Ensuring Health Equity: What Local Governments Must Do Now to Expand Access to Quality Public Health

In the United States, quality public health is not a luxury, it’s a foundational condition for a functioning society. But for many Americans, access to preventive care, disease monitoring, health education, and basic public health services remains uneven. The result is not only worse health outcomes but also declining trust in public institutions that are meant to protect us.

This article argues that local governments must step into the breach. Because our public health system is structurally decentralized, the local tier often bears the greatest responsibility and greatest opportunity to shape meaningful access to public health. Drawing on empirical research and governance theory, I propose a roadmap of what local governments can do now to close the gap.

The U.S. Public Health System: Patchwork and Challenge

Public health in the U.S. is often described as a “patchwork” system: responsibilities are split among federal, state, and local agencies, with overlapping roles, gaps in funding, and variation in capacity (Kaiser Family Foundation, 2025; Public Health Law Center, n.d.). The federal government sets standards, provides technical support, and disburses grants, but states and localities have primary authority to regulate, monitor, and act (NCBI, 2011).

The 10 Essential Public Health Services framework remains the reference standard for what a public health system should deliver: from assessment and monitoring to community partnership, to policy development and enforcement (CDC, n.d.). Local health departments (LHDs) are typically closest to the people and often operate at the margin, they vary widely in staff size, funding, and scope (NCBI, 2011; Huston et al., 2023). Because many LHDs are under-resourced, they cannot always fulfill all ten essentials, especially in rural settings or economically distressed counties.

Recent scholarship shows local governments can play a central role in health if they use research, coordinate across sectors, and embed accountability in governance. A systematic review conducted in 2023 indicated that the integration of research evidence into local government-led public health initiatives is inconsistent; while certain programs achieve success through data-driven strategies, others encounter challenges related to capacity and effective translation of evidence into policy (Dam et al., 2023). Another recent study argues that local policy environments are well placed to address social determinants of health because of their nimbleness and proximity to constituents (Local Government Policymaking Environment for Health, 2024).

Given these conditions, local governments are uniquely poised to make visible, high-impact improvements in public health access.

Why Access to Quality Public Health Matters for Democracy

Access to public health is not merely a technical matter; it is a question of justice, legitimacy, and trust. When residents see that disease surveillance is weak, that preventative services are distant or unaffordable, or that health education is inconsistent, they lose faith in the institutions meant to protect them. Public trust is built when government delivers what people need, not what is convenient to supply.

Additionally, public health plays a role in supporting workforce stability, education, safety, and resilience by enabling people to work, facilitating children’s learning, controlling epidemics, and providing preparedness for crises. Local governments that allocate resources to preventive infrastructure effectively safeguard communities from reactive measures, which tend to be both more expensive and ethically complex.

What Local Governments Can Do: A Practical Roadmap

Below is a strategic yet actionable set of interventions local governments can adopt to improve access to quality public health.

1. Map Gaps and Treat Them as Infrastructure

Begin with a public health access audit: map geographic areas with low clinic density, long travel times, low provider-to-population ratios, and vulnerable populations (e.g., low-income, minority, rural). Use GIS tools and publicly available health data to do this.

Public health is infrastructure. Just as a county plans roads or water lines, it must plan sites for local health services (clinics, mobile units, outreach hubs). In many places, clinics are simply too far for residents to reach.

2. Support and Expand Federally Qualified Health Centers (FQHCs) and Community Clinics

Federally Qualified Health Centers provide primary care and preventive services in underserved areas regardless of ability to pay. (See: FQHCs, n.d.). Local governments should partner with FQHCs through land donations, tax incentives, or co-locating services in municipal buildings to increase their reach.

3. Embed Public Health Units in Local Government Strategy

Public health should not be siloed. Local governments should integrate public health functions into planning, housing, transportation, and economic development departments. Zoning, transit access, environmental policy, and housing regulation all influence health outcomes.

4. Strengthen Data, Monitoring & Reporting

Using the “assessment and monitoring” essential service (CDC) as a foundation, local agencies can implement continuous reporting of health metrics such as disease incidence, vaccination rates, lead exposure, and behavioral health trends on public dashboards. This approach facilitates transparent sharing of data with the community.

5. Partner with Community Stakeholders

Public health cannot be done in isolation. Engage schools, faith-based organizations, nonprofits, and private providers as partners. The model of The Community as a Full Partner (Chen et al., 2024) argues for upgrading communities from data recipients to co-producers of health strategies. Empower community health workers and local voices in decision-making.

6. Guarantee Access through Mobile, Telehealth & Outreach

Many underserved areas lack fixed clinic infrastructure. Local governments should support mobile health units, telehealth hubs, and outreach teams that go into neighborhoods. Provide broadband access and telehealth kiosks in libraries or community centers.

7. Fiscal Commitment & Flexible Funding

One perennial barrier is rigid funding. Local governments should allocate predictable, flexible revenue to health departments rather than one-off grants. Matching local funds often unlocks federal or state grants. Invest also in workforce training, epidemiology capacity, and emergency surge reserves.

8. Apply Performance Contracts & Public Benefit Covenants

Where local governments contract with private providers or hospital systems to deliver public health services, embed performance-based contracts tied to outcome metrics (immunization rates, screening uptakes) and require public reporting. Make the contract terms enforceable in government audits.

A Closing Reflection: Health Access as a Test of Public Trust

Access to quality public health is not only a moral obligation, but also a litmus test of governance capacity. When local governments proactively address disparities, establish collaborative partnerships, and invest in health infrastructure, they enhance both community resilience and foster greater public confidence.

As local leaders and citizens, the question is not whether we care about health, but whether we will govern it. If we choose to invest in audit, in clinics, in data, in partnerships, we signal that public health is not a passive service but a dynamic, shared commitment to life, dignity, and collective wellbeing.

References

Centers for Disease Control and Prevention. (n.d.). 10 Essential Public Health Services. https://www.cdc.gov/public-health-gateway/php/about/index.html

Chen, A. T., et al. (2024). The Community as a Full Partner: A new model for public health. Health Affairs. https://doi.org/10.1377/hlthaff.2024.00033

Dam, J. L., et al. (2023). Research evidence use in local government–led public health interventions: A systematic review. Health Policy and Systems, 21(1). https://doi.org/10.1186/s12961-023-01009-2

Huston, S. L., et al. (2023). State and local health departments: Role and challenges. Public Health Reports.

Kaiser Family Foundation. (2025). How is public health governed and delivered in the U.S.? https://www.kff.org/health-policy-101-u-s-public-health/

Local Government Policymaking Environment for Health. (2024). Article [journal]. (Article discusses how local governments are well positioned to address health determinants.)

McClellan, M. (2025). Updating U.S. public health for healthier communities. Health Affairs. https://doi.org/10.1377/hlthaff.2024.01010

Public Health Law Center. (n.d.). State & local public health: An overview of regulatory authority.

Seto, C., Khademi, A., Graif, C., & Honavar, V. (2020). Commuting network spillovers and COVID-19 deaths across U.S. counties. arXiv. https://arxiv.org/abs/2010.01101