Individual and organizational factors associated with public health workforce competencies to advance health equity

Paula M Kett; Shahida Shahrir; Betty Bekemeier; Kay Schaffer; Danielle J Zemmel; Davis G Patterson

doi:10.1371/journal.pgph.0004068

Individual and organizational factors associated with public health workforce competencies to advance health equity

PLOS Glob Public Health. 2025 Jan 9;5(1):e0004068. doi: 10.1371/journal.pgph.0004068. eCollection 2025.

Authors

Paula M Kett¹, Shahida Shahrir¹, Betty Bekemeier², Kay Schaffer³, Danielle J Zemmel⁴, Davis G Patterson¹

Affiliations

¹ Center for Health Workforce Studies, University of Washington School of Medicine, Seattle, Washington, United States of America.
² Department of Child, Family and Population Health, University of Washington School of Nursing, Seattle, Washington, United States of America.
³ De Beaumont Foundation, Bethesda, Maryland, United States of America.
⁴ Region V Public Health Training Center, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America.

Abstract

Little is known about how to develop public health workforce capacity for health equity work. We explored associations of individual and organizational characteristics of local public health departments (LHDs) with competencies essential for advancing health equity. Data included responses of 29,751 staff from 742 LHDs in 48 states to the 2021 Public Health Workforce Interests and Needs Survey, plus LHD characteristics and county demographics. Logistic regression assessed associations between key factors and staff-reported "knowledge of" and "confidence in addressing" structural racism, health equity, social determinants of equity (SDoE), social determinants of health (SDOH), and environmental justice, as well as belief and involvement in addressing racism through one's work. Staff with a master's degree or higher compared to others had greater odds of reporting confidence in addressing structural racism (adjusted odds ratio [AOR] = 1.23) and health equity (AOR = 1.56), agreeing that addressing racism should be a part of their work (AOR = 2.45) and being involved in such efforts (AOR = 1.57). Staff identifying as Black, compared to white, had greater odds of reporting confidence in addressing all concepts: structural racism (AOR = 1.98), health equity (AOR = 1.34), SDoE (AOR = 1.53), SDOH (AOR = 1.21), and environmental justice (AOR = 1.72) and agreeing that addressing racism should be a part of their work (AOR = 2.11). Patterns were similar among staff identifying as Hispanic/Latino and other persons of color. Black (AOR = 0.68) and Hispanic/Latino (AOR = 0.83) staff had lower odds, however, of reporting engagement in activities to address racism. Finally, competencies positively associated with nearly all outcomes included cross-sector collaboration, ability to incorporate health equity into programming, and policy advocacy. LHD workforce development should include training that involves explicitly naming structural racism's effects and complementary skills, such as policy development and cross-sector partnership building. Further exploration is needed into how best to grow commitment among white staff and to support staff of color in health equity work.

Copyright: © 2025 Kett et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) through an award totalling $543,300, with zero percent financed by non-governmental sources. The contents are solely the responsibility of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov (https://www.hrsa.gov/grants/manage/acknowledge-hrsa-funding). Funding support through HRSA was provided to PMK, SS, BB, and DGP. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.