Racial and Ethnic Representation of the Local Public Health Workforce

Objectives. To describe racial and ethnic representativeness of the local health department (LHD) workforce compared with the populations served. Methods. In this study, we used a cross-sectional design of the 2021 Public Health Workforce Interests and Needs Survey, 2019 National Association of County and City Health Officials Profile data, and other sources to estimate the racial and ethnic representativeness of LHD workforce. We calculated representativeness as a binary measure of at least representative of the populations served for each race and ethnicity group. We present bivariate analyses comparing LHD representativeness by region and rurality, and multivariate analyses to estimate the associations between representativeness, agency, and jurisdiction characteristics. This study was conducted in Tennessee in 2023. Results. Sixty percent of LHDs in the sample were at least representative of the Black, Indigenous, and People of Color populations they serve. For most race and ethnicity groups, urban-serving LHDs were more representative of the populations they serve than rural-serving LHDs. Conclusions. Racial and ethnic representativeness of the LHD workforce varies by rurality, region, and race or ethnicity. These findings may help inform training, recruitment, and retention efforts in public health. (Am J Public Health. 2025;115(3):333-343. https://doi.org/10.2105/AJPH.2024.307903).