Determinants and Impacts of Public Health Accreditation: Evidence from U.S. Local Health Departments
Date of Award
Spring 2026
Language
English
Embargo Period
11-5-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Public Administration and Policy
Program
Public Administration and Policy
First Advisor
Ashley Fox
Committee Members
Susan Appe, Trang Nguyen
Keywords
Local Health Department, PHAB, Accreditation, Population Health, Performance Measurement
Subject Categories
Population Health | Public Health
Abstract
Local health departments (LHDs) play a critical role in delivering essential public health services in the United States, yet they operate under persistent resource constraints, increasing accountability demands, and evolving population health needs. In response to calls for greater quality and consistency in public health, the National Public Health Accreditation Program was launched in 2013. Implemented by the Public Health Accreditation Board (PHAB), the program aims to improve and protect population health by advancing the quality and performance of public health departments. Given that accreditation is a key strategy for strengthening public health systems, it is critical to build robust evidence base on both its adoption and impact. However, few studies have quantitatively examined factors associated with accreditation adoption or its relationship with LHDs performance and population health outcomes, and key areas, including organizational benefits and population health impacts, remain insufficiently explored.
This dissertation addresses these gaps by examining (1) the characteristics associated with PHAB accreditation among LHDs, (2) the relationship between accreditation and financial outcomes, and (3) the association between accreditation and population health outcomes. The first study uses pooled cross-sectional data and multinomial logistic regression to examine factors associated with accreditation status among local health departments. Findings indicate that LHDs serving larger populations, with greater financial and workforce capacity, and stronger leadership and planning infrastructure are significantly more likely to be accredited or express intent to pursue accreditation, highlighting uneven adoption across LHDs. The second study employs a quasi-experimental Two-Way Fixed-Effects Difference-in-Differences (TWFE-DD) design to estimate the effect of accreditation on selected financial outcomes. Results show that accreditation is associated with a significant improvement in fiscal balance, a measure of a government’s ability to sustain operations over time. However, these findings indicate that accreditation may improve financial management of resources but does not increase revenue. The third study examines the relationship between accreditation and population health outcomes using a matched longitudinal design with generalized estimating equations. Results indicate that accredited LHDs experienced greater improvements over time in selected health care utilization and behavioral risk measures, including reductions in uninsured prevalence and smoking, and increases in blood pressure medication use and cholesterol screening. These effects emerged gradually, supporting the view that accreditation operates as a long-term organizational process rather than a discrete intervention.
Overall, this dissertation provides evidence that PHAB accreditation is associated with improvements in organizational performance over time and has the potential to transform public health system delivery. Accreditation supports sustained system improvement, with organizational gains appearing earlier and population health benefits emerging over time. However, disparities in resources and capacity and uneven participation persist. These findings have important implications for policymakers and public health leaders seeking to expand accreditation participation and better understand its impact. They highlight the need to reduce structural barriers through targeted investments to expand accreditation efforts, while promoting accreditation-informed practices for system-wide improvement. Additional research is needed to better understand the long-term effects of accreditation, especially among health departments that sustain accreditation and continuously engage in improvement efforts.
License
This work is licensed under the University at Albany Standard Author Agreement.
Recommended Citation
Alaali, Zahra S., "Determinants and Impacts of Public Health Accreditation: Evidence from U.S. Local Health Departments" (2026). Electronic Theses & Dissertations (2024 - present). 463.
https://scholarsarchive.library.albany.edu/etd/463