The commissioner is appointed by the Mayor of New York City, and also serves on the city's Board of Health with the chairperson of the Department's Mental Hygiene Advisory Board and nine other members appointed by the mayor.

[4] The modern Department of Health, under a single commissioner, was formed by the New York City Charter revision pursuant to Chapter 137 of the Laws of 1870 passed by the New York State legislature.

In the early years after its formation, commissioners were sometimes political appointments, with no experience in medicine or related fields.

[2] City regulations currently require that the commissioner of health must be a doctor of medicine, and have either According to the New York City Charter, the commissioner is broadly responsible for preparing plans for construction and operation of medical and health care facilities and establishing their priorities, has the power to compel the testimony of witnesses and produce reports and documents in matters regarding health, and assess penalties up to $1,000 for violations or failures to comply with health notices or regulations.

[7] These duties involve regulating and overseeing matters ranging from reportable contagious diseases,[8] to registration of birth and deaths,[9] restaurant inspections,[10] selling food from carts,[11] selling tobacco products to minors and monitoring of smoking in public areas,[12] regulation of wild animals,[13] and sending health alerts to the public and doctors.