The Local Boards of Health Toolkit is designed to assist board of health and board of supervisor members with their roles and responsibilities in promoting the mission of public health.

This toolkit is not intended to be completed all at one time.

The toolkit focuses on the resources local board of health members may need during their tenure. If you would like to leave your comments or feedback, please click on the Evaluation link below.          

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Roles and Responsibilities of a Local Boards of Health Member [15]

Quick Links:

A. Local/County Boards of Health

B. Local Public Health Agency (LPHA)

As a member of the Local Board of Health, this section of your orientation will acquaint you with your role, responsibilities, and authority.

A. Local/County Boards of Health

The documents and information listed are samples; your local board of health may have different or additional material.

1. Functions of the Board and Membership List [16]

As a volunteer member of your county's Board of Health, you will be devoting your efforts to prevent, promote, and protect the health of your friends and neighbors. You will be introduced to the functions of your Board by the Public Health Director/Administrator in your county or community. The Public Health Director/Administrator in your county or community will provide you with a list of your fellow members of the Board of Health. Every Board of Health has 5 members (including one physician) that are appointed by the County Board of Supervisors.

2. Mission/Vision

Some county Boards of Health have developed a mission and vision statement for the work of the Board. Your Public Health Director/Administrator will provide you with this if these statements are present in your county or community.

3. Ethics

Local Board of Health members are held in high regard in the community, as they are elected to protect the health of the public. To maintain this standing in the community, local board of health members must have knowledge of ethics. One of the major ethical issues facing local board of health members is conflict of interest between the board member and a citizen, organization, or company petitioning the board. This section describes the legal definition of conflict of interest, including the procedure for dealing with potential conflicts of interest, and what board members must do to avoid these conflicts.

Conflict of Interest - Policy [17]

Conflict of Interest Disclosure Statement [18]

4. Roles and Responsibilities

A. Guidebook for Local Boards of Health [19]

This document provides a basic outline of the relationship between local boards of health, the Iowa Department of Public Health, and the communities with whom the local Boards of Health work. This resource outlines basic responsibilities of local boards of health, and can be used as a reference for new members of local board of health, as well as seasoned board members that want to maintain current knowledge of the relationships that local boards of health must maintain.

B. Ten Rules of Thumb for Local Boards of Health [20]

This document highlights some of the legal aspects of Boards of Health and their relationships with the public, Board of Supervisors, and state-level public health. Topics include answers about the jurisdiction of local boards of health, the level of independence the local board of health has from its board of supervisors, as well as some recent decisions that Iowa courts have made that relate to boards of health. It can be used as a quick reference for any board members or people interested in matters of their local board of health.

C. Simplified Parliamentary Procedure [21]

Orderly meetings are critical when running a governmental organization. Parliamentary procedure is a standard set of rules used when conducting formal business meetings, such as the meetings conducted by local Boards of Health.  It is important to have a solid understanding of these rules as a member of a local board of health. The Iowa State University Extension has compiled a brief overview of parliamentary procedure in an effort to increase understanding of the many rules involved, including order to business, the process of voting, and submitting and amending motions before the committee.

D. Robert's Parliamentary Made Simple [22]

This official website of Robert's Rules of Order provides information that you need to know about Robert's Rules, including: a simple introduction to parliamentary procedure, the authors who have created the leading manual of parliamentary procedure, and how you can use Robert's Rules of Order Newly Revised to help your organization run more smoothly.

5. Legal Responsibilities

A. Local Board of Health (LBOH) Law: Code of Iowa, Chapters 137 [23]

This statute defines the local board of health and all of the components contained in the board of health unit, as well as the powers that local boards of health possess, policies to changing the local health district, funding issues, penalties for non-compliance with the statute, and references to the public health standards created by the Iowa Department of Public Health.

B. LBOH Rules: Iowa Administrative Code, [641], Chapters 77 [24]

This section from Iowa Administrative Code outlines the requirements that local boards of health must follow to comply with state law. Chapter 77 discusses the roles and responsibilities of local boards of health and outlines the requirements and application process for District Boards of Health.

C. Open Meetings: Code of Iowa, Chapter 21 [25]

This statute requires the governmental bodies hold open meetings, so that the public can keep the government accountable, as well as allowing the public to educate themselves on policies that governmental bodies create. Local boards of health fall under this "Open Meetings" statute, as defined in the text. This chapter of Iowa Code also defines when it is appropriate for governmental bodies, such as local boards of health, to go into closed session.

D. Open Records: Code of Iowa, Chapter 22 [26]

This statute defines the rights of citizens to examine public records, otherwise known as the "Open Records Laws." Subsections of this chapter include definitions, access to information, what constitutes a fair information practice, as well as penalties that can be assessed for blocking access to records that are protected under this chapter of Iowa Code.

E. Local Board of Health (LBOH) Law: Code of Iowa, 455B.172 [27]

This statute explains the legalities of local boards of health, including over what local boards of health have jurisdiction in regards to water pollution and wastewater treatment, collection, and disposal.

6. Professional Advisory Personnel Responsibilities [28] (if the Local Board of Health Serves in This Capacity)

484.16 Medicare Condition of Participation [29]: A group of professional personnel, which includes at least one physician and one registered nurse (preferably a public health nurse), and with appropriate representation from other professional disciplines, establishes and annually reviews the agency's policies governing scope of services offered, admission and discharge policies, medical supervision and plans of care, emergency care, clinical records, personnel qualifications, and program evaluation. At least one member of the group is neither an owner not an employee of the agency.

7. Contracts and Financial Management

A. Local Boards of Health Financial Management [30]

This document discusses the financial aspects of running a local public health agency, including developing and setting a budget, managing finances throughout the fiscal year, setting fees for services provided by the agency, keeping accurate financial records, and the responsibilities administrators have in keeping to the agency's budget and maintaining transparency in the flow of money to and from the local public health agency. Statutes from Iowa Code are included for quick reference throughout this document, highlighting the financial relationship between local public health and public health at the state level. In addition, questions to ask when developing a budget are included, in order to streamline the process.

B. Code of Iowa Chapter 28E: Joint Exercise of Governmental Powers [31]

This statute outlines the abilities of local governments to work collaboratively to solve common problems. This chapter of Iowa Code is used in cases of joint use of emergency services and public safety resources, and lists financial and legal considerations in sharing resources.

8. Calendar of Meeting Dates and Other Events for Orientation

Your local public health department director will provide you with a calendar of times and meeting dates for Board of Health meetings, as well as any other events for orientation.

9. Human Resources

A. Successful Interviewing [32]

The Successful Interviewing Guide is designed to help companies and organizations when hiring new employees. The guide is designed to make the interviewing and hiring process go more smoothly, and to help employers avoid problems such as claims of discrimination and not hiring someone who fits the actual job description. Contained in the Successful Interviewing Guide are tips on how to write a job description, how to advertise the position, finding qualified applicants, answering pre-employment questions, setting reasonable salaries, and what a job application should look like depending on the position.

B. Model Board Candidate Form [33]

This sample interview form is designed to be a template for local boards of health and boards of supervisors to use and modify for interviewing candidates for open board of health positions. This form can be used as-is but can be modified to fit the needs of localities with special populations or issues that new board members need to address as leaders in public health.

C. Mentoring Documents - ASTHO [34] and NACCHO [35]

These documents are for new directors and administrators of state and local public health agencies, and list out the potential roadblocks and pitfalls that may occur during the first months of new leadership at the state or local public health agency.

B. Local Public Health Agency (LPHA)

1. Mission/Vision

Every local public health department has identified its own mission and vision. Your local public health director will provide you with this information.

2. Table of Organization

Your local public health director will provide you with a table organization for the local public health department.

Sample Table of Organization (Black Hawk County) [36]

3. Annual Report

Every year, each local public health department completes an annual report of the programs, goals, and evaluation of their services. Your public health director will provide you with a copy of this report.

Sample Annual Report (Scott County) [37]

4. Health Department Programs

Your local public health director will share program policy information for all programs and services provided by the local health department. Policies and procedures should include specific enough information to provide adequate guidance for the provision of the service as well as the goals and objectives for the program.

5. Environmental Health

A. Environmental Health Websites [38]

This document lists 20 websites frequently used by public health practitioners, with a strong emphasis on environmental health professionals. New local board of health members can browse through the included links to learn more about different topics facing public health today.

B. Environmental Health Documents

The documents and links listed on this page are Iowa-specific, and include responsibilities of local boards of health in regards to environmental health, organization and structure at the Iowa Department of Public Health's Environmental Health Bureau, programs available through the Iowa Department of Public Health, and other resources that may expand the knowledge of local board of health members.

Board of Health Responsibilities Specific to Environmental Health Programs:

• Powers of Local Boards [39]
• Additional Powers of Local Boards [39]
• Legal Definitions [39]

Environmental Health Divison Table of Organization [40]

Toxicology Resources [41]

Environmental Health - A Profile of Iowa's Systems [42]

IDPH Bureau of Environmental Health Website [43]

Identification and Abatement of Nuisances [44]

C. Environmental Health Specialist Positions - Interview Questions [45]

This document covers the basic areas relating to the Environmental Health Specialist Position. Each question covers one of the different areas in either the Core Functions or the Ten Essential Services, and a scoring guide is included at the end of the document.

6. County Budget Process: IAC Chapter 331.434 [46]

For those health departments in the county system, this gives guidance to the Board of Health and health department staff for the budget process.

Your local public health director will provide past and current budget information and the agency process for approval of the budget. If the Board of Health governs the public health department, the Board of Health has legal authority for fiduciary responsibilities as identified in Iowa Code 137.

7. Public Health Partners that Serve the County Residents and Linkages with Them

Your local public health director will provide you a listing of their partners.

8. Promoting Health in Your Community

In 1988, the Institute of Medicine issued a report entitled "The Future of Public Health." In this report, state and local public health agencies were charged with regularly and uniformly collecting, assembling, analyzing, and publishing statistics on the health of the community. The Iowa Department of Public Health uses the Community Health Needs Assessment and Health Improvement Plan, otherwise known as CHNA-HIP, to standardize and produce information on the health of Iowans, and carry out the assessment core function of public health. Reports were issued in 2000 and 2005, and 2011. The next CHNA & HIP are due February 2016. These reports display the major public health concerns of each county in Iowa, and can help local boards of health better allocate money and services for solving these public health problems.

CHNA & HIP Reports - Iowa Department of Public Health [47]

Healthy Iowans sets the agenda for solving priority health issues facing Iowans so they can live longer, healthier, more productive lives and enjoy our rich quality of life. The plan is the outcome of a statewide needs assessment involving public and private partners as well as individuals that have identified Iowa's health issues and are committed to making changes. Since the 1990s, Healthy Iowans has included a set of measurable goals with objectives/action steps. The Iowa Department of Public Health coordinates ongoing technical assistance, tracking yearly progress, and making revisions. The current Healthy Iowans: Iowa's Health Improvement Plan 2012-2016 [48] is built on health needs identified by Iowa's 99 counties, contributions from individuals, private and public organizations, and advisory groups, data analysis, and such national resources as Healthy People 2020 [49].

Healthy Iowans - Iowa Department of Public Health [50]

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The Local Board of Health and County Board of Supervisors [51]

In this section, you will be introduced to working with the County Board of Supervisors. You will learn how the local board of health is part of the local government structure, and how you are appointed.

A. Board of Supervisors Appointment Guide [52]

This document explains what requirements board of supervisor members have for potential new local board of health members, including board responsibilities, and information needed before appointment to the board of health. This guide also shows the oversight that boards of supervisors have over boards of health.

B. Appointment and Removal of Board of Health Members: Iowa Code Section 331.321 [53]

This statute explains the process a board must follow to appoint new members or remove members found to be in violation of state law. Board members can only be appointed to the board or removed from the board in accordance with this section of Iowa Code.

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Other Public Health Law

The Code of Iowa is the law of the State of Iowa. The Code of Iowa is created and adopted through legislative process. Once a bill is introduced, it must go through a series of events before becoming law.

The Iowa Administrative Code is a set of rules for each of the agencies within state government. In order for an agency to adopt a rule, authority must be given to the agency through an act or law of the legislative body. This section contains a flow sheet that describes this process.

A. How Iowa Rules and Law Are Made [54]

This document explains the process in which laws are created and published in the state of Iowa.

B. Appointment and Removal of Board of Health Members: Iowa Code Section 331.321

1. The Iowa Legislature General Assembly [55] website.

2. State Board of Health: IAC [641], 170 [56]

This document contains Iowa Administrative Code that pertains to the Iowa Department of Public Health and the state-level Board of Health. Iowa Administrative Code adds clarity and specificity to statutes listed in Iowa Cide. These statutes form the basis for day-to-day operations for the Iowa Department of Public Health, and offer rules and regulations governing the state Board of Health, which oversees the Iowa Department of Public Health.

3. Code of Iowa, Chapter 135 [57]

This document highlights Chapter 135 of Iowa Code, which pertains to public health at the state level. Sections of interest include general provisions governing the Iowa Department of Public Health; statutes on the release of data, licensing of health care agencies and institutions, health improvement programs, disaster preparedness, and gambling treatment programs; as well as responsibilities of public health in the care of those who cannot pay for treatment.

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A. Legal Resources

B. Evaluation Resources

C. Other Web Resources

A. Legal Resources

1. List of all Iowa Code sections which make reference to a "Local Board of Health" or "County Board of Health" [61]

This document was created to bring together all of the different instances in Iowa Code in which local public health is mentioned. Many of the statutes listed in this document are scattered throughout Iowa Code in sections that do not generally apply to local public health. Board of health members can use this document as a reference to save time when determining the legality of programs created by their local health department.

2. Tort Liability: Code of Iowa, Chapter 670 [62]

This statute discusses financial and legal issues related to local boards of health. Topics included in this chapter of Iowa Code include definitions, insurance, legal settlements, taxes, and what to do in case of judgments in Iowa courts that are against the local board of health.

3. A Baker's Dozen - 13 Issues Regarding the Open Meeting Law [63]

This PowerPoint presentation summarizes the details of the Open Meeting Law, and explains which governmental bodies are covered by the law. This presentation is an excellent introduction for individuals who do not have a background in law, or are new to public health or the local board of health system in Iowa. It may be too basic for seasoned members of local boards of health.

4. Iowa Attorney General Sunshine Advisories (related to Iowa Code Section 21 and 22) [64]

The Iowa Attorney General's Office has issued monthly "Sunshine Advisory" bulletins since November 2001. The Advisories discuss basic requirements and application of Iowa's Open Meetings Law and Public Records Law (Chapter 21 and 22 of the Iowa Code).

B. Evaluation Resources

1. Director's Evaluation: Guide for Performance Evaluation [65]

This document provides a tool for evaluating directors of local public health agencies on several criteria relating to job performance: meeting set goals, employing and maintaining personnel; public policy information; creating, maintaining, and evaluating programs; community involvement; and the creation and maintenance of contracts with other agencies. While rating directors is at the discretion of the local board of health using the tool, it is standardized and can be used across the state to compare the performance of different health department directors.

2. Director's Evaluation: Community Leadership Questionnaire [66]

This document provides a tool for evaluating directors of local public health agencies on criteria related to community leadership. While rating directors is at the discretion of the local board of health using the tool, it is standardized and can be used across the state to compare the performance of different health department directors.

3. Director's Self-Evaluation on Job Performance [67]

This evaluation form allows board of health members to evaluate themselves and their board of health, in order to create improvement of boards of health through active discussion. The form is entirely qualitative, which allows individuals using the tool the freedom to add material to the evaluation.

4. Board of Health Questionnaire: Administrator's Evaluation [68]

This evaluation form evaluates administrators of local public health agencies on thirteen different abilities, including management skills; forging relationships between the local board of health, board of supervisors, and other partners in the community; and developing standards for performance in the local public health agency. While rating directors is at the discretion of those using the tool, it is standardized and can be used across the state to compare the performance of different health department directors.

5. Guide for Performance Evaluation of Health Department Director/Administrator [69]

This evaluation form focuses on evaluating the performance of a public health department director. The evaluation is based on eight core competencies: analytic assessment skills, policy development and program planning, communication skills, cultural competency, community dimensions of practice skills, knowledge of the basic public health sciences, financial planning and management, and leadership and system thinking.

These eight core competencies line up with the Core Competencies of Public Health, which all public health directors should be following in running local public health agencies. While rating directors is at the discretion of the local board of health using the tool, it is standardized and can be used across the state to compare the performance of different health department directors.

6. Self-Evaluation Tools and Process

These tools allow members of local boards of health to look internally and evaluate how the board handles matters of policy and administration.

For the first tool (A Self Member Self Evaluation of the Boards of Health [70]), the questions are in a simple "yes or no" format, so that evaluation takes as little time as needed, and allows board members to discuss how to improve board operations. However, section V of the tool includes a short answer format which will promote discussion and solution.

As for the second tool (Tool for BOH Members to Assess "Governance or Administration" [71]), there are no right or wrong answers. The list is intended to be used to promote discussion within the Board of Health team and the Administrator to come to a consensus of the activities that best fit for your board's policy and the activities that best fit for administration to implement policy.

C. Other Web Resources

• Healthiest Nation in One Generation [72]
• Healthy People 2020 [73]
• Core Public Health Functions and Ten Essential Services [74]
• National Association of Local Boards of Health [75]
• Public Health Law Program at the CDC [76]
• Local Board of Health Training Materials from NALBOH [77]

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If you have any questions regarding toolkit materials, please contact Diane Anderson [78] at the Iowa Department of Public Health.

If you have any technical difficulties this toolkit, please contact help@prepareiowa.com [79].

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Entire Toolkit in Word Document (136 MB) [80]

Local Board of Health Toolkit Flyer [81]

How Should I Use the LBOH Toolkit? - A Tutorial [82]

Materials from the 2010 Iowa Governor's Conference on Public Health
Presentation [83] | Presentation [84]
Quiz: Version 1 [85] | Version 2 [86] | Version 3 [87]

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