An Application of the Theory of Representative Bureaucracy, Gender Concordance, and Symbolic Representation in the Health Care Context

• Published date: 01 February 2022
• Date: 01 February 2022
• Author: Kenicia Wright
• DOI: 10.1177/02750740211049343
• Subject Matter: Articles

An Application of the Theory of

Representative Bureaucracy, Gender

Concordance, and Symbolic

Representation in the Health Care

Context

Kenicia Wright

Abstract

Although the United States spends more on health care than comparable nations, many Americans suffer from poor health.

Many factors are emphasized as being important for improved health outcomes, including social and economic indicators, liv-

ing and working conditions, and individual-level behavior. However, I argue the overwhelming attention to male health out-

comes—compared to female health outcomes—and focus on factors that are “traditionally understood”as important in

shaping health are two limitations of existing health-related research. I adopt an innovative approach that combines the theory

of representative bureaucracy, gender concordance, and symbolic representation to argue that increase in female physicians

contribute to improved female health outcomes. Using an originally collected dataset that contains information on female phy-

sicians, health outcomes, and state and individual-level factors, I study how female physicians influence the health outcomes of

non-Hispanic White women, non-Hispanic Black women, and Latinas in the United States from 2000 to 2012. The findings

suggest female physicians contribute to improved health outcomes for non-Hispanic White women and non-Hispanic

Black women, but not Latinas. Supplemental Analysis bolsters confidence that the findings are not the result of increased

access to health care professionals. This study highlights the importance of applying the theory of representative bureaucracy

and symbolic representation to health care, the promise of greater female representation in health, and the insight gleaned

from incorporating intersectionality in public administration research.

Keywords

the theory of representative bureaucracy, symbolic representation, female health outcomes, intersectionality

Date received: 16 October 2020; final manuscript received September 3, 2021; accepted: 10 September 2021

Introduction

In 2017, there was national news coverage of the death of

Shalon Irving. Shalon earned two master’s degrees and a

dual doctorate; she served as a Lieutenant Command in the

US Public Health Service Commissioned Corps and as an

epidemiologist for the Centers for Disease Control and

Prevention (CDC), but died 3 weeks after giving birth to

her daughter. Sha-asia Washington was a seemingly

healthy 26-year-old who died shortly after receiving an epi-

dural for an emergency cesarean section. Kira Johnson and

her husband were told she would give birth via a routine

cesarean section; delayed response to changes in her condi-

tion after the procedure resulted in her death shortly after

giving birth to her second child. All three were Black

women. These are only a few examples of a troubling

pattern in the United States. The maternal mortality rate

(MMR) for non-Hispanic Back mothers (44/100,000) is sig-

nificantly higher than the MMR for non-Hispanic White

women (13/100,000) and women of other races (14/

100,000) (CDC, 2020). Factors that the existing literature

posits as being important for positive health outcomes,

such as education and income, do little to improve the

health outcomes and health inequality non-Hispanic Black

women face. For example, the infant mortality rates of

School of Politics, Security, and International Affairs, University of Central

Florida, Orlando, FL, USA

Corresponding Author:

Kenicia Wright, School of Politics, Security, and International Affairs,

University of Central Florida, 4297 Andromeda Loop N., Howard Phillips

Hall, Room 302, Orlando, FL 32816-1356, USA

Email: Kenicia.Wright@ucf.edu

Article

American Review of Public Administration

2022, Vol. 52(2) 139–153

© The Author(s) 2021

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DOI: 10.1177/02750740211049343

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