State Health Agency Investments in Health Equity: Employee Perceptions of Commitment to Diversity, Equity, and Inclusion

BACKGROUND AND OBJECTIVES: The United States is experiencing a public health workforce shortage, elevating the importance of workplace initiatives that support employee retention. In recent years, state health agencies (SHAs) have increasingly implemented diversity, equity, and inclusion (DEI) policies to promote fairness in the workplace, which have been associated with employee satisfaction and intentions to stay. SHAs have also increased investments in health equity infrastructure, aiming to address population health inequities. Less is known about the connection between these 2 forms of equity investment, specifically, if SHA investments in health equity infrastructure are associated with employee perceptions of organizational commitment to DEI. This research fills this gap by exploring individual- and agency-level characteristics associated with SHA employee perceptions of organizational commitment to DEI. METHODS: This study utilized data from the 2022 Profile of State and Territorial Public Health and the 2021 Public Health Workforce Interests and Needs Survey. The study sample includes responses from 12 978 nontemporary employees of 38 state public health agencies. Multilevel logistic regression was used to analyze predictors associated with positive perception of organizational commitment to DEI. RESULTS: Findings indicate that SHA investments in health equity infrastructure and top prioritization of health equity initiatives (ie, increasing workforce diversity, increasing cultural competency/health literacy, and data collection and tracking of demographics and disparities) are associated with agency employees' positive perceptions of organizational commitment to DEI. CONCLUSION: This study shows that investing in health equity infrastructure is a strategic decision that strengthens agency culture and capacity. By embedding equity into operations and leadership, public health agencies can improve workforce retention, organizational climate, and their ability to serve communities fairly.