When we first began exploring the link between accreditation and report quality among Kentucky’s Local Health Departments (LHDs), we expected the findings to confirm what many already suspected: that accreditation status matters. But what we didn’t anticipate was just how wide the gap in Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) quality would be, or what that gap might mean for the future of public health infrastructure in rural and under-resourced communities.

In our recently published article for the Journal of Public Health Management & Practice, “Comparative Analysis of Community Health Assessments and Community Health Improvement Plans by PHAB Accreditation Status Among Local Health Departments in Kentucky, 2015–2022,” our team analyzed 32 CHA/CHIP reports from LHDs across the state, comparing quality scores using a framework adapted from Pennel et al. What we found was clear: PHAB-accredited LHDs consistently scored higher across almost every criterion of report quality, from stakeholder engagement and data integration to plan feasibility and alignment with evidence-based strategies.

Still, this wasn’t a simple story of “good” versus “bad.” We also discovered that both accredited and unaccredited LHDs struggled in key areas like LHD–hospital collaboration and formal evaluation strategies. These are areas that are essential for creating sustainable public health improvements. Moreover, although accreditation was associated with higher report quality, our analysis revealed that factors like rurality and community income level didn’t significantly predict CHA/CHIP quality. That was a surprise—and one that matters.

It matters because it challenges the assumption that low-resource settings are inherently less capable of generating high-quality public health plans. What we saw instead was a picture of possibility: with the right guidance, tools, and staffing support, even small or underfunded LHDs can produce strong, actionable reports that serve their communities well.

That brings us to the heart of why this work feels urgent right now. In Kentucky, as in many parts of the US, LHDs are the frontline of public health. They are the ones responding to crises, coordinating community-wide health initiatives, and shaping long-term strategies for population health. Their work often goes unrecognized. But behind every well-organized vaccination campaign, every community health fair, every effort to prevent chronic disease, there is a team of professionals doing the hard, hopeful work of public health.

If we want to see more effective, equity-centered health outcomes across the country, we must invest in this work, and in those who do it.

That means:

• Supporting PHAB accreditation pathways with real funding and technical assistance.
• Developing updated, standardized tools that help LHDs assess and improve the quality of their CHA/CHIPs, regardless of accreditation status.
• Strengthening hospital–LHD collaboration with clearer expectations and shared incentives and reporting timelines.
• Training and retaining public health leaders who understand the communities they serve.

Read Our Article in JPHMP

It’s worth saying again: accreditation matters. But it’s not the whole story. What also matters is capacity, mentorship, and a culture that values planning as much as it values intervention.

This research grew from a deep belief in the role of local health departments as both data stewards and community advocates. Our team, based at the University of Kentucky College of Medicine, College of Public Health, and Morehead State University, was fortunate to have the support of colleagues and mentors who care deeply about Kentucky’s public health system. This study wouldn’t have been possible without the insight and encouragement of Dr. Richard Ingram, Dr. Angela Carman, Dr. Douglas Scutchfield, and Ms. Carrie Conia.

As we look ahead, our hope is that this research will not only contribute to the scholarship on PHAB accreditation but also serve as a practical tool for LHDs across Kentucky and beyond. CHA/CHIPs are more than checkboxes—they are blueprints for how we invest in health at the local level. When done well, they give communities a shared vision and a way forward. For further reading, check out the full article, “Comparative Analysis of Community Health Assessments and Community Health Improvement Plans by PHAB Accreditation Status Among Local Health Departments in Kentucky, 2015–2022,” in the July Issue of JPHMP!

Let’s give public health professionals the tools they need to make those visions possible.

Bradley Firchow is a fourth-year medical student in the University of Kentucky College of Medicine’s Rural Physician Leadership Program, with a commitment to practicing rural Family Medicine in central Appalachia. His research specializes in community- and rural health systems, including the CATS Clinic he co-founded in Morehead, Kentucky.

Kathryn Boroughs is a second-year medical student at the University of Kentucky College of Medicine in the Primary Care Scholarly Concentration. Her expertise is in community health and public health program evaluation.

Joseph Howard is a third-year undergraduate in the Department of Biology and Chemistry at Morehead State University. He has contributed to Community Health Assessment and Improvement Planning at Greenup County Health Department in Kentucky. He is affiliated with the Northeast AHEC in Kentucky and is an aspiring rural physician.