Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention (CDCs) System in China, 2008–2017

Abstract

ObjectiveAllocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention. Using the Centers for Disease Control and Prevention (CDCs) system of China as an example, we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017, with the aim of providing information for policymakers to support resource allocation and address growing health inequities. MethodsWe used three standard public health workforce inequality indices - Gini coefficient, Theil L, and Theil T - and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces, visualized with geographical tools. ResultsThe aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017, and was consistently lower than the National Health Commission's (NHC) recommended critical shortage threshold of 1.75. The workforce distribution inequality indices varied by regional socioeconomic and health system development. Geographic clustering of CDCs workforce distribution was evident, with H–H and L–L clusters in western China and the Guangdong-Fujian region, respectively. ConclusionsOur study addressed key issues for government and policymakers in allocation of public health human resources. There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era, alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.