Public Health
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The Three Core Functions of Public Health: The Job of the Local Board of Health


In 1988, the Institute of Medicine issued The Future of Public Health report which stated that America’s public health system was in disarray. The Institute’s panel recommended new governmental functions at federal, state and local levels to strengthen our nation’s public health system. Localities, they said, should reestablish boards of health or “public health councils” to assess public health needs, develop public health policy, and assure that public health services are available. It is these three core functions –

assess, address, and assure – that constitute the job of the local board of health.


To scan, weigh and balance community needs, resources, statistics and politics.


To determine a course of action; to set targets, to allocate resources, to make policy and assign responsibility.


To make certain that progress is made

Adapted from Assess, Address, Assure: Manual for North Carolina’s Local Health Boards. Copyright 1993 – Association of North Carolina Boards of Health.


The Eleven Essential Public Health Services

The Eleven Essential Public Health Services provide the fundamental framework for the National Public Health Performance Standards Program instruments. They describe a list of activities associated with the core functions and responsibilities of local public health agencies: assessment, policy development, and assurance.



1. Monitor health status to identify and solve community health problems.

2. Diagnose and investigate health problems and health hazards in the community.


Address (Policy Development)

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships and action to identify and solve health problems.

5. Develop policies and plans that support individual and community health efforts.



6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

8. Assure competent public and personal health care workforce.

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.

11. Emergency preparedness.


1. Website of Department of Health and Human Services – Centers for Disease Control and Prevention -
2. National Association of Local Boards of Health: Being an Effective Local Board of Health Member




History of Public Health in North Carolina


The North Carolina Office of Archives and History, Government Records Branch traces the history of the Department of Health and Human Services beginning with a reference to “an act of the 1755 Assembly ordering quarantine on vessels" and concluding with the 1990s. The history notes that in 1877, the General Assembly created the first State Board of Health composed of the entire Medical Society of North Carolina. The county boards of health were composed of the affiliated county medical societies and were under the direction of the State Board of Health. The intent was to create a uniform system of health and sanitation throughout the state. But “the General Assembly appropriated only one hundred dollars to establish this health system; and the existence of the State Board of Health was nominal.”


For the complete history, please visit this link:


Here are some excerpts from this history:


  • “In 1899 the General Assembly passed additional legislation to protect public water supplies from contamination, and the State Board of Health was charged with instructing local health boards and water company inspectors on the procedures for sampling and inspection.”

  • “… in 1911 the General Assembly recognized the State Board of Health as the state's medical adviser …. The state board was also required to issue bulletins statewide in the event of a dangerous outbreak of disease.”

  • “In 1917 the General Assembly also charged the state board with responsibility for the sanitary conditions and the hygienic care of prisoners in state prisons, local jails, county prison camps, and all other places of confinement…. .”

  • “In 1931 the dental care program was established as a separate Division of Oral Hygiene and expanded its efforts to educate the public preventive dental care. In the early 1930s the Division of Preventive Medicine took responsibility for school health services, health education and information, and maternal and child health services. Later in the decade, they initiated a nutrition program offering consultation services to local health departments, schools, and other institutions requesting services.”

  • “… in 1945, the General Assembly instructed the state board to initiate a program related to the prevention and cure of cancer, with emphasis on the early detection and treatment of cancers. Under terms of the law, the board was to provide a system of financial aid for low-income cancer patients; establish minimum standards for cancer clinics or departments in general hospitals; collect information on cancer and sponsor an educational program for citizens; and compile and preserve statistical, clinical, and other records relating to cancer prevention and cure. …

  • “In 1949 the last remaining county established a full-time health department."

  • “In 1963 the General Assembly created a new Department of Mental Health, transferring to that department the services previously performed by the Division of Local Health and its Mental Health Section. Other laws during the same period significantly increased the state board's responsibilities. In 1961 the legislature provided for the licensing of nursing homes by the State Board of Health rather than by the Medical Care Commission and the State Board of Public Welfare. The 1963 General Assembly gave the state board responsibility for a program of air pollution control, although they failed to fund it. In 1965 Governor Dan K. Moore designated the State Board of Health as the official state agency to administer Title XVIII of U.S. Public Law 89-97, commonly referred to as Medicare. The Office of Chief Medical Examiner and a Division of Medical Examiner were created in 1967 …."

  • “Under the 1973 act, the Commission for Health Services was granted the power and duty to adopt rules and regulations for the conduct of the state's public health programs, to protect and promote public health, and to control diseases and other health impairments. … Furthermore, the law stipulated that local health departments, when directed by the DHR, would enforce rules established by the Commission for Health Services and that DHR would supervise the local health departments."

  • “New programs in place by the early 1990s included the Office of Chief Nurse, charged with coordinating public health nursing services with local health departments and statewide programs; the Office of Health Education, charged with providing various services and developing teaching strategies for environmental, community, and personal health programs; and the Office of Legislative Affairs to represent the department in the General Assembly and to monitor proposed legislation and the work of the legislative study and research committees."