The first Medical Director of Health in Iceland was Bjarni Pálsson. He was appointed by royal decree on 18 March 1760. The residence of the first Medical Director of Health was in Nesstofa by Seltjörn in Seltjarnarnes from 1763 and remained there until 1834 when the Medical Director of Health moved to Reykjavík.

The first Medical Director of Health was issued a relatively detailed letter of appointment, dated 19 May 1760, entrusting him, among other things, with the responsibility for the administration of health affairs in Iceland, for the medical care of sick people in the country, and the teaching of medicine. The Directorate of Health was also to educate midwives, serve as a pharmacy and take care of quarantine.

The Medical Director of Health's letter of appointment was revised 25 years later and then issued again on 21 September 1787 and in 1824. The 1824 letter of appointment primarily provided for the rights and obligations of the Medical Director of Health in medical matters. Still, it also stated that he should contact the relevant authority to fulfil his duties.

During the first decades of the office, in 1760–1799, five medical offices were established in Iceland, in addition to the Directorate of Health. In 1828, the Westman Islands (Vestmannaeyjar) were added as a separate medical district and a physician was employed in the county of Húnavatnssýsla in 1837. The number of medical offices did not increase in Iceland until the introduction of the School of Medicine, established in Reykjavík in 1876. As a result, there were twenty medical districts in total. Since then, the activity of the health service has increased, as well as the responsibilities of the Medical Director of Health.

The current Medical Director of Health is Alma D. Möller, appointed on 1 April 2018. She is the first woman to be the Medical Director of Health. Seventeen men before Alma have served as Medical Directors of Health.

The tasks of the Medical Director of Health according to past and present law

On 1 September 2007, the Medical Director of Health and Public Health Act, No. 41/2007, entered into force. The Act stipulates the status and role of the Directorate of Health as a supervisory and administrative institution. It also defines the main objectives of the Directorate of Health, which are to promote the quality and safety of the health service and the health of the citizens.

This Act is the first to deal with the Directorate of Health in a separate law section. Previously, the legal provisions of the Medical Director of Health were included in the older Health Services Act, No. 97 of 1990, and its predecessors, but those laws were substantially revised by the Health Services Act, No. 40/2007. In addition, as of 1 January 1998, an Act on Health Security and Communicable Diseases, No. 19/1997, was passed, establishing the Office of the Chief Epidemiologist within the Directorate of Health.

In 2011, a comprehensive amendment was made to Act No. 41/2007, now called the Medical Director of Health and Public Health Act.

It was not until Act No. 44/1932, on the appointment of medical districts, that the duties of the Medical Director of Health and the responsibilities of regional physicians were defined for the first time. It stated:

“The Medical Director of Health is a counsellor to the Minister on all matters related to health. He supervises all physicians and healthcare practitioners in the country, district physicians and other public health workers."

Act No. 44/1932 was subsequently abolished by the Medical Appointment Act No. 16/1955. Article 4 of that Act states that the President appoints the Medical Director of Health, and Article 7 defines the scope of the Medical Director of Health's tasks. The 1955 Act was repealed by the Medical Appointment Act, No. 43/1965, but the provisions on the appointment and scope of work of the Medical Director of Health remained unchanged.

Act No. 43/1965 was then abolished by the Health Services Act, No. 56/1973. This Act entered into force on 1 January 1974, replacing the decentralized provisions on the organization of health services, hospitals, and health protection, and was intended to promote and simplify the administration of health matters in Iceland.

Act No. 56/1973 was valid until the Health Services Act No. 57/1978 was adopted. The new Act contained provisions on the tasks of the Medical Director of Health, identical to Article 3 of the older Act.

However, an innovation in the 1978 Act was that the Deputy Medical Director of Health was to be a substitute for the Medical Director of Health and an assistant. Still, provisions to that effect had already been included in the Directorate of Health regulation. The provision for the Deputy Medical Director of Health remained in the Act until it was abolished with amendments to the Act, which entered into force on 1 May 2011.

An unbroken thread in legislation and work

The Medical Director of Health Act, No. 41/2007, established for the first time a particular Act on the role of the Medical Director of Health and the activities of the Office. This Act replaced the Health Services Act, No. 97 of 1990, but the provisions which relate specifically to the Medical Director of Health and the Office are nearly identical to the corresponding provisions of the older Act, cf. above. Article 3 of Act No. 97/1990 stated:

"The Medical Director of Health is the advisor to the Minister and the Government on all matters relating to health and is responsible for the implementation on behalf of the Minister according to laws, regulations, and practices. They shall supervise the work and facilities of health professionals."

Looking back on this and comparing the current legislation on the Medical Director of Health and Public Health, no. 41/2007 (with subsequent amendments), with Act no. 44/1932, which defined the scope of the work of the Medical Director of Health for the first time in Icelandic legislation, one can say that the thread that was adopted there is still unbroken. It emphasizes the importance of the Directorate of Health and its usefulness to the citizens.

From the beginning, the Medical Director of Health has played an extensive role in health services, both as a physician and as an official in the service of the health authorities. The Medical Director of Health's primary task has been monitoring and supervising physicians and other healthcare practitioners.

Another main task of the Medical Director of Health at the beginning was to provide medical care to the sick. This role of the Medical Director of Health has evolved into a focus on general health protection, monitoring the health of Icelanders, and promoting public health, and this is a significant part of the work of the Office, not least since the operations of the Public Health Institute were merged into the Directorate of Health by law on 1 May 2011.

Education, one of the primary responsibilities of the Medical Director of Health in the early days, is still an aspect of his work today. Furthermore, an essential part of his duties is collecting and processing information and reporting on health matters in Iceland.

The Directorate of Health is one of the oldest offices in Iceland and is more than 260 years old.