While there is no single law describing the minimum services that a local agency must provide, there are three primary state laws that affect the scope and range of local service provision.

• Essential public health services. The law that establishes the mission and purpose of North Carolina’s public health system also describes the public health services that the General Assembly has determined are essential to promoting and contributing to the highest levels of health and that should be available to everyone in the state. This law identifies four general categories of services and specifies some of the services that fall in each category.[1]
• Mandated services. Another statute authorizes the Commission for Public Health to establish standards for the nature and scope of local public health services.[2] The commission has adopted rules, known as the mandated services rules, which specify some of the public health services that local public health agencies must guarantee.[3]
• Local health department accreditation. Each local public health agency in the state must be accredited by the North Carolina Local Health Department Accreditation Board.[4] To be accredited, a local agency must satisfy accreditation standards that address the agency’s capacity to provide the “ten essential public health services,” a nationally recognized set of services that was adopted in 1994 by a national committee charged with providing a framework for effective public health systems.[5]

While each of these three laws addresses many of the services and activities of a local public health agency, none of them offers a complete view of a LPHA’s legal obligations. There are many other state and federal laws that are require an agency to deliver particular services. For example, a state law requires local health directors to hold annual rabies vaccination clinics for dogs, cats, and ferrets;[6] and a federal law requires LPHAs to provide language assistance to their limited-English proficient clients.[7] Other laws may compel an agency to perform activities that arise from the services the agency performs. For example, LPHAs must maintain and secure patient medical information in accordance with the HIPAA medical privacy rule.[8] Among many other things, HIPAA requires agencies to develop numerous policies and procedures, engage in employee training activities, permit clients to inspect their health records, and respond appropriately to requests for the release of health information.