Local Health Departments in Illinois

What is a local health department?

An agency of local government, a local health department (LHD) develops and administers programs and services that are aimed at maintaining a healthy community. To ensure that these efforts address a community's most important health problems and concerns, the local health department encourages residents to participate in assessing public health needs and in formulating a community health plan. It also works with other community organizations to assure that needed services and programs are available.

Services and programs available through local health departments include —

  • vision/hearing testing (preschool and school-age children)
  • well-baby clinics
  • immunizations
  • communicable disease investigations
  • issuing water well permits
  • consulting and permits for private sewage systems
  • health awareness information
  • dental sealants
  • case management
  • health screenings (blood pressure, diabetes, cholesterol and other chronic diseases)
  • restaurant inspections
  • training for food service workers
  • foodborne illness investigations
  • screening/testing of water samples
  • well inspections and surveys
  • investigation of solid waste, insect, rodent and nuisance complaints
  • referrals to other agencies
  • breast cancer awareness
  • AIDS counseling and testing

What is a county board of health?

A county board of health initiates and carries out programs and activities necessary or desirable for the promotion and protection of health and control of disease. It may make and adopt rules to protect and improve the public health of residents in the county. A board of health reports to the county board. Board of health members are appointed by the chairman of the county board. By law, the board must be composed of two physicians, one dentist, one county board member and four citizens-at-large. It is the policy of the Illinois Department of Public Health (IDPH) to recognize and certify new health departments that serve no less than a county.

Does a county board of health have options in providing local health services for its citizens?

Once a board of health is established and the county board appoints members, the board of health has four options for providing public health services for the citizens of its county. They are —

  • Develop a single county health department that will provide programs and services to address the public health needs of the citizens it serves. This is being done in most Illinois counties.
  • Develop a bi- or multi-county health department by joining with one or more counties to provide programs and services that address the public health needs of all citizens within all of the counties served.
  • Contract with an entity within the county, such as a hospital, to provide programs and services to address the public health needs of county residents.
  • Contract with an existing local health department in a neighboring county to provide programs and services to address the public health needs of the county residents. Currently, Marshall County contracts with Peoria City/County Health Department, Putnam County contracts with the Bureau County Health Department, Stark County contracts with the Henry County Health Department, Menard County contracts with the Sangamon County Department of Public Health and Champaign County contracts with the Champaign-Urbana Public Health District.

What are the bi-county or multi-county health departments? Are the revenues and expenses shared proportionately? Has this been done successfully?

Bi-county or multi-county health departments are like single-county health departments except they serve a larger area and are responsible to more than one county board. Several Illinois local health departments are bi-county or multi-county health departments. With this arrangement, a board of health is created by resolution of each county board or by voter approval in county-wide referenda. The board has representatives from each county. The revenues and expenses are shared proportionally. Successful examples are the DeWitt-Piatt Bi-County Health Department, the Franklin-Williamson Bi-County Health Department, the Southern Seven Health Department (Alexander, Hardin, Johnson, Massac, Pope, Pulaski and Union counties), and the Egyptian Health Department (Gallatin, Saline and White counties).

How are local health departments funded?

Local health departments are funded from a combination of sources. Local health departments receive monies from local fee-for-services, local tax support, state funding from IDPH, other state agencies, federal sources and non-governmental grant sources.

How may a county provide local funding to a local health department?

A county has several options in providing financial support for local health services:

  • If the local board of health was created by county board resolution, financial support may come from the county's general fund.
  • If the board of health was created by county wide referendum, a separate tax of up to $0.10 per $100 of assessed property valuation may be levied.
  • The county board may convert the county's existing tuberculosis tax levy to support public health programs (see the next question).

No matter what method is used to provide local support, the board of health reports to the county board, which has full budgetary approval authority.

If a county has an established levy to support tuberculosis services, how may that levy be converted to help fund public health services, including tuberculosis, for the county?

A county board may dissolve its tuberculosis board by resolution, establish a board of health, and convert the tuberculosis levy (up to $0.075 per $100 of assessed property value) to support public health services, including tuberculosis services, for the county. With this conversion, any funds in the county tuberculosis fund would be transferred to the county board of health for public health services, including tuberculosis.

How does the Illinois Department of Public Health financially assist new local health departments?

The Illinois Department of Public Health awards Local Health Department Development Grants to newly formed local health departments. The annual grant award amount is $50,000. Eligibility is limited to local health departments that are provisionally certified by IDPH. This money, along with local financial support (either county general funds, separate health department levy or converted tuberculosis tax levy), is used to establish services and programs. During the developmental period, additional revenues to support the county health department's activities may be secured by establishing fees for services and by applying for other state and federal program grants.

What financial support does the Illinois Department of Public Health provide to assist IDPH- certified local health departments?

Once a local health department is established and able to meet all certification requirements, it is granted certification by the Department. Certification makes a local health department eligible for the Local Health Protection Grant. This grant, with award amounts determined according to a need-based formula, provides state financial support for local health protection programs including, but not limited to, infectious diseases, food protection, potable water supply and private sewage disposal. The minimum annual award is $63,201. A county's population, per capita income and assessed property valuation are factors in determining grant amounts.

Certified local health departments are eligible for IDPH categorical grants to address specific health needs. State and federal funds are also awarded annually by IDPH.

How does a local health department become certified?

Local health departments apply to the IDPH for certification. IDPH may award either provisional certification or certification. Provisional certification is granted to newly formed local health departments that serve one or more counties and make a commitment to complete a comprehensive planning process within two years. Certification is granted to local health departments that meet the IDPH's requirements for employing a qualified executive officer and public health practice standards (completion of an internal organizational capacity assessment and a community health needs assessment, development of a community health plan and compliance with required activities). Requirements for provisional certification and certification are contained in the Certified Local Health Department Code, 77 Il. Adm. Code 600.

When a local health department is established, are there minimum requirements for staff, facilities, population served, etc.?

There are few requirements for establishing a local health department. There is no minimum number of staff; there is no requirements for buildings and infrastructure; and there is no minimum size population to serve. A county must maintain a full-time health department that is administered by a board of health. The board must appoint a qualified medical health officer or public health administrator to act as the executive officer for the health department. The number of staff and type of facility are local decisions and are dependent on how the health department is organized, what types of programs are offered and what is required by specific grants.

Some public health services may be provided in a county by another provider. What will happen to such programs if a health department is established?

Once a board of health and a health department are established, both will coordinate public health services with the services offered by other community agencies to make sure the community's needs are met. In counties where some public health services exist, the services could continue to be provided by the current providers. From IDPH's perspective, a local health department does not have to provide all of the essential health programs itself. Rather, the board of health and the local health department must assure these services are provided to the citizens within its jurisdiction.

What public health services does Illinois provide in counties not served by a local health department? Why should a county take action to provide for local public health services?

Currently, IDPH provides very limited direct environmental health services through some of its regional offices. IDPH staff only respond to complaints about food service establishments; no routine inspections are provided to promote quality food handling practices in restaurants. While IDPH does provide some permits and sporadic inspections for potable water and private sewage, these services do not favorably compare with the environmental health services that could be provided by a local health department. IDPH provides no direct personal health services. A local health department is essential because it gives the community better accessibility, more continuity and uniformity of service, knowledge of local concerns and practices and improved services. Additionally, locally-based programs give citizens and local officials greater control over the public health in their community.

Why should citizens consider establishing a local health department for their county?

All Illinois citizens should have public health services available to them and delivered by a local health department. Presently, two Illinois counties (Edwards and Richland) do not have access to these essential services. A local health department is the focal point in the development of a comprehensive system of preventive health and primary care in a rural area. A local health department employs local people in the worthwhile jobs of nursing, environmental health, administration and clerical service. Local health department employees are hardworking, dedicated people who are committed to improving and assuring the safety and health of their fellow county residents.

For more information, contact the Illinois Department of Public Health's State/Local Liaison Unit, 217-785-3164.

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