The purpose of this study was to examine the relationship between the appointment process and the effectiveness of boards of health in the state of Ohio. In Ohio, board of health members are appointed by a District Advisory Council (DAC), chaired by a county commissioner, that meets once a year for this purpose. The literature review documented model appointment practices within two frames, recruitment and selection, and board effectiveness research using the seminal findings of Holland, Chait and Taylor’s (1989) six frames of board effectiveness: contextual, educational, interpersonal, intellectual, political and strategic.
Data for this study were collected concurrently using mailed surveys (adapted from Brown, 2000, 2006) for three populations groups appointers (chair of DAC), board of health members, and health commissioners for the 131 health districts. Likert scale responses were used to rate the responses from appointers (N = 131) regarding recruitment and selection, from board of health members (N = 912) on board effectiveness, and from health commissioners (N = 131) on recruitment, selection, and board effectiveness.
Final survey returns (20.7%) included 170 board member responses (19%), 57 health commissioner responses (44%), and 16 appointer responses (12%). There were 14 health districts that had responses from all three population groups enabling paired set analysis. The demographic characteristics of the health commissioner and board of health member sample were male (62%), college educated (85%), with a mean age over 55.
Descriptive statistics and a Mann-Whitney U found the self-ratings of appointer’s recruitment and selection frames to be significantly higher than the health commissioner ratings to the same questions. Descriptive statistics and a Mann Whitney U also found the self-ratings of board of health members board effectiveness frames to be higher than the health commissioner ratings to the same questions with significant differences in the intellectual, political and strategic frames. The final research question analyzed data using Pearson’s r correlations for paired responses from health districts in three groups. First, appointers’ ratings (recruitment and selection) and board of health members’ ratings (board effectiveness) found no significant correlations. Second, health commissioners’ ratings (recruitment and selection) and board of health members’ ratings (board effectiveness) found no significant correlations. The final group, pairing health commissioner ratings for recruitment and selection with health commissioner ratings for board effectiveness showed significant correlations (p < .01) for recruitment in all frames except contextual which was not significant and interpersonal, which was significant at the .05 level.
The literature identified having the right mix of trustee capabilities and then utilizing those skills as key characteristics and predictors of board effectiveness. Together the board of health and health commissioners comprise a health district’s leadership team. As the leadership team, they have direct responsibility for building an environment of collaboration where trust, communication, and on-going learning are nurtured. When these leadership roles and responsibilities are understood by all concerned, the health district and public health will be the ultimate beneficiaries. In most cases, boards of health are underutilized and underdeveloped. They are a much needed but largely untapped resource.