摘要：We conducted a literature review in 2011 to determine if accepted governance functions continue to reflect the role of public health governing entities. Reviewing literature and other source documents, as well as consulting with practitioners, resulted in an iterative process that identified 6 functions of public health governance and established definitions for each of these: policy development; resource stewardship; continuous improvement; partner engagement; legal authority; and oversight of a health department. These functions provided context for the role of governing entities in public health practice and aligned well with existing public health accreditation standards. Public health systems research can build from this work in future explorations of the contributions of governance to health department performance. In today’s public health system, governing entities play a key role in linking health departments with the communities they serve. The Public Health Systems and Services Research agenda, initially developed in 2003 1,2 and revised in 2010–2011, 3,4 called for research that addressed governance structures and performance. The national research agenda for accreditation 5,6 reinforced the need for research that covered governing entities. We provided context for these research questions and for the efforts aimed at improving public health practice by attempting to more consistently define the functions of public health governing entities. Public health governing entities can include bodies such as a board of health, commission, or council, or an individual (e.g., a mayor or governor). 7–9 Boards of health are the most common type of public health governing entity and are used in 26 states at the state level 10 and 41 states at the local level. 11 There is no clear understanding of the total number and type of public health governing entities in the United States or the total population they serve. 11–13 However, there has been long-standing interest in the role and performance of governing entities, because some evidence has linked having a board of health to a more effective health department. 14 One of the early efforts to define the role of public health governing entities occurred as part of developing the National Public Health Performance Standards (NPHPS) in the late 1990s. The Centers for Disease Control and Prevention (CDC), in collaboration with the National Association of Local Boards of Health (NALBOH), developed and released the NPHPS Local Public Health Governance Assessment in 2002 15 and updated it in 2006–2007. 16 These tools were framed around the 10 essential public health services 17 and 5 governance functions: ensure authority; ensure resources; policy development; ensure continuous evaluation and improvement; and ensure collaboration. 18 A decade later, the national voluntary public health accreditation program was launched by the Public Health Accreditation Board (PHAB). The PHAB Standards and Measures, 8,9 against which all health departments are evaluated when they apply for accreditation, are framed around 12 domains of public health practice. Domain 12 focuses on the relationship between the health department and its governing entity. Initial development of the domain was based on a review of governing roles and responsibilities in various national and state standards, including those discussed previously, and a think tank co-convened by PHAB and NALBOH in 2010. 19 To inform the 2011–2013 update to NPHPS 20 and to contribute to the growing body of knowledge around the role of public health governing entities in public health accreditation, CDC and NALBOH conducted a review to aid in validating, refining, and updating the public health governance functions. The work resulted in identifying and establishing the 6 functions of public health governance (also referred to as “the governance functions” or “functions,” which are distinct from the general term “governance functions”) presented in this article.
