Attachment I Letters of Support

February 23, 2007
Dennis Lenaway, PhD
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
1600 Clifton Road, MS D-30
Atlanta, GA 30333
Dear Dr. Lenaway:
I would like to express NACCHO’s continued commitment to the National Public Health
Performance Standards Program (NPHPSP) and strong support for the use of the updated
NPHPSP instruments as means to assess and improve public health system performance.
Since 2001, NACCHO has worked to promote the NPHPSP and provide technical assistance to
NPHPSP users under the leadership of the Centers for Disease Control and Prevention and in
partnership with the American Public Health Association, Association of State and Territorial
Health Officials, National Association of Local Boards of Health, National Network of Public
Health Institutes, and Public Health Foundation.
NACCHO represents the nearly 3,000 local health departments in the country, and since the
national release of these standards in 2002, the NPHPSP Local Public Health System Assessment
has been used in hundreds of localities with great success and valuable lessons learned.
NPHPSP data have helped local communities inform strategic planning, quality improvement,
and performance management efforts.
In addition to the benefits experienced by NPHPSP users to date, NACCHO contends that those
elements of the NPHPSP specific to governmental public health roles and responsibilities can
serve as a valuable building block for future local and state agency accreditation and could be a
component of, or a complement to, agency accreditation efforts.
Over the past year and half, NACCHO has helped coordinate the update of the Local Public
Health System Assessment to ensure that the instrument continues to reflect optimal standards in
public health practice. Experienced local public health practitioners, through participation in an
advisory workgroup, informed the update process, and field testing confirmed the applicability of
the new version. NACCHO is confident that the updated NPHPSP instrument will continue to
effectively measure system performance and inform system improvement efforts.

Dennis Lenaway, PhD
February 23, 2007
Page Two

While NACCHO has been mostly involved with the Local Public Health System Assessment, it
supports the implementation of all three NPHPSP instruments. The state, local, and governance
instruments complement each other and strengthen the science base for public health practice
improvement. In addition, the use of all three NPHPSP instruments have promoted collaboration
among system partners and has provided our members with key information for policy
development, program evaluation, and leveraging new resources.
NACCHO is a strong proponent of the NPHPSP as an effective resource for strengthening public
health systems. We remain dedicated to the NPHPSP and look forward to continued
collaboration with national, state, and local partners in promoting the use of performance
standards.
Sincerely,

Patrick M. Libbey
NACCHO Executive Director

National Association of Local Boards of Health
1840 East Gypsy Lane Road
Bowling Green, OH 43402
Phone: (419) 353-7714 z Fax: (419) 352-6278
Email: nalboh@nalboh.org; Website: www.nalboh.org

Marie M. Fallon
Executive Director

Washington DC Office
1300 L Street, N.W.
Suite 800
Washington, DC 20005
Ph.: (202) 218-4413
Fax: (202) 218-4409
lauren@nalboh.org

Executive Officers
President
John Gwinn (OH)
(330) 678-2239
President-Elect
Alice Davis (OH)
(419) 352-9064
Past President
Lee Kyle Allen (NC)
(252) 447-3684
Secretary/Treasurer
Gladys Curley (MD)
(410) 730-2308

Regional Directors
East Great Lakes Region
Alice Davis (OH)
(419) 352-9064
Mid Atlantic Region
Walter Stein (NJ)
(732) 792-3506
Midwest Region
Larry Hudkins (NE)
(402) 796-2254
New England Region
Carolyn Wysocki (CT)
(781) 237-9852
Southeast Region
James Gallenstein (KY)
(606) 564-4308

February 26, 2007
Dennis Lenaway, PhD
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
1600 Clifton Road, MS D-30
Atlanta, GA 30333
Dear Dr. Lenaway,
The National Association of Local Boards of Health (NALBOH) supports and requests the
approval for the National Public Health Performance Standards Program’s (NPHPSP) 3-year
revision request of the State, Local and Governance performance assessment instruments. The
NPHPSP serves is a valuable tool for states, locals, and governing bodies to assess and improve
their performance.
NALBOH’s work with the Governance Instrument has reinforced the need for a concerted effort to
bring state, local and governing practices into sync. Boards of health that have completed the
Governance Instrument acknowledge that it offers an opportunity to review specific roles and
responsibilities and to make changes within the framework of the ten essential public health
services.
NALBOH has been involved in the revisions of the Governance Instrument and looks forward to
the improved Instrument’s use by board of health members. We also look forward to teaching
board of health members how to advocate for the use of the revised State and Local Instruments
as part of their oversight responsibilities.
The National Association of Local Boards of Health wholeheartedly supports the 3-year revision
request for the State, Local and Governance performance assessment instrument of the National
Public Health Performance Standards Program.
Sincerely,

West Region
Ann Benson (UT)
(801) 544-9265
West Great Lakes Region
Sharon Hampson (WI)
(608) 785-2022

State Affiliate
Donna Rozar (WI)
(715) 387-8121

State Affiliate
Ed Schneider (NE)
(402) 466-7196

Marie M. Fallon
Executive Director

NATIONAL NETWORK OF
PUBLIC HEALTH INSTITUTES
Fostering Innovations that Improve Health
February 26, 2008
Dennis Lenaway, PhD
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
1600 Clifton Road, MS D-30
Atlanta, GA 30333
Dear Dr. Lenaway:
The National Network of Public Health Institutes (NNPHI) strongly supports the 3-year
revision request of the State, Local and Governance performance assessment
instruments of the National Public Health Performance Standards Program (NPHPSP).
Since 2002, under the leadership of the Centers for Disease Control and Prevention,
NNPHI has worked collaboratively with the Association of State and Territorial Health
Officials, the National Association of County and City Health Officials, the National
Association of Local Boards of Health, the Public Health Foundation, and the American
Association of Public Health in the implementation of the NPHPSP.
As you know, the NPHPSP was designed to build and enhance the Nation’s public
health systems. While various strategies have been used in the past to improve the
performance of public health agencies, the NPHPSP offers a comprehensive sciencebased approach for assessing and improving the performance of state and local public
health systems and governance bodies. The data generated from the assessments
address the landscape of the public health infrastructure and capacity, and guides the
creation of performance improvements critical to enhance our pubic health systems.
The State, Local, and Local Governance instruments serve as valuable tools in assessing
performance capacity and ensuring that a strong system is in place to respond
effectively to both day-to-day public health issues as well as public health emergencies.
The NPHPSP instruments have an increased importance in today’s environment as
national efforts – such as the Turning Point Performance Management National
Excellence Collaborative and the National Association of County and City Health
Officials (NACCHO)’s development of an operational definition of a local public health
agency – have focused attention on the importance of public health performance
standards and quality improvement. In addition, as national accreditation continues to
move forward, the NPHPSP instruments can serve as a tool to raise performance and

1515 Poydras Street, Suite 1200 • 504-301-9811 • 504-301-9820 • www.nnphi.org •

prepare state and local health departments for accreditation.
The improved
instruments will have even more value for the field as they have been updated to reflect
current public health practice.
NNPHI looks forward to continuing to work in collaboration with Program partners in
support of the NPHPSP, which helps health systems across the nation improve their
ability to deliver public health services to their communities.

Sincerely,

Joseph Kimbrell, MA, LCSW
President and CEO

February 26, 2007

Dennis Lenaway, PhD
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
1600 Clifton Road, MS D-30
Atlanta, GA 30333
Dear Dr. Lenaway:
The Public Health Foundation strongly supports the proposed three-year revision request
for the state, local, and governance performance assessment instruments in the National
Public Health Performance Standards Program (NPHPSP).
The NPHPSP represents an important step toward achieving more consistently effective,
high-performing public health systems in the United States. By providing national
performance standards, a means for jurisdictions to assess their performance, and a spark
for improvement strategies, the Program supports performance improvement with regard
to Essential Public Health Services at the state, local, and governance levels.
The Program evaluation data and PHF’s first-hand interactions with NPHPSP users attest
to the value of the three instruments. For many jurisdictions, these instruments and the
resulting data have:
• informed public health leaders, front-line staff, and diverse partners of their roles and
model standards for protecting and promoting the health of populations;
• diagnosed strong and weak areas of performance in participating systems;
• helped jurisdictions set priorities for improvement; and
• captured valuable data useful for reporting state and local performance.
The revised and streamlined instruments are highly relevant to today’s public health
practice, as demonstrated by the field test responses and its insightful updates. By
preserving a focus on the 10 Essential Public Health Services, the instruments remain
aligned with the public health framework that is already in use by thousands of
jurisdictions and that is expected to be the basis of future voluntary agency accreditation.
The proposed instrument updates in areas such as public health preparedness, performance
management, and quality improvement will improve the instruments’ relevance to
contemporary public health system performance for the years to come.
The continued availability of quality, nationwide data on performance is critical to our
nation's ability to research and track factors related to system performance, public health
investments, and better health outcomes. Because the revised instruments will increase and
extend voluntary assessment participation throughout the U.S., we anticipate the
instruments to yield excellent opportunities for longitudinal research and improved
practice among participating jurisdictions. In addition, continued data from the NPHPSP

Public Health Foundation letter of support
2/26/2007, page 2 of 2

are required to track the nation's progress on Healthy People 2010 infrastructure targets.
Without continued system performance data collection on the NPHPSP instruments, there
will be no other measures for some Healthy People 2010 targets.
As a national partner in the NPHPSP, PHF is fully committed to the success of the
initiative and will continue to provide users of the revised instruments with high quality
reports and performance improvement resources. PHF looks forward working with CDC
and other Program partners to make this important program a continued success in the
upcoming years.
In summary, PHF believes that the three-year revision request for the state, local, and
governance performance assessment instruments is essential to achieve the Program's
national performance improvement, participation, and research goals.
Sincerely,

Ron Bialek, MPP
President

FARGO CASS PUBLIC HEALTH
John R. Baird, M.D.
Health Officer
401 Third Avenue North
Fargo, ND 58102
Phone 701-241-8118
Fax 701-241-8559
E-mail: JBaird@cityoffargo.com

March 2, 2007
Dennis Lenaway, PhD
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
1600 Clifton Road, MS D-30
Atlanta, GA 30333
Dear Dr. Lenaway:
I would like to express my strong support for the National Public Health Performance Standards
Program (NPHPSP) and the use of the updated NPHPSP instruments as means to assess and
improve public health system performance.
North Dakota has used the NPHPSP instruments since 2003 and has found them to be very
useful. We have used the local instrument in thirteen local health departments and on four
American Indian reservations, the state tool, and the governance tool. I have assisted in
facilitation of many of these assessments. The instruments have been an excellent way to engage
our community partners to examine how we practice public health. It has assisted local planning
and will continue to be used in our state.
Over the past year and a half, I was a member of the NACCHO workgroup that updated the
NPHPSP local instrument. The workgroup ensured that the assessment reflects optimal
standards in public health practice. Field testing further confirmed the applicability of the new
version. I feel confident that the updated NPHPSP instrument will continue to effectively
measure system performance and inform system improvement efforts.
I believe the NPHPSP is an effective resource for public health practitioners and their system
partners. Local and state public health systems can greatly benefit from completing all three
NPHPSP instruments and applying the results toward performance improvement. I look forward
to seeing other states and localities use the updated NPHPSP instruments to strengthen public
health in their communities.

Sincerely,

John R. Baird, M.D.
Health Officer
The mission of Fargo Cass Public Health is to assure a healthy community for all people
through on-going assessment, education, advocacy, intervention, prevention and collaboration.

March 2, 2007
Dennis Lenaway, PhD
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
1600 Clifton Road, MS D-30
Atlanta, GA 30333
Dear Dr. Lenaway:
I would like to express my strong support for the National Public Health Performance Standards
Program (NPHPSP) and the use of the updated NPHPSP instruments as means to assess and
improve public health system performance.
I am a member of the NACCHO MAPP Workgroup committee that updated the NPHPSP local
instrument. Northern Kentucky also reviewed the Governance Instrument. I believe that the expert
knowledge, public health experience and dedication of the committee and staff working on the
NPHPS update will ensured the assessment reflects optimal standards in public health practice.
Field testing further confirmed the applicability of the new version. I feel confident that the
updated NPHPSP instrument will continue to effectively measure system performance and inform
system improvement efforts.
The Kentucky Public Health Association just recently endorsed a policy paper promoting the use of
the NPHPS in Kentucky. Local and state public health systems can greatly benefit from completing
all three NPHPSP instruments and applying the results toward performance improvement
As a MAPP Demonstration Site, Northern Kentucky was one of the first public health systems to
use the NPHPS. This assessment and CDC Report was a key a dataset for developing the strategic
initiatives highlighted in the Master Health Plan for Northern Kentucky 2005. Northern Kentucky is
in the early stages of planning a second MAPP process and will look forward to repeating the
NPHPS to measure changes since our first MAPP plan was published. Hopefully the revised version
will soon be available.
Sincerely,

Alan V. Kalos, M.Ed.
Health Planning Administrator

February 26, 2007
Dennis Lenaway, PhD
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
1600 Clifton Road, MS D-30
Atlanta, GA 30333
Dear Dr. Lenaway,
The Park Ridge Board of Health supports and requests the approval for the National Public Health
Performance Standards Program’s (NPHPSP) 3-year revision request of the State, Local and
Governance performance assessment instruments. The NPHPSP serves is a valuable tool for states,
locals, and governing bodies to assess and improve their performance.
Through the National Association of Local Boards of Health (NALBOH), the Park Ridge Board of Health
has participated in the field tests of the original (full) and revised instruments (partial test). Both
instruments have assisted board members to fully realize their role, especially in an era where agencies
and governing bodies are responding not only to day-to-day activities but also public health emergencies
and emerging issues.
We have found the Governance Instrument to be of great value to the Park Ridge Board of Health and
promote the use of the Local and State Instruments as well. We appreciate the work to continue to
improve the instruments and look forward to using and promoting the revised instruments.
Sincerely,
Joan Valas
Joan Valas, PhD, RN, APRN, BC
Member, Park Ridge Board of Health