U.S. Army Moves Closer to Achieving Public Health Accreditation

Apr 10, 2015, 12:55 PM, Posted by Pamela Russo

The U.S. Army is gearing up for public health accreditation for the first time, a development that opens the door for collaboration between military and civilian public health departments—leading to better health for all.

A decade ago, there was a common maxim heard about governmental public health departments that declared “if you’ve seen one health department; you’ve seen one health department.”

This tongue-in-cheek expression arose in part from the federalist administration of public health, which has resulted in public health codes that vary by state, and department-specific financing and structure. Additionally, this maxim reflected a fragmented and dysfunctional national system that lacked consistency across public health settings.

Today, the Robert Wood Johnson Foundation is working to realize a new era of public health defined by the application of strong and universal public health standards. That’s why the Foundation is a proud supporter of the Public Health Accreditation Board (PHAB) and their efforts to establish national performance standards for public health agencies across the United States.

In December 2014, PHAB passed a major milestone as the United States population served by accredited health departments reached 111 million, or 36% of the population. Another 100 million people are served by health departments that are currently in the application review process, and this year PHAB will finalize its first standards for the military setting.

The military interest in PHAB accreditation began in 2012, and has been led by the US Army Public Health Command (USAPHC). Based at the Aberdeen Proving Grounds in Aberdeen, Md., USAPHC helps protect and promote the health and safety of more than 400,000 active-duty Army soldiers, civilian staff, their families, and Army veterans. From 2012 to 2015, retired Maj. Gen. Dean Sienko, MD, served as the leader of the Public Health Command, and built support among Army leadership for the accreditation effort.

Maj. Gen. Sienko brought a unique perspective to the push for Army accreditation that was shaped by an accomplished career within county, state and national public health setting. Prior to leading the Army’s Public Health Command, Sienko served as an Epidemic Intelligence Officer with the United States Centers for Disease Control, a medical epidemiologist for the Michigan Department of Public Health, and Director of the Ingham County Health Department in Lansing, Michigan.

“It’s important that we demonstrate that we have the services akin to our civilian counterpart,” said Sienko of the Army’s accreditation effort. “Often times in public health we need to work together. It’s important that we have a common set of services, a common language in which we can engage effectively with each other, military and civilian.”

USAPHC has staff deployed across 14 time zones, at facilities that vary in size, scope, and capabilities. While one department at a rural outpost may serve a small population, another at a large base may serve tens of thousands of staff and service members. Just like public health departments in the civilian setting, the needs of Army preventive medicine departments vary greatly from place to place.

PHAB has a well-tested framework for accreditation across the multitude of civilian environments, yet as USAPHC and PHAB began to explore accreditation, they quickly realized that the unique nature of the Army structure would require some changes to be made. For instance, the governing structure of the Army Public Health Command is nothing like the civilian governing structure. Over the course of the last few years, PHAB and USAPHC have been working together to identify issues such as this, and develop customized criteria that would still maintain PHAB’s strong standards.

For the Army’s public health officials, the final standards cannot come soon enough. Already, USAPHC is working with Fort Riley in Kansas—home to a daytime population of nearly 25,000—to submit a final application for PHAB accreditation. The goal, says Lauren Shirey, who currently leads the army’s accreditation efforts, is for Fort Riley to be a model of public health accreditation and continuous quality improvement for other Army facilities around the world.

In addition to the growing interest among the Army’s ranks, other military branches are taking notice, too. Representatives from the Navy and Air Force have inquired to USAPHC about the accreditation process, and the Air Force sent emissaries to a recent meeting between USAPHC and PHAB.

Of course, the benefits of achieving accreditation extend well beyond the military setting. Particularly at installations such as Fort Riley, military personnel and their families are integral members of the surrounding community. Establishing clear and consistent standards opens the door for collaboration between military and civilian public health departments, which can lead to better health for all.

“Public health doesn’t have boundaries,” said Sienko. “For example, we talk a lot about the services that we provide on our installation, but the fact is that we have our soldiers for about eight hours a day and the rest of the time they’re out living in communities outside the installation.  So when we think about the places where people live, work and play, it’s both places.  It’s on the installation and it’s off the installation, and it’s important that there be quality public health services in both places.”