Elucidating public health administrators' conceptions of health in public health departments

Public health scholarship increasingly finds that health outcomes are better explained by social determinants of health rather than by individualistic determinants alone. The institutions of the United States public health system, however, predominantly reflect the biomedically oriented, individualistic perspective but it is unknown whether this is due to a prevailing paradigm among public health officials. This research investigates the ideas of health that public health administrators hold by exploring the models of health to which public health administrators in state-level health departments in the U.S. adhere. It also assesses the factors that affect public health administrators' orientation towards such a model of health. Survey data is used to empirically examine the conceptions of health and health causation held by key state-level public health administrators. A multivariate regression model is used to estimate the effect of demographic and ideological characteristics on the health perspective held by study participants. The results indicate that a majority of public health officials adhere to a social determinants of health perspective. Statistically significant predictors of the health model to which a public administrator adheres include professionalization, level of education, term in office, and political ideology. Understanding public health administrators' definition of health has important implications for the types of practice in which administrators engage.