Policy and Position Statements


Accreditation Position Statement

I. The Association of State and Territorial Health Officials (ASTHO) supports national accreditation in public health

ASTHO endorses the Public Health Accreditation Board’s (PHAB) state and territorial health agency standards and measures for accreditation as the national accreditation program for public health agencies.

II. Within this context ASTHO recommends:

  • Attaining national accreditation status as an agency strategic goal or priority.
  • Developing a performance management system that includes the following components:

a. Identification of leadership through a position, such as a performance improvement manager, to build, institutionalize, and implement performance management capacity within the agency.

b. Designation of staff and quality improvement experts dedicated to performance management and continuous quality improvement who routinely evaluate and improve the effectiveness of the organization, practices, partnerships, programs, use of resources, and the impact the improvements have on the public’s health.

c. Establishment of an organizational capacity that utilizes a health information technology system to integrate data and information used in a performance management system.

d. Development of core competencies in quality improvement and performance management with routine staff trainings within the state and territorial health agency.

  • Development and routine updating of a state health assessment1, using reliable, comparable, and valid data to provide a complete picture of the health status of the population and conditions of public health importance; a state health improvement plan, using data from the state health assessment to establish programmatic resource allocation and improvement targets; and a strategic plan, linking to the state health assessment and the state health improvement plan to establish organization goals, strategies, and objectives to strengthen the organization to better serve the state’s population.
  • Educating governing entities (governor, state legislature, board of health) on the PHAB standards and measures.
  • Exploring alternative sources of funding for accreditation in response to the elimination of National Public Health Improvement Initiative funding.  

III. Background

Accreditation is a means for advancing the overall quality and accountability of state public health practice.  The 2003 Institute of Medicine (IOM) report, The Future of the Public’s Health, called for the establishment of a national Steering Committee to examine the benefits of accrediting governmental public health departments and as a result of this, the Exploring Accreditation project was launched in 2005. The Exploring Accreditation project resulted in the establishment of the Public Health Accreditation Board (PHAB) in 2007 to serve as the non-profit entity to implement and oversee national public health department accreditation.

In 2011, version 1.0 of the PHAB Accreditation Standards and Measures and the Guide to National Public Health Department Accreditation were released to the public and national public health department accreditation was launched.

Since the initial launch, improvements were made to version 1.0 based on feedback from the field and in July 2014 version 1.5 was released. The majority of states are working towards accreditation.

IV. National Trends

The national trend towards accountability and quality in state health agencies reinforces the increasing importance of quality improvement initiatives and national accreditation in public health. Leveraging resources through quality improvement tools and techniques, such as self-evaluation through a set of standards and measures, improvement cycles like plan -do-study-act, data-driven performance management, and balanced scorecard approaches may contribute to improved health agency performance, and ultimately improved health outcomes.

Additionally, given the economic and public health challenges facing states, health agencies are increasing efficiency and providing more services with smaller budgets. According to data collected in ASTHO’s survey of state budget cuts, most state and territorial health agencies (48 states, three territories, and the District of Columbia) have experienced budget cuts since 2008, many experiencing multiple successive cuts resulting in continually shrinking budgets. According to the ASTHO Profile of State Public Health, Volume Three, 69 percent of state health agencies had formal quality improvement activities implemented in specific programmatic/functional areas in 2012, while 27 percent of state health agencies have implemented a formal quality improvement program agency-wide.

There are many things health agencies can do to prepare for PHAB’s accreditation program. ASTHO supports federal and non-federal funding opportunities to provide support for building infrastructure to improve performance of public health practice and to support national public health accreditation in state and territorial health agencies. The Preventive Health and Health Services Block Grant (PHHSBG) is a cornerstone public health program for preventing disease, illness, and injury. It is designed to allow states/territories and their communities the flexibility to implement, support, and coordinate statewide prevention efforts while at the same time creating efficiencies that eliminate duplication of effort. See ASTHO's proposed guiding principles for further information on using these funds for accreditation readiness activities.

Additionally, in October 2012, CDC began using a standardized template which provided consistent language and formatting for all new non‐research, domestic funding opportunity announcements (FOAs). The new FOA template includes language related to applicants from state, tribal, local, or territorial governments and the ability to use funds to seek or maintain national public health accreditation, so long as it aligns with the intent and statutory authorities of the FOA. See CDC’s guidance here: http://www.cdc.gov/stltpublichealth/Accreditation/docs/foa_phablanguage.pdf.

Preparing for, seeking, and maintaining national accreditation is an ongoing process that will require state and territorial health agencies to institutionalize a culture of quality improvement, accountability, and use of data to drive agency performance.

V. Early Evaluation Results

Accreditation provides a framework for a health department to identify performance improvement opportunities, to improve management, develop leadership, and improve relationships with the community. The process is one that will challenge the health department to think about what business it does and how it does that business. Early evaluation results show the following:

  • Health departments that have had a PHAB site visit strongly agree that the accreditation process has improved the performance of the department.*
  • According to health departments that have had a site visit, accreditation identifies strengths and areas for improvement, strengthens internal and external partnerships, encourages prioritization of long-standing concerns, and acts as a stimulus for CQI and performance management.*

*From PHAB evaluation of 33 health departments.

  • Health departments reported many motivators for applying for accreditation, such as accountability to external stakeholders, documentation of capacity, creditability, competiveness for funding opportunities, and communication with their governing entity.*

*From National Opinion Research Center (NORC) at the University of Chicago evaluation survey of 62 health departments that have applied for accreditation.

Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position Statements are not voted on by the full ASTHO membership.

Performance Policy Committee Review and Approval: July 2014
Board of Directors Review and Approval: July 2014
Policy Expires: July 2017

For further information about this Position Statement, please contact ASTHO Performance Policy staff at accreditation@astho.org. For ASTHO policies and additional publications related to the Position Statement, please visit this page.


  1. ASTHO recognizes that the Public Health Accreditation Board uses the wording “community health assessment” to apply to all health assessments – state, local and tribal; however, for the purposes of this position statement, ASTHO wishes to emphasize the importance of the state health assessment as a prerequisite for voluntary accreditation for state health agencies.