History: Minnesota's Public Health System
and the Community Health Services Act
Minnesota’s statewide public health system is referred to in state statute as “Community Health Services”, or CHS. The CHS system uses a coordinated approach, among state and local public health departments, to protect, maintain, and improve the health of all Minnesotans.
A history of public health in Minnesota
Minnesota has a long history of commitment to the public’s health. Since the first state and local boards of health were established in 1872, the Legislature has recognized the important role of local government to protect the health of their communities.
The first action of the Legislature related to public, or community health ("community health" and "public health" are used interchangeably on this Web page) was to authorize the appointment of local health officers and local health boards for townships and cities. County boards of health were also established, but their jurisdiction was limited to unorganized territories not covered by cities or towns. At that time, public health efforts were directed primarily at the control of communicable diseases and public nuisances. One statutory provision, only just repealed in 1987, stated that “the collection and disposal of night soil from privy vaults and the contents of cesspools shall be under the charge and supervision of, and shall be done by the departments of health in cities of first class.”
In 1904, the first public health services were formed, financed by the Red Cross and Christmas Seals. The services provided were mainly school nursing, the control of communicable diseases, and infant welfare. Family members usually took care of the sick at home, and were taught how to provide the needed care.
The influenza epidemic of 1918 and the high rates of maternal and infant death—more than ten times their current level—led to major developments in local public health law. In 1919, local government was authorized to organize and provide public health nursing services. Additional authorities were added in the following decade.
In 1947, the Legislature authorized the formation of county health departments and provided a small state aid for the cost of providing local public health nursing services. Such services typically included maternity services, health supervision of infants and children, communicable disease control with immunizations for diphtheria/tetanus and smallpox, and some bedside nursing.
County public health nursing services grew slowly in the 1950s, when only fifteen counties had more than one nurse. By 1955, counties were allowed to adopt a sliding fee scale to employ registered nurses and licensed practical nurses to assist public health nurses in home care.
By this time, the general public health authority of the state Board of Health also was well established. The state Board of Health encouraged communities to create local boards of health. The responsibilities of these boards were three-fold:
- to assess the health of their community, including reporting live births and local causes of death and disease;
- to develop policies to limit the spread of communicable disease; and
- to assure sanitary conditions conducive to a healthy community. Eventually, all political jurisdictions, townships, counties, villages, and cities were required to appoint health officers.
This effort was so successful that it created a new problem: over 2,100 local boards of health with which the State Board of Health was expected to communicate and coordinate (Figure 1). In July of 1977, the state Board of Health was replaced by a state agency, the current Minnesota Department of Health (MDH).
A system for public health
In the mid-1970’s, local and state public health activities were regulated by a patchwork of laws. The laws did little to govern the relations among local units of government, there were no provisions for funding general local public health activities, and there were few clear explanations of the relative roles of state and local health authorities. In addition, the sheer number of boards of health complicated efforts by state and local governments to share responsibility for public health.
In 1976, a landmark bill was passed – the Community Health Services (CHS) Act – which began the creation of the CHS system we have today. The 1976 CHS Act, and its revisions through the 1987 Local Public Health Act, was designed to overcome the confusion over roles and authorities and to establish a comprehensive system and an effective public health partnership among state and local governments.
The 1976 CHS Act allowed county and city boards of health to organize themselves as community health boards (CHBs), providing they met certain population and boundary requirements. By meeting those requirements, counties and cities became eligible to receive a state subsidy. The new CHBs also could preempt all township and city boards of health within their jurisdictions or could decide to authorize and give certain powers and duties to a board of health within its jurisdiction through joint powers or delegation agreements.
In 1987, the Minnesota Legislature further clarified the roles and responsibilities of the state and local public health system and replaced the CHS Act with the Local Public Health Act, also known as Chapter 145A.
The Local Public Health Act was again modified in 2003 to streamline administrative requirements and combine several categorical grants.
In 2009, local boards of health are consolidated into 53 CHBs. Twenty-eight counties function as single-county CHBs; 59 counties cooperate in 21 multi-county or city-county CHBs; and four metropolitan cities have their own CHB.
