An Examination of State Laws and Policies Regarding Public Health Agency Accreditation Prerequisites

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States use various legal tools to authorize or mandate health departments to complete accreditation prerequisites.

The Issue:

While accreditation of public health departments is voluntary, numerous legal devices are being used to authorize or require state or local health departments to complete one or more of the three prerequisites of accreditation. Those three prerequisites, as set forth by the Public Health Accreditation Board (PHAB), are: (1) a community health assessment, (2) a community health improvement plan, and (3) a strategic plan.

Key Findings

  • Twenty-six of 50 states have some type of mandate requiring at least one PHAB requirement.

  • One state (Vermont) requires national PHAB accreditation; others have state accreditation programs (Iowa, North Carolina, and Michigan).

  • Most states consider general public health authority sufficient for health departments to complete accreditation prerequisites.


Resources, capacity, and training vary from state-to-state and present barriers to completing prerequisites.

About the Study:

A legal research team used standardized term methodology to search online and identify legal mandates, laws, rules, executive orders, contracts, legislative resolutions, and other tools used by states to push state or local health departments toward accreditation. They followed up and verified results through interviews with key informants in every state.