Association for Public Policy Analysis & Management

The theory of representative bureaucracy is centered on the idea that government agencies should “look like” the populations they serve. The theory further suggests that minority representativeness within public agencies will be positively associated with policy agendas designed to advance minority concerns (i.e., active representation). Researchers have frequently noted patterns of active representation on behalf of racial and ethnic minority groups by ‘street-level’ bureaucrats, but the association is less than clear for higher-ranking administrators. Additionally, the topic of active representation among women deserves specific attention due to the relative lack of empirical studies and—until more recent research—divergence in findings.

Using data from a national survey conducted in 2013, our study assesses activities conducted by local public health departments to address health disparities, giving specific attention to the representativeness of the departments’ top executives. We ask the question: “Are local health departments with top executives who are representative of minority populations more likely to address health disparities?” While representative bureaucracy has been examined extensively in the literature, the public health context has not been made a direct focus until now.

Our findings indicate that representativeness by race/ethnicity and gender are associated with policy agendas by local health departments to address health disparities. Health departments with White top executives were significantly less likely than other health departments to pursue disparity agendas in five of eight measured domains. Conversely, health departments with Black/African American top executives were significantly more likely than those headed by Whites and others to pursue disparity agendas in four of the eight domains. Finally, local health departments with female top executives were significantly less likely than health departments headed by males to pursue disparity agendas in two of the domains; however, educational attainment was shown to attenuate the association between gender and health disparity activities.

Our study has several implications for public-sector agencies interested in advancing social equity. First, “pipelining” of minority public service personnel for future executive leadership should be considered. Second, hiring processes for top executives in the public sector must continue to balance the competing demands of representativeness and impartiality based on merit. Third, understanding that social equity has joined efficiency and effectiveness as the third pillar of public administration, this study surfaces the continued need for equity training among White top executives. Finally, these findings underscore the importance of higher education—particularly terminal degrees—among executive leaders in public health departments.