An Analysis of How Characteristics of Local Health Department Jurisdictions Influence Involvement in PHAB Accreditation: Implications for Health Equity

Abstract

Objective: To explore how characteristics of local health department (LHD) jurisdictions impact involvement in Public Health Accreditation Board (PHAB) accreditation and to characterize the implications for health equity. Methods: Data from the 2016 National Profile of LHDs survey were linked with data from the American Community Survey, National Center for Health Statistics, Behavioral Risk Factor Surveillance System, and the 2016 presidential election. Outcome measures included LHDs that were formally engaged in PHAB accreditation and LHDs that planned to apply for PHAB accreditation but were not formally engaged. Logistic regression was used to assess for the impact LHD jurisdictions' socioeconomic position, demographics, population health status, political ideology, and LHD organizational characteristics have on PHAB accreditation. Results: Approximately 37% of the participants were formally engaged (n = 297) and planned to apply (n = 337) for PHAB accreditation. Involvement in PHAB accreditation was equal among LHDs based on poverty and income inequality, but median household income was negatively associated. Diverse jurisdictions were more likely to be involved in PHAB accreditation but less likely to be involved after controlling for covariates. Jurisdictions with worse population health status were either as likely or more likely to be involved in PHAB accreditation. Jurisdictions with a greater conservative political ideology were less likely to be involved. Conclusion: LHD involvement in PHAB accreditation varies by their jurisdiction's characteristics. This has implications for health equity based on socioeconomic, racial, and population health status. Policies and practices are needed to improve the uptake of PHAB accreditation in LHD jurisdictions impacted most by health inequities.

How Do We Define and Measure Health Equity? The State of Current Practice and Tools to Advance Health Equity

“…Finally, some definitions of health equity focus on the “absence of disparities.” For example, health equity is often described 14 , 23 – 25 as the “absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically.” 26…”

“…22 Finally, some definitions of health equity focus on the "absence of disparities." For example, health equity is often described 14,[23][24][25] as the "absence of unfair…”

Local Health Departments' Characteristics and Their Performance Scores in PHAB Accreditation Standards

“…These characteristics have been shown to be associated with whether LHDs were involved in accreditation or not. 20,[25][26][27]36 For example, LBoH authority, LHDs' governance structure, and LHDs' jurisdiction population have been associated with LHDs' decisions to participate in accreditation. 20,25,26 Therefore, these characteristics may be similarly important for understanding factors that could affect performance scores of LHDs that have completed accreditation assessments in each of the standards.…”

“…Our analyses also described the organizational and jurisdiction characteristics of the LHDs in each of the clusters in the sample. These characteristics have been shown to be associated with whether LHDs were involved in accreditation or not 20,25–27,36. For example, LBoH authority, LHDs' governance structure, and LHDs' jurisdiction population have been associated with LHDs' decisions to participate in accreditation 20,25,26.…”

“…21 In all of the approximately 2400 LHDs in the United States, only about 12% of LHDs have been accredited at the time when data for this study were obtained in 2020 and accreditation has occurred disproportionately among large LHDs. 21,22 Many studies of PHAB accreditation have revealed variation in aspects of the accreditation process, such as decisions regarding pursuing accreditation and preparation for accreditation, leading to variability in LHDs pursuing and participating in accreditation 14,[23][24][25][26] because of factors such as organizational and jurisdiction characteristics, 27 LHD size, 22 resources and time needed for the process, 22,28 type of governing structure, 25,28 perception of inadequacy to tackle accreditation demands and fear of underperforming, 28,29 and lack of will to invest in the process because of perceptions that the effort exceeds the benefits. 26,28 However, among accredited LHDs, data show there is also variation in accreditation assessment performance scores.…”