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

Furthermore, research has shown that the decomposition of overall inequality into within-group and between-group inequality is important for identifying the sources of inequality [19, 27] . Contribution rate can improve the understanding of the causes of inequality in the allocation of PHWs. From the perspective of inequality decomposition, we found that PHWs in China were unevenly distributed across geographical areas, including regions, provinces, and municipalities. The contribution of within-region inequality has an overwhelming superiority, although there are differences between regions in terms of comparative analysis of data concerning basic characteristics. This suggests that the imbalance of PHWs is internal to each region, including all three categories of PHWs. Further, the contribution of inequality within-province also has significant weight, suggesting that although provinces are smaller geographical partitions than regions, the PHW inequities are greater within each province. This supports the results of the decomposition by describing the density of PHW. For the density of provinces, the difference between the averages of PHWs was smaller than the difference between the maximum density and the minimum density of counties within each province, and the difference within provinces was greater than that between provinces. The subsequent decomposition of intercounty inequality by municipality also supports this point. The overall decomposition of inter-county inequality (by municipality) shows that staff and health professionals have a similar proportion of withinmunicipal and between-municipal inequality. However, the results of the decomposition of inter-county inequality by municipality of 31 provinces indicates that withinmunicipality inequalities still cause the municipal inequality of most provinces. This suggests that the government, especially at the municipal level, should focus on eliminating PHW inequalities between counties within their jurisdictions. The finance and human resources departments of the government should introduce various incentive policies, such as signing contracts with medical colleges to train medical students to serve at the basic level or improving the salary level of basic public health workers, in order to attract more talents to county-level CDCs with weak human resource allocation. The regression analysis revealed the contextual factors affecting the geographical distribution of PHWs, which included living environment, working conditions, personal development, and children's education. For the first time, large-scale and representative data sets were used to measure the role of these factors in explaining the inequality of PHW distribution in China. Agency building area per employee caused between-municipality and within-municipality inequalities for all three categories of PHWs. Per capita GDP had a similar effect, except for between-municipality inequality of professionals and within-municipality inequality of field epidemiological investigators. Therefore, our results reveal that the key incentives for the unequal distribution of PHWs among municipalities are the level of infrastructure construction of institutions and the level of economic development of residential areas. A good level of infrastructure construction means that PHWs can have a better and more spacious working environment, which may be an aspect that PHWs pay more attention to. The level of economic development in the re