Term of Award

Spring 2018

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Gulzar Shah

Committee Member 1

Jeff Jones

Committee Member 2

William Mase


Objectives: The primary purpose of this study is to examine whether engagement in Public Health Accreditation Board (PHAB) accreditation process and its requirements are associated with budget cuts prevention for local health departments (LHDs). Methods: For this study, we performed multinomial logistic regression using the 2016 National Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials. Results: While budget did not change for a majority of LHDs in comparison with previous year (48.6%), there were 28.7% that reported budget increase, and almost a quarter of LHDs had reduced budget (23%). The multinomial logistic regression showed no significant association between LHDs’ level of engagement in accreditation by PHAB or having completed three requirements (sometimes referred to as pre-requisites) and their budget increase than the previous year or even maintaining their budget the same as last year. However, government type, service delivery reduction, and proportion of revenue from local sources were significantly associated with budget increase or preserving it at the same level as previous year. Conclusion/implications: Given that the improved public health outcomes rely heavily on LHDs capacity to deliver quality essential public health services, which in turn depend on adequate and consistent funding, it may be essential for LHDs to find ways to overcome financial difficulties, maintain their existing funds, and try to find new revenue sources. Funding agencies and policymakers should support LHDs with adequate funding and find strategies to help LHDs to be well-prepared for any future financial threats. LHDs may also want to diversify their funding through strategies to increase funding from local sources.

OCLC Number


Research Data and Supplementary Material