Date of Award

Fall 2022

Document Type


Degree Name

Doctor of Public Administration (DPA)


Public Policy and Administration

Committee Chairperson

Kristen Crossney, Ph.D.

Committee Member

Angela Kline, Ph.D

Committee Member

Whitney Katirai, Ph.D


Ohio has 112 local health districts and in 2013 these health districts were mandated by state law to achieve national accreditation by July of 2020 from the Public Health Accreditation Board (PHAB) that was established in 2011. To understand the impact on local health districts of the state policy approach, thirteen question paper surveys were mailed to the Environmental Health Directors at all Ohio health districts in May of 2022 and the results were analyzed.

A survey response rate of 54.5% was achieved and the Directors reported that on average they experienced 76-100 annual hours due to accreditation, as did their staff. The highest costs associated with accreditation, other than personnel included PHAB fees and office supplies. Smaller health districts were impacted by fees to a greater extent than the larger health districts. Program performance was reported by 57% to have not changed, with 20% indicating improvement and 9% indicating a decline. Positive impacts relating to the outcomes of state program audits were reported as ‘no impact’ and ‘policies and procedures’, where negative impacts were dominated by ‘time away from other programs’ (46%) followed by ‘none’ (29%).

The impact of mandatory accreditation in Ohio on environmental health programs can be summarized by increased cost associated with PHAB fees and staff time, as well as supplies, with most programs experiencing no change in performance. Positive impacts can be associated with policies/procedures, quality improvement and documentation, and the most dominant negative impact reported was time away from other programs.