Board of Health Meeting Minutes: What they say about issues facing local health departments

Introduction: In many jurisdictions, local boards of health (BOH) make key decisions affecting the local health department (LHD), and provide some degree of economic oversight. However, little is known about the breadth of issues considered by local BOH. Study question. What do the discussions and deliberations of local BOHs say about LHD functions?

Methods. Publically available minutes from 168 meetings of 6 BOH in two states were content analyzed using qualitative data analysis software. Multiple coders identified key themes, and inter-rater reliability was established on coding into the themes.

Results. Nine themes emerged: 1) Financial Health; 2) Staffing the Health Department; 3) Public Health Infrastructure; 4) Emergency Preparation Initiatives; 5) Strategic Planning; 6) Disease Surveillance and Response; 7) Health Program Efforts; 8) Health Policies; and 9) Community Input. “Financial Health” was the dominant and anchoring theme, with 6 aspects: a) shortfall and cuts; b) financial planning; c) health department as employer; d) financial management and contracts; e) routine payments; and, f) grant specific decisions. “Staffing the Health Department” encompassed ensuring adequate public health staff and meeting increasingly stringent fiscal limitations. The other eight themes were less frequent and seemingly less pressing.

Conclusions. BOHs were preoccupied with fiscal issues, potentially distracting them and the LHD from addressing local health issues. The inconsistent quality and details in the BOH minutes deserve closer attention, with research into its association with the quality of decision making. BOHs seem distracted from staying focused on longer term plans that ensure the competencies of the LHD.