Representative Bureaucracy in Local Public Health Agencies: Do Top Bureaucrats Represent Women and Minorities?
*Names in bold indicate Presenter
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.
- Abresch Lee Manuscript_2.1.pdf (631.1KB)