Public Health Board of Health
Ned E. Baker, Marie Fallon
  • LAST REVIEWED: 23 February 2011
  • LAST MODIFIED: 23 February 2011
  • DOI: 10.1093/obo/9780199756797-0015


Boards of health and other public health governing entities are legally designated governing bodies whose members are appointed or elected to provide governing, oversight and/or advisory functions of public health activities, including assessment, assurance, and policy development, for the protection and promotion of health in their communities. There are fifty-nine different names for public health governance bodies, with the most common name being board of health. Boards of health have been a part of public health democracy since the late 1700s. They are citizen trustees expected to provide leadership, guidance, and oversight of the delivery of public health services and programs in their communities. The roles of boards of health vary by state, as does the authority to carry out their responsibilities. State statutes define the legal powers and duties of local boards of health. Forty-four state codes (statutes) address local boards of health, defining jurisdiction; appointing authority; and determining terms of office, composition, roles, powers, and duties. State statutes also define board of health member composition and assignment. The majority of boards enact rules and regulations, while others may only advise or make recommendations to the governing body for public health, such as a board of county commissioners. The board of health also serves as an advocate for public health. It can provide important influence in assuring that adequate resources are available to provide needed public health services. All boards of health, regardless of the extent of their legal authority, are obligated to either enact or recommend policies that serve the interests of the public’s health. There are more than thirty-three hundred public health boards in forty-three states. Each state has unique statutes defining public health governance roles and responsibilities. More than twenty thousand volunteers serve as public health trustees. Trustees, whether elected or appointed, come with a wide range of skill sets, many with little or no education or training in governance, public health, or health in general. Responsibilities can include hiring, evaluating and, if necessary, firing the health commissioner; overseeing fiscal and performance accountability; representing the health department to the community and representing the community to the health department; and setting health policy. The board of health provides governance leadership and is ultimately responsible for ensuring public health in a community. Despite two hundred years of practice and more than twenty thousand individuals currently serving in this capacity, there is a dearth of research to inform and improve practice.

Introductory Works

Boards provide guidance and oversight for organizations. Boards of health have similar responsibilities for public health departments or agencies. In the United States, such boards exist at the state and local levels. Specifics about duties and responsibilities are provided in state constitutions. Because each state constitution is unique, the public health boards in each state are slightly different from those in other states. Tribal reservations also have public health agencies. Boards also provide oversight for these organizations. Because tribal reservations have sovereignty under American law, the legal guidelines for tribal boards are locally (at the tribal nation level) defined. The National Association of Local Boards of Health (NALBOH) was formed in 1992 to represent public health boards throughout the country. NALBOH represents boards having jurisdiction at the local, state, tribal, and territorial levels. Baker 2001 provides a historical context for the formation and duties of the National Association of Local Boards of Health. Beitsch, et al. 2006 focuses on the organization and operations of state public health departments. Conway, et al. 1997 discusses how local communities establish priorities for programs related to health. Fallon 2009 writes about how members of local health boards are appointed to their positions and the relationship to board effectiveness. The National Association of Local Boards of Health 2008 document discusses the sources of legal authority for local public health governance (boards of health).

  • Baker, N. E. National Association of Local Boards of Health In Encyclopedia of Public Health.

    The author was a principal founder of NALBOH. This article provides a brief history of NALBOH and an overview of its present scope of programs and activities.

  • Beitsch, L. M., Robert G. Brooks, Meade Grigg, and Nir Menachemi. 2006. Structure and functions of state public health agencies. American Journal of Public Health 96.1: 167–172.

    DOI: 10.2105/AJPH.2004.053439

    Assesses the structure and basic areas of responsibility of state health departments in the United States compared to a previous study conducted in 1990, verifying core changes in the structure and duties of state public health systems, including governance.

  • Conway, T., Tzyy-Chyn Hu, and Terrill Harrington. 1997. Setting health priorities: community boards accurately reflect the preferences of the community’s residents. Journal of Community Health 22.1: 57–68.

    DOI: 10.1023/A:1025198924501

    Authors address the importance of establishing priorities that are relevant to the people who will be affected by them. As board priorities are more closely aligned with the needs of community members, the probability for success of the programs increases.

  • Fallon, M. M. 2009. “A quantitative study of the appointment process of local board of health members in Ohio and the relationship to board effectiveness.” PhD diss., Bowling Green State University.

    Research examines the relationship between the appointment process (recruitment and selection) and the effectiveness of the board of health. Data collected concurrently using surveys for three population groups—appointers, board of health members, and health commissioners. One conclusion is that the appointer and board of health members rate the effectiveness more highly than do the health officials.

  • National Association of Local Boards of Health. 2008. State statutory authority for local boards of health Bowling Green, OH: National Association of Local Boards of Health.

    Provides an executive summary and a state-by-state review of public health governance statutes for local boards of health. Each state statute is unique. Topics include board jurisdiction, appointing authority, terms of office, composition, role, powers, duties, compensation, budget oversight, and limitation of powers.

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