Local boards of health play an important role in our public health system. They provide oversight and guidance for local health departments and they set public health priorities for our communities. By operating at the local level, boards of health are closer to the communities whose health they are charged with protecting than are state or federal agencies.

Their local nature makes boards of health an integral part of improving and promoting population health. Most states have local boards of health and state law often dictates a board of health’s role, duties, authority and composition. While the roles, duties, authority and composition vary from state to state, some generalities and commonalities do exist.

The role of local boards of health is often set out by state statute. For example, in California boards of health advise local health officers, whereas North Carolina boards of health play the policy-making, rulemaking and adjudicatory roles for local health departments. Respondents to the 2005 National Profile of Local Health Departments, a report from the National Association of County and City Health Officials (NACCHO), indicated that 73 percent of local boards of health have governing functions, 77 percent have policy-making roles, 83 percent act as advisers, 58 percent perform all three roles and 13 percent are advisory only.

State statues may also give local boards of health broad authority to protect public health and responsibility for certain actions. For example, local boards of health may have some or all of the following functions:

• Hiring or firing the local health officer, director or commissioner
• Making rules and regulations
• Levy and impose taxes
• Establish and collect fees
• Approve the local health department’s budget
• Enforce local and state laws
• Issue licenses

The above list is not inclusive of all the functions local boards of health perform. Also, whether these functions are mandatory or discretionary varies from state to state. NACCHO’s 2008 National Profile of Local Health Departments revealed that with 73 percent of local boards of health adopt public health regulations, 68 percent set and impose fees, 59 percent approve local health department budgets, 56 percent hire or fire the health officer and 17 percent impose taxes for public health.

State statutes also set out the composition of local boards of health. This is usually a mix of health professionals, citizens and elected officials. The number and makeup of the boards vary widely among the states. For example, in Washington State, a majority of board’s membership must be local elected officials (e.g., county commissioners, city and town mayors etc.). Other states require health professionals to be on the board. For example, North Carolina requires county boards of health to include a physician, a dentist, an optometrist, a veterinarian, a registered nurse, a pharmacist, a county commissioner, a professional engineer and three representatives of the general public.

For more information about local board of health governance issues you can visit the National Association of Local Boards of Health (NALBOH) Web site. NALBOH provides education and training for local boards of health across the country, as well as a state-by-state guide for the Legal Authority for Local Boards of Health. This online tool allows you to search by state, topic or keyword for state-specific information pertaining to the legal authority of local boards of health.

The Network for Public Health Law also provides assistance to local boards of health on the use of law to improve and protect public health. Recently, the Network has provided technical assistance to board of health members on legal issues ranging from board of health liability to public health agency accreditation. If you have any questions or need assistance please contact us.

This information was developed by Andy Baker-White, assistant director for the Network for Public Health Law – Mid-States Region at the University of Michigan School of Public Health.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.