Enumerating the Environmental Public Health Workforce-Challenges and Opportunities

By Massoudi, Mehran; Blake, Rob et al. | Journal of Environmental Health, November 2012 | Go to article overview

Enumerating the Environmental Public Health Workforce-Challenges and Opportunities


Massoudi, Mehran, Blake, Rob, Marcum, Larry, Journal of Environmental Health


Workforce enumeration is the foundation for identifying workforce needs. In 2000, the Health Resources and Services Administration (HRSA) sponsored an enumeration of the public health workforce (HRSA, 2000), but since then, no comprehensive enumeration has occurred. The Centers for Disease Control and Prevention (CDC) and HRSA are now collaborating on an effort to determine the number and composition of the U.S. workforce at the federal, state, and local levels.

Limited public health workforce data are being captured by periodic profile studies by the Association of State and Territorial Health Officials (ASTHO, 2011), the National Association of County and City Health Officials (NACCHO, 2011), the U.S. Office of Personnel Management (OPM, 2011a), the Bureau of Labor Statistics (BLS, 2011), and similar surveys. No one source, however, provides complete data on all, or even the majority of, public health workers. One key goal of the CDC-HRSA collaboration is to establish public health workforce enumeration as an ongoing activity--a surveillance-like system--by using existing data sources and focusing first on the governmental public health workforce.

To that end, a case definition for public health worker for this phase of the project has been developed that encompasses governmental public health workers at the federal, state, and local levels. The governmental public health workforce was defined as "all persons responsible for providing any of the 10 Essential Public Health Services who are employed in federal, state, or local governmental public health agencies and those providing environmental health and public health laboratory services (University of Michigan/ Center of Excellence in Public Health Workforce Studies & University of Kentucky/Center of Excellence in Public Health Workforce Research and Policy [U MI & U KY], 2012)." This case definition might underestimate the total number of public health workers, but it serves as the necessary first step in routinely enumerating and characterizing the nation's governmental public health workforce. Such a surveillance-like system can provide accurate and timely information to researchers, public health decision makers, health planners, and policy makers.

One of the more difficult groups to enumerate and categorize accurately is the environmental public health (EPH) worker because, of all the public health disciplines, they might be the group with the most diverse assignments. EPH workers in a state health department or in a state environmental protection agency might have similar job functions described within a state personnel system, but as with other public health professions, job titles for EPH workers vary widely and are difficult to enumerate precisely. This can also be observed at the local level and in large cities where EPH workers often are situated in agencies outside the traditional health department. Consequently, NACCHO's and ASTHO's profile studies probably do not capture the data necessary to enumerate EPH workers thoroughly. In contrast, double-counting personnel likely occurs in states with centralized personnel systems where state-funded employees are deployed to the local level.

Given the complexity of the EPH workforce in terms of the specialization of the occupations and workplace settings, conducting an accurate characterization of the workforce is imperative. One of the grandfathers of the EPH profession, Larry Gordon, drew an important distinction between environmental health professionals and professionals working in environmental health. Later, in 2009, a message from then-president of NEHA Welford C. Roberts said, "There is a current need for a comprehensive enumeration of the environmental health workforce (Roberts, 2009)." Enumeration is important because it leads us to question why the EPH profession does not have a standardized curriculum or competency standards and how broad job descriptions and titles can obscure identification of the actual EPH discipline. …

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