State Health Officials: Backgrounds and Qualifications

Abstract

Context: State health officials (SHOs), the executive and administrative leaders of state public health, play a key role in policy development, must be versed in the relevant/current evidence, and provide expertise about health issues to the legislature and the governor. Objective: To provide an empirical examination of SHO backgrounds and qualifications over time. Design, Setting, and Participants: Cross-sectional survey of current/former SHOs. Main Outcome Measures: State health official educational backgrounds; public health experience; previous employment setting. Results: Two-thirds of respondents (64.6%) reported having a medical degree, approximately half (48.3%) a formal public health degree, and almost one-quarter (21.8%) a management degree. The majority had governmental public health experience at some prior point in their career (70.0%). Almost two-thirds worked in governmental public health immediately before becoming an SHO. The proportion that was female increased significantly by decade from 5.6% in the 1970s/80s to 46.4% in the 2010s (P = .02). Conclusions: The main finding from this study shows that more than two-thirds of SHOs have had governmental public health experience at some point in their career. This is not a new trend as there were no statistical differences in public health experience by decade. More than half of the SHOs were appointed to the role directly from governmental public health, indicating that their public health experience is timely and likely germane to their appointment as SHO. Findings also indicate improvements in gender diversity among one of the most influential leadership roles in governmental public health whereas significant changes in racial and ethnic diversity were not identified. Women are increasingly being appointed as SHOs, indicating increasing gender diversity in this influential position. Given that governmental public health employees are predominantly women, there is still room for gender equity improvements in executive leadership roles. This is coupled with the need for further racial and ethnic diversity improvements as well.

Laws Governing State Health Official Appointments: A Legal and Historical Review

“…However, this finding does not align with recent research that asked current and former SHOs to reflect on the skills they need the most. 20 Rather, in that research, SHOs reported that the most important skills include understanding the core public health competencies, experience managing large organizations and budgets, and know-how for navigating the policymaking process. Medical doctors do not receive this kind of training and experience in medical school or residency.…”

“…The majority of this research occurred prior to the COVID-19 pandemic and primarily comes from the SHO-CASE Study, which involved a 2017 national survey of current and former SHOs. [17][18][19][20][21][22] This body of research found that SHO tenures have decreased over time and that 54% of SHO turnovers (prior to the COVID-19 pandemic) were involuntary. 21 Given the late-19th-and early-20th-century roots of most laws governing the establishment and leadership of state public health agencies, it is not surprising that a frequent statutory requirement to qualify as an SHO has been possession of a medical degree.…”

“…Although these laws have been evolving, 23 the vast majority of current and recent SHOs have had a medical degree as their primary "health"-related professional qualification, although a recent study found that the majority of SHOs reported having governmental public health experience at some prior point in their career prior to their appointment as an SHO. 20 Furthermore, current and former SHOs report that the skills they need the most are focused on core public health competencies, managing large organizations and budgets, and navigating the policymaking process. 17,18 The current study presents the legal epidemiological review of the SHO appointment laws, including the evolution of educational and experience requirements of SHOs over time.…”

Deficient Response to COVID-19 Makes the Case for Evolving the Public Health System

“…Finally, evolution will require bold leadership from public health and medicine. The 3 decades after the first NAM report on the future of public health, only half of the nation's state health officers have formal public health training before their appointment, 18 requiring a longer learning curve to be effective. The average tenure is 4.1 years (median=2.9 years), and every year, 12 states replace their state health officers.…”

Official tenure and governance effectiveness of China's basic pension insurance system: An inverted U-shaped curve

“…To our knowledge, the rational allocation of basic pension insurance system is related to officials' performance, and the implementation of officials will affect personal promotion ( 16 ). Therefore, officials also have governance motives, hoping that basic pension insurance system will be more efficient and it can be promoted accordingly ( 17 ). In view of theoretical knowledge of politician' incentives and behaviors for career advancement ( 18 ), we believe that there is a relationship between the characteristics of officials and the governance performance of China's basic pension insurance system.…”