prevention rather than acute clinical care for individuals. The first version of the plan, published in November 1994, articulated how the public health system would assure accountability for its contribution to health status improvement through a set of system capacity standards and health status outcomes (Washington State Department of Health, 1994). In addition, the health care industry was rapidly preparing for anticipated changes in the delivery of and reimbursement for personal health care services.

The changes in the state's health system were slowed considerably in the spring of 1995 when the legislature repealed large sections of the 1993 Health Services Act. The new legislation contained some insurance reforms, portions of the previous health data system, and quality improvement initiatives. It increased state-sponsored health care for low income individuals and families and left intact the public health system reforms reflected in the Public Health Improvement Plan.

Despite the legislative changes, some activities already underway emphasized the need to develop partnerships among public, private, and academic health systems to improve community health status. The growing emphasis on cost containment, managed care, and quality also made a focus on prevention crucial. At the workshop, representatives of the public health, academic, and private health care systems in Washington State described some of the partnership activities underway and work being done on health status monitoring.

Public Health in Washington State4

The Washington State Health Department functions in a state with a strong populist tradition combined with acceptance of an active role for state government. Washington's population of about 5 million is served by 33 local health jurisdictions. With an area of roughly 71,300 square miles and 50 percent of the population living in the Puget Sound area, large portions of the state remain sparsely populated. Washington's local health jurisdictions are independent of the state health department and offer relatively few personal health care services.

In the late 1980s, the state reestablished a Department of Health separate from the combined Department of Social and Health Services that had been established several years earlier. The broad perspective of public health and the concerns of local health departments had not fit well with the more targeted responsibilities of the various social service programs. Several state actions leading up to this departmental reorganization set a pattern for a broad systems approach to health issues. The role of the state board of health was specifically


This section is based on a presentation by Kristine Gebbie.

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