In recent years, the longstanding challenges of public health leadership have been on full global display. The field, long recognized as highly complex, is lately even more riddled with divisive challenges that have spilled over into public view. Controversies regularly arise about how best to distribute finite resources to address seemingly infinite health needs (1). Volatile conflicts can divide the involved parties that regularly include powerful vested interests. A coordinated response usually, if not inevitably, falls outside the control of a single authority (2). During the pandemic, these kinds of challenges, debated daily, left public health leaders facing resistance and threats which accelerated burnout, and complicated worker retention and recruitment (3). Now, major uncertainty and disruption stemming from substantial public health changes being made nationally further highlight the pressing need for more effective public health leaders.

New leadership paradigms can help animate the future of Public Health Leadership especially as the post-pandemic world demands shifting from acute crises to sustained crises (4). While much has been written about leadership in professions such as business, the military, and sports, Public Health Leadership still remains a relatively new field of scholarly inquiry. Understanding, and potentially applying, established models and frameworks developed for other societal sectors can stimulate education and research innovation. In a recent article, two of us (HK, FP) proposed that exploring the spiritual foundations of Public Health Leadership could inform future education, training, and research. “Spirituality” has been defined in one international consensus conference as “a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred.” Indeed, public health is regularly viewed by its practitioners as a “calling,” imbued with a sense of mission, service, and connection to something bigger than themselves (5).

However, spirituality has not yet been widely recognized in an explicit way as an essential aspect to leadership in general and in public health in particular. For example, the three most widely adopted, leadership-focused textbooks—Northouse’s Leadership: Theory and Practice (2024) (6). Daft’s The Leadership Experience (7), and Yukl & Gardner’s Leadership in Organizations (2020)—cite the importance of values-based models with an emphasis on moral principles and ethical conduct (7–8) such that leadership is authentic (9), transformational (10), and/or ethical (11). In addition, servant leadership, which has deep roots in Christian leadership traditions (12–14), emphasizes service, humility, and follower wellbeing. But all of these important models may not fully qualify as a comprehensive model of workplace spirituality (15). Even the critical and invaluable model of servant leadership could benefit from more attention to an operational set of core values to guide practice; a clearer approach to aligning values, attitudes, and behaviors across individuals, teams, and organizations; clarification of how to balance follower needs with organizational goals; and greater attention to outcomes for both leaders and followers.

Such themes are addressed through Spiritual Leadership, a model developed within business and organizational management over the past 25 years (15). Spiritual Leadership holds that spirituality is necessary for religion, but religion is not necessary for spirituality. At its core, spirituality reflects the human quest for transcendence through the energy drawn from one’s values and beliefs, producing a sense of interconnection and harmony with others (16, 17). While these themes are often expressed within religious traditions, Spiritual Leadership frames them in broader and more inclusive terms. As such, it provides a spiritual approach to leadership—grounded in vision, values, and the search for ultimate meaning and purpose—that can resonate with individuals from many faiths—or with no formal religious affiliation at all (18).

Spiritual Leadership uniquely theorizes a pathway through hope and faith in a vision of serving key stakeholders within a culture anchored in altruistic values. This process addresses fundamental human needs for spiritual wellbeing by cultivating calling (meaning and purpose) and membership (belonging and community), which together support both individual flourishing and organizational effectiveness. In doing so, Spiritual Leadership incorporates and extends servant leadership, for example, by explicitly operationalizing values such as integrity, compassion, forgiveness, humility, and courage; by making vision and value congruence a central leadership objective across organizational levels; and by specifying calling and membership as intrinsic motivational mechanisms. In this way, Spiritual Leadership reconciles the care for followers with the pursuit of organizational performance, offering a more fully elaborated framework for leadership in the modern workplace.

Spiritual Leadership also has the potential for addressing pressing public health leadership challenges: burnout remains a major post-pandemic challenge for the workforce and positive working conditions can lead to better mental health (19); the National Academy of Medicine’s National Plan for Health Workforce Wellbeing calls for restoring meaning, joy, and fulfillment in work (20); and the WHO’s Framework for Action on Interprofessional Education & Collaborative Practice emphasizes shared purpose and relational trust as prerequisites for team-based care (21). By making spiritual wellbeing (meaning and belonging) the explicit driver of culture and performance, Spiritual Leadership offers a competency-based framework to address these challenges.

In this article, we review the key concepts and evolution of Spiritual Leadership, a model uniquely and explicitly focused on spirituality, mission, vision and values, and explore its relevance to public health (18). Originally proposed and developed over the past two decades by one of the co-authors (LF), the Spiritual Leadership framework contends that spirituality, while inherently personal, can serve as an explicit foundation for leadership in the workplace. We begin by describing the model and its necessary elements and competencies (i.e., key qualities contributing to organizational success). We also note the model’s evolution in the fields of organizational development (OD) and business and highlight the major published studies and meta-analyses linking it to relevant individual, organizational, and stakeholder outcomes (22–25). We then discuss how the necessary and organizational development competencies can inform Public Health Leadership, noting not only the opportunities but also acknowledging challenges and nuances involved. Finally, we consider possible ways of applying the Spiritual Leadership model to Public Health Leadership research, education, and practice.

In 2013, Fry and Nisiewicz wrote a foundational book describing six interrelated elements, as well as the necessary and organizational development competencies, required of leaders to align the values of their organizations with the individuals who work in them. They argued that doing so can further organizational performance goals or outcomes, such as employee wellbeing and life satisfaction, productivity, and social and environmental responsibility (22, 23, 26). As Figure 1 describes, the first of these elements, mindful practice, enables self-awareness and the ability of leaders to draw strength from a power greater than themselves. That element also facilitates hope and faith in a vision shared throughout an organization, which, in turn, creates a sense of purpose fostering intrinsic motivation. A culture of altruism (aka “altruistic love”) creates a sense of membership in a community that supports this purpose. By encouraging individuals to first understand themselves and by facilitating shared reflection among all parties, the Spiritual Leadership model shapes collaborative, discerning, and creative choices in times of decision. It can also reveal assumptions limiting the ability to hear and appreciate different points of view, essential for building trust.

Over the past two decades, the Spiritual Leadership model has evolved into a robust framework supported by a growing body of empirical evidence (Table 1).¹ The pioneering work of Mitroff and Denton first allowed the concept of Spiritual Leadership to gain recognition as a legitimate area for academic research (27). They theorized that recognizing these spiritual needs in the workplace positively influences employee health and psychological wellbeing (28). Subsequent work established and extended this concept. In a 2005 special issue of the Leadership Quarterly dedicated entirely to Spiritual Leadership, Fry expressed his aim to advance Spiritual Leadership toward “paradigmatic status” as a comprehensive framework for organizational transformation (29).

A period of initial testing and validation of the model followed. In 2013, scholars of business development began publishing studies about ways to incorporate personal spiritual journeys, including spiritual concepts from outside the Western tradition from the Dalai Lama and Buddhist philosophy, for example, into organizational culture. Mindfulness has taken center stage as the source of Spiritual Leadership. Thich Nhat Hanh, known as the Father of Mindfulness, wrote that “you cultivate the energy of mindfulness with mindful breathing and mindful walking, and with that energy, you can recognize and tenderly embrace your worry, fear and anger” (30). The most recent work has focused on ways Spiritual Leadership might enhance business leadership on the global stage, with particular attention to sustainable development. These principles encourage business leaders to extend considerations beyond immediate stakeholders and financial outcomes to broader community and environmental wellbeing highlighting the “triple bottom line” (social, environmental, financial). Table 1 offers a timeline of the development of the Spiritual Leadership model.

Necessary Spiritual Leadership competencies (Figure 2) represent the knowledge, skills, and personal attributes essential for effective outcomes (26, 40–44). With the overall goal of enhancing performance, adaptability, and wellbeing, Spiritual Leadership competencies inform a process of organizational change to improve overall effectiveness (42). Ultimately, it aligns people, processes, and resources with the organization’s vision and strategic goals (42).

More attention to spiritual grounding can be valuable in navigating the complexities and challenges of Public Health Leadership (5). An approach emphasizing the interconnectedness of values, meaning, purpose, mindfulness, and leadership can cultivate more resilient, compassionate, and effective public health leaders. Spiritual Leadership in the public health context has the potential to enhance staff engagement and satisfaction by fostering spiritual growth and wellbeing for all those in the field trying to mobilize people to make change. For direct healthcare professionals, prompting them to understand and acknowledge these themes can be useful for both them and also their patients, especially in times of serious illness (57).

Adapting the Spiritual Leadership model to the public health workplace offers a way to deepen this conversation, while introducing intriguing, and often nuanced and challenging, opportunities. Baber and Baber (70) have emphasized that creating a spiritually supportive work environment within healthcare organizations should be viewed not just as a personal attribute, but also as a crucial component of organizational health and effectiveness.

Despite this clear potential, successfully applying Fry’s model to public health education, research, and practice will require certain adaptations. Starting by modifying some of the wording can allow stronger resonance with a larger public health audience. More research can explore which elements of the Spiritual Leadership model most resonate with public health leaders. Indeed, the term “spiritual leadership” itself may engender hesitancy in some public health practitioners due to negative personal experiences with religion or wariness about how religious differences have contributed to conflict and wars through history. Educators may also be concerned about the longstanding caveats associated with the Establishment Clause of the Constitution that serves as the basis of separation of church and state.

Pre-empting these reactions could start by emphasizing that Fry’s model addresses a broad definition of spirituality that does not necessarily equate to religion. Currently, over 90% of the US public believes in the existence of a soul, something spiritual beyond the natural world, while ~50% consider themselves religious (58). The broader Public Health Leadership community can more readily engage in discussions about their values, core beliefs and sense of mission and calling which has broad appeal to anyone feeling a connection to something greater than themselves. Doing so helps all aspiring public health leaders crystallize what gives them ultimate meaning and purpose in their work.

Equally important will be adapting some of the terms used in the Spiritual Leadership model to apply more directly to public health. The element of “mindful practice,” for example, might be translated more concretely as “developing self-awareness.” The term “membership” in Fry’s model, which refers to a sense of belonging, relates to “community.” Fry’s original term “altruistic love,” potentially difficult to incorporate into data-dominated public health practice, might be adapted simply to “altruism”—a concept reflecting a person’s concern for both self and others. Such a concept fits comfortably into the practice of Public Health Leadership, which inherently involves building unity among those separated by health status, income, structural barriers to health, and other disparities.

Still other terms like “hope & faith” might be more effectively described as an “unwavering belief in a mission and purpose, instilling resilience and perseverance in pursuit of a meaningful goal.” As opposed to “optimism” which implies that the external odds are likely to change for the better, “hope” implies an internal belief in a positive outcome regardless of odds. Meanwhile, “faith” implies a sense of perseverance and commitment to the journey, however difficult. As Yale University Chaplain Reverend William Sloane Coffin, a civil rights and antiwar campaigner, once said, “Hope puts you on the road, but faith keeps you there” (5). Some combination of hope, faith and optimism can empower public health leaders to more fully live the mission that fulfills the larger purpose of improving population health and wellbeing.

Other elements of the Spiritual Leadership model may resonate more readily if focused more explicitly on aspects of public health. The element of purpose, for example, can be relevant in addressing some basic Public Health Leadership questions such as “What are you good at?,” “What does the world need from you?,” and even “What brings you joy?” (59). While public health leaders may not necessarily experience “happiness” as they struggle to execute the hard things required of them, they can nevertheless feel joy as a “sense of deep delight in being called to something before you” (59). In a recent documentary, Archbishop Desmund Tutu captures the power of such joy in describing the ability of “Doctors Without Borders to go into hugely dangerous situations with an outpouring of love, compassion, and caring for people they do not know. We are wired to be caring for each other” (60).

Public Health Leadership programs regularly focus on external skills, like strategic thinking and time management, while sometimes overlooking the critical inner motivation and purpose required to execute such skills effectively. In public health, where interventions must always adapt to shifting evidence, funding and frontline feedback, leaders can create spaces that welcome innovation and even risk failure. The Spiritual Leadership framework can facilitate connecting passion with purpose and build upon the foundation of calling to sustain leaders. With greater clarity about purpose, leaders can leverage emotional resilience in the face of complexity, uncertainty, and potential burnout.

Most aspiring public health practitioners inevitably wrestle with identifying their precise role in upholding the broad lofty, and sometimes overwhelming, mission of public health. Their very personal decisions about when and how to respond to a call to lead are essentially spiritual acts. Teaching students to explore their personal “why” can help them understand their motivations and connect more deeply with others and navigate the challenges of decision making (61). While discussions around faith and spirituality in classrooms can be sensitive, they can also highlight shared values like service and empathy that resonate across belief systems. Gupta has written in his book Bridges Across Humanity that in fact, all the major religions share 54 common themes including compassion, service, unity and emphasis on caring for the vulnerable—all these themes relate to Public Health Leadership (18). Developing the necessary Spiritual Leadership competencies can reduce reactivity and set the stage for emotional regulation, creative problem-solving, and reflective decision-making, the currency of modern public health leadership.

The mindfulness and reflective practices noted earlier in Section 4.1 not only draw from myriad wisdom traditions but also align with established leadership frameworks such as emotional intelligence, authentic leadership, adaptive leadership, and key concepts like psychological safety and transformative learning. Among many foundational ideas grounding this approach is Warren Bennis’ classic work on “crucibles of leadership,” which shows how proven leaders have often endured unanticipated, intense, traumatic experiences that forced re-examination of basic values to emerge more committed to mission. Such leaders who endure such experiences can find renewed, even heightened, meaning in their work, while understanding, as Coffin has said “giant obstacles are brilliant opportunities, brilliantly disguised as giant obstacles!” (62). Another framework, Ronald Heifetz’s adaptive leadership model, intertwines the values of Spiritual Leadership and Public Health Leadership in using self-awareness to mobilize people to tackle complex and ever-evolving challenges, often through loss and discomfort, that cannot be solved through technical expertise alone (63). Similarly, adrienne maree brown’s [sic] Emergent Strategy, rooted in decades of community organizing, provides practical guidance for cultivating trusting and ethical cultures, a core spiritual leadership competency especially relevant for public health leaders seeking to align interventions across self, family, and community, and systems (64).

Two of us (BW, LF) conducted a literature search on Public Health Leadership using Scopus, Web of Science and the EBSCO host platforms, covering publications from database inception through our last search on August 23, 2025. Our search used controlled vocabulary and free-text terms related to public health and leadership competencies/management/governance, including the following terms: public health leadership, public health leadership competencies, spirituality, transcendence, interconnectedness, mindfulness, purpose, belonging, meaning, faith, spiritual leadership, altruism, vision, stakeholder relationships, trust, organizational development, collaboration, and change management. We limited results to peer-reviewed journal articles while excluding commentaries, conference abstracts, and studies focused solely on education and clinical care settings without mention of leadership in the public health space. Scopus was selected because it is the largest multidisciplinary database of peer-reviewed literature and incorporates MEDLINE content, ensuring broad coverage across health sciences and social sciences. EBSCO host was included because it hosts key disciplinary databases such as CINAHL, APA PsycInfo, and Business Source Complete, thereby extending coverage to nursing, psychology, and management literature. Together, Scopus and EBSCO host provide comprehensive coverage of the interdisciplinary domains most relevant to public health leadership. While other databases such as Web of Science and Embase overlap substantially with Scopus, and Global Health (CAB Abstracts) provides more niche international coverage, we determined that Scopus and EBSCO host were sufficient to capture the relevant peer-reviewed studies for this review.

Our review² identified nine studies that focused on Public Health Leadership competencies (Table 3).³ To analyze the relevance of these competencies to the practice of Spiritual Leadership, two authors (BW and LF) independently reviewed each study and coded the competencies that aligned with either a necessary or organizational development spiritual leadership competency (Tables 4, 5). A comparative review was then conducted, during which the two authors discussed their independent coding. Discrepancies were resolved through consensus. Competencies for which consensus could not be reached regarding their alignment were excluded from the final mapping.

Tables 4, 5 detail how specific Spiritual Leadership competencies map to Public Health Leadership competencies noted in the literature. Each cell includes an example competency from the public health literature alongside the number of total competencies that were relevant in parenthesis. If there were no relevant competencies, we have included (0). For example in Table 4, in the article Czabanowska (87), there were 4 competencies listed related to mindfulness, and we have shown “demonstrating the awareness of the impact of your own beliefs, values and behaviors on your own decision-making and the reaction of others” as the one example competency to include in the table. A full list of the relevant competencies can be found in Appendix 2. The large overlap supports the proposition that Spiritual Leadership competencies are relevant to public health leadership.

Given the relevance of Spiritual Leadership to Public Health Leadership as demonstrated by the overlap in competencies in Tables 3–5, further research can evaluate public health leaders and organizations and track their progress on the competencies for the practice of Public Health Leadership grounded in Spiritual Leadership model.

Advancing empirical research further can investigate how Spiritual Leadership competencies can apply to Public Health Leadership. Fry’s validated Spiritual Leadership Survey (SLS) outlined in Section 3.1 and Appendix 1, which includes scales aligned with these key competencies, has demonstrated strong psychometric properties across diverse organizational contexts, including some health-related settings (23). The SLS offers a reliable means to measure the impact of Spiritual Leadership competencies on outcomes (such as wellbeing, engagement, commitment, and performance). Researchers applying the SLS to assess baseline competency levels in public health leaders and organizations can identify both areas of strength and those needing improvement (e.g., mindfulness habits, trust-building behaviors, or the clarity and resonance of an organization’s vision) to guide targeted leadership development and organizational transformation efforts.

Longitudinal SLS tracking at 12- to 24-month intervals can enable public health organizations to monitor changes in Spiritual Leadership competencies over time to evaluate leadership development interventions and their impact on outcomes (such as reduced burnout, improved collaboration, or enhanced adaptability). Longitudinal studies can establish causal relationships between strengthening Spiritual Leadership competencies and achieving critical public health goals. Research should also explore Spiritual Leadership’s application across a range of public health organizations, including global health systems, government agencies, academic centers, and community-based entities. Comparative studies across these settings can identify which competencies are most impactful in various contexts and how best to tailor interventions. Such research enhances the generalizability of findings and supports the integration of Spiritual Leadership into broader leadership development frameworks.

Importantly, studies can align Spiritual Leadership competencies with public health impact through metrics related to organizational resilience, quality of stakeholder relationships, employee wellbeing and effectiveness in advancing population health outcomes. For example, higher trust and ethical leadership scores may correlate with stronger community partnerships, while greater mindfulness may reduce stress and support ethical decision-making. Linking competency development to such outcomes provides evidence of Spiritual Leadership’s practical relevance to Public Health Leadership. Finally, research should examine how Spiritual Leadership supports values-based organizational change, especially in turbulent environments. Fry and colleagues emphasize that Spiritual Leadership fosters transformation by aligning individual purpose with organizational vision and creating cultures grounded in altruism. In the public health sector—where burnout, complexity, and inequities persist—this alignment may be critical for building sustainable, compassionate, and high-performing systems.

Case studies, pilot studies and eventually meta-analyses, along with mixed methods approaches combining quantitative and qualitative data, can deepen evaluation. In addition to surveys that quantify competency levels, interviews and focus groups can qualitatively explore how Spiritual Leadership competencies are expressed in practice—for example, how reflective practices inform crisis decisions or how a shared vision supports stakeholder alignment. Such designs enhance insight into the mechanisms by which Spiritual Leadership influences organizational culture, resilience, and effectiveness.

In summary, although substantial anecdotal evidence suggests that many public health leaders exhibit Spiritual Leadership values, attitudes, and behaviors, empirical evaluation of Spiritual Leadership competencies using validated tools, mixed-methods, and longitudinal designs can more deeply establish the model’s effectiveness in public health contexts. Such research will clarify how Spiritual Leadership can enhance resilience, collaboration, and purpose—hallmarks of impactful Public Health Leadership.

Spiritual Leadership as a moral compass can support a leader’s resilience and growth while fostering inclusive, collaborative approaches that reduce resistance and create sustainable, community-centered efforts; these are especially important for a field with so many challenges and often no clear solutions. To stay resilient and motivated, public health leaders must “start with why” and hold onto their purpose (65).

This paper contributes a review and conceptual framework demonstrating how spiritual leadership can inform and enrich public health leadership theory, education, and practice. Although not an empirical study, it identifies key research gaps and offers directions for future systematic and applied investigations. Public health, often understood as a values-driven profession—a “calling”—can learn from the Spiritual Leadership model which has long been studied and validated for workplace settings. Indeed, Spiritual Leadership could play a foundational role for effective Public Health Leadership by encouraging research and practice pathways in the midst of seemingly insurmountable challenges. Public Health Leadership in an inherently demanding field requires hope & faith, a commitment to something greater than oneself, and a self-awareness of how one’s personal values motivate service to a diverse array of individuals and communities. We encourage the public health community to engage in continued conversations about how Spiritual Leadership can animate and inspire the purpose-driven work to improve the health of all.