All “traditional” boards of health (county BOHs, district BOHs, and hospital authority BOHs) are required by state statute to elect a chair on an annual basis. The BOH must have a quorum of BOH members in order to elect a chair and only BOH members can vote (the county manager, for example, would not get to vote). Anyone on the BOH can be elected by their BOH colleagues to serve as chair. Additionally, some BOHs elect a vice-chair who can step in if the chair isn’t available for some reason- but having a vice-chair is entirely optional and is not required by state law. For consolidated human services agencies, the county government has chosen to bring social services and at least one other human services agency (often, but not always, public health), under one roof- thereby collapsing them into a single county agency. The governing board that is then created mirrors this setup and instead of having a separate BOH and DSS boards, you’d have a single consolidated human services (CHS) board that includes representatives from the DSS and public health worlds, as well as members of the public. Under state law, the CHS board, just like a “traditional” BOH, must elect a chair every year- and the chair could be anyone on the CHS board who is properly elected by a majority of their fellow CHS board members at a meeting of the CHS board where there is a quorum present. Finally, there’s the question of who is considered the “chair” if the board of county commissioners (BOCC) dissolves the “traditional” BOH or the CHS board and takes on their functions. It sounds like in some counties where the BOCC serves as the board of health (or the CHS board, in the case of a county with a consolidated human services agency), the perception is that the BOCC’s role as the BOH is separate from the existence/other work of the BOCC. For example, it sounds like in some counties, the BOCC adjourns and then reconvenes (essentially holding an entirely separate meeting) to take up any public health related matters. When the BOCC serves as the BOH (or the CHS board), the “chair” is the same person who was elected to serve as chair of the BOCC under G.S. 153A-39. There is no legal basis for electing a different chair who takes over the gavel only when the BOCC takes up public health related matters. Finally, when the BOCC serves as the BOH, they are required to appoint an advisory committee on public health. There is no law directing the advisory committee to elect a chair, though they could certainly do so. Because the advisory committee is solely advisory in nature, the duties and powers of the chair of the advisory committee would be limited to things like scheduling the advisory committee meetings, and running those meetings. ​All “traditional” boards of health (county BOHs, district BOHs, and hospital authority BOHs) are required by state statute to elect a chair on an annual basis. The BOH must have a quorum of BOH members in order to elect a chair and only BOH members can vote (the county manager, for example, would not get to vote). Anyone on the BOH can be elected by their BOH colleagues to serve as chair. Additionally, some BOHs elect a vice-chair who can step in if the chair isn’t available for some reason- but having a vice-chair is entirely optional and is not required by state law. For consolidated human services agencies, the county government has chosen to bring social services and at least one other human services agency (often, but not always, public health), under one roof- thereby collapsing them into a single county agency. The governing board that is then created mirrors this setup and instead of having a separate BOH and DSS boards, you’d have a single consolidated human services (CHS) board that includes representatives from the DSS and public health worlds, as well as members of the public. Under state law, the CHS board, just like a “traditional” BOH, must elect a chair every year- and the chair could be anyone on the CHS board who is properly elected by a majority of their fellow CHS board members at a meeting of the CHS board where there is a quorum present. Finally, there’s the question of who is considered the “chair” if the board of county commissioners (BOCC) dissolves the “traditional” BOH or the CHS board and takes on their functions. It sounds like in some counties where the BOCC serves as the board of health (or the CHS board, in the case of a county with a consolidated human services agency), the perception is that the BOCC’s role as the BOH is separate from the existence/other work of the BOCC. For example, it sounds like in some counties, the BOCC adjourns and then reconvenes (essentially holding an entirely separate meeting) to take up any public health related matters. When the BOCC serves as the BOH (or the CHS board), the “chair” is the same person who was elected to serve as chair of the BOCC under G.S. 153A-39. There is no legal basis for electing a different chair who takes over the gavel only when the BOCC takes up public health related matters. Finally, when the BOCC serves as the BOH, they are required to appoint an advisory committee on public health. There is no law directing the advisory committee to elect a chair, though they could certainly do so. Because the advisory committee is solely advisory in nature, the duties and powers of the chair of the advisory committee would be limited to things like scheduling the advisory committee meetings, and running those meetings. If additional information is desired, please contact Kirsten Leloudis, JD at the School of Government at UNC Chapel Hill. Email - kirsten@sog.unc.edu. Note: Answered for the ANCBH BOH Chair Network Working Group on February 3, 2024