Race and Ethnicity of Local Health Department Staff and Leaders

Carolyn J. Leep

Academy Health PHSR Interest Group Meeting

June 7, 2008

Background

• NACCHO Strategic Plan: Address the under-representation

of racial and ethnic communities in the public health

workforce and leadership

• 2005 Profile of LHDs Study included questions about

employee race and ethnicity for the first time

Methodology

2005 Profile questionnaire sent to every LHD in the U.S. (N=2,864)

• LHD top executive race/ethnicity to all LHDsResponse rate = 80%

• LHD staff race/ethnicity to sample of 520 LHDsResponse rate = 82%

1993 Profile questionnaire sent to every LHD in the U.S. (N=2,888)

Response rate = 72%

Race and Ethnicity of LHD Top Executives: 1993 and 2005

Percent of Responding LHDs

Race/Ethnicity of Top Executive 2005 1992-93

White 92.7% 96.2%

Black 4.7% 1.9%

American Indian/Alaska Native 1.6% 0.2%

Asian or Pacific Islander 1.2% 0.8%

Some other race 0.6% 1.0%

Hispanic ethnicity 1.5% 1.7%

Source: 2005 National Profile of LHDs

Percentage of LHDs and U.S. Population Served by Top Executive in Selected Racial and Ethnic Groups

Percent of Percent of Population Responding LHDs Served by Respondents

White 93% 82%

Black 5% 15%

Other races 3% 3%

Hispanic ethnicity 1% 5%

Source: 2005 National Profile of LHDs

LHD Workforce

Three analyses:

• Overall percentages by race and ethnicity

• Comparing percentages in LHDs staff and jurisdiction population

• Actual and expected numbers of employees

Race and Ethnicity Estimates for the LHD Workforce

Race or EthnicityPercentage of

LHD StaffPercentage of U.S.

Population*

White 74.0% 80.2%

Black 14.7% 12.8%

American Indian 0.3% 1.0%

Asian 2.7% 4.3%

Pacific Islander 0.1% 0.2%

Two or more 0.5% 1.5%

Some other 6.3% Not included

Hispanic ethnicity 11.2% 14.4%

*Based on U.S. Census Bureau estimates for 2005.

Source: 2005 National Profile of LHDs

Comparison of Racial Diversity of LHD Staff and Jurisdiction Population

n=398

Staff much less diverse

(>10% difference)

26%

Staff less diverse (2 to 10% difference)

42%

Staff more diverse (>2%

difference)

15%

Staff and population served similar (within 2%)

16%

Source: 2005 National Profile of LHDs

Comparison of Ethnicity of LHD Staff and Jurisdiction Population

LHD staff less Hispanic (2 to

10% difference)

30% LHD staff and community similar

(within +/- 2%)

49%

LHD staff more

Hispanic

13%

LHD staff much less Hispanic (>10% difference)

8%

Source: 2005 National Profile of LHDs

Differences Between Actual and Expected Number of Employees in Selected Racial and Ethnic Groups

Differences between Actual and Expected

Numbers of EmployeesPercentage of Respondents

White Black Other Hispanic races ethnicity

Greater than 10 fewer 7% 4% 8% 6%Between 5 and 10 fewer 3% 4% 8% 5%Between 0 and 5 fewer 11% 66% 70% 66%Between 0 and 5 more 59% 16% 9% 18%Between 5 and 10 more 10% 2% 2% 2%Greater than 10 more 10% 7% 3% 4%Number of Observations 388 388 385 359

Source: 2005 National Profile of LHDs

Study Limitations

• Relatively small number of observations Large uncertainties Does not permit analysis for specific races

• Does not provide information about specific professions or positions at LHDs

• Service population may be very different from jurisdiction population

Findings (1)

• Almost all LHDs could provide information on

race & ethnicity of staff 7% missing for race 11% missing for ethnicity

• “Promoted” to the core questionnaire for 2008

Profile study

Findings (2)

• Number of Black LHD leaders is increasing 5% of all LHDs (more than double %

than in 1993) Cover 15% of the U.S. population

• Number of Hispanic LHD directors is very small

and not growing

Findings (3)

• Overall racial and ethnic make-up of LHD employees is

similar to that of the U.S. as a whole

• Most LHDs show small excesses of White employees and

small deficits of Black and Hispanic employees (compared to

their jurisdiction populations)

• Larger jurisdiction LHDs are more likely to reflect the racial

diversity of their jurisdiction

• LHDs in areas with substantial Hispanic populations are less

likely to reflect the ethnicity of their jurisdictions

Implications—Size of Problem

• Overall discrepancy is actually smaller than some of

NACCHO’s leaders believed

• Discrepancies in professional or managerial positions are

likely larger & recruitment of minorities is challenging:

LHDs experience major challenges in hiring professional employees, regardless of race & ethnicity

Pool of qualified Black & Hispanic candidates is smaller

Implications—Potential Solutions

• Long-term: eliminate inequities that result in racial

and ethnic differences in educational attainment and

employment

• Short-term: identify ways to attract and retain

minority PH workers

NACCHO Workforce Development Programs

• Survive and Thrive – year-long orientation program to prepare

new local health officials with the necessary knowledge and

skills to succeed within the multi-faceted environment of local

public health practice

• Community Colleges as pathways to PH careers

• Compilation of stories about minority PH leaders

Further Research

• Collecting individual-level data to further explore the issue

• Exploring strategies of LHDs that have met with success in

recruiting & retaining a diverse workforce

• Understanding whether it matters — Can a more diverse

LHD workforce deliver public health services more

effectively?

For more information

Carolyn Leep

NACCHO

Director, Research and Evaluation

cleep@naccho.org

www.naccho.org/profile