In 2003, the Institute of Medicine recommended serious examination of health department accreditation as one strategy to improve public health agency performance.1 Three years later and just over 6 years ago, national voluntary public health accreditation was a promising idea with a blueprint for implementation, courtesy of the Exploring Accreditation Project, jointly funded by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention.2,3 The concept had the broad support of national public health practice organizations and drew from the experiences of states such as Michigan, Missouri, North Carolina, and Washington, which had developed their own state-driven accreditation or standards programs.4,5 Nonetheless, the road ahead has not always been a straight, unwavering line, with a guaranteed successful outcome.

In 2007, the Public Health Accreditation Board (PHAB) was formed as a fledgling organization under the auspices of a board of incorporators made up of the executives of the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of Local Boards of Health, and the National Association of County & City Health Officials, representing the larger practice community. The Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention co-supported PHAB's activities to lead the field-driven development and testing of the many critical elements of a national accreditation program. In September 2011, national voluntary public health accreditation launched to receptive audiences, even as health departments grappled with budget reductions and staffing shortages. Throughout the years of exploring and developing a national accreditation program, the nexus between accreditation and strengthening health department performance has remained a central tenet, essential to PHAB, to its earliest applicants and to the hundreds of health departments preparing to apply.

The convergence of the accreditation effort 6 years ago coincided with an accreditation-themed issue of the Journal of Public Health Management and Practice (JPHMP) (June/July 2007). Few may remember an even earlier JPHMP issue (July 1998) that largely highlighted the promise of accreditation for public health departments by discussing experiences from other sectors. The hopeful and perhaps visionary musings of these earlier JPHMP issues are now unfolding current events. National accreditation has indeed arrived. The contents of this edition include research and practice reports, case reports, and commentaries that highlight the growing evidence base around accreditation. A series of 11 case reports describe in rich detail how health departments at all levels and sizes have prepared for accreditation: how they used newly designed readiness tools, developed prerequisites, and documented evidence of conformance with the standards. Likewise, the case for the mutual dependency between accreditation, quality improvement, and health department performance is strikingly made. The issue also illustrates the many linkages between accreditation and other public health initiatives, including the National Public Health Performance Standards Program, the National Public Health Improvement Initiative, and the Guide to Community Preventive Services. Several articles discuss the various incentives and supports designed to assist health departments in their pursuit of accreditation. There are also commentaries setting forth challenges that health departments and the accreditation program must face in the future for PHAB to fulfill its lofty promise.

In recent years, 3 Institute of Medicine reports6-8 further highlighted recommendations and actions that reinforce the roles of quality improvement and performance management in the contemporary practice of public health. The reports underscore the need for a well-developed and evolving PHAB accreditation program with standards that lead to stretch gains in health department efficiency, effectiveness, and performance. These reports draw attention to (1) the critical role of measurement in public health for attainment of desired health outcomes, (2) how law and policy can be better used to achieve improved health, and (3) how investments in a minimum package of public health services and accompanying infrastructure are instrumental for consistently meeting public health needs across the country.

The contents of this issue represent an important step toward establishing a stronger evidence base for the national accreditation program. The need for ongoing and strong research and evaluation has been consistently recognized, first in the Exploring Accreditation Project recommendations and later through PHAB's establishment of a Research and Evaluation Committee that oversaw the development of a research agenda for accreditation.9 The articles within this issue address many of the research agenda topics, including technical assistance, connections with public health categorical programs, readiness, and the impact of accreditation on public health departments of many sizes, types, and structures. While we recognize that much more research and field experience is needed for the future, especially to understand and document the impacts and outcomes of accreditation, we are hopeful that this Special Issue is able to contribute meaningfully to the collective progress that has been made in advancing a national accreditation program.

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