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

Document Type

Journal Article

Publication Date



Journal of public health management and practice : JPHMP




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.


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