pandemic response highlighted the importance of having a robust public health infrastructure that is well supported in the areas of foundational capabilities. Substantial infrastructure investments will allow health departments to close gaps in health inequities; contribute to the significant work needed postpandemic in the areas of chronic disease, behavioral health, climate change, and social determinants of health; and be better prepared for future emergencies.