What types of services do local public health agencies provide?

Local public health agencies provide services at both the community and individual levels. While there is no single law describing the minimum services that a local agency must provide, there are three primary state laws that affect the scope and range of local service provision.

The first is a law that describes the public health services that the General Assembly has determined are essential to promoting and contributing to the highest levels of health and that should be available to everyone in the state.[1]  This law incorporates the “ten essential public health services,” a set of services that was adopted in 1994 by a national committee charged with providing a framework for effective public health systems,[2] and directs local health departments to ensure the services are available and accessible to the population served by the department. The ten essential public health services fall into three categories: assessment of community health status and health problems; policy development to educate the community about health, solve community health problems, support individual and community health, and protect health and ensure safety; and assurance of quality public health and public and private health care services within the community. The table below identifies the specific services in each category.

Essential Public Health Services (G.S. 130A-1.1)

Another law requires each local public health agency in the state to be accredited by the North Carolina Local Health Department Accreditation Board.[3] To be accredited, a local agency must satisfy standards that address the agency’s capacity to provide the ten essential public health services, as well as several additional duties imposed by state law.[4] The standards are divided into three categories: agency core functions and essential services, facilities and administrative services, and local boards of health. The Accreditation Board assesses a local health department’s performance of 148 specific activities. A health department must satisfy about 90 percent of the activities in order to obtain or maintain accreditation.[5]

A third law authorizes the N.C. Commission for Public Health to establish standards for the nature and scope of local public health services.[6]  The commission has adopted rules, known as the mandated services rules, which specify some of the public health services that local public health agencies must guarantee.[7]  The mandated services  rules address thirteen types of services that fall into one of two categories: (1) services that the local agency must provide under the direction of the local health director and supervision of the local board of health; or (2) services that a county may provide through the local agency, contract with another entity to provide, or not provide at all if the local agency can certify to the state’s satisfaction that the services are available in the county from other providers. Each of the mandated services has its own rule that identifies more specifically which services must be provided or assured. 

The mandated services that a local health department must provide are:

• Food, lodging, and institutional sanitation
• Individual on-site water supply
• Sanitary sewage collection, treatment, and disposal
• Communicable disease control
• Vital records registration

The mandated services that a local health department must provide, contract for, or certify as available are:

• Adult health
• Home health
• Dental public health
• Grade A milk certification*
• Maternal health
• Child health
• Family planning
• Public health laboratory

* In 2011, responsibility for milk sanitation at the state level was transferred from the former Division of Environmental Health, Department of Environment and Natural Resources, to the Food and Drug Protection Division of the Department of Agriculture and Community Services. S.L. 2011-145, sec. 13.3.(b).

These laws provide a starting point for understanding local public health services, but they do not paint the complete picture. Local public health agencies also must provide services or perform activities to comply with other laws. For example, in order to comply with the federal HIPAA medical privacy rule, local health departments must develop and maintain numerous forms, notices, and policies and procedures for keeping health information confidential and secure and for honoring individuals’ rights regarding their health information.[8]

The North Carolina Department of Health and Human Services (DHHS) conducts a biennial survey of services that are provided by local public health agencies in North Carolina, which provides additional insight into the range of local public health services that are provided by the state’s local agencies. The services that are typically included in the survey cover a wide range of activities, from epidemic investigations, to school nursing services, to childhood lead poisoning prevention, to chronic disease control, to name just a few.[9]