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State Health Officials

Backgrounds and Qualifications

Yeager, Valerie A. DrPH; Menachemi, Nir PhD, MPH; Jacinto, Corey M. MPH; Chapple-McGruder, Theresa PhD; Danielson, Elizabeth C. MA; Halverson, Paul K. DrPH, FACHE for the SHO-CASE Steering Committee

Journal of Public Health Management and Practice: January/February 2020 - Volume 26 - Issue 1 - p 9–15
doi: 10.1097/PHH.0000000000000937
Research Reports: Research Full Report

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.

Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Yeager, Menachemi, and Halverson, Mr Jacinto, and Ms Danielson); and de Beaumont Foundation, Bethesda, Maryland (Dr Chapple-McGruder).

Correspondence: Valerie A. Yeager, DrPH, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN 46202 (

Additional authors for the SHO-CASE Steering Committee include Edward L. Baker, Brian C. Castrucci, Steven Boedigheimer, Glen P. Mays, and Hugh Tilson. The SHO-CASE study is a collaborative effort between the Indiana University Richard M. Fairbanks School of Public Health, de Beaumont Foundation, and the Association of State and Territorial Health Officials (ASTHO). The authors thank ASTHO for supporting the collection of these data and the de Beaumont Foundation for their financial support of the project.

This work was funded by the de Beaumont Foundation.

The authors declare no conflicts of interest.

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