Investigating the Role of Local Board of Health Governance on Local Health Department Policymaking Behavior

This study sought to identify groupings of policymaking behavior among local governmental health departments (LHDs) across the country and assess whether such groupings were associated with the governance activity of their board of health (BOH).

We conducted latent class analysis (LCA) to identify possible classes of policymaking behavior among LHDs. Once classes were identified, we used multinomial logistic regression (MLN) to estimate the association between an LHD's policymaking behavior and the governance activity of their BOH.

2019 wave of the National Association of City and County Health Officials (NACCHO) Profile Survey.

All LHDs with BOHs in the 2019 NACCHO Profile Survey (n = 1003).

Within our MLN, our primary outcome of interest was the association between an LHD's policymaking class (the main dependent variable) and the governance activity of its BOH (the main independent variable).

Based on our LCA, we determined our sample to be composed of what we characterized as "Limited Policy-Involvement," "Average Policy Involvement," and "Expanded Policy Involvement" LHDs. Those in the Expanded Class were more likely to be involved across all policy areas compared to the Limited and Average class, especially among social determinants of health (SDOH)-related areas. Our MLN estimated that having a BOH active in legal authority was associated with an 86% increased chance that an LHD would be in the "Average Class" compared to the "Limited Class" and having a BOH active in partnership engagement was associated with an 86% more likely chance that an LHD is in the "Expanded Class" compared to the "Average Class."

Using nationally representative data on LHD activity, we found distinct groups of policymaking behavior, including a quarter of LHDs that are highly active in traditional and SDOH-related policy areas. We also found that groupings of policymaking behavior, as indicated by class designation, are strongly associated with the BOH's governance activity.