Public health emergencies do not discriminate. Whether an agency serves millions in a dense urban center or a small rural community, every local health department (LHD) must be prepared to plan for, respond to, and recover from emergencies that threaten their communities’ health. This is where Project Public Health Ready (PPHR) can help.
PPHR is a criteria-based training and recognition program developed by NACCHO in partnership with the Centers for Disease Control and Prevention (CDC) to assist LHDs in building core preparedness competencies through a structured continuous quality improvement model focused on all-hazards planning, workforce development, and readiness demonstration. Since 2004, more than 500 LHDs have achieved PPHR recognition and demonstrated to their communities and their professional peers that preparedness excellence is possible in jurisdictions of every size.
PPHR-recognized jurisdictions range from some of the nation’s largest metropolitan health departments to very small rural and regional agencies — highlighting the flexibility and scalability of the program.
Large-Scale Preparedness: Dallas County Health and Human Services
Among the largest jurisdictions recognized is Dallas County Health and Human Services in Texas. It serves a population of more than 2.6 million residents in one of the nation’s largest metropolitan regions. Recognized in the 2025 PPHR cycle, Dallas County operates in a highly complex preparedness environment that must account for infectious disease outbreaks, severe weather events, mass gatherings, and other large-scale emergencies.
Achieving PPHR recognition required Dallas County to demonstrate that it maintains:
- A comprehensive, all-hazards emergency response plan aligned with national standards;
- A trained workforce capable of implementing emergency operations effectively; and
- Demonstrated readiness through exercises or real-world response activities.
For a large jurisdiction, the PPHR framework helps strengthen coordination across multiple divisions, healthcare systems, emergency management partners, and community organizations. The process also reinforces consistency and continuity across complex operational landscapes where preparedness demands are constantly evolving.
Small-Scale Preparedness: Monroe County Health Department, Kentucky
At the other end of the spectrum, small rural jurisdictions have also successfully achieved PPHR recognition. One example is Monroe County Health Department in Kentucky, which serves a rural community of fewer than 12,000 residents. While significantly smaller than major metropolitan jurisdictions, Monroe County still faces a broad range of preparedness challenges from severe weather events and public health emergencies to difficulties with healthcare access and resource limitations common in rural communities.
Through the PPHR process, Monroe County Health Department demonstrated how it:
- Developed and maintained an all-hazards preparedness plan tailored to the needs of its rural population;
- Cross-trained staff to fulfill multiple emergency response roles during incidents; and
- Strengthened partnerships with local emergency management, healthcare providers, schools, and community organizations.
For smaller health departments like Monroe County, PPHR provides a practical framework for building sustainable preparedness systems despite limited staffing and resources. The recognition process also helps formalize coordination with local partners and reinforces a culture of preparedness that can improve response effectiveness during real-world emergencies.
Monroe County’s recognition demonstrates that strong public health preparedness is not dependent on the size of a jurisdiction. Even the smallest communities can build resilient emergency response systems when guided by clear standards, collaboration, and continuous improvement.
Shared Framework, Diverse Contexts
What connects jurisdictions like Dallas County and Monroe County is not their population size, but their commitment to the same nationally recognized preparedness standards. PPHR’s framework supports health departments of every scale by emphasizing:
- Comprehensive all-hazards preparedness planning;
- Workforce training and capability development; and
- Readiness demonstration through exercises and evaluation.
The program’s flexibility allows health departments to adapt preparedness strategies to their unique operational realities while still meeting consistent national benchmarks.
Preparedness at Every Scale
PPHR recognition is more than a designation. It is evidence that a local health department has invested in sustainable preparedness systems designed to protect its community before, during, and after emergencies. From major metropolitan jurisdictions serving millions to rural communities serving only a few thousand residents, the PPHR program demonstrates that effective public health preparedness is achievable at every scale.
Interested in becoming a PPHR applicant?
Click here to learn more about how you can demonstrate your health department’s excellence in preparedness by participating as an applicant for the upcoming 2027 Cycle.
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Or sign up for an email letting you know when applications open up.
Also check out our blog series exploring program updates, sharing expert perspectives, and highlighting how PPHR can help strengthen your department’s preparedness.
