How does a district health department compare to a public health authority?
There are many similarities between district health departments and public health authorities. For example, they both provide public health services, and have governing boards and directors. They are both public authorities for purposes of the North Carolina Local Government Budget and Fiscal Control Act, which means that they are responsible for their own budgets and financial management, independently from the counties that comprise them. They both are public entities that are subject to laws generally applicable to government agencies, such as open meetings and public records laws.
There are, however, some differences between a district health department and a public health authority:
Governing board: The governing boards of the two types of agencies are composed differently and may be appointed differently.
- Composition: A district board of health has 15-18 members and must include representatives of specific professions, as well as a member of the board of commissioners of each county served by the district. A single-county public health authority is composed of 7-9 members, while a multi-county authority may have up to 11 members.[1] A public health authority board must include either a county commissioner or a commissioner’s designee from each county in the authority. It must also include a hospital administrator and representatives from several other professions, but not every profession mentioned in the statute must be represented. A comparison of the membership of the different types of boards is available in the attached document.
- Appointment: For a district board of health, the boards of commissioners of each county comprising the district appoints one commissioner to serve on the board, then those commissioners appoint the remaining members. A multi-county public health authority board is appointed in the same fashion, except a board of county commissioners may appoint non-commissioner designee. The board of county commissioners appoints all the members of a single-county public health authority board.
Powers and duties of directors and governing boards: District health directors and public health authority directors have the same general powers and duties, such as hiring and firing employees, enforcing public health laws, and investigating and controlling the spread of disease within their jurisdictions. (More information about the powers and duties of public health directors is available here.) However, district health directors have one power that public health authority directors do not: the authority to enter contracts on behalf of the agency.[2] In public health authorities, the power to enter contracts is given to the board, not the director.[3] However, the board could delegate this power to the director.[4]
Public health authority boards have expanded powers and duties compared to district boards of health. For example, a public health authority board may impose fees for services without the approval of county commissioners. A public health authority board also has greater powers related to acquiring and disposing of property.[5]
Jurisdiction: A district health department serves the counties that comprise the department. While it may serve residents of other counties in some circumstances, a district health department does not typically perform services in counties outside the district (unless there is a specific arrangement in place with the other county or counties for it to do so), nor does it operate offices outside the boundaries of the counties comprising the district. In contrast, a public health authority is specifically authorized to provide or contract to provide public health services and to operate public health facilities outside the boundaries of the county or counties making up the authority.[6]
[1]In some instances, a public health authority may want to apply to the federal government to become a community health center so that it may be eligible for additional funding from specific federal programs. The federal law governing community health centers has strict requirements related to board membership. Therefore, state law allows a public health authority interested in applying for that status to have up to 25 board members. See G.S. 130A-45.1(a) (“Boards which intend to pursue federally qualified health center (or look-alike) status may have no fewer than nine and no more than 25 members.).
[2]G.S. 130A-41(b)(13).
[3]G.S. 130A-45.3(a)(12).
[4]G.S. 130A-45.3(a)(9) (authorizing a public health authority board to “delegate to its employees or agents any powers or duties as it may deem appropriate”).
[5]G.S. 130A-45.3.
[6]G.S. 130A-45.6. This law specifies that a public health authority may operate outside the territorial limits of the county or counties it serves “within reasonable limitation,” but this is not further defined. The law also states that a public health authority may not be held liable for failing to provide public health services outside its territorial limits.
