Assessment of epidemiologic capacity in state and territorial health departments—United States, 2004

Morbidity and Mortality Weekly Report, May 13, 2005 by M.L. Boulton, J. Abellera, J. Lemmings, L. Robinson

In November 2001, the Council of State and Territorial Epidemiologists (CSTE) conducted a survey of state and territorial health departments to assess their core epidemiologic capacity (1,2). The survey was completed just before distribution of approximately $1 billion in terrorism preparedness and emergency response funds in fiscal year 2002, intended to improve the U.S. public health infrastructure (3). Results of the 2001 survey, published in 2003, indicated inadequate capacity in six of eight key epidemiology program areas (all except infectious disease and chronic disease) to fully perform the essential public health services most dependent on epidemiology (1,4). In 2004, CSTE conducted a follow-up survey that assessed epidemiologic capacity in the United States and its territories in the same eight program areas, estimated the number of additional epidemiologists needed for full performance, and identified education and training needs (5). This report summarizes the results of that 2004 follow-up survey, which indicated a 26.9% increase * from 2001 in the overall number of epidemiologists working in state and territorial health departments, increased capacity in two program areas (i.e., terrorism preparedness and emergency response; maternal and child health) and decreased capacity in six other program areas (i.e., infectious disease, chronic disease, environmental health, injury, occupational health, and oral health) (2). Results also revealed that 28.5% of epidemiologists lacked any formal training or academic coursework in epidemiology, Creation of a strong public health infrastructure fully capable of performing essential services will require additional trained epidemiologists in state and territorial health departments.

The CSTE survey was pilot tested in five states (Florida, Michigan, New York, North Carolina, and Tennessee) during April-May 2004 and made available online to all state and territorial health departments during May-September 2004. State epidemiologists or their designees provided information for the survey. Participants included representatives of all 50 states, three of eight territories (37.5%), and the District of Columbia, for an overall response rate of 91.5%. The definition of epidemiologist was unchanged from the 2001 survey, although further clarification was provided regarding who should be counted as an epidemiologist in a state or territorial health department in the 2004 assessment ([dagger]). If epidemiologists divided their time between two program areas, increments of 0.5 full-time equivalent were allocated to each program area.

In 2004, a total of 2,580 epidemiologists were reported working in state and territorial health departments; survey participants estimated that a total of 3,790 epidemiologists (an increase of 47%) were needed to fully address the essential services of public health most dependent on epidemiology (Table). Participants reported that more epidemiologists were needed in all eight key program areas. The number of epidemiologists in each program area, the estimated number of additional epidemiologists needed to fully serve each program area, and the percentage increase needed were as follows: infectious disease (926 epidemiologists, 325 additional needed, 35. 1% increase); chronic disease (390, 183, 46.9%); environmental health (324, 164, 50.6%), terrorism and emergency preparedness (424, 192, 45.3%), maternal and child health (239, 155, 64.9%), injury (74, 131, 177.0%), occupational health (51, 102, 200.0%), and oral health (39, 71, 182.1%).

Participants were asked to assess epidemiologic and surveillance capacity in eight key program areas by using a six-point scale, which was converted to the four-point scale ([section]) used in the 2001 assessment to enable comparison. Participants reported increased capacity from 2001 to 2004 in two program areas (i.e., terrorism preparedness and emergency response and maternal and child health) and decreased capacity in six other program areas (i.e., infectious disease, chronic disease, environmental health, injury, occupational health, and oral health) (Figure). The majority of state and territorial health departments reported full, almost full, or substantial capacity in only two program areas, infectious disease and terrorism preparedness and emergency response.

In addition, respondents were asked to self-assess their abilities to provide the essential public health services most dependent on epidemiology (1,4). Among the 50 states, 31 (62.0%) reported having substantial-to-full capacity to monitor health status and solve community health problems, and 29 (58.0%) reported substantial-to-full capacity in diagnosing and investigating health problems and health hazards in the community. In contrast, 11 states (22.0%) reported having substantial-to-full capacity in evaluating effectiveness, accessibility, and quality of personal and population-based health services, and six states (12.0%) reported substantial-to-full capacity in researching for new insights and innovative solutions to health problems.