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Leadership Development Survey of State Health Officers -- United States, 1988

In 1988, the Institute of Medicine (IOM) -- in its report, The Future of Public Health -- recommended that public health education efforts increase emphasis on managerial and leadership skills (1). To identify the highest priority managerial and leadership knowledge, skills, and abilities (KSAs) needed by new state and territorial health officers, the Public Health Foundation (PHF), the Association of State and Territorial Health Officials (ASTHO), and CDC surveyed state health officers. This report presents the findings of this survey and describes a new leadership development option for state health officers.

For this survey, a state health officer was defined as the chief public health official of a state as specified by law or as designated by the chief executive of each state. A work group with representatives from the PHF, ASTHO, the National Association of County Health Officials, the U.S. Conference of Local Health Officers, and CDC developed a questionnaire that addressed 78 potential managerial and leadership KSAs. These KSAs were divided into eight general competency areas: 1) policy development and program planning (eight KSAs); 2) agency (office) management (15); 3) interpersonal skills (six); 4) personnel management (11); 5) communications skills (12); 6) financial planning and management (17); 7) public image (working with the community) (five); and 8) legal issues (four). The PHF mailed the questionnaire to state and territorial health officers (in the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, and American Samoa).

Each state health officer was asked to score each KSA from one (low) to five (high) on the KSA's importance to the job (IJ); his or her perception of a new health officer's initial ability (IA); and his or her opinion of the desired ability (DA) for someone in that job (2). KSAs were ranked by the mean IJ scores. For KSAs ranked in the highest 25%, a composite score was calculated for each KSA (i.e., composite score=IJ x (DA-IA)); these KSAs were then ranked by their composite scores to determine the highest priority skill needs.

Completed questionnaires were returned by 38 (69%) health officers. Twenty-nine (76%) of the respondents were physicians; of the remaining nine respondents, the highest degrees held were master's degrees in areas other than public health (five), master's degrees in public health (two), and bachelor's degrees (two). Twenty-seven (71%) reported greater than 10 years' experience in public health; 19 (50%) had less than or equal to 3 years in their current position. The likelihood of participation in the survey did not appear to be associated with geographic distribution, nature of state relations with local health departments, annual health department expenditures, years of public health experience, tenure in current job, or highest level of education.

Overall, health officers identified as most important those KSAs in the competency areas of public image, interpersonal skills, and policy development and program planning. KSAs that ranked in the highest 25% of KSAs for importance included all five of the public image KSAs, four of the interpersonal skills, and four representing policy development and program planning.

Agency management KSAs and communications skills KSAs were of intermediate importance; four agency management KSAs and three communications skills KSAs ranked in the highest 25% of all KSAs. In comparison, financial planning and management KSAs and personnel management KSAs scored relatively low in importance; none of the 28 KSAs in these areas ranked in the highest 25%. Average composite scores for all KSAs ranged from 2.4 to 10.4. Average composite scores for KSAs most important to the job ranged from 4.9 to 10.4 and, for the highest 10 KSAs, 7.6 to 10.4 (Table 1).

Reported by: Public Health Foundation. Association of State and Territorial Health Officials. Public Health Practice Program Office, CDC.

Editorial Note

Editorial Note: The IOM report addressed basic issues regarding public health leadership at the national, state, and local levels (1); effective leadership and management in public health at all levels are essential to achieve the national health objectives for the year 2000 (3). In 1989, state health officers concurred with the IOM perspective that public health agencies should engage in outreach activities to their communities and develop effective networks (4). In particular, state and territorial health officers targeted as high priorities the needs for building constituencies, working with legislative and community leaders, and communicating health information through the media.

During 1992, to address the needs for management and leadership skills in public health, CDC and a consortium of schools of public health in California have offered the first annual Public Health Leadership Institute (5). The institute is a 1-year educational and training experience for 50 practicing state and local public health leaders that includes a personal management and leadership assessment, the use of self-study packets, participation in computer conferences with other scholars, and attendance at a 5-day workshop.


  1. Institute of Medicine. The future of public health. Washington, DC: National Academy Press, 1988;119-22,155.

  2. Renard PG, Sinnock P. Training needs assessment: fact or fiction? Performance & Instruction 1990;29:12-5.

  3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50213.

  4. Scott HD, Tierney JT, Waters JW Jr. The future of public health: a survey of the states. J Public Health Policy 1990;11:296-304.

  5. CDC. Public health leadership institute. MMWR 1991;40:678-9.

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