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:
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.