The lead article in this issue of the Journal of Public Health Management and Practice is "Piloting a State Health Department Accreditation Model: The North Carolina Experience." In this article, Joy Reed and colleagues report on a pilot state health department accreditation process, initiated in the fall of 2006, using a voluntary self-assessment of the North Carolina Division of Public Health's and the Division of Environmental of Environmental Health's (Department of Environment and Natural Resources) capacity to perform the essential public health services. This is the first report of a state health department accreditation process.

The Journal of Public Health Management and Practice, now in its 15th year of publication, has published numerous articles on performance measurement and local health department accreditation. Most recently, in July-August 2007, the Journal of Public Health Management and Practice published a special issue on the "Accreditation of Local Public Health Agencies," edited by Leslie Beitsch. In addition to articles in this issue describing accreditation of local public health agencies, the importance of accrediting state public health agencies was emphasized. This had been recommended by Institute of Medicine's report The Future of the Public's Health in the 21st Century.1 The Exploring Accreditation Project supported by the Robert Wood Johnson Foundation also recommended both state and local public health agency accreditation.2

North Carolina is a leader in local public health agency accreditation enabled by state legislation and an appropriation. The benefits of this effort are recognized by the various partners in this process: local health directors; Division of Public Health; local boards of health; and the North Carolina Institute of Public Health. Our faculty at the Department of Public Health of East Carolina University is contracted to train local boards of health in North Carolina. We have observed firsthand the commitment and high regard for this relatively new development by board members and local health directors alike.

Now the next step has been taken-extension of accreditation to the state public health agency. The rationale of the state health director, Leah Devlin, as expressed in the article, is to demonstrate support for the local process and to advance accountability and performance management at the state level. Certainly, if local health agencies are held accountable through accreditation, then state health agencies should meet the same standard.

The method described is based on a self-assessment tool that is followed by a site visit within 90 days. For the most part, this parallels the accreditation method for a local health department. The detailed essential services format and documentation required argue for the stringency of the review. Benefits were reported, notably identification of areas for agency improvement and team building. A significant problem encountered was the high number of staff hours required by the process. This apparently was the principal limitation. No timetable or indication of when a repeat accreditation effort would be implemented is described.

This article documents the implementation of a state public health agency accreditation. Just as this effort benefitted from previous public health assessment efforts, such as that done by the Washington State Department, The North Carolina model will provide a foundation for state health agencies considering similar efforts in the future.

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