Public health addressing gender gap in workforce leadership
===========================================================

* Teddi Nicolaus

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/52/6/1.2/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/52/6/1.2/F1)

From left, Barbara Ferrer, PhD, MPH, MEd, director of the Los Angeles County Department of Public Health; Barbara De Ridder, county public health nurse; Rochelle Walensky, MD, MPH, director of the Centers for Disease Control and Prevention; and Cristin Mondy, RN, MSN, MPH, county clinical nursing director, visit a Los Angeles COVID-19 vaccination site in May. In the nation’s big cities, nearly three-quarters of supervisors, managers and executives are women, according to new PH WINS data scheduled to be released this month.

Photo by Frederic Brown, courtesy AFP/Getty Images

> “In all indications from our survey, it’s getting better, not worse, over the past decade, and I think we should be proud of that.”
> 
> — Lori Tremmel Freeman

The pursuit of social justice and its promise of fairness, equal treatment and opportunity for all has long been a major motivator for people seeking careers in public health. But even as they fight to ensure equal rights and opportunities for others, the public health workforce itself — which is predominantly made up of women — has yet to achieve those same ideals.

Within the U.S. governmental public health workforce, studies show the gender gap has narrowed in the last several decades, but disparities between women and men continue to persist in pay and leadership positions.

Overall, women make up 79% of the governmental public health workforce, but occupy only 36% of leadership positions, according to the 2017 Public Health Workforce Interests and Needs Survey, or PH WINS, which captured data from tens of thousands of employees of state, city and local health departments at all levels of staff. On average, the survey showed women in leadership roles in governmental public health brought home about $3,000 less per year than their male counterparts. The gap was even greater at the executive level, and particularly high in state health departments.

The findings align with research exploring women’s pay and work roles in public health at the federal level. A 2021 study in *Human Resources for Health* found that while the gender pay gap has narrowed within the last two decades, pay disparities between women and men in the federal public health workforce persist. Female employees in the U.S. Department of Health and Human Services earned about 13% less than men in 2010, and 9.2% less in 2018.

Compared to female workers overall, women in public health are faring better, earning 90 to 95 cents for every dollar earned by a comparable male, according to PH WINS. In the national workforce overall, women make 82 cents on the dollar compared to their male counterparts, according to a Pew Research Center analysis of 2019 Census Bureau data. For non-white women, the gaps are much larger. Although more work must be done, the data show the gap has narrowed from a decade ago when women made only 77 cents to the dollar. The gains are attributed to a mix of educational attainment, years worked and women moving into higher paying fields traditionally filled by men.

## Closing the gender gap requires action

Increasing data transparency could help reduce and ultimately eliminate gender pay gaps, said Adam Chen, PhD, MS, an associate professor in the College of Public Health at the University of Georgia.

“Pay transparency is a step in the right direction,” Chen told *The Nation’s Health*. “It has been proven effective in reducing the gender pay gap in Denmark and has been adopted in the U.K. There is minimal cost with the current information technology we have. I cannot think of any legitimate reasons not to increase transparency with minimal cost.”

On the home front, progress is being made, as gains are being seen in U.S. local health departments overall. According to the 2019 National Profile of Local Health Departments, published by the National Association of County and City Health Officials, about two-thirds of top executives of local health departments identify as female. The number has steadily increased from 56% in 2008 to 66% in 2019 when the last study was done.

“In all indications from our survey, it’s getting better, not worse, over the past decade, and I think we should be proud of that,” NACCHO CEO Lori Tremmel Freeman, MBA, told *The Nation’s Health*. “It shows a broader environment of acceptance and willingness to recognize the value of executive women in leadership.”

And more good news is just around the corner. New PH WINS data, scheduled to be released this month, show health departments in America’s largest metropolitan cities have closed the gaps in pay and leadership, said Chrissie Juliano, MPP, executive director of Big Cities Health Coalition.

“In BCHC-member health departments that participated in the 2021 PH WINS, there is no gender gap in executive compensation, which is different than state and other local health departments where gaps do exist,” Juliano told *The Nation’s Health,* noting that women are in top positions in large city health departments.

The soon-to-be-released PH WINS data show that in big cities, nearly three-quarters of supervisors, managers and executives who participated in PH WINS are women and nearly two-thirds of supervisors, managers, and executives are people of color.

“The big cities are typically our most progressive places in the country,” said Brian Castrucci, DrPH, MA, president and CEO of the de Beaumont Foundation, which conducts PH WINS with the Association of State and Territorial Health Officials. “They’ve made a greater commitment to justice, equity, diversity and inclusion.”

Ensuring more women are in leadership positions at health departments involves undoing the systemic biases that keep women out of the top positions at health departments, Castrucci said. For example, some jurisdictions set up barriers to inclusivity by requiring that their health official be a physician, although 64% of doctors are men. And far too often the top job goes to someone an elected leader knows, he said.

## Training new crop of women leaders

To get ahead of need, the Association of State and Territorial Health Officials has partnered with the Satcher Health Leadership Institute at Morehouse School of Medicine to offer Diverse Executives Leading in Public Health. The landmark leadership development program aims to increase and strengthen participants’ visibility and exposure in public health systems and provide them with access to key networks and leadership development opportunities.

“We also have leadership development programs for the state health officials who help to prepare them for their roles as new leaders in governmental public health agencies,” said ASTHO Workforce Development Director Joanne Pearsol, MA, MCHES.

To boost workforce development in general and build diverse promising leaders, ASTHO also is building out its workforce programs to better support state health agencies in their workforce efforts.

“Women tend to carry a household burden that is supportive of children, so we need to have policies and structures that are supportive of women who may need to have flexible work schedules, flexible hours, work from home, or child care opportunities,” Pearsol told *The Nation’s Health*. “Those are all things that make working as a woman in the workplace a little bit easier.”

Looking to the future, the governmental public health workforce must continue its efforts to overcome gender inequity even as it copes with the fallout and unprecedented challenges of COVID-19. The workforce lost more than 600 local and state health officials during the highly politicized pandemic due to pressure, burnout, resignations, firings and conflicts with elected officials, Freeman said.

During the pandemic, women leaders in executive roles at health departments faced “extraordinary” pressure, Freeman said, adding that it seemed as though women were held to a different standard or put under added scrutiny.

For the public health workforce, that observation might be one of the pandemic’s legacies.

“That’s what makes it even worse,” Castrucci said. “The pandemic was bore by the people that we pay the least and that we promote the slowest, yet this was the group who stood up, as women have done throughout the history of the nation. They stepped up to take care of us, and so now it is so necessary to mediate these pay gaps.”

For more information on PH WINS, visit [www.phwins.org](http://www.phwins.org).

*   Copyright The Nation’s Health, American Public Health Association