What are the key legal differences between the different types of local public health agencies?
There are important differences between the types of agencies in five general areas: budget and finance, boards, appointment of directors, director qualifications, and personnel policies.
- Budget and finance: County health departments and consolidated human services agencies are components of county government and are units of the county for many purposes, including finance and budgeting. The budget of a county health department or consolidated human services agency is established by the county it serves, and the county is held accountable for financial management under state law. In contrast, public health authorities and district health departments function as separate entities. They establish their own budgets, separate from the county, and are directly accountable for compliance with state financial management laws.[1] They may submit budget requests to the county for funding to support their work, but the overall budget remains within their control.
- Boards: The boards of the different types of agencies differ, both in powers and duties and in membership. Click here to see a table comparing the membership requirements, powers, and duties. In general, public health authority boards have expanded powers and duties compared to county and district boards of health. Consolidated human services boards have all of the powers of county and district boards of health, except a consolidated human services board may not appoint the agency director (who is appointed instead by the county manager, with the advice and consent of the board). The number of board members may be as few as seven for a public health authority board, or as many as 25 for a consolidated human services board. Finally, in counties with county health departments or consolidated human services agencies, the board of county commissioners may abolish the appointed governing board for the agency and directly assume its powers and duties. A board of commissioners that takes this action must appoint an advisory committee on health that has the same membership as a county board of health.[2]
- Appointment of directors: The appointment of the local health director is managed differently by the different types of agencies.
- In county and district health departments, the director is appointed by the local board of health after consultation with all applicable boards of county commissioners.
- In a public health authority, the authority board appoints the director after consultation with all applicable boards of county commissioners.
- In a consolidated human services agency, the agency director is appointed by the county manager with the advice and consent of the consolidated human services board. The agency director then appoints a person who meets the statutory qualifications of a local health director. The county manager must approve the appointment of that person.
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.
- Director qualifications: The directors of county health departments, district health departments, and public health authorities must meet minimum education and experience requirements set forth in state laws, which generally require a background in medicine, public health, or public administration related to health services. There is no similar education and experience requirement for the director of a consolidated human services agency. However, if the director of a consolidated agency that provides public health services does not meet those qualifications he or she must appoint a person who does.[3] 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.[4]
- Personnel policies: The employees of county and district health departments are ordinarily subject to the State Personnel Act (SPA).[5] Public health authorities are exempt from the State Personnel Act and establish their own personnel policies and salary plans.[6] The employees of consolidated human services agencies are subject to county personnel policies or ordinances, unless the board of county commissioners elects to make the agency employees subject to the SPA.[7] The directors of all of the different types of local public health agencies may appoint employees, but appointments made by a director of a consolidated human services agency must be approved by the county manager. The directors of the other types of departments are not required to obtain the county manager’s approval before appointing employees.
[1] G.S. 130A-36(a) (a district health department is a public authority as defined in the Local Government Budget and Fiscal Control Act and thus subject to that Act); 130A-45.02(g) (a public health authority is a public authority as defined in the Local Government Budget and Fiscal Control Act and thus subject to that Act).
[2] G.S. 153A-77(a). It is possible for a board of commissioners to assume the powers and duties of a board of health for a county with a district health department or a public health authority, but the commissioners must first dissolve or withdraw from the district or authority, an action that may be taken only at the end of a fiscal year. G.S. 130A-38 (district health department); 130A-45.2 (public health authority). After dissolving the district or authority, the commissioners could create either a county health department or a consolidated human services agency to provide public health services within the jurisdiction, and then assume the powers and duties of the agency’s board.
[3] G.S. 130A-40 (county and district health departments); 130A-45.4 (public health authority); 153A-77(e) (consolidated human services agency). In general, the local health director must have education and experience in medicine, public health, or public administration related to health.
[4] 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 statutory 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 an agency could be accredited without meeting this standard. However, the agency would still be required by state statute to appoint a person with the statutory credentials of a local health director. The statutes for county health departments, district health departments, and public health authorities require the director to have those qualifications. G.S. 130A-40; 130A-45.4. The statute for consolidated human services agencies requires the director to appoint a person with those qualifications, unless the director meets them him or herself. G.S. 153A-77(e)(9).
[5] G.S. 126-5(a)(2).
[6] G.S. 130A-45.12; 130A-45.3(a)(7).
[7] G.S. 153A-77(d). If a county that has a consolidated human services agency withdraws its employees from the State Personnel Act, the county personnel policy or ordinance must comply with the applicable federal merit personnel standards found in 5 C.F.R. Subpart F.
