Public health leadership is the practice of mobilizing people, organizations, and communities to effectively tackle tough public health challenges.1 Our population health goals include protecting and promoting equity and health, transforming people and place, ensuring a healthy planet, and achieving health equity. We are all public health leaders, and embodying and promoting equity is our core value.
Unless we meaningfully pursue eliminating workplace inequities in all its forms we will be hampered in addressing other inequities, including racial and health. The pursuit of equity starts with honestly acknowledging our workplace power and/or privilege and how, combined with implicit biases, we can unintentionally create, perpetuate, and defend inequities in the workplace.
First, some definitions. Power is the capacity or ability to direct or influence the behavior of others, the course of events, or the allocation of resources. Power comes from positional, moral, or relational authority. Authority is granted by appointment or earned by trust and credibility. It is exercised by embodying universal values (humility, compassion, equity, dignity), or by persuasion, manipulation, or deceit. The dynamics and impacts of power are multi-dimensional, context dependent, cumulative, and can be subtle. For example, the mere presence of a boss can unintentionally shut down subordinates.
Privilege is a form of unearned power that comes from social or workplace advantage. All of us have some form of privilege. Privilege exists because of sociopolitical systems and cultural norms that create, reinforce, and amplify power inequities, explicitly or implicitly. For example, in the US, if you are like me: male, heterosexual, cisgender, or have lighter skin color, you have more privilege. You do not choose privilege, but you can acknowledge it, and, more importantly, you can make “the noble choice to forgo your status, [and to] use your influence for the good of others before yourself”—this is humility.
Biases are preferences, cognitive processes, or inferences that shape our mental models, knowledge, attitudes, beliefs, decisions and behaviors in ways that cause or contribute to inequities in power, opportunities, or outcomes for ourselves and/or others. Biases can be known to you and others (open), known to you and not others (hidden), known to others but not you (blind spot), or not known to you and others (unknown).2
Implicit (unconscious) biases account for the unknown and blind spot biases, and are the most common and challenging type of bias because we all have them, and they are difficult to identify, measure, and mitigate. Power and/or privilege plus implicit biases can result in unintended inequities. The inequities show up in many ways: race, gender identity or expression, sexual orientation, social class, religion, job class, funding source, etc.
Workplace privilege is a form of unearned power or advantage at work. For example, if I lead or work on a programmatic grant (especially with unspent funds) I may have access to training, travel, and other professional development opportunities not available to non-grant staff. If funding is growing in my area I may have access to new job opportunities. Over years the benefits of these advantages accumulate3 and create or contribute to workplace inequities—even if we have “equality” (see Figure). The status quo is defended by rational arguments that leadership (and program and resource allocation decisions) can—and should—only come from “experts.” Consequently, nothing changes.4
For supervisor examples: do we treat our staff equitably? Are some staff asked to log their daily job activities in detail, but other staff are not? Are some staff forbidden from merely speaking to peers in other units without prior approval, but other staff are not? For persons with less power or privilege, this treatment feels oppressive or discriminatory, even if unintentional.
Those are just a few examples—there are many! Because of cognitive dissonance5 acknowledging our contribution can be difficult, even painful. If we are serious about eliminating racial and health inequities we must also be committed to eliminating all workplace inequities. As an organizational leader, my performance improvement focus is protecting and promoting equity, and eliminating all inequities, including workplace. Our managers will be demanding fairness (equity), transparency, and financial stewardship in how we operate. We want everyone at work to be treated with respect and compassion, and to feel equity and dignity in all aspects of their work.
From readers, I value your active support in eliminating inequities in its many forms. I want you to bring inequities to my attention, including those I create or contribute to. I want you to hold me accountable. We need all of us—and this includes me—to acknowledge honestly our privilege (in its many forms) and to make “the noble choice to forgo our status, [and to] use our influence for the good of others before ourselves.”
- Begun J,Malcolm J.Leading Public Health: A Competency Framework. 1st ed. Springer Publishing Company; 2014. ^
- To learn more study “JoHari Window in Interpersonal Communication”—Video lecture by Dr. Lori Zakel, Professor and Chair of the Communication Department at Sinclair College, Dayton, Ohio. Available at https://youtu.be/-7FhcvoVK8s. ^
- I know this firthand as a direct beneficiary. I have directed many grant projects over the years, some programmatic, some research. In contrast to competitive research grants, for government program grants recipients are stewards of the funds: the funds do not belong to the “principal investigator” or “program director.” ^
- It is possible to improve decision-making and transform the organization culture and systems towards equity and justice. This cannot happen until we acknowledge our role in sustaining the status quo. This means we must be willing to share or give up power and control. This is not easy—it’s hard for me! ^
- Whenever we sense data that conflicts with a mindset, we experience a discomfort psychologists call cognitive dissonance. Our mind cannot sustain dissonance; therefore, we mitigate it by ignoring, discrediting, or explaining away the data. Accepting the data would require changing our mindset which is difficult because we seek out data that confirms our mindset (confirmation bias) and we avoid data that challenges it (avoiding dissonance). ^