Sustained and Shared Funding for Accreditation of Health Departments, United States, 2005-2023

The Centers for Disease Control and Prevention (CDC) supports health departments in meeting public health accreditation standards, but how cumulative investments in these activities are related to growth in accreditation nationwide has not been documented. We analyzed CDC funding for accreditation activities for an 18-year period to determine cumulative investment relative to reach and coverage of the US population by accredited health departments.

We conducted a secondary analysis of Public Health Accreditation Board (PHAB) data to examine changes in the percentage of state health departments (SHDs) and local health departments (LHDs) that were accredited during 2005-2023.

During 2005-2023, CDC distributed $248 million to 3 recipient types for accreditation activities, including health departments, PHAB, and other partner organizations. During this time, the number of accredited SHDs increased from 2 of 51 (4%) in 2013 to 41 of 51 (80%) in 2023, and the number of accredited LHDs increased from 20 of 2297 (1%) in 2013 to 395 of 2297 (17%) in 2023. In 2023, 83% of the US population was served by an accredited SHD and 43% by an accredited LHD. Among the 395 accredited LHDs nationwide, 322 (82%) were in states that provided funds to localities for accreditation activities from investments we analyzed.

Sustained funding for multicomponent accreditation activities was followed by growth in accredited SHDs and LHDs. States that allocated CDC funding to support local accreditation had more accredited LHDs than states that did not allocate such funding. Further research is needed to understand how accreditation of health departments changes in relation to other funding sources and supports.