Equity in the allocation of professional public health human resources and its improvement path in China

Professional public health human resources (PPHHRs) are fundamental to determining a nation’s capacity to respond to public health emergencies. To address the critical challenge of inequitable PPHHRs allocation in China, this study systematically evaluated the current state of allocation equity, investigated its underlying determinants, and identified potential pathways for improvement. The findings provide evidence-based recommendations for achieving optimal PPHHRs distribution across China. The equity of human resource allocation in professional public health in China was measured by calculating the health resource density index (HRDI) of health technicians in professional public health institutions. We integrated Necessary condition analysis (NCA) and fuzzy set qualitative comparative analysis (fsQCA) to identify critical factors and effective pathways influencing the equity of PPHHRs allocation in China. The allocation of PPHHRs in China showed significant disparities across regions and provinces. The western region and its provinces demonstrated lower equity in PPHHRs allocation compared to the eastern and central regions. No single necessary condition was found to affect the equity of PPHHRs allocation. Based on configurational analysis, four condition configurations were identified that lead to high equity in PPHHRs allocation. The analysis demonstrates that high equity in PPHHR allocation is achievable through multiple distinct configurations, with no single condition being formally necessary. The findings reveal that high equity in the allocation of PPHHRs in China is achieved through multiple distinct configurations of conditions, with no single factor being necessary. For western and other equity-disadvantaged provinces constrained by low population density and limited fiscal capacity, the key strategy is to establish a centrally-led, locally-collaborative systematic intervention system that provides external support to compensate for inherent disadvantages. For regions that already possess certain foundational conditions, efforts should focus on enhancing the synergistic effects across social, governmental, residential, and economic dimensions to promote sustainable high-quality equity.