Measuring inequalities in the public health workforce at county-level Centers for Disease Control and Prevention in China

Cai, Weiqin; Li, Chengyue; Sun, Mei; Hao, Mo

Since the outbreak of severe acute respiratory syndrome (SARS) in 2003, China has established an effective public health system and invested significant human, financial, and material resources [13] . Regarding PHW allocation, our previous research found that the number of PHWs in Centers for Disease Control and Prevention (CDCs) increased after the outbreak of SARS [13] . In China, CDCs are an important component of the public health system and are the core force for preventing and controlling health threats [14, 15] . The main functions of CDCs include disease prevention and control, disease monitoring and investigation, health education and promotion, research and guidance, and technical management and service. In mainland China in 2012, there was a four-tiered Disease Control and Prevention System, which contained one national, 31 provincial (including five autonomous regions and four municipalities), 333 municipal (including 285 prefecture-level cities, 30 autonomous prefectures, 15 districts, and 3 leagues), and more than 2852 county-level CDCs [16] . In a country with a large population and a wide geographic area, public health personnel is distributed over a sizable system. Therefore, one issue that is of relevance is its geographical distribution, especially in the most basic geographical units. Regarding policy-making related to health equity, it is crucial to identify the geographical distribution characteristics of PHWs in China and to determine the sources and contextual factors of PHW inequality. This can also simultaneously contribute to enriching the literature on PHW distribution factors in similar developing countries.