High Turnover Among State Health Officials/Public Health Directors: Implications for the Public's Health

Abstract

Context:State health officials (SHOs) serve a critical role as the leaders of state public health systems. Despite their many responsibilities, there is no formal process for preparation to become an SHO, and few requirements influence the selection of an SHO. Furthermore, to date, no studies have examined SHO tenure or their experiences.Objective:This study examines SHO tenure over time and the relationship between SHO tenure and organizational and state attributes.Design:This longitudinal study employed primary data on SHOs and secondary data from the Association of State and Territorial Health Officials on organizational attributes of state public health agencies.Setting:This study examines SHOs within the United States.Participants:SHOs who served in years 1980-2017.Main Outcome Measures:Annual average SHO tenure; average SHO tenure by state.Results:In the 38 years of this study, 508 individuals served as SHOs in the 50 states and the District of Columbia. The average tenure over this period was 4.1 years, with a median tenure of 2.9 years. During the study period, almost 20% of SHOs served terms of 1 year or less. A total of 32 SHOs (32/508 or 6.3%) served for 10 years or longer. Excluding SHOs who served 10 years or longer (n = 32 SHOs who had a collective 478 years of tenure) reduces the average term in office to 3.5 years. The average number of new SHOs per year is 12.3. SHOs appointed by a board of health averaged more than 8 years in office compared with averages just under 4 years for those appointed by governors or secretaries of state agencies.Conclusions:There are notable differences in SHO tenure across states. Future research is needed to further examine SHO tenure, effectiveness, job satisfaction, transitions, and the relationship between SHOs and state health. It may be valuable to expand on opportunities for new SHOs to learn from peers who have moderate to long tenures as well as SHO alumni. Given that average SHO tenure is approximately 4 years and that an SHO could be thrust into the national spotlight at a moment's notice, governors may want to consider experience over partisanship as they appoint new SHOs.

Considering Leaving, But Deciding to Stay: A Longitudinal Analysis of Intent to Leave in Public Health

“…Other forms of voluntary turnover are adding to departures due to retirement. This creates the potential for an unprecedented turnover in the governmental public health workforce in which senior, experienced staff are lost and the availability of staff to replace them who have governmental public health experience is also compromised 3. Although the workforce across the public and private sectors is both aging and may face similar challenges, state and local public health faces a different challenge, as the size of the workforce has declined by 50 000 since 2008, and state public sector full-time employee totals are still several hundred thousand below their peak in 2008-2009 2,4,5…”

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

“…The average tenure is 4.1 years (median=2.9 years), and every year, 12 states replace their state health officers. 19 If the nation is to achieve the goal of public health leaders serving as chief health strategists as suggested in Public Health 3.0 11 in which they architect solutions in partnership with healthcare and other sector leaders, the lack of experienced senior leadership must be addressed seriously. This includes applying the Association of State and Territorial Health Officers workforce recommendations to implement leadership training with current and future public health leaders.…”

Succession Planning in State Health Agencies in the United States: A Brief Report

“…In addition, universities with offices and programs of public health practice are resources for practice-based tools and guides. 27–31…”