Key Players in NC Local Public Health: Local Health Directors
This page includes questions and answers about local health directors in North Carolina.
Please Note: These questions and answers have not been updated to reflect the changes from the 2012 legislative session. For more details, see the "legislative updates" page.
FAQs
Each type of local public health agency must have a director, who serves as the administrative head of the agency and exercises legal powers and duties prescribed by law. The term “local health director” includes the director of a county health department, a district health department, or a public health authority, as well as the director of a consolidated human services agency or his or her designee.[1]
The director of a county health department, a district health department, or a public health authority must meet minimum education and experience requirements that are set out in state law. In general, the director must have education and experience in medicine, public health, or public administration related to health.[2] The director of a consolidated human services agency (CHSA) is not required by statute to meet particular education or experience requirements. However, if the director of a CHSA that provides public health services does not meet the statutory qualifications for a local health director, he or she must appoint a person who does.[3]
[1] The inclusion of a director of a consolidated human services agency requires some explanation. The term “local health director” is defined by statute to mean “the administrative head of a local health department appointed pursuant to this Chapter.” The same statute defines “local health department” as “a district health department or a public health authority or a county health department.” G.S. 130A-2. Although these definitions do not capture consolidated human services agencies and directors, a separate statute assigns local public health roles to the agency by: (1) giving the agency “the responsibility to carry out the duties of a local health department”; (2) providing that the consolidated human services board “shall have all the powers and duties of a local board of health” except for appointing the director and transmitting or presenting the budget for local health services; and (3) stating that “a human services director shall have all the powers and duties of a local health director provided under G.S. 130A-41,” except that the human services director’s activities in managing the department are subject to the oversight of the county manager, and the human services director may appoint agency staff only with the county manager’s approval. G.S. 130A-43.
[2] G.S. 130A-40 (county and district health departments); 130A-45.4 (public health authorities).
[3] G.S. 153A-77(e)(9).
The appointment of the local health director varies by type of local public health agency. For a county or district health department, the local health director is appointed by the county or district board of health after consultation with all applicable boards of county commissioners.[1] The same procedure is followed by a public health authority board when it appoints the public health authority director.[2]
The director of a consolidated human services agency is appointed by the county manager with the advice and consent of the consolidated human services board.[3] The consolidated human services director then appoints a person who meets the statutory qualifications of a local health director, with the approval of the county manager. This person may be designated to serve as the local health director for the jurisdiction, if the consolidated director delegates the role.[4]
Local Public Health Agency | Appointment of Director | Statute |
County health department (single-county) | Board of health, after consulting with the board of county commissioners | G.S. 130A-40 |
District board of health (multi-county) | Board of health, after consulting with the boards of county commissioners of all counties in the district | G.S. 130A-40 |
Public health authority (single- or multi-county) | Public health authority board, after consulting with the board(s) of county commissioners served by the authority | G.S. 130A-45.4 |
Consolidated human services agency | County manager appoints CHS director with the advice and consent of the board; CHS director appoints a person who meets local health director qualifications with the approval of a county manager | G.S. 153A-77 |
If the county commissioners have abolished the board of health pursuant to G.S. 153A-77(a), then the commissioners have all the powers and duties of the local board of health. For a county health department, this includes the power to directly appoint the local health director. For a consolidated human services agency, this includes the power to advise and consent to the county manager’s appointment of the consolidated human services director.
A local health director is supervised by the governing body or person who appointed him or her.
[1] G.S. 130A-40. Although the board of health must consult with the commissioners, the statute does not require the commissioners to consent to or approve the appointment. The law does not specify how consultation with the commissioners is carried out. An informal survey of local health directors conducted in 2008 by Jill Moore, UNC School of Government, revealed that practices varied, but two common components were involvement of the commissioner member of the board of health in the recruitment process, and approval of the health director’s salary by the board of county commissioners. (Survey question and de-identified responses on file with Professor Moore.)
[2] G.S. 130A-45.4.
[3] G.S. 153A-77(e).
[4] By statute, the CHS director acquires the legal powers and duties of a local health director; however, he or she may delegate most of the powers and duties to the person who meets local health director qualifications or another appropriate person. See G.S. 130A-6 (“Whenever authority is granted by this Chapter upon a public official, the authority may be delegated to another person authorized by the public official.”). While generally quite broad, this authority to delegate may be limited by another statute. For example, the law that permits a local health director to embargo food or drink in some circumstances specifies that the embargo authority may not be delegated to local environmental health specialists. G.S. 130A-21.
For all agency types except a consolidated human services agency (CHSA), the local board of health appoints the local health director. The director of a CHSA is appointed by the county manager with the advice and consent of the board, and the CHSA director must then appoint a person with the qualifications of a health director.
The different statutes that describe the procedures for appointing a local health director all use mandatory language—the word “shall”—suggesting that the appointment of a local health director is obligatory, not discretionary. For example, the statute addressing county and district health directors states that the local board of health “shall” appoint a health director who meets particular qualifications.[1] There is also a state rule that requires each local health department to have a local health director,[2] and a state accreditation standard that requires the local board of health to assure that a qualified health director is in place to lead the agency.[3] Finally, the local health director has a number of legal powers and duties, which someone must be empowered to exercise.[4] It thus appears that the appointing entity (the board or the county manager) does not have the discretion to choose not to appoint a director.[5]
When vacancies in the health director position occur, there may be a period of time during which an individual is named as an acting or interim health director while a search is conducted. However, if a director of a county health department, a district health department, or a public health authority is not appointed within 60 days after the vacancy is created, the State Health Director may appoint a person to serve as local health director until the local board makes its appointment.[6] The CHSA statute does not include a provision authorizing the State Health Director to make an appointment if the county manager fails to appoint an agency director, or if the agency director fails to appoint a person with the qualifications of a local health director.[7] It is unclear what would happen if either of the positions were to remain vacant for an extended period of time.
[1] G.S. 130A-40(a) (county or district health director); 130A-45.4 (public health authority director). If the board of county commissioners has abolished the board of health and assumed its powers and duties, it acquires the duty to appoint a local health director. G.S. 153A-77(a).
[2] 10A NCAC 46.0301.
[3] 10A NCAC 48B.1304(b)(1). Local public health agencies do not have to satisfy 100 percent of the accreditation activities, so it is possible for an agency to skip a particular provision and still be accredited.
[4] See, e.g., G.S. 130A-41; see also Question 5.
[5] See also GS 153A-76 (prohibiting a board of county commissioners from abolishing an office established or required by law); 52 Op. Atty Gen. 44 (1982) (concluding that the office of local health director is unaffected by GS 153A-77(a) and must be filled by a board of commissioners acting as a board of health under that provision).
[6] G.S. 130A-40(d) (director of a county or district health departments); 130A-45.4(d) (director of a public health authority).
[7] G.S. 153A-77(e).
A director of a county or district health department or a public health authority must meet minimum education and experience requirements.[1] In general, the director must have one of the following:
- A medical doctorate
- A master’s degree in public health administration plus at least one year of employment in health programs or services
- A master’s degree in another public health discipline plus at least three years of employment in health programs or health services
- A master’s degree in public administration plus at least two years of experience in health programs or health services
- A master’s degree in a field related to public health plus at least three years of experience in health programs or health services[2]
- A bachelor’s degree in public health administration or public administration plus at least three years of experience in health programs or health services
There is also a law that created a limited pilot program (one county only) to allow a person with education and experience in public health nursing to serve as a local health director, as long as the appointment is approved by the NC Secretary of Health and Human Services.[3]
A consolidated human services director is not required by statute to meet particular education or experience requirements. However, a consolidated human services director who does not satisfy the statutory qualifications for a local health director must appoint a person who does.[4] In addition, North Carolina’s standards for local public health agency accreditation specify that the agency’s governing board must appoint a local health director who meets the requirements of the law that applies to county and district health directors.[5]
[1] G.S. 130A-40(a) (county or district health directors); 130A-45.4 (public health authority director).
[2] The State Health Director must review requests by educational institutions to determine whether a master’s degree offered by the institution is related to public health for purposes of this law.
[3] G.S. 130A-40.1. This law requires the health director in the pilot county to either: (1) have a bachelor of science in nursing degree from a program that includes a public health nursing rotation, plus ten years’ public health experience, at least five of which were in a supervisory capacity at the agency at which the person is a candidate for local health director; or (2) be a registered nurse without a bachelor’s degree but with at least ten years’ experience, including at least seven years in an administrative or supervisory role and at least five years at the agency at which the person is a candidate for local health director. At the time of this writing, Northampton County’s health director is serving pursuant to this law.
[4]. G.S. 153A-77(e).
[5] See 10A NCAC 48B .1304; see also 10A NCAC 48B .0901(b)(1) (requiring the agency to have, or be recruiting, a local health director who meets legal requirements for the position). The accreditation program does not require local agencies to satisfy every provision in the standards—agencies may skip a small proportion of the standards and still be accredited. Therefore, it is possible that a consolidated agency could satisfy accreditation standards without meeting the specific standard that addresses the director’s qualifications.
All local health directors have powers and duties that come from multiple sources of law.[1] A local health director’s powers and duties fall into five general categories:
Administration: The local health director administers programs under the direction of the board of health.[2] All types of local health directors have the authority to employ and dismiss health department staff, but the employment decisions of a director of a consolidated human services agency must be approved by the county manager.[3] In addition, the director of a county health department, a district health department, or a consolidated human services agency may enter contracts on behalf of the department, but the law that gives local health directors this authority also states that it shall not “be construed to abrogate the authority of the county commissioners.”[4] Thus, it is a common practice to have county managers involved in the approval or execution of health department contracts.
Other administrative functions include serving as secretary to the board of health;[5] explaining the department’s activities to the board, local officials, and the public; preparing the agency’s budget; and preparing the department for accreditation. While these activities are the local health director’s responsibility, some of them may be delegated to other department staff and the way particular functions are handled may differ from place to place.
Remedies: The local health director is responsible for enforcing public health laws within his or her jurisdiction and may employ a number of legal remedies when public health laws are violated. The director may:
- Initiate civil or criminal proceedings against a public health law violator[6]
- Abate public health nuisances or imminent hazards[7]
- Impose administrative penalties (fines) for violations of state or local laws regulating smoking in public places[8]
- Embargo food or drink in some circumstances[9]
- Impose administrative penalties for violations of local on-site wastewater rules, or conditions imposed on permits issued under such rules[10]
The local health director may also play a role in actions taken by local public health employees to suspend or revoke permits, such as a permit to operate a restaurant.[11]
Communicable disease control: The local health director must investigate cases and outbreaks of communicable diseases and ensure that communicable disease control measures are given.[12] The director may order isolation or quarantine if the legal conditions for exercising the isolation or quarantine authority are met.[13] The local health director also has the duty to enforce the North Carolina laws requiring the immunization of children.[14]
Other disease control: The local health director must examine, investigate and control rabies in accordance with state public health laws.[15] The director must also investigate the causes of other diseases in the jurisdiction, whether or not they are communicable.[16]
Educate and advise: The local health director must disseminate public health information, promote the benefits of good health, and advise local officials about public health matters.[17]
This list is not exhaustive. Local health directors are responsible for the overall operation of the local public health agency, which makes the director ultimately accountable for administrative activities associated with the agency’s performance of local public health services and functions. A consolidated human services director also has duties that go beyond those of a traditional local health director, largely reflecting the consolidated human services director’s role as the chief administrator for human services programs other than public health. More information on the services and activities of local public health agencies is available here.
[1] The main statute setting forth the powers and duties of local health directors is G.S. 130A-41. See also G.S. 153A-77(e) (consolidated human services directors); 130A-45.5(c) (public health authority directors). However, other powers and duties appear in elsewhere in Chapter 130A or in other laws.
[2] G.S. 130A-41(b)(1) (county and district health directors); 130A-45.5(c)(1) (public health authority directors).
[3] G.S. 130A-41(b)(12) (giving local health director the power to employ and dismiss health department employees in accordance with the State Personnel Act); 130A-45.5(c)(12) (giving public health authority director the power to employ, discipline, and dismiss authority employees); 153-77(e)(1) (authorizing consolidated human services director to appoint agency staff with the approval of the county manager).
[4] G.S. 130A-41(b)(13). In public health authorities, the board has the power to enter contracts, not the director. G.S. 130A-45(a)(12). However, the board could delegate this power to the director. G.S. 130A-45(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-35(e) (local health director serves as secretary to county board of health); 130A-37(f) (local health director serves as secretary to district board of health); 130A-45.1(h) (public health authority director serves as secretary to public health authority board); G.S. 153A-77(e)(4) (consolidated human services director serves as secretary and staff to consolidated human services board under the direction of the county manager).
[6] G.S. 130A-18 authorizes the local health director to institute an action for injunctive relief in superior court. G.S. 130A-25 makes violation of most state and local public health laws or rules a class 1 misdemeanor (see also G.S. 14-3, providing for the classification of misdemeanors). However, violations of laws and rules pertaining to smoking in public places may not be prosecuted as misdemeanors. G.S. 130A-497(d). Further, in counties in which the county commissioners have assumed the role of the local board of health, the commissioners are authorized to enforce local rules through civil penalties--an option that is not available in counties with other forms of public health governance. G.S. 153A-77(a). However, if the commissioners exercise the option to impose a civil penalty, violation of the local rule subject to the penalty is not a misdemeanor unless the rule specifically states that it is. Although G.S. 130A-25 does not specify a role for a local health director, in practice the director is likely to be the person who asks the district attorney to bring the misdemeanor charge.
[7] G.S. 130A-19 (public health nuisance); 130A-20 (imminent hazard).
[8] G.S. 130A-22(h1).
[9] G.S. 130A-21.
[10] G.S. 130A-22(h). Very few counties have local on-site wastewater rules. In most counties, the state on-site wastewater laws apply and different remedies are available.
[11] See G.S. 130A-23, authorizing the Secretary of Health and Human Services to revoke or suspend permits upon finding a violation of state environmental health laws. Although the power to exercise this remedy is given to a state official, in practice violations are discovered and permit actions are taken by local environmental health specialists acting under the supervision of the local health director.
[12] G.S. 130A-144.
[13] G.S. 130A-145.
[14] G.S. 130A-41(b)(7).
[15] G.S. 130A-41(b)(10).
[16] G.S. 130A-41(b)(3).
[17] G.S. 130A-41(b).
Most of the powers and duties of a local health director may be delegated to another person.[1] However, the director’s authority to embargo food and drink in some circumstances may not be delegated.[2]
[1] G.S. 130A-6 (“Whenever authority is granted by this Chapter upon a public official, the authority may be delegated to another person authorized by the public official.”).
[2] G.S. 130A-21(a).
No. A state law prohibits county commissioners from abolishing an office established or required by law. [1] State laws establish the office of local health director[2] and require the appointment of an individual to serve in that role.[3]
In one type of public health agency – a consolidated human services agency – some or all of the responsibilities of the local health director may be assumed by other individuals. If a county creates a consolidated human services agency, the county manager must appoint a consolidated human services director with the consent of the consolidated human services board.[4] The consolidated human services director must then appoint an individual who meets the statutory education and experience requirements for a local health director (see question 4). By statute, the consolidated human services director acquires the powers and duties of a local health director.[5] He or she may exercise those powers and duties directly or may delegate most of them to the appointee who meets health director qualifications, or to other agency employees.
[1] G.S. 153A-76 (prohibiting a board of county commissioners from abolishing an office established or required by law); see also 52 Op. Atty Gen. 44 (1982) (concluding that the office of local health director is unaffected by G.S. 153A-77(a) and must be filled by a board of commissioners acting as a board of health under that provision).
[2] G.S. 130A-40 (establishing the office of local health director for a county or district health department); 130A-45.4 (establishing the office of public health authority director for a public health authority); 153A-77(b)(1) (establishing the office of human services director for a county with a consolidated human services agency).
[3] G.S. 130A-40(a) county or district board of health shall appoint a local health director); 130A-45.4 (public health authority board shall appoint a public health authority director); 153A-77(e) (county manager shall appoint a consolidated human services director with the advice and consent of the consolidated human services board).
[4] G.S. 153A-77(e).
[5] G.S. 130A-43(c).
The main differences relate to the appointment and qualifications of the director and the director’s powers and duties.
Appointment. A county or district health director is appointed by the local board of health after consultation with the county commissioners. A consolidated human services director is appointed by the county manager with the advice and consent of the consolidated human services board.
Qualifications: The directors of county health departments, district health departments, and public health authorities must meet the minimum education and experience requirements described in question 4. The law creating the position of consolidated human services director does not require any specific education or experience, but a consolidated human services director who does not satisfy the statutory qualifications for a local health director must appoint a person who does.[1] In addition, North Carolina’s standards for local public health agency accreditation specify that the agency’s governing board must appoint a local health director who meets the requirements of the law that applies to county and district health directors.[2]
Powers and duties. A consolidated human services director has all of the same statutory powers and duties of a county or district health director, with two limitations:
- the consolidated human services director’s hiring decisions must be approved by the county manager, and
- the consolidated human services director may serve as the executive officer of the agency only to the extent and in the manner authorized by the county manager.
A consolidated human services director also has duties that go beyond those of a traditional local health director, largely reflecting the consolidated human services director’s role as the chief administrator for human services programs other than public health.[3]
[1] G.S. 153A-77(e).
[2] See 10A NCAC 48B .1304; see also 10A NCAC 48B .0901(b)(1) (requiring the agency to have, or be recruiting, a local health director who meets legal requirements for the position).
[3] See G.S. 153A-77(e).
There is a great deal of similarity in the laws governing these different types of directors. In each case, the director is appointed by the governing board after consultation with the county commissioners, and the appointee must meet the education and experience requirements described in question 4.
Further, a public health authority director has all of the same powers and duties of a county or district health director,[1] with one exception: the public health authority director does not have the power to enter contracts. Instead, the public health authority board holds that power. The board could, however, delegate contracting authority to the director or another agent or employee.[2] It is possible that in practice a public health authority director would have an expanded role compared to a county or district health director, as the public health authority director is responsible for administering programs as directed by the public health authority board, which has expanded authority compared to a traditional local board of health. More information about the powers and duties of the different types of governing boards for local public health agencies is available here.
[1] G.S. 130A-45.5(c) (powers and duties of a public health authority director) is substantially identical to G.S. 130A-41(b) (powers and duties of a local health director), except it lacks the provision relating to contracting.
[2] See G.S. 130A-45.3(a)(9) (allowing the public health authority board to “delegate to its agents or employees any powers or duties as it may deem appropriate”).
