Understanding State Public Health Agency Structure and Governance as They Relate to Workforce Recruitment Systems

OBJECTIVE: The purpose of this study was to examine how state public health agency governance and structure relate to recruitment systems such as hiring laws, recruitment barriers, and workforce practices. DESIGN: This cross-sectional study uses secondary data from the 2022 Association of State and Territorial Health Officials (ASTHO) Profile Survey and the 2023 Public Health Hiring Laws Dataset. Descriptive statistics and bivariate analyses were conducted to assess relationships between governance, structure, and recruitment systems. SETTING: State public health agencies in the United States. PARTICIPANTS: 50 US state health departments. MAIN OUTCOME MEASURES: Associations between governance type (centralized, decentralized, mixed) and agency structure (free-standing vs. umbrella) with statutory hiring requirements, reported recruitment barriers, adoption of workplace practices, and distribution of responsibility for human resource (HR) functions. RESULTS: Governance and agency structure were not significantly associated with statutory hiring requirements, including use of hiring lists, civil service examinations, or merit-based criteria. Most reported recruitment barriers did not vary by governance or structure. One exception was difficulty advertising or engaging qualified applicants, which was reported more frequently among decentralized states compared with mixed governance states. Agency structure was associated with certain workforce practices: free-standing agencies were more likely than umbrella agencies to report employee recognition programs and physical wellness programs. Responsibility for HR functions was often shared between public health agencies and centralized administrative entities, with notable ambiguity in benefits administration, occupational health and safety, and labor relations. Agencies in which public health retained sole responsibility for selected HR functions were also more likely to report implementation of workforce development and employee engagement practices. CONCLUSIONS: Governance and agency structure were largely not associated with recruitment-related factors. However, variation in HR authority and workplace practices suggests organizational arrangements may shape workforce management. Strengthening the public health workforce may require aligning HR authority with workforce priorities alongside improvements to administrative infrastructure and hiring systems.