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As the authors of ‘‘Accountability: The Fast Lane on the Highway to Change’’1 point out, public health accreditation appears to be similar to a train with a strong head of steam. The train’s destination of improving population health by improving public health management is laudable.

The arguments behind holding local public health departments accountable with accreditation are that it will improve population health, that marginal benefits outweigh marginal costs, and that undesirable unintended consequences can be mitigated. The causal mechanism is that accountability will result in better performance of the essential health services, which will result in improved population health. 2, 3 Because the accreditation standards focus on the essential services functions rather than on content, such as Healthy People 2010, the accreditation effect presumably occurs in 2 ways:(1) accreditation makes resource acquisition …