Commentary: County Health District Better Than State Districts


In December, Gov. Jay Inslee announced his intention to put forward “legislation that creates a regional, coordinated approach to local public health through comprehensive public health districts.”

His plan, in the form of House Bill 1152 and Senate Bill 5173, would repeal local health boards’ authority over most public health responsibilities and create regional health districts operated by the state.

Such a policy shift is a mistake.

The motivation for such a change comes from the state and those utopians who believe that big state government should be managing more and more details of our lives. 

Advocates for such a policy, of course, include the state governor, the state Department of Health and those who think their niche agenda might have a better shot with a state agency administering programs. Their argument is an old one. It relies on three myths: 1) people farther away are smarter than people nearby; 2) if the source of funding for an entity is vague we can assume there will be more of it; and 3) large entities have “economies of scale” which allow them to do more with less money.

None of these are guaranteed to be true. 

The idea that people farther away are smarter is just silly. If this is true, then the governor should be advocating that all public health responsibilities be turned over to the national government. But our governor spent a great deal of energy criticizing the federal involvement in public health even though federal government employees are presumably smarter given this thesis.

If anything, the knowledge of local officials is far more extensive on local needs, local allies and local priorities. It is also doubtful that a remote overlord of public health policies would accurately reflect local values and desires. Remote experts who are unaligned with local values end up losing credibility and the critical “buy-in” of the citizenry. 

Funding that comes “from somewhere else” is easier to squander as the federal government demonstrates on a minute-by-minute basis. The reality of government is that once programs are established at a centralized level, underfunding is actually easier to hide. Limited resources collected from a local source for local needs are much more likely to have the scrutiny, sweat equity and leveraging than inscrutable budgets at the state level.

It is true that the larger boat of a state agency will have some economies of scale, but ultimately the work of direct service is the same, and the costs are the same or possibly less at the local level. Furthermore, the larger boat of a giant state program invites more passengers. Empirically, the deep pockets of the state invite more “me too” programs, services, missions, and special interests demands. State programs have rampant “mission creep” and mandates that are not properly funded. This development inevitably jeopardizes the core services. 

Local control prevents mission creep because local leaders spending local funds more carefully scrutinize special interest demands. As it happens, the centralization of health services with the governor’s regional bureaus is supported by various niche special interests who hope the state will be easier to lobby than a host of local county health districts.

Keep in mind also that the majority of the funds for the county health department comes from the state Department of Health and the federal government (WIC). The administration of those funds is very specifically prescribed and overseen. In a way, the state is already controlling the county health services, so perhaps all they really want is the empire. 

A more sinister allegation is that the racism of local officials can only be overcome by a state takeover. This is absurd. As evidence of this claim they suggested in The Chronicle (Jan. 25) that “Hispanic Washington residents make up 13% of the population but 33% of COVID-19 cases in which ethnicity is known.” Do they think that local health officials are causing higher infection rates among Hispanic residents? 

High-strung critics have suggested that even the officials of Seattle were racists, so what makes us think that Olympia-appointed officials are free of this blight? At least local officials can be scrutinized for alleged bad actions by local voters.

The reality is that our highly educated professionals of Lewis County are more motivated to look after the needs of their community members — all of them — than strangers in another city would be. 

Health care work requires developing a high level of trust. Local leaders are best equipped to work on that; faceless bureaucracies simply dole out their expertise and Olympia-designed solutions and collect their pay. Do we really want governor appointees from urban areas or other states prescribing what the priorities for this area are? What if they decided not to partner with our local charities? What if they decided school medical clinics were a public health priority? Started a needle exchange program and drug injection sites? The resident’s avenues for input would be almost nonexistent. 

We are already seeing the flaws of the state-run Employment Security Department, which lost $600 million of unemployed workers’ money. Or the state auditor who lost 1.4 million Washingtonians’ Social Security numbers. Or the flaws of the state-run vaccination distribution effort. The evidence that Olympia is wiser is awfully thin right now.

I guess the governor and special interests want you to believe in the great and powerful Oz, but to “pay no attention to the man behind the curtain.” State lawmakers should oppose HB 1152, which is now moving through the legislature. 


Jami Lund serves as a member of the Lewis County Public Health & Social Services Advisory Board.