Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Martha Riddell

Committee Member

Dr. Heather Bush

Committee Member

Dr. F. Douglas Scutchfield


Background/Objectives: State Health Officials (SHOs), the physician-leaders of state public health departments in the US, have long been indicated as potential peacemakers between the fields of medicine and public health. However, the average term length of SHOs has declined in recent years. Meanwhile, the COVID-19 pandemic has increased public visibility of state public health departments and their leadership. Some have hypothesized that the political strain of the pandemic has further accelerated SHO turnover, compromising their leadership efficacy. Contrarily, others have suggested that the pandemic would force public health and organized medicine into closer collaborative alignment through a common enemy. To weigh these claims, this study aims to (1) evaluate the self-reported impact of “derailing factors” that contribute to SHO job turnover and unsuccessfulness, highlighting any factors that the pandemic might have exacerbated and (2) examine the impact of COVID-19 on formal collaborative efforts between medicine and public health, using SHOs and state medical society executives (SMEs) as surrogates for these groups.

Methods: Between August 1 and December 23, 2021, original cross-sectional survey feedback was requested from the entire population of current SHOs (N=51) and SHO alumni that left office between January 1 and June 30, 2020 (N=50). SHOs’ relative perceived importance of “derailing factors” during their tenure were compared to the relative frequency of derailers reported by area experts prior to the pandemic. Post-pandemic frequencies of formal collaborative activities between SHOs and SMEs were also collected and compared to pre-pandemic frequencies on the same activities. Free responses about communication between SHOs, SMEs, and other stakeholders was thematically post-coded.

Findings: The average reported tenures for current SHOs (n=19) and SHO alumni (n=8) were not significantly different: 2.26 y (SD=2.47) and 2.75 y (SD=2.19), respectively (p > 0.05). These tenures were consistent with the published tenure for current SHOs in 20174 (2.8 y, SD 2.1). The relative ranked importance of eight accepted derailers among SHOs did shift compared to pre-pandemic estimates; publicity crises, political disinformation, and voluntary staff turnover increased in relative significance between 2017 and 2021. SHOs in office 3 years or less were more likely to rank voluntary staff turnover as significantly problematic (p=0.049).

Overall, respondents reported a decline in the presence of a state health department board or advisory committee between 2019 and 2021 (76.9% in 2019 to 33.3% in 2021; p < 0.001), as well as a decline in state medical society representation on that board (46.2% in 2019 to 14.8% in 2021; p=0.008). Finally, SHOs reported weekly to monthly communication with SMEs, which was equivalent to SHOs’ frequency of communication with other key stakeholders. Post-coded topics of communication were also similar across stakeholder groups, focusing primarily on COVID-19 mitigation and surveillance.

Conclusions: SHOs’ top derailers appear to have shifted from friction with elected superiors to negative public perception and political disinformation. This is likely secondary to the public’s increased awareness of SHOs’ role during the pandemic and resultant outsized backlash. Reported decreases in state public health committees and organized medicine representation therein are concerning given the nationwide legislative pushback against state health departments’ pandemic powers. Given this study’s limited sample size, more research is needed to detail the breadth and impact of this change. Otherwise, most formal collaborative channels between SHOs and SMEs appear unchanged since pre-pandemic times. Thematic analysis of free response data suggests that the pandemic has encouraged collaboration and political allyship between SHOs and SMEs on par with SHOs’ other key stakeholder relationships.

Available for download on Sunday, October 16, 2022