Leadership in Public Health: Development, Cross-Sector Collaboration, and Mental Health Among U.S. Public Health Leaders

Abstract

The U.S. public health system faces mounting challenges that demand resilient leadership and greater integration across sectors. Despite longstanding calls to bridge public health and primary care, systemic fragmentation persists, and public health leaders continue to face heightened psychosocial strain. This dissertation explores public health leadership development, intersectoral collaboration, and the organizational conditions that shape public health leader mental health. Employing a three-paper format, this study integrates qualitative and quantitative approaches to examine how collective efficacy and organizational climate may serve as levers for leadership development and healthy working environments.Paper 1 explores the experiences of public health and primary care leaders participating in an interprofessional leadership development program. Through qualitative interviews, participants described individual- and collective-level changes, including shared mental models, dissolution of previously held beliefs about the other sector and shifts in collective identity. These findings underscore the behavioral and affective underpinnings of collective efficacy in public health leadership. Paper 2 constructs a conceptual framework for collective leadership development. The framework articulates a developmental model in which leadership is cultivated through supportive structures, shared accountability, and intentional investment in relationship-centered practice. The model offers practical guidance for leadership programs aiming to build workforce capacity for systems change. Paper 3 employs a multilevel analytic approach to examine the association between role-related harassment and mental and emotional health among public health leaders, using data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS). Drawing on Lazarus and Folkman’s transactional model of stress and Hobfoll’s conservation of resources theory, the study assesses whether organizational climate moderates the negative effects of harassment. Findings reveal that leaders exposed to role-related harassment report significantly worse mental health, but that supportive organizational climates may buffer these effects. Taken together, these studies advance an integrated understanding of public health leadership that centers collective efficacy, prioritizes organizational conditions, and addresses psychosocial threats to public health leader mental health. The dissertation contributes actionable insights for leadership development, workforce resilience, and capacity for systems-level transformation in the public health sector.