North Carolina House bill 438 opened a new door for county commissioners. It gives them more control over public health and social services departments. Brunswick County’s already switched over. New Hanover and Pender counties are now considering adopting the legislation.
Local county boards of health cover a lot of territory beyond funding birth control and offering flu shots.
According to Dr. Michael Goins, a Wilmington optometrist and long-time member of the New Hanover County Board of Health, “Public health encompasses everything you touch...When you go out to eat, restaurant, travel immunizations, making sure people are taking TB medicine, involved in clinics, we are involved in septic tank evaluations, involved land perks? Vector control, we spray for mosquitoes.”
In North Carolina, a local board of health is made up of 11 people. It’s voluntary; they’re not paid. State law requires very specific people: a physician, a dentist, an optometrist, a veterinarian, a nurse, pharmacist, engineer, a county commissioner, and three members of the general public.
“Historically, the board of health has had the ability to make difficult decisions without politics involved,” said Goins.
In the past, some of those decisions included removing outhouses from properties, implementing smoking bans, and bicycle helmet requirements. The director of a county health department reports directly to the board of health, and the board of health answers to county commissioners, but it’s independence is protected by state policies. Until now. House bill 438, signed by former Governor Bev Perdue last summer, allows the board of commissioners many new options to change the way social service and local health departments operate. One big change is commissioners can now assume the role of the boards of county health. The law isn’t required, but if commissioners do take this route they’re required to set up an advisory board, with the same make-up of a board of health. But that advisory board is different.
Jill Moore is with the UNC School of Government and specializes in public health law. “A regular board of health would have definite powers under the law, one of the most powerful powers of a local board of health can make rules for public health within its jurisdiction. An advisory committee might be able to suggest that that action be taken, but wouldn’t have the authority to actually take it.”
In 2011, Moore began researching the bill and the impact it could have on local public health departments. Champions of the bill say it’s more efficient, that consolidating agencies could mean better services for consumers. Former state house representative Carolyn Justice was instrumental in drafting and passing 438.
“I think some of the concern is these departments would become political footballs and decisions would be made on politics and not what’s best for the citizens,” said Moore. “I don’t know of any commissioner who came and lobbied me for this bill who wanted to take away services to people.”
Those who are not fans of 438 say the system’s working fine as-is. And they worry about county commissioners tossing around those political footballs.
“They would have the ability to accept or reject programs based upon their philosophical points of view. It might not be as science-based, it might be more a knee-jerk response of I don’t think we need to do that,” said Goins.
He points to an example from last spring. New Hanover County commissioners turned down a $9,000 state grant earmarked to supply the county health department with Intrauterine devices, a long-term form of birth control.
Audio transcripts from that meeting included comments from former commissioners Rick Catlin and Jason Thompson:
RICK CATLIN: The answers that I got were that there were patients that were not being responsible with existing family planning that was being offered, and this would provide a more reliable solution for those people, and I had an issue with that.
JASON THOMPSON: So we’re taking irresponsible patients and trying to make them responsible?
RICK CATLIN: That’s the way it was described to me. And I have a fundamental, philosophical issue with using taxpayer dollars to fund someone’s irresponsibility.
Voters were outraged.
“Well, I’m glad you brought that up, because isn’t that a perfect example?” said former Representative Carolyn Justice. “The commissioners moved in a direction that was not satisfactory to its citizens, the citizens spoke, the commissioners changed their minds?”
New Hanover commissioners went back to the table and accepted the grant.
“You know, when county commissioners make a bad decision, citizens will let them know about that,” continued Justice. They don’t stay in office very long when they make really bad decisions,” said Justice.
Catlin won a seat in the state house, as did Chairman Ted Davis. Commissioner Jonathan Barfield kept his seat, but Jason Thompson lost his. Jill Moore with the UNC School of Government says because 438 is so new to counties, there’s no data to compare new and old models. The state’s three largest counties, Mecklenberg, Wake, and Guillford, can already exercise this law because they have populations greater than 425,000. North Carolina House bill 438 removed the population threshold, Moore says analyzing those examples aren’t helpful either.
“So we looked at those counties, but we couldn’t reach any conclusions about what those outcomes were because the counties that had the option of being a consolidated agency were so different from the rest of the state.”
Pender County is moving closer to deciding on implementing bill 438. In New Hanover, county staff is getting ready to present the new board of commissioners with a proposal to create a review committee to research and weigh all the options of 438. Right now, there’s no study measuring the impact this bill could have on social service departments. Moore says the final report from the UNC School of Government study will be released in May. But until then, no one really knows if 438 is actually more efficient and cost-effective.