Law and public health agencies

 Law And Public Health Agencies

Boards of health and public health agencies often wield public health jurisdiction at the state and municipal levels. The legal power and jurisdiction of these institutions varies from state to state. Within each state, the relationship between state agencies and municipal public health departments is unique and complicated.

A state or territory health agency exists in each of the 50 states, the District of Columbia, and the territories of Guam, Puerto Rico, American Samoa, and the United States Virgin Islands (which we will call a State agency for brevity). A health commissioner or a secretary of health oversees each state's health agency. Each state also has a chief state health officer, who is the state's highest public health official. (The top State health officer may report to the head of the State agency, or the two posts may be filled by the same person.)

In general, a state health agency is organised as follows:

• A state board of health or a governor-appointed independent agency that reports directly to the governor (33 States)

• Within a supra-agency, a division.

In 1982, 24 states had health boards. In the majority of these states, the chief health officer is responsible to the board of health. The chief health officer is a member of the board in several states. The Governor appoints more than 90 percent of the State boards. Professional associations or the director of the state health department appoint the rest.

State boards of health have policy and budgetary duties in general. The Texas Board of Health, for example, as the governing body of the Texas Department of Health, develops goals and regulations to guide the department's actions. The six-member board has final legal power over the majority of public health matters in the state.

In the United States, there are around 2,900 municipal health departments. They are organised in one of several ways:

Structure Type	Explanation
Centralized at the State level	About one-third of the States use this organizational structure, with the State agency operating whatever local health agency units exist within the State (1981 data).
Autonomous units	Some local health agencies operate completely independently of the State health agency and receive only consultation and advice from the State.
Semi-centralized	In the majority of States, some programs are operated completely by the State; some are shared with the local health department, and in some, the State acts merely as an adviser to the local health department. The extent of local health department jurisdiction also varies within States and across the Nation. Some local health departments serve a single city or county; others serve a group of counties, and some serve a city-county combination.

 Approximately 73 percent of local health departments are responsible for serving a jurisdiction with a local board of health. Eighty-eight percent of municipal boards of health have legislative power to determine local health policy, fees, ordinances, and regulations (under the notion of "home rule"). Furthermore, 61 percent of local boards of health have the legal competence to approve the budget of the local health department.