The Epidemiology Workforce in State and Local Health Departments— United States, 2010 During 2001–2009, the Council of State and TerritorialEpidemiologists (CSTE) conducted four epidemiology capacityassessments (ECAs) in state and territorial public healthdepartments in the United States ( 1 –5 ). In October 2010, CSTE sent a follow-up, Internet-basedquestionnaire to the state epidemiologist in each of the 50 statesand the District of Columbia. The purpose was to enumerate thestate-level epidemiology workforce and determine whether it hadvaried since 2009 because of changes in state and federal fundingand, for the first time, to estimate concurrently the number ofepidemiologists working in local health departments using the samedefinition for local health department epidemiologist as forstate-level epidemiologist. A total of 3,754 epidemiologistsworking in state and local health departments were reported: 2,476(66%) at the state level and 1,278 (34%) at the local level, thelatter number consistent with results of several recent surveys ( 6,7 ).
The state-level epidemiology workforce increased 12.9% duringthe 18 months since the previous assessment. Although 63% of statesreported fewer state-funded positions, only 24% reported fewerfederally funded positions. Federal stimulus funding might havehelped preserve and enhance the state-level epidemiology workforce.Future epidemiology workforce assessments should include both thestate and local epidemiology workforce, possibly through CSTEcoordination with the National Association of County and CityHealth Officials and other agencies. The main objectives of the periodic CSTE ECAs are to count andcharacterize the state-level epidemiology workforce and to measurecurrent epidemiology capacity by program area.
The epidemiologyworkforce was enumerated in late 2010 because 1) state budgetcutting and federal stimulus funding might have affected the numberof epidemiologists and 2) previous CSTE assessments included onlythe state-level workforce. Given that some local health departmentsserve larger populations than states and receive direct federalfunding (e.g., New York City, Los Angeles, and Chicago) and somestates fund local-level epidemiologists whereas others do not, aconcurrent assessment would more accurately and completely depictthe epidemiology workforce in states. The assessment was pilottested during September 2010 in seven states, revised on the basisof feedback from those states, and sent in October as anInternet-based questionnaire to state epidemiologists. The finalquestionnaire asked whether the number of state and federallyfunded positions at the state-level had decreased, asked for thenumber of epidemiologists working at the state-level by programarea, and asked for the number of epidemiologists in local healthdepartments.
Additional questions addressed the nature of statebudget cutting activities.* Follow-up questions were sent to localhealth departments in two states when the state epidemiologistscould not report local health department data. As in past CSTEassessments, an epidemiologist was defined as any person who,regardless of job title, performs functions consistent with thedefinition of epidemiologist † in A Dictionary of Epidemiology ( 8 ). Respondents were asked to report part-time positions to thenearest 0.1 full-time equivalent. The final results compriseresponses from all 50 states and the District of Columbia and thenumbers of epidemiologists reported by 48 state epidemiologists forlocal health departments in their state and by local healthdepartments in the two remaining states. Population estimates wereobtained from the 2010 U.S.
Census. Respondents reported a total of 3,754 full-time equivalentepidemiologists working at the state or local health departmentlevel. A total of 2,476 (66%) epidemiologists were working at thestate-level in 2010, a 12.9% increase from the 2,193epidemiologists enumerated in 2009 but slightly fewer than the2,498 working in 2004, when federal preparedness funding to statespeaked. Compared with the 2006 ECA, the number of state-levelepidemiologists changed substantially in several program-specificareas.
The largest overall increases were in infectious diseases(+162 [16%]), "other" (+41 [70%]), and chronic diseases (+35[11%]); the largest decreases were in bioterrorism/emergencyresponse (-84 [25%]), environmental health (-77 [27%]), injury (-25[27%]), and oral health (-18 [62%]) ( Figure ). Of the 51 jurisdictions, 27 (53%) showed a 10% increase in thenumber of state-level epidemiologists, and 12 (24%) showed a 10%decrease compared with 2009. Overall, decreases in state fundingresulted in a greater loss of positions than did decreases infederal funding (63% versus 24%). Among the 32 states reporting adecrease in state-funded positions, the most commonly used means ofreducing spending were hiring freezes for vacant state-fundedpositions (25 [78%]), elimination of vacant state-funded positions(23 [72%]), early retirement options (13 [41%]), and layoffs (nine[28%]). Common budget cutting measures in the 51 jurisdictionsincluded salary freezes (86%), travel restrictions (76%), andfurloughs (41%).
In 2010, a total of 1,278 (34%) epidemiologists were working inlocal health departments, 384 (30%) of whom worked in the five mostpopulous cities (New York City, Los Angeles, Chicago, Houston, andPhiladelphia), which constituted 6% of the total U.S. population in2010. The overall number of state-level and local-levelepidemiologists per 100,000 population was 1.22 (median: 1.20;range: 0.44–4.08) ( Table ). Reported by Matthew L. Boulton, MD, Univ of Michigan School of Public Health.James L.
Hadler, MD, New Haven, Connecticut. Lisa Ferland, MPH,Ellyn Marder, Jennifer Lemmings, MPH, Council of State andTerritorial Epidemiologists, Atlanta, Georgia. Corresponding contributor: Matthew L. Boulton, mboulton@umich.edu , 734-936-1623. Editorial Note The timely detection, investigation, control, and prevention ofoutbreaks and major long-term public health problems require awell-trained and competent epidemiology workforce as a keycomponent of the national public health infrastructure.
The 2010CSTE ECA describes the size of the state and local epidemiologyworkforce as of late 2010 and reveals important trends during atime of unprecedented fiscal challenges for governmental publichealth. Including epidemiologists working in local health departmentsyields a total number of epidemiologists approximately 50% greaterthan the number of state-level epidemiologists. Althoughepidemiologists in local health departments have not been includedin previous CSTE ECAs, they contribute to the functionalepidemiology capacity of states as described in the 2009 andearlier ECAs ( 1 –5 ). Clearly, changes in numbers of local epidemiologists affectoverall state-level functional capacity. Furthermore, theseepidemiologists need to be included in future assessments ofcompetency and training needs of the public health epidemiologyworkforce.
The National Association of County and City HealthOfficials has assessed the size of the epidemiology workforce inlocal health departments as part of its larger periodic assessmentof the national local health department workforce ( 9 ). The 2010 National Profile of Local Health Departments, whichdirectly surveyed local health departments and used weightedestimates to account for nonrespondents, calculated that 1,500epidemiologists (range: 1,100–1,800) worked in local healthdepartments, a range encompassing the number described in thisreport by CSTE ( 6 ). The Bureau of Labor Statistics estimated that 1,100epidemiologists worked in local health departments in 2010 ( 7 ). The findings of this report are subject to at least threelimitations. First, even though all state and local healthdepartments used the same definition of epidemiologist,jurisdictions supplying counts might have applied the definitiondifferently.
Second, because program-specific information wasobtained for state-level but not local-level epidemiologists, theactual proportion of the entire state epidemiology workforce in anygiven program area likely varied from that reported. Finally,unlike in previous ECAs, this assessment only counted staffmembers; it did not measure functional epidemiology capacity ( 1 , 2 , 4 ). The extent to which the 12.9% increase affected overallfunctional capacity is unknown. Because previous CSTE ECAs did not enumerate local healthdepartment epidemiologists, assessment of trends is limited tostate-level epidemiologists. The 12.9% increase in epidemiologistssince 2009 was unexpected given the sustained national economicdownturn, which has resulted in reported reductions in the localand state public health workforce ( 6,9,10 ).
The data suggest that although the number of state-fundedepidemiologists decreased in most states, federal funding appearedto compensate for those losses. New federal funding streams duringthis time included funding to respond to 2009 pandemic influenza A(H1N1) and federal stimulus funding that supportedhealth-care–associated infection initiatives. Despite thisnew funding and a boost in the number of epidemiologists, it istroubling that 12 states had overall 10% decreases in the numberof state-level epidemiologists, given that states consistently havereported a need for additional epidemiologists ( 2 –5 ) and epidemiologists have been identified as a workforce shortageoccupation in several studies ( 6,9,10 ). The number of epidemiologists decreased in a number of programareas including bioterrorism/emergency response, environmentalhealth, injury, occupational health, and oral health. In all theseareas, except bioterrorism/emergency response, epidemiologycapacity already was marginally functional ( 4 ).
Trends in the workforce, and functional epidemiology capacity inthese areas especially, require continued monitoring to identifygaps and address future needs. Such monitoring will be particularlyimportant as federal funding fluctuates and states operate underpersistent budget deficits. Acknowledgments State and local epidemiologists. Katrina Hedberg, MD, Oregon Deptof Health and Human Svcs. Richard Hopkins, MD, Florida Dept ofHealth.
Timothy Jones, MD, Tennessee Dept of Health. Robert Rolfs,MD, Utah Dept of Health. Thomas Safranek, MD, Nebraska Dept ofHealth and Human Svcs. Forrest Smith, MD, Ohio Dept of Health.Stephen Ostroff, MD, Pennsylvania Dept of Health. References CDC.
Assessment of the epidemiologic capacity in state andterritorial health departments—United States, 2001. MMWR2003;52:1049–51. CDC. Assessment of epidemiologic capacity in state and territorialhealth departments—United States, 2004.
MMWR2005;54:457–9. Boulton, ML, Lemmings J, Beck AJ. Assessment of epidemiologycapacity in state health departments. 2001–2006. J PublicHealth Manag Pract 2009;15:328–36.
CDC. Assessment of epidemiology capacity in state healthdepartments—United States, 2009. MMWR 2009;58:1373–7. Boulton, ML, Hadler J, Beck AJ, Ferland L, Lichtveld M. Assessmentof epidemiology capacity in state health departments,2004–2009.
Public Health Reports 2011;126:84–93. National Association of County and City Health Officials. 2010national profile of local health departments. Washington, DC:National Association of County and City Health Officials; 2011:38.Available at topics/infrastructure/profile/resources/2010report.
Accessed March 22, 2012. Bureau of Labor Statistics. Occupational employment statistics, May2010. Washington, DC: US Department of Labor, Bureau of LaborStatistics; 2012. Available at www.bls.gov/oes/home.htm.
Accessed March 22, 2012. Last JM, Spasoff RA, Harris SS, Thuriaux MC, eds. A dictionary ofepidemiology. 4th ed.
New York, NY: Oxford University Press; 2001. National Association of County and City Health Officials.Describing the local public health workforce: workers who prevent,promote, and protect the nation's health. Washington, DC: NationalAssociation of County and City Health Officials; 2011:1–4.Available at topics/workforce/upload/lphworkforce.pdf . Accessed October 13, 2011. Association of State and Territorial Health Officials.
2007 statepublic health workforce survey results. Washington DC: Associationof State and Territorial Health Officials; 2008. I am Bamboo, Rattan & Wicker Furniture writer, reports some information about 50 gallon drums , plastic cosmetic tubes.
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