First Year Checkup: Strategies for a Stronger Public Health System


January 23, 2009

For Additional Information Contact:
Stuart Drown, Executive Director
(916) 445-2125

Commission Calls on State to Strengthen the New California Department of Public Health

The Little Hoover Commission on Thursday urged the governor and the Legislature to build on the progress achieved in California’s public health system by strengthening its leadership and capacity to meet the state’s health and safety needs.

In its report, First Year Checkup: Strategies for a Stronger Public Health Department, the Commission recommends bolstering the independence of the public health department by moving the department out of the Health and Human Services Agency so that the department director reports directly to the governor’s office. The department’s director should act as an advocate for the public on issues of public health and safety and be aided in this effort by the expert guidance of a permanent and independent public health board.

The Commission reiterated that the state must prioritize public health as one of the core components of public safety, equal to fire and police. The leadership of the new department must forcefully make the case for budget priorities that reflect the department’s public safety role.

The Commission’s interest in the department’s public safety role stems from its 2002 report on California’s emergency preparedness after the 9-11 terrorist attacks. In that report, Be Prepared: Getting Ready for New and Uncertain Dangers, the Commission found that public health represented the largest single weakness in the state’s emergency response network. The Commission followed that study with two public health reports, one in 2003 and another in 2005, citing the state’s lack of strong, independent leadership as well as the need to improve the ability to quickly detect and respond to disease outbreaks, natural or manmade.

In this study, the Commission found that the state has implemented some of the Commission’s earlier recommendations, including creating a new department of public health and a public health advisory committee to assist the state public health officer. It is close to piloting a web-based disease surveillance system to track the emergence of contagious illnesses, and it has conducted laboratory assessments to determine needs and potential solutions. The department, with the state’s help, performed a comprehensive assessment of state and local emergency preparedness and established guidelines for responding to a health care surge. The department also developed an emergency operations center within the public health department to coordinate with other emergency response partners.

In First Year Checkup: Strategies for a Stronger Public Health Department, the Commission acknowledged the strides made by the state in each of these areas, but emphasized that more work is needed to strengthen California’s public health system.

“The Commission is encouraged that the state’s response to its earlier recommendations will lead to further improvements and urges the governor and Legislature to continue transforming the public health department into a strong and effective public health leader,” Little Hoover Commission Chairman Daniel Hancock said.

In First Year Checkup: Strategies for a Stronger Public Health Department, the Commission’s recommendations include:

  • Make the California Department of Public Health an independent office, reporting directly to the governor, to act as a stronger advocate for Californians on public health and safety issues. The public health department must be led by a state surgeon general who reports directly to the governor and who acts as a stronger advocate for Californians on public health and public safety issues.
  • Transform the public health advisory committee into a state Board of Public Health to provide independent advice and guidance to the governor, Legislature and state public health officer. The new board should provide scientific expertise on the department’s public health programs and projects and examine ways to address problems and improve the health and safety of Californians. Until a new advisory committee is created, the state public health officer should bolster the stature of the existing advisory committee.
  • Broaden the efforts of the California Department of Public Health to grow and maintain the public health workforce. The public health department should partner with the state’s higher education systems to fill the pipeline for public health workers and educate students about employment opportunities in the state department of public health. The department also should regularly assess workforce needs and identify priority areas based on those needs, pipeline capacity and the future of public health practice. Public health workforce needs and solutions should be communicated to the governor and Legislature.
  • Develop the state’s laboratory capacity. To ensure a robust public health workforce is in place in the state’s public health labs, the public health department should facilitate consolidation of county laboratories into regional laboratory programs. The department also should assess its laboratory capacity priorities and seek leadership from the governor and Legislature to eliminate barriers to workforce development.
  • Create more flexible funding mechanisms to provide more efficient and effective services to the public. To provide more efficient and effective services to the public, the public health department should review its categorically-funded programs and determine which could be consolidated into block grants. The department also should continue to work with the federal government to streamline federal funds coming into California.

The Little Hoover Commission is a bipartisan and independent state agency charged with recommending ways to increase the efficiency and effectiveness of state programs. The Commission’s recommendations are sent to the governor and the Legislature. To obtain a copy of the report, First Year Checkup: Strategies for a Stronger Public Health Department, contact the Commission or visit its Web site: