What role do county commissioners play in the creation and operation of local public health agencies?

North Carolina law requires counties to provide public health services to their residents. County commissioners take several actions to ensure that this happens:

• Selection of agency type: Commissioners are key players in the selection of the type of local public health agency. The commissioners alone may choose to operate a county health department or to provide public health services through a consolidated human services agency. The commissioners may jointly resolve with the local board of health to join a district health department or form a public health authority.
• Appointment of board: County commissioners make appointments to the local public health board. The board of county commissioners appoints all the members of a county board of health, a single-county public health authority board, or a consolidated human services board. The boards of district health departments or multi-county public health authorities are appointed somewhat differently: the board of county commissioners of each participating county appoints one county commissioner to the health board, and then those commissioners appoint all the remaining members. Finally, the county commissioners may serve as the local board of health by adopting a resolution assuming the powers and duties of the county board of health or county consolidated human services board.
• Approval of budget or budget request: County commissioners approve the budgets of local public health agencies that are county departments (either a county health department or a consolidated human services agency that includes public health). If the county participates in a public health authority or district health department, the commissioners are involved in approving budget requests or providing funding to the agency.
• Other duties: A board of commissioners may have other duties as well. Here are a few examples:
  
  • If the local board of health imposes fees for services, those fees must be approved by the county commissioners (except in counties that participate in a public health authority).
  • If the county forms a consolidated human services agency, the commissioners must decide whether the employees will be subject to the State Personnel Act.
  • If the county commissioners directly assume the powers and duties of the local board of health, the commissioners become the body that is responsible for protecting and promoting the public health in the jurisdiction, and for exercising the rule-making, adjudicatory, and policy-making authority of a board of health. A board of commissioners that assumes the powers and duties of a local board of health must also appoint an advisory committee on health.