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At the table, on the menu, and under the bus: are Black local health department employees psychologically safe?

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At the table, on the menu, and under the bus: are Black local health department employees psychologically safe?

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Content At the Table, on the Menu, and Under the Bus:
Are Black Local Health Department Employees Psychologically Safe?
Nicole D’Anise Vick, MPH
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
May 2024

© Copyright by Nicole D’Anise Vick 2024
All Rights Reserved

The Committee for Nicole D’Anise Vick certifies the approval of this Dissertation
Jessica DeCuir-Gunby
Lavonna Blair Lewis
Nomsa Khalfani
Briana Hinga, Committee Chair
Rossier School of Education
University of Southern California
2024

iv
Abstract
Psychological safety is an important topic to address because of its association with positive
work environments and job satisfaction. In the context of this study, psychological safety is
defined as an employee’s perception of the consequences of taking interpersonal risks in their
work environment. This study explored the nexus of psychological safety and institutional
racism as an antecedent to job satisfaction among Black employees of local health departments
(LHDs) in the United States. To examine the impact of psychological safety on job satisfaction
for Black LHD employees, interviews were conducted with a purposeful sample of Black LHD
employees. Participants shared their lived experiences related to their perception of the
relationship between institutional racism and psychological safety in local health departments;
aspects of the work that promoted or inhibited psychological safety; how their identities,
position, tenure, and/or place of employment impacted their experiences of psychological safety;
and how psychological safety impacted job satisfaction. The interview findings showed that
Black employees experience institutional racism and a lack of psychological safety in local
health departments. The results suggest that Black LHD employees experience a lack of
psychological safety in the workplace regardless of their identities that negatively impacts job
satisfaction. For this reason, LHDs and other public health institutions should consider
examining the disconnect between public health/LHD stated mission and vision, the
operationalization of that mission/vision, and the impact it has on the psychological safety of
Black LHD employees; implementing programs, policies, and practices that shift the
organizational culture towards diversity, equity, and inclusion (DEI); and providing the resources
necessary to equip LHD supervisors and managers with the knowledge, skills, and abilities
necessary to create psychologically safe environments for Black LHD employees.

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Keywords: public health, local health department, governmental public health, Black
employees, psychological safety, institutional racism

vi
Dedication
To my great-grandmother Tommie Lee Pyles Cross Simpkins, one generation removed from
slavery, who asked me as a young girl if I was going to go to college to become Dr. Vick. I told
her I would, and I did.

vii
Acknowledgments
To my daughter Andréa A’jane Hamilton, who has been with me on this journey through
academia since the very beginning. You were literally in my womb when I first walked onto the
campus of USC for the first time in 1996 and was with me every step of the way through all
three of my degrees. I brought you to class in your little stroller during undergrad and made sure
you were at every graduation. Thanks for being my biggest cheerleader through it all and my
biggest motivator as well. I wanted you to be proud of me and know that you can do anything
that you want in this life. Your presence forced me to grow up and do all I could to make sure we
were good. We are good!
To my family, friends, classmates, and colleagues who took the time to check on me,
send words of encouragement, comment on my many social media posts about my doctoral
journey, and call me “Doctor Vick” way before it was time. Some of you had no idea what I was
doing or why I was doing it, but you cheered me on just the same because you knew it was
important and was part of something that would get me closer to where I want and need to be.
Your words meant so much to me as I spent hours and hours and hours researching and writing.
To Theresa Lucas and Porsia Curry, who shared their insight and offered support and
encouragement at various points in the program. I am very appreciative of everything you have
done to help me along the way. I hope I was as helpful to you as you were to me. Theresa, you
kept us all connected and grounded, which was so important to our collective success. Porsia, we
connected at Immersion I and stayed connected the whole way through. Thank you for holding
space for me during this journey.
To Josette Sprott, it was always me and you! We spent hours writing at Coffee
Connection in Mar Vista, Leavey Library, and finally at your home. I did not know my classmate

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would become my friend, but I’m glad about it! We held each other up, talked each other into
and out of things, lamented about coding, and complained about assignments. At the end of the
day, we got it done, and now we are here! We did it!
To my dissertation chair, Dr. Hinga and committee, Dr. De Cuir-Gunby, Dr. Blair Lewis,
and Dr. Khalfani, thank you for your guidance and expertise throughout this academic and
dissertation process. Dr. Hinga, I didn’t bother you much until the very end, but you always
pointed me in the right direction and gave me enough guidance to get me going. Dr. De CuirGunby, your expertise in critical race theory (and your research which I leaned on quite heavily)
was valuable. Dr. Blair Lewis, your presence on this committee completes the circle for me, as
you were one of my professors in undergrad all those years ago. Dr. Khalfani, my friend and
colleague, I am forever grateful for your wisdom, knowledge, and guidance, not just in this
space, but every day!
To the Black Local Health Department workforce. I hear you, I see you, I AM you! Your
experience afforded me the opportunity to shine a light on the many ways that institutional
racism and psychological safety impact your work. Thank you for trusting me with your
experiences and your stories. It is my hope that this research brings to light the value that you
bring to public health and the work that must be done to make things right.

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Table of Contents
Abstract .......................................................................................................................................... iv
Dedication .................................................................................................................................... vii
Acknowledgments......................................................................................................................... vii
List of Tables ............................................................................................................................. xiiiii
List of Figures ........................................................................................................................... xiviii
Chapter One: Overview of the Study .............................................................................................. 1
Background of the Problem ................................................................................................ 1
Statement of the Problem .................................................................................................... 2
Purpose of the Study ........................................................................................................... 3
Significance of the Study .................................................................................................... 4
Theoretical and Conceptual Framework ............................................................................. 6
Definition of Terms............................................................................................................. 9
Organization of the Study ................................................................................................. 11
Chapter Two: Review of the Literature ........................................................................................ 13
Defining Public Health ..................................................................................................... 13
Where Public Health Work Happens ............................................................................... 16
The Evolution of Public Health Practice .......................................................................... 18
Public Health and White Supremacy ................................................................................ 19
Other Systems of Oppression and Their Links to Public Health ...................................... 22
Present Day White Supremacy in Public Health .............................................................. 25
Significance of LHDs to Public Health Practice ............................................................... 28
Demographics of LHDs are Misaligned with US Demographics ..................................... 30
Significance of BIPOC LHD Workforce in Addressing Health Disparities..................... 31

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Unique Challenges of Black Employees in the Workforce .............................................. 35
Psychological Safety in the Workplace ............................................................................ 38
Black LHD Workforce and Psychological Safety ............................................................ 41
Summary .......................................................................................................................... 43
Chapter Three: Methodology ........................................................................................................ 44
Research Questions ........................................................................................................... 44
Overview of Design .......................................................................................................... 44
Research Setting................................................................................................................ 46
The Researcher.................................................................................................................. 46
Data Sources ..................................................................................................................... 49
Participants ........................................................................................................................ 49
Instrumentation ................................................................................................................ 50
Data Collection Procedures ............................................................................................... 51
Data Analysis .................................................................................................................... 52
Credibility and Transferability .......................................................................................... 53
Ethics................................................................................................................................. 53
Chapter Four: Results or Findings ................................................................................................ 57
Participants ........................................................................................................................ 59
Research Question 1: How do Black employees perceive the relationship between
institutional racism and perception of psychological safety in local health
departments? ..................................................................................................................... 66
Research Question 2: What aspects of work in local health departments promote
or inhibit psychological safety for Black employees? ...................................................... 82
Research Question 3: How do experiences of psychological safety differ for Black
local health department employees based on age, gender, type and location of
health department, position, or tenure? ............................................................................ 95
Research Question 4: From the perspective of Black local health department
employees, how does psychological safety impact their job satisfaction ? .................... 103

xi
Summary ......................................................................................................................... 115
Chapter Five: Discussion and Recommendations....................................................................... 116
Discussion of Findings .................................................................................................... 119
LHD Organizational Structure Reinforces Institutional Racism Which Create
Psychologically Unsafe Environments ........................................................................... 120
Local Health Department Workplace Dynamics Can Help or Harm LHD
Employees ....................................................................................................................... 123
Black LHD Employees Experience the Intersection of Institutional Racism and
Lack of Psychological Safety Regardless of Demographic, Type and Location of
LHD, Position, or Tenure................................................................................................ 127
Black LHD Employees Experience Emotional and Mental Distress Due to
Institutional Racism and Lack of Psychological Safety and Have Low Job
Satisfaction As a Result .................................................................................................. 130
Recommendations for Practice ....................................................................................... 132
Recommendation 1: More Research on Black LHD Employees' Experiences with
Psychological Safety and Institutional Racism, with Specific Emphasis on Men,
Gender Expansive, LGBTQ Employees, as Well as Recent Retirees and Those
Who Have Left the Industry .......................................................................................... 133
Recommendation 2: LHDs Should Implement Stronger Diversity, Equity, and
Inclusion Programs and Strategies Aimed at Improving Workforce Experience for
Black LHD Employees ................................................................................................... 135
Recommendation 3:LHDs Should Better Equip Supervisors and Managers to
Create Psychologically Safe Environments for Black LHD Employees ........................ 139
Limitations and Delimitations ......................................................................................... 142
Recommendations for Future Research .......................................................................... 144
Conclusion ...................................................................................................................... 146
References ................................................................................................................................... 148
Appendix A: Information Sheet for Exempt Research ............................................................... 174
Appendix B: Demographic Survey Protocol .............................................................................. 178
Appendix C: Interview Protocol ................................................................................................. 191
Appendix D: Research Design Matrix ........................................................................................ 196

xii

xiii
List of Tables
Table 1: Participant Demographics 57

xiv
List of Figures
Figure 1: Conceptual Framework 8

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Chapter One: Overview of the Study
Background of the Problem
Black, Indigenous, and Other People of Color (BIPOC) public health employees are
integral to eliminating health disparities and improving access to care among BIPOC populations
(Mitchell et al., 2022). Black public health employees have a significant role in both program
development and community engagement with Black populations, who have many of the worst
health outcomes in the United States due to systemic oppression and racism (Institute of
Medicine, 2003). Additionally, the COVID–19 pandemic that disproportionately impacted the
Black population and the deaths of Black men and women at the hands of law enforcement laid
bare the gaps in the provision of services and representation in the public health workforce
(Travis, 2022). Black people bring tremendous value to the institution of public health as
employees (Mitchell et al., 2022; Owens-Young et al., 2023; Wilbur et al., 2020) but the intrinsic
value of their humanity is often unrecognized. Ross characterizes this inability or refusal to
recognize Black humanity as anti-Blackness (2020).
The underperformance of local health departments in providing psychological safety for
Black public health employees lowers morale, decreases productivity, and increases turnover
(Harper et al., 2015; Singh et al., 2013). Moreover, the likelihood that local health departments
will effectively reduce health inequities and increase healthcare access to society’s most
vulnerable populations is diminished (Coronado et al., 2020; Mitchell et al., 2022; Porter et al.,
2023). There is consensus that a lack of diversity in local health departments negatively affects
the ability to “improve community service, patient treatment, and access to care” (Mitchell et al.,
2022, p. e769). However, according to the Public Health Workforce Interests and Needs Survey
(PH WINS), the public health workforce is “predominantly White, aging, and shrinking”

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(Mitchell et al., 2022, p. e769) and BIPOC public health workers are more likely to report intent
to turnover because of dissatisfaction with their employment (Mitchell et al., 2022). Not
addressing the psychological safety of Black public health employees is a glaring oversight of
local health departments as they engage in work to reduce health disparities.
Statement of the Problem
There is consensus that workforce diversity in local health departments is essential to
providing adequate health care, improving access to care, and eliminating health disparities
(Coronado et al., 2020; Grissom & Keiser, 2011). However, the current public health workforce
is predominantly white and nearing retirement age (Mitchell et al., 2022). Additionally,
governmental public health agencies need to be more staffed. Since 2008, the workforce has
been short 50,000 staff since 2008 (Bogaert et al., 2019). An analysis of the intent to turnover of
respondents to the PH WINS showed an increase from 15% in 2014 to 26% in 2017 (Bogaert et
al., 2019). BIPOC public health employees are more likely to report intent to turnover and actual
turnover than their white counterparts (Grissom & Keiser, 2011; Mitchell et al., 2022). Black
employees face a unique set of challenges in the workplace (McCluney et al., 2017) including
exposure to racially traumatic events both inside and outside the work environment. Workplace
conditions and climate are important factors relative to job satisfaction (Bogaert et al., 2019;
Mitchell et al., 2022).
Although consensus exists that workforce diversity in local health departments is
essential, there is a growing sociopolitical movement towards equity that has resulted in
jurisdictions restricting diversity, equity, and inclusion (DEI) initiatives across the United States
(Lange & Lee, 2024; Murray et al., 2023). Protests associated with causes such as Black Lives
Matter, separation of migrant children from their parents at the border between Mexico and the

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United States, and the anti-Asian sentiment from the COVID–19 pandemic made many aware of
the injustices present in the United States. As a result, many health care agencies, academic
institutions, and other businesses shared public support of DEI initiatives that would foster
organizational and institutional change (Murray et al., 2023). As this heightened awareness
occurred, a powerful anti-DEI movement began, with over 34 bills introduced restricting DEI
initiatives in higher education as of May 2023. Although these efforts are largely occurring in
academic settings, their reach can affect how local health departments operate, including how
they hire and train employees. For example, the Stop Wrongs to Our Kids and Employees
(WOKE) Act introduced by Florida Governor Ron DeSantis in 2021, prohibits workplaces with
at least 15 employees from providing training on LGBTQ issues, Black history, and other social
justice issues (Gordon & Turner, 2022).
Purpose of the Study
The purpose of this study was to examine psychological safety as an antecedent to job
satisfaction among Black public health employees of local health departments. Four research
questions were used to guide this study:
1. How do Black employees perceive the relationship between institutional racism and
perception of psychological safety in local health departments?
2. What aspects of work in local health departments promote or inhibit psychological
safety for Black employees?

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3. How do experiences of psychological safety differ for Black local health department
employees based on age, gender, type and location of health department, position, or
tenure?
4. From the perspective of Black local health department employees, how does
psychological safety impact their job satisfaction?
Significance of the Study
This problem of practice is important because local health departments are doing a
disservice to both their Black employees (Mitchell et al., 2022) and the diverse populations they
serve by not ensuring the psychological safety of the segment of their workforce most capable of
addressing health inequities (Porter et al., 2023). Furthermore, the disregard by public health and
local health departments for the health and safety of the Black public health workforce as they
endeavor to eliminate health inequities perpetuates Black suffering by the very institution
responsible for eliminating it (Dumas, 2018).
BIPOC public health employee job satisfaction has been researched (Bogaert et al., 2019;
Harper, 2015; Mitchell et al., 2022), but there is a gap in research on Black public health
employees specifically, with some studies differentiating by race using terms “white” vs
“nonwhite” (Harper et al., 2015) or “white” vs “minority” (Mitchell et al., 2022). Based on the
literature, few studies examine the antecedents and mechanisms of turnover of minority public
health employees (Mitchell et al., 2022). Also missing are the unique work challenges of the
Black public health workforce. Cluney et al. (2017) discussed the impact of racially traumatic
events (such as police brutality) on Black employees who may “call in Black” to protect their
mental health from organizations that do not have the capacity to provide psychological safety.

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Black Americans have some of the worst social and health outcomes and are typically the focal
point for public health programs and interventions intended to reduce health disparities and
improve health outcomes. What happens when the “racially traumatic event” is African
American infant mortality, disparities in COVID–19 death rates, or a workplace race equity
training, common topics of focus in local health departments that focus on Black suffering.
Few studies have addressed the role of psychological safety as a measure of job
satisfaction of the Black public health workforce and instead focus on job satisfaction and
turnover/intent to turnover for employees. More research is needed around the problem of
practice as it relates to this population, particularly because the Black public health workforce
plays a significant role in reducing health disparities and increasing health care access among
Black Americans who have some of the worst health outcomes in the country (Institute of
Medicine, 2003).
Local health departments would benefit by better understanding the motivators that cause
dissatisfaction among Black public health employees so that they can implement strategies to
retain staff better. Additionally, few studies examine the antecedents and mechanisms of
turnover of Black public health employees (Mitchell et al., 2022). Black public health employees
entering the workforce will feel better supported, have higher morale, and better work outputs if
their psychological safety is protected in the workplace (DeCuir-Gunby & Gunby, 2016; Harper
et al., 2015; Mitchell et al., 2022). It would be enlightening to the public health profession if
psychological safety is examined as an antecedent to job satisfaction so that further research
could be done on resources and strategies to protect Black employees and retain them in local
health departments (Mitchell et al., 2022).

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While many studies measure job satisfaction by using “turnover” and “intent to turnover”
or “quit” or “intent to quit” as metrics (Allen et al., 2003; Bogaert et al., 2019; Kruzich, 2014;
Mitchell et al., 2022), this study seeks to offer a counter narrative to the prevailing ideals of the
Black workforce as workhorses or servants (ross, 2020), exploited by organizations for their
value “while not valuing those who create the value” (Clark, 2020, The Bowling Lane and the
Gutters, para. 3). Furthermore, many Black workers in public service jobs such as local health
departments cannot quit or even consider quitting because of the economic burden to themselves
and their families (Kruzich, 2014), and the potential lost opportunity of maximizing their pension
or health benefits during retirement (Viceisza, 2022).
Theoretical/Conceptual Framework
Critical race theory (CRT) was used in this study. CRT is used to understand societal
oppression and create individual and societal change (Solorzano & Yosso, 2001). CRT positions
narrative as inquiry (Graham et al., 2011) and has three primary objectives – to highlight
narratives of racism and discrimination from the viewpoint of Black people and other people of
color, to acknowledge that race and racism are pervasive while arguing for the eradication of
racial oppression, and to address intersectionalities with other characteristics such as sexuality
and class (Graham et al., 2011). Narratives have value as data because of the rich narratives of
the participant’s lived experiences and feelings (Graham et al., 2011).
The institution of public health upholds White supremacy culture like other systems such
as healthcare and education. Local health department claims of race neutrality, objectivity,
meritocracy, and equality/equity among the workforce must be challenged as these claims “act as
a camouflage for self-interest, power, and privilege of dominant groups in U.S. society”
(Solorzano & Yosso, 2001). Finally, the experiential knowledge of the Black public health

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workforce is critical to analyzing and understanding racial subordination in local health
departments and can offer a strong counter narrative to the prevailing discourse of equity and
social justice in public health (Solorzano & Yosso, 2001).
CRT has become an increasingly common framework utilized in public health practice to
examine racism's role in health inequities (Cross, 2018; Ford & Airhihenbuwa, 2018). CRT is a
powerful tool for targeting racial and ethnic health inequities and is well aligned with public
health’s social justice foundation (Ford & Airhihenbuwa, 2010). Although CRT use in public
health has become increasingly common, some of the main tenets of CRT (such as counter
storytelling) were being utilized in healthy equity work several decades before CRT was
formalized (Ford & Airhihenbuwa, 2018). Public health scholars have adopted principles of CRT
to create a new theoretical framework, Public Health Critical Race Praxis (PHCRP) or healthcrit
to examine the causes of racial patterns of health and disease (Ford & Airhihenbuwa, 2018).
Lately, CRT has been the recipient of much criticism (Cabrera, 2018, Kang, 2021). This
criticism began in 2012 when a video of President Obama, at the time a law student, hugging
CRT founding father Derrick Bell was published by Breitbart.com (Cabrera, 2018). The murder
of George Floyd and other Black Americans at the hands of law enforcement in 2020 spurred an
overflow of commitments from organizations to adopt DEI principles. Anti-CRT rhetoric
reached critical mass in the following years. CRT has been adopted as a method of framing
higher education scholarship and has been adapted to education research by the likes of LadsonBillings and Tate (Cabrera, 2018). The result of this adaptation was legislative efforts to ban the
teaching of CRT, which researchers believe is a “weaponizing of white emotionality designed to
codify white ignorance” (Kearl, 2023, p. 114). This weaponization harms Black and other
students of color by centering whiteness and decentering everyone else (Kearl, 2023). Despite

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the negative backlash on the use of Critical race theory, specifically in education, it is used in
this study to counter the centering of whiteness. As mentioned earlier, the institutions of public
health and education are both seen as a common good. Examining public health through the lens
of CRT allows for a deeper analysis of the workings of the system and who is deemed worthy of
public health investment and who is not.
Several key concepts have emerged that are integral for understanding the research
problem:
○ Public health is a highly politicized institution that upholds white supremacy culture,
a direct conflict of the concepts of social justice and health equity. This is similar to
other helping professions such as education (Dumas, 2018), healthcare, and urban
planning.
○ A shrinking, aging, homogenous public health workforce (Mitchell et al., 2022).
○ A diverse population that requires culturally competent public health services.
○ Lack of data on the experiences of Black public health employees, specifically
regarding job satisfaction and psychological safety.
Race based violence inadequately addressed at the workplace, coupled with public health
work content that disproportionately impacts the Black population (e.g. infant mortality,
homelessness, and COVID–19) and discriminatory work practices leaves Black local public
health employees without psychological safety (DeCuir-Gunby & Gunby, 2016; McCluney et al.,
2017; McCluney et al; 2020). This phenomenon reduces job satisfaction, reduces work
performance, and causes low morale (see Figure 1).

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Figure 1: Conceptual Framework
Definition of Terms
 BIPOC is an acronym for is an acronym for Black, Indigenous, and people of color. It
is an acronym for people of color, with Black and Indigenous listed first to highlight
that these two groups are “foundational to understanding the racial history of the
United States” (Deo, 2021, p. 117).
 Bicultural/biculturalism describes the relationship of Blacks to white society under
the assumption that Blacks have been socialized into both cultural systems
simultaneously (Bell, 1990).
 Black people refers to a people having origins in any of the Black racial groups of
Africa (United States Census Bureau, 2022).

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 Double consciousness is a term coined by W.E.B. DuBois to explain the tension that
Black Americans hold between their Blackness and their American-ness in various
settings (Itzigsohn & Brown, 2015; Bell, 1990).
 Health disparity refers to the racial or ethnic differences in the quality of healthcare
that are not due to access-related factors or clinical needs, preferences, and
appropriateness of intervention (Institute of Medicine, 2003).
 Health equity is the idea that everyone has the opportunity to attain their highest level
of health (American Public Health Association, 2022 and is the assurance of the
conditions for optimal health for all people. Achieving health equity requires valuing
all individuals and populations equally, recognizing and rectifying historical
injustices, and providing resources according to need. Health disparities will be
eliminated when health equity is achieved (Jones, 2014).
 Health outcome - an interrelated set of attributes that describe the consequences of
disease for an individual. These include impairments, symptoms, functioning,
participation in activities and social roles, and health-related quality of life (Ward,
2009).
 Intent to turnover/leave is a metric used to measure an employee’s intention to leave
their organization within a specified time period, usually a year. Employees intending
to retire are typically excluded from this definition. Also referred to as voluntary
nonretirement separations (Bogaert et al., 2019).
 Local health department is the governmental public health presence at the local level”
(National Association of County and City Health Officials NACCHO, 2005, pg. 9).

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 Oppression is a combination of prejudice and power that creates a system that
discriminates against marginalized groups and benefits non-marginalized groups
(Smithsonian National Museum of African American History and Culture, n.d.).
 Public health is the promotion of health and prevention of disease in communities
(American Public Health Association, 2021).
 Psychological safety refers to individuals’ perceptions of the consequences of taking
interpersonal risks in their work environment (Edmondson, 1999, 2004; Kahn, 1990).
 Racial battle fatigue is the accumulated impact of racism experienced by Black
people (Smith, Allen, & Danley, 2007).
 Racism is “a system of structuring opportunity and assigning value based on the
social interpretation of how one looks, which unfairly disadvantages some individuals
and communities, unfairly advantages other individuals and communities, and saps
the strength of the whole society through the waste of human resources (Jones, 2014).
 Social justice is the view that everyone deserves equal rights and
opportunities (American Public Health Association, 2022).
 Turnover/leave is a metric used to measure attrition at an organization within a
specified time period.
 white supremacy/white supremacy culture is a term used to characterize a several
beliefs, one of which is the belief that white people “should have dominance over
people of other backgrounds” (Anti Defamation League, 2017).
Organization of the Study
This dissertation contains five chapters. An overview of the problem of practice, the
purpose of the study, research questions, and methodology was provided in Chapter One.

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Chapter Two outlines relevant research examining the origin and function of public health
practice in the United States, a review of historical and current anti-Blackness in public health
and other institutions, an overview of the significance of local health departments and the local
health department workforce in advancing public health practice, gaps in the provision of
services to BIPOC communities that perpetuates health disparities will be examined, and finally
the unique challenges of the Black local health department workforce will be discussed with a
focus on psychological safety. Chapter Three connects the methodology and data analysis to the
problem of practice based on the literature review. Chapter Four presents the findings and data
analysis from the semi-structured interviews. Chapter Five discusses the findings and suggests
recommendations for the problem of practice and future research considerations to support the
psychological safety of Black employees working in local health departments.

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Chapter Two: Review of the Literature
This chapter provides an overview of the public health system in the United States, the
context of where public health work happens, and how public health practice has evolved over
the years. The anti-Black historical foundation of public health, compare and contrast other
institutions’ anti-Black historical foundations, and examples of past and present anti-Black
public health practices are also discussed. The significance of local health departments in
advancing public health practice and insight into the demographics of the local health department
workforce are examined. Lastly, I discuss the unique challenges of Black people in the
workforce generally and in local health departments specifically with an analysis of the
significance of psychological safety among Black local health department employees.
Defining Public Health
Modern American public health is an institution focused on promoting health and
preventing disease in communities (American Public Health Association, 2021). Other
definitions place emphasis on development of an evidence base and use of theory to drive
improvements in population health (Heller et al., 2003). At its core, public health is a societal
effort “to ensure the conditions in which everyone can be healthy” (DeSalvo et al., 2017, p. 1)
Health promotion and prevention of disease can occur through various methodologies,
from individual counseling and health education to improving socioeconomic factors such as
poverty and education with varying degrees of effort, impact, and controversy (Frieden, 2010).
Frieden (2010) conceptualized these strategies in the Health Impact Model, a five-tier pyramid
with changes in socioeconomic factors at the base and individual level interventions at the top.
Strategies and interventions at the top of the pyramid require greater individual effort, are
generally less controversial, but have lesser public health impact because of their reliance on

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long-term individual behavior change (Frieden, 2010). Conversely, interventions at the base of
the pyramid require less individual effort, have greater public health impact, and are more likely
to be controversial (Frieden, 2010).
There are three levels of disease prevention. Primary prevention is preventing illness or
injury before it occurs, with a focus on limiting risk exposure or increasing the immunity of
healthy individuals (Kisling & Das, 2022). Immunization is a form of primary prevention
(Kisling & Das, 2022). Secondary prevention is catching illness or injury early when it can be
mitigated. Strategies for secondary prevention are screenings such as a Pap smear to diagnose
cervical cancer in its early stages before progression (Kisling & Das, 2022). Tertiary prevention
is implemented in symptomatic patients to prevent further progression of disease, complications,
or death (Kisling & Das, 2022).
Community is defined as a group of individuals who share common interests and
characteristics, often live in the same geographical area, and have cultural and historical heritage
(Sharma, 2014). Communities can be identified by geography, race/ethnicity, gender, age,
common interest, and risk group (Sharma, 2014). Communities can be further classified into
three types: those that accomplish basic needs for sustenance, those that exist for social
interaction, and those with symbolic collective identity (Sharma, 2014).
Public health operates within a framework of three core functions (assessment, policy
development, and assurance) and ten essential public health services, to ensure fidelity to the
operation, function, and vision of the discipline (Alang et al., 2021). Assessment, the
foundational function of public health, is the collection, assembling, analysis, and reporting of
the health of the community (Institute of Medicine, 1988). Epidemiologic surveillance and

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investigation, diagnosis and mitigation of health hazards and their causes are the two primary
assessment functions (American Public Health Association, 2020).
Policy development is the development of comprehensive public health policies by using
evidence-based decision making (Institute of Medicine, 1988). Health communications,
community partnerships, policy development and implementation, and legal and regulatory
advocacy are primary policy development functions (American Public Health Association,
2020). Many public health policies, community partnerships, and legal and regulatory activities
past and present were conducted in a racialized manner that negatively impacted Black and other
people of color (Abel, 2004; Corburn, 2007; DeSalvo et al., 2017; McGrew, 2018).
Assurance is making sure constituents have access to the services they need, and that the
public health workforce is competent in providing those services (Institute of Medicine, 1988).
Alang et al (2021) highlighted the significance of addressing ongoing distrust in public health
and healthcare, which significantly burdens equitable access to services and care. Key assurance
functions include strengthening the public health infrastructure; evaluation, research and quality
improvement of public health policy and practice; workforce development; and health equity
(American Public Health Association, 2020). The foundational structure and function of public
health may appear neutral, but the racialized implementation of these core functions perpetuate
Black suffering (Dumas, 2018) by ignoring or outright harming the health of Blacks in the
United States (Abel, 2004; Bates & Harris, 2004; Corburn, 2007; De Salvo et al., 2017; LaVeist,
2012; Oppenheimer, 2001). The remainder of this chapter will provide specific examples of how
public health has contributed to Black suffering past and present, both inside and outside its
organizational structure.

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Where Public Health Work Happens
Public health work occurs in various settings (Institute of Medicine, 1988; Institute of
Medicine, 2002). Examples include governmental agencies at the federal, state, and local levels.
Governmental public health organizations have the important role of assuring the provision of
vital public health functions and that the mission of public health is appropriately addressed
(Institute of Medicine, 1988). Quasi-governmental (Mead & Warren 2016) and nonprofit
organizations such as the RAND Corporation and the American Red Cross operate as a hybrid
private/public entity providing important public health services and research. Educational
institutions and professional associations such as schools of public health and the American
Public Health Association (APHA) provide education and training for aspiring and existing
public health professionals, conduct research on emerging and important public health topics,
and provide consultative public health services to various organizations (Wandschneider et al.,
2020). Additionally, sectors such as communities, business and employers, the healthcare
delivery system, and the media all have a role in public health (Institute of Medicine, 2002).
LHDs are “the critical components of the public health system” (Institute of Medicine,
1988, p. 78). A significant amount of public health work in the United States occurs locally at
local health departments (LHDs) across the country (National Association of County and City
Health Officials, 2005). The National Association of County and City Health Officials
(NACCHO) defines a local health department as the “governmental public health presence at the
local level” (NACCHO, 2005, p. 9). The agency could be locally governed, a division of a state
health department, or some other arrangement where the local health department is responsible
for public health functions and has governmental authority (NACCHO, 2005).

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There are more than 3,300 LHDs in the United States (Cunningham et al., 2024). In 2022,
of the 2,512 LHDs surveyed by the National Association of County and City Health Officials,
62% served fewer than 50,000 people. These LHDs are classified as small and together serve
less than 10% of the US population. Six percent of LHDs studied serve 500,000 or more people.
These LHDs are considered large and serve over half of the US population (Cunningham et al.,
2024). Two thirds of LHDs are county level with the balance being city or town, multi-county, or
other (Cunningham et al., 2024).
Approximately 182,000 employees are employed by local health departments in the
United States with most of them working in larger health departments in urban areas
(Cunningham et al., 2024). There are a variety of occupations employed in local health
departments. Examples include environmental health worker, epidemiologist, public health
nurse, health educator, nutritionist, laboratory worker, and public health physician (Cunningham
et al., 2024). Larger LHDs include a wider variety of occupations than smaller LHDs
(Cunningham et al., 2024).
The local health department workforce increased by about 19% after continuously
shrinking (Cunningham et al., 2024). This increase was caused by the COVID–19 pandemic,
which allowed LHDs to hire additional staff as supplemental funding came in from the federal
government. This increase is likely temporary (Cunningham et al., 2024). NACCHO (2020)
estimates a 17% increase in the LHD workforce from 2008 to 2019 resulting in a loss of
workforce capacity of 21% during the same timeframe (Bogaert et al.,2019). According to a
subset of midsized and larger health departments sampled from the 2017 Public Health
Workforce Interest and Needs Survey, 70% of local health department staff are white, nonHispanic, 81% are female, and 40% of the workforce is age 51 or older (Robin et al., 2019).

18

Public health is financed through various federal, state, and local funding (Institute of
Medicine, 2002). Local health departments are typically responsible for financing essential
governmental public health services such as workforce development, infrastructure (information
and surveillance systems), laboratories, and population-based prevention and education programs
(Institute of Medicine, 2002).The federal government also bears some responsibility for local
public health funding as well but has fallen short in comparison to other aspects of healthcare
such as the hospital industry and biomedical research (Institute of Medicine, 2002).
Approximately 95 percent of governmental healthcare expenditures are directed towards medical
care and biomedical research, a short-sighted strategy to improving population health when
social and environmental factors are the primary drivers of poor health (Institute of Medicine,
2002).
The Evolution of Public Health Practice
Public health has evolved from its early focus on sanitation and bacteriology, often
referred to as “Public Health 1.0” (DeSalvo et al., 2017; Winslow, 1920), towards health equity
by improving the social determinants of health, referred to as “Public Health 3.0” (De Salvo et
al., 2017). The social determinants of health are social and behavioral conditions that “influence
morbidity, mortality, and functioning” (Institute of Medicine, 2002, p. 57). Hahn further defines
the social determinants of health as the power of societal systems to “control and distribute,
allocate and withhold” resources and hazards such that health outcomes are impacted (2021).
Variations in the social determinants of health are documented but healthy and safe
environments, housing, access to food, education, employment, transportation, and access to
health care are most common in the literature (Hahn, 2021; CDC, 2013).

19

Three landmark publications highlighted the need to address health inequities by
improving public health capacity to address the social determinants of health, but earlier works
by W.E.B. Du Bois, Marmot, and others highlighted the impact of social status, economics, and
environment on health (Yao et al., 2019). The 1988 Institute of Medicine report “The Future of
Public Health'' and the follow up publication, “The Future of Public’s Health in the 21st
Century”, took an in-depth look at the current state of public health in the United States and
offered six strategies to improve public health that include adopting a population health
approach that “builds on the evidence of the multiple determinants of health” (Institute of
Medicine, 2002, p. 33). “Unequal Treatment,” also published by the Institute of Medicine in
2003 highlighted the glaring disparities in health outcomes by race in the United States and
offered recommendations for eliminating health disparities (Griffith et al., 2007; Institute of
Medicine, 2003).
Public Health and White Supremacy
The development of the American public health system is rooted in white supremacy
culture (Ford et al., 2019; Griffith et al., 2007; Hardeman et al., 2016; Oppenheimer, 2001).
Miller asserted that hegemonic whiteness is maintained through force, discrimination, and a
“complex interplay of racialized social processes” (2022, p. 3). One process involves
determining who is deemed white based on phenotype and granting them social position that
affirms their status (Miller, 2022). This social position gives them access to structural, cultural,
and societal institutions that affirm their history, values, and sense of self. Since whiteness is a
“privileged social position” (Miller, 2022, p. 3), whites have shared interested in maintaining
their identity and dominance. Withers asserted that whiteness is racial power that is achieved
through “worldviews, values, frames, repertoires, narratives and symbolic values” (2017, p. 1)

20

that maintains and normalizes the oppression of non-whites. As such, whiteness and white
supremacy is accomplished through culture.
Modern public health practice in the United States began in the mid nineteenth century
and was very closely aligned with early urbanization efforts that focused on improving living
conditions and housing (Fairchild et al., 2010). There was a tremendous accumulation of
knowledge and resources for both healthcare and public health, but disparities in access to both
were prevalent (De Salvo et al., 2017). At the time, solutions to health crises that originated from
poor living conditions were to displace and remove Blacks and immigrants (Abel, 2004;
Corburn, 2007).
By the 20th Century, the growth of public health governmental capacity was occurring in
the United States (De Salvo et al., 2017). At the time there was a movement to capture and
quantify the link between socioeconomic conditions and health. The US Public Health Service
used methods developed by Metropolitan Life Insurance Company to implement social surveys
to quantify metrics such as poverty, illness, mortality, and social unrest (Garcia, 2021). Despite
the growth of public health programs and strategy, Black people’s health issues were of no
importance to public health. Public health experts of the time believed that the Black community
should bear the burden of resolving their issues without any funding or government support
(LaVeist, 2012; Oppenheimer, 2001). This line of thinking was a departure from earlier interest
in the Black populations’ health by slave owners who wanted to ensure their property was
healthy for optimal productivity (Ford et al., 2019). In 1913, only one of nine health departments
surveyed in the South reported focusing on Black health issues (Oppenheimer, 2001). One
notable diversion to this line of thinking was the Tuskegee Syphilis experiment conducted by the
US Public Health Service from 1932 to 1972 (Lombardo & Dorr, 2006). The Public Health

21

Service Study of Untreated Syphilis in the Male Negro is infamous for its racism and medical
research abuse, but post study commentary document eugenics, bureaucratic inertia, and personal
agendas of study personnel as explanations for the initiation and long duration of the study
(Bates & Harris, 2004; Lombardo & Dorr, 2006). Bates and Harris posited that the exploitation
and arrogance of the US Public Health Service led researchers to believe they owned the bodies
of the hundreds of Black men who participated in the study (2004), much like slave owners
owned the Black bodies of slaves (Patterson, 1982). This commodification of Black bodies likely
occurred because white oppressors saw Black people as not human, which made it easier to
justify extracting labor from and controlling Black people (Patterson, 1982). The legacy of this
study and earlier acts of exploitation is a distrust of the field of medicine and public health, low
Black participation in clinical trials and organ donation, and fear of genocide (Gamble, 1997).
Civil rights law has been proven to reduce health disparities, further proving that
structural racism is a primary driver of poor health in Black and other communities of color
(Hahn, 2018). Almond et al., (2006) examined national infant mortality data to determine the
association between Title VI of the Civil Rights Act and infant mortality rate trends and found
that between 1965 and 1971, infant mortality rates among non-whites fell by 40%. Similar
findings were observed for childbearing outcomes for Black women in 1955-1975 and their
daughters born in the 1980s-1990s (Chay & Greenstone, 2000). Recent data on infant and
maternal mortality in the Black population indicate regression in many of the advancements
made during the Civil Rights era. From 2007 to 2016, Black women had higher pregnancy
related deaths than their white, Hispanic, and Asian/Pacific Islander counterparts (Peterson et al.,
2019) and although infant mortality rates have decreased overall, the Black/white disparity
remains and can be linked to social determinants of health such as racism related stressors,

22

healthcare access and quality, education, economic stability, and build environment or “place”
(Jang, 2022). There are similar findings for all-cause mortality in the Black population as well.
From 1999-2020, the Black population in the United States had more than 1.63 million excess
deaths and over 80 million excess years of life lost compared to the white population. After a
period of improvements in reducing disparities, progress stalled, and the differences in Black and
white mortality worsened in 2020 (Caraballo et al., 2023). Estimates of the economic cost of
these health inequities range from 421- 940 billion US dollars (LaVeist et al., 2023).
Other Systems of Oppression and Their Links to Public Health
Public health is not unique in its white supremacist foundation. Other social systems,
such as urban planning (Corburn, 2007), education (Tuck & Yang, 2018), and healthcare (Dent,
et al. 2021; Elers et al., 2021; Ford & Airhihenbuwa, 2010; Institute of Medicine, 2003;
Oppenheimer, 2001), have similar white supremacist foundations (Griffith et al., 2007; King et
al., 2022) and ironically play a significant role in population health (Hahn et al, 2018).
Consequently, these institutions bear responsibility for the intentional and unintentional
systemic inequalities of public and private organizations that are birthed from them, becoming
tools of oppression for the marginalized populations they claim to want to help (Griffith et al.,
2007). “When social determinants of health such as “place”, education, and healthcare are
improved in a community, improvement of population health follows (American Public Health
Association, 2022; Hahn et al., 2018), but when organizations control resources and critical
services in a racialized manner, the oppression is maintained (Griffith et al, 2007).
American public health and urban planning developed and aligned during the rapid
industrialization of society with the primary purpose of improving living conditions (Corburn,
2007). Solutions to overcrowding; disease outbreaks; and industrial, human, and animal waste by

23

sanitarians and urban planners included the removal and displacement of Blacks and poor
immigrants or placing the burden of environmental waste on the slums inhabited by this
population (Abel, 2004; Corburn, 2007). These efforts, along with more deliberate actions by
legislators and other officials such as zoning and redlining (McGrew, 2018), led to segregated
communities with highly variable resources that negatively impacted life expectancy for Blacks
and other people of color by as much as 20 years (DeSalvo et al., 2017; McGrew, 2018). As
such, a person’s zip code may be a “stronger determinant of health” than their genetic code
(DeSalvo et al., 2017 page 1).
Dumas provided commentary on Black suffering in the education system (Tuck & Yang,
2018), comparable to the public health system because of the similar population focus on
improving outcomes through prevention and promotion strategies. Education is an applied field,
where scholarship improves the lives of the population (Tuck & Yang, 2018). Public health is
both an applied and academic field (Cross, 2018). Similarly, research in public health is used to
improve health and prevent disease in populations. There is an implicit assumption that public
education is “a social good with the potential to improve society for all” (Tuck & Yang, 2018, p.
31), which is similar to public health which is typically regarded as an institution that is
constantly seeking to improve health, prevent disease, and reduce health inequities (APHA,
2022). Public health employees typically view themselves as protagonists, doing their best to
prevent disease and promote health (Annas & Mariner, 2016). However, the education system,
much like public health, was subject to anti-Black policies such as Plessy v. Ferguson that
sanctioned segregation practices that persisted after such policies were struck down (Hahn et al.,
2018).

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There is consensus that racial disparities exist in healthcare (Gamble, 1997; Hahn et al.,
2018; Institute of Medicine, 2003; Jones, 2002; Pasco, 2016; Rotenstein et al., 2021) and those
racial disparities exist partly because of the pervasiveness of anti-Blackness and Black suffering.
Pasco et al argues that racism “is undoubtedly embedded into the very foundations of
medicine…” (2016). In the 19th and 20th centuries, enslaved and free Blacks (living or dead)
were used as subjects for dissection and medical experimentation without their consent (Gamble,
1997). Dr. Marion Sims, often labeled the father of gynecology, performed up to 30 operations
on three enslaved Alabama women to develop a procedure to repair vaginal fistulas without the
benefit of pain management (Gamble, 1997). Medical professionals believed that there were
biological differences between Black and white people that impacted their susceptibility to
disease (Oppenheimer, 2001). Blacks were used as unwilling research subjects in gynecological
experiments without anesthesia, experimented on under the guise of a better understanding of the
natural course of untreated syphilis, and used as guinea pigs to determine cost effective ways to
reduce exposure to lead paint (Buchanan & Miller, 2006; Pasco et al., 2016). After the
acceptance of germ theory, Black people were blamed as the primary spreaders of communicable
diseases such as tuberculosis and syphilis (Oppenheimer, 2001; Smillie, 1943) despite the works
of scholars like W.E.B. DuBois (2003) linking the poor health of Blacks to social conditions
(Fullilove, 1943; Fullilove, 2020; Oppenheimer, 2001). In 1963, the United States Commission
on Civil Rights reported that 85% of hospitals in the South admitted racial segregation or
exclusion in their processes and protocols including refusing to place Black women in labor in
the obstetrics ward, separating white newborns from Black newborns in the maternity ward, and
excluding Black fathers from the delivery room (Muigai, 2022). In some cities, Black women
could only deliver their babies in certain hospitals (Muigai, 2022). The following year, the Hill-

25

Burton Act financed the construction of hospitals in the United States using the “separate but
equal” principle even after it was invalidated in education (Hahn et al., 2018).
The racist foundations of these systems and others such as housing, banking, and
employment further demonstrate that systems in American society are racist (Hahn et al., 2018;
Paradies et al., 2015). Furthermore, these systems are also social determinants of health, and
their racialized implementation in the United States further impacts the health of the Black
population (Hahn et al., 2018; Namer et al., 2022). Hahn argues that social determinants of
health are social systems and critical components of those systems are how they categorize and
assign value based on demographic categories such as race and class (2021).
Present Day White Supremacy in Public Health
As altruistic as public health may seem, it is anti-Black (King et al., 2022) and benefits
from Black suffering both externally regarding the Black population it serves (along with other
people of color) and internally among the Black public health workforce (Dumas, 2018). Modern
public health continues to operate under the same system of white supremacy, although much
more covertly (Ford & Airhihenbuwa 2010; Jones, 2018). Health disparities by race documented
hundreds of years ago (Burghardt Dubois, 1971; García & Sharif, 2015; Oppenheimer, 2001)
still persist today (Cobbinah & Lewis, 2018; Institute of Medicine, 2003) and have not improved
since 1985 (Neighbors et al., 2023). Schools of public health continue to reinforce hierarchy and
privilege (Chander et al., 2022) while subjecting students of color to marginalization and outright
violence (Wandschneider et al., 2020).
How public health conducts research and reports data can be used to reinforce
predominant stereotypes of racial and ethnic minoritized people and uphold white supremacy
(Day, 2021; Fullilove, 2020; Gilborn, 2010). Day (2021) contends that much of the data

26

reporting on Black people and communities reflects a deficit narrative that centers Black death
and suffering with lasting negative impacts on the Black community, those that view the data,
and those that research and collect the data. Prevailing beliefs about the unbiased nature of
quantitative research hides the realities of false interpretations, misleading arguments, and
assumptions that promote racial discrimination among minoritized populations (Gilborn, 2010).
The public health response to COVID–19 laid bare many pervasive gaps in addressing
the public health needs of diverse populations in the United States (Foster et al., 2021; Neighbors
et al., 2023). Data on COVID–19 hospitalization and death rates in July 2020 were higher for
Black Americans than white Americans. The pandemic has also increased unemployment and
decreased life expectancy for Black Americans (Andrasfay & Goldman, 2021; Neighbors et al.,
2023). Similar gaps in the provision of public health services were observed during hurricane
Katrina in 2005 (De Salvo et al., 2017).
Syphilis, once regarded as a “Negro problem” (Smilie, 1943) without regard to the social
conditions of the Black population at the time (Fullilove, 1943; Fullilove, 2020), still runs
rampant today (Lin, 2020). Ironically, Smilie’s (1943) analysis of syphilis data collected from
selectees for army service occurred from 1940 to 1942, a decade after the Tuskegee Syphilis
Experiment began and reinforce predominant stereotypes of racial and ethnic minoritized people
and their propensity to spread disease (Day, 2021; Fullilove, 2020; Gilborn, 2010).Currently, six
states do not require screening for congenital syphilis (Lin, 2020) and one of those states,
Mississippi, had a 900% increase in congenital syphilis from 2014-2021(Oeth, 2023).
The Flint Water Crisis of 2014 is a prime example of environmental racism. In early
2014, officials switched the Flint (Michigan) water supply source from the Detroit water
department to the Flint River (Muhammad et al., 2018). The switch caused lead to leach directly

27

into the water supply (Masten et al., 2016; Muhammad et al., 2018). The impact of the crisis
highlights the joint failings of urban planning and public health as thousands of predominantly
Black young children were exposed to high levels of harmful lead (Aquino & Montgomery,
2018; Inwood, 2018; Masten et al., 2016). The crisis went unabated for more than 1.5 years until
Dr. Hanna-Attisha, upon noting that the number of children with lead poisoning in the city had
nearly doubled, held a press conference demanding that the city’s water source be switched
(Aquino & Montgomery, 2018). Muhammad et al (2018) interviewed 68 predominantly Black
youth from Flint to understand how they conceptualized, interpreted, and responded to the
perception of racism as it relates to the Flint Water Crisis. Participants did not explicitly discuss
racism but brought up concepts of genocide that Gamble (1997) correlates to the aftermath of the
Tuskegee Syphilis Experiment, internalized racism, and acute awareness of the negative
perceptions of Blacks in Flint (Muhammad et al., 2018).
Disparities in Black infant and maternal mortality have been documented for generations
and are still occurring (Muigai, 2022). In the United States Black mothers and infants die at rates
two to three times higher than their white counterparts (Muigai, 2022). These disparities can be
partially traced back to the criminalization of Black midwives in the early 20th Century which
left Black women without vital prenatal care. Ironically, social welfare initiatives and the
increase in Black births in hospitals did not reduce the disparities in negative health outcomes
(Muigai, 2022).
The COVID–19 pandemic and summer of racial reckoning prompted by the murder of
George Floyd in May 2020 spurred many jurisdictions to confront racism as a public health issue
and a social determinant of health (APHA, 2022; City of Long Beach, California, n.d.; García &
Sharif, 2015, Owens-Young et al., 2023; Paradies et al., 2015). These declarations came over 40

28

years after the first studies on racism and health outcomes (Paradies, et al., 2015). Since August
2021, over 200 jurisdictions have passed declarations of racism as a public health issue in 37
states (APHA, 2022). For example, in June 2020 the City of Long Beach (California) adopted a
framework for reconciliation to end systemic racism in the city and underwent a two-month
process of engaging stakeholders to identify actionable goals and strategies (City of Long Beach,
n.d.). Although these actions are laudable, the irony of this collective action to seek racial justice
is that it is an exercise in seeking repair within a system designed and rooted in White supremacy
instead of working to dismantle the system (Tuck & Yang, 2018). Few of the resolutions provide
specific actionable steps on improving DEI and the pervasiveness of racism within public health
organizations (Owens-Young et al., 2023)
Significance of Local Health Departments to Public Health Practice
Local health departments (LHDs) have an important role in the provision of public health
services in the United States (Shah et al., 2016) and have been referred to as the backbone of the
public health system (Institute of Medicine, 2003). According to NACCHO, all LHDs exist “for
the common good and are responsible for demonstrating strong leadership in the promotion of
physical, behavioral, environmental, social, and economic conditions that improve health and
well-being, prevent illness, disease, injury, and premature death’ and eliminate health
disparities” (2005, p. 4).
Urban LHDs have a greater responsibility for health promotion and disease prevention
efforts as the United States continues to urbanize. More than 80% of Americans reside in urban
areas presumably under the jurisdiction of large LHDs focused on the social, economic, and
environmental challenges such as income inequality and housing affordability concerns (Juliano
et al., 2019). Some of the largest urban LHDs (part of the Big Cities Health Coalition) also

29

provide services such as clinical infectious disease screening and treatment activities for
HIV/AIDS and other sexually transmitted infections, chronic disease prevention services, smokefree ordinance enforcement, and injury prevention more frequently than smaller LHDs (Leider et
al., 2015).
LHDs in the United States provide various services that vary by organization location and
size. Clinical services include immunizations, screening, and treatment for both communicable
and chronic conditions, and maternal and child health services such as Nurse Family Partnership
(Cunningham et al., 2024). Population-based programs and services include epidemiology and
disease surveillance; primary prevention regulation, inspection, and licensing; and other
environmental services such as vector control and land use planning (Cunningham et al., 2024).
Local health departments also engage in policy in several areas related to tobacco, emergency
preparedness and response, infectious disease, and the social determinants of health
(Cunningham et al., 2024).
Many areas of focus within LHDs have an impact on the Black population. For example,
the HIV/AIDS pandemic disproportionately impacts Black people in the United States (CDC,
2013; McCree et al., 2020; Pellowski et al., 2013). HIV infection impacts populations who
experience economic adversity, live in urban areas with large income disparity and low social
capital, are subjected to more discrimination and prejudice, and have poor access to health care
(Pellowski et al., 2013). According to NACCHO, 58% of LHDs screen for HIV/AIDS while
39% provide treatment services for HIV/AIDS (2019).
Infant and maternal mortality continue to be a prevalent issue in the Black population
(Jang & Lee, 2022; Singh et al., 2021) despite overall reductions in infant mortality in the United
States over the last decade (Jang & Lee, 2022). In 2020, the Black infant mortality rate was 10.8

30

per 1,000 live births, almost double the overall rate of 5.58 per 1,000 live births (Jang & Lee,
2022). The disparities are greatest in Southern states but also persist in states with lower Black
populations such as Colorado (Jang & Lee, 2022). The risk of maternal mortality remained 2.3 to
5.3 times higher among Black women than white women during the past 50 years. In 2013-2017,
the maternal mortality rate per 100,000 live births was highest among Black women at 48.2
(Singh et al., 2021). LHDs provide programs and services for Women, infants, and children such
as WIC (64%), EPSDT (28%), and prenatal care (22%) (Cunningham et al., 2024).
The social determinants of health and health equity are a recent focus of local health
departments (DeSalvo et al., 2017; Hahn, 2021; Narain et al., 2019). Black people are
disproportionately overrepresented in homelessness, unemployment, incarceration, have poor
educational outcomes (Hahn et al., 2018; Ross, 1995), and continue to live in racially segregated
neighborhoods (CDC, 2013; Cobbinah & Lewis, 2018). Although the social determinants of
health and health disparity work are becoming more commonplace in public health practice, it is
often discussed and examined without explicit acknowledgement of the connection to racism,
allowing these disparities to continue unabated (Garcia & Sharif, 2015).
Demographics of the Local Health Department Workforce Are Misaligned With U.S.
Demographics
The public health workforce has been regarded as most critical in improving population
health, reducing health disparities, and advancing health equity in the United States (Bogaert et
al., 2019; Welter et al., 2020; Wilbur, 2020). However, LHD workforce composition is not
aligned with the myriad needs of a growing and diverse population (Bork et al., 2022; OwensYoung et al., 2023). This disconnect, if left unresolved, will allow racial health inequities to
continue unabated.

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Limited research existed on the make-up of the LHD workforce (Robin et al., 2019) until
2014 (Bogaert et al., 2019). Before that time, the public health workforce research was
organizationally focused (Bogaert et al., 2019). Most of what is known about the public health
workforce generally and the local health department workforce is from the Public Health
Workforce Interest and Needs Survey (PH WINS). First released in 2014, PH WINS is the
nation’s largest public health workforce survey (Leider at al., 2019) and is a collaboration
between the Association of State and Territorial Health Officials and the de Beaumont
Foundation. The survey contains four domains: workplace environment, training needs,
emerging concepts, and demographics (Leider et al, 2019).
The public health workforce is disproportionately white, older, and fewer in number
(Mitchell et al., 2022; Owens-Young et al., 2023; Porter et al., 2023) and white employees
remain overrepresented among upper management (Alang et al., 2021; Coronado et al., 2020;
Cunningham et al., 2024), except in larger LHDs, which tend to be more diverse (Bork et al.,
2022) albeit among lower level staff (Wilbur, 2020; de Beaumont, 2021). BIPOC public health
workers are more likely to report intent to turnover because of dissatisfaction with their
employment (Mitchell et al., 2022). The public health workforce has been short 50,000 staff
since 2008 (Bogaert et al., 2019) and concerns about staffing levels have been documented since
the early 1990s (Institute of Medicine, 2002). An analysis of intent to turnover of respondents to
PH WINS showed an increase from 15% in 2014 to 26% in 2017 (Bogaert et al., 2019). Lack of
diversity in LHDs negatively impacts ability to “improve community service, patient treatment,
and access to care” (Mitchell et al., 2022; Grissom & Keiser, 2011).
The demographic makeup of the United States is predicted to shift dramatically in the
next two decades (Coronado et al., 2020; Wilbur, 2020). By 2060 racial and ethnic minorities

32

will become the majority at 56% while the white population will decrease to 44% (Colby &
Ortman, 2014) with a unique set of health care challenges such as lack of access to care, greater
exposure to health risks, and limited financial resources (Schur et al., 2011). Additionally,
growth of the foreign-born population over the next several decades will exceed that of US
natives (Colby & Ortman, 2014; Coronado et al., 2020). Despite the shifts in US demographics,
racial and ethnic diversity in a number of healthcare professions has not kept pace with those
changes (Institute of Medicine, 2002; Owens-Young et al., 2023; Wilbur, 2020).
Marginalized communities are best served by “a diverse, equitable, and inclusive public
health workforce” (Owens-Young et al., 2023). Simply hiring more BIPOC public health
workers does not address the issue because the organizational culture needs to center diversity,
equity, and inclusion so that attitudes, beliefs, and practices of the public health workforce can be
centered towards equity (Owens-Young et al., 2023). Although public health has focused on DEI
and racial equity in recent years (Alang et al., 2021), perceptions of organizational focus on DEI
efforts by the workforce vary (Owens-Young et al., 2023). Black employees had the lowest level
of perception of organizational prioritization of DEI efforts when surveyed possibly due to lived
experience, increased likelihood of experiencing discrimination and exclusion, and the
perception of public health DEI efforts as performative (Owens-Young et al., 2023).
Deeply rooted structural racism embedded in our social systems, including the health care
system and its health workforce, is a core cause of racial health inequities (Dent, Vichare, &
Casimir, 2021; Schenk et al., 2022). These systems and structures are overt and covert, and
deeply pervasive (Neighbors et al., 2022). Furthermore, employee bias in local health
departments contributes to health disparities by race, distrust of the healthcare system (MurrayGarcia et al., 2014), and poor quality of care (Institute of Medicine, 2003).

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Significance of BIPOC Local Health Department Workforce in Addressing Health
Disparities
BIPOC public health employees are integral to eliminating health disparities and
improving access to care among BIPOC populations (Mitchell et al., 2022; Owens-Young et al.,
2023 et al., 2023; Wilbur et al., 2020). Black public health employees have a significant role in
program development and community engagement with Black populations, who have many of
the worst health outcomes in the United States due to systemic oppression and racism (Institute
of Medicine, 2003). Black governmental public health employees reported the highest levels of
confidence in addressing health equity in their work compared with their colleagues who selfidentified as members of other racial and ethnic groups (Porter, et al., 2023). Unfortunately, their
unique experiences are not captured as data for Black LHD employees is typically aggregated
under the category of “BIPOC” or “nonwhite” in research (Deo, 2021; Harper et al., 2015).
Despite the value BIPOC public health employees bring to the field, they are more likely
to report intent to turnover and actual turnover than their White counterparts (Mitchell et al.,
2022). There may be a number of reasons that BIPOC reports intending to leave or actually
leaving the public health workforce such as compensation, poor workplace conditions, and
negative climate (Mitchell et al., 2022). Workplace conditions and climate are important factors
relative to job satisfaction and employee turnover (Bogaert et al., 2019; Mitchell et al., 2022).
As mentioned earlier, many researchers use “turnover” and “intent to turnover” as a means to
study job satisfaction (Bogaert et al., 2019; Mitchell et al., 2022). Although useful in some
respects, it does not address the exploitation of organizations who seek to extract value while not
“valuing those that create value” (Clark, 2020, The Bowling Lane and the Gutters, para. 3). The
metrics used to measure job satisfaction perpetuate the stereotype that Black people are only

34

valuable as laborers, workhorses, or servants. The use of these metrics also ignores the economic
implications of quitting for Black workers in public service jobs who often have families to
support and considerations such as health insurance and pensions. In essence, turnover and intent
to turnover may not be accurate or realistic metrics to determine job satisfaction.
Public health work can be challenging and stressful, particularly when enforcing
mandates during a highly politicized COVID–19 pandemic along with ensuring core services are
maintained (Hwang, 2022; Jackson, 2022; Schenk et al., 2023; Sears et al., 2022). Public health
workers also face stress from underfunded programs, shortened or non-existent career ladders,
and overwhelm from increased workload (Schenk et al., 2023). A key stressor among helping
professionals such as public health workers is exposure to the traumatic experiences of the
populations served, which leads to secondary traumatic stress. Symptoms of secondary traumatic
stress mimic those of post-traumatic stress disorder and can lead to burnout (Jackson, 2022). In
2021, more than half of the public health workforce reported symptoms of post-traumatic stress
disorder and more than 20% reported fair or poor mental health (deBeaumont Foundation, 2021).
BIPOC employees report greater discriminatory incidents at work (Bell et al., 1997;
Utsey et al., 2002), and due to negative stereotypes and racial discrimination, they often concede
to a subordinate status at work (Feagin, 1991; Heilman et al., 1992). Because their identities are
not consistent with their workplace requirements, BIPOC employees may find it hard to express
their true self and limit their work behaviors (Foley et al., 2002). Poor racial conditions in the
workplace have a “double-negative impact on minorities” (Singh et al., 2013, p. 248) – they
undermine BIPOC perceptions of the work environment, and prompt poor behaviors in response.

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Unique Challenges of Black Employees in the Workforce
The unique experience of Black workers in the United States dates back to slavery where
mass labor and production led to organizational and management practices that are still used
today (King et al., 2023). At the time, the goal was to understand “how best to extract labor,
knowledge, and other resources from Black workers” (King et al, 2023, p. 146). It is against this
context that anti-Blackness in the workforce persists.
Anti-Black racism “exerts a significant effect on the well-being” (Clark et al., 1999) of
Blacks in a variety of settings and is a “common, unifying” experience (West et al., 2010 pp 332)
that shapes lived experiences (King et al, 2023). In the workplace, Blacks face a unique set of
challenges as they deal with environments that center whiteness and devalues non-whiteness
(King et al., 2023). Anti-Black racism, both overt and covert, manifests within the workplace and
upholds employment discrimination (McCluney et al., 2021), microaggressions (DeCuir-Gunby
& Gunby, 2016), and other forms of oppression (King et al., 2023). These actions increase
stereotyping, marginalization and isolation of Black workers which makes it difficult for them to
leverage social networks (Wingfield, 2019).
One example of this is the concept of professionalism. Black employees engage in a
number of behaviors to promote a professional image at work and avoid being stereotyped
(McCluney et al., 2021). Another example is racial code switching, a process where Blacks
adjust how they present to mirror the norms, behaviors, and attributes of white culture
(McCluney et al., 2021). Examples of code-switching techniques are using white sounding
names and removing the evidence of racial and cultural activities on resumes, reducing the use of
African American Vernacular English and colloquialisms to increase perceptions of competence,
and straightening hair to match the dominant culture’s standard of beauty (McCluney et al.,

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2021). Blacks in the United States are likely to engage in racial code switching at work given
their underrepresentation in professional settings and their desire to combat stereotypes of
incompetence, anger, and hostility (McCluney et al., 2021). Members of marginalized groups
tend to fare better in the workplace when they adjust self-presentation and manage other’s
perceptions of their identity (McCluney et al., 2021).
Exposure to racially traumatic events outside of the workplace can negatively impact
Black employees at work. McCluney, et al. (2017) discussed the impact of racially traumatic
events (such as police brutality) on Black employees who may “call in Black” to protect their
mental health from organizations that do not have the capacity to provide psychological safety.
What remains unknown is the effects of racially traumatic events such as African American
infant mortality or a workplace race equity training, common topics of focus in local health
departments, on the mental health of the Black local health department workforce.
Many Black employees struggle with belongingness and uniqueness in the workplace
where aspects of their personhood are devalued in favor of the white male status quo (McCluney
& Rabelo, 2019). Black employees are likely to be proactive about managing their professional
image in anticipation of bias due to negative racial stereotypes such as inadequate skills and low
job competence (Wayne et al., 2023). Self-promotion or strategic visibility (McCluney &
Rabelo, 2019) is one method used to counteract those biases, but doing so can have deleterious
effects on Black employees, especially Black women (McCluney & Rabelo, 2019), particularly
if supervisors perceive the self-promotion as counter-stereotypical behavior (Wayne et al, 2023).
Black employees are then left to decide to either endure negative perceptions of their
competency or face racial backlash for self-promotion (McCluney & Rabelo, 2019; Wayne et al.,
2023).

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Blacks experience double consciousness in a variety of settings, including the workplace.
DuBois coined the term double consciousness to explain the tension Black Americans hold
between their Blackness and their American-ness in various settings (Itzigsohn & Brown, 2015;
Bell, 1990). There are three elements to DuBois theory: the veil, twoness, and second sight
(Itzigsohn & Brown, 2015; Kirkland, 2013). The veil signifies the color line and the separation
of races (Itzigsohn & Brown, 2015; Kirkland, 2013) present in American society. Thomas (in
LaVeist, 2013) discusses the color line and describes its central role in the persistence of health
disparities. Twoness refers to accepting the position of two worlds, the Black world, and the
white world during the process of self-formation (Itzigsohn & Brown, 2015). Second sight refers
to racialized individuals who can only see themselves through the world of the racializing group
(Itzigsohn & Brown, 2015). This ability subjects the racialized to constant dehumanization but
also allows glimpses into white society (Itzigsohn & Brown, 2015). The main point of DuBois
thoughts on double consciousness is that the existence of the color line prevents “the full
recognition of humanity of racialized groups” (Itzigsohn & Brown, 2015). Bell (1990)
documents this biculturalism as inherent in Black professional life and how race and racism
inform and impact the psyche of Black people at work generally and Black women specifically.
Langston grapples with the concept of twoness, biculturalism, and second sight as she describes
this tension as a physician working in a healthcare system that “continues to dismiss, ignore, and
mistreat Black people (2021, pp 1978). Foster et al., express similar dismay and lament of
carrying the burden of the “minority tax” of having to explain and consequently fix racism in
their work in the medical field (2021).
Black communities possess a collective consciousness and group identity (Sanchez &
Vargas, 2016) that develops from the shared experiences of trauma from exposure to systemic

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police terror (Evans & Clay, 2018; Waldron, 2021) and other forms of violence. Durkheim
defines collective consciousness as “the totality of beliefs and sentiments common to the average
members of the same society” (1893, p. 17). Collective consciousness requires emotional labor
and emotion work that leads to negative health outcomes for individuals directly affected and the
community as a whole (Evans & Clay, 2018). More describes this collective consciousness as
Blacks experiencing themselves as “invisible” (2009, page unknown) and interchangeable.
Racial battle fatigue is the accumulated impact of racism experienced by Black people
(Smith et al., 2007). Quaye et al (2020) describe racial battle fatigue among Black people
working in student affairs. Because they are Black workers in a helping profession (similar to
public health) they often provide assistance and support to BIPOC students who also hold the
cumulative effect of racism in their bodies. This continuous exposure to racism has negative
effects on Black people, causing stress, anxiety, depression, and other health impacts (Smith, et
al. 2007)
Black Americans have some of the worst social and health outcomes in the United States
(Gale et al., 2020; Wiliams & Mohammed, 2013) and are typically the focal point for public
health programs and interventions intended to reduce health disparities and improve health
outcomes (Institute of Medicine, 2003). Continued exposure to negative public health statistics
and social conditions of Blacks may cause Black employees working in healthcare and public
health to internalize and adopt the negative beliefs about their race that are held by whites,
causing detrimental mental and physical health outcomes (Gale, 2020; Jackson, 2022).
Psychological Safety in the Workplace
Psychological safety as a concept has its foundation in organizational change. Schein and
Bennis theorized that psychological safety was important in ensuring individuals felt secure and

39

capable of taking chances (Aranzamendez et al., 2015; Edmonson, 1999). It is defined as "one’s
perception of consequences for taking interpersonal risk in their work environment”
(Aranzamendez et al., 2015 p.172) and making decisions to proceed or retract based on that
assessment (Edmondson, 2004). Psychological safety is directly linked to engagement and
disengagement (Aranzamendez et al., 2015; Kahn, 1990; Kruzich et al., 2014), creativity,
commitment, and learning behaviors at work (Singh et al, 2013). Khan further describes
psychological safety as “feeling able to show and employ one’s self without fear of negative
consequences to self-image, status, or career” (1990, p. 708).
Clark argues that psychological safety consists of the security, belonging, and fulfillment
needs from Maslow’s hierarchy of needs and is “the manifestation of the need for selfpreservation in a social and emotional sense” (Clark, 2020, Introduction, para. 6). There are four
stages of psychological safety - inclusion safety, learner safety, contributor safety, and challenger
safety (Clark, 2020).
Inclusion safety is respect for the innate need to be included and accepted. In the
workplace it is the formal and informal admittance and acceptance into the organizational culture
generally and work teams specifically. Inclusion safety is not about tolerance but about genuine
invitations into one’s space in society and acknowledging their humanness (Clark, 2020).
Inclusion safety can be difficult to realize for Black workers because they typically have to mask
their identity (code switch) to conform to the dominant culture’s idea of professionalism and
acceptability (DeCuir-Gunby & Gunby, 2016).
Learner safety is respect for the need to learn, ask questions, experiment, and make
mistakes while developing subject matter expertise. Those without learner safety become passive
because of the potential consequence of crossing the line. Learner safety requires individuals to

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exert themselves and develop self-efficacy, but the organization may supply some of the
confidence and support the individual is lacking (Clark, 2020).
Contributor safety is respect for the need for meaningful contribution as a full-fledged
member of the team. Individuals are granted contributor safety when competency or subject
matter expertise is obtained. As individuals demonstrate subject matter expertise, the
organization typically grants more autonomy and authority. Individuals with subject matter
expertise often may be denied contributor safety for reasons such as bias, prejudice,
discrimination, or a lack of empathy (Clark, 2020). Blacks may receive fewer rewards, resources,
or opportunities (such as autonomy and authority) than they legitimately deserve despite
achievements. This phenomenon is referred to as treatment discrimination and is a prime
example of critical race theory’s critique of meritocracy (DeCuir-Gunby & Gunby, 2016).
Challenger safety is respect for the need to innovate and challenge the status quo.
Challenger safety provides individuals with the power to overcome the pressure to conform and
lends to creativity and innovation. Organizations tend to refrain from challenger safety because it
threatens existing power structures, resources, reward systems, and operation systems (Clark,
2020). Locke et al (2019) found that less than half of the governmental public health workforce
surveyed in 2014 believed that creativity and innovation are rewarded, an indication that
psychological safety, and more specifically challenger safety, might be lacking. An analysis of
2014 and 2017 PH WINS data (Bogaert et al., 2019) found that workforce members who wanted
to leave in 2014 were more likely to decide to stay in 2017 if they worked in an organization that
rewarded innovation and creativity (contributor safety), where communication was effective
(challenger safety), where professional development was taken seriously (learner safety), and
where employees were treated with respect (inclusion safety).

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Psychological safety and organizational DEI efforts are closely linked (Owens-Young et
al., 2023). “Most organizations grant equality and inclusion as a matter of policy; few live and
breathe it as a matter of culture and behavior” (Clark, 2020, Challenger Safety, para. 13).
Organizational commitment to DEI efforts can have positive and negative impacts on
organizational environment and culture. Organizations with a strong DEI culture tend to be more
psychologically safe, welcoming, and inclusive, which is integral to job satisfaction and
retention. The public health workforce reports greater job satisfaction in organizations they
perceive as prioritizing DEI (Owens -Young et al., 2023).
Black Local Health Department Workforce and Psychological Safety
Positive work climates influence all employees’ identification and behaviors but hold an
even greater significance for racial minorities (McKay et al., 2007; Singh & Winkel, 2012).
Research indicates that BIPOC employees find a pro-diversity work environment as more
affirming of their social identity, making them feel psychologically safe and motivated to
meaningfully contribute to the organization (Singh et al., 2013). However, the reverse can also
be true, illustrating the importance of psychological safety in such settings (Singh et al., 2013).
In diverse work environments, race plays an integral role in employees’ organizational
experiences, which impacts their attitudes and behaviors (Singh et al., 2013). BIPOC employees
have more occurrences of racism at work (Bell et al., 1997; Utsey et al., 2002) and react more
strongly to bias, discrimination, and prejudice at work, causing them to feel psychologically
unsafe in a workplace where they are not included or valued (Singh et al., 2013). Additionally,
they may fear negative evaluations which decreases employee confidence, forces them to limit
their behaviors and self-expression, and makes employees suspicious of surveillance and
judgment by superiors (Singh et al., 2013).

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Previous research has linked psychological safety to positive career outcomes and workrelated well-being (McCluney et al., 2021). Presenting or pretending to present one’s authentic
self (inclusion safety) through racial code switching generates respect in one’s field, status,
power, and access to networks (DeCuir-Gunby & Gunby, 2016; Clark, 2020; McCluney et al.,
2021). This comes at great cost to the physical and mental health of Black people who are forced
to suppress their cultural identity (McCluney et al., 2021). Organizations also lose creativity and
innovation (contributor safety) as Black employees promote the values and norms of the
dominant group instead of utilizing their lived experiences and cultural resources (McCluney et
al., 2021).
Griffith et al (2007) analyzed how allegedly neutral organizations such as local health
departments can be “oppressive and oppressed” (p.290) in the context of institutional racism and
how that impacts BIPOC employees. One form of oppression is administrative evil, described as
the idea that people can uphold the values of public service and ethics and still cause harm
(Griffith et al., 2007). In a county health department study in the rural South, Griffith found
patterns of oppression and administrative evil at the extraorganizational, intraorganizational, and
individual levels (2007). Such patterns can lead to a lack of psychological safety.
Few studies have addressed the role of psychological safety as a measure of job
satisfaction of the Black LHD workforce. More research is needed around the problem of
practice as it relates to this population, particularly because the Black public health workforce
plays a significant role in reducing health disparities and increasing health care access among
Black Americans who have some of the worst health outcomes in the country (Institute of
Medicine, 2003; Porter et al., 2023).

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Summary
Understanding institutional racism and psychological safety that may affect job
satisfaction among Black employees of LHD is an important problem to address. The review of
the literature demonstrates the complexity of the problem. Factors discussed include the white
supremacist nature of public health and local health departments, the misalignment of the
demographics of the public health workforce against an increasingly diverse US population, and
the unique challenges of Black employees in the workforce that have the potential to negatively
affect job satisfaction for Black LHD employees.

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Chapter Three: Methodology
Chapter Three presents the methodology of the research study. This study aimed to
examine psychological safety as an antecedent to job satisfaction among Black public health
employees of local health departments. Thematic research was utilized to study the participants’
lived experiences as it relates to psychological safety as described by participants. This chapter
explains the detailed process of developing research questions, design, setting, researcher’s
positionality, data sources, credibility and transferability, and ethics.
Research Questions
The study aimed to examine psychological safety as an antecedent to job satisfaction
among Black public health employees of local health departments. Four research questions were
used to guide this study:
1. How do Black employees perceive the relationship between institutional racism and
perception of psychological safety in local health departments?
2. What aspects of work in local health departments promote or inhibit psychological
safety for Black employees?
3. How do experiences of psychological safety differ for Black local health department
employees based on age, gender, type and location of health department, position, or
tenure?
4. From the perspective of Black local health department employees, how does
psychological safety impact their job satisfaction?
Overview of Design
The research study employed a qualitative research approach. Qualitative research
focuses on individuals, how they describe their experiences, and the meaning they derive from

45

those experiences (Merriam & Tisdell, 2018). Braun and Clarke defined qualitative research as
“words as data…collected and analyzed…” (Merriam & Tisdell, 2018, p. 6). In qualitative
research, the researcher collects and interprets the data (Creswell & Creswell, 2018).
Specifically, thematic research was used to study the lives of participants as they provided stories
about their lives (Creswell & Creswell, 2018). This research approach aligned with the purpose
of my study because I was interested in the lived experiences of Black local health department
employees relative to their psychological safety in the workplace. Additionally, it meshed well
with my theoretical framework, critical race theory, because the goal was to highlight narratives
of racism and discrimination from the viewpoint of Black employees (Graham et al., 2011).
Narratives have value as data because of the rich narratives of the participants’ lived experiences
and feelings (Graham et al., 2011). This research approach allowed me to focus on Black local
health department employees’ unique experiences and perspectives in a way that quantitative
research does not allow.
Semi structured individual interviews were used as a data collection technique (Merriam
& Tisdell, 2018). Semi-structured interviews include a mix of more or less structured questions
that allow for some flexibility in how the interview is conducted. Some of the questions, such as
demographic information, were highly structured, and questions about work experiences were
less structured to allow for more candid conversation with participants.
The study employed a purposive sampling method. This method assumes that the
researcher “wants to discover, understand, and gain insight and therefore must select a sample
from which the most can be learned” (Merriam & Tisdell, 2016, p. 96). The objective of the
purposive sampling was to select participants of varying perspectives and experiences to address
the research questions, speak to the conceptual framework, provide information to inform a

46

thematic analysis, and build rapport with participants to engage in conversations about their
experiences with psychological safety and institutional racism as local health department
employees. The data source was semi-structured, individual interviews to provide a safe and
confidential space for participants to share their experiences, thoughts, and perspectives on
psychological safety and institutional racism as local health department employees.
Research Setting
This study was conducted virtually via Zoom to accommodate Black local health
department employees working at any of the approximately 2,800 local health departments in the
United States (NACCHO, 2020; Porter et al., 2023). Recent data estimates the governmental
public health workforce at between 153,000 and 190,000 employees, with the number of Black
local health department employees ranging from 12 to 14 percent (Bogaert et al., 2019; Porter et
al.,2023) and larger local health departments having a Black workforce as high as 22 percent
(Juliano et al., 2019) .
The Researcher
I am most closely aligned with the transformative worldview. This worldview arose thirty
years ago and “holds that research inquiry needs to be intertwined with politics and a political
change agenda to confront social oppression at whatever level it occurs” (Creswell & Creswell,
2018, p. 9). The worldview focuses on the needs of marginalized populations, how their lives
have been impacted by oppression, and the political change needed to address these issues
(Creswell & Creswell, 2018).
Qualitative researchers are most interested in understanding how people interpret their
experiences and the meaning they attribute to them (Merriam & Tisdell, 2016). The role of the
researcher is to produce valid and reliable findings, develop or identify appropriate data

47

collection protocols, collect data ethically and responsibly, analyze results of the data collected,
and propose recommendations (Merriam & Tisdell, 2016). As such, researchers must understand
their positionality. I have a very close relationship with this topic based on my lived and work
experiences. I have twenty years of experience as an educated Black woman working for a large
local health department in a variety of capacities. I also have significant lived experience as a
former teen mother and lifelong resident of South Los Angeles where liquor stores outnumber
grocery stores. I understand public health from the perspective of a public health expert, a former
recipient of social services, and a resident of an under-resourced community.
I became interested in workforce issues in public health around 2014 when the unit I
worked in started to examine issues related to health equity and the social determinants of health.
I was asked to create a training module to increase staff awareness of the impact of racism and
the social determinants of health on health outcomes in the unit’s service area. Additionally, I
conducted a mixed methods study to determine if the staff had the skills to address the social
determinants of health and health equity using components of the Bay Area Regional Health
Inequities Initiative (BARHII) Local Health Department Organizational Self-Assessment Toolkit
(Public Health Institute, 2023). My research won a departmental award, and I drafted an
unpublished journal article on the research findings.
As part of my work, we are sometimes asked to attend racial justice trainings so that we
are better equipped to address race-based health inequities. On one occasion I was in a race
equity training and had a strong physical and emotional reaction to content that highlighted the
impact structural racism had on how Blacks navigate the various systems and institutions in
United States society. In short, the slide highlighted how Blacks had been failed by every system
in society (education, housing, employment, etc.). I became angry and sad instantaneously as I

48

reflected on the fact that the conversation was not about “those people,” it was about my
neighbors, my family, and me.
At the time of this research, I experienced the stress, anxiety, and frustration of being
passed over for a promotional opportunity for a job that I had successfully done for 3 years. I had
implemented a highly critical function for my place of employment during the COVID–19
pandemic, built processes and functions that did not exist previously – sometimes at a moment’s
notice, managed hundreds of staff, all while maintaining most of my regular work duties. The
work I did was so pivotal that it won three awards in two years and was the catalyst for building
out a more permanent program after the pandemic subsided. Once I realized that I would not be
given the opportunity to compete for the promotion, I began to experience mental and physical
distress. I felt my heart breaking. I experienced back pain and was told I have borderline high
blood pressure. I felt helpless, without knowing how to defend or stand up for myself. I kept
replaying in my mind how unfair it was and I would cry or become very upset when trying to
talk about it with friends and family. I wondered if I was being passed over for the opportunity
because I was a Black woman. In sharing my experiences with other Black colleagues in my
field of work and other industries, they shared similar frustrations with the inability to promote
or the unshakeable feeling that they were not safe. I now know that I was being actively denied
inclusion safety and contributor safety, two of the four types of psychological safety Clark
(2020) describes in his book on the topic.
My first understanding of the power structures that exist in society occurred when I was
in junior high school. In 1991 the Rodney King beating and the murder of Latasha Harlins taught
me very important and difficult lessons about the value of Black lives. Both incidents, and the
resulting civil unrest in 1992, taught me that American systems and institutions were not

49

designed to benefit Black people. As I aged and entered the workforce, I came to understand that
every system in society devalues Black lives in much the same way.
I am keenly aware of the anti-Blackness within the public health workforce because of
the time I have spent working there and the many experiences I’ve had, but I realize that I may
not be aware of the full breadth of extant strategies to improve psychological safety of Black
employees. I also don’t have a full understanding of the politics behind decision making and
policy change that would create a more psychologically safe environment for Black public health
employees.
Data Sources
This thematic research included at least ten semi-structured interviews with 18 openended questions and corresponding probes. Appendix A includes the interview questions and
shows alignment to the research questions and conceptual framework. The target population was
current local health department employees who identify as Black. Interviews were conducted via
Zoom’s recorded video conference format and transcribed using Otter.ai. Password protected
digital files were kept for all interviews and documents to protect confidentiality. This section
provides details about the data sources and how they were applied to the study.
Participants
Participant selection was done with purposeful intent (Creswell & Creswell, 2018).
Purposeful sampling is “based on the assumption that the investigator wants to discover,
understand, and gain insight” (Merriam & Tisdell, 2016, p. 96) and must select participants from
which the most information can be learned. Participants were selected based on meeting the
criteria of self-identifying as Black and being currently employed at a local health department in
the United States.

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Network sampling is the most common form of purposeful sampling (Merriam & Tisdell,
2016). This strategy was used to identify new participants by asking for referrals from previously
identified participants (Merriam & Tisdell, 2016). Network sampling was selected as a
recruitment method because of the extensive network I have acquired over twenty years in the
public health field. I can easily locate a few key participants who meet the sampling criteria who
I can ask to refer me to other participants.
The literature suggests that one to two participants should be studied in a narrative study
(Creswell & Creswell, 2018). Ten participants were studied, with a focus on reaching a point of
saturation (Creswell & Creswell, 2018). To select the 10 participants, I used social media sites
such as LinkedIn and Instagram to target public health affinity groups. Doing so was critical to
recruitment as it offered instant communication with people from a broader geographical area
(Marks et al., 2017). The sampling criteria eligibility questions were:
1. Name
2. Email
3. Gender
4. Do you self-identify as Black?
5. Are you currently employed at a local health department in the United States?
a. If yes, which city/county and state
6. Are you employed full-time or part-time?
Instrumentation
An interview protocol was the chosen implementation (Appendix A). Semi-structured
interviews using open-ended questions are ideal for beginning researchers (Burkholder et al.,
2020). Additionally, due to the sensitive context of some of the questions, honest answers would

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not be likely shared in a focus group setting. Open-ended interviewing was selected because it
offered the researcher and participant a subjective conversation experience. I explored emerging
themes during the interview (Morgan, 2014). Further, the constructed narrative and historical
context from the participant’s experiences and perspectives led to more beliefs and meanings for
me to examine (Morgan, 2014).
The interview questions were constructed for clarity to avoid confusion for the participant
(Krueger & Casey, 2009). Interview questioning included the three factors from Bandura’s
triadic reciprocal model (Bandura, 1989). Strategic placement of the questions for a
conversation-style interview included personal, behavioral, and environmental factors.
According to Kruger and Casey (2009), question sequences generally start broad and narrow
down to the specific research questions the researcher is trying to answer. For this study, the
sequence of questions started broadly about general work history and then narrowed to specific
obstacles the participant may have faced during their tenure in the local health department.
Pilot testing was conducted to establish the content validity of the scores on the interview
protocol; provide an initial evaluation of the internal consistency of items; and to improve
questions, format, and instructions. Pilot testing also provided an opportunity for determining
length of study (Creswell & Creswell, 2018).
Data Collection Procedures
Data was collected in August and September 2023. This included at least 10, 45-to-60-
minute virtual interviews with participants. I used social media sites such as Instagram and
LinkedIn as potential recruitment sites. These are best suited to give me access to the ideal
participants for the study because there are many Black public health professionals on these
applications and there are a number of active public health groups and accounts there as well.

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Examples of groups and accounts on LinkedIn that I used to recruit Black local health
department employees across the United States are Black in Public Health, Sisters in Public
Health, and American Public Health Association
Data Analysis
Analysis of data collection followed a systematic method by following Creswell and
Creswell’s (2018) data analysis process. There are five steps:
1. Data from recorded interviews will be collected and stored in organized digital,
password-protected files.
2. Data will be reviewed and assessed for mean-making, connections between
participants’ comments, and generalizability.
3. Data will be continuously coded and organized categorically and chronologically
to help identify patterns and themes from the participant’s perspective and attempt
to explain those patterns and themes (Merriam and Tisdale, 2016). Major ideas
that arise will be noted.
4. Thematic findings from the coding analysis will be presented. Findings will
include narratives and direct quotes.
Data was coded and analyzed using critical race theory which focuses on race-based
power dynamics, privilege, and the life experiences of marginalized populations. Additionally,
the transformative worldview was also taken into consideration while coding. The worldview not
only focuses on the needs of marginalized populations, but on how their lives have been
impacted by oppression, and the political change needed to address these issues (Creswell &
Creswell, 2018).

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ATLAS.ti, a computer-assisted qualitative data analysis software, was used to code
interview transcripts. The software’s “AI Coding” feature was used for first round open coding.
Subsequent rounds of coding were conducted by hand using Microsoft Excel.
Credibility and Transferability
Credibility is “one of the strengths of qualitative research” (Creswell & Creswell, 2018,
p. 199) and is based on the accuracy of findings from the perspective of the researcher,
participant, or the reader. To ensure credibility, member checking and clarification of researcher
bias was used. The participants of the study served as a check throughout the data analysis
process. I entered into an ongoing dialogue regarding my interpretation of the participant’s
experiences and interpretation to ensure the validity of the data. I used a rich, thick description to
convey my findings. Additionally, I clarified my bias in the dissertation proposal under the
heading “The Researcher.”
To ensure transferability I included rich and detailed descriptions so that those interested
in transferability will have a framework to follow (Merriam & Tisdell, 2016, p. 203). Transcripts
were checked for errors that may be made during transcription. Continuously comparing data
with the codes to prevent a drift or shift in the definition of codes was also employed. Finally, I
cross checked codes with another researcher to seek intercoder agreement.
Ethics
This research served several interests. First, Black local health department employees'
thoughts, concerns, and experiences were acknowledged and validated. Second, upper
management and human resource offices of local health departments as well as entities such as
the American Public Health Association and the National Association of County and City Health
Officials would also be interested in this research since these entities have a vested interest in the

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public health/local health department workforce. Third, the general public benefits from this
research because it will hopefully help local health departments improve job satisfaction for
Black employees which will in turn improve health outcomes and reduce disparities in
communities.
Qualitative interviewing can be an intrusive and traumatic process for the participant
(Merriam & Tisdell, 2016). It can be traumatic for Black local health department employees to
recall negative work experiences and there can also be some discomfort in disclosing details that
would have negative consequences if discovered by the employer. I followed the ethical
principles set forth by the University of Southern California’s Office for the Protection of
Research Subjects (OPRS) and the Institutional Review Board (IRB) to recruit and conduct
research on human subjects. Recruitment of participants included a detailed information sheet
regarding consent for recording interviews, the voluntary process of participation, that interviews
can be stopped at any time, the confidentiality of the interview and associated data, and the
faculty advisor’s contact information. Additionally, information and data related to the study was
stored in password-protected digital files and locked cabinets for hard copies. Ensuring the
protection of confidentiality and integrity of the subject and study is critical. Interviews were
conducted via Zoom, a web-based conference platform, in a closed office for added privacy and
confidentiality.
Using affirming and appropriate language in the research setting is important in building
rapport with participants (Patton, 2002). One example is avoiding the use of gendered language
or making assumptions about identity when asking questions. Providing space for participants to
show up as their true selves helped eliminate labeling (Patton, 2002).

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Avoiding ethical dilemmas helped to enhance the validity of the research. Extant
relationships with participants can be a major ethical dilemma (Merriam & Tisdell, 2016).
Therefore, participants were not direct reports or immediate colleagues of my place of
employment. Also, correspondence shared with participants addressed the intention of ceding
power as the researcher and maintaining a collegial relationship (Merriam, et al., 2001). Results
were shared with all participants and they were given pseudonyms to ensure the protection of
confidentiality and anonymity (Creswell & Creswell, 2018).
Unfortunately, the group most likely to be harmed is the focus of the research, Black
local health department employees. It can be traumatic to recall negative work experiences and
there can also be some discomfort in disclosing details that would have negative consequences if
discovered by the employer. Local health departments could be harmed if the data is negative.
For example, philanthropic organizations may decide not to provide funding if it is found that
local health departments are not ensuring their workforce is psychologically safe. Community
agencies may decide not to collaborate with local health departments. County, state, and/or
federal agencies might sanction or penalize the local health departments in some way based on
the research.
The study design was based on a personal experience I had during a race equity training
at work where I experienced emotions of anger and sadness after seeing the glaring negative
outcomes experienced by Black people across all systems in society. This study has implications
on the health and longevity of Black Americans because it will highlight what is happening to
the Black public health workforce who play a vital role in improving health access and
eliminating health disparities.

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Voluntary participation and informed consent were ensured by requiring participants to
sign consent forms that provided information on any potential harms as a result of participation.
Participants’ information will remain confidential. Any identifying information, including video
and audio of participant interviews, was stored securely per IRB guidelines.

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Chapter Four: Results or Findings
This study aims to examine psychological safety as an antecedent to job satisfaction
among Black public health employees of local health departments. For purposes of this study,
psychological safety was defined as "one’s perception of consequences for taking interpersonal
risk in their work environment” (Aranzamendez et al., 2015 p.172) and making decisions to
proceed or retract based on that assessment (Edmondson, 2004). Psychological safety is directly
linked to engagement and disengagement (Aranzamendez et al., 2015; Kahn, 1990; Kruzich et
al., 2014), creativity, commitment, and learning behaviors at work (Singh et al, 2013). Khan
further describes psychological safety as “feeling able to show and employ oneself without fear
of negative consequences to self-image, status, or career” (1990, p. 708). NACCHO defines a
local health department as the “governmental public health presence at the local level” (2005, p.
9). The agency could be locally governed, a division of a state health department, or some other
arrangement where the local health department is responsible for public health functions and has
governmental authority (NACCHO, 2005, 2020). LHDs are “the critical components of the
public health system” (Institute of Medicine, 1988, pp. 78). A significant amount of public health
work in the United States occurs locally at local health departments (LHDs) across the country
(NACCHO, 2020). The LHDs represented as part of this study include small, medium, and large
agencies in rural and urban areas with varying degrees of diversity.
A purposeful sample of Black LHD employees, defined as current local health
department employees who identify as Black, were identified via a demographic survey. Twelve
Black LHD employees were initially identified to participate in the study. From the initial
participants, 10 agreed to participate in the study. One did not follow through with their desire to
participate in the study, and one person did not meet the criteria outlined in the demographic

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survey. The demographic survey allowed participants to confirm their membership in the
intended target population for the research study and their willingness to participate.
Interviews were conducted with 10 participants to gather data on their lived experiences
and to document their actual LHD experience from their perspective. The interviews allowed an
opportunity to gather experiential data to better understand the lived experiences of Black LHD
employees including experiences of institutional racism and lack of psychological safety as it
relates to job satisfaction. Four research questions were used to guide the interviews:
1. How do Black employees perceive the relationship between institutional racism and
perception of psychological safety in local health departments?
2. What aspects of work in local health departments promote or inhibit psychological
safety for Black employees?
3. How do experiences of psychological safety differ for Black local health department
employees based on age, gender, type and location of health department, position, or
tenure?
4. From the perspective of Black local health department employees, how does
psychological safety impact their job satisfaction?
This chapter includes a discussion of the participants including specifics on key
demographics and brief biographical sketches. Following are the experiences of the participants.
The experiences are categorized into themes and organized by the four research questions
developed for the study.

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Participants
Ten Black governmental public health employees participated in the study. Two of the
participants identified as men, and the remaining eight identified as women. The age of the
participants ranged from 26 to 43 years. Tenure of the participants ranged from 13 months to 6
years. Participants represented seven states, identified by the federal division name and region
number to protect the identity of participants, and worked in local health departments of varying
sizes. A wide range of occupations were noted among participants. Although all participants
indicated they were Black in the screening survey, two self-disclosed during interviews that they
were African Diasporans. Table 1 provides an overview of the participants in the study. The
participants come from seven States that have been de-identified to five of the nine the U.S.
Census Bureau Census Regions and Divisions of the United States (U.S. Census Bureau, n.d.).
Participants have a variety of occupations including DEI, environmental sciences, community
engagement, community health, program coordination, research, training/facilitation, program
supervision, education consultation, and health education. The participants have over 29 years of
collective LHD experience, with an average of 2.975 years of experience per participant. The
average age of participants is 32.5 years with the youngest participant being 24 and the oldest
being 43 years.

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Table 1
Participant Demographics
Participant
pseudonym
Federal division the
LHD is located (Region
#)
Occupation Tenure Age
Crenshaw South Atlantic (5) DEI 1 year 1 month 27
Slauson South Atlantic (5) Environmental sciences 1 year 26
Nipsey West South Central (7) Community engagement 5.5 year 34
Leimert Pacific (9) Community health worker 4 years 24
Bradley Pacific (9) Program coordinator 5 years 40
Ridley Middle Atlantic (2) Research 3 years 34
Mitchell Middle Atlantic (2) Trainer/facilitator 6 years 32
Dawson West North Central (4) Program supervisor 2 years 34
Baldwin Pacific (9) Education consultant 2.5 years 43
Burke Pacific (9) Health educator 8 months 31
Each participant’s pseudonym represents a significant aspect of my lived experience.
Crenshaw and Slauson are major intersections on the west side of South Los Angeles where I
currently reside. My mother also graduated from Crenshaw High School in the early 1970s.
Nipsey Hussle, also known as Ermias Joseph Asghedom, was a highly respected rapper,
businessman, and activist who grew up and ultimately died in the Crenshaw and Slauson area.
Leimert Park and Leimert Park Village are considered the center of Black history, culture, and
art in Los Angeles. Baldwin Hills, sometimes referred to as Black Beverly Hills, is a
neighborhood where my great grandparents moved after restrictive covenants were lifted in Los
Angeles. My great-grandfather, a respected Realtor, helped many Black families purchase homes

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in the area. Tom Bradley was the first Black Mayor of the City of Los Angeles and lived in the
Baldwin Hills area. Mark Ridley-Thomas, former 2nd District Supervisor of the County of Los
Angeles, created and implemented the Empowerment Congress, a coalition of community
members who helped shape the 2nd Supervisorial District. I participated in the Empowerment
Congress for several years as a member and co-chair of the health subcommittee. Holly J.
Mitchell is the current 2nd District Supervisor of the County of Los Angeles. Mitchell has been
an ardent supporter of programs that I participated in such as the Women’s Policy Institute (now
called the Solis Policy Institute) and the Los Angeles African American Women’s Public Policy
Institute (LAAAWPPI). Mitchell also wrote the foreword of my first book. Marqueece HarrisDawson is the Councilmember for the 8th District of the City of Los Angeles where I live.
Councilmember Harris-Dawson appointed me to the inaugural Health Commission of the City of
Los Angeles, which I chaired for two years before stepping down. Yvonne Brathwaite Burke was
the first Black woman Supervisor in Los Angeles County and is a graduate of University of
Southern California Law School.
This section includes brief sketches of the 10 study participants to further contextualize
their identities and work environment. The sketches are also a statement of the value to the
institution of public health they bring as employees (Mitchell et al., 2022; Owens-Young et al.,
2023 et al., 2023; Wilbur et al., 2020) and the intrinsic value of their humanity, which is often
unrecognized. Further, these summaries offer a counter narrative to the prevailing ideals of the
Black workforce as workhorses or servants (ross, 2020).
Crenshaw
Crenshaw is a female who does DEI work for a local health department in a primarily
conservative area in the South Atlantic Division in the United States. Crenshaw works on a

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variety of initiatives based on the social determinants of health such as healthy food initiatives
and access to healthcare. Crenshaw’s work also focuses on internal policy development,
specifically equitable hiring practices and training. Crenshaw is proud of the work she’s done so
far but feels that her “skills and capabilities are being very limited” because of the conservative
nature of the jurisdiction.
Slauson
Slauson is a female who works in environmental sciences in the South Atlantic Division
in the United States. Slauson described a lack of effective onboarding, communication gaps, and
microaggressions in her first work location while reporting to a white supervisor. However, she
underwent a positive shift when switched to a different lab under a new mentor, a Black woman.
The new supervisor provided a supportive, open-minded atmosphere, embraced reverse
mentoring, and allowed Slauson to work independently, fostering a healthier work environment.
Nipsey
Nipsey is a female located in the West South Central Division of the United States. She
shares her five-and-a-half-year experience working for a health district as the director of
community engagement and strategic partnerships. Nipsey discusses encounters with pay
disparity, the emotional toll and challenges of being one of the few black directors in her
organization and grappling with systemic racism and unequal treatment. Despite adversity,
Nipsey remains committed to her job, acknowledging the value of her role and the support from
her executive director.
Leimert
Leimert is a male working as a community health worker for a Health Department in the
Pacific Division of the United States. The department serves a diverse county, although the

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hosting area is predominantly white. As one of the few Black males in the department, he
emphasizes the importance of being a role model, especially in youth outreach and advocacy.
Leimert discussed the need for more diversity in public health roles. He touched on institutional
racism within policies and cultural norms and addresses issues like burnout, difficult work
schedules, and the lack of affinity spaces for marginalized groups.
Bradley
Bradley is a female who works in a local health department in the Pacific Division of the
United States. Bradley, started as a temp and progressed to a program manager. She discussed
disparities in hiring and wages for people of color within her organization. Bradley expressed
frustration with organizational challenges, such as the lack of acknowledgment of racial
injustice, communication issues, and financial decisions that seem contradictory. Despite the
difficulties, Bradley finds fulfillment in her work, emphasizing the importance of community
engagement and equity.
Ridley
Ridley is a female who works at a local health department in the Middle Atlantic
Division of the United States. Ridley, a researcher, started her role during the early days of the
COVID–19 pandemic, adding to the unique and traumatic nature of her experience. Despite the
rewarding aspects of her job, Ridley finds the bureaucracy frustrating and observes disparities in
the execution of health equity goals. Ridley expressed frustration with the underfunding of public
health, especially in community-based programs, and the constant struggle to achieve
meaningful impact with limited resources.

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Mitchell
Mitchell is a female who works at a local health department in the Middle Atlantic
Division for the past 6 years. Mitchell shared the complexity of her work environment,
emphasizing the challenges faced during her initial year at the agency, which prompted her to
change roles. Mitchell reflects on the intersectionality of her work and the importance of
addressing racial disparities in her role as an overdose prevention trainer. Mitchell reflected on
her contrasting experiences working with two teams within the New York City Health
Department. The first team, despite being led by people of color, presented a challenging
dynamic with unsupportive supervisors and a toxic work environment. In contrast, Mitchell
describes her positive experience with the second team, which prioritizes racial equity and
provides a supportive work environment.
Dawson
Dawson, a 34-year-old male working at a local health department in the West North
Central Division, shared his experiences as an African American gay man in a predominantly
white LHD. He discusses the challenges he faced such as encountering racism and anti-black
sentiments. Dawson reflects on the differences in racism between the South, where it is overt,
and his current location, where it is more passive-aggressive. He highlights the disparities in
healthcare, particularly in addressing outbreaks like mpox (monkeypox), and criticizes the lack
of genuine efforts to engage with Black communities.
Baldwin
Baldwin is a female who has 2.5 years of work experience in public health at two local
health departments in the Pacific Division in the United States. Baldwin highlighted the
challenges of being a minority in a workplace where stereotypes and biases affect hiring

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practices and the overall work environment. Baldwin expressed the difficulties of navigating a
predominantly white workspace and emphasizes the emotional toll it took. She talked about the
added pressure to prove her worth and facing skepticism even when holding advanced degrees.
Despite the challenges, she remains proud of her cultural background and strives to create a more
inclusive work environment.
Burke
Burke, a 31-year-old female working at a local health department in the Pacific Division
of the United States, serves as the program coordinator for the oral health program in a public
health unit. Working with a diverse team, Burke focuses on outreach to vulnerable communities,
including children, and emphasizes the importance of in-person networking despite technological
advances. Proudly characterizing her team as superheroes, Burke acknowledges being one of the
few Black team members and emphasizes the significance of representation. Despite challenges,
her rewarding experiences keep her dedicated to the mission, and discussions with colleagues
inspire her to explore a potential future in the medical field, recognizing the importance of
diversity in healthcare leadership.
Participant interviews were the first step in data collection. Since this study consisted of a
purposeful sample of Black LHD employees, themes were developed not solely on the number
of times an issue was discussed but also as the issue related to the literature reviewed as part of
the development of the study. For example, participants may not have explicitly identified
experiences related to psychological safety, institutional racism, or job satisfaction, however, it
was determined through the research whether or not the information provided fit based on the
prior research discussed in Chapter Two.

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Black Local Health Department Employees’ Experiences
The significance of the findings was based on participant experiences through their
explanation of the issue being discussed, the outcome as it related to career experience, and the
analysis of the issue as it aligned with study research. In some instances, the narrative data was a
phrase. However, the significance of the phrase was magnified as a result of what the research
has shown. The interviews captured participants’ experiences and were experiential therefore,
they did not express their ideas in the same way. Following the data collection, responses were
collated and analyzed to frame them for meaningful analysis.
Stories “are the foundation of qualitative research” (Banks-Wallace, 2002, p. 410).
However, the influences of Black and Black American oral tradition are minimized or
completely ignored in qualitative research (Banks-Wallace, 2002) despite being “vital to our
[Black people’s] very existence” (Toliver, 2021, p. xv). In research settings, stories shared by
Black women specifically typically focus on struggles against oppression; but storytelling can be
healing as well, as the storyteller's experiences are affirmed (Banks-Wallace, 2002). As such, in
some sections of the following research findings, quotes are kept in their entirety to acknowledge
the importance of storytelling in narrating the Black experience in local health departments in the
United States.
LHD Organizational Structure Reinforces Institutional Racism Which Creates
Psychologically Unsafe Environments
Research question one focuses on Black LHD employees’ perceptions of the relationship
between institutional racism and the psychological safety in local health departments. The three
themes identified from the research include the following 1) the misalignment of institutional
and organizational alignment with public health mission and vision, 2) lackluster or nonexistent

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DEI policies and practices that harm Black LHD employees, and 3) the shortcomings of
organizational leadership as it related to the lack of psychological safety of Black LHD
employees. Participants were asked to share their lived experience as a Black person working at
the local health department. Each participant was also asked to share their experiences with
institutional racism at the local health department. Finally, each participant was asked to share
how experiences with institutional racism affected their productivity or enjoyment of their job.
Seven out of 10 participants recognized and experienced the relationship between
institutional racism and psychological safety at the macro and micro levels as they navigated
through the organization. This phenomenon impacts Black LHD employees inside the
organization and Black and other people of color outside of the organization. Participants
experienced institutional racism in local health departments in three key dimensions: institutional
and organizational structure; lack of (or lackluster) organizational DEI policies and practices;
and organizational leadership deficiencies.
Theme 1: Institutional and Organizational Operation Are Not Aligned with Public Health
Mission and Vision
Five out of 10 participants were acutely aware of the disconnect between their
organizations’ goals of racial health equity and the day-to-day operationalization of those goals.
Participants were able to link this disconnect in their respective LHDs to negative impacts on
their administration of programs, staffing, and compensation.
Ridley shares her opinion on how white supremacy ideology in LHDs prevail:
It’s a unique space in which you’re trying to achieve health equity and try to make
sure that you have a healthy population. The modalities to get there are inherently
progressive. And so people conceptualize these ideas [but] when it comes to the

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execution … it always falls into a white supremacist framework…We have
opportunities to provide services and goods for individuals in the community, but
there will always be something, some kind of cutoff point, or some type of
requirement that disregards everybody who probably needs it. And so it's
institutionally in word, there's issues but also even the way that the Health
Department moves as an agency outside of it, it feels like there's no escaping it …
Ridley’s quote clearly highlights the disconnect between her LHD’s goal to achieve
health equity and the operationalization of those goals. She shares the viewpoint of other
participants that also observed this phenomenon. Other participants were able to identify a goal
of health equity, reduced health disparities, or some other population or program metric, and the
subsequent failure of LHDs to meet that goal due to lack of political or organizational will, lack
of funding, or some other resource that ultimately caused communities to suffer. This disconnect
is a clear example of institutional racism as it outlines the default white supremacist framework
of local health departments. The suffering that ensues as a result has a negative impact on the
psychological safety of the Black LHD workforce who bear witness.
Participants noted that this disconnect between stated goals and operationalization has a
direct impact on the success of LHD initiatives. Ridley saw this disconnect working in a division
that focuses on health equity
Because we are always in the fight or flight mode, mostly like fight, where certain
things that are tasked to us - a team of 2 or 3. Sometimes we've had to allocate
help from people who don't even have experience. What we need to do is a
constant trying to make do with what you can. And it's been a running joke, 'yeah,
look at the division with mostly Black people', and we're always struggling, right?

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But it literally is like we always have to make do and perform with a little bit of
resources, so I always find myself in a position where I have to overextend
myself.
Ridley’s experience further highlights the disconnect between her LHD’s goal to achieve
health equity and the operationalization of those goals. The lack of resources in her LHDs health
equity office further elucidates the disconnect between stated mission and vision and
operationalization of the mission and vision. The fact that the staff of the health equity office is
primarily Black and made to struggle for resources further drives home the disconnection
between mission, vision, and action.
Participants’ observations of the oppressive and white supremacist nature of local health
departments and the negative impact it has on the workforce and the community shed light on the
pervasive challenge of bridging the gap between organizational rhetoric and practical
implementation, particularly in the pursuit of racial health equity. This disconnect not only
hampers the success of LHD initiatives but also perpetuates a cycle of resource scarcity and
overextension among Black LHD employees.
Pay Inequities
Eight of 10 participants interviewed noted discrepancies in pay based on job titles and
functions. There appears to be greater value placed on “hard” sciences compared to community
level work typically done by Black employees, women, and other employees of color.
Participants noted that contracted employees tend to be Black, women, and other employees of
color as well. Other examples of pay disparity include being paid less than other staff of similar
title and responsibility, being given a raise (as little as one dollar) and having that raise be
reversed, being given an increase in responsibility (commonly referred to in LHD spaces as

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working “out of class”) with no commensurate increase in salary, and being promised a salary
increase only to have that option be denied after the fact. Nipsey tried to advocate for a
comparable salary as a result of a promotion but was met with hesitation due to the bureaucracy
commonly seen in LHDs
They were only offering me a $7,000 pay raise to become a director when I have
white counterparts who were managers that were making $10,000 more than that,
just as a manager. . . And I was like ‘no, if the pay isn't right, I'm not accepting it,
this isn't nothing that I applied for that I came to you all with, you all approached
me. So let's do this the right way’. And they were like, ‘well, no, if we do above a
$10,000 raise we have to go to the board’ and I was like, ‘Let's go to the board
because I want my money…And so we agreed verbally on a number and it was
going to be split so that…it wouldn't have to go to the board. But that's where I
was immature. It was verbal, nothing was in writing, and so I've only gotten one
part of my pay and they refuse to do any more. So every time it comes up like
they're like, ‘Oh, no, we're not doing it’.
Mitchell wondered if her challenges regarding compensation were linked to her race:
My own experiences have been challenging in regards to compensation at the
agency. And I think at the end of the day, the question is like, ‘if I wasn't Black,
would it be this challenging to navigate this system?’ So as a Black person most
of the time, because of the nature of the work I do we have to have those
conversations. I think I'm one of the people in the room that will continue to flag
and say, “this is not holding true to actually helping the people we want to help”.

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Nipsey and Mitchell’s experiences with pay inequities are another example of the
intersection of institutional racism and psychological safety that participants experienced in their
LHDs. Both participants shared similar experiences with pay inequities and lack of promotional
opportunities that other participants experienced to some degree as well. Unequal promotion and
compensation policies are a direct assault on inclusion safety, one aspect of psychological safety.
Black employees being compensated differently is a form of exclusion, does not make them feel
wanted or appreciated in the workplace (Clark, 2020), and undermines their contributions to the
workplace, a form of institutional racism.
Despite the issues and concerns regarding pay inequities, some participants choose to
stay because they enjoy the work. Burke explains, “the pay in public health is not always the
best, but I feel like the work is just as rewarding. Which is why I've been there for this long."
Burke is not the only participant that expressed enjoyment of the work, which could be indicative
of the interest of Black participants to contribute meaningfully to their communities even while
being underpaid.
Pay inequities and lack of promotional opportunities underscore broader systemic
disparities prevalent in the United States. These discrepancies, rooted in discrimination,
perpetuate a racial wage gap that disproportionately affects Black employees, women, and other
employees of color. Moreover, the undervaluation of community-level work compared to "hard"
sciences exacerbates these disparities. Despite facing obstacles in advocating for fair
compensation, many individuals remain committed to their work in public health, driven by a
sense of fulfillment and purpose. However, the ongoing struggle for equitable pay and
promotional opportunities highlights the urgent need for systemic reforms to ensure fair and just

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compensation practices, thereby fostering an inclusive and supportive environment for all
employees.
Theme 2: Lackluster Diversity, Equity, and Inclusion Policies and Practices Keep Black
LHD Employees in Flux
Four out of 10 participants mentioned their experiences with the nexus of institutional
racism and psychological safety in the lack of (or lackluster) DEI policies and practices of LHDs.
The lack of (or lackluster) DEI policies have internal and external impacts. The lack of DEI
policies and practices often means Black LHD employees end up being the first, one of a few, or
the only Black employee in their organization.
LHDs are at the forefront of addressing racial health inequities in their respective
jurisdictions. However, participants noted outright disinterest or minimal effort in the
operationalization of that work despite mission and vision statements that support these efforts.
Bradley describes how non-Black groups determine how anti-racism and DEI are operationalized
The dominant groups really determine what anti-racism looks like. That obviously
always works in favor of the oppressors, not the oppressed. And obviously we see
in history the repetition of that over and over again. But they continuously choose
to go after a low hanging fruit, and by that I mean - I hate that phrase too-
…they're definitely taking the easiest route for the organization that requires the
least amount of effort. And that speaks volumes to folks of color who work at the
department and also in the community.
Bradley’s commentary on leadership’s decision-making on what anti-racism looks like
and how it is operationalized or not speaks to the lack of interest in the dominant culture to fully
address race equity internally and externally. Mitchell’s commentary adds a different perspective

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to the origin of this disinterest, how it impacts the workforce, and the impact it has on
communities.
Mitchell describes the varied levels of knowledge of employees on DEI matters and how
it can impede progress on important public health work such as substance use disorder,
When it comes to racism and being able to identify how it plays out, some people
are very much in like the ABC, the Kindergarten, and many of us who have that
lived experience, we got PhDs in this. So first, most of the staff has to get on one
page. A lot of it was just education. So I will say it's fortunate that at least the
agency itself is aware, in trying to make a difference in that. A lot of it is lip
service at the same time. …The work that we do is to promote the health and
wellness of people who use drugs. Inherently we have to talk about racism,
because just the history of how drug policies have been enforced in our society.
So my view is very unique in that we really do try to ingrain a health equity,
social equity, antiracism into our work, and do so in a way that our policies, or
like the contracts we have with other organizations can support that the way we
go about our work. And that in itself can be challenging, because sometimes we'll
raise flags like this … this does not feel right like or point something out and
acknowledging that is just the intersectionality of the work that we do.
Bradley and Mitchell’s experiences highlight deficiencies in their respective LHDs
approach to DEI. The deficiencies highlight the disconnect between their respective LHD’s goal
to achieve health equity and the operationalization of those goals. Additionally, these
deficiencies are examples of how participants experience institutional racism and the lack of
psychological safety. Bradley’s comments about the dominant culture determining what anti-

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racism looks like and the lack of knowledge about racism among the workforce at Mitchell’s
LHD are examples of institutional racism because they reinforce the ideals of the dominant
culture and exclude the ideals of Black culture. The fact that Bradley and Mitchell are aware of
what is happening and have to navigate through it perpetuates negative impacts on their
psychological safety, particularly if they have to exert emotional labor in trying to explain racism
to those that don’t understand, as mentioned in Mitchell’s example.
Participants also experienced workforce disinterest in DEI initiatives, policies, and
practices in their LHDs. Baldwin shares what disinterest looks like and the negative impact it has
on the workforce and the community:
When you talk about equity, almost everybody rolls their eyes. And they think,
“wow, what I'm so busy, I'm too busy, why are you coming to me with this?” But
the thing is, actually, what you're doing and the way you're doing it is affecting
people's health and people's life so it's important. …People getting really offended
by “white supremacy” or “white privilege” or words that you used…and some
people get pretty scary…you get scared by their reactions.
As stated previously, experiences such as Baldwin’s highlight glaring deficiencies in
LHDs approach to DEI. The reaction that Baldwin witnessed reinforces the idea that the nondominant culture has been othered and deemed unworthy of attention. Baldwin correctly
surmised that these reactions have a negative impact on the health of the population. When DEI
is brought up, it becomes a source of frustration for the dominant culture because they are forced
to address issues that are not germane to them. Additionally, Black employees and other
employees of color suffer from lack of psychological safety as a result of the hostility observed.

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Lackluster or lacking DEI initiatives in LHDs not only harm the workforce, they also
harm the public. Mitchell describes the subpar programming developed for Black and Brown
school age children in the LHD's jurisdiction:
This first program I worked with the majority of the staff were Black and Brown
and we were working to improve the health of children who were Black and
Brown. And I feel like in the health department that just like whatever program
we throw at them like they just going to take, it doesn't have to be quality. So I do
feel like that did impact the work in that program.
Mitchell’s observation exemplifies how LHDs fail Black and Brown communities due to
institutional racism and insufficient DEI policies. The fact that the staff were also Black and
Brown shows that all races can be actors in upholding white supremacy and institutional racism.
Additionally, the staff working the programs can also be harmed by bearing witness to the low
quality programs offered to Black and Brown children, causing poor psychological safety among
the workforce.
Participants also noted more hostile actions such as a departmental investigation being
initiated when a Black director hired Black staff, push back on Black focused initiatives despite
supporting data, and anti-Black Lives Matter comments. Baldwin describes the hostility felt
when programming and interventions are directed towards the Black population
Sometimes you give data, we have disparities in equity, in Black people on this
and this and this, and then you…talk about the interventions that you're doing.
And so people would be like, “Why are you doing this interventions for Black
people only?”. I'm like, “but I just gave you the data, that there is a huge
disparity”... I think that's making people becoming protective and becoming more

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aggressive towards things and not accepting things. And then also another thing
is, even when you work with other groups that advocate for equity, whether it's
the LGBTQ community or other, I'm not generalizing, but just from my
experience. When you share with them… do you know that even within your
community, the people who experience more racism or inequities are Black?
Experiences of hostility, aggression, and subpar programming that Baldwin and Mitchell
witnessed highlights the impact of inadequate DEI programming and policies. Mitchell’s
experience validates the negative impact on Black and Brown communities who utilize LHD
services. Baldwin experienced being questioned in the face of concrete data which reinforces the
idea that the non-dominant culture has been othered and deemed unworthy of attention.
The experiences of participants within local health departments with regards to the
intersectionality of institutional racism and psychological safety, are exacerbated by the lack of
DEI policy and practices internally and externally. Despite the critical role of local health
departments in addressing racial health inequities, the operationalization of anti-racism and DEI
efforts often falls short, influenced by dominant groups' preferences for superficial solutions that
require minimal effort. This disinterest not only undermines the well-being of the workforce but
also perpetuates harm to the communities they serve, evident in subpar programming and hostile
reactions to initiatives targeting Black populations.
Being the only or one of a few
Three out of 10 participants shared that lack of diversity and inclusion can also show up
as them being the first, only, or one of a few in their LHD. This isolation of Black LHD
employees can have negative impacts on psychological safety. Dawson is “the only African
American gay male” in his organization’s leadership structure. Crenshaw is “one of five black

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women within the health department”, and Nipsey is one of “three Black directors”. Sometimes
being the only or one of a few allows leadership to shirk responsibility for DEI issues and
delegate them to Black leadership or staff, ignore issues that impact Black employees or the
Black community entirely, or relegate all Black focused programs or initiatives to Black staff.
Crenshaw shares how her work to bring an evidence-based program for Black males was
received
I tried to bring on this program where we would go to different barbershops,
where … men will mostly go, because that's what they feel comfortable. That's
their safe space, and maybe talk about chronic disease, because a lot of times our
Black men may not go to a doctor or seek medical attention because of the stigma
behind it, so maybe they talk about it with their barber. So why not meet them
where they are, instead of us expecting them to come to us when there's a stigma?
. . . I tried doing that twice, but it was shot down… and then, maybe a couple
months or so later, down the line an idea similar to it would be brought up and all
of a sudden, it's a great idea and we want to do this.
Crenshaw, a Black public health professional, wanted to introduce a program that would
positively impact the health of Black men in her community and it was shot down twice. When
other staff presented a similar idea, it is lauded as a great idea worth implementing. The
difference in reception of the same or similar idea appears to impact contributor safety, a type of
psychological safety where employees feel safe to contribute their own ideas, without fear of
embarrassment, ridicule, or avoidance. When a non-Black employees’ idea about the Black
community is easily accepted over a similar idea presented by a Black employee, it reinforces
that idea that dominant culture’s ideas hold greater weight and therefore are more respected.

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As mentioned previously, Dawson is the only Black gay male in his organization. His
work focuses primarily on HIV and mpox, which disproportionately impact Black and Brown
communities. In the quote below Dawson discusses the lack of care shown to specific Black and
Latino communities and how his positionality as the only Black gay male in leadership
compelled him to help
There wasn't space being held for African Americans and Latinx and native
individuals who were disproportionately impacted by STDs, HIV, which correlate
with mpox...Even questioning how do we hold space for ensuring that we can
distribute vaccinations for communities of color, I was immediately met by our
clinical supervisor saying, “'Well, the CDC and the local health department
haven't put out guidance, and so we're not gonna do anything”. And so my push
back was, “well we're driven by our county policy that says treat racism as a
public health crisis. So that equips us with the ability to autonomously make an
act, set a plan, an action to ensure that we have equitable distribution of vaccine”.
And it really didn't happen. You know, I pushed ideas, I even did a video about
mpox and our communications team shut it down. And so what it led to was
honestly, we didn't do our due diligence in getting into the Black community, and
we saw that in disparities, we saw increased number of Latinx and African
Americans being disproportionately impacted by mpox.”
Dawson, because of his positionality, felt compelled to push back against the LHDs
inaction regarding distribution of mpox vaccine even though there was existing DEI policy in
place that would support the efforts. Similar sentiments were expressed by another participant
regarding growing teen pregnancy rates in the face of abstinence-only sex education. In both

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instances the negative outcomes disproportionately affect Blacks and other people of color,
highlighting institutional racism due to inaction on the part of the LHD.
The profound impact of being the first, only, or one of a few Black LHD employees
places undue burdens on Black employees to address DEI issues but also allows leadership to
sidestep responsibility and disregard the needs of Black communities. Instances such as the
dismissal of innovative programs tailored to Black men's health underscore the systemic barriers
faced within these organizations. Moreover, the experiences of neglecting specific Black and
Latino communities highlight the urgent need for inclusive practices and equitable distribution of
resources. The voices of Black employees within local health departments serve as vital catalysts
for change, advocating for genuine commitment to DEI principles and ensuring that all
communities receive the care and attention they deserve.
Theme 3: Organizational Leadership Deficiencies Perpetuate the Lack of Psychological
Safety of Black LHD Employees
Five out of 10 participants experienced the intersection of institutional racism and
psychological safety in interactions with leadership. Lack of communication and support are key
concerns brought up by participants. Participants shared that upper management does not listen
to their concerns and are out of touch with what is happening with the workplace and the
community. This has a negative impact on the workforce and community programming. Burke
shares that upper management is “kind of in their own world. I don't really think that they hear a
lot of our concerns personally, even though they always kind of encourage us to.”
Some participants don’t believe management has the ability to provide spaces for open
communication. Bradley shares her feelings about the management at her LHD,

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Our management team is just not really in a place to have those conversations and
adequately support staff to ensure that we are responsive in the way that our
community deserves, and then also to develop programming that is responsive to
our mission and strategic plan…There's a lack of cohesiveness.
Dawson believes that this inability is tied to the lack of Black leadership in his LHD
“there's not many champions who are like us, who are predominantly white non-Hispanics that
are not interested in tackling this issue unless it's centered around self-gain and not collective
gain of people of color.”
Burke, Bradley, and Dawson highlight the oblivious nature of management regarding the
needs of staff and the community. Some of the obliviousness may be attributable to lack of
diversity in management. Overall, there seems to be a lack of wherewithal, direction, or drive to
adequately address the needs of staff and community that negatively affects both groups.
A lack of or unbalanced staff support from management teams was also lifted up as a key
concern. One example is the difference in how workplace conflict is handled between Black and
white coworkers. Nipsey was verbally assaulted by a white co-worker and notes the difference in
response that would not be afforded to her or her Black coworkers.
I've watched Black employees get in trouble for less, get sent to HR for less. But
for you as a director to sit here and witness that and all you can tell her is, go take
a walk - now had I responded, let's not even go there. Because the minute I say
something back, who would have been gone and without a job, right? It wouldn't
have even been a question and investigation. It wouldn't have been anything it just
would have been, “we can't have that here”. But it was okay for her.

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Nipsey’s experience highlights the dangers of oblivious, unprepared, or under-resourced
management referenced above, particularly during workplace conflict. The lack of support for
Black staff, and the abundance of support for white staff (real or assumed) creates an
environment where Black staff are othered. This creates a lack of inclusion safety, where
superiority and hierarchy dominate. Additionally, the fact that Nipsey is aware that the outcome
would be different if the situation had been reversed further reinforces the lack of psychological
safety and the presence of institutional racism.
The experiences shared by Black LHD employees within local health departments
highlight the troubling intersection of institutional racism and the absence of psychological
safety in interactions with leadership. The pervasive lack of communication and support from
upper management not only undermines staff morale but also hampers the effectiveness of
community programming. The disconnect between leadership and frontline staff, as articulated
by participants, underscores a fundamental failure to address systemic issues and provide spaces
for open dialogue. Moreover, the absence of diverse representation in leadership exacerbates
these challenges, perpetuating a cycle of neglect and mistrust. Instances of differential treatment
in workplace conflict further underscore the disparities in support afforded to Black LHD
employees.
Black LHD employees conduct their work against a backdrop of institutional racism and
bias that negatively impacts their psychological safety. Black LHD employees are keenly aware
of the disconnect between organizational mission and vision and operationalization of LHD
goals. They experience this disconnect in their interactions with leadership, community
programming in the implementation, and compensation and promotional opportunities.

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Local Health Department Workplace Dynamics Can Help or Harm Black LHD Employees
Research question two focuses on the aspects of work in LHDS that promote or inhibit
psychological safety for Black employees. The three themes identified from the research include
1) the considerable power supervisors hold over the psychological safety of their Black LHD
employees, 2) the workplace as an important space for Black LHD employees, 3) the oppressive
workplace culture that makes it difficult for Black LHD employees to present their full selves at
work. Each participant was asked to share their lived experience related to the aspects of the
work at the local health department that made them feel safe to express ideas, feedback,
mistakes, or errors. Conversely, each participant was asked to share aspects of the work at the
local health department that made it difficult to express ideas, feedback, mistakes, or errors.
Theme 1: Supervisors of Black LHD Employees Hold Considerable Power Over the
Psychological Safety of Their Employees
Supervisors can make or break the psychological safety of Black LHD employees. Black
supervisors appear to provide much needed support and guidance to Black LHD employees. Four
out of 10 participants shared positive experiences with their supervisors. Slauson discusses in
great detail how her Black mentor/supervisor has promoted psychological safety in her LHD
With my current mentor… she is so open minded to everything that I say. She
takes everything that I say into consideration…I think that there is room for
reverse mentoring where… it's not necessarily a hierarchy at all… She works
collaboratively with me on my ideas. Whatever methods I want to bring on…she
is supportive of me because she knows that there's life outside of this fellowship.
She's very much a go-getter and wants me to do the same. She's just like…” just
go get the opportunity… if there's nothing here, don't get stuck here”... whereas in

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the other lab there was never any opportunity for me to even feel remotely
comfortable to ask a question... My current supervisor makes it a safe
environment for me to make mistakes and learn from them, as I'm also working
independently, too. She does this thing …she shows you what to do. First, you
mirror her, secondly, and then, thirdly, you do it on your own, but she's right there
to provide any feedback or recommendations regarding what she saw you do. If I
made a mistake. Whatever the case may be, she just. She makes it a safe
environment to make mistakes.
Some participants also reported positive experiences with non-Black supervisors and
managers. Mitchell describes her experience with non-Black supervisors in her work in harm
reduction
Inherently in the work of harm reduction is having the conversations about
racism...I was really fortunate to have supervisors who were not Black, not some
other people of color, but the majority of them have been white. But they had to
do their own self work around racism and race, and like really start to figure out
like, how do they sit in that space? And what they perpetuate unconsciously and
even trying to do the work to undo that.
Bradley describes the supportive relationship she has with her Korean supervisor
[She] is super receptive. She's a great listener, great thought partner and
collaborator. If there was something that needed some tweaking, She's often a
great person to have this conversation, but really allows me to make mistakes and
figure it out. And I love that cause you have to mess up to experience growth.

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Slauson, Mitchell, and Bradley's experiences with their respective supervisors highlights
the importance of supportive and capable leadership in promoting psychological safety and
positive work environments among staff. Supportive supervisory leadership can positively
impact the wellbeing of Black LHD employees, regardless of the race of the supervisor. Slauson,
Mitchell, and Bradley mention qualities such as openness, active listening, collaboration, being
accepting of mistakes, and actively working to be anti-racist, as positive attributes of a good
supervisor.
Six out of 10 participants had negative experiences with their supervisors. Lack of
communication with the supervisor was a predominant problem. Slauson highlights this problem
in her interactions with a previous supervisor “… she was very always over my shoulder
watching what I'm doing, and so there was really no…space at all for me to feel comfortable
asking anything, and…I never had direct communication with my mentor.”
Bradley highlights experiences of gaslighting and other negative experiences when
interacting with leadership
Particularly with leadership, if you…disagree with something you'll…get gaslit
saying like, “Oh, you're saying the same thing just a different way”. And you're
like, no, I'm not saying that. But, all of a sudden, …because they're really good at
it, you get interrupted, talked over... really evasive answers. And then it's, “defer
to me when you need support with this” when it's someone who … has no
experience. … you could have all the academic credentials and experience doing
the exact same thing for 80 years and someone is not going to value your
expertise and opinion. So it's pretty…tough.

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Sixty percent of participants shared experiences with subpar supervisors. Their
experiences with their respective supervisors highlights how common unsupportive and
incapable leadership in LHDs. Poor supervisory support impedes psychological safety and
promotes toxic work environments, negatively impacting the wellbeing of Black LHD
employees. Slauson and Bradley mention qualities such as micromanaging, lack of
communication, and being gaslit as negative attributes of a supervisor.
The pivotal role of supervisors in shaping the psychological safety of Black employees
within local health departments cannot be overstated. Positive experiences with supportive Black
supervisors highlight the importance of representation and mentorship in fostering a nurturing
work environment where individuals feel valued and empowered. Additionally, instances of nonBlack supervisors actively engaging in self-work around racism demonstrate a commitment to
understanding and addressing systemic biases. However, negative experiences, such as lack of
communication, gaslighting, and dismissive behavior from supervisors, underscore the urgent
need for improved leadership practices and accountability within these organizations. Creating a
culture of openness, trust, and support starts with effective communication, active listening, and
genuine respect for diverse perspectives. Local health departments can cultivate an inclusive and
empowering workplace where everyone thrives by prioritizing the well-being and professional
development of Black LHD employees.
Theme 2: The Workplace Is Also Integral to the Psychological Safety of Black LHD
Employees
Three out of 10 participants mentioned the significance of "safe spaces" as an important
aspect of their work. The concept of safe spaces grew out of the need for safe physical spaces for
the LGBTQ community in the 1960s. At that time, safe spaces were gay and lesbian bars where

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the community and allies could meet without fear of attack (Kenney, 2001). The term has since
grown to include the idea of taking up space (physical or virtual) with like-minded individuals in
a communal and safe way. For participants, the right team of colleagues and a strong support
system are important contributors to their psychological safety. Safe spaces appear to act as a
protective factor against the institutional racism of LHDs. Bradley shares the positive aspects of
her current team
It was the most refreshing thing joining this team because I'm like “Oh my God,
okay, ‘cause I was about to quit”...I was over it, and so that is fantastic…in other
spaces like our community engagement team, we are very intentional about
cultivating that space of belonging and support and acknowledging all the
differences and similarities of everyone, and…we can listen and support each
other. And it's fantastic.
Mitchell also stresses the importance of the right team in creating a safe environment
Who you work with makes a load of difference because the bureaucracy is always
there. I think it's just a difference. Do you have a team who is willing to help push
the bureaucracy to make it more equitable, or are they just feeding into it and
continuing to exploit their staff?
Safe spaces make it more conducive for Black LHD employees to speak up. Affinity
groups or other spaces with predominantly Black employees make it easier to share. Leimert
shares their experience “...I feel safer or more often to speak up and out or get things when
there's other folks of color in the space of the room…having those affinity spaces to detox and
stuff like that, especially when they know what's going on, is definitely helpful.”

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Bradley, Mitchell, and Leimert’s experiences with safe spaces illuminate the importance
of places, either physical or a state of being, for Black employees to be their full selves. In their
experience, safe spaces include qualities such as belonging, support, acknowledgement of
differences, and equity. Leimert's comments about safety directly relate to the concept of
inclusion safety, an important aspect of psychological safety.
Not all LHDs have safe spaces for Black employees, creating an environment where
psychological safety is elusive. Three out of 10 participants mentioned experiences with
Microaggressions such as hyper-visibilizing, also known as “othering”, that created an
unpleasant workplace for Black LHD employees. Slauson laments about her workplace “…it's
just a negative environment that doesn't make it conducive for collective feedback…". Baldwin
shares what a lack of learner safety (a type of psychological safety) looks like "If you make a
mistake … then you're the target as opposed to people who made huge mistakes and nothing
happens… I still speak up. And I see that people start to look at you in a different way. And
people in leadership might start noticing you… that's scary.
Baldwin shares examples of microaggressions that Black colleagues experienced on their
first day at her LHD, "if like your first day, you start 'Oh, where's the lunch room?', and that
person would be like, they want to see your badge, like, do you even belong here, things like
that. Or if you wear your hair natural… and sometimes you see people who you‘ve been
encountering and… you have your hair different, [I] actually had one person saying 'oh it's scary
today'".
Slauson and Baldwin spoke candidly about their experiences with toxic work
environments. In their experience, toxic work environments do not allow for mistakes to be
made, are not open to feedback, and even go so far as to question Black employees' presence in

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the space and how they choose to be present in those spaces. Also, the difference in response by
race in toxic work environments should be noted. The impression that Baldwin leaves is that
what might be a toxic work environment for Black LHD employees is not so for white LHD
employees.
Hypervisibility, or othering “based on perceived deviance from the norm” (McCluney &
Rabelo, 2018, p. 146) was also experienced by participants. Both Ridley and Crenshaw discuss
the silence that happens when they bring ideas to colleagues and superiors and the difference in
response when colleagues of other races bring up the same idea. Ridley discusses how virtual
meetings make it easier for that silence to happen
There have been spaces where I have been in, working with other colleagues
outside of where I sit where if you have an idea–silence, especially in the moment
of Zoom . . .but if a colleague, who is perhaps white, or maybe Asian says the
same thing, maybe in a different manner, then agreement happens.
Crenshaw discusses a conversation she had with a Latina colleague and their suspicion
that the organizational push back they receive is rooted in racism
Whenever we bring up ideals that could possibly work for our health department,
things that need to be done, and it's being shot down. But let our coworker…bring
up ideas, it’s good to go. It's a great idea, whereas for us it’s like “Hmm, let me
see, let me think about it”. Then it's shot down, or let's revisit this later down the
line- push it back, or something. So I think in that aspect, now that I think about
it, probably. And I could be wrong. But just, you know, just putting things
together it just seems like that.

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Ridley and Crenshaw's experiences with othering are a clear example of a lack of
inclusion safety in their respective LHDs. There is some degree of lack of contributor safety as
well, since participants' suggestions and contributions were met with silence or delay. The
difference in response to contributions, suggestions, or questions by race appears to be grounded
in institutional racism.
Hypervisibility also shows up as lack of support from non-Black staff when faced with
injustice at work. Baldwin explains the lack of support when a Black manager was investigated
for hiring too many Black employees who were presumably unqualified,
Everybody else, whether they were afraid because of retaliation or whatever, but
they didn't sign it to support those of us who were experiencing the horrible
situation, like nobody…from the other races. And… we were only 10% of the
organization, not a lot. So, wow. And you will see that nowadays, they have all
the data about “we're hiring this many Black people or ethnicities,” but I would
want to look at the retention because most people left …because it's too much for
some people.
Baldwin's experience was unique among participants but clearly showed the negative
impact on the nexus of institutional racism and psychological safety. Baldwin indicated that only
10% of the workforce at her LHD was Black. Yet, at the appearance of too many Black people
being hired by the Black manager, a full-fledged investigation was launched. Baldwin noted that
none of the other non-Black staff signed a letter or petition in support of the Black supervisor
and employees being targeted, which signifies that the non-Black staff may have perceived the
impacted staff as “other” and therefore deserving of the scrutiny.

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Workplace conditions and climate are important factors relative to job satisfaction and
employee turnover (Bogaert et al., 2019; Mitchell et al., 2022). The concept of "safe spaces"
emerged as a critical component of the work environment for Black LHD employees. The right
team of colleagues, characterized by openness, collaboration, and belonging, plays a pivotal role
in fostering psychological safety for Black employees. Affinity groups and supportive
supervisors also create spaces where Black employees feel empowered to voice their concerns
and ideas without fear of reprisal or marginalization. However, the absence of safe spaces
perpetuates a culture where microaggressions, discrimination, and hypervisibility of Black LHD
employees are allowed to thrive. Prioritizing the creation of safe and supportive environments
can enhance the well-being and effectiveness of the Black LHD workforce.
Theme 3: Black LHD Employees Exist in an Oppressive Workplace Culture That Makes It
Difficult to Present Their Full Selves at Work.
Six of 10 participants mentioned they are very aware of the role their identities play in
their work. Because they work in an institution that is based on a white supremacist culture, they
often have to decide whether or not they will bring their true selves to work. They also have to be
concerned with how they will be received and perceived in the workplace, which brings another
set of mental health challenges. Additionally, the organization’s white supremacist culture
creates a work environment where Black LHD employees are relegated to working on Black
issues only, have to juggle multiple identities at once, or navigate nuanced public health and
social justice issues that aren’t immediately apparent to non-Black colleagues.
Identity is a key driver in the participants desire to work in LHDs. Three of 10
participants shared experiences ranging from realizing they were members of the “target group”
to growing up as a recipient of social services or otherwise being system impacted that drove

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them to public health. For participants, there is a responsibility to do this work for the betterment
of the Black community. Dawson speaks on how he could not do his work without bringing his
identity to the forefront and the internal conflict that ensued:
Without bringing my identity to work…I wouldn't be able to do this work. ..I've
tried it, even in the West North Central Division, when I was working in human
services, coming to the table just as Dawson to survive. And even that didn't
benefit me, because at some point your real identity starts to scream when you see
BS playing out in front of you, and you kind of dive back into yourself and it
shocks people because they never saw that Dawson was talking about race and
disparities. “Oh, my God, what is this? He didn't need to do this” compared to
when I do it from day one when I do it in an interview, you know exactly what
you're gonna get.
Dawson's experience with trying to hide his true self at work proved unsuccessful in a
previous role which compelled him to bring his identity to work in his current position. The fact
that Dawson had to contemplate bringing his identity to work or not supports the idea that
inclusion safety was not present. Colleagues likely expressed shock at Dawson's reactions for a
number of reasons 1) Dawson was pushing back against the status quo, which might have caused
discomfort to the dominant group, and 2) as a Black male, the dominant group might have found
his shift in demeanor aggressive, which fits stereotypes regarding Black men.
Two of the 10 participants mentioned how the ability or inability to bring their identities
to work can have negative consequences. As mentioned previously, hypervisibility (or othering)
can be harmful to Black LHD employees. One aspect of this harm is being placed in low power

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roles or being relegated to particular types of work, Crenshaw explains her frustration with being
typecast into a specific role
There's more to my position than just going to a Black church. Yes, I understand,
I probably have more of a connection with that church being I am Black, but it's
also that I should be working with all populations, so that I could be able to better
understand. Okay, how can we make sure that the programs we're providing for
people and the services that we're providing at the health department are equitable
for everyone and not just one particular population if I’m not being placed in
those spaces as well, so I feel like there’s that disconnection.
Crenshaw's experience of being typecast into one role is rooted in institutional racism.
The organization has othered her by focusing her work only on Black communities and not
offering her opportunities to work with other populations. She is also being impacted by a lack of
contributor safety since she is not able to provide the breadth of knowledge and skills to other
types of work beyond the Black community.
Three of the 10 participants also discussed the nuances of holding multiple identities:
race, gender, sexual orientation, and government employee, as well as the challenges they
present. Baldwin shares her thoughts on the difficulties of being herself as it relates to being a
government employee
As a Black person, I think it is just hard to be yourself. That's because you need to
make sure you go along...Sometimes even the way we wear our hair or we dress
or we talk or whatever it is, it's being judged. So that by itself is kind of stressful.
And you need to be more careful because you're also a government representative.
Dawson explains further

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I think that for African Americans there's an expectation to hit the ground running
because they think we're the monolith of information. They think we're the
problem solvers. They think we can tackle DEI issues and the reality is, I wasn't
hired to do that. I am coming into a new space. I need to understand this
community and what makes them think. And there is much more burden on us,
because again, we're looking at representing not only our organization, but our
brand and our individual selves right?... folks of color, more specifically African
Americans, have to walk on water.
Baldwin characterizes this holding of many spaces as being “squeezed like a sandwich.
The reason why I say that is because before you had community trust in people
that you've worked with before, and once you're in government space, even the
people who know you…you're also in that space advocating against so many odds
that …some people …do not understand disparities, inequities, institutional
racism, and structural racism. And so in government, you want to push that out,
and it's kind of hard… But outside people don't understand how hard that is and
they think you're not pushing enough. And so you're kind of squeezed because
outside there are people who say, 'Oh, why don't we do this?'. But here you're
actually advocating and there are people working against you. So you're kind of
squeezed.
Baldwin and Dawson’s experiences with bringing their full selves to work subjects them
to judgment. Baldwin highlights judgment directed at her as an individual. She remarks that how
she chooses to dress or wear her hair is often scrutinized, another example of othering in the
workplace. Dawson (and Baldwin to some extent) focused on the nexus between individual

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identity and cultural identity and the pressure to meet the expectations of the organization to
perform over and above what is asked. Both also touched on the struggle of juggling multiple
identities and how that causes them psychological harm.
One out of 10 participants mentioned self-silencing as a mechanism to protect themselves
from racism. The strategy was initially employed by Black women during slavery to endure
enslavement and the resulting “physical, sexual, and emotional violence” (Scott et al., 2023, p. 2)
and is still used today to endure instances of police brutality and workplace discrimination. Black
women in particular will silence their true selves “to conform to expectations or resist
stereotypes of being angry or assertive” (Scott et al., 2023 p. 2). Slauson explains how she
considered self-silencing as a means of self-preservation in the workplace
I automatically internalized what was happening. and I very quickly tried to
wiggle myself out of that, because it was more so the thing of okay, I'm a new
graduate in this predominantly white space. I don't want to rattle anything. I need
to be quiet, but a lot of these things are happening and no one's talking about it,
nobody is seeing it. But maybe I'm also tripping myself because maybe this is just
how the environment is so maybe I should just shut up. Sit back and continue to
struggle.
Slauson experiences with the absence of psychological safety led her to consider selfsilencing as a means to protect herself from harm in a predominantly white workplace. She
struggled with whether to speak up or not about the workplace issue that was bothering her,
which speaks to a lack of contributor safety. Additionally, her fear of causing discord by
speaking up means she has likely been othered in her organization.

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The experiences shared by Black LHD employees underscore the profound impact of
identity within their professional environments. Navigating through a landscape entrenched in a
white supremacist culture, these individuals often confront the dilemma of bringing their
authentic selves to work. Their experiences reveal the complexities of juggling multiple
identities, from race and gender to government employee roles. The realities of hypervisibility,
coupled with the burden of representing not only themselves but also their communities and
organizations, create a challenging dynamic.
Black LHD Employees Experience the Nexus of Institutional Racism and Lack of
Psychological Safety in Their Workplace Regardless of Their Identity, Where They Work,
What Position They Hold, and Tenure
Research question three focuses on the differences in experiences with psychological
safety based on participants age, gender, type and location of health department, position, or
tenure. There were no specific themes identified because these identifiers had no bearing on
participants' experiences with psychological safety and institutional racism. In other words,
participants, regardless of age, gender, ethnicity or nationality, location, role, and tenure had no
experienced institutional racism and a lack of psychological safety in LHDs. However, some
interesting observations are highlighted in this section. Each participant was asked to share
gender, age, and the part of the country in which they work. Each participant was also asked to
share information about the local health department they work for: size, type of jurisdiction.
Additionally, each participant was asked to share their work history at the local health
department, the number of years they have worked there, and their current position. Finally, each
participant was asked to characterize their work experience at the local health department.

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Theme 1: Age
Participants ranged in age from 24 years old (Leimert) to 43 years old (Baldwin). Age
had no bearing on their experiences with institutional racism and psychological safety in their
respective LHDs. However, two of the 10 participants noted their interactions with staff from
older generations and how they were perceived/received because of their age. Slauson shares her
opinion on the significance on younger workers in her line of work
You have a fresh set of eyes on things, a fresh thinking, a fresh mentality on a lot
of these older methods ... It's okay to allow the new person coming in to give
feedback on what they think would work best …and maybe take what they're
saying into consideration, maybe to some of the elderly scientists, or, you know,
new technological methods so that the lab can run more officially and effectively
and not thinking that… the old way is the best way, because maybe it's not.
Participants expressed a desire to offer new ways of approaching the work in their
respective LHDs which were met with resistance. It was not apparent that race was a factor in
these experiences. However, it should be noted that making it difficult for younger workers to
provide feedback and suggestions at work impact inclusion and contributor safety.
Theme 2: Gender
Two males and eight females participated in the study. Both Black men and women who
participated in the study were very aware of the intersectionality of their race and gender in their
roles at LHDs. In some instances, their race and gender led them to feel greater responsibility
for the work they were doing or gave them additional understanding of the work beyond that of
their non-Black colleagues. Their positionality also gave them the awareness that they are

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members of the population of focus for many LHD initiatives because of the burden of disease in
their respective communities. Ridley explains her positionality concerning her job
As I navigate as a Black woman…It feels like I see or I care more about
certain issues than my colleagues, or I understand the impacts a little bit
more especially where I live and how certain things are harmful to the
communities that we serve.
The two Black male participants were aware of their status as one of a few or the only
ones in their respective LHDs. Participants also expressed a desire for Black male mentors and
leaders
Leimert shares his experience as a Black man
There's definitely that perception that you have to have different capes on like on
some Olivia Pope type stuff …there's not a lot of black males at my health
department… I'm trying to think there's less than 10… There's less than five,
less than seven, yeah, less than seven. There's not a lot, it's mostly filled up with
Black women, which is great, but you know it will be nice to have some male
public health role models.
Leimert’s ability to quantify how many Black males are employed in his LHD speaks to
the lack of diversity and inclusion that shows up as being the first, only, or one of a few
discussed in the findings for RQ 1. This isolation of Black male LHD employees can have
negative impacts on psychological safety and can also make it harder for Black males in LHDs to
get much needed support and mentorship by other Black males in the workplace, as discussed in
the quote below.
Dawson shares his disappointment in the lack of mentorship opportunities as a Black man

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For two years now... I asked my old clinic manager…”can you find me somebody
in leadership somewhere that's black…preferably male, who can help me?”
Maybe navigate these nuances? …nothing. I sat under her leadership for 4
months. Nothing. And so that's a policy issue within itself - the lack of
development, mentorship, and sponsorship for African Americans, and people of
color.
Both Black male and female participants were very aware of the intersectionality of their
race and gender in their roles at LHDs. Ridley believes that her lived experience as a Black
woman gives her an enhanced ability to understand certain public health issues more than her
non-Black colleagues. Dawson and Leimert note that they are one of a few or the only Black
men in their LHDs and desire more role models and support from Black male LHD
professionals.
Theme 3: African Americans vs African Diasporans
Two of the 10 participants shared their African Diasporan ancestry during their
interviews. Although their experiences with institutional racism and psychological safety did not
differ from the other participants, it is important to note the experiences of this population.
Slauson, a Ghanaian American, discussed her identity and why she chooses not to bring her
identities to work
I don't necessarily bring all of my identities into the workplace right? Like people
can't see queerness. But I'm a queer Ghanaian American woman. So, I show up
and work. Regarding what's comfortable for me, they don't need to know all of
my lived experiences and identities

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Baldwin, another participant who indicated she is originally from Africa, shared her
experiences as she expressed pride in her culture at work. On one occasion she was gifted two
Black African statues that she displayed at work and coworkers did not have a favorable
response. She also stopped displaying family photos because others had received lynching
threats, which did not make her feel safe. Baldwin expressed her cultural heritage and pushed
back against archaic narratives around professionalism by wearing ethnic clothing and styling
her hair in natural hair styles.
Slauson and Baldwin’s experiences as African Diasporans in their LHDs highlighted that
lack of inclusion safety does not only negatively impact African Americans. their experiences
with institutional racism and psychological safety did not differ from the other participants who
did not disclose African Diaspora ancestry. African Diasporan participants also expressed the
need to protect their identity in the workplace as a means to create boundaries and safety.
Theme 4: Location
All participants worked in a variety of settings, rural and urban, conservative and liberal,
diverse and homogenous. Despite the differences in work location and jurisdiction, there was no
difference in experiences in lack of psychological safety and institutional racism experienced by
the participants. Crenshaw believes her “skills and capabilities are being very limited …because
… our county is very conservative.” Ridley works in an urban area and had an interesting
experience with colleagues
Certain colleagues would label themselves as like liberal or forward thinking or
progressive and they have the language…Colleagues who are non-Black, most
have the language, they understand the speak. They're very sensitive to what they
write, what they say, how they articulate themselves to not offend anybody, but in

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that process it's also disregard of what's really happening here and so you deal
with a lot of microaggressions.
Crenshaw and Ridley’s experiences in two different settings exemplify that institutional
racism and lack of psychological safety can occur in any LHD. Ridley’s experience in an urban
and liberal LHD gives some indication that colleagues understand, to some extent, issues
regarding DEI. However, that understanding is incomplete and results in microaggressions
directed toward non-Black colleagues, contributing to a lack of inclusion safety.
Theme 5: Position or Occupation
All participants represent various occupations ranging from community engagement to
research/lab work to health education to program development and coordination. All participants
experienced institutional racism and a lack of psychological safety in their respective LHDs,
regardless of their position within the organization. Mitchell, a trainer/facilitator in substance use
prevention, explains her experience with the intersection of institutional racism and
psychological safety in her line of work
People would ask me, “Well, they're out giving out Naloxone now but nobody
was doing this when it came to crack [cocaine]'' and it has to be transparent, it’s
like, you're right, the approach that was given [then] is just lock folks up because
it really was seen as Black and Brown people who use drugs, even though we
know that's not the case. Even in presentations, bring up acknowledging the war
on drugs and racism, and …some days like it's easier to do those conversations,
because it's not so upfront, but sometimes those conversations could be a little bit
triggering. So as a Black person just in the work, I've been fortunate to be around
people who try to at least identify and work against a racist system.

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Slauson’s experience with her supervisor in an environmental sciences lab elucidates the
intrapersonal issues prevalent
I'm under the division of a female white boss, and just automatically from the first
day there was not an onboarding process or an effective onboarding process
…there were just multiple gaps in training, multiple gaps in communication…I'm
expecting mentorship from my boss and I was never given that even in the
laboratory we would literally walk past each other. She would never speak to me,
never look at me.
Mitchell and Slauson work in very different fields in their respective LHDs. Both
experienced a lack of inclusion safety. Mitchell felt triggered and likely othered by conversations
regarding the difference in response to the opioid epidemic vs the crack cocaine epidemic that
predominantly impacted Black and Brown people. Slauson’s inclusion safety issue was more
interpersonal, as she was directly ignored by her supervisor as she tried to navigate her role in the
lab.
Theme 6: Tenure
All ten participants had less than a decade of LHD experience and would likely be
characterized as early career professionals. Burke, Crenshaw, and Slauson worked in LHDs for
one year or less at the time of their interviews. Mitchell, Nipsey, and Bradley had the longest
tenure of all participants at five to six years. All participants experienced the intersection
between institutional racism and psychological safety. Dawson experienced it within six months
at one work location
I…dealt with a lot of racism, anti-Black sentiments, and two weeks before my
probationary review - with no issues at all, no documentation, no write ups or

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anything- I was told that I would fail probation, and basically was told that it was
because of my lack of soft skills and my lack of communication. And after I went
to HR two times that next day I was demoted back into my community health
specialist position…
Nipsey has close to 6 years of experience and expressed disappointment in how her
organization mishandled her career trajectory and pay
They've watched me enroll in school for my Master’s [degree] completed in less
than two years …And yet I'm still fighting to make more than my white
counterpart, who's just a manager…And they brought in people since then with no
Bachelor's degree, no Master’s [degree], no experience. Those people have started
out making $15,000 more than me. …I'm like, “Oh, so this is what we
doing”...that's the part that hurts is, you actually watched me enroll and complete
a program … not to mention, I was already working here prior to that, so you
know my work ethic, you know everything, and yet you’re still bringing in your
friends.
Dawson and Nipsey’s experiences highlight the fact that time spent in LHDs appears to
have no bearing on experiences of institutional racism or lack of psychological safety. Dawson
experienced racism, anti-Blackness, and a demotion within the first 6 months of employment.
Nipsey witnessed others with less experiences and education be hired and paid more. Both
examples point to a lack of inclusion safety and aspects of institutional racism that impact
employment advancement.
The experiences shared by participants highlight the pervasive nature of institutional
racism and the absence of psychological safety within Local Health Departments (LHDs).

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Regardless of age, gender, ethnicity, location, role, or tenure, individuals encountered barriers
and challenges rooted in systemic biases. From the reflections on age dynamics to the nuanced
intersectionality of race and gender, and from the impact of African Diaspora identity to the
disparities in mentorship opportunities, the narratives underscore the lack of psychological safety
within LHDs. Furthermore, the diverse range of occupations represented among the participants
reinforces the understanding that no corner of the organization is immune to the effects of
institutional racism.
Black LHD Employees Experience Emotional and Mental Distress Due to Lack of
Psychological Safey at Work and Have Low Job Satisfaction as a Result
Research question four focuses on the perception of psychological safety on job
satisfaction of Black LHD employees. The four themes that were identified from the research
include 1) the emotional trauma Black LHD employees experience as a result of the lack of
psychological safety, 2) the mental trauma Black LHD employees experience as a result of the
lack of psychological safety, 3) the coping mechanisms Black LHD employees use as protection
against lack of psychological safety and institutional racism in the workplace, and 4) the lack of
psychological safety and institutional racism in LHDs have negative impacts on job satisfaction
among Black LHD employees. Each participant was asked to share their experiences sharing
ideas, feedback (both positive and negative), and errors they have made at work. In addition,
each participant was asked to share how those ideas, feedback, and mistakes were received by
their supervisors. Participants were also asked if they believed the reception had anything to do
with their race, gender, or position. Finally, each participant was asked to share their experiences
bringing their lived experience to work.

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Theme 1: Black LHD Employees Experience Emotional Trauma as a Result of the Lack of
Psychological Safety in Their Respective LHDs
Participants were gravely affected by the lack of psychological safety in their respective
LHDs which ultimately had a negative impact on their emotional and mental health. Frustration,
worry, anxiety, and anger were some of the emotions that the participants felt as a result of their
experiences. The negative experiences subsequently affected participants' job satisfaction.
All participants experienced a myriad of mental and physical reactions to the lack of
psychological safety in the workplace. Four of 10 participants mentioned frustration and worry
as common work-related emotions. Crenshaw shares that frustration is misinterpreted as
exaggeration by colleagues at her LHD, “we are faced with so many things and to them it seems
like we're exaggerating. We're …not exaggerating. We're just frustrated."
Ridley’s frustration at work comes from a number of sources,
People are just going back and forth having strategies or ideas that never get
executed. It is something that I get frustrated with, like a bureaucratic institution.
So it's like if they're not gonna take my idea, which I know I'm right and then they
fall and burn, that's not my fault… you come out of school being very eager,
wanting to contribute to the world and …make your mark… but within interaction
with people, …if you're gonna discount what I'm saying because of the way I'm
saying it, or the tonality, or the roughness, or how assertive I'm saying it, then you
can just burn, and that's where it is. ..it's not something in which I can give more
energy towards. And so that's where I've literally had to cope in a way. But also, it
helps me refocus on certain things.

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Burke shares her frustration with trying to secure a promotion and her financial situation
due to her salary :
Sometimes it does make you feel kind of hopeless and very, very depressed. I also
have anxiety so it does kind of give me very moody up and down days, because I
feel like, “wow! This would have been a great opportunity…I really feel like this
would have worked out well. What am I doing wrong on my end?” So it's
definitely very frustrating and very, very depressing. At times, and again, I love
my job, but of course I know that … as far as the financial aspect, it's a bit more
of a stressor. And I'm starting to realize that that is something that is important
that I have to even bring it up. I mean, there's not really much that can be done,
‘cause it's a grant, and only so many funds can go into my salary…and others in
my program salary. So yeah, it's definitely very frustrating. It's been…kind of like
being…on a seesaw.
Crenshaw, Ridley, and Burke experienced frustration as a result of institutional racism
and a lack of psychological safety caused by bureaucratic inefficiencies, lack of consideration of
ideas from staff, lack of opportunity, and salary. In addition to frustration and worry, participants
expressed hopelessness and moodiness. Of note is Crenshaw’s experience that her experiences
aren’t believed or are determined to be exaggerated, which is aligned with a lack of inclusion
safety.
Three of the 10 participants also expressed feelings of worry and anxiety as a result of
their experiences at work. Baldwin shares
I have had …sleepless nights, that's for sure. Really sleepless nights. Really, like,
worry that I might lose my job for this...because there were really people who

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were fighting for that. And I'm sure probably that would contribute to
productivity. I don't know. Like, I usually do work very hard and do more than
what I'm told to do. But um, yeah, it definitely kind of brings disappointment…
Ridley explains her experiences with anxiety with regards to making mistakes in the
workplace:
I observe a lot. So if I've seen reactions to other mistakes it makes me super
anxious to the point where I have to double check triple check to make sure I'm
not making a mistake and that perfectionist kind of personality does get in the
way of like creativity. It does get in the way of productivity because you're not
trusting yourself.
Baldwin and Ridley’s experiences with worry and anxiety manifested into sleeplessness,
low productivity, low creativity, disappointment, and hypervigilance. Baldwin’s sleeplessness,
lack of productivity, and disappointment were linked to the investigation of the Black manager
who allegedly hired too many Black employees and had their qualifications questioned. The
participants faced challenges in working in non-inclusive and unsupportive environments that
impacted their health and wellbeing.
Two of the 10 participants mentioned anger as another emotion experienced. Nipsey
shares her anger at being denied the raise she was promised as part of her promotion, “I was mad
at first… because we always have to just get over it, you know what I mean? …I'm grateful, I'm
still able to pay my bills …But it was the eye opener.”
Nipsey experienced anger at being denied a promotion. She talked about having to “get
over it”, in other words she had to hide or tamp down her emotions in order to conform and
continue on with business as usual. This experience appears to align with concepts of inclusion

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and challenger safety since Nipsey felt compelled to quash her emotions after the grievance she
had regarding the refusal of the LHD to fulfill their original agreement to compensate her for her
promotion.
Theme 2: Black LHD Employees Experience Mental Trauma as a Result of the Lack of
Psychological Safety in Their Respective LHDs
Three of the 10 participants mentioned compromised mental health as they navigated the
intersection between psychological safety and institutional racism. Leimert shares
I would …disassociate, like a lot of disassociation and mental health anguish
more so just burnout, because, especially with COVID [19], there weren't a lot of
… models of recovery for us. A lot of it was just workaholic culture and dealing
with that on top of the Black Lives Matter protest and stuff like that. So a lot of it
was just very taxing, and there was only so much self-care models that could be
done in a half hour timeframe, and there's only so many at home stuff you can do.
Slauson shares her struggle with managing a health condition, navigating issues at work,
and the impact it had on her mental health
You know, it was a lot with me going back and forth with myself, mentally. And
…during that time I was having really low energy… And so my mood was really
taking an impact, and it wasn't necessarily like me being unproductive, which it
probably looked like to them. But I'm struggling over here on top of multiple gaps
in my training on top of me not really knowing what I'm doing at work…Here's
the health problems and then mental health.

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Nipsey expressed anguish about how she was treated by management “How do you all
sleep at night knowing what y'all are doing? …of course, they sleep like babies. I'm not gonna
say mentally, I'm okay with it, because now I'm able to be fake and speak…it took me a while.”
Leimert, Slauson, and Nipsey experienced mental health impacts, including burnout, as a
result of the nexus of institutional racism and the lack of psychological safety in their respective
LHDs. Leimert spoke of external factors that impacted his mental health, such as COVID–19 and
the Black Lives Matter protests. Slauson and Nipsey expressed mental health challenges as the
result of workplace issues such as lack of training and mistreatment by management. In Nipsey’s
case, a coping strategy she employed was to be “fake” which allowed her to navigate her
workplace.
The range of emotional responses recounted by participants in response to the lack of
psychological safety in their respective LHDs underscores the profound impact of such
environments on individual well-being. Frustration, worry, and anger permeated their
experiences, reflecting a deeper struggle against systemic barriers and injustices. These
emotional burdens not only affect individuals' mental and emotional health but also undermine
their ability to engage and contribute to their work thoroughly. As participants grapple with
feelings of hopelessness, depression, and anxiety, it becomes apparent that the toll extends far
beyond the confines of the workplace.
Theme 3: Black LHD Employees Use Self-Esteem, Personal Efficacy, and Boundary Setting
as Coping Mechanisms and Protection Against Lack of Psychological Safety and
Institutional Racism in the Workplace
Workplace relationships can be quite tenuous for Black LHD employees. Two of the 10
participants mentioned drawing upon their self-esteem and personal efficacy to manage the

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impact of the absence of psychological safety and the presence of institutional racism in LHDs.
Mitchell shares her unwavering sense of self-esteem and personal efficacy, “I have an internal
confidence. And …this job is not going to take that from me. And I'm not going to allow it to.”
Burke relies on self-efficacy to speak up for herself and others in the workplace. “So I
tend to be very forward with my curiosity. I get very forward with my ideas or … addressing the
elephant in the room, and I'm very blunt. So usually with our department meetings, I'll usually
kind of ask the question. Maybe everybody else is thinking, but didn't wanna ask for whatever
reason …”
Mitchell and Burke rely on a strong sense of self to protect themselves from harm in the
workplace. Mitchell used her self-confidence like a shield in the workplace to buffer against real
or perceived harm. Burke uses hers to speak up for herself and others in the workplace to try and
bring important issues to the forefront of the LHD.
Black LHD employees exemplify the resilience and determination required to thrive
amidst challenges of psychological safety and institutional racism. Their unwavering self-esteem
and personal efficacy empower them to stand firm in their convictions and advocate for
themselves and their colleagues.
Participants felt compelled to create boundaries in their work relationships in order to
protect themselves from retaliation or other harm. Five of the 10 participants perceived their
workplace as something to guard themselves against as they navigate through their careers.
Crenshaw discusses the boundaries she has set with her colleagues and supervisor
I'm there to do my job, get my money and go home. I'm not obligated to tell you
my personal business. I understand you're trying to highlight this close knit team,
which is fine, and it's a great team, but I think because she has that relationship

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with that other coworker like they're like close friends. They tell each other all
their business, and I'm just not the one to do that, especially like if I don't feel
comfortable doing that with you.
Other participants shared similar experiences with boundary setting and the importance
of reserving parts of themselves for themselves. Nipsey shared her experience with boundary
setting and how she sought to invisibilize herself,
I'm just like, I'm not here. Don't crack no jokes, we not here to laugh and talk. Say
what you need to say, so I can move on. So that's my attitude now, and really just
praying every day like “Lord, you know my attitude…so if I don't have to be
around them, rearrange my schedule, redo my to-do list, the halls that I walk” … I
want to remain positive…but … for months… after that happened …I'm like I
can't believe they will openly do that. You know what I mean. But now I feel like
I'm at a place where I'm fine. I just know it’s strictly business.
Crenshaw and Nipsey’s experiences highlight the impact of othering and lack of
inclusion safety has on Black LHD employees. In both instances a workplace harm taught them
that creating boundaries by protecting their identities was of benefit to them as they navigated
through the organization. Both perceived attempts at workplace socialization as disingenuous
and performative.
In one instance, Dawson’s work boundaries were not respected which caused concern
about his status on the work team
My white colleagues take over some of my work without consulting with
me…but from the Black experience of us having to consistently hit the ground
running and be responsible for our work I took offense to that because …I came

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here to do this job. ..So when you take over that it compromises my ability to do
this work. And you know some folks may think that I'm not needed in this space.
Dawson’s work boundary was crossed, which caused him to take offense. He also feared
that the expectations related to his identity would be compromised. He also worried that the
white colleague undermining him might cost him his job.
Other examples of boundary setting are adopting strategies and vocabulary to protect
participants' workload. Ridley explains how she has adopted corporate speak to set boundaries
and some of the guilt associated with trying to create boundaries: …even though I wanna say no,
I've learned to … adopt corporate language and say ‘I don't have the bandwidth’. I've had to do
all these …tricks and tips, but like it still doesn't take away from the guilt of ‘Oh, my God. I have
to help them because they're not gonna have anybody and they don't have anybody. And certain
things will just be on the wayside for years. …and people's jobs will be threatened if I don't help
them’.
Nipsey discusses the burden of having to be hyper vigilant during an interaction with a
colleague in a different office in order to protect herself and how she has adopted specific
documentation practices to cover her
I'm like, why couldn't this have been a conversation, but of course, because it's
me, everything gets blown up... That's just another example of how we have to
always make sure our stuff is together, that we have all of our evidence,
everything... I don't do nothing that's not in writing, if you call me and say, “Hey,
how you doing?”, [response by email] “per our conversation, I'm doing fine,
everything is going good over here”.

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Nipsey’s experience with hypervigilance appears to reinforce an idea that Black LHD
employees have to have all their affairs in order that has been expressed elsewhere in Chapter 4.
The inability to make mistakes and to always be “put together” is a type of psychological called
learner safety. This hypervigilance compels Nipsey to document everything in writing to protect
herself.
The narratives of Black LHD employees underscore the necessity of establishing
boundaries within the workplace to safeguard their well-being and professional integrity.
Whether it's Crenshaw's firm stance on separating personal and professional spheres, Nipsey's
intentional invisibility to shield herself from undue scrutiny, or Dawson's rightful assertion of
ownership over his responsibilities, these individuals exemplify the resilience required to
navigate environments where boundaries are often challenged. Ridley's adaptation of corporate
language and Nipsey's meticulous documentation practices further highlight the lengths they
must go to protect themselves. Yet, amidst these strategies lies a burden of guilt, a reminder of
the additional weight carried by those who must constantly defend their boundaries.
Theme 4: Black LHD Employees’ Experiences With The Lack of Psychological Safety and
Institutional Racism Have Negative Impacts on Job Satisfaction
Two of the 10 participants expressed great pride in their and the ability to impact the
community in some way. However, participants’ experiences with institutional racism and the
lack of psychological safety had negative impacts on job satisfaction. Ridley appreciated the
opportunity to serve the community she grew up in but struggled with the “constant battle of ‘I'm
not really doing anything’...It doesn't feel like the impact is really there”. This feeling has
impacted her view about how long she plans to stay in the agency. Slauson expressed emotional
distress she felt as a result of her job dissatisfaction. She shares, “honestly, if they hadn't

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switched me, I would have been ending my fellowship in August of this year…because I was
driving myself crazy. I was also venting to people, and you know, just getting their opinions,
…,cause I'm like, ‘I can't be crazy. Do I sound this type of way?’”. Baldwin’s experiences with
microaggressions also made her question her desire to stay “...do I want to be here forever
because that was your dream, but then the situation makes it just so stressful that sometimes
you're like, do I really want to be here?”
Ridley, Slauson, and Baldwin grapple with their desire to remain employed at the LHD
despite the perceived lack of progress and impact in LHD work. Additionally, they express
dissatisfaction with the work environment due to the lack of psychological safety. These
compounding factors cause them to contemplate leaving the LHD workforce.
Participants also made mention of money not being a motivating factor with regard to job
satisfaction. Nipsey is not actively looking to leave her job but would do so if the opportunity
presented itself. She explains further,
“I know my worth… and to me it's not even about the money, so to me it’s more
of you [her employer] just keeping your word. And once I realized that your word
means nothing. I lose all respect for you, …So now what type of people y'all are?
So now it just makes me more cognizant. But in hindsight it really made me be a
better leader for my staff because now I make sure what I say, that's what I mean.
I want everything in writing. So it's kind of just made me a better person and a
better leader for my staff.”
Mitchell explains her approach
Try to keep your head down and find your exit….and until you find your
exit try to do the best that you can, and create boundaries the best that you can

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because… folks need to get paid, because in order to live life, to get basic
resources, you have to have money. So it's not to say just do it for the money but
realizing that you have a life to live outside of this job. This is not your whole life,
and if it becomes too much to find your exit. And that's what I did with that first
position…I wouldn't have even gave them more than two weeks notice…I was
very much willing to just give two weeks notice and then move on. I was sitting
there quiet with a whole ‘nother job waiting.
Nipsey and Mitchell share similar sentiments of low pay with at least one other
participant. For them, money does not appear to be a motivating factor relative to job
satisfaction. In fact, Nipsey remarked that self-worth was more valuable than pay and expressed
disdain at the lack of integrity of superiors. Mitchell also mentioned boundaries, similar to what
other participants shared previously, as a means of protection while navigating the workplace.
Mitchell’s expression of boundaries includes creating an exit plan and focusing on interests
outside of work.
Despite their dedication to serving their communities and making a positive impact, the
pervasive effects of institutional racism and the absence of psychological safety have taken a toll
on the job satisfaction of participants. Ridley's struggle with feeling the weight of her impact,
Slauson's emotional distress, and Baldwin's questioning of her long-term aspirations highlight
the profound challenges they face. Moreover, realizing that monetary incentives are not enough
to sustain motivation underscores the more profound need for integrity and respect within the
workplace.

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Summary
This study afforded the opportunity to explore the impacts of institutional racism and the
lack of psychological safety on job satisfaction among Black LHD employees. The four themes
identified during the study revealed LHDs reinforcement of institutional racism, negative
workplace dynamics, Black LHD employees' experiences with intersection of institutional
racism and lack of psychological safety, and the emotional and mental distress Black LHDs
experience. The exploration of lived experiences of Black employees provided an opportunity to
better understand how these factors impacted their job satisfaction within their respective LHDs.
Through interviews with participants there is a better understanding of the experiences of Black
employees in LHDs in the United States. The findings revealed that institutional racism and a
lack of psychological safety are factors that negatively impact job satisfaction. There is an
opportunity for LHDs to address institutional racism and psychological safety of Black
employees to ensure that job satisfaction is improved.
.

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Chapter Five: Discussion and Recommendations
This study aims to examine psychological safety as an antecedent to job satisfaction
among Black public health employees of local health departments. The conceptual framework of
this study focused on Critical race theory (CRT) and the transformative paradigm of inquiry. The
transformative paradigm of inquiry encourages the pursuit of topics related to marginalized
individuals to improve society (Creswell, 2014). CRT seeks to examine the ways race and racism
affect Blacks and other people of color directly and indirectly (Graham et al., 2011). Framing the
study using this conceptual framework afforded the opportunity to shine a light on issues of
institutional racism, bias, power, and marginalization within the institution of public health
(specifically local health departments) from the perspective of Black employees.
The answers to the research questions were obtained via a qualitative analysis. This study
consisted of interviews with 10 Black local health department employees in the United States.
Participants’ experience working in local health departments ranged from 8 months to 6 years.
The study was designed to understand their lived experiences working in local health
departments and interpret what, if any, impact institutional racism and psychological safety have
had on their job satisfaction. During the interviews, a narrative inquiry was utilized, enabling
participants to tell stories that were counter to the narratives of the dominant culture of what it
means to be a Black employee in local health departments across the United States. The study
addressed the following research questions:
1. How do Black employees perceive the relationship between institutional racism
and perception of psychological safety in local health departments?
2. What aspects of work in local health departments promote or inhibit
psychological safety for Black employees?

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3. How do experiences of psychological safety differ for Black local health
department employees based on age, gender, type and location of health
department, position, or tenure?
4. From the perspective of Black local health department employees, how does
psychological safety impact their job satisfaction?
Following the interviews with participants, the following four themes were identified
1. LHD organizational structure reinforces institutional racism which create
psychologically unsafe environments.
2. LHD workplace dynamics can help or harm Black LHD employees.
3. Black LHD employees experience the intersection of institutional racism and lack
of psychological safety in their workplace regardless of their identity, where they
work, what position they hold, and how long they have worked in the industry.
4. Black LHD employees experience emotional and mental distress due to lack of
psychological safety in the workplace and have low job satisfaction as a result.
The themes discovered during the analysis of the interviews focused on the manifestation
of institutional racism at the organizational level, workplace dynamics that help or harm Black
LHD employees, and the emotional and mental distress Black LHD employees experience at
work. These themes provided the opportunity to examine the research questions through the
lived experiences of Black LHD employees. The findings are supported by study research and
demonstrate the ways in which Black LHD employees are marginalized and harmed at work
(Bogaert et al.; Ford & Airhihenbuwa 2010; Jones, 2018; Harper et al., 2015; Mitchell et al.,
2022; Porter, et al., 2023; Singh, Winkel, & Selvarajan, 2013).

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The conceptual framework used to guide this study integrated CRT and the
transformative paradigm of inquiry. The view of the research in this manner allowed an
exploration of the impact of institutional racism in the oppression and marginalization of Black
employees in their respective LHDs. Critical race theory proved to be an appropriate lens to
study the convergence of institutional racism and psychological safety because of its three
primary objectives: to center narratives of discrimination from the perspective of Blacks and
other people of color, to argue for the elimination of racial oppression and anti-Blackness while
also acknowledging that race is a social construct; and to address other types of oppression such
homophobia and classism, and any other oppression experienced by communities. In research
settings, the use of CRT provides the researcher the opportunity to make race and racism
prominent in all facets of the research (Graham, 2011). Participants of the study shared the
myriad ways they were harmed by their experiences as Black employees of local health
departments. Specifically, the conceptual framework describes the nexus of the impact of
societal issues such as COVID–19 and anti-Black police violence; type, content, and context of
their work; and discriminatory work practices. This convergence of factors exposes Black LHD
employees to institutional racism and a lack of psychological safety, resulting in reduced job
satisfaction, a reduction in work performance, and low morale.
This chapter first discusses the findings connected to the conceptual framework and
extant literature. Following are the study’s limitations, recommendations for practice, as well as
recommendations for future research. Finally, this chapter concludes with the study’s
conclusions.

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Discussion of Findings
Seven out of the 10 of the Black LHD employees interviewed as part of the study
confirmed that LHD structure reinforces institutional racism which creates and perpetuates the
absence of psychological safety for Black employees. The experience of interviewed participants
is supported by the study research which highlights the white supremacist nature of LHDs past
and present (Burghardt Dubois, 1971; Cobbinah & Lewis, 2018; Ford & Airhihenbuwa 2010;
García & Sharif, 2015; Institute of Medicine, 2003; Jones, 2018; Oppenheimer, 2001). The study
findings also revealed that Black LHD employees experience various workplace dynamics that
help or harm their psychological safety. The experience of interviewed participants is supported
by the study research which highlights the impact the provision of or absence of “safe spaces”
and supervisor supports have on the wellbeing of Black LHD employees (Bell et al., 1997; Foley
et al., 2002; Griffith et al., 2007; Singh et al., 2013; Utsey et al, 2002; Wayne et al, 2023). The
study findings also revealed that Black LHD employees experience institutional racism and the
absence of psychological safety regardless of where they worked, their position, age, tenure at
the organization, or nationality/ethnicity. The experience of interviewed participants is supported
by the study research which highlights the pervasiveness and permanence of racism in the
workplace (DeCuir-Gunby & Gunby, 2016; King et al., 2023; McCluney, 2017; Wayne et al.,
2023). Finally, the study findings revealed that Black LHD employees experience emotional and
mental distress as a result of the absence of psychological safety and their experiences of
institutional racism. This finding is supported by the study research from King et al who
discussed how unfavorable work conditions can “negatively affect individuals’ emotions,
cognitive functioning, and self-esteem” (2022, p. 146) as a result of overt and covert racism.

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Local Health Department Organizational Structure Reinforces Institutional Racism Which
Create Psychologically Unsafe Environments
Participants’ observations of the oppressive and white supremacist nature of local health
departments’ organizational structure reflect the CRT concept of the centrality of racism and
intersects with other forms of oppression such as classism, as evidenced by a participant’s
observations about the quality of LHD programming for Black and Brown students (Solorzano &
Yosso, 2001). Additionally, participant observations elucidate Griffith's analysis of supposed
neutral organizations being both “oppressive and oppressed” (2007, p. 290) via administrative
evil. Participant Ridley’s comment that LHD work is inherently progressive and yet defaults into
a white supremacist framework aligns with King et al assertion that workplaces continuously
manifest racism both overtly and covertly (2022).
Pay inequities and promotional barriers, mentioned by 8 of the 10 participants, are salient
examples of organizational issues that Black LHD employees experience. This observation
supports evidence of a persistent racial wage gap in the United States (Gasser et al., 2000; Green
& Ferber, 2005; Hernandez et al., 2018). Blacks and other people of color are overrepresented in
low-paid services jobs and are underrepresented in management level health services jobs. Also,
BIPOC employees in health care management positions “tend to earn lower salaries and report
less job satisfaction than their White counterparts “(Griffith et al., 2007, p. 146). Gasser et al
(2000) note that several reasons for these differences include discrimination and differences in
pay expectations. Participants' experiences with pay disparity illustrate the CRT myth of
objectivity, meritocracy, and equal opportunity that many institutions adhere to. Critical race
theory asserts that these claims are cover for "self-interest, power, and privilege of dominant

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groups in U.S. society" (Solorzano and Yosso, 2001). Participant Nipsey had a negative
experience at her LHD regarding pay disparity. She was promoted to a director position and only
offered a $7,000 raise when her white colleagues in lower-level positions were making $10,000
more than the pay she was requesting. Management was reluctant to agree to the additional pay
because it required board approval. Nipsey and management entered into a verbal agreement to
break the payments up to avoid the board. At the time of the interview, management made one
payment and refused to honor the rest of the agreement. Nipsey has worked in the LHD for over
5 years and during that time earned a graduate degree. In Nipsey’s case, the myth of objectivity,
meritocracy, and equal opportunity as outlined in CRT gave her the impression that her tenure,
graduate degree, and skill set would afford her a promotion with commensurate salary. When
that did not occur, the organization perpetuated a lack of inclusion safety by othering Nipsey.
The resulting frustration, anger, and disappointment had impacts on Nipsey’s mental health and
wellbeing. Mitchell et al (2022) asserted that Black employees (more so than whites) place more
value on extrinsic job-related factors, such as salary, than on intrinsic factors such as autonomy.
Black employees likely value salary and job security more than autonomy because Black
employees are typically underpaid and hold less secure jobs (Gasser et al., 2000; Green &
Ferber, 2005; Hernandez et al., 2018; Griffith et al. 2007). Autonomy may not be valued as much
because it is elusive among Black workers. Additionally, this perspective may not be completely
true, as at least three participants in the study made note that money was not a motivating factor
for them. Griffith et al (2007) found that when exclusion from opportunities for power and
integration into the organization increases for BIPOC workers, job performance decreases and
vice versa. Conversely, white employees are typically paid well and therefore would find more

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value in autonomy. Griffith et al (2007) suggested that these social structures of power and
privilege negatively affect job opportunities for Blacks and other people of color.
Four out of 10 participants mentioned their experiences with the nexus of institutional
racism and psychological safety in the lack of (or lackluster) DEI of LHDs internally and
externally. Participants' experiences of lackluster and lacking DEI practices aligns with the CRT
idea that institutions function based on "values, principles, and foundations that are not culturally
diverse or representative" (Graham et al., 2011, p. 85) and that the dominant culture is universal.
This perspective is used to discredit and disqualify non-dominant culture's admission into those
institutions. The outcome of discrediting and disqualification of admission into those institutions
is a lack of psychological safety for Black LHD employees among other harms.
Griffith et al, in their analysis of a county health department, asserted that all
organizations are grounded in systemic inequalities much like other US societal institutions
(2007). As such, they function as “tools of oppression, reproducing and reinforcing the very
marginalization” they are charged with undoing (Griffith, 2007, p. 288). Lacking or lackluster
DEI programming in LHDs is the embodiment of the attempt by the dominant culture to
discredit and disqualify the non-dominant culture’s admission into public health and is a
reinforcement of the marginalization that LHDs are responsible for undoing based on
organizational mission and vision. Baldwin’s experiences of colleagues rolling their eyes when
conversations about equity occur and challenging the justification of focusing LHD resources on
the Black community in the face of data that supports it are examples of the dominant culture
working to actively discredit and disqualify entrance of non-dominant culture into public health.
Organizations that build a strong DEI culture tend to be more psychologically safe,
welcoming, and inclusive. Those components are integral to job satisfaction and retention. The

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findings align with the assertion by Owens-Young et al that the public health workforce finds
greater job satisfaction in organizations with strong DEI programs (2023).
Local Health Department Workplace Dynamics Can Help or Harm Black LHD Employees
All participants experienced aspects of their work that either promoted or inhibited
psychological safety at their respective local health departments. Participants shared ways their
workplace dynamics and interpersonal relationships created positive work environments or
fostered toxic work environments. Singh et al (2013) suggested that psychologically safe work
environments are important in increasingly diverse ones.
Four of 10 participants indicated positive relationships with supervisors. However, six of
10 participants shared that they had negative experiences with supervisors. Some participants
had negative and positive experiences with multiple supervisors during their tenure in the LHD.
The study findings revealed that supervisors can help or hinder Black LHD employees'
psychological safety. Smeets et al (2021) posited that direct supervisors are integral in shaping
workers perceptions of psychological safety. More specifically, the behavior of leaders
contributes to the staff’s feelings of psychological safety. Inclusive and ethical leadership
positively affect psychological safety. Conversely, leaders who have higher status and decisionmaking power within the organization tend to act out abusive supervision behaviors. Therefore,
abusive supervision has a positive effect on psychological distress (Liu et al., 2016).
Three of 10 participants shared that their positive supervisor experiences were with Black
supervisors. Mitchell et al (2022) suggested that when supervisors and staff are of the same race,
the quality of their relationship, specifically how they work together to “define, negotiate, and
routinize their roles in the organization” is optimized. However, “public health supervision and
leadership opportunities tend to be lower for minorities,” resulting in less likelihood of same-race

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supervisor-staff interaction, therefore impacting supervisory support and job satisfaction. Other
participants shared positive experiences with non-Black supervisors, indicating that there are
positive attributes that can be potentially culled from both groups and used for training purposes.
In addition, three out of 10 participants shared that safe spaces were a significant
workplace dynamic that could promote psychological safety. Conversely, toxic work
environments were harmful to participants. Due to their oppressive nature, workplaces are not
safe spaces for Black people (DeCuir-Gunby & Gunby, 2016; King et al., 2023; McCluney,
2017; Wayne et al., 2023). Anti-Black racism, both overt and covert, manifests within the
workplace and upholds employment discrimination (McCluney et al., 2021), microaggressions
(DeCuir-Gunby & Gunby, 2016), and other forms of oppression (King et al., 2023). As a counter
to the oppression experienced at work and society in general, the Black community has utilized
locations such as churches and beauty/barbershops. These safe spaces are “important for the
mental, physical, and emotional well-being of Black men and women” (Boehme et al., 2023, p.
2388) and serve as social conduits, spaces that encourage social interaction (Wickes et al., 2019).
Employee resource groups (ERGs), formed in the United States in the 1960s, were
created to align the need for employees to be socially connected with organizations’ goal to
improve diversity and inclusion (Welbourne et al., 2017). Welbourne et al analyzed existing
research of various ERG groups and found that Black ERGs reduced turnover for higher level
ERG employees, had positive impact on career optimism due to mentoring, and had no effect on
discrimination.
The concept of safe spaces within workplaces is pivotal to understanding the dynamics of
psychological safety, particularly for marginalized groups like Black LHD employees who often
face overt and covert racism in their professional environments. The prevalence of toxic work

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environments exacerbates the challenges faced by these individuals, perpetuating employment
discrimination, microaggressions, and other forms of oppression. As revealed by previous
research, traditional workplace settings are often not considered safe spaces for Black
employees. However, alternative spaces such as churches, beauty/barber shops, and employee
resource groups (ERGs) offer opportunities for social interaction, support, and mentorship,
which are essential for fostering psychological well-being and mitigating the impact of
workplace discrimination.
Also, six out of 10 participants discussed the degree to which they can bring their full
selves to work, a key aspect of psychological safety. As stated previously, there is consensus that
Black people bring tremendous value to the institution of public health as employees (Mitchell et
al., 2022; Owens-Young et al., 2023 et al., 2023; Wilbur et al., 2020) but the intrinsic value of
their humanity is often unrecognized. Ross characterizes this inability or refusal to recognize
Black humanity as anti-Blackness (2020).
In some instances, participants bringing their identities to work was necessary. Black
LHD employees were able to advocate for the needs of their respective communities because of
their shared identity. One participant specified that she felt like she understood the nuances of
public health issues and the population of interest more than her non-Black coworkers because of
her lived experience as a Black woman. Another participant shared how his experiences as a
Black gay male informed his work and compelled him to advocate for community members who
shared his identity. The literature supports diversity in the public health workforce as a means of
eliminating health disparities by ensuring culturally competent services th(Coronado et al.,
2020). In a study of 19 Black gay or bisexual men who have sex with men working in HIV
prevention in Atlanta, Georgia, Jones et al. discovered that the participants considered their

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identities as assets which made them more effective at work. Many also shared examples of
using their own experiences to connect with, mentor, or inspire clients (Jones et al., 2022).
Intersectionality theory posits that Black LHD employees occupy a unique social position,
shaped by systemic racism, and other related social structures such as homonegativity and
misogyny (Crenshaw, 1991). As such, Black people may be drawn to public health work because
of their intersectional identity. Their relatability to clients/patients is an incredible asset as
diversity has been proven to “improve community service, patient treatment, and access to care”
(Mitchell et al., 2022, p. e769).
In other instances, bringing their full selves to work was not possible or desirable. Three
out of 10 participants shared experiences of challenges with sharing their identity at work that
stemmed from being members of the “target group” to being a recipient of social services or
otherwise being system impacted as youth that drove them to public health. Members of
marginalized groups tend to fare better in the workplace when they adjust self-presentation and
manage other’s perceptions of their identity (McCluney et al., 2021). In diverse work
environments, race plays an integral role in employees’ organizational experiences, which
impacts their attitudes and behaviors (Singh et al., 2013). BIPOC employees have more
occurrences of racism at work (Bell et al., 1997; Utsey et al., 2002) and react more strongly to
bias, discrimination, and prejudice at work, causing them to feel psychologically unsafe in a
workplace where they are not included or valued (Singh et al., 2013). Additionally, they may
fear negative evaluations which decreases employee confidence, forces them to limit their
behaviors and self-expression, and makes employees suspicious of surveillance and judgment by
superiors (Singh et al., 2013). Presenting or pretending to present one’s authentic self (inclusion
safety) through racial code switching generates respect in one’s field, status, power, and access

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to networks (DeCuir-Gunby & Gunby, 2016; Clark, 2020; McCluney et al., 2021). This comes at
great cost to the physical and mental health of Black people who are forced to suppress their
cultural identity (McCluney et al., 2021). Organizations also lose creativity and innovation
(contributor safety) as Black employees promote the values and norms of the dominant group
instead of utilizing their lived experiences and cultural resources (McCluney et al., 2021).
Another negative aspect of identity that should be examined is the typecasting that at
least one participant experienced in her respective LHD. Crenshaw was frustrated because her
LHD focused her work on the Black population, specifically the Black church. While Crenshaw
conceded that she was likely the most appropriate person to work with the population, she called
out that she should be working with all populations to become more familiar with their needs and
ensure that programming was equitable. This practice of typecasting Black LHD employees has
its foundations in 20th century public health practice. Despite the growth of public health
programs and strategy at the time, Black people’s health issues were of no concern to public
health. Public health experts of the day believed that the Black community should bear the
burden of resolving their own issues without any funding or government support (LaVeist, 2012;
Oppenheimer, 2001). Crenshaw’s experiences at her LHD are a reflection of those same ideals.
Black LHD employees experience the intersection of institutional racism and lack of
psychological safety in their workplace regardless of demographic, type and location of
health department, position, or tenure.
All participants experienced institutional racism and the absence of psychological safety
regardless of demographic, type and location of the health department, position, or tenure. The
unique experience of Black workers in the United States dates back to chattel slavery where the
occurrence of mass labor and production led to organizational and management practices that are

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still used today (King et al., 2023). At the time, the goal was to understand “how best to extract
labor, knowledge, and other resources from Black workers” (King et al, 2023, p. 146). It is
against this context that anti-Blackness in the workforce persists.
Also at play is the concept of intersectionality. McCluney and Rabelo (2019), in their
study on belongingness and distinctiveness of Black women at work, highlight that
intersectionality “is embedded within institutions, leading to profoundly different lived
experiences at the intersection of…race, gender, sexuality, and class”. Black employees struggle
with belongingness in the workplace where their personhood is devalued in favor of the
dominant culture (McCluney & Rabelo, 2019). DuBois' thoughts on double consciousness are
that the existence of the color line prevents “the full recognition of humanity of racialized
groups” (Itzigsohn & Brown, 2015). Bell (1990) documents this biculturalism as inherent in
Black professional life and how race and racism inform and impact the psyche of Black people at
work generally and Black women specifically. Participants discussed juggling multiple identities
of race, gender, sexual orientation, and government employee, and the challenges it presents.
Baldwin mentioned how hard it was to be herself at work; things like how she wore her hair or
how she dressed were being judged. Her characterization of being squeezed like a sandwich as
she navigates community, organizational, and government spaces speaks to the labor involved in
holding various identities at once. Dawson also spoke about the burden of not only representing
self but also the Black community, and the organization, characterizing it as having to walk on
water.
Of note are the experiences of the two self-disclosed African Diasporans who participated
in the study. Their experiences offer a counter-story to the experiences of Black American LHD
employees. Counter-story is a core concept of critical race theory that centers on the narratives of

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marginalized groups (Solórzano & Yosso, 2002). African Diasporans’ experiences elicited a
different kind of double consciousness that can be counter to the double consciousness that Black
Americans experience (Nordberg & Meshesha, 2019). Black people are typically regarded as
monolithic and monovocal, which requires further research into variables such as “gender, age,
and immigration, since those factors can distinctly impact their perspectives” (p. 705). Although
African Diasporan communities are increasing in larger cities, they are “still not integrated into
traditional black institutions and remain invisible to most African Americans” (Nordberg &
Meshesha, 2019, p.705). African immigrant experiences and perspectives are “missing both in
participation and in data” (Nordberg & Meshesha, 2019, p. 706).
In a study on African Diasporans’ experiences with police violence, Nordberg &
Meshesha (2019) identified two groups, ‘those who were born in the USA or who immigrated as
young children; and those who immigrated from another country, had memories of that country
of origin and felt distinctly separate from AAs and police violence” (2019, p. 711). African
Diasporans who had memories of their country of origin clearly felt othered by African
Americans specifically and the United States in general. African Diasporans who came to the
United States as small children or were born in the United States, as is the case of the two
participants in the study, identified more with African Americans and their social justice causes,
were more likely to consider themselves Black, and were also more likely to code-switch
between their American-ness and their African Diaspora status (Nordberg & Meshesha, 2019).
The two African Diasporan participants in the study experienced institutional racism and the
absence of psychological safety in their respective health departments. One of them specifically
mentioned microaggressions related to the way she dressed, how she wore her hair, and African

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artifacts she chose to display in her office. The other discussed her intentional protection of her
identity in the workplace as an act of self-preservation.
The CRT tenets of permanence of racism and whiteness as property, specifically the right
to exclude, are at play. Permanence of racism suggests that there is an “ever-present reality of
racism that is systemic in nature and institutionalized throughout all economic, social, and
political systems” (DeCuir Gunby & Gunby, 2016, p. 392). This system of racism burdens
Blacks and other people of color with racial subordination without regard to their social status,
place of employment, location, or other demographics (DeCuir Gunby & Gunby, 2016).
Black LHD Employees Experience Emotional and Mental Distress Due to Lack of
Psychological Safety in the Workplace and Have Low Job Satisfaction as a Result.
Perceived racism has a negative impact on Blacks at significant cost to their
psychological and physiological health (West et al., 2010). Clark et al (1999) mentioned
frustration, fear, and anxiety (among others) as psychological stress responses that may follow
experiences of racism. Both psychological and physiological responses to perceptions of racism
may be linked to health outcomes such as anger, anxiety, frustration, resentment, fear,
depression, self-esteem issues, and helplessness.
Clark, Anderson, Clark, and Williams (1999) highlighted the importance of coping in
their biopsychosocial model of racism stress for African Americans. They posit that coping style
influences the “magnitude and duration” of responses to the stress caused by racism (Clark et al.,
1999, p. 809). They suggest that maladaptive coping responses likely exacerbate negative
outcomes, and adaptive coping responses likely lessen negative outcomes. One aspect of coping
with racism requires protecting the self which “requires focusing on one’s individual
psychological and physical safety after experiencing a racist event” (DeCuir Gunby & Gunby,

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2016, p. 395). Self-silencing and self-determination are two methods used by participants in this
study to protect themselves from real or anticipated workplace harm.
Self-silencing, not speaking in moments of injustice or duress, is one coping mechanism
used by participants, particularly Black women, to preserve mental and physical well-being in
the workplace. Historically, self-silencing has been used by Black women to endure enslavement
and other forms of racial violence in the United States (Scott et al., 2023). Contemporarily, selfsilencing is used in professional settings to protect employment status and livelihood. Black
women in the Scott et al study reported regretting their decisions to self-silence and also
discussed the amount of “mental calculations” necessary when deciding to self-silence. (2016,
p.7). Slauson discusses in great detail the mental calculations she used to determine if she should
speak up about what was happening to her in the lab or remain quiet and struggle. Mitchell
characterized self-silencing as “keep your head down” as she advised colleagues unhappy with
their environment on what to do. She mentioned being quiet in her current role with another job
waiting for her. Self-silencing in these situations were very calculated strategies to either cope
with the current work environment or leave.
Seven of the 10 participants discussed self-determination, resilience, and resistance to
oppressive forces in the workplace. Hasford (2016), in his study on the lived experiences of
racism and resistance of young Black Canadians in the workplace, characterizes this resistance as
reframing. Reframing involves “internally deconstructing and challenging dominant cultural
narratives about race and racism, and a refusal to internalize such narratives” (Hasford, 2016, p.
167). Mitchell expressed reframing when she declared “I have internal confidence. And this job
is not going to take that from me. And I’m going to allow it to.” Reframing serves as a motivator
in resistance efforts (Hasford, 2016).

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Recommendations for Practice
This study provides an understanding of the impacts of institutional racism and the
absence of psychological safety on the job satisfaction of Black employees of LHDs. Limited
research on Black LHD employees exists, however evidence suggests that Black LHD
employees leave the public health workforce in greater numbers than their white counterparts
due to low job satisfaction (Mitchell et al., 2022). Black LHD employees are subject to
marginalization and other workplace issues as a result of institutional racism and the absence of
psychological safety. This marginalization and oppression negatively impacts job satisfaction.
Grailey et al (2021) and Nembhard & Edmondson (2006) suggest that openness, innovation, and
strategies to prevent errors can help address psychological safety in the workplace.
The target audience for the following recommendations is governmental public health
leaders at the federal, state, and local levels; elected officials at the county or local levels who
govern local health departments; public health and governmental public health research and
training organizations such as the National Association of County and City Health Officials
(NACCHO) and the American Public Health Association (APHA); accreditation bodies such as
Public Health Accreditation Board (PHAB) and Council on Education in Public Health (CEPH);
funders such as de Beaumont Foundation; and schools of public health and public health
programs and colleges and universities in the United States. These entities can leverage the
findings of this study to inform workplace practices. These findings can inform or establish
initiatives, programs, policies, and workplace practices to better inform LHD operations
including diversity initiatives, human resources, employee retention and acquisition, and
workforce development programs. Based upon the extensive review of extant literature and
intersectional qualitative analysis of the lived experiences of the study participants, it is

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recommended that public health organizations take the following actions to protect the
psychological safety of Black LHD employees and eliminate institutional racism in LHDs
1. Examine the disconnect between public health/LHD stated mission and vision and
the operationalization of that mission/vision and the impact it has on
psychological safety of Black LHD employees.
2. Implement programs, policies, and practices that shift the organizational culture
towards DEI
3. Provide the resources necessary to equip LHD supervisors and managers with the
knowledge, skills, and abilities necessary to create psychologically safe
environments for Black LHD employees
Recommendation 1: Examine the Disconnect Between Public Health/LHD Stated Mission
and Vision, the Operationalization of that Mission/Vision, and the Impact It Has on the
Psychological Safety of the Workforce (Specifically the Emotional and Mental Wellbeing of
Black LHD Employees) and the Implementation of Community Level Programming.
Participants were able to identify the disconnect between public health/LHD goals and
how those goals were operationalized internally and externally. Participants shared instances of
pay disparity, lack of diversity and inclusion among the workforce, and poor workplace
dynamics that subsequently harm Black employees. They were also able to draw clear lines
between this disconnect and the quality of community level programming, particularly
programming intended for Black and Brown audiences. Participants also saw persistent health
inequities, lack of sufficient funding, and poor implementation of programming that was
intended for BIPOC communities that appeared to counter the purpose and intent of public health

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practice directly. These actions appeared to perpetuate health inequities instead of eliminate
them.
In 2016, the US Department of Health and Human Services, Office of the Assistant
Secretary of Health recommended five qualities for communities to achieve health for all in a
report called Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the
21st Century:
1. Ensure leadership to serve as the chief health strategist for their communities;
2. Establish structured, cross-sector partnerships;
3. Acquire actionable data and clear metrics;
4. Enhance funding flexibility and reduce siloes; and
5. Seek accreditation with the goal of everyone in the United States being supported
by an accredited health department (DeSalvo & Wang, 2018, p. 1280).
None of the qualities listed explicitly name the workforce as an area of focus, highlighting a
glaring omission in strategy for local health departments to achieve their intended goal of
community health.
A core function of public health practice is assessment. A number of entities have
engaged in assessment of the function of local health departments and/or the public health
workforce over the years. However, it is uncertain if there has been research on the public health
workforce in relation to LHD mission and vision and psychological safety. Until 2014 there
wasn’t much research on the LHD workforce (Bogaert et al., 2019; Robin et al., 2019). Prior to
that time the research on the public health workforce was organizationally focused (Bogaert et
al., 2019). Most of what is now known about the public health workforce generally and the local
health department workforce specifically is from the Public Health Workforce Interest and Needs

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Survey (PH WINS). First released in 2014, PH WINS is the largest public health workforce
survey in the nation (Leider at al., 2019) and is a collaboration between the Association of State
and Territorial Health Officials and the de Beaumont Foundation. The survey contains four
domains - workplace environment, training needs, emerging concepts, and demographics (Leider
et al, 2019). Governmental public health entities tend to focus their assessment efforts on the
health of the external community, including data on “health status, community health needs, and
studies of health problems” (Institute of Medicine, 1988, p. 7). Unfortunately, the assessment
function is often under-resourced, signaling that local health departments may not be best
equipped to fully examine the disconnect between mission/vision and operationalization.
Additionally, since this issue appears to be occurring across LHDs, there may be a need for
research at the interorganizational level.
Entities such as the American Public Health Association, Association of State and
Territorial Health Officials, National Association of City and County Health Officials, Robert
Wood Johnson Foundation (RWJF), and de Beaumont Foundation should develop a LHD ad hoc
planning and research team to conduct research on this issue. A potential strategy could be to
augment the existing PH WINS survey and add questions related to organizational
mission/vision or create a different process and present findings via a report, conference, and
journal article. Additionally, workforce health should be added as an area of focus during
accreditation, facilitated by the Public Health Accreditation Board.
Recommendation 2: Local Health Departments Should Implement or Strengthen Diversity,
Equity, and Inclusion Programs and Strategies Aimed at Improving Workforce Experience
for Black LHD Employees

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As stated previously, psychological safety and organizational DEI efforts are closely
linked (Owens-Young et al., 2023). Unfortunately, many organizations have adopted DEI as
policy, but have not embodied it in their culture (Clark, 2020). Additionally, in public health,
those policies are typically focused outward on the population, not inward on the workforce
(Owens -Young et al., 2023). Organizations with a strong DEI culture tend to be more
psychologically safe, welcoming, and inclusive, which is integral to job satisfaction and
retention. The public health workforce report greater job satisfaction in organizations they
perceive as prioritizing DEI (Owens -Young et al., 2023).
Public health is an institution that purports to be focused on social justice, yet there is still
a lack of DEI policies and practices among the LHD workforce. Participants noted ambivalence
or outright hostility regarding workplace DEI initiatives in their respective LHDs. It becomes
difficult to reconcile LHDs mission to improve population health in their respective jurisdictions
when they are not addressing basic issues of DEI among the workforce.
Marginalized communities are best served by “a diverse, equitable, and inclusive public
health workforce” (Owens-Young et al., 2023). However, simply hiring more BIPOC public
health workers does not address the issue because there needs to be a shift in organizational
culture to center DEI so that attitudes, beliefs, and practices of the public health workforce can
be centered towards equity (Owens-Young et al., 2023). Creating a more diverse workforce by
simply hiring more BIPOC employees without concurrently adjusting workplace culture can
cause undue harm to the new BIPOC hires.
Although public health has focused on DEI and racial equity in recent years (Alang et al.,
2021), perceptions of organizational focus on DEI efforts by the workforce vary (Owens-Young
et al., 2023). Black employees had the lowest level of perception of organizational prioritization

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of DEI efforts when surveyed possibly due to lived experience, increased likelihood of
experiencing discrimination and exclusion, and the perception of public health DEI efforts as
performative (Owens-Young et al., 2023).
The workforce also sees instances of racism differently (Baum, 2021; Gurchiek, 2020). A
survey conducted by the Society for Human Resource Management (SHRM) of 1,275 people in
the U.S. found that 49% of Black HR Professionals think that race-based discrimination exists in
their workplace, but only 13% of white HR Professionals agree. The same survey found that
35% of Black workers say that such discrimination is part of their workplace, while only 7% of
white workers say that this is the case. This disparity in perception of race-based discrimination
can lead to tension regarding organizational DEI efforts. Black staff may think the efforts are
performative or short sighted, white staff may think the efforts are an overreach.
The need for relevant, timely, and productive DEI work in LHDs is important. Injustice is
deeply ingrained in society's institutions, even public health, and is very resistant to change.
Indeed, “justice and health are intertwined throughout society” (King,2022). DEI efforts in
LHDs must go beyond diversity hires (King, 2022; Owens-Young et al., 2023). When
institutions focus solely on diversity hires as a solution they place the burden on new non-white
hires to shift organizational culture. The belief is that these staff can improve workplace
conditions by serving on committees or being their employer’s being the spokespeople (King,
2022). This allows LHDs to shirk responsibility of broader organizational culture shifts and
policy change. Additionally, simply focusing on diversity can harm diverse hires because
inclusion and belonging initiatives aren’t in place, subjecting diverse employees to bias,
discrimination, microaggressions and toxic work environments (Bell et al., 1997; Utsey et al.,
2002).

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Although diversity hires might not be the best option, examining hiring practices and
practices such as assessment of job qualifications, promotion and retention standards and
practices including eliminating pay disparities, employee voice in the workplace, and other
workforce practices could prove to be an effective strategy in improving equity, inclusion,
belonging, and psychological safety among the workforce (King, 2022).
NACCHO, APHA, ASTHO, and public health academia should work with a
representative group of LHDs to develop a LHD organizational DEI program/policy toolkit or
some other guidance to be adapted by LHDs across the United States. LHDs should receive
technical assistance and implementation support from one or more of these entities as well as
share resources and information with each other. Many LHDs operate at the city, county, or
regional level and are held accountable via a Board of Health, county seat, city council, or other
legislative body. Workplace DEI at LHDs can be implemented there and accountability could be
potentially tied to funding.
As mentioned in Chapter 1, an added barrier to the adoption of DEI principles and
practices in LHDs is the push back against the sociopolitical movement towards equity
associated with causes such as Black Lives Matter, separation of migrant children from their
parents at the border between Mexico and the United States, and the anti-Asian sentiment from
the COVID–19 pandemic (Murray et al., 2023). At the time, many organizations shared public
support of DEI initiatives and implemented workplace initiatives that would foster organizational
and institutional change (Murray et al., 2023). As this heightened awareness occurred, a
powerful anti-DEI movement began, with over 34 bills introduced restricting DEI initiatives in
higher education as of May 2023. As of April 2024, 10 states have implemented restrictions on
DEI and an additional 19 have proposed similar restrictions, with some being defeated

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(Alfonseca, 2024). Local health departments in any of these states may experience challenges in
implementing DEI strategies in the face of these challenges. Although these efforts are largely
occurring in academic settings, their reach can affect how local health departments operate;
specifically how they recruit, hire, and train employees (Gordon & Turner, 2022). For example,
the Stop Wrongs to Our Kids and Employees (WOKE) Act introduced by Florida Governor Ron
DeSantis in 2021, prohibits, among other things, workplaces with at least 15 employees from
providing training on LGBTQ issues, Black history, and other social justice issues (Gordon &
Turner, 2022).
Recommendation 3: Local Health Departments Should Better Equip Supervisors and
Managers to Create Psychologically Safe Environments for Black LHD Employees
Harper et al posited that “good working relationships between supervisors and
supervisees are critical” (2015, p. S53). Team members are very aware of the behavior of
supervisors and take note of leader actions about what is expected and acceptable. If a leader is
authoritarian, not supportive, or defensive, team members are more likely to feel that speaking
up is unsafe. Alternatively, if a leader is fair, supportive, and is open to questions and opposition,
team members are likely to feel greater psychological safety (Nembhard & Edmondson, 2006).
As mentioned in chapter 4, supervisors of participants had positive and negative impacts in
creating a psychologically safe work environment for employees. Lack of communication and
gaslighting were common negative experiences between supervisors and staff.
Positive work climates influence all employees but hold greater significance for racial
minorities (McKay et al., 2007; Singh & Winkel, 2012). Research indicates that BIPOC
employees find a work environment that is pro-diversity as more affirming of their social
identity, making them feel psychologically safe and motivated to meaningfully contribute to the

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organization (Singh et al., 2013). Previous research has linked psychological safety to positive
career outcomes and work-related well-being (McCluney et al., 2021).
Supervisory support is associated with higher job satisfaction (Harper at al., 2015).
Leaders are a central lever for creating a psychologically safe learning environment (Nembhard
& Edmondson, 2006). A higher degree of job satisfaction lends itself to higher psychological
safety.
LHDs should provide training and skill building to managers and supervisors that
emphasizes active listening, open communication, and clear expectations; timely and
comprehensive feedback to staff; and providing learning opportunities for staff. Furthermore,
LHDs should provide coaches to supervisors and managers and provide adequate training and
support for supervisors to act as coaches to their staff (Harper et al., 2015). Supervisor coaching
is a viable solution as psychological safety is “not implemented through top-down command, but
is created through attitudes and behaviors of local managers, supervisors, and unit leaders”
(Smeets et al., 2021).
LHDs should also provide support for supervisors and managers to acquire behaviors that
promote psychological safety. One such behavior is being tolerant towards errors. Findings
indicate that professionals who perceived their manager to be intolerant of errors were more
likely to have strong negative emotional responses to errors and to be reluctant to engage in
learning behaviors, such as discussing errors with their supervisor (Smeets et al., 2021).
Exhibiting openness is also important. Having an “open door” policy promotes communication
between supervisor and staff as well as engagement in social learning activities (Smeets et al.,
2021). Modeling fallibility by admitting errors and revealing their limitations is another behavior
supervisors should acquire to create psychological safety in the workplace. When supervisors

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disclose errors made and limitations it makes it easier for staff to do the same (Smeets et al.,
2021). Lastly, physical presence is important in promoting psychological safety among staff.
Smeets et al asserted that being physically present lowered barriers for staff to reach out to their
supervisor for help (2021).
Finally, LHDs should provide support to managers and supervisors in encouraging
employees to use their voice. Employee voice is the expression of ideas, information, and
opinions in the work setting (Xu et al., 2019). Employee voice is integral to organizational
performance, providing the organization with essential information about work processes and
problems, and enabling innovation (Xu et al., 2019). Given the findings on the need for safe
spaces, self-silencing, and other coping mechanisms employed by Black staff, consideration
must be given to the context in which Black LHD employees navigate the workplace. Black
LHD employees may find it difficult to activate their employee voice if they feel that their ideas,
information, and opinions might be co-opted, discarded, or will be used against them.
The significance of fostering good working relationships between supervisors and
supervisees cannot be overstated, as highlighted by Harper et al. (2015). The behavior of
supervisors profoundly impacts team dynamics and psychological safety within the workplace.
Positive work climates, particularly those supportive of diversity, have been shown to enhance
psychological safety, especially for minority employees (McKay et al., 2007; Singh & Winkel,
2012). This psychological safety, in turn, correlates with positive career outcomes and workrelated well-being (McCluney et al., 2021). It is evident that supervisors play a central role in
creating psychologically safe environments, and investing in their training and support is crucial.
Providing supervisors with coaching, training, and resources to promote active listening, open
communication, and tolerance for errors can significantly contribute to fostering psychological

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safety within teams (Harper et al., 2015; Smeets et al., 2021). Encouraging employee voice
further enhances organizational performance and innovation (Xu et al., 2019) but proper context
and consideration to specific issues with Black employees must be examined. Therefore, it is
imperative for organizations, particularly Local Health Departments (LHDs), to prioritize
initiatives aimed at supporting supervisors in cultivating environments where employees feel
valued, respected, and empowered to contribute their ideas and opinions.
Robert Wood Johnson Foundation or de Beaumont Foundation should convene
NACCHO, APHA, ASTHO, and public health academia, and a representative group of LHDs to
develop a comprehensive supervisory support curriculum to be adapted by LHDs across the
United States. LHDs should receive technical assistance and implementation support from one or
more of these entities as well as share resources and information with each other. Accountability
for implementation could be mandated by civil service rules or mandated during public health
accreditation.
Limitation and Delimitations
Limitations are defined as the “weaknesses in the study acknowledged by the researcher
to include biases” (Creswell & Creswell, 2018, p.273). There were four limitations in this study.
Qualitative research focuses on process, understanding, and meaning. The researcher is
responsible for data collection and analysis in an inductive process that yields descriptive results
(Creswell & Creswell, 2018). Qualitative studies are less predictable and controlled than
quantitative studies and are dependent on context and narrative (Creswell & Creswell, 2018).
There will not be full representation of the Black local health department workforce and
therefore the unique experiences of Black professionals may be varied regarding their
experiences of psychological safety. To increase the validity and reliability of the study,

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snowball sampling was used to explore opinions and perspectives outside of my network. The
self-reporting of experiences is also a limitation. I had to take the accuracy of what participants
say at face value. Self-reported data can contain several potential sources of bias such as
selective memory, telescoping, attribution, and exaggeration (McGregor, 2018). Interviewing
participants until saturation occurred helped to address this limitation (Merriam & Tisdell, 2016).
Finally, lack of prior research studies on the topic is a limitation. There is existing research on
the unique experiences of the Black workforce in general, but not much on the Black public
health workforce specifically. Data on the Black public health workforce tends to be aggregated
under the category of BIPOC or non-white public health employees (Harper et al., 2015).
Additionally, there were limitations of the researcher that were discussed in detail in “The
Researcher” section. I have cultural bias as a Black woman who was born, raised, and lives in a
highly racialized United States society. I also have organizational bias as a 20-year employee of
a large urban local health department in the Pacific Division of the United States.
Delimitations are the boundaries the researcher sets when conducting the study
(Theofanidis & Fountouki, 2018). Three delimitations were identified in this study. The research
sample size is a delimitation. Recent data estimates the governmental public health workforce at
between 153,000 and 190,000 employees working in approximately 2,800 local health
departments in the United States (NACCHO, 2020; Porter et al., 2023). Estimates on the number
of Black local health department employees range from 12 to 14 percent (Bogaert et al., 2019;
Porter et al., 2023) with larger local health departments having a Black workforce as high as 22
percent (Juliano et al., 2019). The sample size of at least 10 Black local health department
employees indicates that the participants’ views, experiences, and opinions may not represent the
entire Black local health department workforce. Secondly, participants are representatives of

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local health departments in the United States. Finally, I am a person of color identifying as Black
who works for a local health department. This relationship may be perceived as me being an
insider.
Recommendations for Future Research
After the murders of George Floyd, Ahmaud Arbery, and Breonna Taylor, considerable
attention has been placed on DEI initiatives by organizations in the United States. Public health
organizations have had some understanding of the importance of these topics as it relates to
health equity but are beginning to understand the need and advantage of these programs in
improving workforce relations. Although public health has focused on DEI and racial equity in
recent years (Alang et al., 2021), perceptions of organizational focus on DEI efforts by the
workforce vary (Owens-Young et al., 2023). Black employees had the lowest level of perception
of organizational prioritization of DEI efforts when surveyed possibly due to lived experience,
increased likelihood of experiencing discrimination and exclusion, and the perception of public
health DEI efforts as performative (Owens-Young et al., 2023).
This research study focused on exploring the experiences of Black LHD employees to
understand whether or not psychological safety is an antecedent to job satisfaction. The study
findings revealed that participants experienced the manifestation of institutional racism at the
organizational level; workplace dynamics that help or harm Black LHD employees; the
pervasiveness of institutional racism and the absence of psychological safety regardless of
location of LHD, their position, age, tenure at the organization, or nationality/ethnicity; and the
emotional and mental distress Black LHD employees experience at work. To address the
underlying issues related to each of the findings and establish processes that can improve
psychological safety, recommendations for change were discussed. These recommendations

145

included examining the disconnect between public health/LHD stated mission and vision, the
operationalization of that mission/vision, and the impact it has on the psychological safety of the
workforce (specifically the emotional and mental wellbeing of Black LHD employees) and the
implementation of community level programming; implementing or strengthening DEI
programs and strategies aimed at improving workforce experience for Black LHD employees;
and better equipping supervisors and managers to create psychologically safe environments for
Black LHD employees. These recommendations have implications for future research. The
purpose of these recommendations is not only to address the issues uncovered during the study
but to begin a process of thoughtful conversations with key stakeholders at all levels of the
public health industry that can be leveraged into ideas with the potential for impacting long term
sustainable organizational change.
In addition to considering the impacts of institutional racism and psychological safety on
the job satisfaction of Black LHD employees, there is an opportunity to explore the experiences
of other populations of Black LHD employees such as Black LGBTQ employees, recent retirees,
and those who have left the industry. There is not enough research on Black LHD employees in
general. The Black public health workforce plays a significant role in reducing health disparities
and increasing health care access among Black Americans who have some of the worst health
outcomes in the country (Institute of Medicine, 2003). Few studies have addressed the role of
psychological safety as a measure of job satisfaction of the Black public health workforce and
instead tend to focus on job satisfaction and turnover/intent to turnover for employees (Mitchell
et al., 2022). More research is needed around the problem of practice as it relates to this
population, particularly because the Black public health workforce plays a significant role in

146

reducing health disparities and increasing health care access among Black Americans who have
some of the worst health outcomes in the country (Institute of Medicine, 2003).
Additionally, it is not clear that there is sufficient research on supervisors and managers
in LHDs and the ways they help or hinder psychological safety, particularly among Black
employees. Positive work climates influence all employees but hold greater significance for
racial minorities (McKay et al., 2007; Singh & Winkel, 2012). Research indicates that BIPOC
employees find a work environment that is pro-diversity as more affirming of their social
identity, making them feel psychologically safe and motivated to meaningfully contribute to the
organization (Singh et al., 2013). Examining the ways that supervisors and managers contribute
or detract from pro-diversity work environments is essential.
It would be helpful to understand supervisors’ and managers’ experiences with
psychological safety as they interact with upper management and whether or not that has an
impact on how they engage with their direct reports. Research should also look into workforce
practices, procedures, and civil service rules in governmental public health organizations as it
relates to the recruitment and retention of supervisors and managers.
Conclusion
This qualitative field study revealed four key issues that have negatively impacted the job
satisfaction of Black employees as they navigate institutional racism and the absence of
psychological safety in their respective local health departments. These issues include the
manifestation of institutional racism at the organizational level; workplace dynamics that help or
harm Black LHD employees; the pervasiveness of institutional racism and the absence of
psychological safety regardless of location of LHD, their position, age, tenure at the
organization, or nationality/ethnicity; and the emotional and mental distress Black LHD

147

employees experience at work. Through this qualitative study, there was an opportunity to better
understand how institutional racism acts as a barrier to psychological safety and job satisfaction
for Black LHD employees. The interviews with participants revealed the manifestation of
institutional racism at the organizational level; workplace dynamics that help or harm Black
LHD employees; the pervasiveness of institutional racism and the absence of psychological
safety regardless of location of LHD, their position, age, tenure at the organization, or
nationality/ethnicity; and the emotional and mental distress Black LHD employees experience at
work contribute to lack of psychological safety and subsequent low job satisfaction described in
the study. The information shared during interviews demonstrated how institutional racism
negatively impacted Black LHD employees. This research study afforded the opportunity to
explore the lived experiences of Black LHD employees. Through the interviews, discussion, and
review of study research there is a clearer understanding of the challenges faced by Black
employees working in local health departments.
According to Singh et al., instances of institutional racism can contribute to the absence
of psychological safety, causing low job satisfaction (2013). Through this study participants
demonstrated the impacts that institutional racism and lack of psychological safety can have on
job satisfaction. Understanding that psychological safety is a limiter to job satisfaction is the first
step in addressing the problem. Through the research conducted as part of this field study, there
is work to be done to improve the understanding of psychological safety and how psychological
negatively impacts job satisfaction in Black LHD employees. A concerted effort is needed to
increase understanding of the negative aspects that institutional racism can have, not only on
psychological safety, but on job satisfaction of Black LHD employees.

148

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Appendix A: Information Sheet for Exempt Research
Informed Consent for Research
Study Title: At the Table, On the Menu, and Under the Bus: Are Black Local Health
Department Employees Psychologically Safe?
Principal Investigator: Nicole Vick
Department: Rossier School of Education
Introduction
We invite you to take part in a research study. Please take as much time as you need to read the
consent form. You may want to discuss it with your family, friends, or your personal doctor. If
you find any of the language difficult to understand, please ask questions. If you decide to
participate, you will be asked to sign this form. A copy of the signed form will be provided to
you for your records.
Key Information
The following is a short summary of this study to help you decide whether you should
participate. More detailed information is listed later in this form.
1. Being in this research study is voluntary–it is your choice.
2. You are being asked to take part in this study because you identify as Black, are over
the age of 18, and are currently employed in a local health department in the United
States. The purpose of this study is to examine how Black employees of local health
departments experience racism at work and how that affects psychological safety.
Your participation in this study will last for approximately 1 hour. Procedures will
include a screening survey and a 1-hour interview via Zoom.
3. There are risks from participating in this study. The most common risks are discomfort
from retelling difficult work experiences. More detailed information about the risks of
this study can be found under the “Risk and Discomfort” section.

175

4. You may not receive any direct benefit from taking part in this study. However, your
participation in this study may help us learn ways to support Black local health
department employees in the workplace.
5. If you decide not to participate in this research, your other choices may include not
participating.
Purpose
The purpose of this study is to hear the experiences of Black employees of local health
departments as they relate to racism and job satisfaction. We hope to learn if psychological
safety (defined as individuals’ insights of the costs of taking personal risks in their work
environment) has an effect on job satisfaction in the workplace. You are invited as a possible
participant because you are over the age of 18, identify as Black, and are currently employed at a
local health department in the United States. About ten participants will take part in the study.
Procedures
If you decide to take part, this is what will happen:
 You will complete a 6-question screening survey The screening survey will ask for
contact information (name and email), if you are over the age of 18, if you self-identify as
Black, and if you are currently employed at a local health department.
 If you answer yes to all survey questions, a message will appear informing you that you
meet the criteria and will be contacted to schedule an interview.
 The Principal Investigator will email you and arrange for an online interview time. The
IRB information sheet will also be provided during the exchange.
 During the interview, you will be asked 16 questions about your work experience.
 At the conclusion of your interview, you will be thanked for their time. No compensation
will be offered.
 All collected data will be analyzed. Interview transcripts will be sent to you to review for
accuracy.
 A brief summary of the study will be emailed to you.
Surveys/Questionnaires/Interviews
Some of the questions may make you feel uneasy or embarrassed. You can choose to skip or stop
answering any questions you don’t want to.

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Breach of Confidentiality
There is a small risk that people who are not connected with this study will learn your identity or
your personal information.
Unforeseen Risks
There may be other risks that are not known at this time.
Privacy/Confidentiality
We will keep your records for this study confidential as far as permitted by law. However, if we
are required to do so by law, we will disclose confidential information about you. Efforts will be
made to limit the use and disclosure of your personal information, including research study and
medical records, to people who are required to review this information. We may publish the
information from this study in journals or present it at meetings. If we do, we will not use your
name.
The University of Southern California’s Institutional Review Board (IRB) and Human Subject’s
Protections Program (HSPP) may review your records.
Possible Future use of data and/or specimens
Your data will be maintained confidentially and may be shared with other researchers. The
research may be about similar or unrelated topics to this study. Our goal is to make more
research possible. We plan to keep your data and/or specimens indefinitely. If shared, data will
be transferred securely. If you are not comfortable with this, you should not participate in this
study.

This study will use Qualtrics. To understand the privacy and confidentiality limitations
associated with using Qualtrics we strongly advise you to familiarize yourself with Qualtric’s
privacy policy (https://www.qualtrics.com/privacy-statement/). USC has no jurisdiction or
oversight of how data are used or shared on third party applications.
Alternatives
An alternative would be to not participate in this study.

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Payments/Compensation
You will not be compensated for your participation in this research.
Injury
The University of Southern California does not provide any monetary compensation for injury. If
you are injured as a direct result of research procedures, you will receive medical treatment;
however, you or your insurance will be responsible for the cost.
Voluntary Participation
It is your choice whether to participate. If you choose to participate, you may change your mind
and leave the study at any time. If you decide not to participate, or choose to end your
participation in this study, you will not be penalized or lose any benefits that you are otherwise
entitled to.
Contact Information
If you have questions, concerns, complaints, or think the research has hurt you, talk to the study
investigator Nicole Vick at nvick@usc.edu or 323 459 2695.
This research has been reviewed by the USC Institutional Review Board (IRB). The IRB is a
research review board that reviews and monitors research studies to protect the rights and
welfare of research participants. Contact the IRB if you have questions about your rights as a
research participant or you have complaints about the research. You may contact the IRB at
(323) 442-0114 or by email at irb@usc.edu.

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Appendix B: Demographic Survey Protocol
Target Population: Black local health department employees in the United States
Question Response options (if close-ended)
1.Name: N/A
2.Email address: N/A
3.Are you over the age of 18? Yes
No (if no, not eligible to participate)
4.Do you self-identify as Black (Black refers to a
person having origins or ancestry in any of the Black
racial groups of Africa)?
Yes
No (if no, not eligible to participate)
5.What is your gender? N/A
6.Are you currently employed at a local health
department in the United States? (A local health
department is a governmental public health agency at
the county or city level)
Yes
No (if no, not eligible to participate)
Conclusion to the Interview:
(Respondent meets criteria)
Thank you so much for taking the time to complete the survey. Your response has been recorded
and you will be contacted to schedule an interview
(Respondent does not meet criteria)
Thank you so much for taking the time to complete the survey. Your responses do not meet the
selection criteria for this research study.

191
Appendix C: Interview Protocol
Hello! My name is Nicole Vick and I am a doctoral student at the University of Southern
California.
I want to thank you so much for taking the time to speak with me today. I am studying the
psychological safety and experiences of institutional racism among Black employees of local
health departments as it relates to job satisfaction.
Before we get started, I wanted to remind you that everything will be kept confidential.
Also, I need to get your permission to record this Zoom interview so that I can refer to it later.
The recording and transcripts will be stored safely and securely. Is it okay that I record?
Wait for response and then turn on recording
Thank you for agreeing to record the Zoom interview
Additionally, I am using an automated transcription service called Otter.ai to document the
interview. Is it okay that I also use this system to document the interview?
Wait for response before turning on transcription service
Interview Questions Potential Probes RQ Key Concept
1.I’m going to collect some
basic background
information from you. Can
please tell me your name,
gender, and age? 3
Demographics to determine if
there are differences in
responses based on age,
gender, tenure, position, etc.
2. What part of the country
do you work 3
Demographics to determine if
there are differences in
responses based on age,
gender, tenure, position, etc.

192
3.Now I’d like to get more
information about the local
health department you work
for. Would you characterize
the service area of the local
health department as rural or
urban? 3
Demographics to determine if
there are differences in
responses based on age,
gender, tenure, position, etc.
4.How big is the workforce
at your local health
department. Would you
characterize it as small,
medium, or large? 3
Demographics to determine if
there are differences in
responses based on age,
gender, tenure, position, etc.
5. Tell me about your work
history at the local health
department. How many years
have you worked there?
Tell me about
your experiences
from those earlier
days. How was it
for you? 3
Demographics to determine if
there are differences in
responses based on age,
gender, tenure, position, etc.
6.What is your current
position ?
Tell me about
your current
experiences. How
is it going for
you? 3
Demographics to determine if
there are differences in
responses based on age,
gender, tenure, position, etc.
7. In general terms, how
would you characterize your
work experience at the local
health department? 3 General themes of experiences
8.Tell me what your
experiences are like as a
Black person working at the
local health department 1 Possible experiences of racism

193
9. Can you describe your
experience sharing ideas,
feedback (both positive and
negative), and errors you’ve
made at work? 4 Psychological safety
10. How are those ideas,
feedback, and mistakes
received by your
supervisors? 4 Psychological safety
11.Do you think the
reception has anything to do
with your race, gender,
position, etc.?
How so, can you
share any
examples? 4 Psychological safety
12. Tell me about your
experiences bringing your
lived experience to work? 4 Psychological safety
13. Describe your
experiences with institutional
racism during your time at
the local health department.
Dr. Camara
Phyllis Jones
(2002) defines
institutional
racism as “the
structures,
policies, practices,
and norms
resulting in
differential access
to the goods,
services, and
opportunities of
society by "race."
Institutionalized
racism is
normative,
sometimes
1 Psychological safety

194
legalized, and
often manifests as
inherited
disadvantage. It is
structural, having
been codified in
our institutions of
custom, practice,
and law, so there
need not be an
identifiable
perpetrator.”
14. How have these
experiences with institutional
racism impacted your
productivity or enjoyment of
your job?
Has your health
been impacted?
Your mental
health? Have you
considered
leaving? 1 Job satisfaction
15. What aspects of your
work at the local health make
you feel safe to express
ideas, feedback, mistakes, or
errors? 2 Psychological safety

195
16. What aspects of your
work at the local health
department make it difficult
to express ideas, feedback,
mistakes, or errors? 2 Psychological safety
Conclusion to the Interview:
Thank you so much for taking the time to meet with me and share your thoughts and experiences

196
Appendix D: Research Design Matrix
RESEARCH
QUESTIONS
OVERALL
APPROACH
PARTICIPANTS AND
SETTINGS
DATA
COLLECTION
METHODS
What are the
research
questions? What
do I need/want to
know? (Use one
row per RQ)
What overall
methodological
approach do I think
is appropriate for
this research
question and why?
Quantitative,
Qualitative, or
Mixed? Why is this
choice appropriate?

Who (what kind of
person) and where (what
site(s)/setting(s))
specifically do I think I
will sample for this
research question?
Who has the answer to my
research question? Where
will I find them? Why are
these the right
stakeholders to include?

What specific
methods do I think I
will use at this time
to answer this
research question?
What methods will I
use to collect data?
How will I get the
answer to this
research question?
How do Black
employees’
perceive the
relationship
between
institutional
racism and
perception of
psychological
safety in local
health
departments?

Qualitative Individuals that identify as
Black or African American
who are currently
employed at a county or
city public health
department (local health
department) in the United
States.
Interviewees will be
recruited via public health
groups on LinkedIn,
Instagram, and Facebook.
Semistructured 1:1
interviews that ask
questions about
psychological safety

197
What aspects of
work in local
health
departments
promote or
inhibit
psychological
safety for Black
employees?

Qualitative Individuals that identify as
Black or African American
who are currently
employed at a county or
city public health
department (local health
department) in the United
States.
Interviewees will be
recruited via public health
groups on LinkedIn,
Instagram, and Facebook.
Semistructured 1:1
interviews that ask
questions about
interviewees’
thoughts on how they
measure job
satisfaction
How do
experiences of
psychological
safety differ for
Black local health
department
employees based
on age, gender,
type and location
of health
department,
position, or
tenure?
Qualitative Individuals that identify as
Black or African American
who are currently
employed at a county or
city public health
department (local health
department) in the United
States.
Interviewees will be
recruited via public health
groups on LinkedIn,
Instagram, and Facebook.
Semistructured 1:1
interviews that ask
questions about
gender, age, position,
and number of years
of service/number of
years to retirement
From the
perspective of
Black local health
department
employees, how
does
psychological
safety impact
their job
satisfaction ?

Abstract (if available)

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University of Southern California Dissertations and Theses

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Asset Metadata

Creator Vick, Nicole D'Anise (author)

Core Title At the table, on the menu, and under the bus: are Black local health department employees psychologically safe?

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2024-05

Publication Date 05/21/2024

Defense Date 04/29/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag Black employees,governmental public health,institutional racism,local health department,OAI-PMH Harvest,psychological safety,public health

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hinga, Briana (committee chair), DeCuir-Gunby, Jessica (committee member), Khalfani, Nomsa (committee member), Lewis, Lavonna Blair (committee member)

Creator Email ndvick.5437@gmail.com,nvick@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113953778

Unique identifier UC113953778

Identifier etd-VickNicole-12997.pdf (filename)

Legacy Identifier etd-VickNicole-12997

Document Type Dissertation

Format theses (aat)

Rights Vick, Nicole D'Anise

Internet Media Type application/pdf

Type texts

Source 20240522-usctheses-batch-1159 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu