North Carolina Public Health Law
Comparing North Carolina’s Local Public Health Agencies: The Legal Landscape, the Perspectives, and the Numbers
This is the final report. For a preliminary version, click here.
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 designed to alter the legal and policy landscape for local public health agencies were introduced in the state legislature. 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, our 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. We presented our findings in a report released in May 2012. Legislation enacted in June 2012 made several changes to the laws related to the organization and governance of local public health agencies. In this final report, we provide updated summaries of the law as well as more recent quantitative data in some areas.
We have not updated the qualitative data in the section entitled “The Perspectives,” but we have reprinted most of that section because its findings are still relevant to ongoing policy discussions at the local level. The key findings of our research are presented below.
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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 designed to alter the legal and policy landscape for local public health agencies were introduced in the state legislature. 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, our 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. We presented our findings in a report released in May 2012. Legislation enacted in June 2012 made several changes to the laws related to the organization and governance of local public health agencies. In this final report, we provide updated summaries of the law as well as more recent quantitative data in some areas.
We have not updated the qualitative data in the section entitled “The Perspectives,” but we have reprinted most of that section because its findings are still relevant to ongoing policy discussions at the local level. The key findings of our research are presented below.
The FY2011 percentage of public health activities offered by each local health department in FY2011 is based on a total of 127 activities across 38 categories captured by the North Carolina Local Health Department Survey.
This supplement presents the comprehensive results of focus groups and key informant interviews that were conducted to gain an understanding of stakeholders’ perceptions of North Carolina’s different organizational/governance models for local health departments (LHDs). Four focus groups were held, two with randomly selected health directors and two with randomly selected county officials (commissioner members of boards of health, county managers, or their designees). Individual key informant interviews were conducted with local and state public health practitioners, county managers and assistant county managers, county commissioners, state legislators, representatives from the North Carolina Association of County Commissioners (NCACC), and representatives from the UNC Gillings School of Global Public Health who work closely with local health departments. A total of sixty-‐four individuals participated in this component of the study. Participant responses are categorized into two groups—public health practitioners and county officials and state legislators. Practitioners include current and former local and state health practitioners and current and former staff of the UNC Gillings School of Global Public Health who work (or worked) closely with LHDs. Officials include county managers, assistant county managers, county commissioners, NCACC representatives, and state legislators.