NC Public Health Systems Research

North Carolina counties are required by law to provide public health services to their residents. State and local policymakers and public health officials share an interest in providing those services in a manner that is efficient, effective, and responsive to local needs. Over time, different ways of providing public health services have been incorporated into the state laws that define various types of local public health agencies and governance structures.

For many years, state and local policymakers, public health practitioners, and others have discussed options for organizing North Carolina’s local public health system. In 2011, the conversation was reignited when several bills were introduced in the state legislature designed to alter the legal and policy landscape for local public health agencies.

At the time of this policy debate, comprehensive information about the state’s existing local public health agencies did not exist. With funding support from the Robert Wood Johnson Foundation, the research team conducted a comprehensive analysis of public health laws in North Carolina, interviewed more than sixty state and local stakeholders, and compared local public health agencies across a variety of quantitative measures.

In the course of this research, we:

• Reviewed, catalogued, and compared the laws that govern the different models for delivering public health services at the local level (single county health departments, district (multi-county) health departments, public health authorities, and consolidated human services agencies). 
• Conducted focus groups and interviews to gather information about the experiences of health departments that have changed from one model to another, perceptions of the different models, and insights about the future of the state's public health system.
• Compiled and analyzed existing data on costs as well as health and service delivery outcomes to provide comparisons across the different models.

We presented our findings in a report, an issue brief, and webinar in May 2012.  It is important to note that we did notoffer recommendations, best practices or other endorsements related to particular service delivery models. Our goal was to provide objective, methodologically sound research findings to support state and local policymakers decisionmaking.

In June 2012, legislation was enacted that made several changes to the laws related to the organization and governance of local public health agencies. We offered a second webinar in August 2012 to explain the revisions to the law.

Several counties were interested in moving quickly to make changes at the local level so the next stage of our project was to offer facilitated discussions in counties across the state during the fall and winter. We invited interested counties to apply for a discussion and ultimately held seven discussions that included elected county commissioners as well as board of health members, social services board members, and representatives of county administration. During the discussions, we described the legal and policy landscape, reviewed our research findings, and led a local conversation about the options being considered within that particularly community.

In May 2013, we released our final report (available here), which included updated summaries of the law as well as more recent quantitative data for selected measures.