Approximately 48 million people in the U.S. become sick with foodborne illness every year (Scallan et al., 2011). While 1 in 6 become ill, 128,000 are hospitalized and an estimated 3,000 die of foodborne illness (Scallan et al., 2011). Food safety and foodborne illness prevention is a primary responsibility of local public health departments. At the local level, environmental health practitioners work with food service outlets and food distribution centers to enforce food safety regulations. According to the Centers for Disease Control and Prevention (CDC), the food safety workforce addresses 4 of the 10 Essential Public Health Services, including: diagnosing and investigating health problems and health hazards in the community; informing, educating, and empowering people about health issues; enforcing laws and regulations that protect health and ensure safety; and assuring competent public and personal healthcare. The ability of the nation's local public health workforce to effectively fulfill their responsibilities is limited by competence, consistency, and the capacity of the workforce (Centers for Disease Control and Prevention, 2014).
In 2013, 13,300 local public health agency employees were identified as environmental health workers, a decrease of 13% of the workforce from the 2008 estimates of 15,300 (National Association of County and City Health Officials, 2014). The decline of environmental health workers affects the health department's ability to ensure an adequate food safety workforce. This decline in staffing capacity of the food safety workforce within local health departments is expected to continue, with contributing factors such as the anticipated retirement of employees within the workforce, salary stagnation, and lack of opportunity to attract new hires (National Environmental Health Association [NEHA], 2013). With more environmental health workers leaving the workforce and fewer joining, the nation's food safety and security capacity is vulnerable.
Standardization of knowledge and behavior of the food safety workforce is a strategy to reduce the potential for incidences of foodborne illness, even given the limited capacity of the workforce. Standardization of knowledge and behavior results from training the current workforce based on national evidence-based standards addressing outbreak detection, response capacity, capacity to implement control measures, and capacity to implement prevention activities (NEHA, 2013). Adoption of national guidance and participation in continuing education opportunities varies among health departments, despite available resources (NEHA, 2013).
Few national resources exist to guide the development and implementation of food safety training for environmental health workers. The Council to Inform Foodborne Outbreak and Response (CIFOR) has developed standardized guidance for outbreak detection and response, but an estimated 30% of environmental health regulatory programs have not adopted these guidelines (CIFOR, 2014). The International Food Protection Training Institute has designed a competency-based career-spanning curriculum framework to provide continuing education opportunities and to establish a career path for the food safety workforce (Kaml et al., 2013). The Environmental Public Health Online Courses is an online training series preparing practitioners to take credentialing exams for national environmental health certifications (McCormick & Pevear, 2013). Despite available training resources, local health departments continue to report a greater need for training compared with state health departments (NEHA, 2013).
Foodborne illness outbreak response efforts are complex and frequently require collaboration among local, state, and national agencies. An inadequately trained workforce can lead to the omission of investigative actions, duplication of efforts, and delays in source identification--leading to wasted resources and excess risk to the public (NEHA, 2013). In contrast, a highly trained and skilled workforce can result in significantly reduced healthcare costs due to lower rates of death and disease (Neistadt & Murphy, 2009). A trained and prepared environmental health workforce is essential to ensuring food safety, and ultimately the safety of the public's health.
The inclusion criteria to participate in the study required current employment as a food protection staff member...