Understanding the Emotional Labor of Public Health Equity Work: a Mixed Methods Study

Abstract

Background Rectifying historic race-based health inequities depends on a resilient public health workforce to implement change and dismantle systemic racism in varied organizations and community contexts. Yet, public health equity workers may be vulnerable to job burnout because personal investment in the continual struggle against inequality exacts an emotional toll. Our study sought to quantify the presence of emotional labor in public health equity work and better understand its dimensions. Methods We conducted a mixed methods study of public health equity workers focused on maternal and child health in the USA. Participants completed a survey on the emotional demands of their public health equity work. A subset of survey respondents was interviewed to gain a better understanding of the emotional toll and support received to cope. Results Public health equity work was found to involve high levels of emotional labor (M = 5.61, range = 1–7). A positive association was noted between personal efficacy (i.e., belief in one’s ability to do equity work well) and increased job satisfaction. However, burnout increased when equity workers did not receive adequate support for their emotional labor. Qualitative analysis revealed eight themes depicting the emotional burden, benefits and drawbacks, and coping strategies of public health equity work. Conclusions Public health equity workers report high degrees of emotional labor and inadequate workplace support to cope with the demands. In our study, workplace support was associated with higher job satisfaction and lower burnout. Research is urgently needed to develop and scale an effective model to support public health equity workers.

Burnout through the Lenses of Equity/Equality, Diversity and Inclusion and Disabled People: A Scoping Review

“…Hawkins used the phrase "racism burnout" [7], reflecting that the continuing experience of racism was a reason for the burnout. Indeed, many studies stated that racism is a factor in burnout [169,229,230,347,348].…”

Preventing Job Burnout: Could Workplace Support Protect Maternal and Child Health Professionals Who Are Doing Public Health Equity Work?

“…According to the 2021 Public Health Workforce Interests and Needs Survey, public health employees have increasing levels of stress, burnout, and intent to leave (de Beaumont Foundation, 2022 ). For public health professionals working to advance health equity (hereafter, “health equity professionals”), the struggle against structural racism and injustice produces high levels of stress and burnout (Abresch et al, 2022 ). In recent years, addressing social determinants of health, including racism, has become a core part of the field of Maternal and Child Health (MCH), which serves vulnerable populations in sensitive developmental periods, and often addresses system inequities to achieve health goals (Pies & Kotelchuck, 2014 ; Rosario et al, 2022 ).…”

“…One important source of stress in work is emotional labor, which occurs when work requires the management of personal emotions for effective job performance, or to meet workplace norms and goals (Hammonds & Cadge, 2014 ; Załuski & Makara-Studzińska, 2018 ). A growing body of research has found high levels of emotional labor and burnout, and a dearth of workplace supports among public health and healthcare workers (Abresch et al, 2022 ; de Beaumont, 2017 ; Yeh et al, 2020 ).…”

“…Participants were recruited using a snowball sampling approach (Parker et al, 2019 ) beginning with a seed list of members of three national MCH organizations representing state and local health departments, and community-based MCH programs. Survey topics included emotional labor, burnout, and supports (Abresch et al, 2022 ). Following a sequential, explanatory study (QUAN-qual) design, a subset of survey respondents was interviewed (Fig.…”

“…The survey tool was adapted from a validated instrument, the GNM Emotional Labor Questionnaire (Guy et al, 2014 ), and was described in a previous paper (Abresch et al, 2022 ). For this study, survey participants who provided complete responses were grouped according to their answer to the single question, “I receive the emotional support I need from my employer to perform health equity work.” Response options were on a seven-point Likert scale (i.e., “never,” “rarely,” “occasionally,” “some of the time,” “frequently,” “usually,” or “all the time”).…”