Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score

•Local boards of health may provide key benefits to a local health department's performance.•Local board of health authority regarding budgets appears to have a positive influence.•Local health department governance structures appear not directly related to performance scores.•Involving boards of health in budget-related decision making could improve agency performance. This study examined the relationship between local board of health authority and local health departments’ budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate. Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments’ budget-related activities, using the governance structure as the group-level variable. Analyses identified positive associations between local board of health authority on local health departments’ budget-related activities and local health departments’ aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies. The analyses suggest that local boards of health with authority related to local health departments’ budgets appear to have an influential role in budget-related activities and may improve local health departments’ performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments’ budgetary decision making on local health departments’ performance can be fully understood.