Public Health Systems Development - Office of the Secretary

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GOVERNMENTAL PUBLIC HEALTH SYSTEM IN WASHINGTON STATE: A Decentralized System Characterized by Local Control and Partnership

County Government

Washington State law gives primary responsibility for the health and safety of Washington residents to 39 county governments. It charges the counties’ legislative authorities with establishing either a county department or a health district to assure the public’s health. (RCW 70.05, 70.08, 70.46) In Washington State the governmental public health system consists of 35 local public health agencies or local health jurisdictions (LHJs) that work with the state Department of Health. In three cases, county legislative authorities have formed multi-county health districts.

Each county legislative authority must also establish a local board of health, which “shall have supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction.” (RCW 70.05.060) Local boards of health approve the budgets, programs, and policies of local public health agencies and may also appoint the agency administrator. Board members include county commissioners or members of the county council and may include elected or non-elected officials. Elected officials must always make up the majority.

Federally Recognized Tribes

A unique government-to-government relationship exists between American Indian and Alaska Native Indian (AI/NI) Tribes and the Federal government. This relationship is not based upon race but instead grounded in the Constitution, numerous treaties, statutes, and executive orders. The U.S., in accordance with these treaties, statutes, Executive Orders (EOs) and judicial decisions, recognizes the rights of Indians to self-governance and self-determination.

In an effort to recognize and bolster the government-to-government relationship between Washington State and the federally recognized tribes located in the state, then-Governor Booth Gardner and tribal chairs signed the Centennial Accord in 1989. The Centennial Accord states that:

"Each Party to this Accord respects the sovereignty of the other. The respective sovereignty of the state and each federally recognized tribe provide paramount authority for that party to exist and to govern. The parties share in their relationship particular respect for the values and culture represented by tribal governments. Further, the parties share a desire for a complete accord between the State of Washington and the federally recognized tribes in Washington, reflecting a full government-to- government relationship and will work with all elements of state and tribal governments to achieve such an accord."

The intent of the Washington State Centennial Accord is to enhance and strengthen the government-to-government relationship that exists between the tribes and the state. In furtherance of this goal, it stresses the importance of state agencies and the legislative branch in working with tribes to develop and implement policy which affects tribal communities and Indian people.

In times of shrinking federal and state discretionary dollars and the devolution of federal programs to the state and local levels, it is more important than ever that tribes and states work together to improve the health status of American Indians and Alaska Natives (AI/ANs). In Washington State, tribes and urban Indian health clinics have been working formally to advance tribal-state collaboration on the delivery of health care services for a decade. The involvement of Indian Tribes in the development of public health and human services policy promotes locally relevant and culturally appropriate approaches to issues of mutual interest or concern. An integral element of this government-to-government relationship is that consultation occurs with Indian Tribes in matters that significantly affect them.