Objective: The aim of this study is to investigate the impact of Public Health Accreditation Board (PHAB) accreditation on the delivery of public health services and on participation from other sectors in the delivery of public health services in local public health systems.

Design: This study uses a longitudinal repeated measures design to identify differences between a cohort of public health systems containing PHAB-accredited local health departments and a cohort of public health systems containing unaccredited local health departments. It uses data spanning from 2006 to 2016.

Setting: This study examines a cohort of local public health systems that serves large populations and contains unaccredited and PHAB-accredited local health departments.

Participants: Data in this study were collected from the directors of health departments that include local public health systems followed in the National Longitudinal Study of Public Health Systems.

Intervention: The intervention examined is PHAB accreditation.

Main outcome measures: The study focuses on 4 areas: the delivery of core public health services, local health department contribution toward these services, participation in the delivery of these services by other members of the public health system, and public health system makeup.

Results: Prior to the advent of accreditation, public health systems containing local health departments that were later accredited by PHAB appear quite similar to their unaccredited peers. Substantial differences between the 2 cohorts appear to manifest themselves after the advent of accreditation. Specifically, the accredited cohort seems to offer a broader array of public health services, involve more partners in the delivery of those services, and enjoy a higher percentage of comprehensive public health systems.

Conclusions: The results of this study suggest that accreditation may yield significant benefits and may help public health systems develop the public health system capital necessary to protect and promote the public's health.

The US health system faces mounting pressure to improve population health. Research suggests a need for greater coordination and alignment across the sectors that deliver medical, public health, and social services. This study uses sixteen years of data from a large cohort of US communities to measure the extent and nature of multisector contributions to population health activities and how these contributions affect community mortality rates. The results show that deaths due to cardiovascular disease, diabetes, and influenza decline significantly over time among communities that expand multisector networks supporting population health activities. The findings imply that incentives and infrastructure supporting multisector population health activities may help close geographic and socioeconomic disparities in population health.

This brief describes the methodology for defining Comprehensive Public Health Delivery Systems using data from the National Longitudinal Survey of Public Health Systems. The systems meeting this definition have been shown to deliver a broader range of recommended public health services, using fewer resources, than the more prevalent types of U.S. public health systems that do not meet this definition. Over time, comprehensive systems are associated with larger gains in population health status than are their counterparts.