History of Public Health Redesign and the Transition to Modernization

Recognizing the need for an integrated and fully funded public health system, the director of the Iowa Department of Public Health commissioned a work group made up of state and local public health partners (13 local and 12 state public health practitioners), in the summer of 2004. The need had become apparent in the collection of comments from public health meetings between state and local public health stakeholders, held throughout the state in 2003.

The charge for the work group was to assess the current structure of public health service delivery and to make recommendations for redesigning public health in the state.

Public Health Delivery in Iowa

The structure of public health is comprised of the State Board of Health, Iowa Department of Public Health, 101 local boards of health (98 counties, 2 cities, and 1 district), and many local public health providers. Local public health agencies (governmental and non-governmental) provide a variety of direct services, while the state provides funding, technical assistance, training, and consultation.

Work Group for Redesigning Public Health in Iowa

Understanding the magnitude of its task, the Work Group for Redesigning Public Health in Iowa decided early to limit initial discussions to governmental public health - local agencies, the state department, and local and state boards of health. Private health care agencies that function as lead public health entities through contractual agreements with local boards of health are considered, for the purposes of this process, to be local health agencies.

The decision to focus initially on governmental public health created a strong backbone of the system before including the other entities that play critical roles in delivering public health services to Iowans.

To gain a national perspective, the Work Group researched improvement plans and performance standards from other states. National resources include organizations such as the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials (NACCHO).

The Work Group decided that one of the first steps for Redesigning Public Health was to develop standards for local and state public health that would define what every Iowan should expect from public health. The Work Group asked a broad group of stakeholders with expertise in public health to serve on committees to draft standards and criteria. Following three public comment periods the Iowa Public Health Standards were finalized in December of 2007.

Upon completion of the Iowa Public Health Standards the Work Group decided to continue to move forward by working to implement the standards. In order to achieve this, five implementation committees were developed. It was the charge of one of those committees to determine whether or not the Iowa Public Health Standards should appear in Iowa Code. The group determined it would be appropriate to do so and drafted the Public Health Modernization Act.

Having met the original goal of developing standards for Iowa's public health system, and having put in motion a mechanism to implement the Iowa Public Health Standards, it seemed that the work of Redesigning Public Health in Iowa was completed. The Work Group voted to officially declare Redesign complete in November 2008. At that same meeting the work of Modernizing Public Health in Iowa began. For more information about Modernization click on the Legislative button.


The Public Health Modernization Act of 2009 established two committees to advise the director of the Iowa Department of Public Health about matters regarding Iowa's governmental public health system. These committees were established to continue the work of the Modernizing Public Health in Iowa Initiative and its Work Group and Implementation Committees.

The Public Health Advisory Council was established to advise the Iowa Department of Public Health (IDPH) and the director of the department about the implementation of a voluntary accreditation system for Iowa's local and state public health departments, further development of the Iowa Public Health Standards, and to make recommendations about furthering Iowa's public health system

The Public Health Evaluation Committee was established to evaluate Iowa's governmental public health system and voluntary accreditation program to assess the impact on population health outcomes.

In January 2016, amendments were made to The Public Health Modernization Act. The newest version can be found here: 135A.

These amendments would eliminate the Public Health Evaluation Committee, while expanding the Public Health Advisory Council. The two committees were essentially integrated as one to be able to more effectively "Develop and make recommendations for improvements to the public health system," in Iowa (Section 5. f. 135A).

The Public Health Advisory Council will continue to advise, while also evaluating the public health system in Iowa.