Prior to recent reforms, Alabama was the only state in the nation where the top public health authority was not directly accountable to the governor or to a board appointed by the governor. During the 2024 legislative session, lawmakers approved Senate Bill 128 by Senator Tim Melson, enacting significant changes to the state’s public health governance structure. Under the provisions of the bill, the State Board of Health is abolished and reestablished under the State Committee of Public Health. The new law revises the appointment process of the State Health Officer, which previously rested solely with the State Committee of Public Health. Now, the Committee will provide a list of names to the Governor and the Governor will appoint the State Health Officer from that list. The bill also provides that any public health order made by the State Health Officer must be approved by the Governor before it can take effect. These changes increase executive oversight and improve accountability within Alabama’s public health system.

While additional emergency powers reforms should be considered in the future, this is a first step towards adding greater oversight and accountability to the State Health Officer position. No major additional public health governance reforms were enacted during the 2026 legislative session, leaving SB128 as the most significant recent change in this area.

Alabama law designates “the State Committee of Public Health” as an advisory board to the state in all medical matters, matters of sanitation, and public health. The Medical Association, which meets annually, is the State Committee of Public Health.” This “Medical Association” is none other than the Medical Association of the State of Alabama (MASA), the association of some of the state’s physicians. MASA operates just like any other professional association does: it has its own leadership, its own practices, and its own decision-making bodies – all of which are determined not by the governor or by the people of Alabama, but solely by the medical practitioners who populate the group’s membership rolls. The Medical Association is also a registered principle (an organization that hires lobbyists) and has, as of May 2024, eight registered lobbyists. In fact, advocacy is, according to their website, the “Medical Association’s primary focus.” Members of the State Committee on Public Health are selected by the Medical Association. This dynamic is similar with county health officers as well. As a result, public health leadership in Alabama has historically been influenced by a private professional association rather than directly accountable to elected officials. The office of Chief Medical Officer in Alabama should be a cabinet level position that is appointed by the governor like his/her other cabinet officials. He or she should also be confirmed by the Senate.

While the State Committee on Public Health will continue to play a role in the appointment process, the Governor will rightly now play a bigger role in the process. Further reforms could strengthen this structure by increasing legislative oversight and ensuring full accountability to the people of Alabama.