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October 25, 2021

Does health professionalism among bureaucrats help weather the Covid-19 pandemic?

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Since the worldwide Covid-19 outbreaks, governments have taken measures to contain the spread of the virus. However, the countermeasures vary substantially in the timing of their implementation and their efficacy. As officials are responsible for formulating and implementing restrictive local policies, an important question is whether leadership competency may offer promise for handling a future similar threat. In particular, in the context of the ongoing Covid-19 pandemic, do bureaucrats who have a public health or medical background (PHMBG) perform better in combating the pandemic?

Our research leverages comprehensive information about officials’ background from résumés of Chinese city leaders, including principal and deputy (Communist Party) secretaries and mayors. Officials with a public health or medical education or who worked in such fields are broadly defined as having a PHMBG. The analysis integrates the characteristics of city officials with rich city-level information, including socioeconomic and meteorological conditions, Covid-19 infections and deaths, health infrastructures, and the timing of policies, in 294 Chinese cities.

Examining the link between officials’ PHMBG and outcomes of the pandemic as of February 29, 2020, when it was largely under control in China (except Wuhan City), the evidence suggests that if anyone in a city’s leadership had a PHMBG, infections per million population were reduced by about 18%. Distinguishing their different roles, having a party secretary with a PHMBG reduced infections per million population by 82%, and having a PHMBG among the deputy officials led to 17.7% lower infections per million. These results show that a PHMBG in the leadership team, especially if it is the secretary, played an important role in mitigating damages resulting from the pandemic.

To understand the mechanisms of these effects, we break the results down to look at whether the probability of adopting policies and the speed of adoption were influenced by officials’ PHMBG. We focus on two critical policies: community closure and family outdoor restrictions, which were taken by a large number of cities. A community closure order limits residents’ visits between communities, while the outdoor restriction further limits outdoor activities. Results indicate that having a secretary with a PHMBG made the city 13.5% more likely to enact community closure, while a mayor’s PHMBG made a bigger difference for the more stringent outdoor restriction. As for the speed of policy adoption, a secretary’s PHMBG significantly accelerated a community’s closure order, by about three days.

The findings do not, however, support international anecdotal evidence that governments led by females seemed to be particularly successful in fighting the coronavirus. It is possible that the small number of female city leaders in China impedes our finding of any gender effect.

These findings strongly suggest that officials’ educational background and work experience in public health or medicine promoted more successful responses to the pandemic. Given that only 3.3% of top-ranked officials in sampled Chinese cities have a PHMBG, diversifying the composition of leadership teams to involve more public health or medical professionals will likely avoid blind spots when major decisions are made in future public health crises. As cultivating professionalism in the leadership team may take time, empowering an independent advisory board that consists of public health or medical experts may aid the policy making process in the face of emergencies. Having government leaders with such professional backgrounds may become increasingly valuable, as the health sector grows in importance and the health consequences of climate change, environmental pollution, and threats of infectious diseases continue to escalate in the interconnected world.

© Xi Chen, Weizheng Lai, Xun Li, and Qianqian Wan

Xi Chen is an associate professor of health policy and economics at Yale University, USA, and a Research Fellow of IZA, Germany. 
Weizheng Lai is a PhD student at the University of Maryland, USA.
Xun Li and Qianqian Wan are respectively an associate professor and a research assistant at Wuhan University, China.

Find more IZA World of Labor content related to the coronavirus pandemic.

Read Xi Chen’s IZA World of Labor article, “Relative deprivation and individual well-being.

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