Kett Paula M, Shahrir Shahida, Bekemeier Betty, Schaffer Kay, Zemmel Danielle J, Patterson Davis G
Center for Health Workforce Studies, University of Washington School of Medicine, Seattle, Washington, United States of America.
Department of Child, Family and Population Health, University of Washington School of Nursing, Seattle, Washington, United States of America.
PLOS Glob Public Health. 2025 Jan 9;5(1):e0004068. doi: 10.1371/journal.pgph.0004068. eCollection 2025.
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.
对于如何培养公共卫生工作队伍开展健康公平工作的能力，我们知之甚少。我们探讨了地方公共卫生部门（LHD）的个人和组织特征与推进健康公平所必需的能力之间的关联。数据包括来自48个州742个LHD的29751名工作人员对2021年公共卫生工作队伍兴趣与需求调查的回复，以及LHD的特征和县域人口统计数据。逻辑回归评估了关键因素与工作人员报告的“对结构性种族主义的了解”、“应对结构性种族主义的信心”、健康公平、公平的社会决定因素（SDoE）、健康的社会决定因素（SDOH）以及环境正义，以及通过工作应对种族主义的信念和参与度之间的关联。与其他人相比，拥有硕士学位或更高学位的工作人员更有可能报告有信心应对结构性种族主义（调整后的优势比[AOR]=1.23）和健康公平（AOR=1.56），同意应对种族主义应成为其工作的一部分（AOR=2.45）并参与此类工作（AOR=1.57）。与白人相比，自我认定为黑人的工作人员更有可能报告对所有概念都有信心应对：结构性种族主义（AOR=1.98）、健康公平（AOR=1.34）、SDoE（AOR=1.53）、SDOH（AOR=1.21）和环境正义（AOR=1.72），并同意应对种族主义应成为其工作的一部分（AOR=2.11）。自我认定为西班牙裔/拉丁裔和其他有色人种的工作人员中也有类似模式。然而，黑人（AOR=0.68）和西班牙裔/拉丁裔（AOR=0.83）工作人员报告参与应对种族主义活动的几率较低。最后，几乎与所有结果都呈正相关的能力包括跨部门协作、将健康公平纳入项目规划的能力以及政策倡导。LHD的劳动力发展应包括明确指出结构性种族主义影响及补充技能（如政策制定和跨部门伙伴关系建设）的培训。需要进一步探索如何最好地增强白人工作人员的参与度，并在健康公平工作中支持有色人种工作人员。
