Creating a Taxonomy of Local Boards of Health Based on Local Health Departments’ Perspectives

Abstract

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...

Developing Continuing Education for Ohio’s Local Boards of Health

“…Public health governance is broadly defined as 6 distinct functions: (1) policy development, (2) resource stewardship, (3) legal authority, (4) partner engagement, (5) continuous improvement, and (6) oversight. 3 A seventh domain pertaining specifically to LBoHs was identified by Shah et al 6 which includes the individual characteristics and strengths of each board and their ability to respond to community needs. The capacity of LBoHs to provide oversight to LHDs is dependent in part on the board's ability to respond effectively, and ensuring LBoH members are adequately trained (ie, equipped with a working knowledge of their role and its responsibilities therein) is an important component of this.…”

Local Boards of Health Characteristics Influencing Support for Health Department Accreditation

“…Presence of variation in LBoH’s own continuous QI 22 and association of LBoH’s own QI with accreditation support imply that LHDs may benefit from supporting their LBoH’s continuous QI, including training of members on topics of relevance such as budget development and training for members not from public health about public health issues and emerging trends. In turn, LHDs can expect benefits of having robust and strong LBoHs, which can effectively do resource stewardship and support LHDs innovations other than the mandated services such as LHD accreditation.…”

“…This study fills an important gap in existing research by using the recently developed taxonomy of LBoHs 13,22 and recent data to assess the impact of LBoH governance and other characteristics on LBoH support of LHD accreditation. LBoHs with high scores on governance and other domains of the newly developed LBoH taxonomy are expected to be more supportive of their LHDs’ seeking accreditation because such LBoHs are more likely to be aware of the desirability of PHAB accreditation.…”

Assessment of Kentucky's Local Health Department Cross-Jurisdictional Sharing: Strategy for Maximizing Efficiency

“…LBOH members often direct a wide variety of initiatives to be delivered by LHJ staff to address issues in specific communities. Examples include decisions regarding community health assessment completion and budget support of activities to address obesity and other community health concerns 6,10–12…”

“…Examples include decisions regarding community health assessment completion and budget support of activities to address obesity and other community health concerns. 6,[10][11][12] In January 2018, the Kentucky legislature began a pension reform process, creating a projected $38.5 million deficit in the state's public health funding. Estimates suggested this deficit would have a substantial negative impact on LHJs in the following year.…”