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Burnout experienced by the dual identity of being Black and a public health department professional

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Burnout experienced by the dual identity of being Black and a public health department professional

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Content Burnout Experienced by the Dual Identity of Being Black and a Public Health Department
Professional
Aunsha Hall-Everett
A Dissertation Defense Proposal Presented to the Faculty of the USC Graduate School
University of Southern California
In Partial Fulfillment of the Requirements for the Degree
Doctor of Education (Organizational Change and Leadership)
December 2023

Abstract
The concept of burnout has been discussed increasingly. Burnout is the condition when an
individual becomes exhausted, physically, emotionally, and mentally. This occurs due to
prolonged stress level among the individuals. This study aims to explore the experience of burnout
that is caused by the dual identity of being Black and a public health department professional.
Further, this study aims to identify the potential factors that contribute to implicit and overt
facilitating acts of racism in the public health industry towards Black public health department
professionals. This study adopts a primary qualitative approach to collect data directly from the
participant gather insights. For data analysis the study developed codes from the interviews using
thematic analysis method. The results of the study shows that that various organizational factors
contribute to the implicit and overt acts of racism in the public health departments towards Black
professionals. Through descriptive and pattern coding, interview participants shared significant
organizational factors both transformational and transactional, which are identical to the themes
identified in Burke and Litwin's (1972) organizational change model.

Dedication
The road to completion of this doctoral journey would not be possible without the following
amazing Souls:
My ancestors: Darlene Hall, Robert and Annie Pearl Harris, Richard and Florida Hall, Josh
Allen, and all others who have paved a path for me to walk with confidence and greatness.
My Family: JadennaMonae Everett, Michael Everett, Chiquita Shields, Frank Sr. and Dion Hall,
Ashanti Hall, Frank Hall Jr., LeTissa Harris, Timia Gardner, and all other members from the
Hall, Harris, Gardner, and Everett families.
My Friends: Andy & Laquanda Spence, Angelo James, Dr. Derrick Morton- Floyd, Tyrell
Ferguson-Hicks, Walter Ravizee, Lanedra Rogers, Alex Williams, Quiana Wheeler, Chaney
Jackson, Mark Johnson, Keisha Spencer, Neshaun Lasley, Ka’leef Washington, Theron Mallard,
Veronica Osorio, Rosie Ruiz, Nimaako Brown, Morgan James, Tai Edward Few, Raniyah
Copeland, Dana Cropper, Greg Mehlhaff, and Julie Galindres
Dissertation Committee: Dr. Esther Kim, Dr. Briana Hinga, and Dr. Erika Page
The Black Public Health Department Professionals Interviewed, Colleagues at the California
Prevention Training Center, and the Entire Black Public Health Network & Allies

Table of Contents
Abstract ........................................................................................................................................ 2
1 Chapter: Introduction .................................................................................................... 1
1.1 Introduction to the Study ....................................................................................... 1
1.2 Context and Background of the Problem ............................................................... 4
1.3 Aims and Objectives .............................................................................................. 6
1.4 Research Questions ................................................................................................ 7
1.5 Significance of the Study ....................................................................................... 7
1.6 Overview of Theoretical Framework and Methodology ....................................... 9
1.7 Definitions ............................................................................................................. 9
Burnout: ..................................................................................................................... 10
1.8 Organization of the Dissertation .......................................................................... 11
2 Chapter: Literature review .......................................................................................... 13
2.1 Preface ................................................................................................................. 13
2.2 Structural Racism in the Public Health Industry ................................................. 13
2.3 Historical Context of Structural Racism in the Public Health Industry ............... 14
Black Slavery ............................................................................................................. 15
Perpetuation of White Supremacy ............................................................................. 20
Efficacy of Anti-Blackness ........................................................................................ 26
Conclusion on the Historical Context of Structural Racism in the Public Health
Industry .................................................................................................................................. 29
2.4 Structural Racism in Today’s Public Health Industry ......................................... 30
Institutional Racism ................................................................................................... 32
3 Chapter: Methodology ................................................................................................ 41
3.1 Preface ................................................................................................................. 41

3.2 Theoretical Framework ........................................................................................ 41
3.3 Research Design .................................................................................................. 44
3.4 Data Collection .................................................................................................... 45
3.5 Study Participants and Sampling Size ................................................................. 46
3.6 Study Setting ........................................................................................................ 47
3.7 Data Collection Procedures ................................................................................. 48
3.8 The Researcher .................................................................................................... 49
3.9 Instrumentation .................................................................................................... 50
3.10 Data Analysis ................................................................................................... 51
3.11 Trustworthiness and Credibility ....................................................................... 52
3.12 Ethical Consideration ....................................................................................... 53
3.13 Limitations and Delimitations .......................................................................... 53
3.14 Chapter Summary ............................................................................................. 54
4 Chapter: Results/ Findings .......................................................................................... 56
4.1 Preface ................................................................................................................. 56
4.2 Demographic Characteristics ............................................................................... 57
4.3 Coding the data .................................................................................................... 59
4.4 Establishing Themes ............................................................................................ 61
Organizational Factors Contributing to Implicit and Overt Acts of Racism in the
Public Health Departments toward Black Public Health Department Professionals ............ 62
The Role Structural Racism Contributes to the Dual Identity of Being Black and a
Public Health Department Professional ................................................................................. 62
The Dual Identity of Being Black and a Public Health Department Professional
Leading to Burnout ................................................................................................................ 62
4.5 Main Themes ....................................................................................................... 62
4.6 Summary of Findings ........................................................................................... 78

5 Chapter: Recommendations and Conclusion .............................................................. 80
5.1 Preface ................................................................................................................. 80
5.2 Findings ............................................................................................................... 80
5.3 Recommendation ................................................................................................. 82
5.7 Concluding statement .......................................................................................... 88
5.8 Future Research ................................................................................................... 88
5.9 Limitation ............................................................................................................. 89
5.10 Implication ....................................................................................................... 90
5.11 Conclusion ........................................................................................................ 90
6 References ................................................................................................................... 92

1

1 Chapter: Introduction
1.1 Introduction to the Study
Over the last decade, the concept of burnout has been discussed increasingly. Burnout is
the condition when an individual becomes exhausted, physically, emotionally, and mentally. This
occurs due to prolonged stress levels among the individual (Costa & Pinto, 2017). When an
individual is not able to meet the demands and feels overwhelmed and completely emotionally
drained, this situation is considered burnout. Burnout results in low productivity of the individuals
and drains the overall energy of the individuals (Gabriel & Aguinis, 2022). People become restless,
helpless, and hopeless when they become burned out. This situation impacts the lifestyle of the
individual including work, home, and personal life (Restauri & Sheridan, 2020). The burnout is
described mainly by three significant subscales such as exhaustion, derealization/cynicism, and
reduction in professional achievements. The exhaustion includes the feeling of being
overextended. Depersonalization involves developing negative perceptions. While the reduction
in professional achievement includes lower performance in the work (Listopad et al., 2021). The
people who are affected by burnout have less energy to cope and are exhausted all the time. This
impacts their physical and mental health. Similarly, the burnout individual has less motivation to
work and remains stressed and frustrated. In addition, they become cynical of their working
environment and their other colleagues. This results in disassociating themselves from their
colleagues and with their emotions. Furthermore., their work, home, and interaction with other
people are negatively affected. They become negative in terms of their working tasks and lack
creativity and interest in their work (National Library of Medicine, 2023).
One of the major reasons for burnout is due to the diverse workforce in the organizations.
Due to the diverse working force, the chances of discrimination, mistreatment, and harassment
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increase, which leads to burnout among individuals (Chandrashekar & Jain, 2020). Managing the
diverse workforce in the 21
st
century has become a challenge for organizations. The diverse
workplace provides opportunities for individuals to interact and represent their identities including
the ethical identity. The ethnic group in the organization faces a lack of instrumental social support
that causes them burnout. Some of the individuals do not manifest their ethical identities in the
organization. Whereas, some of the individuals hold up their ethical identities in their organization
as well. Moreover, they do not assimilate the culture of the ignition and remain with their ethical
identities (Carrim, 2019). When employees are outwardly expressing their identities, they face
discrimination in the workplace. In addition, they also encounter difficulties in not providing
competitive job posts and limitations to their career development (Syed, 2014). Moreover, they
experience stereotyping and encounter microaggressive behavior in the organization (King et al.,
2023). The strong identification of the employees makes the workplace environment conflicting
due to the potential conflict in the ethnicities and identities. These are transparent in terms of
different religions and values (Leigh & Melwani, 2019). The concept of organizational burnout is
common in terms of demographic characteristics of the employees such as gender and age. While
the concept of physician ethnicity organizational burnout is considered less known and understood.
Physicians are having high levels of occupational burnout. They are more prone to the high score
of cynicism and emotional draining (Garcia et al., 2020).
In the US, burnout has also become a significant problem. Many healthcare practitioners
have left their jobs due to the high level of burnout. Moreover, this is the potential issue that makes
healthcare professionals consider leaving their jobs (Shah et al., 2021). The people of the United
States face burnout due to several reasons such as work, money, and their health. The level of
burnout among the US population depends differently from person to person. The factors of high
3

stress among the people are related to the status of employment, age, income level, and ethnicity
(Statista. 2023a). Similarly, burnout among professionals in public health departments is also
growing with time. For instance, the level of burnout among US physicians has been raised by
around 25% from the period 2020-2021, in which two-thirds of physicians in the US have
experienced burnout, including a high level of emotional exhaustion and derealization (Statista,
2023). The ethical minorities in the US such as Blacks professionals in the public health sector
have faced discrimination and mistreatment in their jobs. The mistreatment and discrimination
factors among Black public health professionals lead to a high rate of burnout (Dyrbye et al., 2022).
Black physicians in the US faces burnout due to implicit biases, resulting in a lower level of
productivity by the black group and less motivation to provide quality care to the patients (Dyrbye
et al., 2019). Similarly, Black public health professionals in the US have a higher level of burnout
than their White colleagues (Westwood et al., 2017). They face different aspects of burnout in their
working environment, such as Black public health professionals have a higher risk of burnout
aspect to depersonalization than White public health professionals. In addition, Black public health
professionals also encounter higher scores of emotional exhaustion than their White counterparts,
as it has been found that, due to their ethnicity, Black public health professionals experience
depersonalization and extreme emotional draining (Stephens, 2020).
The Covid-19 pandemic put a spotlight on burnout experienced by the dual identity of
being Black and a public health department professional. Before the Covid-19 pandemic, the
World Health Organization (2019) emphasized the increased feelings of chronic workplace fatigue
leading to mental and emotional health concerns, particularly among Black employees. This is
evident as other research studies indicated that Black employees have poorer health outcomes than
their White peers due to structural racism (McCluney et al., 2018). This is because Black
4

employees who experience structural racism are often clinically diagnosed with severe anxiety and
depression (Lewis et al., 2015). For example, 46% of public health professionals reported their
mental health worsened during the Covid-19 pandemic mostly comprised of Black frontline public
health professionals (Morning Consulting, 2021). Black public health professionals have
experienced pervasive workplace inequities such as lack of representation in leadership, resulting
in unhealthy coping strategies and other health implications such as burnout (Ossom-Williamson
et al., 2021; Dent et al., 2021). However, there is a lack of studies concerning the dual identity of
being Black and a public health department professional, resulting in experiences of burnout.
Therefore, contemporary and further research is needed to examine the experiences of
burnout due to the dual identity of being Black and a public health department professional. While
to address this significant issue is critical to eradicating acts of structural racism. Encountering and
coping with the acts of structural racism such as racial workplace discrimination is an emotional
burden, oftentimes impacting job performance Egeruoh, F. M. (2022). Racial battle fatigue and
detachment coping are outcomes of dealing with acts of structural racism (Quaye et al., 2019).
Hence, understanding the various forms of racial discrimination and their impact on Black public
health department professionals will provide insight into coping strategies when navigating the
dual identity of being Black and a public health professional.
1.2 Context and Background of the Problem
Structural racism in public health departments can be seen as the root cause of the
experiences of burnout due to the dual identity of being Black and a public health department
professional (Burwell-Naney et al., 2021). Structural racism is a macro-level condition to
marginalizes racial groups' opportunities, resources, and well-being (Bailey et al., 2017). Structural
racism is believed to be the most prevalent scheme of racism and the facilitator of all other forms
5

of racism (Valdez & Golash-Boza, 2017). Under-representation in leadership is an indicator of
structural racism in public health departments. According to Woodhead et al. (2022), due to the
under-representation of Black public health senior leaders, Black public health professionals
disproportionately experience and witness workplace discrimination from colleagues and
managers, leading to emotional and mental stress such as greater depression, anxiety, and low job
satisfaction.
Navigating the dual identity of being Black and a public health department professional is
mentally challenging, particularly if under-represented in senior leadership (Lipscomb et al.,
2020). According to a 2021 public health study, 6% of U.S. public health organizations have a
Black chief executive officer (Chartis Group and the National Association of Health Services
Executives, 2021). Black employees, who are often under-represented in professional occupations,
are consistently figuring out how to counteract negative racial stereotypes that undermine their
professional images, resulting in having to adjust their opinions, appearances, and behaviors to
boost the comfort of others with the hopes of receiving fair treatment and opportunities (Roberts
& McCluney, 2020). The conditions under which many Black public health professionals work
produce a specific kind of burnout, stress, and exhaustion, which are a result of the racial
implications on their jobs (Wingfield, 2020). Structural racism in a workplace setting limits
advancement opportunities, influences organizational culture, and exacerbates physical conditions
and mental demands (International Labour Organization, 2021).
Existing research has informed that detachment coping is strongly associated with less job
satisfaction among Black employees due to acts of structural racism Black employees have
endured (DeCuir-Gunby & Gunby, 2016). Turnover due to burnout in today’s workforce is costing
up to $322 billion annually (Hart, 2022). To move toward a healthcare workforce that is diverse,
6

equitable, and inclusive, the public health industry should listen to Black public health
professionals and enact concrete policies and actions that change their experience within the public
health industry (Dent et al., 2021). Such known and unknown illustrations continue to highlight
the need to ensure culturally relevant support and equitable opportunities for Black public health
department professionals.
1.3 Aims and Objectives
The purpose of this qualitative study is to examine the experiences of burnout due to the
dual identity of being Black and a public health department professional. This research study will
rely on Burke-Litwin's (1972) organizational change model as a theoretical framework, explaining
various elements that influence organizational performance and overall effectiveness (Martins &
Coetzee, 2009). Infusing self-efficacy and critical race theories along with Burke-Litwin will
explore how Black public health professionals’ self-efficacy in job performances may be
influenced via specific acts of structural racism in the public health industry. The psychological
impact of the acts of structural racism is problematic yet challenging to address. To achieve the
aims of the research, the following major objectives have been formulated. The objectives will be
addressed in the research.
• To explore the experiences of burnout that is caused by the dual identity of being Black
and a public health department professional.
• To identify the potential factors that contribute to implicit and overt facilitating acts of
racism in the public health industry towards Black public health department professionals.
• To assess how the dual identity of being Black and a public health department professional
leads to burnout.
7

• To delve into the significant role of structural racism in contributing to the dual identity of
being Black and a public health department professional.
1.4 Research Questions
To achieve the objectives of the research concerning the problem of burnout experienced
by Black public health department professionals, the research has designed research questions.
These research questions will be answered in the research. The following are the main research
questions.
1. What organizational factors contribute to implicit and overt facilitating acts of racism in the
public health industry towards Black public health department professionals?
2. How does the dual identity of being Black and a public health department professional lead
to burnout?
3. What role does structural racism contribute to the dual identity of being Black and a public
health department professional?
1.5 Significance of the Study
It is critical to examine how burnout is a result of the dual identity of being Black and a
public health department professional. This will help to understand the impact of structural racism
in the field of public health. Since the horrific acts from 200-plus years of forced slavery, structural
racism continues to exist and harm the lives of Black professionals. With the normalization of
structural racism, the ideology of racism is rooted in the psychology of the beliefs, resulting in
marginalization, isolation, dehumanization, and trauma for Black people (King, 1963; Jung, 2015).
Research has discussed how the workplace can influence professionals’ psychological and social
identities. Ainsworth (2013) shared that the workplace is of crucial importance, being a site in
which personal identity is developed because the workplace is a physical space in which most
8

people spend most of their waking hours and a primary venue for the realization and projection of
their authentic selves. Yet, Black professionals who downplay their racial identities are perceived
as more professional and are more likely to garner career advancement opportunities than those
who do not assimilate in predominately White workplace settings (Roberts & McCluney, 2020).
For example, from a study by Dickens and Chavez (2017), Black women waver between the
benefits and costs of their racial identity in the workplace, leading to them altering their dialect
and behavior to social norms. This highlights how structural racism exists in the lack of
representation in senior leadership among Black public health department professionals.
The lack of representation in senior leadership is an indicator of the connection between
burnout and the dual identity of being Black and a public health department professional. Diversity
in public health departments’ leadership can enhance the quality of care, workplace culture,
community engagement, and the ability to improve community health status (American College
of Healthcare Executives, 2020). Whereas, the lack of diversity hinders the workforce's capacity
for higher economic growth. This is due to the establishment of policies and practices by the
decision-makers that are not inclusive nor welcoming of employees who have had experiences of
social marginalization (Bush, 2021). In institutions such as public health departments, Black
professionals have had to lug the restraint of resolving structural obstructions impacting their
progressions. As a result, state, county, and city public health departments across the U.S. have
declared racism as a public health crisis, which is an important first step in the movement to
advance racial equity and justice (County Health Rankings & Roadmaps, 2021). Researchers have
reported that three sets of human needs can be fulfilled in the workplace, which are survival and
power, social connection, and self-determination - all of which are central to understanding the
complex ways in which working functions in the human experience (Blustein et al., 2008).
9

However, structural racism disrupts that fulfillment, impacting the mental and emotional well-
being of Black employees.
1.6 Overview of Theoretical Framework and Methodology
This research study will rely on Burke-Litwin's (1972) organizational change model as a
theoretical framework, explaining various elements that influence organizational performance and
overall effectiveness (Martins & Coetzee, 2009). Infusing self-efficacy and critical race theories
along with Burke-Litwin will gauge the dual identity of being Black and a public health department
professional, particularly as it relates to burnout. Addressing this problem helps to understand
further the impact of structural racism in the field of public health.
The present study used a qualitative phenomenological research method via semi-
structured interviews with 12 Black public health department professionals representing each of
the four U.S. geographic regions – Northeast, South, Midwest, and West (three interviewees from
each region). The interview participants for this research study are Black health department
professionals hired at least one year before the Covid-19 pandemic to compare experiences of
structural racism before and during the pandemic. This global pandemic highlighted workplace
inequities experienced by Black public health department professionals, which allows this study
to gauge the experiences of burnout as it relates to the dual identity of being Black and a public
health department professional.
1.7 Definitions
Definitions of key terms for this dissertation study specify a foundation for understanding
the purpose and findings of this study. While exploring structural racism in the public health
industry contributing to employee burnout via the dual identity of being Black and a public health
department professional, the following definitions help explain key terms relevant to the research:
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Anti-Blackness
The behaviors, attitudes, and ideologies of people and institutions striving to dehumanize
Black people to normalize Whiteness (Bledsoe, 2020).
Burnout:
This is the situation of exhaustion of physical and emotional strength (Rabha, 2022).
Dual Identity
Dual Identity includes the identification with both one's ethnocultural minority identity and
one's identity in different societal spaces (Simon et al., 2013).
Implicit bias
Implicit bias is the Unconscious prejudices or stereotypes that are usually expressed by
individuals through actions or attitudes (Roberts, 2011).
Institutional Racism
The visible and invisible racist norms, practices, tasks, and power relations are embedded
in how organizational policies are decided and administered (Lim et al., 2022).
John Henryism
A cultural adaptation on the part of Black people to make possible a coherent expression
of core American values such as hard work, self-reliance, and freedom (James, 2002).
Microaggressions
Everyday interactions send denigrating messages to people of color, resulting in more overt
forms of racism, that often leave the victim confused, distressed, and frustrated and the perpetrator
oblivious of the offense they have caused (Rollock, 2012).
Racial Battle Fatigue
11

The physiological, psychological, and behavioral burdens that are exacted upon racially
marginalized and stigmatized groups (Smith et al., 2011).
Racism
A social construct that assumes members of racial categories have distinctive
characteristics, resulting in some racial groups believing they are inferior to others (American
Psychological Association, 2023).
Respectability Politics
A tool of Whiteness that weaponizes the denial of power to manipulate and control Black
people, further silencing and oppressing Black people with a paradox of inclusion (Stanley.
2020).
Stereotype Threats
The socially premised psychological threat that arises when one is in a situation or doing
something is connected to a negative stereotype about one's identity (Steele & Aronson, 1995).
Structural Racism
A macro-level condition to marginalize racial groups' opportunities, resources, and well-
being (Bailey et al., 2017).
White Supremacy
An ideological system of power, via the exploitation and oppression of Blacks, Indigenous,
and other people of color (BIPOC) globally, for the establishment and sustainability of wealth and
access for White people (Amherst College, 2020).
1.8 Organization of the Dissertation
This dissertation study addresses the problem of burnout due to the dual identity of being
Black and a public health department professional. Addressing this problem will help to
12

understand the impact of structural racism. According to Blaisdell (2016), many Black
professionals struggle to cope emotionally with the profound awareness and experiences of
structural racism. The organization of this dissertation contains the following chapters:
Chapter 2 provides a review of the existing literature studying from various settings the
dual identity of being Black and a public health department professional and its contributions to
burnout, particularly in the impact of structural racism in the public health industry. Chapter 3
details the methodology for this dissertation study which includes the research design and
protocols for this study. Chapter 4 shares the data analysis and findings from this dissertation study
that are presented with both written and graphic summaries. Lastly, Chapter 5 summarizes the
study and findings while also presenting research implications and recommendations for future
study.

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2 Chapter: Literature review
2.1 Preface
This chapter delved into the exploration of various aspects of structural racism in the public
health industry. This chapter described the historical context of structural racism, shedding light
on how it has shaped the current landscape of public health. Additionally, analyzed the presence
of structural racism in today's public health industry and its detrimental effects, particularly in
contributing to burnout among Black public health department professionals. Furthermore, this
chapter established connections to the study, and presented a conceptual framework.
2.2 Structural Racism in the Public Health Industry
Structural racism in the public health industry refers to the pervasive and deeply ingrained
systems, policies, and practices within the healthcare sector that disseminate racial disparities in
health outcomes (Bailey et al., 2021). According to the study of Avant & McGee (2021), these
disparities are not the result of individual biases or overt acts of discrimination, but rather the
consequence of historical and ongoing inequities that disproportionately affect marginalized racial
and ethnic groups, particularly Black, Indigenous, and people of color (BIPOC). Structural racism
manifests in various ways, such as limited access to quality healthcare services, unequal
distribution of resources, disparities in health insurance coverage, and the social determinants of
health like housing, education, and employment opportunities (Yearby, 2020). This systemic bias
can lead to burnout, i.e., higher rates of chronic diseases, shorter life expectancies, and poorer
health outcomes for BIPOC communities (Churchwell et al., 2020).
Since the COVID-19 pandemic, evidence of burnout among black public health department
employees has caused great concern (Leo et al., 2021; Beagan et al., 2022). This is because many
black public health department employees frequently come from communities with high rates of
14

medical mistrust as a result of previous and ongoing experiences with White supremacy in a public
health department setting (Evans et al., 2020). Black employees represent 11.9% of the United
States (U.S.) workforce, with 17.5% of black employees working in the public health industry,
while only 6% of U.S. public health organizations have a black chief executive officer (Wilson,
2020; Chartis, 2021). Under-represented in their profession, black public health professionals are
more susceptible to negative racial stereotypes, resulting in having to adjust their opinions,
appearances, and behaviors to make others feel safe and for professional advancement
opportunities (Roberts & McCluney, 2020).
According to the study of Ali et al. (2019), this lack of representation is an indicator of
structural racism. Structural racism is the process that makes racial discrimination possible through
socio-ecological systems that reinforce biased beliefs and attitudes. Similarly, Briggs et al. (2018),
stated that, racism is a social manifestation of behaviors that try to hide the experiences of another
person or group. Black, Indigenous, and other people of color (BIPOC) are discriminated against
and harassed while feeling unsafe and isolated in the workplace, leading to unhealthy coping
strategies and other health implications (Hagle et al., 2021). Confronting structural racism requires
not only changing individual attitudes but also dismantling the structural policies and systems that
undergird the U.S. racial hierarchy (Bailey et al., 2021).
2.3 Historical Context of Structural Racism in the Public Health Industry
In USA, the structural racism is deeply rooted in the history of slavery, segregation, and
discrimination (Ahmed, 2020). Slavery, which existed in the United States for nearly 250 years,
subjected African Americans to brutal living and working conditions, leading to significant health
disparities (Ainscow, 2020; Aldrich, 2019). After slavery was abolished in 1865, African
Americans continued to face segregation and discrimination in access to healthcare, education, and
15

employment, creating a legacy of inequality in health outcomes (Cramer & McElveen, 2020).
From the end of Jim Crow to the present-day Black Lives Matter movement, Black people continue
to fight for representation and equity, including in the workforce in the United States (DeLombard,
2019).
According to Lopez et al. (2021), the deprivation of Black people in the U.S. has been a
historical staple for over four hundred years, leaving a stain that continues to hinder societal
advancement and individual achievement for Black people. Structural racism is linked to the
beginnings of U.S. history, permeated across its institutions and economy, and is embedded within
our culture (Bailey et al., 2021). The historical context of structural racism is explored through the
enslavement of Black people, the perpetuation of White supremacy, and the efficaciousness of
anti-Blackness.
Enslavement of Black People
The enslavement of Black people in the United States represents a dark and deeply
ingrained historical injustice that spanned nearly two and a half centuries, from the early 17th
(1619) century until the Civil War ended in 1865 (Dryden & Nnorom, 2021). This brutal system
of slavery had profound and enduring impacts on the lives of Black individuals and their
descendants (Dugan, 2020). With the arrival of a group of enslaved Black individuals referred to
as the "20 and odd Negroes" who were logged as being sold in Jamestown, Virginia, in 1619 to
John Rolfe (Leo et al., 2021). These individuals had been disembarked from the cargo ship named
the White Lion, a vessel commanded by Captain John Jope, who engaged in the trading of these
captives in exchange for provisions and essential supplies (Ossom-Williamson et al., 2020). This
transaction is widely regarded as the pivotal moment marking the advent of the institution of
slavery within the American context (Paine et al., 2021).
16

According to the study of Ross et al. (2020), the early historical episode serves as a
foundational instance in the understanding of the dual status conferred upon Black individuals at
the time, as human beings and simultaneously as possessed property. It laid the groundwork for an
enduring and dehumanizing system of racial slavery that persisted for over two centuries (Tsui et
al., 2023). During this prolonged period, countless Africans were forcibly abducted from their
homelands in Africa and subsequently subjected to abhorrent and inhumane conditions as enslaved
individuals within the United States (Ali et al., 2019). The slavery, as underscored by Burton and
Burton (2008), was strategically undertaken by European colonizers to render for land cultivation.
The utilization of enslaved labor was instrumental in cultivating the land for agricultural
production. This exploitative system of coerced labor and the commodification of human beings
for economic gain precipitated the establishment of White supremacy as a pervasive and enduring
social construct within the American context (Collins et al., 2023).
The foundation of White supremacy in America also began to set the blueprint for
America’s economic infrastructure. Coronado et al. (2023), conveyed how the immorality of
slavery designed America’s infrastructure through power, labor, class, and race. This is evident as
nearly four million slaves with a market value estimated to be between $3.1 and $3.6 billion lived
in the U.S. just before the Civil War (Evans et al., 2020), with slave owners gaining high rates of
return on slaves comparable to those on other assets, further institutionalizing the practice of
slavery as cotton consumers, insurance companies, and industrial enterprises benefited from the
enslavement of Black people (Kaltiso et al., 2021). As the institution of slavery persisted,
legislative measures and institutional frameworks were established to uphold and facilitate the
abhorrent practices (Lim et al., 2022). For a span of more than two centuries, the compulsory
enslavement of Black individuals in the United States resulted in the generation of riches,
17

opportunities, and prosperity for a significant number of White Americans (Olson et al., 2022). In
order to establish the legitimacy of this institution, legislation was formulated with the purpose of
restricting the basic human rights and existence of Black individuals inside the United States
(Quaye et al., 2019).
According to Ross et al. (2020), it is noteworthy that before the Civil War, which ultimately
led to the abolition of black enslavement, a significant majority of the first twelve presidents of
the United States, namely eight of them, were slave owners throughout their tenure as presidents.
This observation underscores the integral role that slavery played within the fabric of the nation's
political establishment (Tsui et al., 2023). Enslaved individuals of African descent were seen and
commodified as chattel, serving as significant contributors to the economic productivity of the
United States (Inikori, 2020). According to Wilk et al., (2023), the expansion of slavery in the
United States corresponded with the proliferation of laws pertaining to slaves. These laws
encompassed various aspects, such as the classification of slaves as commodities that could be
acquired through both maritime and terrestrial means, as well as regulations that restricted their
mobility, forbidding them from leaving their owners plantations without written authorization
(Williams et al., 2020).
Additionally, Walker & Tolentino (2020) stated that, these laws imposed limitations on
slaves' abilities to engage in activities such as reading, writing, swearing, and smoking, walking
with a cane, or expressing happiness. The aforementioned legislation delineated the legal
framework, including the proprietary entitlements held by slave owners over their enslaved
individuals and the extent of control they might exert over them (Legha & Martinek, 2023).
Additionally, these laws established the obligations that slaves were required to fulfil towards their
masters (Skeffrey, 2023). The existing laws and regulations persist in reinforcing the notion of
18

White supremacy while also presenting a persistent dilemma about the dual identities of
individuals as both human beings and property owners (Speicher & Francis, 2023). The structural
rules were established with the intention of safeguarding a growing economy, but their
implementation resulted in the systematic marginalization of Black individuals and the
perpetuation of the idea of inferiority (Arday, 2022). The reconceptualization of heredity played a
vital role in the implementation of slavery, which actively marginalized enslaved individuals from
their familial connections and ancestral heritage (David et al., 2022). This deliberate separation
aimed to portray enslaved Black individuals as deprived, thus providing a rationale for the
widespread practice of enslavement (Darity & Mullen, 2022).
The repudiation of the cultural traditions and rituals of enslaved individuals of African
descent served to exacerbate systemic racist practices and the degradation of their humanity.
Gabriel & Aguinis (2022), asserts that slavery had a central role in economic production, hence
establishing the master-slave dynamic as a prototype for many social relationships, including those
between spouses, parents and children, and employers and employees. In his study, Stovall (2022)
examined the process through which prevalent traditions were codified, leading to the
institutionalization and endorsement of racial discrimination against individuals of Black ethnicity.
The perpetuation of these abhorrent acts of institutional racism served to further marginalize and
devalue individuals of African descent. Black people were historically dehumanized and treated
as possessions, hence exemplifying the origins of their dual identity (Vrcelj & Karabašević, 2022).
According to Anderson (2021), Black people were seen as three-fifths of a human being
and subjected to circumstances of slavery that were intentionally crafted to instill feelings of
inferiority and powerlessness. According to Andrews (2021), during the period of slavery, a
prevailing belief among American physicians was that Blackness encompassed not only the
19

physical appearance of an individual's skin, but also served as a racial classification that conveyed
significant insights into the biological aspects of race (Dazey, 2021). This belief further propagated
the notion that Black individuals could belong to the same species as their White counterparts,
while simultaneously possessing distinct biological characteristics that rendered them inferior to
Whites (International Labor Organization, 2021). There was a prevailing belief among many
individuals that slaves had a reduced vulnerability to some diseases, such as malaria, while
simultaneously being more vulnerable to other health-related conditions, including syphilis and
mental disorder (Jones, 2021). These attitudes and practices had a significant role in shaping the
public health system and medical field in the United States. In his scholarly work, Lopez et al.,
(2021) expounded upon the impact of slavery on the field of medicine.
According to Nkomo (2021), the reproductive medicine played a crucial role in supporting
and ensuring the continuation and prosperity of southern slavery, particularly in the antebellum
period, which saw the most significant movement and trade of black women in the nation's early
history (Shim, 2021). Physicians established a distinguished group, including mostly White males,
whose professional endeavors, notably their gynecological assessments of black women, had an
influence on the nation's slave markets (Payne & Hannay, 2021). Every enslaved individual who
was sold had a medical examination in order to determine their value (Spears, 2021). Furthermore,
it was recognized by physicians in the southern region that the reproductive labor performed by
enslaved women played a significant role in advancing the field of women's medicine (Wallington,
2021). This labor included several aspects, including the treatment of gynecological ailments and
the management of pregnancies (Ahmed, 2020). The legitimization of the terrible treatment
inflicted upon enslaved individuals of African descent and the abhorrent deeds perpetrated against
their bodies was facilitated by systemic laws and practices (Ainscow, 2020). Slave masters
20

exercised social dominance and derived economic benefits by subjecting enslaved individuals to
a range of dehumanizing practices (Banks, 2020). The slavery of individuals of African descent
was intrinsically connected to the ideology and preservation of White supremacy (Bell, 2020). The
abhorrent practices of enslavement, along with the establishment of institutional frameworks and
legal measures to safeguard these practices, contribute to the perpetuation of the ideology of White
supremacy (Cénat, 2020).
Perpetuation of White Supremacy
White supremacy has a profound and extensive historical foundation, originating from the
era of colonialism, the transatlantic slave trade, and the subsequent construction of structures that
perpetuated racial discrimination (Cook, 2020). Prior to the era of colonization and the subjugation
of those of African descent, the notion of race predicated upon variations in skin pigmentation was
absent (Embrick & Moore, 2020). The concept of race is a socially constructed phenomenon,
although it is intertwined with deep-rooted structural factors that have resulted in intentional and
systematic attempts, starting from colonial periods and continuing to the present day, aimed at
establishing a privileged attachment to Whiteness for those of European American descent (Hirata
& Soares, 2020). The United States grapples with complex racial dynamics, characterized by
profound racial disparities (Maree Stanley, 2020). These disparities are exemplified by historical
events such as the forcible displacement of Indigenous communities from their ancestral lands and
the suppression of their cultural practices, as well as the coerced labor imposed on black
individuals via the institution of slavery (Nakamura, 2020). Nazroo et al. (2020) emphasized that
black people have had a central position within the White-racist system of the United States since
the advent of the nation's slave history (O’Reilly, 2020). This is primarily due to the fact that they
have experienced significant levels of oppression, distinguishing them as the racial group most
21

profoundly affected by such circumstances (Sakamoto, 2020). The persistence of White supremacy
has resulted in the ongoing marginalization and segregation of black people, mostly based on the
pigmentation of their skin (Stanford, 2020).
As per the study of Taren, (2020), the concept of race, predicated upon the differentiation
of individuals based on their skin color, may be traced back to the historical need for one racial
group to assert dominance over another. According to the University of California San Francisco
(2020), dominance is a construct that has emerged from the historical fabric of the United States.
It is characterized by a power dynamic that is established and maintained by a range of acts and
mistreatment directed against certain groups. White supremacy emerges from the
conceptualization of race as a determinant based on skin color, which has historically been used
as a means to assert dominance over other racial groupings (Waite, 2020). White supremacy is an
ideological framework that emerged in the 17th century, characterized by the exertion of power
and control over black individuals, indigenous communities, and other people of color on a global
scale (Yearby, 2020). Its primary objective is to secure and maintain wealth and privileges for
White individuals, predicated on unfounded notions of White superiority and dominance (Aldrich,
2019).
This system is perpetuated both consciously and unconsciously by White individuals and
other racial and ethnic groups and manifests itself in multiple domains, including institutions,
interpersonal relationships, social dynamics, cultural practices, political structures, ideological
beliefs, and historical narratives (Yearby & Mohapatra, 2020). Cramer & McElveen (2020) posits
that the concept of White supremacy often pertains to persons, organizations, or ideologies that
openly and knowingly exhibit racism in its most blatant and explicit form, often grounded in the
22

belief of an immutable genetic lineage. Adhering to the notion of White racial superiority
(DeLombard, 2019).
As per the study of Gorski (2019), White supremacy is an ideology that may be understood
within the framework of the social construct of racism. White supremacy is a multifaceted
construct that manifests in nuanced manners and is characterized by its aim to derive advantages
from behaviors rooted in racism (Hannah-Jones, 2019). The emergence of White supremacy may
be attributed to persistent systems of genocide, the displacement of Indigenous populations, and
the subjugation of Blacks and other non-Whites, which were implemented with the purpose of
dehumanizing them and asserting dominance (Himmelstein & Venkataramani, 2019). According
to Kline & Lewis (2019), White supremacy can be characterized as a collection of conscious or
unconscious beliefs, behaviors, or structures that uphold, sustain, or fail to address the social,
political, historical, economic, or institutional control and presumed superiority of individuals who
are socially recognized as hit. Melaku (2019) argue that White supremacy serves as the
fundamental framework for understanding both racism and privilege. They contend that the
normalization and concealment of White racial identities, along with the associated privileges
bestowed upon individuals with White skin, are products of the institutionalized systems of White
supremacy. Consequently, Mello (2019), stated that privilege and racism can be seen as
manifestations of this underlying disease. White supremacy has deleterious effects on those who
are not of White racial background, with a special emphasis on the Black community, which has
endured significant suffering as a result of the historical institution of slavery.
Payne et al., (2019), stated that, White supremacy has been safeguarded by the
implementation of legislation that has resulted in the relocation of Indigenous communities, the
perpetration of violence against them, and the slavery of Black individuals. Additionally, this
23

ideology has been reinforced through the establishment of structural laws and the propagation of
unfounded convictions. According to Alang et al. (2021), the presence of White supremacy
facilitates the perpetuation of structural racism via several processes, resulting in the
marginalization and oppression of racial groups that are not of White descent. Robinson et al.
(2019) underscored the significance of five prevailing factors in the marginalization and
oppression of racial groups that are non-White.
1. Racial stereotypes and prejudices;
2. Racial narratives and interpretations;
3. Racialized imagery;
4. Racialized emotions; and
5. Common inclinations to discriminate along racial lines.
White supremacy, as a pervasive worldwide phenomenon, exerts its influence on the lived
experiences of individuals via the establishment and enforcement of structural laws and practices.
Ruane (2019) asserts that the pervasive influence of Whiteness in American society may be
attributed to historical factors such as the legacy of slavery and segregation, the implementation
of immigration restrictions, policies towards Native and Indigenous populations, as well as the
perpetuation of subjection and colonialism (Smith, 2019). The recognition of challenges and
disruptions to the prevailing discourse necessitates an acknowledgment that normative Whiteness
perpetuates itself via aspirations of supremacist rejuvenation and an ideology centered on
entitlement, power, and privilege, sometimes to the detriment of those who do not identify as White
(Wooten, 2019). The pervasive phenomenon of White supremacy persists on a worldwide scale,
perpetuating the marginalization of Black individuals by means of social and cultural standards as
well as structural measures (Montañez, 2020).
24

The concept of race is a socially constructed framework that has been created to establish
and maintain systems of power and privilege. The effect of Whiteness as a concept is seen in the
societal ideals and practices that are deeply rooted in White logic (Embrick & Moore, 2020).
Stanley (2020) posits that the concept of Whiteness encompasses an ideology that upholds the
societal position of individuals identified as White within the framework of White society. This
ideology is characterized by the manifestation of power and privilege associated with Whiteness,
which is evident in three key domains: normativity, structural advantage, and lack of racial
consciousness (Wright & Merritt, 2020). Normativity refers to the capacity to determine social
acceptability, while structural advantage pertains to the protection afforded to White individuals
through institutional policies and laws. Lastly, the lack of racial consciousness entails a failure to
recognize and acknowledge the experiences of non-White racial groups. Whiteness refers to a
collection of cultural behaviors or practices, both conscious and unconscious that are shown by
individuals of White racial background (Reiners, B., & Whitfield, 2023). These behaviors either
depend on, contribute to, or neglect to oppose the structural laws or institutions that perpetuate
White privilege and systemic racism (Silverstein, 2021). The establishment of norms or
expectations rooted in the advantages associated with Whiteness has perpetuated the
marginalization of Black people.
The presence of White supremacy is not just confined to formal legal frameworks and
legislation but also permeates societal norms and anticipated behaviors. Within a societal
framework characterized by racialization and the pervasive influence of White supremacy, the
allocation of space becomes a site of contention, determining inclusion and exclusion as well as
access to the space's resources (Embrick & Moore, 2020). The perpetuation of the idea of
Whiteness poses a complex challenge for Black individuals and their experiences within various
25

social contexts, leading to a dual-identity struggle. The concept of Whiteness plays a significant
role in shaping colonial social norms and marginalizing individuals or communities that deviate
from these norms (Massaquoi, 2023).
Additionally, Whiteness influences the categorization and treatment of people of color
based on notions of acceptable conduct and equitable treatment (Stanley, 2020). Embrick and
Moore (2020) argue that the racial experiences and encounters with racism among various groups
in the United States have been characterized by notable differences. This can be attributed to the
historical and ongoing racial structuring of the United States as a White supremacist state, which
has systematically denied individuals who are not White access to the power and privileges that
are typically enjoyed by White individuals. According to Massaquoi (2023), the practices of
slavery and segregation served to establish a system where individuals strongly identified with
Whiteness, resulting in a lasting impact of structural racism inside the social democracy of the
United States. The pervasive impact of structural racism has transcended national boundaries,
emerging as a pressing issue on a worldwide scale. Motivated by the ideology of White supremacy,
the institution of slavery yielded substantial economic benefits for White slave owners and their
peoples (Leo et al., 2021).
The worldwide perception and treatment of Black people have been significantly shaped
by White supremacy, which has been perpetuated via historical factors such as slavery,
segregation, and the continued marginalization of Black communities. According to Spears (2021),
White supremacy is a systemic phenomenon that aims to establish itself as a universal framework,
permeating all aspects of political economics, influence, income distribution, and people's overall
well-being. According to Embrick and Moore (2020), the historical documentation of violence
directed against individuals of African descent has not only contributed to the enhancement of the
26

economic and political status of White individuals, but it also persists in influencing the
perpetuation of White supremacy and the prevalence of anti-Black racism. The phenomenon of
White supremacy has had an influence on cultural perspectives, shaping ideas and attitudes,
particularly in relation to the effectiveness of anti-Black sentiments (Robinson et al., 2019).
Efficacy of Anti-Blackness
The concept of anti-Blackness, first articulated by Akua Benjamin, a professor of social
work, refers to the distinct characteristics of systemic racism that arise from the historical backdrop
of racism, namely stemming from the enslavement and colonization of individuals of Black-
African heritage (Ahmed, 2020). The intrinsically problematic nature of anti-Blackness lies in its
effectiveness, which operates systematically to deprive Black individuals of their humanity and
dignity, rendering them effectively excluded from attaining full citizenship (Ainscow, 2020). The
persistence of White supremacy has resulted in the incorporation of anti-Black sentiments into
institutional laws and regulations, which impede the progress of Black individuals and shape
societal attitudes towards them (Aldrich, 2019). Consequently, this has had an impact on how
black people see and manage their own dual identities. The social fabric of the United States is
intricately intertwined with historical and contemporary manifestations of racism, including the
perpetuation of White supremacy and the systemic marginalization of Black individuals in terms
of equitable opportunities and fair representation (Ali et al., 2019). The institution of slavery served
as a means to systematically dehumanize those of African descent, therefore establishing a
framework of legal and social norms that perpetuated their inferiority and lack of value (Anderson,
2021).
The perpetuation of a conviction in the inherent superiority of White individuals has
resulted in the displacement of Black people and other individuals from communities of color,
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leading to the loss of ancestral lands, separation from family, and erosion of cultural practices that
have historically shaped their collective identity (Andrews, 2021). Individuals of African descent
who were forcibly removed from their countries of origin and subjected to the dehumanizing
institution of slavery possess a distinct narrative and psychological conditioning as a result of the
pervasive ideology of White supremacy, which manifests in the complex struggle of navigating a
dual identity. The historical period of America's enslavement of Black people, spanning more than
four centuries, has resulted in a significant absence of recollection pertaining to the pre-slavery
experiences and identities of Black individuals (Olaloku-Teriba, 2018). The use of myths and
stereotypes has been employed as a means to rationalize the institution of slavery and the
mistreatment endured by enslaved individuals of African descent. These justifications have
included the propagation of the notion that Black people had inherent biological differences or
were of a subhuman nature, exhibiting lower intellectual capacities, heightened pain thresholds,
and a lack of trustworthiness (Maynard, 2017).
The aforementioned mindset is often referred to as anti-Blackness.
Anti-Black racism is a distinct manifestation of racism that is explicitly targeted at those of African
descent, with its origins and perpetuation deeply intertwined with historical instances of slavery
(Dryden & Nnorom, 2021). According to Bledsoe (2020), anti-Blackness may be defined as a
cultural framework that presupposes the absence of humanity and, thus, the inherent illegitimacy
of black communities across time. According to additional scholarly perspectives, anti-Blackness
encompasses the actions, beliefs, and ideologies exhibited by individuals and institutions with the
aim of devaluing Black individuals in order to uphold White dominance. It is worth noting that
anti-Blackness can also be internalized by Black individuals, leading to the manifestation of
colorism or other similar expressions that serve to elevate White culture while eradicating Black
28

cultural norms (Amherst College, 2020). In the work of Olaloku-Teriba (2018), the author
emphasizes that the perceived unique relationship between "the human and the Black" is
commonly expressed through the concept of 'anti-Blackness and its modern manifestations.
However, the contemporary understanding of 'anti-Blackness' extends beyond mere racism against
individuals identified as Black, encompassing the fundamental role of this racism in all systems of
racial dominance. The perpetuation of Whiteness ideology is sustained by the presence of anti-
Blackness. The marginalization of Black individuals under norms that priorities Whiteness serves
to invalidate their lived experiences and is a significant obstacle to the development and
affirmation of their own identities.
According to Emrick and Moore (2020), the philosophies associated with Whiteness are
prevalent in social contexts and characterized by adherence to White standards. However, these
norms are deeply intertwined with an underlying implicit anti-Blackness within White racial
ideology. Bledsoe and Wright (2019) examined the interconnectedness between anti-Blackness
and capitalism, positing that anti-Blackness serves as an inherent prerequisite for the accumulation
of capital. Hence, anti-Blackness manifests in two distinct forms: overt and covert. The overt
manifestation is evident in socially unacceptable remarks, while the covert manifestation operates
through structural systems and legal frameworks. Both manifestations contribute to the
devaluation of Blackness and the systematic marginalization of Black individuals (University of
California, San Francisco, 2020). To elaborate, it may be argued that anti-Blackness has served as
a significant impediment for those of black descent in their pursuit of employment opportunities,
educational attainment, and access to adequate housing, and quality healthcare (Quillian et al.,
2017). Anti-blackness is a pervasive phenomenon that is deeply ingrained within cultural and
29

social norms, leading to the propagation of negative stereotypes and prejudiced attitudes against
individuals of Black descent.
The prevailing unfavorable presumption towards individuals of African descent is rooted
in the view that they possess inherent inferiority compared to other racial and ethnic groups.
Bledsoe and Wright (2019) assert that the persistence of anti-Blackness is a distinct phenomenon
rooted in the historical legacy of chattel slavery in the United States. This enduring receptivity to
mistreatment of Black populations continues to shape the lives of Black individuals. According to
Olaloku-Teriba (2018), the concept of race is intricately linked to the pervasive influence of White
supremacy and anti-Blackness. It is a construct that is deeply embedded within the structural
framework of society, functioning as a powerful worldwide force characterized by a hierarchical
arrangement of distinct physical characteristics. This arrangement serves as the primary source of
conflict within the context of modernity. Anti-Blackness, despite its status as a social construct,
functions as a weaponized mechanism intended to curtail the lived realities of individuals
belonging to Black communities and other racial and ethnic minority groups. The persistence of
anti-Blackness in America serves to underscore the flawed underpinnings of the nation, extending
beyond colorism and including other dehumanizing beliefs.
Conclusion on the Historical Context of Structural Racism in the Public Health Industry
Systematic discrimination against people of colour is justified by racism, a societal concept
with institutional origins in White supremacy. Slavery's power came from the dehumanisation of
African-Americans, which started with the 1619 shipment of the first 20 enslaved persons from
Africa to the newly colonial America. The term "anti-Blackness" is used to describe the societal
norms that have allowed for both overt and subtle racism towards Black people. In today's
workforce, especially in the public health industry, anti-blackness and capitalism are the driving
30

drivers of structural racism. Slavery gave rise to White supremacy, and today's structural policies
and practices are continuations of that racism's goal of maintaining White economic and political
power.
2.4 Structural Racism in Today’s Public Health Industry
Structural racism manifests in unequal access to healthcare resources and services.
Minority communities often face barriers such as limited access to quality healthcare facilities, a
shortage of healthcare providers in their neighborhoods, and insufficient health insurance
coverage. These disparities result in delayed or inadequate care for many individuals. Research
indicates that racial and ethnic minorities often receive lower-quality healthcare and experience
disparities in treatment outcomes. Implicit biases among healthcare providers can lead to
differential treatment, misdiagnoses, and inadequate pain management.
Structural racism operates inside the fabric of society via the establishment of legal
frameworks and rules, consequently exerting influence on prevailing attitudes and practices and
ultimately impeding the progress of individuals belonging to racial minority groups. Givens (2021)
asserts that the presence of structural racism has had a significant influence on the development of
institutional policies and practices, resulting in the perpetuation of obstacles to equal opportunities
and the persistence of racial inequities. According to Dent et al. (2021), Black public health
professionals experience racial inequalities in the form of racial wage discrepancies and debt loads.
In the year 2018, research indicated that there was a disparity in earnings between Black and White
doctors on a national scale, with Black physicians earning $50,000 less than their White
counterparts (Ault, 2021). The COVID-19 pandemic on a worldwide scale has brought attention
to further disparities within the workforce, namely in relation to healthcare workers on the
frontlines who have been disproportionately affected by the outbreak. It has been observed that
31

individuals belonging to racial and ethnic minority groups, notably those of Black descent, have
been significantly impacted by these inequalities (Ossom-Williamson et al., 2021). According to
McKinney's (2022) research, in 2021, a significant number of Black workers in the United States,
totaling over eight million individuals, voluntarily left their employment. Among these
individuals, 31% cited experiences of discrimination and/or abuse, while 29% reported
experiencing burnout. The persistence of systemic racism in the workforce, namely within the
public health sector, is evident.
Within various institutional settings, such as public health departments, individuals of
African descent have been burdened with the task of addressing and resolving systemic obstacles
that hinder their professional progress. Throughout history, individuals belonging to the Black
community and other ethnic minority groups have been tasked with confronting and resolving the
presence of structural racism. This arduous undertaking involves navigating several obstacles, such
as the need to persuade those in positions of power, mostly White decision-makers, of the existence
and impact of structural racism (Ross et al., 2020).
According to Rosario et al. (2022), it has been recognised by public health departments,
including the Department of Public Health at the University of North Carolina at Greensboro, that
issuing formal declarations to condemn structural racism is an initial action that must be
complemented by the implementation of strategies, enforcement mechanisms, and accountability
measures in order to bring about meaningful transformation. In order to effectively address the
issue of structural racism within the public health sector, it is imperative to examine the concepts
of institutional racism, implicit bias, microaggressions, and respectability politics. These factors
contribute to the persistence of structural racism in the contemporary public health industry,
32

particularly in relation to the complex experiences of Black individuals who also work as public
health professionals.
Institutional Racism
Scholars persist in emphasizing the presence of racism, as shown by many forms such as
legislation, governmental measures, and societal establishments. Over the course of the last two
years, several state and local public health departments have officially recognized structural racism
as a public health concern. This acknowledgment stems from the understanding that racism has a
pervasive historical narrative inside the United States and globally, permeating almost all societal
establishments (American Public Health Association, 2020). The establishment of public health
departments was undertaken with the aim of safeguarding and enhancing the health outcomes of
individuals and the communities they belong to. The public health sector, which encompasses
three primary functions - assessment, policy development, and assurance, is characterized by a
predominantly White workforce. This profession and field of study are responsible for educating
and addressing the needs of communities that are disproportionately represented by individuals
from Black, Indigenous, and Latinx backgrounds. This dynamic perpetuates the influence of White
supremacy within the realm of public health (Alang et al., 2021). The COVID-19 pandemic's first
stages revealed a significant racial disparity in adverse health consequences, whereby Black,
Hispanic, and Indigenous communities in the United States had markedly inferior social and health
circumstances compared to other groups (Lopez et al., 2021). This analysis underscores the
persistent influence of racism on the experiences of those from non-White backgrounds, with a
special emphasis on the enduring effects on Black individuals.
Structural racism is deeply ingrained into many systems, laws, and practices, while
institutional racism works to uphold and perpetuate these systems, laws, and practices via
33

organized structures and physical environments. Institutional racism is a phenomenon that is
manifested within the organizational culture, makeup, and practices of various organizations
(Pattel, 2022). According to the findings of Lim et al. (2022), institutional racism is influenced by
both overt and covert racial norms, practices, responsibilities, and power dynamics that are
ingrained in the processes of formulating and implementing organizational policies. According to
Embrick and Moore (2020), the concept of institutional racism in the United States encompasses
the existence of White-dominated spaces, which are maintained by systems of White privilege and
corresponding beliefs.
According to Jones (2000), institutionalized racism is characterized by its normative and
legalized nature, since it is systematically codified in a manner that obscures the identification of
any one offender. The presence of institutional racism is a significant obstacle for Black workers
in their pursuit of professional aspirations. The presence of institutional racism throughout several
sectors, including the public health industry, perpetuates the marginalization of individuals of
Black descent, hindering their ability to achieve equitable socioeconomic progress. According to
a study conducted by Quillian et al. (2017), there is a significant disparity in callback rates between
White candidates and similarly qualified Black applicants. Specifically, White applicants get an
average of 36% more callbacks compared to their Black counterparts. The pervasive effects of
discrimination on Black individuals' opportunities, experiences, and outcomes, as well as their
perceptions and expectations in various professional roles, can be attributed to enduring and
intentional economic, social, and legal policies (Bell, 2020).
The underrepresentation of Black individuals in the medical profession is apparent, as seen
by the fact that while they make up around 13% of the total U.S. population, only 5% of U.S.
doctors are Black, as reported by Ross et al. in 2020. According to a research conducted by the
34

Institute for Diversity in Health Management in 2015, it was found that a mere 8% of healthcare
professionals holding positions on hospital boards and executive leadership roles were identified
as Black. Black public health workers not only face a lack of visibility within the public health
business, but they also encounter compensation disparities, hence exacerbating the complexities
associated with their dual identity as both Black individuals and public health professionals.
Pay discrepancies serve as a further manifestation of institutional racism. Numerous studies have
shed light on diverse empirical findings that support the notion of wage disparities as a
manifestation of institutional racism. In the year 2020, Jackson National Life Insurance Co.
reached a settlement amounting to $20.5 million as a result of allegations of discriminatory
practices against Black female workers. These employees were found to have been subjected to
unequal compensation in comparison to their White counterparts and were also overlooked for
promotions in favor of less-qualified White males (Tucker, 2021). According to Gruver (2019),
there exists a disparity in earnings between black and White males in U.S. labor, with Black men
earning around 87 cents for every dollar made by their White counterparts.
According to Temple and Tucker (2017), it was found that Black women get a pay of
around 63 cents for every dollar earned by White men. Additionally, the average annual wage for
black women with a four-year college degree is $46,694, while White males with a high school
diploma earn an average annual salary of $46,729. According to Himmelstein and Venkataramani
(2019), there exists a disparity in wages between Black and White public health nurses, with Black
nurses earning $0.97 less per hour and experiencing an annual compensation gap of $2,018.
Institutional racism has a significant influence on impeding equitable opportunities for Black
public health practitioners. The persistence of institutional racism in the workplace perpetuates the
35

disempowerment and marginalisation of Black workers, particularly in relation to their prospects
for career progression.
Embrick and Moore (2020) emphasised that within the workforce, there exists a tendency
to question the mere existence of Black individuals and other individuals of color. This tendency
inadvertently reinforces the organization of social spaces based on White values, beliefs, logics,
ideologies, and activities. The presence of institutional racism is evident in tangible circumstances
and the distribution of authority, which can be traced back to specific historical occurrences.
However, its endurance may be attributed to ongoing structural elements that perpetuate the
injustices of the past (Jones, 2000). Institutional racism is a systemic construct aimed at depriving
individuals of African descent of equitable access to opportunities and upward mobility.
Institutional racism has been identified as a significant barrier preventing Black personnel from
accessing development opportunities. This is often attributed to the perception of a "ghetto-
centered" attitude or a propensity for violence (Smith et al., 2011). A current study consistently
demonstrates the detrimental effects linked to institutional racism in the workplace.
In contemporary public health discourse, the issue of institutional racism has emerged as a
persistent paradigm that poses significant challenges in terms of recognition and elimination.
Delgado and Villalpando (2016) highlighted the perception of tackling institutional racism in the
workplace as an act of rebellion, resulting in encounters with challenges and impediments. Ture
and Hamilton (1992) observed that institutional racism is predicated upon the widespread and
ongoing manifestation of anti-Black sentiments and behaviors, rooted in the notion of White
superiority and the consequent subordination of Black individuals to their White counterparts. This
particular concept poses a significant obstacle in the contemporary labor market, exerting a notable
influence on the economy of the United States.
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According to Ahmed (2012), the presence of institutional racism inside organizations poses
a significant danger to their image and economic progress. Cook (2020) emphasized the potential
impact of achieving racial equality in the workplace on the level and long-term development of
the United States economy. According to Cook, the gross domestic product (GDP) of the United
States reached $21.4 trillion in 2019, but it could potentially increase to $5 trillion if equitable
opportunities for individuals of all races were realized. The presence of institutional racism inside
the workforce has a negative impact on the United States economy as it perpetuates the
marginalization of Black people and undermines their experiences within the workplace.
The presence of both recognized and unrecognized examples underscores the need for robust and
expeditious efforts aimed at enhancing workforce diversity, especially within the realm of public
health. The presence of institutional racism within the public health business manifests itself in
many forms of inequities in hiring practices, pay, and leadership positions. These disparities pose
significant obstacles to the progression of Black individuals pursuing careers in public health. In
contemporary society, there persists a manifestation of institutional racism that perpetuates
unethical behaviors targeting those of black descent inside the workforce.
Consequently, these discriminatory practices create substantial barriers for Black workers,
hindering their ability to access equitable opportunities and necessitating their navigation of the
unique obstacles associated with their racial identity in relation to their various job responsibilities.
There is a pressing need to initiate a transformative movement in the field of public health, which
entails the identification and examination of empirical facts pertaining to racially discriminatory
actions as well as a concerted effort to confront and rectify instances of institutional racism (Taren,
2020). In order to address this pervasive issue, it is imperative for institutions to go beyond mere
discourse or reliance on explicit proof of institutional racism. Instead, they should mandate
37

purposeful measures, demonstrate organizational dedication, and, of utmost significance, foster a
collective aspiration for the future (Ross et al., 2020).
In the study conducted by Waite et al. (2020), it was shown that decision-makers possess
the necessary authority and structural power to establish mechanisms and tactics that influence the
construction of meaning, which can be categorized as invisible power. Additionally, decision-
makers also possess the ability to choose the agenda, which is considered a kind of hidden power.
Lastly, decision-makers exhibit observable decision-making processes, which can be classified as
visible power. By advocating for racial justice, the concealment of difficulties and challenges
associated with racism throughout decision-making processes will be eliminated, allowing these
concerns to permeate the thoughts and awareness of everyone engaged, addressing the concept of
invisible power. The implementation of comprehensive policies on recruitment procedures, salary
parity, employee incentive schemes, chances for professional growth, representation of diverse
backgrounds in leadership roles, and similar measures is vital to foster equitable practices within
the public health sector, specifically with regard to racial demography.
According to Taren (2020), it is imperative for the public health sector to implement
established rules that mandate the inclusion of policies and programs that are free from racial bias.
To achieve this, health department accreditation should necessitate the establishment of a
dedicated office focused on promoting racial equality. Dent (2021) proposed the implementation
of proactive strategies aimed at recruiting and retaining black public health professionals, as well
as facilitating their professional development via mentorship programs and opportunities for
advancement into leadership roles. Enhancing the diversity of leadership teams is a crucial element
in the pursuit of health equality, as the inclusion of varied leaders may contribute to the mitigation
of cultural disparities. The use of equitable recruitment strategies contributes to the enhancement
38

of diversity and overall organizational efficacy as it leverages the diverse array of skills, abilities,
backgrounds, and knowledge possessed by recruited personnel. The implementation of structural
modifications within the public health sector is imperative, with a primary focus on diversity and
equality as explicitly outlined objectives, accompanied by well-defined and practical measures for
enhancement (Morgan et al., 2021). Ongoing research consistently highlights the need to adapt
current anti-racism laws in order to mitigate any potential manifestation of institutional racism that
may persist in contemporary society.
The research also presented potential approaches for addressing institutional racism.
According to Waite et al. (2020), the establishment of a proficient Black public health workforce
necessitates the implementation of deliberate and focused recruitment and retention strategies that
are rooted in principles of equity and racial justice. Furthermore, it is crucial to provide clear
avenues for advancement into leadership positions within the field. In order to achieve a public
health sector that accurately reflects the racial composition of the United States, it is imperative
for public health organizations to embrace certain principles and actively seek input from public
health experts belonging to historically marginalized communities. This collaborative approach
will facilitate the development of specific policies and initiatives aimed at transforming the
healthcare system and improving the experiences of these underrepresented groups (Dent et al.,
2021). Recognizing the existence of racism and its detrimental impact on the professional progress
of black individuals in the field of public health is crucial to addressing and mitigating institutional
racism.
Scholarly investigations have underscored the significance of recognizing the historical
pain and consequences associated with racism. The act of positioning the workforce, particularly
within the public health business, as race-neutral fails to acknowledge the historical context of
39

colonialism and slavery, the existing racial structures, the racist elements within these systems,
and the enduring presence of anti-Black sentiments (Wooten, 2019). An increasing number of
organizations are recognizing the significance of eliminating institutional racism due to its
potential to enhance organizational well-being (Ahmed, 2012). Since the era of coerced servitude,
individuals of African descent have persistently encountered challenges in their pursuit of fairness
and parity. Specifically, within the realm of employment, the prospects for black individuals to
progress and attain higher positions are often constrained. Based on data from the Pew Research
Centre (2019), a significant majority of Black Americans, namely 63%, perceive that their skin
color has a notable influence on their standing within several societal domains, including but not
limited to the job, inside American culture. The data from the IBM Institute for Business
Executives (2021) reveals a notable disparity between the perspectives of White and Black
organizational executives about their belief in equal opportunities for success in America.
Specifically, the study indicates that 66% of White leaders hold the view that individuals may
achieve success in the United States via hard work, but just 40% of Black leaders share this belief.
The assertion was substantiated by Gooch (2021), who reported that 6% of hospitals in the United
States are led by Black chief executive officers. The contention lies in the notion that institutional
racism is sustained by the normalization of Whiteness and anti-Blackness ideologies within the
workforce, facilitated by institutional policies and practices.
The existing body of research has also shown the challenges associated with effectively
tackling institutional racism in the workplace. The phenomenon of institutional racism operates
through the systematic implementation of practices that marginalize individuals of Black racial
background. By analyzing the ways in which discriminatory actions, segregation, and oppression
are deeply ingrained in the fundamental elements of public health, such as assessment, policy
40

development, and assurance, the ultimate objective is to provide public health practitioners with a
comprehensive understanding of the structural aspects of racism. This knowledge aims to enhance
their effectiveness in promoting equitable health outcomes (Rosario et al., 2022).
The capacity to implement necessary modifications is greatly impeded by enduring societal
attitudes and structural obstacles that impact recruitment, hiring, and mentorship policies and
practices within the field of public health. These disparities are manifested through explicit and,
more subtly, implicit mechanisms that necessitate identification and resolution within our
organizations, both at the individual level (micro) and the level of policies and practices (macro)
(Waite et al., 2020). The employment environment in the public health business presents ongoing
challenges for black workers' sense of self due to the presence of subtle phenomena, including
implicit prejudice and microaggressions.

41

3 Chapter: Methodology
3.1 Preface
This chapter describes the methodology for this study. The research has employed a
qualitative research approach. The interview has been conducted to collect valuable insights to
achieve the result of the research. This chapter highlights the data collection method, sampling
approach, study participants, and recruitment strategy, including study participants' selection
criteria and rationale. The chapter also entails proposed instrumentation (including interview
protocols) and subsequent procedures for data analysis. The validity and reliability aspects of the
study, ethical considerations, and limitations and delimitations are also included in this chapter.
3.2 Theoretical Framework
The problem this study seeks to address is burnout experienced by the dual identity of being
Black and a public health department professional. This research study utilizes Burke-Litwin's
(1972) organizational change model as a theoretical framework, explaining various elements that
influence organizational performance and overall effectiveness (Martins & Coetzee, 2009).
According to the Burke-Litwin organizational change framework, the organization should
consider 12 key factors when assessing the change in the organization. The model is designed
based on the structure of input-input-throughput-output with a feedback loop. The change occurs
and flows at different levels of the organization. Therefore, the model has characterized factors in
the level of the organizations. At the macro level, there are external factors. Similarly, at a strategic
level, there is the culture of the organization. Additionally, at the micro level, there are individual
factors (Cooper, 2015). Firstly, the external factors are those, which indicate the need for the
change. This could be any significant issue that has arisen suddenly, and the organization is
required to initiate a change in the organization. Similarly, the transformational factors of the
42

organization such as Mission and Vision, Leadership, and organizational culture are significant in
making the structure of the organization. The decision to change in the organization emphasizes
the organization to look at and address these factors. The Mission and Vision involve making
people know about the desired future state of the organization and how it would be achieved. The
Leadership includes the actions, practices, and values of the senior manager of the organization.
The Organizational culture involves the expected norms, behaviors, and values that are practiced
in the organization (Filej et al., 2019).
In addition, the transactional factors can be changed easily and have less impact on the
performance of the organization compared to the transformational factors. These factors include
structure, systems, management practices, work climate, task and individual skills, individual
needs and values, and motivation. The structures involve the hierarchy of the designations in the
organization. The system involves regular processes for the operation of the organization. The
management process includes the practices of the managers in executing day-to-day tasks in the
organization. The work climate indicates the attitude behavior, and morale of the people in the
organization. The task and individual skills involve the right job placement with the right employee
with the necessary skills. The individual needs and values the degree of fulfilling the needs of the
employee by the organization. Lastly, motivation includes both intrinsic and extrinsic factors that
motivate people to perform effectively and consistently. In a similar context, the positive outcomes
of the change result in enhancing individual and organizational performance. This ultimately
reflects the performance and effectiveness of the change. Therefore, when the performance of the
individual and organization changes, it impacts the changes in the external environment and other
factors (Filej et al., 2019).
43

Consisting of twelve factors, the organizational change model helps to understand how
organizations function and how organizations may change (Burke & Litwin, 1992). As the study
explores the dual identity of being Black and a public health department professional contributing
to burnout, social cognitive and critical race theories are also applied. The Social Cognitive Theory
(SCT) entails that social influence has an impact on the external and internal social reinforcement
of the individual. According to the SCT, the individual adopts and maintains any behavior due to
the social environment. The social environment influences individuals to perform particular
behaviors. The theory also reflects that the past experiences of individuals are the factors that
influence individuals to adopt any behavior. Past experience impacts the reinforcement and
expectations of the individuals. These factors influence individuals and indicate whether the
Figure1: Burke-Litwin Model of Organizational Performance and Change
Source: (Cooper, 2015).
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individual will acquire and maintain the particular change (Schunk & DiBenedetto, 2020). In
addition, the Critical Race Theory (CRT) is the legal framework analysis that proposes that race
is a socially constructed idea and does not is a natural or biologically grounded feature of the
apparently different subgroups of humans. The social constraint of race is an act of oppressing and
exploiting individuals based on their colors Daftary, (2020). The critical race theory emphasizes
and holds that racism is a character attribute that is inherited in the United States' legal institutes.
These functioned to ensure equality in the social, economic, and political inequalities among non-
White and White Americans (Hamilton, 2021). The purpose of critical race theorists is to
implement their concept of the nature of racism with the significant goal of eliminating the concept
of inequality in the hierarchies and disparities due to racism (Wingfield & Chavez, 2020).
3.3 Research Design
To conduct the research, a qualitative phenomenological research method has been utilized.
The purpose of this study is to examine the dual identity of being Black and being a public health
department professional leading to burnout. As per the work of Stake, (2010), a qualitative study
is appropriate when the goal of the research is to explain a phenomenon by relying on the
perception of Black public health department professionals’ experiences in a given situation.
According to Merriam and Tisdell (2016), qualitative research is based on the belief that
knowledge is formed by people in an ongoing fashion as they are involved in the significance of
an activity, experience, or phenomenon. This qualitative study is an approach to capture the unique
experiences of Black public health department professionals when encountering acts of structural
racism in their respective workspaces. This qualitative study also utilizes grounded theory
methodology. According to Stake (2010), grounded theory is a qualitative approach that moves
from individual experience to collective experiences (Stake, 2010). Through grounded theory,
45

there is a comprehensive understanding of Black public health department professionals’
experiences, specifically when encountering acts of structural racism in the workplace. Grounded
theory methodology highlights human experiences with complete objectivity (Birks & Mills,
2011). This approach helps to ensure the validity and reliability of this qualitative study. As
described in the study of Noble, & Mitchell, (2016), Grounded Theory is a research method
approach that is concerned with the generation of theory. The theory is grounded systematically
and analyzed in this theory. According to the work of Tirumalesh, (2019), grounded theory unfolds
the behavior and social relationships of a group of people which is also is also known as social
processes. The theory is considered important as it provides a well-structured and systematic
approach to the methodology for qualitative research. It also serves to provide significant strategies
that are helpful in managing the analytic phases of the data collection. Moreover, it accelerates the
process of the integration of data collection and analysis. Furthermore, it aids in offering a
conceptual analysis of the collected qualitative data in the study.
3.4 Data Collection
The research is focused on the problem of burnout experienced by Black public health
department professionals. The study aims to determine the experience of the Black public health
department professionals. For this, the research has incorporated a qualitative data collection
approach such as interviews. Specifically, the semi-structured interview approach is integrated to
collect information from Black public health department professionals in the U.S. According to
the research of Harrell & Bradley, (2009), Semi-structured interviews are effective in obtaining
the relevant information. This approach is well known for acquiring reliable and comparable
information for different individuals. Additionally, it provides detailed and rich information
regarding the topic, due to the more open-ended questions (Cohen & Crabtree, 2006). The use of
46

phenomenological research will provide the meaning of interviewees’ lived experiences about the
phenomenon (Creswell, 2018). This study has served Black public health department professionals
in sharing their experiences of navigating dual identities, resulting in burnout. Interviewees are
asked 16 open-ended questions, with the duration of each interview being between 45-60 minutes.
3.5 Study Participants and Sampling Size
For the contemporary study, purposeful sampling is used to recruit Black public health
department professionals. In using purposeful sampling, the researcher actively seeks study
participants who will provide in-depth contextual qualitative data (Creswell & Creswell, 2018).
The rationale for incorporating purposeful sampling is to gather qualitative information which is
helpful in providing valuable insights and precise research outcomes. In addition, purposeful
sampling involves participants who are best fit for the research (Obilor, 2023). In the study, US
black health professionals were interviewed, which provided relevant information about their
experiences specific to the research questions. The researcher, as a public health trainer with access
to various public health department networks across the county, 12-16 Black public health
department professionals are identified and invited from the four geographic regions across the
United States (North, South, Midwest, West). The participants of the interviews are from the four
U.S. geographic regions including North, South, Midwest, and West (3-4 interviewees from each
region). For each region, study participants represent one of the following roles within the public
health department infrastructure – branch chief, program manager, and program
specialist/coordinator. An email (see Appendix A for email script) is sent to Black public health
department staff from each of the four geographic regions.
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3.6 Study Setting
The interview participants for this research study are Black health department professionals
hired at least one year before the Covid-19 pandemic to compare experiences of navigating dual
identity before and during the pandemic. Since August 2021, public health departments in 37 states
have declared racism as a public health issue (American Public Health Association, 2021). Black
public health department professionals hired during the Covid-19 pandemic are compared in the
study who have experienced challenges related to dual identity as a result of structural racism in
public health departments. Moreover, it has been also identified that actions have to be taken to
address the known acts of structural racism to reduce burnout. According to Creswell and Creswell
(2018), a phenomenological approach gauges the unique experiences via the sense-making of
study participants. This approach captures the significant statements of Black public health
department professionals based on the depictions of structural racism shared based on their Black
identity as public health department professionals. The overall purpose is to understand how Black
public health department professionals make sense of their lives and their experiences (Merriam
& Tisdell, 2016). The Covid-19 pandemic has modified the operations of organizations,
particularly in the public health industry. In addition, the Covid-19 pandemic caused a shift in the
workforce for the reasons of social isolation for disease containment, moving away from in-person
and toward virtual settings, specifically in public health. From this shift, telework and other
innovative practices become the new workplace norm. Findings from the work of Walker and
Tolentino (2020) showed that the pandemic caused public health professionals to have worsening
work conditions and increased workloads, with understaffing being a contributing factor. This has
resulted in high levels of stress for public health professionals and unveiled the need to change
policies, practices, and protocols in the public health industry.
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3.7 Data Collection Procedures
The researcher's access to a vast network of Black public health department professionals
across the U.S. helped in leveraging the ability to recruit study participants immediately.
Simultaneously, as recruitment has happened during March and April. The researcher has
conducted virtual semi-structured interviews with 12-16 Black health department professionals
working in various parts of the country. As a recruitment strategy, the researcher emails potential
study participants from each of the four geographic regions. At the beginning of the interview, the
researcher provides the study participants with an overview of the research study, including its
purpose (see Appendix B for the introductory script in the interview guide). Following the
overview of the research study, the interview questions begin by asking additional demographic
questions. The researcher has taken informed consent before the interview and did not conduct any
interviews without permission from study participants, including their verbal consent to record the
interview.
Interviews are conducted and recorded using the Zoom platform, with all interviews
recorded on that platform as it offers transcribing and recording features. Moreover, Phone
interviews were also conducted due to the rise of technical issues. The interview has been also
recorded via the smartphone app, TapeACall. Because of my role as a public health trainer to
health departments across the U.S., I have access to various public health department networks
across the country. For the interview, the before-interview email was sent as a recruitment strategy
to the Black public health department professionals in those networks to participate in this study
(see Appendix A for draft email). Those who were interested in participating in the study are then
sent a Doodle poll to schedule the interviews, followed by a calendar invite and Zoom link once
an agreed-upon date and time to conduct the interview has been set. Member checks and
49

sharebacks are also provided to ensure the validity and trustworthiness of this study. Notetaking
of discussion was performed by the researcher during the interview as a secondary source to collect
information in case of any technological failures. Because interview participants are in different
geographical regions in the United States, interviews are conducted via Zoom. According to
Archibald et al. (2019), the key advantages of using Zoom for qualitative semi-structured
interviewing reflect neutral, methodological, and logistical considerations: (1) rapport, (2)
convenience, and (3) simplicity and user-friendliness. The utilization of Zoom allows data to be
collected through the platform’s recording features, which also has the ability for transcriptions.
When Zoom technicalities had potentially served as a barrier to conducting any of the interviews,
interviews were conducted via telephone along with a user-friendly voice recorder to support data
collection. Moreover, the study participants were also provided with a follow-up thank you email
within 24-48 hours of their interview participation and for member checking to ensure accuracy in
their responses.
3.8 The Researcher
The researcher is a Black public health professional, serving in the role of Manager of
Capacity Building Services for a national public health training center that works with public
health departments across the country. Based on the researcher’s role, he provides training and
capacity building to health departments around the integration of HIV programs and structural
interventions to leverage HIV prevention and care services in communities most impacted by the
HIV epidemic. He has experienced burnout as a result of having to navigate his own dual identity
as a Black person and public health department professional.
As this study was on the researcher's own past experiences of workplace burnout, this is an
opportunity to test this study’s hypothesis through the findings of this qualitative research study.
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According to Shaw et al. (2020), the key to alleviating any of the researcher’s influences in a
qualitative interview is to acknowledge that it happens and ensure strategies for proactively
managing such situations. Strategies to mitigate these influences are adhering to the research
questions alongside the theoretical and conceptual frameworks.
3.9 Instrumentation
The method used for the collection of the data in the study is based on semi-structured
interviews (see Appendix B for interview questions). According to Galletta (2012), one of the main
advantages of a semi-structured interview approach is enabling reciprocity between the researcher
and the interview participant. According to Ford and Airhihenbuwa (2010), research based on the
actual experiences of Black and other marginalized populations provides more meaningful data,
informing the need for change and growth. Utilizing a semi-structured interview approach allows
for a rich conversation with interview participants that may elicit additional probing questions.
The interview consists of 16 questions that are aligned with key concepts from Burke-
Litwin organizational theoretical framework as well as social cognitive and critical race theories.
The 16 interview questions, along with probing questions, help to answer the guiding research
questions, thereby garnering a deeper understanding of structural racism in the public health
industry and its contributions to employee burnout. For many Black employees, the workplace is
of crucial importance as it is a site in which personal identity is performed (Ainsworth, 2013). A
semi-structured interview is best for this study as questions asked gauge Black public health
department professionals’ experiences with working in the public health industry, including
encountering acts of racism and perceptions of racism in the workplace, along with any
physiological or psychological impacts. The duration of each interview was between 45-60
minutes.
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3.10 Data Analysis
After data had been collected, the researcher conducted a data analysis which involved
transcribing data and thematic coding. With interviews conducted and recorded via Zoom, the
platform provides transcriptions. The researcher uses the transcription services of Rev Max to
support with cleaning up or editing transcripts. Due to the Rev Max app, the interview data from
the Zoom meeting has been automatically transcribed. This transcribed data has been further used
in editing and sharing the interview information on Zoom. Notes captured by the research are also
transcribed to ensure that all data is analyzed. The researcher conducts member checks as needed
to guarantee the accuracy of participants’ responses.
With the use of Atlas. Ti, a qualitative data analysis software, the researcher infused both
deductive and inductive approaches to coding. The Atlas. Ti is considered a useful tool in
identifying the themes and codes from a large data set. The analysis of the huge data from the
interview is difficult to handle and is time-consuming (Paulus & Bennett, 2017). Therefore,
utilizing Atlas. Ti has helped in handling the large data and identifying nuanced data from the
interview data. Atlas. Ti is the software used for data analysis to code common themes and
findings. This is done first by starting with a set of codes based on the research and interview
questions, followed by additional open codes that are organized into categories and subcodes. In
using a grounded model theory approach, coding has a key focus on the experience of the study
participants in a semi-structural manner. The researcher conducted further rounds of qualitative
coding while continuing to organize codes in the appropriate categories and subcodes for the data
analysis narrative (Chapter 4).
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3.11 Trustworthiness and Credibility
To maximize credibility and trustworthiness in the research study, various strategies are
used from the qualitative interviews. Merriam and Tisdell (2016) shared that being able to trust
research outcomes is beneficial to professionals in applied fields because practitioners intervene
in people's lives. Interviewing Black health department professionals in different regions of the
United States and obtaining perspectives from different parts of the country as well as diversity in
roles of Black health department professionals. According to Natow (2020), a researcher may
interview people who hold different viewpoints or possess varying amounts of power. For this
reason, member checking is important when analyzing data to ensure participants’ responses are
valid and accurate. Following the interview protocols and conducting a thorough data analysis has
helped to mitigate any personal influences, as both assist with ensuring the validity and
trustworthiness of this study. The trustworthiness of the study has been maintained through
applying approaches such as member checks/follow-up and sharebacks to ensure accurate
responses from study participants.
Triangulation is the primary strategy that has been used for the validity and reliability of
this research. According to Rossman and Rallis (2012), triangulation is a way to draw from various
secondary data sources to inform the same question or issue by collecting data through other
methods. It provides share-backs of preliminary findings with research participants for initial
feedback on the emerging themes from the interviews. Merriam and Tisdell (2016) stated by
highlighting the importance of the research study to be clear about how the study was done.
Moreover, ensuring a convincing presentation of the findings of the study is a key element of
trustworthiness. When the study had concluded and the data was analyzed, the researcher hosted
a Zoom webinar with participants to share findings from the study and solicit feedback.
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3.12 Ethical Consideration
As this qualitative study conducts interviews as a research approach, this study possessed
a low risk to the participants. While interviews are voluntary, each study participant is provided
with the purpose of this research study and asked for their permission to participate in the study
and for the interviews to be recorded. Interviews are also confidential, with each study participant
assigned a unique identifier, which is the first initial of their first and last name, along with the
month and year of their hiring date at their respective public health department. To further adhere
to the confidentiality of the study participants, personal data collected are not shared with anyone
outside of the research team. Data collected is stored in dually authenticated Google Drive, which
is a protected data storage platform. Personal data is stored for two years after the research study
and then permanently deleted from Google Drive. In addition, approval from the Institutional
Review Boards (IRB) has been also taken for this research.
3.13 Limitations and Delimitations
This study has some limitations, such as dependence on the accuracy of study participants’
responses, particularly interview questions that may be emotionally triggering. Based on prior
research captured in the literature review (Chapter 2), structural racism in the workplace has had
psychological impacts on the lives of Black employees - traumatic impacts on the lives of accuracy
and their intensity in terms of time, expense, and possible emotional strain. Timing also served as
a limitation, as the duration of conducting interviews and the timeframe for which interviews
occur, study participants may have a long history of experiencing acts of structural racism in the
respective public health departments.
Delimitations for this study include the focus on one specific racial/ethnic population, the
dual identity of being Black, and a public health department professional. Whereas, not capturing
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the dual identity of other non-White racial/ethnic public health department professionals may not
provide the full gambit of structural racism in the public health industry nor its contribution to
burnout. Another delimitation is conducting interviews via Zoom. Providing that racism can be a
sensitive topic, conducting face-to-face interviews serves as a more effective manner. As
qualitative data is being collected from the semi-structured interviews, other limitations and
delimitations are identified.
3.14 Chapter Summary
The chapters provided the overall methodological structure of the research. The theoretical
framework is also presented in it. The research has employed the model of organizational change
which its 12 constructs that are effective for assessing and managing change in the organization.
Similarly, the cognitive social theory as well as the critical race theory are also discussed in the
Chapter. Moreover, the research has employed a qualitative phenomenological research approach
as it is effective in assessing the phenomena of the perception of the individuals. In addition, the
grounded theory is also incorporated in the study which aided in the structured and systematic
research approach for contemporary research. Furthermore, the chapter also highlighted that data
is collected through semi-structured interviews which are significant in acquiring the most relevant
and comparable data. In a similar context, the chapters represented the Study participants and
Sampling Size. The study has conducted interviews with 12 - 16 Black public health department
professionals in the four regions of the U.S. including North, South, Midwest, and West. Moreover,
the chapter also includes the setting of the research. The participants for the interviews were
recruited from the study who were hired before the Covid-19 pandemic. The reason for this is to
compare the changes in their experience of dual identity pre-post the Covid-19. Along with this, a
detailed data collection procedure is discussed which includes conducting interviews and storing
55

the data. Moreover, the data analysis techniques are also discussed in this chapter. The interview
data is transcribed by Rev Max and the codes and themes are generated by incorporating Atlas. Ti.
Similarly, the reliability and validity of the research are also presented in this chapter. The ethical
considerations which have been followed in conducting the research are discussed in this chapter.
Lastly, the limitations and delimitations of the students are also included in this chapter.
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4 Chapter: Results/ Findings
4.1 Preface
This chapter entails the findings from the interview. The participant’s demographic
characteristics are also presented in this chapter. In addition, the data collected from the interview
is assessed and analyzed into themes. Overall, the findings from the data analysis for this research
by thematic coding are presented in this chapter. Lastly, the summary of the findings is also
discussed at the end of the chapter.
The contemporary qualitative, phenomenological study aims to examine burnout
experienced by the dual identity of being Black and a public health department professional in the
U.S. For conducting the study, Burke and Litwin's (1972) organizational change model is used as
a guiding theoretical framework. The organizational change model comprises 12 factors that are
categorized under four primary themes namely external environment, transformation factors,
transactional factors, and individual/organizational performance (Gordon, 2022). The use of this
framework has helped to identify and connect organizational factors leading to experiences of
burnout based on the dual identity of being Black and a public health department professional.
Moreover, the interview has been conducted to collect insights regarding the burnout experiences
of the Black public health department professionals. To achieve the outcomes of the research, the
following research questions are formulated for this study:
RQ1: What organizational factors contribute to implicit and overt acts of racism in
public health departments toward Black public health department professionals?
RQ2: How does the dual identity of being Black and a public health department
professional lead to burnout?
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RQ3: What role does structural racism contribute to the dual identity of being
Black and a public health department professional?
The research questions have helped in developing an open-ended semi-structured
interview guide consisting of 16 questions which have been utilized to collect data from the Black
health department professionals. In addition, to ensure the validity of the interview guide, a pilot
interview was also conducted, and comments by the pilot interviewee were taken into
consideration. After the pilot interview, 10 Black health department professionals were recruited
and interviewed. The duration of each interview was between 45-60 minutes.
4.2 Demographic Characteristics
Demographic Characteristics
Interview
Participants
Type of Public
Health Department
Public Health
Department Role
Number of
Years
Working in
the Public
Health
Department
Region of Public
Health Department
J.A.01 State Public Health
Department
Grants Manager 8yrs South
J.A.02 County Public
Health Department
Communicable
Disease Supervisor
27yrs West
S.J.03 State Public Health
Department
Deputy Director of
Health Disparities
7yrs South
M.M.04 State Public Health
Department
AIDS Program
Specialist
15yrs Northeast
M.W.05 City Public Health
Department
Learning and
Development Manager
4yrs West
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C.S.06 State Public Health
Department
Director of Health
Equity
11yrs South
S.K.07 State Public Health
Department
AIDS Drug Assistance
Program Branch Chief
8yrs West
M.L.08 City Public Health
Department
Director of Capacity
Building Assistance
5yrs Northeast
J.W.09 City Public Health
Department
HIV Prevention
Program Manager
4yrs Northeast
S.A.10 State Public Health
Department
Minority AIDS
Coordinator
17yrs South
Table 1: Demographic Profile of Black Public Health Department Professionals Interviewed
The interview participants for this research study were 10 Black health department
professionals hired at least one year before the Covid-19 pandemic. This is due to comparing
experiences of navigating the dual identity before and during the pandemic. The semi-structured
interview questions examined the dual identity of being Black and a public health department
professional, contributing to experiences of burnout. Moreover, utilizing a phenomenological
study has helped to capture the phenomenon's essence (Gill, 2020). During the semi-structured
interviews, interview participants were asked about their experiences working in health
departments and gauged their perceptions of organizational factors that contribute to burnout.
The public health department roles assumed by the 10 interview participants consisted of
the following (see Table 1 for the demographics of public health department professionals
interviewed): three of the participants were in a Branch Chief/Director role, five were in a Deputy
Director/Manager role, and two were in a Coordinator/Specialist role. Based on the number of
years working in a public health department, six of the public health department professionals
interviewed have worked in a public health department between four and nine years, with the
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remaining having worked more than 10 years. Across the country, local and state public health
departments have declared racism as a public health concern, an important first step to advancing
racial equity and justice (American Public Health Association, 2020). The 10 interview
participants in this study represented city, county, and state health departments in the northeast,
south, and west geographic regions of the country, with six of the interview participants working
in state public health departments (one in the northeast region, four in the south region, and one in
the west region), three working in city public health departments (two in the northeast region and
one in the west region), and one working in a county public health department (west region). The
interview from the Black public health department professionals across the various geographic
regions of the country, with different job roles has helped in gaining insights into the common and
unique experiences of the dual identity of being Black and a public health department professional
that results in burnout.
4.3 Coding the data
In the data collection of the study, 10 interviews were conducted and recorded via the Zoom
platform. The interview data has been analyzed by the researcher. After the transcript and
assessment of the recorded interviews, the data is interpreted by the researcher, and the main
information is obtained from the data. The data collected from the interview was transcribed and
coded. Data were first analyzed and interview recordings were familiarised and assessed by the
researcher for making themes. The study utilized descriptive coding to identify words and terms
representing what participants were describing, followed by pattern coding to discover emergent
themes. The utilization of the factors of Burke and Litwin's (1972) organizational change model
has assisted with coding and establishing themes and achieving the outcomes of the study.
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At the beginning of the interview, general questions were asked of the participants. After
that, research objectives-related questions were asked, and the answers were further coded in the
study. The focus of the study is to collect data on the experience of Black Health Development
Professionals with the Dual Identity of Being Black and a Public Health Department Professional.
From the interview discussion, several codes were generated. The generated codes are further
discussed into themes. These themes include the potential factors contributing to racism, dual
identity contribution to burnout, and the role of structured racism on the Dual Identity of Being
Black and a Public Health Department Professional. The following table provides an overview of
the participant’s responses and the codes which are generated from the response.
Data Excerpts Initial Codes
“Leadership is racist and biased and folks who only look
out for their best interest rather than the communities
served.”
Need for a supportive environment
“In my health department, we have a White hetero-male
dominated culture. (…) There is no challenge that White
supremacy exists even in its policies and practices due
to the fear of being fired.”
The prevalence of insensitive culture
“I have shared with my direct supervisor how my team
is feeling overwhelmed and underpaid, but nothing has
happened as of yet. (…) This made me frustrated and
stressed”.
Need for an inclusive work environment
“During the work, I experienced a lack of my identity.
(…) Code-switching happens a lot, which usually comes
from policies around appearance or expression of self.”
Highly negative attitude and behavior toward dual
identity
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“ Now the state government is looking to remove critical
race theory in education, which has also impacted the
thoughts and voices expressed by state employees (…)
”.
Negative influence on the overall organizational culture
Table 2: Data Excerpts and Initial Codes
4.4 Establishing Themes
After identifying codes from the interview responses, the thematic mind map was created.
This map correlates the themes with the codes and the context of the study. Through the
incorporation of the thematic analysis., the codes have become relevant to the categories of themes.
This has resulted in providing valuable interpretation by the insights of the interview. The below
mind mapping consists of three main themes and their related sub-themes. The mind map is
focused on providing the data that would aid in offering significant recommendations to limit
racism in the health departments. The generated codes and themes have been interpreted accurately
by the interview responses and peer-viewed studies

Transformati
onal factors
Lack of Commitment
Adressing racial Inequity
nd State laws
Political Climate and
State laws

Lack of Commitment Addressing
Racial Inequity

Transformational Factors
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4.5 Main Themes
The contemporary research has identified three main themes from the generated codes. The
formulated themes are relevant to the potential factors that contribute to implicit overt acts of
Racism toward Black healthcare professionals. In addition, the dual identity of the black and
healthcare department leads to burnout is included. Moreover, the significant role of structural
racism in dual identity and public health department professionals is also included. The table
presented following indicates the main themes and their relevant codes.

The desired to
be included
Lack of Black
inclusion in Public Health
Deapartment
Theme
Sub-Theme
Relationship Between Themes
Link to Sub Theme
Figure 1: Mind-map of Organized Themes (Own) Illustration)
Organizational
Factors
Contributing to
Implicit and Overt
Acts of Racism in
the Public Health
Departments
toward Black
Public Health
Department
Professionals

The Dual Identity of
Being Black and a
Public Health
Department
Professional
Leading to Burnout

The Role Structural
Racism Contributes
to the Dual Identity
of Being Black and
a Public Health
Department
Professional

Transactional Factors
Lack of Black inclusion in
Public Health Department

The desired to be included

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Themes Relating Codes
Leadership is racist and biased
• Lack of support
• Lack of diversity
• Negative impact on job performance

Dissatisfaction with workplace
• Micromanaged by my supervisor
• Need for equal advancement opportunities
Significance of the Safest Workplace
• Feeling Valued
• Enhanced physical, mental, and emotional
health
• Job satisfaction

Structural racism creates inequality
• Impact on Leadership and organizational
culture
• Impact on the dual identity of being Black and
a public health department professional
Table 3: Data Excerpts and Initial Codes
4.5.1.1 Organizational Factors Contributing to Implicit and Overt Acts of Racism in the Public
Health Departments toward Black Public Health Department Professionals
Based on the responses of the interview participants, it is found that various organizational
factors contribute to the implicit and overt acts of racism in the public health departments towards
Black professionals. Through descriptive and pattern coding, interview participants shared
significant organizational factors both transformational and transactional, which are identical to
the themes identified in Burke and Litwin's (1972) organizational change model. Transformational
factors are those that happen in response to the external environment, such as mission, strategy,
organizational culture, and leadership of health departments; because of those transformational
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factors, transactional factors are affected, which include structure, systems/policies, management
practices and work unit climate (Gordon, 2022). Interview participants expressed how leadership
and organizational culture (transformational factors), as well as hiring practices and policies
(transactional factors), have facilitated acts of racism toward Black public health professionals.
4.5.1.1.1 Transformational Factors
Two transformational factors were identified as interview participants shared the
contributions to implicit and overt acts of racism in public health departments which are leadership
and organizational culture.
Leadership
Burke and Litwin (1992) highlighted that leadership provides overall direction, serving as
a role model for all employees. When interview participants were asked about their perceptions of
leadership in their respective public health departments, six interview participants expressed that
the majority of leadership is White and hence, lacks diversity. This is supported by previous
research reporting that only 6% of U.S. public health organizations have a Black chief executive
officer (Chartis Group and the National Association of Health Services Executives, 2021). J.A.01
stated, “Leadership is racist and biased and folks who only look out for their best interest rather
than the communities served.” In a similar context, C.S.06 said, “Leadership does not support
employees of color.” The responses indicated negative perceptions of leadership and the lack of
support leadership offers to Black public health department professionals. As leadership provides
overall direction in public health departments, the lack of diversity and support from leadership
expressed by the interview participants impacts their job performance.
Upon asking Interview participants about organizational factors that may disempower
their performance, seven of the interview participants mentioned “leadership”. S.J.03 emphasized
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that “leadership is very firm, so people are afraid to challenge or push back.” J.A.01 provided a
specific example of their experience with leadership:
“I serve on the Equity and Inclusion Action Council and the chair of that committee is a
Division Director who is a White woman. She often misuses her position to not include
other voices, which disrupts the productivity of the committee. Now I don’t feel
comfortable showing up, and not participating as much on the council.”
Orgnaizational Culture
Based on the interview participants’ responses, Black public health department
professionals are engaging in an organizational culture of fear and discomfort, hindering their
ability to authentically exist and thrive while on the job. In providing overall direction in
organizations, leadership shapes the culture of organizations. When the participants were asked to
describe the culture in their respective public health departments, eight of the interview
participants described the culture as a White-dominated culture. In this regard, Embrick and Moore
(2020) shared that institutional racism in the United States implies the presence of White space,
with mechanisms of White privilege and values. In addition, J.A.02 defined the culture of their
health department as “White hetero-male dominated culture, so there is no challenge that White
supremacy exists even in its policies and practices due to the fear of being fired.” J.W.09 declared
that“The workforce of my health department is predominately White women in leadership, so the
practices are very White-driven and at times unintentional racist acts occur.” Interview
participants’ responses highlighted how the characteristics of White supremacy (Okun, 2021) in
public health departments influence an organizational culture that promotes implicit and overt acts
of racism toward Black public health professionals.
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Consequently, when the participants were asked about subtle workplace cultural practices
they perceived as racist. Nine of the interview participants expressed a culture of insensitivity and
a lack of awareness of racist acts in public health departments. C.S.06 stated, “People are truly
clueless this happens, which is why we need unconscious bias, but we can’t do that.” S.J.03 also
shared that “There are people in my health department who have said things that may be racially
inappropriate to say.” And S.K.07 emphasized, “Microaggressions, which are driven by a
leadership of Whiteness.” M.L.08 also added, “It is usually more interpersonal racism or where it
seems unintentional, but it is still racism.” From the interview participants’ responses, it has been
revealed that Black public health department professionals have to endure an organizational
culture that upholds implicit and overt acts of racism such as color blindness, implicit bias, and
racial microaggressions.
Interview participants pointed out other implicit and overt acts of racism in their public
health departments, such as leaders disregarding racism. M.L.08 stated, “The rule around racism
is very blurry but you can tell that folks are looking out for their own.” This is also supported by
another participant J.A.01 who stated, “White fragility shows up a lot whenever we try to address
the subtle acts of racism.” Both show the challenges when navigating the dual identity of being
Black and a public health department professional when transformational factors such as
leadership and organizational culture create anxiety in calling out racism due to the fretfulness of
being fired.
4.5.1.1.2 Transactional Factors
Transformational factors also influence transactional factors such as policies, management
practices, and work unit climate.
Policies and Procedures
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Interview participants mentioned transformational factors such as a White supremacist
organizational culture, which manifests in the policies and practices within public health
departments. J.A.01 emphasized, “The traditional get ol’ boys policies – how you
communicate/share information and the make-up of leadership, which is predominately White.”
This could also highlight the experience of M.L.08, who expressed, “Racial microaggressions and
a lot of tokenism happen within my health department.”
Black public health department professionals experiencing micromanagement is a result of
racial implicit bias, microaggressions, and tokenism, which the interview participants interpreted
as their supervisor’s lack of trust in their staff's ability to perform a job. S.A.10 added, “I felt being
micromanaged by my supervisor who is White, and had to tell them that I have my degree, trust
my degree.” And C.S.06 stated, “We are always provided a reason for why we cannot perform a
task.” The participants' responses are validated by the study of Rolluck (2012). According to the
study, microaggressions can manifest in subtle acts such as interrupting, ignoring, or questioning
the validity of the contributions of Black and minority ethnic individuals. The perceived racist
policies and practices shared by the interview participants revealed the challenges they must
navigate in their respective public health departments.
Interview participants also discussed how managers, who are predominantly White, do not
follow public health department policies. M.M.04 shared, “Adherence to policies on different
management levels – some managers have more influence over others which can impact the culture
of the organization in a not-so-good way. The lack of accountability with managers adhering to
the policies.” Based on the interview participants' responses, managers not adhering to public
health department policies can minimize a level of safety, which S.K.07 stated, “I do feel that there
is some lack in safety around other nuances that happen within the health department.” Further
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illustrating how the racial inequities in policies and practices lead to indefensible situations for
Black public health department professionals.
Management Practices
When sharing other implicit and overt acts of racism in their public health departments, six
of the interview participants stressed policies, specifically hiring policies and advancement
opportunities. Dissatisfaction with workplace attributes has been associated with implicit bias and
acts of discrimination, with Black employees receiving fewer rewards, resources, or opportunities
on the job than they legitimately deserve based on job-related criteria (DeCuir-Gunby & Gunby,
2016). M.M.04 described their public health department’s hiring policies and advancement
opportunities as, “Providing opportunities to certain individuals who are not of color over those of
color who may have helped to benefit the health department.” S.K.07 expressed that “More of the
recruitment and hiring practices can make it difficult for Black and other non-White people to
apply for positions at the health department. “Educational/credential requirements often seem to
block us from applying. I am usually the only one to speak out about it.” Both are examples of the
challenges Black people encounter when seeking to have a career as a public health department
professional or advancement opportunities.
Not only do the education or credential requirements for certain management or leadership
positions limit Black public health department professionals from applying, but having the
experience to assume those roles, other hiring and advancement inequities occur. J.W.09 discussed
the hiring of contract (hired directly by the funded programs in the public health department) and
union (hired through the formal government protocols) public health department professionals:
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“Union positions are very difficult to obtain, but many of them are Black women. While
the contract positions are heavily White and the recruitment for those positions looks a lot
different with also a lot of flexibility for contract positions, with minimal justifications.”
Motivation
With predominantly White leadership in public health departments, as mentioned in the
transformational factors, this could influence who is in those contract positions, which may provide
more work flexibility and pay. J.A.02 also highlighted the outcome of the inequitable
advancements, “It has been frustrating, and the health department has lost a lot of people who look
like me with lots of public health experience.” Pay inequities are other transactional factors that
have contributed to the implicit and overt acts of racism toward Black public health professionals.
M.L.08 shared:
“We were working on a grant, and two of the staff members (White women) wrote in the
grant to get raises but not for anyone else. So, the two White women got raises, but the two
Black women who also worked on the grant did not.”
M.W.05 also added, “I have shared with my direct supervisor how my team is feeling
overwhelmed and underpaid, but nothing has happened as of yet.” This demonstrates how Black
public health department professionals are ignored for pay increase opportunities and perceived as
racist. The transformational and transactional organizational factors contributing to the implicit
and overt acts of racism towards Black public health department professionals disempower job
attitudes and performance.
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4.5.1.2 The Dual Identity of Being Black and a Public Health Department Professional Leading
to Burnout
For exploring the dual identity of being Black and a public health department professional
that brings burnout in employees, some of the questions asked of the interview participants
centered around their needs and values. As individual motivation and performance are factors of
Burke and Litwin's organizational change model, based on the interview participants’ responses,
Black public health department professionals must navigate their own identity while fighting to be
included when the culture, policies, and practices may exclude them. Based on the findings,
interview participants discussed how the lack of Black inclusion in public health departments and
the desire to be included have led to their experiences of burnout.
4.5.1.2.1 Lack of Black Inclusion in Public Health Departments
Interview participants were asked how they would define a safe space, with six of the
interviewed responses being “freedom of oneself” or “authentic expression.” Yet, six of the
interview participants felt their respective public health departments were not meeting their
definition of a safe space. S.K.07 emphasized, “I don’t like the phrase “safe space. " I find it to be
an excuse as it lacks accountability. Hence I love the phrase “brave space,” but there are no safe
spaces at work.” And S.J.03 revealed, “I have seen some practices that have been disrespected
towards Black women. Or for myself, I have had to face some consequences that may not be the
same for others.” Both explaining as to why safe spaces for Black public health department
professionals are nonexistent.
Other interview participants also voiced how their respective public health department may
not be meeting their definition of a safe space, as J.A.02 shared:
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“It has been a difficult 5 or 6 past years – meaning not feeling appreciated by leadership
and administrators. I don’t feel they would care that much or would do anything to make
me feel better. I have brought up the need for safe spaces for Black people in the health
department, especially when evidence of racism exists.”
The interview participants acknowledged moments of being singled out or harassed
because of their racial identity. S.K.07 emphasized their experience of burnout due to being Black
and a public health department professional:
“A lot of chronic and emotional exhaustion due to the work demands. There have been
some harassment behaviors from others which I made aware of to my direct supervisor.
But it made me lose interest in my job, and it was hard to focus and make confident
decisions. Fear of making mistakes also resulted from that.”
This can be tied to the transformational factor, organizational culture. As mentioned before,
many of the interview participants described the culture of their respective public health
departments as White-driven and/or fearful. From the interviews conducted, lack of inclusion due
to the interview participants’ racial identity is a facilitating agent to the experiences of burnout.
Perceived racial discrimination in the workplace is negatively associated with job satisfaction, as
well as physical, mental, and emotional health (Triana et al., 2015). S.J.03 stated:
“I was constantly being oppressed and considered non-eligible for professional
development such as attending conferences. Coming to work every day and knowing that
you are restricted, can’t be authentic, or make the changes that can be impactful.”
Another depiction of how the dual identity of being a Black and a public health department
professional leads to experiences of burnout. Half of the interview participants feel their respective
public health department does not make them feel included. M.L.08 stated, “I am one of thousands
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in my health department, so I am unsure if I am heard.” Other participants also stressed the
frustration of not feeling included as J.A.02 replied:
“I often have to remind people what we do and what is our will-house. It takes time to
know what myself and my staff do and tap into our talents, experiences, and historical
knowledge. I must constantly repeat what I do. I do not get respect and often I think it is
because I don’t have a certain title or because I am Black.”
The lack of Black inclusion can be closely connected to the transformational and
transactional factors contributing to the implicit and overt acts of racism towards Black public
health department professionals, making it difficult to feel included or supported because of their
racial identity.
4.5.1.2.2 The Desire to be Included
When asked how they would like to feel included in their respective public health
departments, six of the interview participants wanted their perspective or voice to be valued.
Interview participants shared how they may be called upon by leadership but for specific race-
related tasks. J.A.01 shared:
“My health department relies on me to give voice to what is happening in communities
reflective of my identity, particularly as it pertains to the focus of Black communities,
including Black gay/queer communities, who are impacted by the HIV epidemic. But that
can become tiresome as I am pulled to be on different panels/workgroups.”
When interview participants were asked what leads to them experiencing burnout in their
respective public health departments, half of the responses were related to not being their authentic
selves at work. M.W.05 shared, “Code-switching happens a lot, which usually comes from policies
around appearance or expression of self.” As a form of respectability politics, code-switching is a
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way of surviving potential race-related harms experienced in the workplace. According to Stanley
(2020), respectability politics is a tool of Whiteness designed to manipulate and control Black
people, further silencing and oppressing Black people with a paradox of inclusion.
The policies and practices in public health departments have also created a sense of self-
doubt with hair choices, specifically Black women. S.J.03 gave an example with a White colleague
about her hair, which made her feel uncomfortable - “I was in a meeting and one of my White
colleagues stopped the meeting to say to me, “Who are you?” And when I said it is me, she replied,
“Oh, I didn’t know because of your hair.” And M.L.08 described the internal stress facing potential
negative consequences because of their hair choice:
“I have started to dread my hair and now that I am wearing dreads, I wonder if I am being
judged by my colleagues. Being a Black woman, I feel I must be very diplomatic because
I don’t want to come off as angry. Sometimes, I feel ignored, and then I pick and choose my
battles. Having to be more strategic when I don’t feel I am being treated fairly.”
Both responses showcased Black public health department professionals struggling to be
their authentic selves for them to feel included in the organization. S.A.10 highlighted,
“Oftentimes, there can be a sense of judgment or a lack of understanding of me as a whole person
and my lived experiences.” It clearly illustrates how Black public health department professionals
may be judged solely on their racial identity.
Based on the interview participants’ responses, the fight to be included is exhausting and
frustrating. Whether overt or covert, the experiences of racism by Black professionals in the
workplace oftentimes result in feelings of isolation or distrust (Williams, 2018). And with known
transformational and transactional factors influencing the attitudes and motivation of the interview
participants, nine of them reported experiencing burnout. J.W.09 replied, “I have applied for jobs
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every week and have been offered 4 jobs, but nothing that has fully enticed me to leave. Though I
usually quit in my head about every day.” M.M.04 emphasized, “There is the saying that Black
people are extra, but that is because we must give more. And when we give more, we still get the
basics and watch others advance and not us.” This response can be connected to what James (2002)
described as John Henryism, a cultural adaptation on the part of Black people to make possible a
coherent expression of core American values such as hard work, self-reliance, and freedom.
From the interview responses, Black public health department professionals are aware of
what they must endure when navigating their dual identities in work settings.
4.5.1.3 The Role Structural Racism Contributes to the Dual Identity of Being Black and a Public
Health Department Professional
Exploring the role of structural racism contributing to the dual identity of being Black
and a public health department professional, questions focused on the external environment of
Burke and Litwin's (1972) organizational change model were asked. According to Abbas (2020),
the external environment is the set of factors outside an organization influencing its leadership,
culture, policies, and management practices. Interview participants highlighted how the political
climate and state laws shape the transformational and transactional factors in public health
departments, influencing the attitudes and motivation of Black public health department
professionals.
4.5.1.3.1 Political Climate and State Laws
With public health departments serving as a government entity, political climate, and state
laws can impact the transformational and transactional organizational factors. According to Arday
(2019), racism has evolved and is continuously refined through societal and political instances of
unfairness and injustice, allowing racial microaggression to maintain a position of prominence.
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Givens (2021) also added that structural racism has shaped institutional policies and practices that
propagate barriers to opportunities and racial disparities. When participants were asked about the
external environmental factors that influence the culture in their public health departments, seven
of the interview participants highlighted the impact of the political climate in their respective
jurisdictions, including state laws. J.A.01 replied:
“The political landscape is a huge factor. For example, the former governor had an old
yearbook of him in Black face that got out to the public, which led to him going on a
public apology tour, which impacted how the state health department was seen. Now the
state government is looking to remove critical race theory in education, which has also
impacted the thoughts and voices expressed by state employees.”
In the same notion, S.J.03 answered, “State law and other external factors have to do with
our geographic makeup, being majority rural and so many health department staff, especially
leadership, come from areas that are not so diverse and those thoughts come into the health
department.” These participants indicate how the political climate can influence both the
organizational culture and leadership in public health departments.
State laws have also instilled fear in Black public health department professionals with
what they can say or address as it pertains to issues impacting the dual identity of being Black and
a public health department professional. This was evident as S.J.03 shared, “We have a state law
that state agencies cannot discuss any isms, which is frustrating because they are a part of our
reality.” While C.S.06 emphasized the influence of newly elected officials once assuming their
political roles, “The new governor is Trump’s former Press Secretary, so there is a lot of fear in
testing the waters.” S.K.07 also added, “Working for a government entity are politics and
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bureaucracy. We have some very passionate employees but some of the approaches can come from
a White Supremacist view.”
Responses from the interview participants provide insight as to how structural racism
contributes to the dual identity of being Black and a public health department professional.
4.5.1.3.2 Lack of Commitment Addressing Racial Inequity
Across the country, public health departments have declared racism as a public health
concern (American Public Health Association, 2021). Taking a stance on this declaration will
require internal work such as modification of policies and diversifying leadership. To move toward
a public health industry that is representative of the current United States racial makeup, public
health entities should espouse values and listen to public health professionals from historically
excluded groups to create concrete policies and actions that change their experience within the
healthcare system (Dent et al., 2021). Addressing racial inequity in public health departments helps
to remove workplace fear and anxiety (The U.S. Surgeon General’s Advisory on Building a
Thriving Health Workforce, 2022), which the interview participants have expressed. When asked
about leadership approaches to racial equity in the workplace, six of the interview participants felt
that their respective public health department was trying but not enough. J.A.02 shared:
“Maybe they are trying to do a better job, and it is slow. We have a Racial Equity
Manager, though I am not sure who internally she is working with. I do know she has the
ear of leadership and HR, so I am hoping for change in the next 3-5 years. Pay is not the
only thing that can keep good employees, there must be other equitable opportunities. We
need a more diverse and positive workforce in our health department.”
J.W.09 also replied, “A lot more work has to be done around racial inclusion – for example,
I am the only Black male in a program development position, but most of the Black men are fiscal
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or contract specialists, and one Black man in a key senior leadership position.” M.L.08
emphasized, “We need to be more racially diverse, but also diverse in age, experiences, skills,
gender/sex. More equity in hiring and pay. More diversified degrees. We just need a much stronger
focus on racial equity.” All responses describe how their public health department is trying but
may lack the understanding of the real-time concerns of Black public health department
professionals.
As the majority of the participants mentioned how their public health departments were
trying to address racial inequity, there were also responses indicating the lack of commitment or
follow-through to ensure racial equity. S.K.07 stated:
“There are a few of us in leadership who are working to address racial equity in the
workplace, while others are not so active. We have a Racial Equity Workgroup and have
implemented a 21-day Racial Equity challenge. I was supported by my direct supervisor,
but as other health department issues were pushed up our racial equity efforts were
rejected….so it is somewhat divided.”
M.L.08 also shared a similar response, “All the racial justice initiatives have been pushed
to the side. So, the racial equity unit has been broken into pieces and fell to the waste side.” Both
are strong examples of the lack of commitment to addressing racial inequity in public health
departments. Taren (2020) emphasized that in the public health industry, established guidelines to
ensure policies and programs are not racist should be a requirement for health department
accreditation, specifically an office on racial equity. The lack of commitment can be a result of not
knowing how to address racial inequity due to the complexity of structural racism - being
embedded in the laws, policies, practices, and other factors. C.S.06 stated, “My health department
has no clue as to how to approach racism.” Based on the findings, there is a need for
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recommendations and evidence-based strategies to address racial inequity in public health
departments.
4.6 Summary of Findings
The dual identity of being Black and a public health department professional is a
contributor to their experiences of burnout. Utilizing Burke and Litwin's (1972) organizational
change model helped to gauge the critical factors that influence how Black public health
department professionals exist in their workplace settings. Based on the findings, transformational
factors such as predominantly White leadership and White-driven organizational culture have led
to implicit and overt acts of racism toward Black public health department professionals. As
highlighted in the normalcy of Whiteness in leadership and organizational culture has garnered
fear in Black public health department professionals using their voices to call out racism or
challenge White supremacy as they fear facing consequences such as job termination.
And with transformational factors shaping transactional factors such as policies and
management practices like hiring, and promotions - many of the interview participants are
experiencing pay inequities and unfair treatment in their respective public health departments.
Existing research reported that in the U.S. workforce, Black men earn $.87 for every dollar earned
by White men, and Black women are paid $.63 for every dollar paid to White men (Gruver, 2019;
Temple & Tucker, 2017). Further illustrating that pay inequity based on race is prevalent in today’s
workforce. Other transactional factors, such as advancement opportunities or management
practices both make it difficult for authentic expressions or other chances for inclusion, resulting
in code-switching or respectability politics. From the findings, it is uncovered that Black health
department professionals have a desire to be included and heard, particularly as it pertains to
addressing racism in their respective public health departments.
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Structural racism is an external factor that shapes the leadership and culture in public health
departments. Interview participants emphasized how state laws and the political climate in their
respective jurisdictions are contributors when navigating the dual identity of being Black and a
public health department professional. Laws that prevent public health departments from
mentioning any isms such as racism, further silence the voices of Black public health department
professionals as implicit and overt acts of racism occur in their respective public health
departments. This can also be linked to an existing study, which indicated, that 46% of Black
public health professionals reported moderate to high stress resulting from experiences of
structural racism (Kaltiso et al., 2021). With the interview participants representing public health
departments from across the various geographic regions of the country, there are strong
commonalities with the dual identity of being Black and a public health department professional
resulting in burnout.

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5 Chapter: Recommendations and Conclusion
5.1 Preface
This study issue centered on experiences of burnout brought on by having a dual identity
as a Black public health department professional. A summary of the results from qualitative, semi-
structured interviews with 12 Black public health department workers serving in a variety of
capacities (director, manager, coordinator, etc.) around the nation is provided in this chapter.
Additionally, this chapter offers suggestions about how to solve the issue. The construction of a
question semi-structured open-ended interview guide to gather information from Black health
department professionals was influenced by the study questions. According to Burke and Litwin's
(1972) model of organizational change was used to highlight the effects of purposeful and
successful change on organizational performance and overall effectiveness.
5.2 Findings
In this chapter, it is demonstrated how the historical backdrop of structural racism has been
established in organizations like public health departments and therefore underlines how the study
findings were consistent with previous studies. Over eight million Black workers in the U.S. left
their occupations in 2021, with more than 20% burnout (McKinney, 2021). Additionally, it was
said that burnout-related turnover in the workforce now costs up to billion (Hart, 2022). Many
applicants mentioned implicit and overt acts of racism as contributing to their experiences of
burnout, including the lack of Black public health department professionals in leadership roles,
discriminatory hiring practices, and unfair treatment of Black public health department
professionals.
Due to the numerous problems they have had to overcome, including persuading White
decision-makers that structural racism exists, Black people have had to bear the burden of
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combating racism (Ross et al., 2020). According to the study findings, the majority of interview
applicants discussed how outside forces like structural racism affected the leadership and culture
in their various public health departments, leading to rules and regulations that demotivated
employees and reduced their productivity. It can be challenging to navigate help when confronted
with understood and overt acts of racism in public health departments Black public health
department personnel must identify and create coping tools to support them in those situations.
Individual values and needs may have an influence on an employee's excitement, work
satisfaction, and dedication, claims (Patricia, 2021). According to the study's findings, three of the
interview applicants felt that their public health departments did not provide a safe space, which
they characterized as a place where people could express themselves honestly without fear of
repercussion. Nine of the applicants disclosed having experienced burnout, emphasizing the
difficulties they have in negotiating their twin identities as Black people and public health
department professionals. Transformational for example, White leadership a White-driven culture,
and transactional such as unfair hiring or advancement practices and pay inequities factors were
identified as two significant contributors to implicit and overt acts of racism in public health
departments through the lens of Burke and Litwin's (1972) organizational change model. Only 8%
of individuals on hospital boards and executive leadership positions are Black, according to
existing research. Public Black public health nurses earn $.97 less per hour than White public
health nurses, resulting in a $2,000 annual salary gap.
Black professionals must constantly figure out how to counteract negative racial
stereotypes that undermine their professional images, resulting in having to adjust their thoughts,
appearances, and behaviors to boost the comfort of others in the hopes of receiving fair treatment
and opportunities. This is because Black professionals are frequently underrepresented in
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professional occupations. To eradicate acts of structural racism, it is essential to address burnout
resulting from a dual identity as a public department professional and Black. Dealing with
structural racism, such as racial discrimination in the workplace, is an emotional burden that
frequently affects job performance. Fair hiring practices rely on the diverse skills, talents,
backgrounds, and expertise of staff recruited to improve diversity and organizational performance.
This will necessitate structural change within the departments of public health, starting with the
stated goals of diversity and equity and providing clear and specific strategies for improvement
(Morgan et al., 2021). These examples, both known and unknown, continue to emphasize the
significance of providing Black professionals in public health departments with support that is
culturally appropriate and equal opportunities (Roberts & McCluney, 2020).
5.3 Recommendation
Recommendations were identified to address burnout experienced by the dual identity of
being Black and a public health department professional. The COVID-19 pandemic highlighted
workplace inequities experienced by Black public health professionals, as many frontline public
health professionals impacted by the epidemic were Black people who experienced higher levels
of work-related stress (Williamson et al., 2022)
Since public health departments have identified racism as a public health issue, it is
essential to address external factors that influence Black professionals' job attitudes and
performance. According to the findings of the study, seven of the applicants stated that some state
laws influence the organizational culture and policies of public health departments, making it
difficult for them to be themselves in the workplace. Organizational transformational and
transactional factors are influenced by external factors, according to Burke and Litwin (1972).
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The applicants also considered state laws that hinder their performance to be racist. The
responses of the people who took part in the interview showed how institutions, like leadership
and management practices, are shaped by structural racism, giving more power to the normal
characteristics of White supremacy in public health departments (Okun, 2021). In the United
States, racism has a long history and permeates almost every organization, including the health
care system, with Black people suffering as a result of racist organizational practices. Engaging
with policymakers to take advantage of opportunities for structural change is necessary if racism
is to be addressed at the structural level.
This study which was motivated by the racial workplace inequities experienced by
healthcare workers during the COVID-19 pandemic, shared how burnout experiences are related
to the dual identity of being Black and working in the public health department. Policymakers can
gain a better understanding of how racist some state laws are and how they have affected Black
public health department professionals' attitudes and motivation, which in turn may limit the
quality of care they provide to communities. According to Easterling et al. (2022) responding to
racial injustices relies on the data collected, analyzed, and shared as an opportunity for structural
change.
Two transformational factors were identified as interview participants shared the
contributions to implicit and overt acts of racism in public health departments' leadership and
organizational culture. Many of the interview participants expressed that leadership in their public
health departments is majority White and lacks diversity and racist organizational culture. Based
on the interview participants’ responses, Black public health department professionals are
engaging in an organizational culture of fear and discomfort, hindering their ability to exist and
thrive while on the job authentically. Transactional factors such as unfair hiring policies, lack of
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advancement opportunities, and pay inequities were mentioned by nine of the interview
participants, further illustrating how racial inequities in policies and practices lead to vulnerable
conditions for Black public health department professionals. The lack of Black inclusion can be
closely connected to the transformational and transactional factors contributing to the implicit and
overt acts of racism towards Black public health department professionals, making it difficult to
feel included or supported because of their racial identity (Jacobs et al., 2023).
Recommendation 1: Prioritize a Culture of Health and Wellness in the Workplace
Black professionals in public health departments will experience less exhaustion and
frustration if public health departments prioritize a culture of health and wellness. Performing work
that is in line with personal identity helps one feel respected involves unity with others, and
contributes to the common good may help one experience work as meaningful. Black public health
department professionals can be role models for the healthy habits they recommend to individuals
and communities thanks to organizational support for work-life integration and personal resilience
(Olson et al., 2019).
According to Habibi et al. (2022) Leadership who have a significant impact on the
organizational culture of public health departments, is the first step in establishing a health and
wellness culture as a priority that senior leaders need to be committed to making sure that all
employees have what they need to grow, like support and encouragement, acknowledging unique
experiences, and continuing discussions about goals and opportunities for advancement. To make
an investment in a culture of health and wellness within public health departments, it may be
necessary to enlist the assistance of outside resources, such as organizational change consultants
or even licensed professional counselors, to help establish procedures that encourage accountable
communication and communication. There are significant advantages to working with therapeutic
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counselors or coaches to enhance workplace communication and encourage self-care practices,
such as a decrease in employee turnover. An investment in Black public health department
professionals' health and wellness is required if public health departments are to stand by their
claim that racism is a public health issue.
As the study findings share that 90% of the interview participants are experiencing burnout,
this is tied to navigating their dual identity of being Black and a public health department
professional. The workplace is a site in which personal identity is developed, in which most people
spend the majority of their waking hours and a primary venue for the projection of their authentic
selves. Acknowledging that burnout is systemic and not personal.Recognizing that burnout is a
result of structural racism will help to begin addressing the transformational such as leadership
and culture and transactional factors such as policies and practices that impact the mental and
emotional health of Black public health department professionals.
Recommendation 2: Racial diversity of leadership
Increasing the overall performance of public health departments will support prioritizing
a culture of health and wellness by diversifying the racial makeup of their leadership. As a public
health issue, racism has been acknowledged by public health departments. To change the implicit
and overt actions taken against Black public health department professionals, strategies and
methods will be required. Offering leadership development opportunities specifically for staff
who are frequently ostracized and underrepresented in leadership is part of the commitment to
diversifying the racial makeup of leadership, and increasing racial diversity in public.
Public health industry, the ideology of Whiteness heightens evidence of structural racism
that continues to exist and challenges the identity of Black employees in their respective workplace
settings. Based on the study findings, transformational factors such as predominately White
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leadership and White-driven organizational culture have led to implicit and overt acts of racism
toward Black public health department professionals. This has also garnered fear in Black public
health department professionals using their voices to call out racism or challenge White supremacy
as they fear facing consequences such as job termination. According to researchers, due to the
underrepresentation of Black public health senior leaders, Black public health professionals
disproportionately experience and witness workplace discrimination from colleagues and
managers, resulting in emotional and mental stress such as greater depression, anxiety, somatic
symptoms, low job satisfaction, and sickness absence (Woodhead et al., 2022).
Contributing factors represent negative workplace feelings and experiences with the dual
identity of being Black and a public health department professional. Researchers have highlighted
that public health industry leaders must acknowledge that their ecosystem is mostly White and
must for male (Lee et al., 2021). Understanding, recognizing, and responding to the challenges
associated with the lack of diversity in the public health industry is critical to the success and
sustainability of organizations (Coronado et al., 2020). Other research has reported that three in
four employees prefer organizations with diverse leadership (Whitfield, 2023). The overall culture
and direction in public health departments are shaped by leadership, therefore is a need for
diversifying the racial makeup in public health departments.
Recommendation 3: Leadership provide opportunities
In public health departments, the development of a culture of health and wellness requires
the provision of fair and equitable workplace opportunities. To create concrete policies and actions
that alter their experience within the healthcare system, public health departments must adopt
values and listen to public health professionals from historically excluded groups (Dent et al.,
2021). Equity can only be achieved if leadership is dedicated to locating and providing the
87

resources necessary for an organization's success for everyone (Zemmel et al., 2022). According
to the findings of the study, their experiences of burnout are impaired by a lack of equitable
workplace opportunities. Diversity in public health departments including leadership, will improve
with equal hiring practices and opportunities for advancement. The establishment of active policies
to recruit and retain Black public health professionals, as well as the encouragement of growth
through mentoring and promotions to leadership positions, have been highlighted by researchers
(Johnson-Agbakwu et al., 2020).
Workplace study conducted by Gallup in 2022, employees who strongly agree that their
organization provides fair opportunities for advancement are 43% less likely to report feeling
burned out very often or always and employees who strongly agree that their organization provides
fair opportunities for advancement to senior management are 30% less likely to experience high
levels of burnout. The structural barriers that prevent Black professionals working in public health
departments from progressing institutionally include disparities in hiring practices, salaries, and
leadership in the departments (Hendrick & Maese, 2022).
Workplace Inequities and Discriminatory Practices Experienced by Black Public Health
Professionals .The COVID-19 pandemic shed light on it, mostly in public health departments. And
with transformational factors such as leadership and culture shaping, and transactional factors such
as policies and management practices like hiring, and promotions. In the respective public health
departments, nine of the interview participants are experiencing pay inequities and unfair
treatment, making it difficult for reliable expressions or other opportunities for presence. Creating
fairness in the workplace is a procedure that goals to guarantee that all staff are on the same playing
field, regardless of their racial and cultural background (Ronzi et al., 2023).
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5.4 Concluding statement
The concluding statement of this study is that was to investigate the effects of burnout on
Black professionals working in public health departments. The workplace is a physical space in
which most people spend the majority of their waking hours and a primary venue for the realization
and projection of their authentic selves. As a result, this study was significant because the
workplace is a site in which personal identity is developed. Even though state, county, and city
public health departments all over the United States have declared racism to be a public health
crisis, many Black public health professionals face a particular kind of burnout, stress, and
exhaustion as a result of the racial implications of their jobs (County Health Rankings &
Roadmaps, 2021; 2020 (Wingfield). The participants in the interview's perceptions of racist
policies and practices shed light on the difficulties that led to burnout.
Using Burke and Litwin's (1972) organizational change framework, the dual identity of
Black and public health department professionals was used to identify and connect organizational
factors that led to burnout experiences. The 10 participants who took part in the interviews for this
study came from all over the country and played different roles. The responses of the interviewees
showed how Black professionals in public health departments struggle to be themselves and feel
included in their workplace. According to the interviews that were conducted, burnout experiences
are facilitated by a lack of inclusion caused by the racial identity of the interview participants.
5.5 Future Research
For future research, it is essential to keep in mind the goal of this study, which was to
investigate burnout as a result of being Black and working in the public health department. This
study revealed the complexity of structural racism and its instruction and operation in public health
departments, as well as several suggestions for future research. Black public health department
89

professionals' experiences of burnout as a result of their gender identity and sexual orientation
would contribute further to the study of the best ways to support them. Additional characteristics
of Black public health department professionals can be investigated.
A comparison study of the burnout experiences of Black and other racial or cultural
professionals working in public health departments is another future research. In public health
departments, this might make it possible to get more help making a health and wellness culture a
priority. The use of stereotype threat theory can help professionals in public health departments
who are members of stigmatized minority groups understand and reduce negative outcomes like
burnout. It is necessary to examine other factors that may delay the inspiration and performance
of other public health departments based on their racial or cultural background, gender identity
and expression, and other cultural identities to foster a culture of presence, diversity, and equity.
5.6 Limitation
The limitation of the study is that there are many analyses of limitation, and the finding of
this research is not generalizable for other people and different locations. The finding of qualitative
that cannot show the accurate connection between the factors. The present study used a qualitative
phenomenological research method via semi-structured interviews with 10 Black public health
department professionals representing each of the four U.S. geographic regions Northeast, South,
Midwest, and West three interviewees from each region. The interview participants for this
research study are Black health department professionals.
Research conducted is only in the USA, this is the study limit that is only conducted in a
single country. The study was also limited by the participants, there were only 10 participants for
the semi-structured interview from the black public health department. The construction of a many
question semi-structured open-ended interview guide to gather information from black health
90

department professionals was influenced by the study questions. If the number of participants
increases in only U.S.A regions then the result is different. For further research, the participants
and the study should be conducted from different countries, areas, regions, and locations. Using
the different factors for the black public health department the outcomes of result is different.
5.7 Implication
The implication of the study is the experience of burnout by the dual identity of being Black
and a public health department professional. This study was important because the workplace is
of vital importance, being a site in which personal identity is developed. After all, the workplace
is a physical space in which most people spend most of their waking hours and a primary venue
for the realization and projection of their authentic selves. All over the U.S. state, county, and city
public health departments have declared racism as a crisis for public health. However the
conditions of many professionals related to black public health experience are exact examples of
burnout, tiredness, and stress, these are the outcomes of the racial implication on their public health
department professional job. The policies racist and practices shared by the interview applicants
highlight the challenges faced by them and result in experiences of burnout.
5.8 Conclusion
This study showed that there is a connection between the experiences of burnout and the
dual identity of being Black and a public health department professional. This study also proved
the need for public health departments to prioritize an organizational culture of health and
wellness, diversify leadership, and provide equitable workplace opportunities. Continuous
research is needed to explore further the implicit and overt acts of racism toward Black public
health department professionals. As public health departments have taken a stance that racism is a
public health issue, internal work is required, such as the modification of organizational policies.
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Addressing racial inequity in public health departments can help to mitigate workplace fear and
anxiety. Based on the outcomes there is a requirement for recommendations and proof-based
policies to address racial inequity in the health department of the public. U.S.A state law has also
implanted fear in black public health department professionals with what professionals see or when
it comes to racial injustice they address. Many of the interview applicants' responses showed that
their public health department is trying to address racial workplace inequity but lacks commitment
and or follow through.

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6 References
Ahmed, S. (2020). On being included: Racism and diversity in institutional life. Duke University
Press.
Ainscow, M. (2020). Promoting inclusion and equity in education: lessons from international
experiences. Nordic Journal of Studies in Educational Policy, 6(1), 7-16.
Aldrich, H. E. (2019). Employment opportunities for blacks in the black ghetto: the role of White-
owned businesses. In The Working Class and Its Culture (pp. 85-107). Routledge. Inikori,
J. E. (2020). Atlantic slavery and the rise of the capitalist global economy. Current
Anthropology, 61(S22), S159-S171.
Ali, M. A., Rahman, M. A., Siddiqua, S. N., Begum, F., Shaheen, A., Rahman, H. ... & Rahman,
M. M. (2019). Application of Burke-Litwin model for capacity assessment of city
corporations for sanitation services in Bangladesh. Waterlines, (3), 217-235.
Anderson, S. D. (2021). The fog of anti-Blackness: Colorism’s lifelong impact on Black females
and its implications for educators (Doctoral dissertation).
Andrews, K. (2021). Racism is the public health crisis. The Lancet, 397(10282), 1342-1343.
Arday, J. (2022). No one can see me cry: Understanding mental health issues for Black and
minority ethnic staff in higher education. Higher Education, 83(1), 79-102.
Avant, N. D. & McGee, H. Y. (2021). Moving from injustice to equity: A time for the pharmacy
profession to take action: The past, present, and futurist role of the pharmacy profession
to achieve Black health equity. American Journal of Pharmaceutical Education, 85(9),
899.
93

Bailey, Feldman, J. M., & Bassett, M. T. (2021). How structural racism works — Racist policies
as a root cause of U.S. Racial health inequities. The New England Journal of
Medicine, 384(8), 768–773. https://doi.org/10.1056/NEJMms2025396
Bailey, Z. D., Feldman, J. M., & Bassett, M. T. (2021). How structural racism works—racist
policies as a root cause of US racial health inequities. New England Journal of
Medicine, 384(8), 768-773.
Banks, N. (2020). Black women in the United States and unpaid collective work: Theorizing the
community as a site of production. The Review of Black Political Economy, 47(4), 343-
362.
Beagan, B. L., Bizzeth, S. R., Sibbald, K. R., & Etowa, J. B. (2022). Epistemic racism in the health
professions: A qualitative study with Black women in Canada. Health,
13634593221141605.
Bell. (2020). Anti-blackness, surface-level diversity continues to matter: what must we
do? Equality, Diversity, and Inclusion an International Journal, 39(7), 749–759
https://doi.org/10.1108/EDI-06-2020-0160
Bernard, D. L., Calhoun, C. D., Banks, D. E., Halliday, C. A., Hughes-Halbert, C., & Danielson,
C. K. (2021). Making the “C-ACE” for a culturally-informed adverse childhood
experiences framework to understand the pervasive mental health impact of racism on
Black youth. Journal of Child & Adolescent Trauma, 14, 233-247.
Briggs, H. E., Holosko, M. J., Banks, L., Huggins-Hoyt, K. Y., & Parker, J. (2018). How are
African Americans currently represented in various social work venues? Research on
Social Work Practice, 28(3), 275-287. https://doi.org/10.1177/1049731517706553
94

Burwell-Naney, K., Mortiboy, M., Zitta, J. P., Stevens, E., Patterson, K., Salter, J. C., ... & Jenkins,
R. (2021). Local government approaches to combating COVID-19 inequities: a Durham
County Department of Public Health perspective. International Journal of Environmental
Research and Public Health, 18(12), 6544.
Carrim, N. M. (2019). Minority employees’ ethnic identity in the workplace. In Oxford Research
Encyclopedia of Business and Management.
Cénat, J. M. (2020). How to provide anti-racist mental health care. The Lancet Psychiatry, 7(11),
929-931.
Chandrashekar, P., & Jain, S. H. (2020). Addressing patient bias and discrimination against
clinicians of diverse backgrounds. Academic Medicine, 95(12S), S33-S43.
Churchwell, K., Elkind, M. S., Benjamin, R. M., Carson, A. P., Chang, E. K., Lawrence, W. ... &
American Heart Association. (2020). Call to action: structural racism as a fundamental
driver of health disparities: a presidential advisory from the American Heart
Association. Circulation, 142(24), e454-e468.
Churchwell, K., Elkind, M. S., Benjamin, R. M., Carson, A. P., Chang, E. K., Lawrence, W. ... &
American Heart Association. (2020). Call to action: structural racism as a fundamental
driver of health disparities: a presidential advisory from the American Heart
Association. Circulation, 142(24), e454-e468.
Cohen, D., & Crabtree, B. (2006). Qualitative research guidelines project.
Collins, R. A., Sheriff, S. A., Yoon, C., Cobb, A. N., Kothari, A. N., Newman, L. A., ... & Clarke,
C. N. (2023). Assessing the Complex General Surgical Oncology Pipeline: Trends in Race
and Ethnicity among US Medical Students, General Surgery Residents, and Complex
General Surgical Oncology Trainees. Annals of Surgical Oncology, 1-8.
95

Cook, L. D. (2020). Racism impoverishes the whole economy. New York Times.
Cooper, R. (2015). The shared services organizational model in higher education enrollment
management: the application of the transactional components of the Burke-Litwin model
of organizational performance and change and the moderating effect of employee
engagement on individual motivation.
Coronado, F., Beck, A. J., Shah, G., Young, J. L., Sellers, K., & Leider, J. P. (2020). Understanding
the Dynamics of Diversity in the Public Health Workforce. Journal of public health
management and practice: JPHMP, 26(4), 389–392.
https://doi.org/10.1097/PHH.0000000000001075
Costa, B., & Pinto, I. C. (2017). Stress, burnout and coping in health professionals: A literature
review. Journal of Psychology and Brain Studies, 1(1: 4), 1-8.
Daftary, A. (2020). Critical race theory: An effective framework for social work research. Journal
of Ethnic & Cultural Diversity in Social Work, 29(6), 439-454.
Darity Jr, W. A., & Mullen, A. K. (2022). From here to equality: Reparations for Black Americans
in the twenty-first century. UNC Press Books.
David, R., Myat, A. K., & Holliday, I. (2022). Can regime change improve ethnic relations?
Perception of ethnic minorities after the 2021 coup in Myanmar. Japanese Journal of
Political Science, 23(2), 89-104.
Dazey, M. (2021). Rethinking respectability politics. The British Journal of Sociology, 72(3), 580-
593.
DeLombard, J. M. (2019). Dehumanizing slave personhood. American Literature, 91(3), 491-521.
Dryden, O., & Nnorom, O. (2021). Time to dismantle systemic anti-Black racism in medicine in
Canada. CMAJ, 193(2), E55-E57.
96

Dugan, Kelly P. "Antiracism and Restorative Justice in Classics Pedagogy: Race, Slavery, and the
Function of Language in Beginning Greek and Latin Textbooks." PhD diss., University of
Georgia, 2020.
Dyrbye, L. N., West, C. P., Sinsky, C. A., Trockel, M., Tutty, M., Satele, D., ... & Shanafelt, T.
(2022). Physicians’ experiences with mistreatment and discrimination by patients, families,
and visitors and association with burnout. JAMA Network Open, 5(5), e2213080-
e2213080.
Dyrbye, L., Herrin, J., West, C. P., Wittlin, N. M., Dovidio, J. F., Hardeman, R., ... & Van Ryn,
M. (2019). Association of racial bias with burnout among resident physicians. JAMA
network open, 2(7), e197457-e197457.
Ebinger, J. E., Botwin, G. J., Albert, C. M., Berg, A. H., Binek, A., Botting, P., & Miles, P. B.
(2020). An opportune and relevant design for studying the health trajectories of healthcare
workers. medRxiv, 2020-06.
Egeruoh, F. M. (2022). Coping with Structural Racism: What Strategies and Adaptation
Mechanisms do Blacks Use to Deal with Perceived Racial Discrimination at
Workplaces? (Doctoral dissertation, Yeshiva University).
Embrick, D. G., & Moore, W. L. (2020). White space (s) and the reproduction of White
supremacy. American Behavioral Scientist, 64(14), 1935-1945.
Errida, A. and Lotfi, B., 2021. The determinants of organizational change management success:
Literature review and case study. International Journal of Engineering Business
Management, 13, p.18479790211016273.
Evans, G. D., Bryant, N. E., Owens, J. S., & Koukos, K. (2004, October). Ethnic differences in
burnout, coping, and intervention acceptability among childcare professionals. In Child
97

and Youth Care Forum (Vol. 33, pp. 349-371). Kluwer Academic Publishers-Plenum
Publishers.
Evans, M. K., Rosenbaum, L., Malina, D., Morrissey, S., & Rubin, E. J. (2020). Diagnosing and
treating systemic racism. New England Journal of Medicine, 383(3), 274-276.
Filej, B., Skela-Savič, B., Vicic, V. H., & Hudorovic, N. (2009). Necessary organizational changes
according to Burke–Litwin model in the head nurses system of management in healthcare
and social welfare institutions—The Slovenia experience. Health policy, 90(2-3), 166-174.
Gabriel, K. P., & Aguinis, H. (2022). How to prevent and combat employee burnout and create
healthier workplaces during crises and beyond. Business Horizons, 65(2), 183-192.
Gabriel, K. P., & Aguinis, H. (2022). How to prevent and combat employee burnout and create
healthier workplaces during crises and beyond. Business Horizons, 65(2), 183-192.
Garcia, L. C., Shanafelt, T. D., West, C. P., Sinsky, C. A., Trockel, M. T., Nedelec, L., ... &
Fassiotto, M. (2020). Burnout, depression, career satisfaction, and work-life integration by
physician race/ethnicity. JAMA network open, 3(8), e2012762-e2012762.
Gorski, P. (2019). Avoiding racial equity deto. Educational Leadership.
Hagle, H. N., Martin, M., Winograd, R., Merlin, J., Finnell, D. S., Bratberg, J. P. ... & Lum, P. J.
(2021). Article Commentary: Dismantling Racism against Black, Indigenous, and People
of Color across the Substance use Continuum: A Position Statement of the Association for
Multidisciplinary Education and Research in Substance use and Addiction. Substance
abuse, 42(1), 5-12.
Hamilton, V. E. (2021). Reform, retrench, repeat: The campaign against critical race theory,
through the lens of critical race theory. Wm. & Mary J. Race Gender & Soc. Just., 28, 61.
98

Hannah-Jones, N. (2019). America wasn’ta democracy, until Black Americans made it one. New
York Times Magazine, 14.
Harrell, M. C., & Bradley, M. (2009). Data collection methods: Semi-structured interviews and
focus groups.
Himmelstein, K. E., & Venkataramani, A. S. (2019). Economic vulnerability among US female
health care workers: potential impact of a $15-per-hour minimum wage. American journal
of public health, 109(2), 198-205.
Hirata, G., & Soares, R. R. (2020). Competition and the racial wage gap: Evidence from
Brazil. Journal of Development Economics, 146, 102519.
International Labour Organization (2021). Working conditions.
https://www.ilo.org/global/topics/working-conditions/lang—en/index.htm
Jones, N. H. (2021). Our democracy’s founding ideals were false when they were written. Black
Americans have fought to make them true. In The Best American Magazine Writing
2020 (pp. 359-382). Columbia University Press.
Kaltiso, S. A. O., Seitz, R. M., Zdradzinski, M. J., Moran, T. P., Heron, S., Robertson, J., & Lall,
M. D. (2021). The impact of racism on emergency health care workers. Academic
Emergency Medicine, 28(9), 974-981.
King, D. D., Fattoracci, E. S., Hollingsworth, D. W., Stahr, E., & Nelson, M. (2023). When thriving
requires effortful surviving: Delineating manifestations and resource expenditure outcomes
of microaggressions for Black employees. Journal of Applied Psychology, 108(2), 183.
Kline, R., & Lewis, D. (2019). The price of fear: estimating the financial cost of bullying and
harassment to the NHS in England. Public Money & Management, 39(3), 166-174.
99

Laaser, K., & Bolton, S. (2022). Absolute autonomy, respectful recognition and derived dignity:
Towards a typology of meaningful work. International Journal of Management
Reviews, 24(3), 373-393.
Legha, R. K., & Martinek, N. N. (2023). White supremacy culture and the assimilation trauma of
medical training: ungaslighting the physician burnout discourse. Medical
Humanities, 49(1), 142-146.
Leigh, A., & Melwani, S. (2019). # BlackEmployeesMatter: Mega-threats, identity fusion, and
enacting positive deviance in organizations. Academy of Management Review, 44(3), 564-
591.
Leo, C. G., Sabina, S., Tumolo, M. R., Bodini, A., Ponzini, G., Sabato, E., & Mincarone, P. (2021).
Burnout among healthcare workers in the COVID 19 era: a review of the existing
literature. Frontiers in public health, 1661.
Lim, S., Boutain, D. M., Kim, E., Evans‐Agnew, R. A., Parker, S., & Maldonado Nofziger, R.
(2022). Institutional procedural discrimination, institutional racism, and other institutional
discrimination: A nursing research example. Nursing Inquiry, 29(1), e12474.
Lipscomb, A. E., & Ashley, W. (2020). Surviving being Black and a clinician during a dual
pandemic: Personal and professional challenges in a disease and racial crisis. Smith
College Studies in Social Work, 90(4), 221-236.
Listopad, I. W., Michaelsen, M. M., Werdecker, L., & Esch, T. (2021). Bio-psycho-socio-Spirito-
cultural factors of burnout: a systematic narrative review of the literature. Frontiers in
psychology, 12, 722862.
Lopez, L., Hart, L. H., & Katz, M. H. (2021). Racial and ethnic health disparities related to
COVID-19. Jama, 325(8), 719-720.
100

Maree Stanley, J. (2020). Intersectional and relational frameworks: Confronting anti-Blackness,
settler colonialism, and neoliberalism in US social work. Journal of Progressive Human
Services, 31(3), 210-225.
Massaquoi, N. (2023, September). Racial humility over competence: Addressing anti-Black
racism and healthcare leadership responsibility. In Healthcare Management Forum (Vol.
36, No. 5, pp. 280-284). Sage CA: Los Angeles, CA: SAGE Publications.
Melaku, T. M. (2019). You Don't Look Like a Lawyer: Black women and systemic gendered
racism. Rowman & Littlefield.
Mello, J. A. (2019). Why the equal pay act and laws which prohibit salary inquiries of job
applicants cannot adequately address gender-based pay inequity. Sage Open, 9(3),
2158244019869106.
Montañez, R. (2020). 10 microinsults and 5 microinvalidations women of color are tired of, are
you guilty? Forbes.
Nakamura, L. (2020). Feeling good about feeling bad: Virtuous virtual reality and the automation
of racial empathy. Journal of Visual Culture, 19(1), 47-64.
National Library of Medicine. (2023). Depression: What is burnout?. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK279286/
Nazroo, J. Y., Bhui, K. S., & Rhodes, J. (2020). Where next for understanding race/ethnic
inequalities in severe mental illness? Structural, interpersonal and institutional
racism. Sociology of health & illness, 42(2), 262-276.
Nkomo, S. M. (2021). Reflections on the continuing denial of the centrality of “race” in
management and organization studies. Equality, Diversity and Inclusion: An International
Journal, 40(2), 212-224.
101

Noble, H., & Mitchell, G. (2016). What is grounded theory?. Evidence-based nursing, 19(2), 34-
35.
O’Reilly, K. B. (2020). AMA: Racism is a threat to public health. American Medical Association.
Obilor, E. I. (2023). Convenience and purposive sampling techniques: Are they the
same. International Journal of Innovative Social & Science Education Research, 11(1), 1-
7.
Olson, K., Marchalik, D., Farley, H., Dean, S. M., Lawrence, E. C., Hamidi, M. S. ... & Stewart,
M. T. (2019). Organizational strategies to reduce physician burnout and improve
professional fulfillment. Current problems in pediatric and adolescent health care, 49(12),
100664.
Ossom-Williamson, P., Williams, J., Goodman, X., Minter, C. I. J., & Logan, A. (2020). Starting
with I: combating anti-Blackness in libraries [Internet]. Leon S. McGoogan Health
Sciences Library, 9.
Paine, L., de la Rocha, P., Eyssallenne, A. P., Andrews, C. A., Loo, L., Jones, C. P., ... & Morse,
M. (2021). Declaring racism a public health crisis in the United States: cure, poison, or
both? Frontiers in public health, 9, 676784.
Paulus, T. M., & Bennett, A. M. (2017). ‘I have a love–hate relationship with ATLAS. ti’™:
integrating qualitative data analysis software into a graduate research methods
course. International Journal of Research & Method in Education, 40(1), 19-35.
Payne, B. K., & Hannay, J. W. (2021). Implicit bias reflects systemic racism. Trends in cognitive
sciences, 25(11), 927-936.
Payne, B. K., Vuletich, H. A., & Brown-Iannuzzi, J. L. (2019). Historical roots of implicit bias in
slavery. Proceedings of the National Academy of Sciences, 116(24), 11693-11698.
102

Quaye, S. J., Karikari, S. N., Allen, C. R., Okello, W. K., & Carter, K. D. (2019). Strategies for
practicing self-care from racial battle fatigue. Journal Committed to Social Change on Race
and Ethnicity (JCSCORE), 5(2), 95-131.
Reiners, B., & Whitfield, B. (2023). 50 diversitiews in the workplace statistics to know: Stay on
top of measuring diversity in your workplace with these statistics.
https://builtin.com/diversity-inclusion/diversity-in-the-workplace-statistics.
Restauri, N., & Sheridan, A. D. (2020). Burnout and posttraumatic stress disorder in the
coronavirus disease 2019 (COVID-19) pandemic: intersection, impact, and
interventions. Journal of the American College of Radiology, 17(7), 921-926.
Roberts, L. M., & McCluney, C. L. (2020). Working from home while Black. Harvard
Business Review. https://hbr.org/2020/06/working-from-home-while-black.
Robinson, K., Fial, A., & Hanson, L. (2019). Racism, bias, and discrimination as modifiable
barriers to breastfeeding for African American women: A scoping review of the
literature. Journal of midwifery & women's health, 64(6), 734-742.
Ross, P. T., Lypson, M. L., Byington, C. L., Sánchez, J. P., Wong, B. M., & Kumagai, A. K.
(2020). Learning from the past and working in the present to create an antiracist future for
academic medicine. Academic Medicine, 95(12), 1781-1786.
Ruane. M. E., (2019). Freedom and slavery, the ‘central paradox of American history. The
Washington Post. https://www.washingtonpost.com/local/freedom-and-slavery-the-
central-paradox-of-american-history/2019/04/30/16063754-2e3a-11e9-813a-
0ab2f17e305b_story.html
Sakamoto, I. (2020). Anh anti-oppressive approach to cultural competence. Canadian social work
review, 24(1), 105-114.
103

Schunk, D. H., & DiBenedetto, M. K. (2020). Motivation and social cognitive
theory. Contemporary educational psychology, 60, 101832.
Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021).
Prevalence of and factors associated with nurse burnout in the US. JAMA network
open, 4(2), e2036469-e2036469.
Shim, R. S. (2021). Dismantling structural racism in psychiatry: a path to mental health
equity. American Journal of Psychiatry, 178(7), 592-598.
Silverstein, J. (2021). The 1619 Project and the long battle over US history. The New York Times
Magazine.
Skeffrey, D. C. (2023). Exploring the Experiences of Black Women Leaders in Business (Doctoral
dissertation, State University of New York at Buffalo).
Smith, D., (2019). Point Comfort: Where slavery in America began 400 years ago. The Guardian.
https://www.theguardian.com/world/2019/aug/13/us-slavery-400-years-virginia-point-
comfort
Spears, A. K. (2021). White supremacy and antiblackness: Theory and lived experience. Journal
of Linguistic Anthropology, 31(2), 157-179.
Speicher, L. L., & Francis, D. (2023). Improving Employee Experience: Reducing Burnout,
Decreasing Turnover and Building Well-being. Clinical Gastroenterology and
Hepatology, 21(1), 11-14.
Stanford, F. C. (2020). The importance of diversity and inclusion in the healthcare
workforce. Journal of the National Medical Association, 112(3), 247-249.
104

Statista. (2023). Share of physicians suffering from burnout in the United States from 2011 to
2021. Retrieved from: https://www.statista.com/statistics/1385556/physicians-burnout-
prevalence-united-states/
Statista. (2023a). Stress and burnout - Statistics & Facts. The US. Retrieved from:
https://www.statista.com/topics/2099/stress-and-burnout/#topicOverview
Stephens, N. M. (2020). A correlational study of burnout and personality among clergy in the
United States (Doctoral dissertation, Andrews University).
Stovall, T. (2022). White freedom: The racial history of an idea. Princeton University Press.
Syed, J. (2014). Diversity management and missing voices. Handbook of research on employee
voice. Cheltenham: Edward Elgar.
Taren. D. (2020). Racism focus needed at health departments: Personal perspectives on public
health. The Nation’s Health, (1971), 50(6), 23.
Tirumalesh, M. (2019). Conceptual Framework on Qualitative Research Design. The International
Journal of Indian Psychology, 7(2), 621-624.
Tsui, E. K., Cooper, S., Elsayed, A., Billings, S., Stewart, S., & Andrews, D. (2023). When it
“Feels like we’re in This Together”: Toward a Trauma-Informed Public Health Pedagogy
Drawing on Lived Experiences. Pedagogy in Health Promotion, 23733799231177045.
University of California San Francisco (2020). Racial equity & anti-Black racism. Multicultural
Resource Center. https://mrc.ucsf.edu/racial-equity-anti-black-racism
Vrcelj, N., & Karabašević, D. (2022). The most influential organizational change management
models from 1950 to 2020. Facta Universitatis, Series: Economics and Organization, 125-
138.
105

Waite, R., Sawyer, L., & Waite, D. (2020). A call to action for community/public health nurses:
Treat structural racism as the critical social determinant of health it is. Public Health
Nursing, 37(3), 470-470.
Walker, D. M., & Tolentino, V. R. (2020). COVID-19: the effects on the practice of pediatric
emergency medicine. Pediatr Emerg Med Pract, 17(3), 1-15.
Wallington, C. F. (2021). Navigating the C-Suite: Exploring the Leadership Journey of African-
American Male Executives in US Corporations (Doctoral dissertation, North Carolina
Agricultural and Technical State University).
Westwood, S., Morison, L., Allt, J., & Holmes, N. (2017). Predictors of emotional exhaustion,
disengagement and burnout among improving access to psychological therapies (IAPT)
practitioners. Journal of mental health, 26(2), 172-179.
Wilk, J.E., Clarke-Walper, K., Nugent, K., Hoge, C.W., Sampson, M. and Warner, C.H., 2023.
Associations of health care staff burnout with negative health and organizational outcomes
in the US military health system. Social Science & Medicine, 330, p.116049.
Williams, M. T., Skinta, M. D., Kanter, J. W., Martin-Willett, R., Mier-Chairez, J., Debreaux, M.,
& Rosen, D. C. (2020). A qualitative study of microaggressions against African Americans
on predominantly White campuses. BMC psychology, 8(1), 1-13.
Wingfield, A. H., & Chavez, K. (2020). Getting in, getting hired, getting sideways looks:
Organizational hierarchy and perceptions of racial discrimination. American Sociological
Review, 85(1), 31-57.
Wooten, M. E. (2019). Race, organizations, and the organizing process. In Race, organizations,
and the organizing process (Vol. 60, pp. 1-14). Emerald Publishing Limited.
106

Wright, J. E., & Merritt, C. C. (2020). Social equity and COVID‐19: The case of African
Americans. Public Administration Review, 80(5), 820-826.
Yearby, R. (2020). Structural racism and health disparities: Reconfiguring the social determinants
of health framework to include the root cause. Journal of Law, Medicine & Ethics, 48(3),
518-526.
Yearby, R., & Mohapatra, S. (2020). Law, structural racism, and the COVID-19 pandemic. Journal
of Law and the Biosciences, 7(1), lsaa036.

Abstract (if available)

Abstract The concept of burnout has been discussed increasingly. Burnout is the condition when an individual becomes exhausted, physically, emotionally, and mentally. This occurs due to prolonged stress level among the individuals. This study aims to explore the experience of burnout that is caused by the dual identity of being Black and a public health department professional. Further, this study aims to identify the potential factors that contribute to implicit and overt facilitating acts of racism in the public health industry towards Black public health department professionals. This study adopts a primary qualitative approach to collect data directly from the participant gather insights. For data analysis the study developed codes from the interviews using thematic analysis method. The results of the study shows that that various organizational factors contribute to the implicit and overt acts of racism in the public health departments towards Black professionals. Through descriptive and pattern coding, interview participants shared significant organizational factors both transformational and transactional, which are identical to the themes identified in Burke and Litwin's (1972) organizational change model.

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Asset Metadata

Creator Hall-Everett, Aunsha Denard (author)

Core Title Burnout experienced by the dual identity of being Black and a public health department professional

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2023-12

Publication Date 09/11/2023

Defense Date 08/02/2023

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

Tag Black public health professionals,Burnout,OAI-PMH Harvest,Public Health,public health department,structural racism

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Kim, Esther (committee chair), Hinga, Briana (committee member), Page, Erika (committee member)

Creator Email aunsha.hall@gmail.com,hallever@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113310102

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Legacy Identifier etd-HallEveret-12362

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Format theses (aat)

Rights Hall-Everett, Aunsha Denard

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Source 20230912-usctheses-batch-1096 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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