Preventive Health and Health Services Block Grant Measurement Framewor

Preventive Health and Health Services Block Grant
Measurement Framework
VERSION 1.5

Table of Contents
Preface......................................................................................................................................................................3
Background..............................................................................................................................................................5
What Is the PHHS Block Grant Measurement Framework?..................................................................................5
Flexibility.......................................................................................................................................................6
Use of Funds.................................................................................................................................................6
Results..........................................................................................................................................................8
How Will the Framework Be Used in the Evaluation?............................................................................................9
What Are the Measures?.........................................................................................................................................9
Public Health Infrastructure Improved Measures....................................................................................11
Emerging Needs Addressed Measures.....................................................................................................15
Evidence-Based Public Health Practiced Measures................................................................................17

List of Figures, Tables, and Appendices
Figure 1. Components of the PHHS Block Grant Measurement Framework.......................................................6
Table 1. Examples of the Use of PHHS Block Grant Funds...................................................................................7
Table 2. Link Between the Evaluation Questions, Logic Model, and Measurement Framework........................9
Table 3. PHHS Block Grant Measures..................................................................................................................10
Appendix A: PHHS Block Grant—Logic Model.......................................................................................................19
Appendix B: Healthy People 2020 Topic Areas....................................................................................................20

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Preface
This document provides an updated overview of the Preventive Health and Health Services (PHHS) Block
Grant Measurement Framework (Version 1.0) to reflect modifications made after data collection in 2017.
The updated document (Version 1.5) defines the purpose of the framework, provides details of its various
components, and offers specific information about the four related measures for future data collections
beginning in 2019.
Grantees will report data on the measures every other year (i.e., data were first collected in 2017; the next
data collection will be in 2019; then 2021, and so forth). Given the complexity of the measurement and
evaluation of the PHHS Block Grant, the framework will be reviewed for potential updates including the
revision of existing measures, the addition of new measures for other aspects of the results, and/or the
development of new results and measures. Further guidance for data collection on the measures will be
provided through training and technical assistance prior to the data collection period.
If you have questions about the measurement framework, measures, or data collection, please contact the
PHHS Block Grant evaluation team at [email protected].

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Important Terms to Know
Agencies: The collective term used in the framework to reference grantee health departments, local
health departments, tribal health departments, and local organizations.
Grantee: The PHHS Block Grant-funded jurisdictional health department (i.e., state, District of
Columbia, American Indian tribe, US territory, freely associated state).
Local and tribal health departments: Governmental health entities within a grantee’s jurisdiction
that receive PHHS Block Grant-funded support to implement public health efforts in support of
communities within that jurisdiction.
Local organizations: Governmental and non-governmental entities within a grantee’s jurisdiction that
receive PHHS Block Grant-funded support to implement public health efforts in communities within
that jurisdiction. Types of local agencies include community-based organizations, schools, faith-based
organizations, community health centers, and medical clinics. For the purposes of the framework, the
term ‘local organizations’ does not include local health departments.
PHHS Block Grant-funded support: Use of PHHS Block Grant funds, in any amount, to directly fund,
provide staff for, or provide technical assistance to support an activity.
Public health efforts: Programs, services, or activities supported by the PHHS Block Grant that are
implemented as potential solutions to public health problems and that address public health needs.
Use of PHHS Block Grant funds: Use of PHHS Block Grant funds, in any amount, to address prioritized
public health needs. Grantees can use grant funds to address their jurisdictions’ needs, as well as
provide support to other entities (i.e., local health departments, tribal health departments, and local
organizations) to address their specific, prioritized public health needs.

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Background
The Centers for Disease Control and Prevention’s
(CDC’s) Center for State, Tribal, Local, and Territorial
Support is evaluating the Preventive Health and
Health Services (PHHS) Block Grant. The purposes
of the evaluation are to assess the grant’s value,
describe and measure select outputs and outcomes
of the grant, and strengthen its performance and
accountability. The evaluation assesses the grant
as a whole—not individual grantee activities or
outcomes.

There are two overarching evaluation
questions:
1.How does the PHHS Block Grant support
grantees in addressing their jurisdictions’
prioritized public health needs related to Healthy
People 2020 objectives?
2. How does the PHHS Block Grant contribute
toward the achievement of organizational,
systems, and health-related outcomes?

These evaluation questions are intended to assess
how the PHHS Block Grant contributes to the
grantees’ ability to meet prioritized public health
needs and achieve outcomes. To help address the
evaluation questions, CDC developed the PHHS
Block Grant Measurement Framework.

About the PHHS Block Grant
Through legislative authority, the PHHS Block
Grant provides federal funding to 61 grantees—
all 50 States, the District of Columbia, 2
American Indian tribes, 5 US territories, and
3 freely associated states. With these flexible
funds, grantees address public health needs
that are a priority within their jurisdictions in
collaboration with local and tribal public health
organizations. The legislation requires grantees
to align their program objectives to Healthy
People 2020, a set of national objectives
designed to guide health promotion and disease
prevention efforts.

What Is the PHHS Block Grant Measurement Framework?
The PHHS Block Grant Measurement Framework
is an innovative approach to assessing the outputs
and outcomes resulting from grantees’ use of
flexible grant funds. Flexible funding is a key aspect
of the grant because it allows grantees to set their
own goals and program objectives and implement
strategies designed to meet their prioritized public
health needs. The framework defines a set of
measures that enable CDC to standardize the
collection of data on grantee achievements. The

PHHS Block Grant Measurement Framework (Version 1.5)

framework is intended to apply to grantee activities,
regardless of how funds are invested or which
Healthy People 2020 objectives are selected.
Grantees should be able to see alignment between
their work and the framework. However, depending
on the grantee’s activities, not every aspect of the
framework will necessarily be relevant in any given
reporting period. The framework consists of three
components—flexibility, use of funds, and results
(see Figure 1).

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Figure 1. Components of the PHHS Block Grant Measurement Framework

Results
Emerging
needs
addressed

Public health
infrastructure
improved

Evidence-based
public health
practiced

Use of Funds

Maintain
existing public
health efforts
Initiate new
public health
efforts

Results – Outcomes of
the grant resulting from
successful use of PHHS
Block Grant funds

Enhance or expand
existing public
health efforts

Flexibility

Use of Funds – Grantees
use PHHS Block Grant funds
to address their prioritized
public health needs

Sustain or
restore public
health efforts

Flexibility – Grantees’ ability
to identify, prioritize, and
address their public health
needs

.... to address public
health needs

Dark blue
Dark blue
Flexibility
The core component of the framework is the
blue
flexibility of theMed
PHHS
Block Grant, as it gives
grantees control over identifying which jurisdictional
Light to
blue
public health needs
prioritize and determining
appropriate strategies to address those needs.
The public health needs can be at the grantee
level or at the local level. Flexible funding allows
grantees to address public health needs for which
other categorical types of funding are insufficient,
unavailable, or too restrictive on how program funds
can be used.
PHHS Block Grant Measurement Framework (Version 1.5)

Use ofMed
Funds
blue
The use of funds component reflects the different
Light blue
ways grantees use grant funds to implement
public health efforts to address prioritized public
health needs, including using funds to support the
needs of local health departments, tribal health
departments, and local organizations. It shows how
flexibility in the use of these funds helps attain the
results identified in the framework. This component
outlines four ways grantees may use PHHS Block
Grant funds:

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1. Initiate new public health efforts:
Develop and implement new programs, services,
and activities that address public health needs
that were previously not funded, either due to a
lack of available funds or an absence of funding
allotted to the need.
2. Maintain existing public health efforts:
Support established programs, services, and
activities from year to year.
3.Enhance or expand existing public health efforts:
Enhance an effort by refining and improving its
quality or expand an effort by adding components
or outreach to additional populations.

4. Sustain or restore public health efforts:
Sustain or restore efforts that have experienced a
partial or complete loss in funding, and are at risk
for discontinuation.1
● Sustain: Continue an effort without disruptions
after original funding for the effort has ended.
● Restore: Reinstate or rebuild an effort that was
significantly disrupted or had ended due to loss
of original funding.2
Examples of the use of funds are provided in Table 1.

Table 1. Examples of the Use of Block Grant Funds
Use of Funds

Examples

Initiate new public health efforts

● Testing new or innovative approaches to addressing needs
● Implementing programs, services, or activities that may have
been conducted elsewhere but are new to the jurisdiction

Maintain existing public health
efforts

● Providing ongoing support to longer-term efforts

Enhance or expand existing public
health efforts

● Fully implementing or scaling up pilots or smaller efforts

● Ensuring consistency and continuation of efforts

● Establishing new or expanding existing partnerships, or
increasing integration across categorical programs
● Advancing existing work, such as updating plans or assessments

Sustain or restore public health
efforts

● Ensuring a program continues, when facing impending loss of
funds, until other funding sources are identified (e.g., stop-gap
funding)
● Institutionalizing public health efforts (e.g., restoring ongoing
funding in the wake of funding loss)

1
2

PHHS Block Grant funds may not be used to supplant state or local funds.
Once a public health effort is restored, it would move into the “maintain” category in subsequent years.

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Med blue

Results
Light blue
The results component includes three cross-cutting
outcomes of agency performance and public health
practice that result from the use of the PHHS Block
Grant’s flexible funding.

Public health infrastructure improved
Public health infrastructure includes the
organizational capacity (i.e., the systems,
workforce, partnerships, and resources) that
enables agencies to perform their core functions
and provide essential services. Improvements to
infrastructure may occur within the grantee health
department, either department-wide or within a
specific program, or across the grantee jurisdiction’s
public health system (e.g., within local organizations).
There are several aspects of improving public health
infrastructure, such as improving information systems
capacity, quality, and communications strategies, as
well as strengthening the workforce, addressing public
health standards, and supporting partnerships.

Evidence-based public health practiced
Evidence-based public health practice involves
implementing effective interventions. It also
includes both building and using evidence (i.e., data
and information) to
● Assess and define the public health need to be
addressed (e.g., surveillance data)
● Prioritize public health needs for action (e.g.,
health improvement plans)
● Determine the effectiveness of specific
interventions with respect to outcomes (e.g.,
evaluation data)
● Describe how to effectively implement
interventions with respect to relevant
contextual factors such as setting, population,
social norms (e.g., translational research data)3

Emerging needs addressed
Emerging needs are public health issues that are
beginning to present themselves as problems within
the grantee’s jurisdiction. Emerging needs may
be newly arising problems, reemerging problems,
or existing problems that have developed new
characteristics (e.g., affecting new populations or
geographic areas). Public health emergencies, or
unexpected natural or manmade events that cause
an immediate risk to the public’s health, are also
considered emerging needs. Emerging needs may
occur in response to external factors or to changing
priorities within a jurisdiction.

3

 rownson RC, Fielding JE, Maylahn CM. Evidence-based public health: a fundamental concept for public health practice.
B
Annual Review of Public Health 2009;30:175–201.

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How Will the Framework Be Used in the Evaluation?
public health infrastructure improved result are
used to demonstrate how grantees are improving
organizational and systems capacity, which is an
intermediate outcome. (See Appendix A for the
complete grant logic model.)

The PHHS Block Grant Measurement Framework
is a practical, yet outcome-focused, approach to
evaluating the grant as a whole. Data collected
for the measures are used to help answer the
evaluation questions. These data show the ways
the PHHS Block Grant supports grantee activities
and outputs and influences achievement of
outcomes in the grant logic model across all
grantees. For example, data collected for the

Table 2 shows how the framework lines up with the
evaluation questions and logic model components.

Table 2. Link Between the Evaluation Questions, Logic Model, and Measurement Framework
Logic Model
Component

Measurement
Framework Component

1. How

does the PHHS Block Grant support
grantees in addressing their jurisdictions’
prioritized public health needs related to
Healthy People 2020 objectives?


● Activities

● Flexibility


● Outputs


● Use of Funds

2. How does the PHHS Block Grant contribute
toward the achievement of organizational,
systems, and health-related outcomes?

● Short-Term Outcome

Overarching Evaluation Question

● Short-Term Outcome
● Results

● Intermediate Outcomes
● Long-Term Outcomes

What Are the Measures?
The framework includes four measures that assess
specific aspects of the results. The measures,
presented in Table 3, are relevant to grantee
objectives and activities, lend themselves to
accurate measurement, and allow for aggregating
data across grantees. Where feasible, the measures
capture results both within the grantee health
department and among local and tribal health
departments as well as local organizations receiving

PHHS Block Grant Measurement Framework (Version 1.5)

support from grantees. These four measures
focus on select aspects of each result that were
considered most important, relevant, measurable,
and feasible for data collection. Additional
measures may be developed for future versions of
the framework. Data collected for the measures
will complement other grantee information, such as
success stories.

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Table 3. PHHS Block Grant Measures
Results
1. P
 ublic Health Infrastructure
Improved

Measure
Information Systems Capacity Improved
1.1 N
 umber of state, territorial, tribal, and local agencies
whose capacity to collect or enhance data that provide
information of public health importance was improved or
maintained through the use of PHHS Block Grant funds

Quality Improved
1.2 N
 umber of state, territorial, tribal, and local agencies
in which the efficiency or effectiveness of operations,
programs, or services was improved through the use of
PHHS Block Grant funds

2. Emerging Needs Addressed

Emerging Public Health Needs Addressed
2.1 N
 umber of emerging public health needs that were
addressed through the use of PHHS Block Grant funds

3. Evidence-Based Public Health
Practiced

Evidence-Based Public Health Interventions Implemented
3.1 N
 umber of evidence-based public health interventions
implemented through the use of PHHS Block Grant funds

More information about these measures is
outlined below.
When will grantees report on the measures?
Grantees will report on the measures during the
fall every other year, reflecting the results and
improvements achieved during the prior 12-month
period (July 1–June 30). Reporting on the measures
is based on whether the PHHS Block Grant
was used to support achievement of results or
improvements; it does not matter which fiscal year
funding supported the work.

Will grantees report on every measure?
Grantees will report data only on the measures
that align with their work. All, some, or none of the
measures might be relevant in any given reporting
period, depending on the grantee’s activities.
The next section provides descriptions of the four
measures for the results included in the framework.

How will grantees report on the measures?
Grantees will report data on the measures by
completing a web-based questionnaire administered
to the PHHS Block Grant Coordinators. The Block
Grant Management Information System (BGMIS) will
not be used to collect data on the measures.

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Public Health Infrastructure Improved Measures
Introduction
Public health infrastructure includes the organizational capacity (i.e., the systems, workforce, partnerships,
and resources) that enables agencies to perform their core functions and provide essential services.
Improvements to infrastructure may occur within the grantee health department, either departmentwide or within a specific program, or across the grantee jurisdiction’s public health system (e.g., within
local organizations). For the Public Health Infrastructure Improved result, there are two measures. These
measures assess information systems capacity and quality improvement.

INFORMATION SYSTEMS CAPACITY IMPROVED
1.1 Number of state, territorial, tribal, and local agencies whose capacity to collect or
enhance data that provide information of public health importance was improved or
maintained through the use of PHHS Block Grant funds.
What are the key definitions?
Capacity to collect or enhance data was improved
or maintained:
Improved or maintained ability of agencies to use
data for decision-making through the
● Collection of new data
● Enhancement of existing data
● Maintenance of existing data

Examples of capacity to collect or enhance
data:
● Developed a new surveillance system
● Added an online, query-enabled database
● Improved standardization of existing data

4

Information of public health importance:
Any data that provide insight into health, health
inequities, contributing factors or causes of health
challenges, and/or potential policy, public health,
or community solutions. These are data that are
needed for the planning, implementation, and
evaluation of public health practice.4

What gets counted?
Each agency (i.e., grantee health department, local
health departments, tribal health departments, and
local organizations) that used PHHS Block Grantfunded support to newly develop, improve, or maintain
one or more information systems will be counted for
this measure. This includes improvements that were
under way during the reporting period, not just those
that were completed.

● Improved reporting functionality

What information will be reported?

● Established linkages across data systems

Grantees will provide the following information for
the information systems that were newly developed,
improved, or maintained using PHHS Block Grantfunded support:

 HAB Standard 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public
P
health importance and on the health status of the population.

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● The number of agencies (i.e., grantee health
department, local health departments, tribal
health departments, and local organizations)
that newly developed, improved, or maintained
information systems through the use of PHHS
Block Grant funds.
● The type of data system improved or
maintained:
○ Laboratory data system
○ Surveillance system
○ Vital events database (e.g., birth, death,
fetal death)
○ Registry (e.g., cancer)
○ Performance management system
○ Program administration
○ Financial management system
○ Human capital management system (e.g.,
human resources, personnel)
○ Health information exchange
○ Electronic health record (EHR) system
○ Public health database (e.g., public facing
database)
○ Public health digital library (e.g., access to
publications, journals)
○ Online mapping system (e.g., GIS)
○ Other information system

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● The name/title of the information system
improved or maintained
● Whether funds were used to
○ Initiate development of a new system or
module
○ Maintain a system or module
○ Enhance or expand an existing system or
module
○ Sustain or restore a system or module
● Whether the information system improved or
maintained at the grantee health department
was also used by local health departments,
tribal health departments, and/or local
organizations and, if yes, by how many

Why is the measure important?
A key component of public health infrastructure is
establishing, maintaining, and using state-of-theart data and information systems to inform public
health action. Data from information systems can
document the impact of an intervention or monitor
and clarify the epidemiology of health problems
to facilitate priority setting. These data are the
foundation for decision making in public health and
empower decision makers to lead and manage more
effectively by providing timely, useful evidence.5
This measure determines whether agencies
use flexible PHHS Block Grant funds to ensure
robust and functional information systems for
systematically collecting, managing, analyzing, and
interpreting data to plan, implement, and assess
programs and services within their jurisdictions.

CDC. CDC’s vision for public health surveillance in the 21st century. MMWR 2012;61(Suppl).

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QUALITY IMPROVED
1.2 Number of state, territorial, tribal, and local agencies in which the efficiency or
effectiveness of operations, programs, or services was improved through the use of
PHHS Block Grant funds.
What are the key definitions?
Efficiency of operations, programs, or services:
Improvements in efficiency result in reductions in
the amount of resources required to implement
the effort.
Effectiveness of operations, programs, or services:
Improvements in effectiveness result in a greater
ability to achieve agency or program goals through
improved delivery of services or programs, or improved
implementation of organizational processes.

Types of Efficiency and Effectiveness
Efficiency
● Time saved
● Reduced number of steps
● Costs saved
● Costs avoided
● Revenue generated due to billable service
● Other efficiency improvements
Effectiveness
● Increased staff satisfaction
● Organizational design improvements
● Quality enhancement of services or programs
● Other effectiveness improvements

What gets counted?
Each agency (i.e., grantee health department, local
health departments, tribal health departments,
and local organizations) that demonstrated

PHHS Block Grant Measurement Framework (Version 1.5)

improved efficiency or effectiveness of one or more
operations, programs, or services through the
use of PHHS Block Grant-funded support will be
counted for this measure. This includes efficiency
and effectiveness improvements that were achieved
during the reporting period.

What information will be reported?
Grantees will provide the following information on
the efficiency and effectiveness improvements
achieved using PHHS Block Grant funds:
● The number of agencies (i.e., grantee health
department, local health departments, tribal
health departments, and local organizations)
that improved efficiency and effectiveness
through the use of PHHS Block Grant funds
● The number of operations, programs, or
services that achieved each type of efficiency
and effectiveness improvement. Types of
improvements include:
○ Time saved
○ Reduced number of steps
○ Costs saved
○ Costs avoided
○ Revenue generated due to billable service
○ Increased staff satisfaction
○ Organizational design improvements
○ Q
 uality enhancement of services or
programs
○ Other – specify

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● Whether funds were used to
○ Initiate a new effort to improve efficiency and
effectiveness
○ M
 aintain an ongoing effort to improve
efficiency and effectiveness
○ E
 nhance/expand an existing effort to improve
efficiency and effectiveness
○ S
 ustain or restore an effort to improve
efficiency and effectiveness
● One example of an operation, program, or
service in which the efficiency and effectiveness
was improved through the use of established
quality improvement methods

6

Why is the measure important?
Quality improvement is a formal approach to
strengthen organizational performance and
increase efficiency and effectiveness in public
health operations, programs, and services. While
individual employee performance may contribute
to increased efficiency and effectiveness, it is
important that the processes to improve efficiency
and effectiveness are infused into agency-wide
public health practice and operations to effect
significant and lasting improvements in quality.6
This measure determines the extent to which
flexible PHHS Block Grant funds assist agencies
in improving the efficiency or effectiveness of
operations, programs, or services.

 HAB Standard 9.2: Develop and implement quality improvement processes integrated into organizational practice, programs,
P
processes, and interventions.

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Emerging Needs Addressed Measures
Introduction
Emerging needs are public health issues that are beginning to present themselves as problems within the
grantee’s jurisdiction. They can affect the jurisdiction as a whole or specific areas within the jurisdiction,
such as counties, tribes, and cities. There is one measure that assesses addressing emerging needs.

EMERGING PUBLIC HEALTH NEEDS ADDRESSED
2.1 Number of emerging public health needs that were addressed through the use of PHHS
Block Grant funds.

What are the key definitions?
Emerging public health needs: Public health needs
within a grantee’s jurisdiction that are newly
developing or newly prioritized.
● Newly developing: A public health need that
○ Is newly arisen
○ Exists but has developed new characteristics
○ Has re-emerged
● Newly prioritized: A public health need that
○ Has been known to the grantee but lacked
funding or support
○ Is new to the public health field
○ Has new expectations for a public health
response
Addressed: Implemented an intervention, service,
or activity designed to reduce or prevent further
impact of the emerging public health need.

PHHS Block Grant Measurement Framework (Version 1.5)

Examples of emerging public health needs:
● Infectious disease outbreaks
● Migrant health
● Opioid overdoses
● Mental health
● Natural disasters

What gets counted?
Each emerging public health need within the
grantee’s jurisdiction addressed through the
use of PHHS Block Grant-funded support will be
counted for this measure. This includes any efforts
to address the emerging public health need that
were under way during the reporting period, not just
those that were completed.

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What information will be reported?
For each emerging public health need reported,
grantees will provide the following information:

● Whether funds were used to
○ Initiate a new effort to address the emerging
public health need

● The name and description of the need and if it
is newly developing or newly prioritized

○ Maintain an effort to address the emerging
public health need

● How the emerging public health need was
prioritized:

○ Enhance/expand an existing effort to address
the emerging public health need

○ Jurisdiction health assessment (e.g., state
health assessment)
○ Topic or program specific assessment
(e.g., tobacco assessment, environmental
health assessment)
○ Identified via surveillance systems or other
data sources
○ Prioritized within a strategic plan
○ Declared as an emergency within grantee
jurisdiction7
○ Governor (or political leader) established as a
priority
○ Legislature established as a priority
○ Tribal government/elected official established
as a priority
○ Other – specify

○ Sustain or restore an effort to address the
emerging public health need

Why is the measure important?
Emerging public health needs may be unique
to each grantee’s jurisdiction. An outcome of
the PHHS Block Grant is improved capacity of
the public health system to respond to these
emerging public health needs. The flexibility of the
grant enables grantees to identify, prioritize, and
address emerging public health needs within their
jurisdiction, which may help lessen their potential
effect, including long-term health impact.
This measure helps determine the extent to which
PHHS Block Grant funds assist in responding to
and addressing emerging public health needs that
occur within the grantee’s jurisdiction at the state,
territorial, local, and tribal levels.

● The Healthy People 2020 health topic area
that best aligns with the emerging need (see
Appendix B for full list)
● The focus of the emerging need (i.e., healthrelated or organizational or systems-related)
○ If health-related, the geographic area affected
by the emerging need
○ If health-related, the estimated size of
the population potentially affected by the
emerging public health need as well as a brief
description of how the population estimate
was identified

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 ublic health emergencies are considered emerging public health needs. They have been prioritized within the grantee’s
P
jurisdiction and can occur locally, regionally, or jurisdiction-wide. These threats include natural disasters, chemical threats,
biological threats, disease outbreaks, and environmental exposures.

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Evidence-Based Public Health Practiced Measures
Introduction
Evidence-based public health practice involves implementing effective interventions. It also includes both
building and using evidence (i.e., data and information) to assess and define the public health needs,
prioritize public health needs for action, and determine the effectiveness of interventions. For the EvidenceBased Public Health Practiced result, there is one measure. This measure assesses the implementation of
evidence-based public health interventions.

EVIDENCE-BASED PUBLIC HEALTH INTERVENTIONS IMPLEMENTED
3.1 Number of evidence-based public health interventions implemented through the use of
PHHS Block Grant funds.
What are the key definitions?
Evidence-based public health interventions:
Any type of planned activity, such as a program,
service, or policy, designed to prevent disease or
injury or promote health in a group of people. Public
health interventions may be supported by varying
levels of evidence ranging from weak to rigorous.
For the purposes of this measure, evidence-based
public health interventions are based on having
rigorous, strong, or moderate evidence according
to Healthy People 2020 strength of evidence
rating criteria.8
Healthy People 2020 strength of evidence rating
criteria:
● Rigorous evidence (Rating category 4) –
Formal, comprehensive, and systematic
review of all relevant literature (i.e., published
intervention evaluations or studies that have
evidence of effectiveness, feasibility, reach,
sustainability, and transferability).
Examples of evidence include
○ Recommendations of the Community
Preventive Services Task Force
○ Recommendations of the US Preventive
Services Task Force
8

○ Systematic reviews published in peer-reviewed
journals
● Strong evidence (Rating category 3) –
An informal, non-comprehensive, nonsystematic review of some but not all relevant
literature (i.e., multiple published evaluations
or studies that have evidence of effectiveness,
feasibility, reach, sustainability, and
transferability).
Examples of evidence include
○ Non-systematic reviews published by the
federal government
○ Non-systematic reviews published in peerreviewed journals
● Moderate evidence (Rating category 2) –
At least one published evaluation or study,
with peer review, that has evidence of
effectiveness, feasibility, reach, sustainability,
and transferability.
Examples of evidence include
○ Journal articles of individual studies
○ Published intervention research
○ Published pilot studies

 ealthy People 2020. Evidence-Based Resources. www.healthypeople.gov/2020/Implement/EBR-glossary#selection-criteria.
H
Accessed April 21, 2017.

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● Weak evidence (Rating category 1) –
At least one unpublished evaluation or study
without peer review, which has evidence of
effectiveness, feasibility, reach, sustainability,
and transferability.

○ Rigorous evidence (Rating category 4)
○ Strong evidence (Rating category 3)
○ Moderate evidence (Rating category 2)
○ Weak evidence (Rating category 1)

Examples of evidence include

○ No evidence

○ Unpublished intervention research

○ For both “Weak evidence” and “No evidence,”

○ Unpublished pilot studies
○ Unpublished case studies
○ Unpublished field-based summaries

Additional information about building
evidence
Grantees rate the strength of evidence for each
intervention according to the Healthy People
2020 criteria. Although interventions supported
by “weak evidence” are not counted in this
measure, additional information about these
interventions will be collected to learn more
about any grantee efforts to build practicebased evidence through testing or evaluation.

What gets counted?
Each evidence-based public health intervention
implemented through the use of PHHS Block Grant
funds that has a rigorous, strong, or moderate
strength of evidence will be counted. This includes
interventions that were delivered for the first time,
are ongoing, or were completed within the reporting
period. The same public health intervention
implemented in multiple settings or in multiple
health departments is counted once.

What information do we report?
For each agency type (i.e., grantee health
department, local health departments, tribal health
departments, and local organizations) implementing
PHHS Block Grant-supported public health interventions
grantees will provide the following information:
● The number of unique public health
interventions implemented by that agency
● The level of evidence supporting the public
health intervention:
PHHS Block Grant Measurement Framework (Version 1.5)

■ The number of interventions that were
untested, new, and/or innovative
■ The number of interventions for which data
or information was collected to determine
effectiveness
● The primary Healthy People 2020 health topic
area addressed by the public health intervention
(see Appendix B for full list)
● Whether funds were used to
○ Initiate a new (i.e., previously not funded or
implemented) public health intervention
○ Maintain implementation of an existing public
health intervention
○ Enhance/expand an existing public health
intervention
○ Sustain or restore a public health intervention

Why is the measure important?
A key component of evidence-based public health
practice is selecting and implementing interventions
based on the best available evidence. Implementing
public health interventions shown to be effective
is an important practice for maximizing public
health outcomes. In cases where evidence of
effectiveness is unavailable, or weak, the public
health interventions that are implemented can be
tested or evaluated with the intent of determining
effectiveness. This is important for building practicebased evidence, which can support further decisionmaking by the grantee and contribute to the overall
evidence base for public health. This measure
determines the extent to which the PHHS Block
Grant supports the implementation of evidencebased public health interventions.
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Appendix A: PHHS Block Grant—Logic Model
Inputs
● Legislative
authorization of
flexible grant funding
● Annual appropriations
● CDC project officers,
evaluation staff

Activities
● Award flexible funds
to grantees
● Administer program
(e.g., guidance/TA,
BGMIS management,
compliance visits)

Outputs

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

● Funded grantees
● Documented grantee
work plans in BGMIS
● Compliance visit
summaries

● HP 2020 objectives
● BGMIS (management
information system)
● Office of Financial
Resources
● Grantee/local staff
(e.g., Block Grant
coordinator, local
health department
staff)
● Grantee Preventive
Health Advisory
Committee
● Local partners
● Knowledge of public
health needs,
challenges, and
priorities

● Develop, implement,
and assess work plans
aligned with HP 2020
objectives that reflect:
◦ Defined public
health needs (i.e.,
organizational-related,
systems-related and/
or health-related)
◦ Prioritize public
health needs to be
addressed, and

● Public health
programs, services,
activities that are:

Improved
organizational and
systems capacity

Improved performance
of public health programs,
services, and activites

Reduced preventable
health risk factors

Improved public health
outcomes related to
HP 2020 objectives

Improved ability to
address prioritized
public health needs

◦ Newly initiated
◦ Enhanced or
expanded
◦ Sustained or
restored, or
◦ Maintained

◦ Selected approaches
to address prioritized
public health needs

Accountability
Key:

PHHS Block Grant Measurement Framework (Version 1.5)

CDC:

Grantee:

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Appendix B: Healthy People 2020 Topic Areas
1. Access to Health Services

22. HIV

2. Adolescent Health

23. Immunization and Infectious Diseases

3. Arthritis, Osteoporosis, and Chronic Back
Conditions

24. Injury and Violence Prevention

4. Blood Disorders and Blood Safety
5. Cancer
6. Chronic Kidney Disease
7. Dementias, including Alzheimer’s Disease
8. Diabetes
9. Disability and Health
10. Early and Middle Childhood
11. Educational and Community-Based Programs
12. Environmental Health
13. Family Planning
14. Food Safety
15. Genomics
16. Global Health
17. H
 ealth Communication and Health Information
Technology
18. Health-Related Quality of Life and Well-Being
19. Healthcare-Associated Infections
20. Hearing and Other Sensory or Communication
Disorders
21. Heart Disease and Stroke

25. Lesbian, Gay, Bisexual, and Transgender Health
26. Maternal, Infant, and Child Health
27. Medical Product Safety
28. Mental Health and Mental Disorders
29. Nutrition and Weight Status
30. Occupational Safety and Health
31. Older Adults
32. Oral Health
33. Physical Activity
34. Preparedness
35. Public Health Infrastructure
36. Respiratory Diseases
37. Sexually Transmitted Diseases
38. Sleep Health
39. Social Determinants of Health
40. Substance Abuse
41. Tobacco Use
42. Vision
43. Emergency Medical Services*
44. Rape or Attempted Rape*

* Note: Healthy People 2020 has designated 42 health topic areas. Two additional categories—“emergency medical services” and
“rape or attempted rape”—are included in the Block Grant Management Information System as health topic areas that grantees
can select to identify the focus of their work.

PHHS Block Grant Measurement Framework (Version 1.5)

20