Wes Moore and Aruna Miller’s policy brief, “A Healthy Maryland Today” promises a renewed emphasis on a world-class health system for all Marylanders. Part of their agenda ought to include reforming Maryland’s boards of health.
Private sector companies like Coca-Cola benefit from governing boards that help the company achieve goals with expert industry knowledge. If our county health departments had better boards, with more health-savvy members, they could benefit in the same way.
Unfortunately, in Maryland — with exceptions in Howard, Montgomery and Baltimore counties — boards of health are exactly the same people as the elected county council members. County officials have helpful insight into general county affairs, but the pandemic has revealed limits to their understanding of health matters when they encounter rampant misinformation. Some of Maryland’s county council members actually helped to promote unproven ideas about disease control. Some became adversarial, and attacked their own county’s health professionals in order to accrue political Brownie points among portions of their voters.
The three Maryland counties with independent boards of health designed them to function as able advisors to local health departments, helping public health workers stay accountable to the objectives of better health for all. These boards meet transparently and share the agenda and the minutes of their meetings with the public. They ask their local health departments to report on local health issues, and they help them stay involved and make connections to businesses and groups that can assist in improving health.
The composition of independent boards varies across the U.S., with regional stipulations indicating numbers of scientists, health professionals, educators, business people and community members. Ideally, these boards of health have people who can speak on behalf of members of the community who are most at risk. A well-designed board can help the health department direct its efforts to the areas that can do the most to improve health and protect citizens against outbreaks, disasters and epidemics like diabetes, loneliness and heat emergencies. Members can be appointed with input from state and local health directors as well as elected officials. When these boards are at their best, they ensure that the county health department is assessing local threats to health and forming partnerships with all potential groups that could help in a crisis or even help in everyday outreach and problem solving.
Across America, about one third of counties have boards of health, and, according to a 2011 analysis, these counties do more for health and have lower mortality levels. Boards of health open the eyes and ears of the local county health department and build partnerships to its schools, private health care resources, faith communities and employers. Boards of health can help a county health department to emphasize policies that serve the well-being of the whole population instead of just the county council members’ political calculations. These boards can build local political interest in actually looking at what is holding back the health of all members of a county and can spearhead initiatives to address gaps and equity.
In a democracy, power and authority should rightfully be vested in elected officials. Boards of health mostly serve in an advisory capacity in keeping with that democratic principle, and their public deliberation adds to, rather than detracts from, good public health policies. The people of Maryland deserve to have both governance by their elected officials as well as the counsel of well-designed boards of health.
Just as the board at Coca-Cola has to ensure that the shareholders are receiving value, local boards of health could keep raising the central question: “Is our county doing what is needed to make all the people healthy and safe?” The way to build a more resilient public health system couples local awareness with partnerships. Public health work has to fit the community’s health profile and values. Having well-crafted boards of health to speak for science and for the people is long overdue in Maryland.
David Bishai (firstname.lastname@example.org) is an adjunct professor of health economics at Johns Hopkins University and a physician at the University of Maryland St. Joseph’s Medical Center. He is a former health officer for Harford County.