Variations in public health governance

Abstract

Background: Studies of public health departments have found mixed results regarding the relevance of governance through local boards of health (LBOHs). Some studies find that LBOHs can be an important component in higher performance by local health departments. Other analyses, however, find no advantage for local health departments having or not having a LBOH. The hypothesis was that a typology of LBOHs nationwide can define different types of LBOHs based on their powers and responsibilities. Methods: Using national profile sample data from the National Association of Local Boards of Health, LBOHs were categorized using 34 variables based on four domains of responsibilities and duties: enforcement powers, regulatory powers, human resource powers, and budgetary powers. Correlations between types of LBOHs defined by this typology were then computed, and whether they shared significant characteristics in terms of the race, ethnicity, sex, and educational demographics of their board members was determined. ArcGIS was used to analyze the data spatially for regional and national patterns. Results: LBOHs vary considerably across the country - from LBOHs with no budgetary, enforcement, regulatory, or human resources authorities to those that have all four. Conclusions: Different types of LBOHs may have different influences on their associated local boards of health. This study provides a typology for future research to allow analysts to distinguish different types of LBOHs nationally.