Are we really saving resources with current hiring practices at local health departments?

Editor’s note: NEHA strives to provide up-to-date and relevant information on environmental health and to build part­ nerships in the profession. In pursuit of these goals, we feature a column from the Environmental Health Services Branch (EHSB) of the Centers for Disease Con­ trol and Prevention (CDC) in every issue of the Journal. In this column, EHSB and guest authors from across CDC will highlight a variety of concerns, opportunities, challenges, and successes that we all share in environmen­ tal public health. EHSB’s objective is to strengthen the role of state, local, and national environmental health programs and professionals to antic­ ipate, identify, and respond to adverse envi­ ronmental exposures and the consequences of these exposures for human health. The services being developed through EHSB include access to topical, relevant, and scientific information; consultation; and assistance to environmental health special­ ists, sanitarians, and environmental health professionals and practitioners. The conclusions in this article are those of the author and do not necessarily repre­ sent the views of CDC. Guest columnist Jeffrey Neistadt is the director of education and training for the National Association of Local Boards of Health. Guest columnist Timothy Murphy is an associate professor at the University of Findlay in Findlay, Ohio. Jeff and Tim are graduates of CDC’s Environmental Public Health Leadership Institute (EPH­ LI) (cohort 2, 2006-2007). nvironmental public health has undoubtedly changed over time. Environmental health practitioners E are on the front line of preserving our na­ tion’s health and safety. These professionals must be able to identify threats, mitigate or eliminate hazards, create innovative solu­ tions, and offer assistance to those exposed or otherwise affected. Yet at a time when the environmental health workforce is most needed, they are too few in number to meet traditional roles, let alone keep pace with mounting responsibili­ ties and rapidly evolving technologies (Na­ tional Association of County and City Health Officials, 2006). The future workforce must possess basic public health competencies including epidemiology, statistics, and com­ munication skills, as well as critical thinking skills and training to anticipate, recognize, evaluate, and control increasingly complex threats to the public’s health (Association of State and Territorial Health Officials, 2005). In 2000, an estimated 19,431 people made up the environmental health workforce em­ ployed by local health departments. This workforce is a small percentage of the total public health workforce and it continues to shrink, further diminishing environmental health services delivery (Centers for Disease Control and Prevention, 2006). The small number of graduates (just over 300 per year [A. Tres, personal communication, 2006]) from academic programs accredited by the National Environmental Health Science and Protection Accreditation Council (EHAC) are in great demand in the private sector for their skills. This has led many local health departments to hire personnel from twoor four-year colleges without a degree or edu­ cational training in environmental health or public health—in some cases, these person­ nel do not have any college degrees. This practice may be creating a new crisis, one in which local health departments hire entrylevel employees who are more limited in the critical environmental health competencies because they lack necessary education and training (Murphy & Neistadt, 2007). Entrylevel employees without basic training in epi­ demiology, food, water, waste, and sanitation will likely be more challenged to rapidly, ca­ pably, and effectively perform the same duties as entry-level employees who received train­ ing from an EHAC-accredited four-year pro­ gram (Table 1) (Murphy & Neistadt, 2007). Lowering hiring requirements to fill open environmental health positions requires sig­ nificant additional training. New hires lack­ ing environmental health educational train­ ing may not offer the same initial value and knowledge, skills, and abilities as graduates from EHAC-accredited academic programs. Therefore, more agency resources will likely be required to develop skills needed for the position. Although an agency may believe it is saving money by hiring less-expensive environmental health staff with limited expe­ rience and educational skills, it may in fact be losing funds over time because of the ad­ ditional training required. Table 2 identifies areas and costs that may be required for new hires in addition to the required training not­ ed in Table 1. EHAC graduates are trained in all of these areas. In addition to the monetary cost of train­ ing, daily work still needs to be done during the training process. This usually increases