In the United States, city and county governments are often responsible for implementing health policies and programs on behalf of state and federal governments. However, local jurisdictions have generally not capitalized on their own expertise or on local knowledge to advocate rights-based health care reform. Working with local public health officials to develop a rights-based health care reform advocacy plan is a way to integrate human rights principles into local government policy and practice at the grassroots level. The concrete policy objectives found in human rights princples can also be the basis of local government advocacy efforts toward state and federal government for reform that addresses local and regional health needs. This article presents a first-person, "hands-on" account of efforts to operationalize a human rights framework in public health advocacy and action in a local setting, King County, a jurisdiction of Washington, USA, that includes the city of Seattle.