Awareness of and Confidence to Address Equity-Related Concepts Across the US Governmental Public Health Workforce

Objective:

To assess the governmental public health (GPH) workforce's awareness of and confidence to address health equity, social determinants of health ( SDoH), and social determinants of equity ( SDoE) in their work.

Design, Setting, and Participants:

A nationally representative population of US local and state GPH employees (n = 41 890) were surveyed through the 2021 Public Health Workforce Interests and Needs Survey (PH WINS 2021).

Main Outcome Measures:

Self-reported awareness and confidence were explored by self-identified racial and ethnic group identity, public health degree attainment, and supervisory status.

Results:

GPH employees reported higher levels of awareness across concepts ( health equity—71%, 95% confidence interval [CI]: 70.5—71.6; SDoH—62%, 95% CI: 62.3-63.5; SDoE—48%, 95% CI: 47.2-48.4) than confidence ( health equity—48%, 95% CI: 47.8-49.0; SDoH—46%, 95% CI: 45.4-46.7; SDoE—34%, 95% CI: 33.4-34.6). Self-identified Black or African American employees reported higher confidence across all concepts ( health equity—56%, 95% CI: 54.3-57.6; SDoH—52%, 95% CI: 50.8-54.1; SDoE—43%, 95% CI: 41.3-44.6) compared to other self-identified racial groups. Employees with a PH degree reported higher confidence across all concepts ( health equity—65%, 95% CI: 63.8-68.8; SDoH—73%, 95% CI: 71.3-74.1; SDoE—39%, 95% CI: 36.9-40.1) compared with employees without a PH degree ( health equity—45%, 95% CI: 44.8-46.1; SDoH—41%, 95% CI: 40.6-41.9; SDoE—33%, 95% CI: 32.6-33.8). We found an inverse relationship between supervisory status and confidence to address SDoE: Nonsupervisors reported higher confidence (35%, 95% CI: 29.2-31.9) than supervisors (31%, 95% CI: 29.2-31.9), managers (31%, 95% CI: 28.8-32.6), and executives (32%, 95% CI: 27.5-34.4).

Conclusion:

PH WINS 2021 reveals that GPH employees are aware of equity-related concepts but lack confidence to address them. Public health agencies should build employees' confidence by prioritizing and operationalizing equity internally and externally in collaboration with communities and partners.