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Impact of Local Boards of Health on Local Health Department Accreditation, Community Health Assessment, Community Health Improvement Planning, and Strategic Planning

Shah, Gulzar H. PhD, MStat, MS; Corso, Liza MPA; Sotnikov, Sergey PhD; Leep, Carolyn J. MS, MPH

Journal of Public Health Management and Practice: September/October 2019 - Volume 25 - Issue 5 - p 423–430
doi: 10.1097/PHH.0000000000000847
Research Reports: Research Full Report

Introduction: Local health departments (LHDs) are increasingly using national standards to meet the challenges presented by the complex environments in which these agencies operate. Local boards of health (LBoHs) might play an instrumental role in improving LHDs' engagement in activities to meet these standards.

Objectives: To assess the impact of LBoH performance of governance functions on LHDs having a current (completed within 5 years) community health assessment (CHA), community health improvement plan (CHIP), strategic plan, and level of engagement in the Public Health Accreditation Board (PHAB) accreditation program.

Methods: Binary and multinomial logistic regression models were used to analyze linked data from 329 LHDs participating in both the 2015 Local Board of Health Survey and the 2016 National Profile of LHDs Survey.

Results: Higher performance of LBoH governance functions, measured by an overall scale of LBoH taxonomy consisting of 60 items, had a significant positive effect on LHDs having completed CHA (P < .001), CHIP (P = .01), and strategic plan (P < .001). LHDs operating in communities with a higher score on the overall scale of LBoH taxonomy had significantly higher odds (P = .03) of having higher level of participation in the PHAB national voluntary accreditation program—that is, being accredited, having submitted application for accreditation, or being in the e-PHAB system (eg, by submitting a letter of intent).

Conclusions: LBoHs serve as governance bodies for roughly 71% of LHDs and can play a significant role in encouraging LHDs' participation in these practices. That positive influence of LBoHs can be seen more clearly if the complexity and richness of LBoH governance functions and other characteristics are measured appropriately. The study findings suggest that LBoHs are a significant component of the public health system in the United States, having positive influence on LHDs having a CHA, CHIP, strategic plan, and participation in accreditation.

Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Corso and Dr Sotnikov); and National Association of County & City Health Officials, Washington, District of Columbia (Ms Leep).

Correspondence: Gulzar H. Shah, PhD, MStat, MS, Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460 (

The study was funded by the Centers for Disease Control and Prevention (CDC) through Cooperative Agreement no. OT13-1302: Building Capacity of the Public Health System to Improve Population Health Through National, Nonprofit Organizations (NACCHO Cooperative Agreement no. 5U38OT000172-03).

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of CDC.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

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