Laws Governing State Health Official Appointments: A Legal and Historical Review

The current study presents the legal epidemiological review of State Health Official (SHO) appointment laws, including the evolution of educational and experience requirements of SHOs over time. Findings can inform the discussion about state laws and the substantive, multidisciplinary qualifications essential to successfully leading state public health agencies in the 21st century.

Standard policy surveillance methods were used to collect and assess the statutes governing SHO appointment and eligibility from all 50 states and the District of Columbia between 1995 and 2020.

SHOs are most frequently appointed by their jurisdiction's Health Secretary (n = 17), followed by Governor nominations with legislative approval (n = 15), and 13 states where the Governor is the sole SHO appointing authority. While a large majority of jurisdictions require certain professional and/or educational minimum qualifications to serve as an SHO, 11 states have no professional or experiential minimum qualifications. The most common minimum requirement found was possessing a medical degree, which is required in 22 jurisdictions (including Washington, District of Columbia). Twelve of these states require the physician to have additional education or experience, such as the possession of experience in public health (n = 5), experience in both public health and management (n = 3), or holding an additional health-related degree (n = 2). Four states added a medical degree as a requirement for SHOs over the last 25 years, while 5 states removed their medical degree requirement.

States should reassess their eligibility requirements for SHO service in light of the advancement and demands of public health leadership in the 21st century, as many states continue to look to those with medical training as the primary source for such leadership.