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
2005
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
1992-93
Percentage of LHDs and U.S. Population Served by
Top Executive in Selected Racial and Ethnic Groups
Percent of
Responding LHDs
Percent of Population
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 Ethnicity
Percentage of Percentage of U.S.
LHD Staff
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
Staff more
diverse (>2%
difference)
Staff much
less diverse
(>10%
difference)
15%
Staff and
population served
similar (within 2%)
16%
26%
Staff less diverse
(2 to 10%
difference)
n=398
Source: 2005 National Profile of LHDs
42%
Comparison of Ethnicity of LHD Staff and
Jurisdiction Population
LHD staff much less
Hispanic (>10% difference)
8%
LHD staff less
Hispanic (2 to
10%
difference)
30%
LHD staff
more
Hispanic
13%
LHD staff and
community similar
(within +/- 2%)
49%
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
races
Hispanic
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