Impacting Health Equity and Other Social Determinants of Health: Public Health Workforce Perspectives

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Research Objective: To examine: (a) the level of public health agency employees’ perceived desirability for impacting health equity and SDoH, and (b) the impact of employee characteristics such as public health degree and awareness of Health in All Policies on such desirability.

Study Design: Observational, quantitative, cross-sectional, based on a large-scale survey.

Population Studied: The study population included a nationally-representative sample of state health agency (SHA) central office staff, as well as local health department (LHD) staff from 47 SHAs, 26 large LHDs, and 71 mid-sized LHDs. The data are extracted from the 2017 Public Health Workforce Needs and Interest Survey. All employees of the SHAs in the sample were included, using a census approach. A total of 47,604 public health employees participated in the 2017 PH WINS, representing a response rate of 48%.

Principal Findings:

Fifty-seven percent of health agency employees believed their agencies should be very involved in affecting health equity in their jurisdictions. A smaller proportions of employees believed in desirability of affecting SDoH with proportions believing agency should be very involvedin affecting specific SDoH was 17.8% for affecting the quality of transportation, 18.5% for affecting economy, 22.2% for quality of housing, 22.4% for quality of built environment, 25.4% K-12 education system, and 34.5% for impacting the quality of social support systems. Agency employees without a public health degree had significantly lower odds (p,

Conclusions: With increasing efforts to reduce health inequities and leverage SDoH for improved population health, gaps exist in public health workforce’s perceived desirability for their agencies to be involved in such efforts. These gaps exist among employees regardless of their demographic characteristics, length of tenure, or agency setting. Policy and practice initiatives aimed to improve health equity might benefit from our findings positing a need for education regarding SDoH and health equity.

Implications for Policy or Practice:

  • Our study finding that public health workforce beliefs do not provide sufficient support for advancing Public Health 3.0 goals, such as SDoH, may imply the need for interventions for improving alignment between employee beliefs and organizational priorities for an effective transformation to Public Health 3.0. However, the extent to which Public Health 3.0 has been adopted nationally is still unclear.
  • To support this transition, public health agencies must foster cross-sector partnerships and collaborations to increase a focus on HiAP, SDoH, and health equity as high priorities in agency and community formal strategic plans.
  • Public health leaders should secure employee buy-in and shared understanding about priorities through communications and operational plans that include health equity and SDoH in its mission, vision, values statements, employee orientation, and continuing education and active feedback about individual and organizational performance.


Academy Health Annual Research Meeting


Washington, D.C.