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Local Boards of Health and
Public Health Authority Boards

A local board of health is the policy-making, rule-making, and adjudicatory body for public health in the county or counties in its jurisdiction. State statutes give boards of health specific powers and duties. Every type of local board may make local public health rules that apply throughout the board’s jurisdiction. Each board has limited authority to set fees for public health services. Each board also influences the day-to-day administration of the local public health agency.

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). A consolidated human services board also plays a more active role in the development of the agency’s budget, and has additional powers and duties related to its oversight of other human services programs. 


North Carolina General Statutes defines both the responsibilities and the composition of local boards of health. The local board of health is charged with being “the policy-making, rule-making and adjudicatory body for a county health department.” And, with few exceptions, the typical board is composed of eleven members:

  • one physician

  • one dentist

  • one optometrist

  • one veterinarian

  • one registered nurse

  • one pharmacist

  • one county commissioner

  • one engineer

  • four general public representatives


The exceptions to the 11-member board include boards for a district health department, public health authority, and a consolidated human service agency or public hospital.

S.L. 2012-126 (H 438) extends to all counties and creates new options to allow a board of county commissioners to assume the powers and duties of certain boards, create a consolidated human services agency, or take both actions. The options are:

  • Assume direct control of certain boards by adopting a resolution abolishing the board(s) and transferring their powers and duties to the board of county commissioners;

  • Create a consolidated human services agency (CHSA) governed by a consolidated human services board appointed by the county commissioners; or

  • Create a CHSA governed directly by the county commissioners and appoint a health advisory committee.

For a comparison of powers and duties by type of board, refer to the attached pdf from this UNC School of Government website:



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