Background: Local boards of health (LBoHs), are a fundamental component of the public health governance structure. Current studies have reported mixed results about the impact of LBoHs as the LHDs' governing bodies, because there is no standardized typology to show variation in LBoHs.

Purpose: The purpose of our research is to develop and apply a taxonomy of LBoH to provide a coherent framework for describing variation in the nature of LBoH functioning, and effectiveness.

Data and Methods: This study uses the 2015 Local Board of Health Survey, conducted by the NACCHO, using a stratified random sampling design. The survey received 394 responses for a response rate of 58%. The creation and application of this taxonomy consisted of the following steps: (a) theoretically guided initial theme development; (b) mapping 2015 LBoH Survey variables to the proposed themes; (c) data reduction using principal component analysis (PCA); and (d) scale development and testing internal consistency.

Results: The final taxonomy included 59 items across six governance functions and four additional themes. The additional themes included: LBoH composition; use of diverse perspective in actively seeking community input on public health issues and initiatives; level of LBoH engagement in LHD affairs; and sophistication in sources of LBoH strategic directions. Application of taxonomy strongly supports the premise that the boards of health differ in significant ways regarding their performance of governance functions and with respect to other crucial characteristics.

Conclusions: The LBoH taxonomy provides a standardized tool for classifying LBoHs from the viewpoint of LHD administrators and professionals. While simple use of presence or absence of the LBoH have historically added to confusion in the literature examining the influence of LBoH, we recommend that future studies use the six governance functions and proposed items measuring those functions, plus the four additional themes in the taxonomy.