A Typology of U.S. Local Boards of Health

Background: Studies of public health departments report mixed results regarding the relevance of governance through local boards of health (LBOHs). These studies find LBOHs can be an important component in higher performance by local health departments. Other analyses, however, find LBOHs have no significance in their associated health departments’ performance.

Research Objectives: Can a typology of LBOHs nationwide define different types of LBOHs based on their powers and responsibilities?

Data Sets and Sources: This study uses the 2011 national profile sample data from the National Association of Local Boards of Health (NALBOH). The database consists of 353 LBOHs randomly selected from 2,420 LBOHs in the 41 states with LBOHs meeting NALBOH’s definition for a LBOH.

Study Design: The data were collected using a mixed methods survey of both online and paper surveys asking about the demographics, authorities, and duties of LBOH.

Analysis: We categorized LBOHs using 33 variables based on four domains of responsibilities and duties: enforcement powers, regulatory powers, human resource powers, and budgetary powers. We then computed correlations between types of LBOHs defined by this typology and whether they shared any significant characteristics in terms of the race, ethnicity, sex, and educational demographics of their board members. We also used ArcGIS to spatially analyze the data for regional and national patterns.

Principal Findings: LBOHs vary considerably across the country from LBOHs with no budgetary, enforcement, regulatory, or human resources authorities to ones who have authorities in all four domains. While some states contain a single type of LBOH, other states have LBOHs reporting varying authorities.

Conclusions: This study provides a typology for future research to allow analysts to distinguish different types of LBOHs nationally.

Implications for Public Health Practice and Policy: Various public health studies find LBOHs are significant in public health performance in some studies and have no statistical significance in others. These differences may result from the variations in LBOHs themselves. This typology will allow future researchers to include greater specificity in their models akin to the variations between centralized, shared, mixed, and decentralized health departments.