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Local Boards of Health as Linkages Between Local Health Departments and Health Care and Other Community Organizations

Shah, Gulzar H. PhD, MStat, MS; Leep, Carolyn J. MS, MPH

Journal of Public Health Management and Practice: November 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000858
Research Full Report: PDF Only

Introduction: Efficient provision of essential public health services may be influenced by collaborative capacity of local health departments (LHDs). Local boards of health (LBoHs) are well positioned to facilitate partnerships.

Objectives: We examined the degree to which LBoHs serve as a linkage between LHDs and 2 types of community organizations, health care providers and local government agencies, and the LBoH characteristics associated with tendency of LBoHs to perform such linkage function.

Methods: We analyzed data from a recent cross-sectional survey, the 2015 National Survey of Local Boards of Health. This survey used a probability sample of 685 LHDs stratified by the state of LHD location and the population size of LHD jurisdiction, resulting in 394 responses for a response rate of 58%. We used multivariate logistic regression to pursue the study objectives.

Results: LHD respondents reported that LBoHs served as a linkage with hospitals or other health care providers for 20% of LHDs and with local government agencies for 19% of LHDs. Significant association of LBoHs' performance of governance functions existed with their chances of linking LHDs with hospitals or other health care providers (adjusted odds ratio [AOR] = 1.25; P < .001) and with local government agencies (AOR = 1.23; P < .001). Among the factors associated with LBoHs serving as the linkage, the governance function oversight was the strongest, followed by governance functions policy development, continuous improvement, and resource stewardship. Legal authority had weakest association with both types of linkages. A strong positive association existed between LBoHs seeking community input from elected officials and LBoHs' tendency of serving as the linkage with both health care providers and local government agencies.

Conclusions: The role of LBoHs in linking with hospitals, other health care providers, and government agencies could be further maximized, particularly given the high proportion of LBoHs that include members who are health care professionals.

Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); and National Association of County & City Health Officials, Washington, District of Columbia (Dr Leep).

Correspondence: Gulzar H. Shah, PhD, MStat, MS, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460 (

The authors are sincerely thankful to Dr Sergey Sotnikov, Dr Jiali Ye, Ms Liza Corso, and Dr Timothy W. Van Wave, for their review and critique of the earlier versions of the manuscript.

The authors declare no conflicts of interest.

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