Board of Health

The board of health provides help with assessing needs, prioritizing, and dealing with calls from the community on health related issues, assists with policy development, improves working relations between sanitarians and other health department staff and finally ensures compliance with the state statutes.

In the area of assessment, the analysis and identification of trends is only part of the picture. Resources are finite, therefore priorities must be established and the community must agree on a plan for improvement. A functional board of health can provide input and guidance to the department as it assesses the vast needs of the community and determines a strategic plan for addressing them.

Additionally, the effectiveness of the intervention must be measured and entered into the political process or policy development in order to assure and modify continuing community support. Local boards of health play a very important role as links with the community as a whole, advocate for the development of programs within the health department and act as a liaison to the state legislature.

Assurance is improved when the board of health is strong. The board brings the environmental health and human health sides of public health together to assure that the public’s health is improved in all
areas. With increased concerns about emergency preparedness, boards of health must be well-versed in responding to health emergencies. The only way to be prepared is to practice and, since there are not many large scale emergencies, systems must be in place to deal with day-to-day health issues. Boards must be prepared to respond to the daily issues in order to respond to big emergencies.

Most importantly, health departments are essentially established through the board of health statutes. The first step in assessing a board of health requires looking at what is mandated in the Montana Code Annotated. The duties of a board of health are outlined specifically in Sections 50-2-101 through 50-2-116, MCA. A tool that I used can be seen in the document following this article. Under each specified duty I was able to assess if our Board was compliant. Once the assessment was complete I was able to approach the commissioners to reorganize our current board to become a “functional” board. The process was also enhanced through support from the health officer and the county attorney. They both saw the need to have a board that would not only comply with the statutes, but also provide support for the public health cases in which they were involved.

Once the current board of health was assessed, the following steps were taken:

• We joined the National Association of Local Boards of Health (NALBOH).
• We reviewed NALBOH’s Board Orientation videotape, Assessment, Policy Development and Assurance: The Role of the Local Board of Health.
• We gathered information from bigger counties with “functional” Boards of Health.
• We received sample board by-laws from other counties.
• We drew up an organizational chart with input from the Sanitarian.
• We reviewed the proposed Board with the Chairman of the Richland County Commissioners.
• We set a date for our first “functional” board of health meeting.

Orientation was critical because most new members had not served on the board in the past and they needed information on their function as board members. A binder was assembled for each member. The new board orientation consisted of a review of the NALBOH Health Board Orientation videotape and a discussion of the orientation worksheets with the new board members. These worksheets included a review of the three core functions of public health.

The Board Member manual consisted of the following sections:

Section 1:
1. Organizational Chart
2. Membership contact information
3. Calendar of meeting dates

Section 2:
1. Functions of the Board of Health
2. Public Health Standards. (I used standards proposed by the State of Washington. These standards were clear and in useable language.)
3. Information on the benefits of Public Health and Montana’s System, written by Jane Smilie for the Montana Policy Review, Fall, 2002
4. Public Health Code of Ethics put out by the American Public Health Association.

Section 3:
1. MCA 50-2-101 through 50-2-130
2. Roles and Legal Responsibilities of Local Public Health Officers written by Joan Miles, JD, Health Officer, Lewis and Clark City-County Health Department

Section 4: Proposed By-laws

Section 5: A section to place meeting minutes and other materials related to issues being discussed.

Even with new board orientation, we continue to learn with each meeting. With every issue that is brought before the board, the members become more comfortable making decisions. It has become clear to me that it is essential that a functional board of health be established long before it is needed in an emergency situation. The functions of a board are many and can be complicated; without practice they can not act as they need to when they are called upon. The county commissioners feel that the board of health is a very worthwhile board as it provides the avenue for resolving community health issues that was not readily available in the past. Moreover, the presence of the county attorney at the board meetings provides needed legal advice when making some tough decisions. As counties prepare for public health emergency response, a thorough review of the board of health and how it functions, is essential to lay the foundation necessary for a sustained public health response to both large scale emergencies, and day-to-day threats to our public’s health.