Time to rethink our county health board? - Salish Current
June 17, 2024
Time to rethink our county health board?
Marian Exall

Is the prescription for public health care leadership in Whatcom County a rethinking of who serves on the board of health? A commentator says yes. (Psiĥedelisto, CC0, via Wikimedia Commons)

June 17, 2024
Time to rethink our county health board?
Marian Exall


The essays, analyses and opinions presented as Community Voices express the perspectives of their authors on topics of interest and importance to the community, and are not intended to reflect perspectives on behalf of the Salish Current.

Commentary: Whatcom County is out of step with the majority of Washington counties whose boards of health consist of members with public health expertise, and career and consumer experience with the populations served by their health departments.

In 2021, legislation was passed mandating that Washington’s county health boards include health care providers, consumers of public health and other community stakeholders (RCW 70.05.030). This legislation was meant to achieve the laudable goals of helping prepare us for the next pandemic, and taking politics out of the decision-making process.

The law contains an exception to the mandate for counties like Whatcom that have a home rule charter and have a public health advisory committee. Currently, the Whatcom County Health Board is composed of the members of the county council. None of the seven current council members are health care professionals. 

Whatcom County does however have a public health advisory board, thus fulfilling the exception requirements of the 2021 law. Whatcom Public Health Advisory Board (PHAB) members do include health care professionals and other stakeholder community representatives. These PHAB members represent 13 different organizations connected to public health, including the Housing Advisory Board, the Opioid Task Force and the Domestic Violence Commission, in addition to four at-large members. Council member Jon Scanlon serves on the advisory board as council liaison. Erika Lautenbach, county health and community services director, serves ex officio.

The PHAB operates on the hub-and-spoke model, meeting monthly to act as a clearing house for information and communication between the organizations represented on it. Although it submits reports to and occasionally meets with the county council/county health Board, it has no policy-making powers, and it is unclear what weight the county council/county health board gives to its recommendations.

Is this an effective way to identify and implement public health policies and priorities? The county council has a myriad of other responsibilities, from courts to parks to planning to public works, to name a few. Council members have no special expertise in public health and are not necessarily representative of the populations served by the health department. While PHAB members do represent those populations and have that expertise, this board is advisory only and cannot set priorities or implement policies.

We do not have to continue with this outdated model of health care government. Nothing in the law prevents a home rule charter county like Whatcom from changing the composition of its board of health. Any change in the composition of the board of health would need to meet the requirements of RCW 70.05.030 — in short, to include members with health care expertise, career experience and consumer experience in areas impacting public health and with populations served by the health department. Most members of the current PHAB would qualify.

A change in the composition of the board of health may be accomplished through an amendment of the county code. There would be no need to wait for the next charter review because the charter does not address the health board. A change in the composition of the health board is solely up to the county council. This should be a nonpartisan issue. Council members should welcome the chance to establish a health board with the expertise, time and focus to serve this crucial function, and, in this polarized time, to take it out of politics.

The next public health emergency may arise at any time. Arguably we already face one with the fentanyl epidemic. Whatcom County needs a structure that can react effectively and promptly to meet the public health needs of all its residents.

— By Marian Exall

Ed.: On a related note, Whole Washington and the Bellingham Whatcom County League of Women Voters will hold a town hall on July 13 in Bellingham, for a community conversation about our current for-profit health care system and how establishing the Washington Health Trust could be a real solution for Washington state, saving lives and saving money.


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