Comparing North Carolina’s Local Public Health Agencies: The Legal Landscape, the Perspectives, and the Numbers

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.