Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Alejandro Arrieta

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Gilbert Ramirez

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Howard Frank

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Boubakari Ibrahimou

Fourth Advisor's Committee Title

Committee Member


Local health departments, public health accreditation, public health funding, performance, public health, health policy, local public health systems

Date of Defense



Public health accreditation and public health funding have the potential to transform the way local health departments (LHDs) deliver public health, but it is unclear if they are having their intended impact. Since performance expectations are high and public health funding is scarce, LHD leadership will continually be interested in finding the most effective ways of improving public health. The purpose of this research is to examine whether LHDs are reaching their goal of public health improvement through public health accreditation and public health funding. Data from the National Association of County and City Health Officials Profile Surveys, Public Health Accreditation Board, County Health Rankings Annual Reports, and the National Longitudinal Survey of Public Health Systems were used to conduct three studies. The first study uses local level panel data and a difference-in-difference methodology to quantify the difference in the change in public health outcomes across counties in Florida and control states, before and after obtaining public health accreditation. Results reveal that public health accreditation was significantly associated with improvements to public health outcomes. This study suggests that accreditation can be a driver for health improvement and a catalyst to advance public health. The second study uses a quasi-experimental design with the use of a panel data difference-in-difference estimator to estimate the treatment effect of public health accreditation on the effectiveness of essential public health activities provided by LHDs. Results suggest that public health accreditation does not lead to the improved effectiveness of public health activities. Findings highlight that accreditation is one element that complements other performance improvement strategies to achieve a significant effect on the health system. The third study employs multivariate linear regression models with the use of local-level cross-sectional and panel data to examine whether increased LHD funding translates to public health benefits. Results suggest that increased LHD expenditures were not associated with any of the studied public health outcomes. The study highlights the need to control for omitted variable bias and reverse causation bias as other public health system components may influence the results, thus leading one to conclude that large expenditures explain better health outcomes. Public health accreditation and public health funding can be successful tools for public health practice when used as starting points to address public health problems.





Included in

Public Health Commons



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