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 LHDs Response rate = 80% LHD staff race/ethnicity to sample of 520 LHDs Response 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 White92.7%96.2% Black4.7%1.9% American Indian/Alaska Native1.6%0.2% Asian or Pacific Islander1.2%0.8% Some other race0.6%1.0% Hispanic ethnicity1.5%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 White93%82% Black5%15% Other races3% Hispanic ethnicity1%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 Ethnicity Percentage of LHD Staff Percentage of U.S. Population* White74.0%80.2% Black14.7%12.8% American Indian0.3%1.0% Asian2.7%4.3% Pacific Islander0.1%0.2% Two or more0.5%1.5% Some other6.3%Not included Hispanic ethnicity11.2%14.4% * Based on U.S. Census Bureau estimates for 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 Employees Percentage 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% Greater than 10 more 10%7%3%4% Number of Observations 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