Untangling Desirable and Undesirable Variation in Public Health Practice

Meeting participants collaborate at a behavioral economics workshop.

The research community can enable the accreditation community to make continual improvements to public health practice—and ultimately, the public’s health.

The Issue:

The American public health system is not one system but many, with variations from community to community, state to state, city to countryside. Accreditation standards and measures encourage health departments to advance public health through quality improvement efforts. Accreditation, along with public health services and system research, can identify which variations in practice should be encouraged and spread and which should not.

  • Adaptation and refinement of existing standards. Research, for example, can help identify the structures and processes that improve effectiveness or efficiency of agency operations or what strategies are best to implement community health assessment plans.
  • Informing accreditation incentives. Research can explore what type of agencies pursue accreditation under what circumstances, assuring that incentives work to close disparities in capacity.
  • Understanding accreditation’s impact. Case studies of agency experience can provide evidence of practice changes while waiting for data on longer term studies of population health impact.


A comprehensive research agenda will help accreditation adapt standards and measures, and incentives to improve public health practice.