Racial and Ethnic Representation of Local county-level Health Departments and the Jurisdictions Served based on Urban or Rural Classification in HHS Regions 5 and 10

Authors' Affiliations

Haleigh Leslie, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN Dr. Casey Balio, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN Dr. Melissa White, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN Dr. Nathan Hale, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN

Location

Culp Center Rm. 217

Start Date

4-25-2023 2:40 PM

End Date

4-25-2023 3:00 PM

Faculty Sponsor’s Department

Health Services Management & Policy

Name of Project's Faculty Sponsor

Nathan Hale

Additional Sponsors

Dr. Casey Balio

Classification of First Author

Graduate Student-Doctoral

Competition Type

Competitive

Type

Oral Presentation

Project's Category

Public Health

Abstract or Artist's Statement

Racial and ethnic representation of public service employees is related to more trust and better focus on the diverse needs of the community served. In public health, a representative workforce may help strengthen existing relationships and address health inequities to improve health outcomes. The purpose of this study is to describe the racial and ethnic representation of the local health department (LHDs) workforce compared to the population served, and potential differences in representation based on rural or urban classification in Regions 5 and 10. This cross-sectional study used the 2019 NACCHO Profiles, 2021 Public Health Workforce Interest and Needs Survey (PH WINS), 2020 American Community Survey, and 2022 Agency Health Resources Files to examine the relationship between the racial and ethnic demographics of the public health workforce at the LHD level compared to the population of the jurisdiction served. Representation was calculated for each race and ethnicity category as the percent of the workforce that race/ethnicity minus the percent of the population served that race/ethnicity. This measure was then divided by the population served that race/ethnicity to scale this measure by the composition of the population served. Ultimately this measure was dichotomized into at least representative indicating the workforce was either the same or greater representation of a given race/ethnicity as opposed to under-representative. Urban and rural jurisdictions were determined using an indicator provided in the NACCHO Profiles. A logistic regression was used to estimate the association between representativeness and rurality while controlling for region. The sample included 186 LHDs that had NACCHO Profiles data and at least 3 responses in PH WINS in Regions 5 and 10. Among these 186 LHDs, 92 were classified as rural (49.5%) and 94 urban (50.5%). Most LHDs served one county (93.5%) and the other 6.5% of LHDs served two to 10 counties. The LHDs had staff sizes ranging from 5 to 1,548 staff (Mean=78, SD=156, Median=37). No differences in representativeness between urban and rural LHDs were found for white or Black races. Urban LHDs have greater odds of representative workforces for Asian race (OR=2.80; 95% CI 1.16-6.74), Native Hawaiian/Pacific Islander and American Indian/Alaska Native races combined (OR=3.76; 95% CI 1.69-8.36), and Two Races (OR= 2.24; 95% CI 1.14-4.3) compared to rural LHDs. This study found that on average, urban LHDs are more representative of the population served for some racial groups as compared to rural LHDs. While this study is the first to estimate representation of the workforce by rurality, it is not without limitations. Limitations include small sample size, especially among smaller LHDs, and survey non-responses. Additional research is recommended to understand the demographic representation of LHDs and the jurisdictions they serve.

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Apr 25th, 2:40 PM Apr 25th, 3:00 PM

Racial and Ethnic Representation of Local county-level Health Departments and the Jurisdictions Served based on Urban or Rural Classification in HHS Regions 5 and 10

Culp Center Rm. 217

Racial and ethnic representation of public service employees is related to more trust and better focus on the diverse needs of the community served. In public health, a representative workforce may help strengthen existing relationships and address health inequities to improve health outcomes. The purpose of this study is to describe the racial and ethnic representation of the local health department (LHDs) workforce compared to the population served, and potential differences in representation based on rural or urban classification in Regions 5 and 10. This cross-sectional study used the 2019 NACCHO Profiles, 2021 Public Health Workforce Interest and Needs Survey (PH WINS), 2020 American Community Survey, and 2022 Agency Health Resources Files to examine the relationship between the racial and ethnic demographics of the public health workforce at the LHD level compared to the population of the jurisdiction served. Representation was calculated for each race and ethnicity category as the percent of the workforce that race/ethnicity minus the percent of the population served that race/ethnicity. This measure was then divided by the population served that race/ethnicity to scale this measure by the composition of the population served. Ultimately this measure was dichotomized into at least representative indicating the workforce was either the same or greater representation of a given race/ethnicity as opposed to under-representative. Urban and rural jurisdictions were determined using an indicator provided in the NACCHO Profiles. A logistic regression was used to estimate the association between representativeness and rurality while controlling for region. The sample included 186 LHDs that had NACCHO Profiles data and at least 3 responses in PH WINS in Regions 5 and 10. Among these 186 LHDs, 92 were classified as rural (49.5%) and 94 urban (50.5%). Most LHDs served one county (93.5%) and the other 6.5% of LHDs served two to 10 counties. The LHDs had staff sizes ranging from 5 to 1,548 staff (Mean=78, SD=156, Median=37). No differences in representativeness between urban and rural LHDs were found for white or Black races. Urban LHDs have greater odds of representative workforces for Asian race (OR=2.80; 95% CI 1.16-6.74), Native Hawaiian/Pacific Islander and American Indian/Alaska Native races combined (OR=3.76; 95% CI 1.69-8.36), and Two Races (OR= 2.24; 95% CI 1.14-4.3) compared to rural LHDs. This study found that on average, urban LHDs are more representative of the population served for some racial groups as compared to rural LHDs. While this study is the first to estimate representation of the workforce by rurality, it is not without limitations. Limitations include small sample size, especially among smaller LHDs, and survey non-responses. Additional research is recommended to understand the demographic representation of LHDs and the jurisdictions they serve.