NALBOH worked with the Centers for Disease Control and Prevention (CDC), other partners, and experts from the field to identify, review, and develop a model of Six Functions of Public Health Governance. The release of the six Governance Functions is a landmark moment in public health. The boards that govern health departments can now assess their own activities against a standard, and non-governing advisory boards can better understand their important role in the governance process.
NALBOH co-founder and Interim CEO Ned Baker, who has championed the important role of boards of health for over 20 years, commented, “Defining the Governance Functions is groundbreaking for the future of public health. These six functions are to public health governance what the three Core Functions and ten Essential Services have been to public health."
All public health governing entities are responsible for some aspects of each function. No one function is more important than another.
Lead and contribute to the development of policies that protect, promote, and improve public health while ensuring that the agency and its components remain consistent with the laws and rules (local, state, and federal) to which it is subject. These may include, but are not limited to:
• Developing internal and external policies that support public health agency goals and utilize the best available evidence;
• Adopting and ensuring enforcement of regulations that protect the health of the community;
• Developing and regularly updating vision, mission, goals, measurable outcomes, and values statements;
• Setting short- and long-term priorities and strategic plans;
• Ensuring that necessary policies exist, new policies are proposed/implemented where needed, and existing policies reflect evidence-based public health practices; and
• Evaluating existing policies on a regular basis to ensure that they are based on the best available evidence for public health practice.
Assure the availability of adequate resources (legal, financial, human, technological, and material) to perform essential public health services. These may include, but are not limited to:
• Ensuring adequate facilities and legal resources;
• Developing agreements to streamline cross-jurisdictional sharing of resources with neighboring governing entities;
• Developing or approving a budget that is aligned with identified agency needs;
• Engaging in sound long-range fiscal planning as part of strategic planning efforts;
• Exercising fiduciary care of the funds entrusted to the agency for its use; and
• Advocating for necessary funding to sustain public health agency activities, when appropriate, from approving/appropriating authorities.
Exercise legal authority as applicable by law and understand the roles, responsibilities, obligations, and functions of the governing body, health officer, and agency staff. These may include, but are not limited to:
• Ensuring that the governing body and its agency act ethically within the laws and rules (local, state, and federal) to which it is subject;
• Providing or arranging for the provision of quality core services to the population as mandated by law, through the public health agency or other implementing body; and
• Engaging legal counsel when appropriate.
Build and strengthen community partnerships through education and engagement to ensure the collaboration of all relevant stakeholders in promoting and protecting the community’s health. These may include, but are not limited to:
• Representing a broad cross-section of the community;
• Leading and fully participating in open, constructive dialogue with a broad cross-section of members of the community regarding public health issues;
• Serving as a strong link between the public health agency, the community, and other stakeholder organizations; and
• Building linkages between the public and partners that can mitigate negative impacts and emphasize positive impacts of current health trends.
Routinely evaluate, monitor, and set measurable outcomes for improving community health status and the public health agency’s/governing body’s own ability to meet its responsibilities. These may include, but are not limited to:
• Assessing the health status of the community and achievement of the public health agency’s mission, including setting targets for quality and performance improvement;
• Supporting a culture of quality improvement within the governing body and at the public health agency;
• Holding governing body members and the health director/health officer to high performance standards and evaluating their effectiveness;
• Examining structure, compensation, and core functions and roles of the governing body and the public health agency on a regular basis; and
• Providing orientation and ongoing professional development for governing body members.
Assume ultimate responsibility for public health performance in the community by providing necessary leadership and guidance in order to support the public health agency in achieving measurable outcomes. These may include, but are not limited to:
• Assuming individual responsibility, as members of the governing body, for actively participating in governing entity activities to fulfill the core functions;
• Evaluating professional competencies and job descriptions of the health director/health officer to ensure that mandates are being met and quality services are being provided for fair compensation;
• Maintaining a good relationship with health director/health officer in a culture of mutual trust to ensure that public health rules are administered/enforced appropriately;
• Hiring and regularly evaluating the performance of the health director; and
• Acting as a go-between for the public health agency and elected officials when appropriate.
The board, commission, council, individual, or other body legally accountable for ensuring the Six Functions of Public Health Governance in a jurisdiction.
Governance Functions (The Six Functions of Public Health Governance)
The identified functions for which a public health governing entity is responsible. The Six Functions of Public Health Governance are policy development, resource stewardship, legal authority, partner engagement, continuous improvement, and oversight.