There is little doubt among public health practitioners that our public health system is being overwhelmed by the deleterious combination of expanding health threats and a resource-limited environment. As leaders struggle to respond, little has been offered to challenge the status quo. From this dismaying picture arises the powerful notion that if state and local public health departments could offer policy makers and the public a means to validate their performance and impact, hence their overall value to the community, then an opportunity might exist to reinstate the primacy of public health. As several articles within this issue clearly articulate, a national accreditation program for state and local public health agencies could be the vehicle that would elevate, and bring recognition to, our effectiveness, efficiency, and community health impact.

One of the results of the Centers for Disease Control and Prevention's (CDC's) Futures Initiative process was to identify six Strategic Imperatives, including CDC's responsibility to provide "leadership to the public health system."1 In this capacity, the Governmental Public Health Systems Implementation Team, under the leadership of Dr Ed Thompson, explored how the CDC could catalyze progress toward state and local agency accreditation.2 Specific recommendations, approved by CDC's Executive Leadership Board, included the need to fund key national partners to support a peer-driven process. Building on this support, CDC's Office of the Chief of Public Health Practice joined with the Robert Wood Johnson Foundation to cofund the Exploring Accreditation Project, which found that developing a national accreditation program for state and local public health agencies was both feasible and practical.3 In this seminal effort, the CDC recognized the decision by public health practitioners to move forward with a national accreditation program as a defining moment of historical importance in public health.

As the lead federal agency entrusted with protecting and promoting the public's health, the CDC places a high priority on enhancing the quality and performance of state and local public health agencies. We have a long history of supporting many of the very programs acknowledged to be critical building blocks of a national accreditation program, such as the National Public Health Performance Standards Program,4 the National Association of City and County Health Officials' Operational Definition of a Local Public Health Agency,5 and the Association of State and Territorial Health Officials' Understanding State Public Health Services.6 We strongly believe the accreditation model's emphasis on quality improvement is essential in creating the capacities and competencies necessary to leverage political and community investments in public health. The ability to achieve accreditation ought to convey to funders and policy makers a commitment to quality and performance that meets or exceeds standards of excellence.

There are several important areas where CDC can provide support to the national effort. First, as mentioned in the accreditation model, the CDC and other federal and philanthropic partners could form a "funder's consortium" to provide the necessary financial support that would move the process from an initial developmental stage to a fully functioning national program. Second, in order to recruit state and local agencies to participate in this voluntary program, the CDC has an important role in developing appropriate incentives, be they financial, programmatic, or procedural. As an example, the CDC could allow flexible use of programmatic funds to assist state or local agencies in building the capacities needed to achieve accreditation. Last, as our nation's public health leader, the CDC has unique expertise and knowledge that can provide important contributions as a participant in the development of a national program.

We also recognize the importance of respecting and learning from the considerable standards setting and accreditation work already undertaken or under way in several states. There are numerous state and local agencies that have assessed the performance of their public health systems utilizing the National Public Health Performance Standards. We applaud our colleagues at the Robert Wood Johnson Foundation for having the foresight to assemble and fund the Multi-State Learning Collaborative.7 Rich and valuable information from these efforts will be absolutely essential in the development of a national program.

While the CDC should participate as a funder and key federal stakeholder, the leadership for developing and fully implementing a voluntary national system lies with the practice community itself. But together, it is our shared commitment to achieving significant health impacts that will drive improvements to the governmental public health system. From CDC's perspective, the potential of accreditation to bring consistency, accountability, and quality improvements to public health appears to be well worth the investment.

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