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Tenure and Turnover Among State Health Officials From the SHO-CASE Survey

Correlates and Consequences of Changing Leadership

Menachemi, Nir PhD, MPH; Danielson, Elizabeth C. MA; Tilson, Hugh A. MD, DrPH; Yeager, Valerie A. DrPH; Sellers, Katie DrPH, CPH; 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 23–31
doi: 10.1097/PHH.0000000000000991
Research Reports: Research Full Report

Objective: To examine characteristics associated with tenure length of State Health Officials (SHOs) and examine reasons and consequences for SHO turnover.

Design: Surveys of current and former SHOs linked with secondary data from the United Health Foundation.

Setting: Original survey responses from SHOs in the United States.

Participants: Respondents included SHOs who served between 1973 and 2017.

Main Outcome Measures: Tenure length and consequences of SHO turnover.

Results: Average completed tenure among SHOs was 5.3 years (median = 4) and was shorter in recent time periods compared with decades prior. Older age at appointment (β = −0.109, P = .005) and those holding a management degree (β = −1.835, P = .017) and/or a law degree (β = −3.553, P < .001) were each associated with shorter SHO tenures. State Health Officials from states in the top quartile for health rankings had significantly longer average tenures (β = 1.717, P = .036). Many former SHOs believed that their tenure was too short and reported that their departure had either a significant or very large effect on their agency's ability to fulfill its mission.

Conclusions: State Health Official tenures have become shorter over time and continue to be shorter than industry chief executive officers and best practice recommendations from organizational researchers. States have an opportunity to consider and address how factors within their control influence the stability of the SHO position.

Department of Health Policy and Management (Drs Menachemi, Yeager, and Halverson, and Ms Danielson) and Department of Epidemiology (Dr Tilson), IU Fairbanks School of Public Health, Indianapolis, Indiana; and de Beaumont Foundation, Bethesda, Maryland (Dr Sellers).

Correspondence: Nir Menachemi, PhD, MPH, IU 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, Corey M. Jacinto, and Glen P. Mays. 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 and facilitating the survey and historical data collection and the de Beaumont Foundation for its financial support of the SHO-CASE Study.

This work was funded by the de Beaumont Foundation.

The authors declare no conflicts of interest.

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