Is a public health authority a separate unit of government?

A public health authority is not an agency or department of the county but it is also not considered to be a separate political subdivision of the state (like cities and counties). It falls somewhere in the middle and has been described as a “quasi-municipal corporation.”[1]

The U.S. Census of Governments catalogs and evaluates the different types of entities in each state and evaluates their relative independence. In order to be considered a separate unit of government, the entity must:

• Exist as an organized entity,
• Have the characteristics of government (such as having elected or appointed public officials, being subject to public records laws, and/or being responsible for performing a function commonly regarded as a governmental function), and
• Have substantial autonomy, which amounts to “considerable fiscal and administrative independence.”[2]

While a public health authority likely satisfies the first two parts of this test, it probably falls short of the test for substantial autonomy, which requires both fiscal and administrative independence. Specifically, an organization like a public health authority that has “considerable fiscal autonomy” may still be classified as a “dependent” agency for one or more of the following reasons:

• The authority has “control … over facilities that supplement, serve, or take the place of facilities ordinarily provided by the creating government,”
• The authority’s “properties and responsibilities revert to the creating government after … debt has been repaid,” or
• The authority may depend on the county for a substantial part of its revenue. [3]

Even though a public health authority is not a separate political subdivision of the state, it is important to remember that it is still considered a governmental entity. It falls somewhere between a separate local government entity and an agency of local government.

[1]An opinion from the Attorney General’s office regarding a public transportation authority described it this way:  “A public transportation authority is neither a private corporation nor a political territorial subdivision, but instead it is a quasi-municipal corporation [that is]… ‘commonly used in this and other states to perform ancillary functions in government more easily and perfectly by devoting to them, because of their character, special personnel, skill and care.’” N.C. Department of Justice, Advisory Opinion of the Attorney General, from Rufus Edmisten to David D. King (April 5, 1984) (citing Greensboro-High Point Airport Authority v. Johnson, 226 N.C. 1, 36 S.E.2d 803 (1945).

[2]U.S. Census Bureau, 2017 U.S. Census of Governments, Individual State Descriptions, available at https://www.census.gov/library/publications/2019/econ/2017isd.html.

[3]Id. There are other factors considered by the U.S. Census in making this determination, but the three identified above are the only ones that appear to be associated with North Carolina’s public health authority model.