Exploring Public Health Accreditation’s Impact on Health Equity

by Ashlyn Lipnicky, University of Kansas Medical Center

The headquarters of American Academy of Family Physicians in Leawood, Kansas.
Headquarters of the American Academy of Family Physicians in Leawood, Kansas.

As I looked at my internship mentor and a patient as they discussed diabetes management at a free clinic in downtown Kansas City, I wondered about all the people who were not managing their diabetes because of a lack of access to services. I realized that though these individual interactions in the clinic are important, it also seemed necessary to focus on providing more health services to people on a larger scale. I became more aware of the impact that the public health delivery system has in reducing health burdens.

So when the opportunity arose to complete my capstone project with the American Academy of Family Physicians (AAFP), I knew it was a fitting step towards my goal of systems level work. AAFP is a medical organization headquartered in Leawood, Kansas that positions doctors to be patient advocates. They support important evidence-based policies and recommendations for both clinical practice and public health. Within their Population and Community Health department, I am collaborating with epidemiologist Dr. Kevin Kovach.

The headquarters of American Academy of Family Physicians in Leawood, Kansas.
The headquarters of American Academy of Family Physicians in Leawood, Kansas.

We are working on a research project that examines public health accreditation of local health departments (LHDs), which is one of the primary strategies to improve the public health system. This focus comes as a result of the important role LHDs play in public health and health care systems in the United States, which has shifted towards carrying out core public health functions. Challenges like insufficient funding, consistent budget cuts and a lack of workforce capacity greatly impacts this role. While accreditation can be beneficial, it is also a fairly resource and time intensive process.

There is great variation among LHD’s intent to become accredited. Evidence shows that key barriers to undergoing the accreditation process include financial, workforce and technical assistance. National voluntary accreditation could have unintended negative consequences because research shows it can lead to improving the quality of public health services but uptake varies by community characteristics. Public health accreditation may exacerbate health inequities if healthier, more socioeconomically advantaged, and less diverse populations are more likely to seek and become accredited.

With this project, I have been able to conduct a thorough literature review and gain experience in working with a large dataset. I have been a part of selecting appropriate variables to study based on the literature and have collaborated on how to run the appropriate analysis. The end goal is to write a manuscript to be published to contribute to the evidence base on public health accreditation.

This is a very exciting project for me as I have been wanting to become involved in health at the larger systemic level and eventually one day influence health policy. The public health delivery system is an extremely important topic to what we do in public health and how we continue to improve population health. I am eager to begin my analysis and determine important findings that will hopefully have an impact on our knowledge of accreditation.

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