These findings provide insight into the specific capabilities and capacities strengthened through accreditation that may, in turn, influence financial outcomes.

In the United States, the public health system includes a diverse and complex constellation of organizations and individuals. The backbone of this system is governmental public health, including state, tribal, local, and territorial public health departments. Health departments do critical work to promote and protect population health, including delivering the 10 Essential Public Health Services and preparing for and responding to emergencies and threats. Yet their capacity to do this work is limited by chronic underfunding and an under-resourced workforce.

The Public Health Accreditation Board (PHAB), through the national health department accreditation program, has a mission “to advance and transform public health practice by championing performance improvement, strong infrastructure, and innovation.” A recent article in JPHMP, “Impact of Accreditation on Health Department Financial Resources” (Heffernan, et al) explored how accreditation has affected the financial status of accredited health departments, including their utilization of resources, competitiveness for funding, and new funding. Exploring the financial impacts of accreditation is important, given the critical need for investment to support health departments in providing services and protecting the public’s health.

Our team of researchers at NORC at the University of Chicago[†] has been examining the impacts of accreditation for the past eight years. Through ongoing surveys, we have learned about perceptions of the impact of accreditation on applicant and accredited health departments’ financial status. The most commonly reported financial outcome is improved utilization of resources; recent data show more than half of accredited health departments have improved utilization of resources one year after accreditation. This may be due to efforts implemented as a result of accreditation, such as quality improvement initiatives. Research has consistently shown that enhanced quality improvement is a key accreditation outcome. These quality improvement efforts likely enhance performance and efficiency. In addition, 39 percent of health departments accredited for one year reported that accreditation increased competitiveness for funding. Examples of new funding reported by respondents included increased emergency preparedness grant funding, funding from state health departments for accredited local health departments, and grants from the Centers for Disease Control and Prevention.

There were also some differences in other outcomes of accreditation, between health departments that reported new funding and those that did not. Specifically, those that reported new funding due to accreditation were also more likely to report increased use of evidence-based practices, increased staff capacities, new opportunities for external partnership and collaboration, increased knowledge of health department roles and responsibilities among governing entities and policy makers, and improved credibility within the community or state. These findings provide insight into the specific capabilities and capacities strengthened through accreditation that may, in turn, influence financial outcomes. If health departments are more likely to experience these outcomes due to accreditation, this could lead to increased competitiveness for funding and ultimately new funding opportunities.

The ongoing COVID-19 pandemic has emphasized the important role of health departments in preparedness and response, and the need for sustainable support and funding. The PHAB accreditation program contributes to building their capacity, as numerous studies have demonstrated, and data show that accreditation has some influence on accredited health department financial status. Continued investment in public health, including sustained funding that addresses public health infrastructure and workforce needs, is crucial to ensure the continued capacity of the public health system to address the complex health and other needs of the population.

[†]Current support for this work is provided by PHAB, through funding from the Centers for Disease Control and Prevention (CDC). The surveys were approved by the Office of Management and Budget (OMB No. 0920-1295; expiration 04/30/2023). Prior support for this work includes funding from: PHAB, through funding from the Robert Wood Johnson Foundation (RWJF) and CDC (2013 to 2016), and from RWJF under Grant Number 72509 (2015 to 2017) and Grant Number 73844 (2017 to 2020).

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Megan Heffernan, MPH, is a Research Scientist in NORC’s Public Health Research department. She has over seven years of experience conducting public health systems and services research. She has expertise in qualitative and quantitative data collection and analysis and her research interests include public health systems, rural health, and health disparities.

Mallory Kennedy, MPH, is a public health researcher in NORC’s Public Health Research department with nearly eight years of experience conducting public health systems and services research. Her research interests include public health systems, healthy aging, and emergency preparedness, response, and recovery. Kennedy’s MPH is from the University of Washington.

Alexa Siegfried, MPH, is a Research Scientist in NORC’s Public Health Research department. She leads program evaluation and research projects in the areas of public health systems and services, rural health, and emergency preparedness and response. She has expertise in qualitative data collection and analysis, and she has led projects related to public health accreditation for 13 years.