Recognizing the public's health is the outcome of dynamic, adaptive, and complex systems of agencies; infrastructure, relationships, and interactions that dictate how to improve health outcomes; and reducing health risks in a population is based on systems thinking and evidence. New methods such as network analysis and public health practice-based research networks demonstrate the potential for new insight to our understanding of how systems and infrastructure influence population health. We examine advances in public health systems research since 1988 and discuss the relevance of this type of research to public health practice. We assess the current infrastructure for conducting public health systems research, suggest how the research infrastructure can be improved, and conclude with a discussion of how health reform in the United States will require research focused on understanding the adaptive complexity inherent in public health and health care systems and strengthening the systems research infrastructure.

Objectives-To develop a local board of health (LBoH) classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs.Methods-This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of local health department administrators, with 394 responses. The classification development consisted of the following steps: (1) theoretically guided initial domain development, (2) mapping of the survey variables to the proposed domains, (3) data reduction using principal component analysis and group consensus, and (4) scale development and testing for internal consistency.Results-The final classification scheme included 60 items across 6 governance function domains and an additional domain-LBoH characteristics and strengths, such as meeting frequency, composition, and diversity of information sources. Application of this classification strongly supports the premise that LBoHs differ in their performance of governance functions and in other characteristics.Reprints can be ordered at http://www.ajph.org by clicking the "Reprints" link.Correspondence should be sent to Gulzar H. Shah, Georgia Southern University, PO Box 8015, Statesboro, GA 30460 (gshah@georgiasouthern.edu). CONTRIBUTORS G. H. Shah coordinated the development of the article, performed statistical analyses, and participated in writing. G. H. Shah and S. Sotnikov prepared the analysis design for the article. All authors participated in writing various sections, editing and improving the entire article, and outlining content in this article through discussions and consensus. HUMAN PARTICIPANT PROTECTIONHuman participant protection was not required because this research used secondary data. HHS Public AccessAuthor manuscript Am J Public Health. Author manuscript; available in PMC 2017 October 10. Conclusions-TheLBoH taxonomy provides an empirically tested standardized tool for classifying LBoHs from the viewpoint of local health department administrators. Future studies can use this taxonomy to better characterize the impact of LBoHs.Local boards of health (LBoHs), a fundamental component of the public health governance structure, have guided public health interventions since the 19th century. 1 Like many other governing bodies, an LBoH is vested with the authority to make decisions, "formulate the policy and direct the affairs of an institution in partnership with the managers … on a voluntary or part-time basis." 2 LBoHs have evolved with the changing public health landscape to address emerging public health threats. 1 Currently, LBoHs govern 7 out of 10 local health departments (LHDs) of all sizes in the United States. 3 The National Association of Local Boards of Health (NALBOH) defines an LBoH as a legally designated body whose members are appointed or elected to provide advisory functions and/or governing oversight for the primary governmental public health agency, and/or public health activities (assessment, assurance, and/or policy dev...