race and ethnicity of local health department staff and leaders carolyn j. leep
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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
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