Characterizing the Roles and Skill Gaps of the Environmental Health Workforce in State and Local Health Departments.

Author:Heidari, Leila
Position::ADVANCE OF THE PRACTICE - Report
 
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Introduction

Environmental health workers (EHWs) make up 8% of the local, state, and federal public health workforce and constitute the largest group of governmental public health workers, after administrative or clerical personnel and public health nurses (Beck, Boulton, & Coronado, 2014). EHWs ensure that the air we breathe, food we eat, and water we drink is safe. They work in the realms of land use, community design, and housing to create health-promoting environments (Srinivasan, O'Fallon, & Dearry, 2003). Their responsibilities are broad, including assessing, communicating, and managing risks related to air quality, drinking water and food safety, industrial hygiene, healthy housing, waste management and disposal, and vector control (National Center for Environmental Health, Centers for Disease Control and Prevention [CDC], & American Public Health Association, 2001). In addition, the duties of EHWs are increasing in scope to include developing programs for climate change adaptation planning; environmental health tracking, which involves monitoring and surveillance of environmental hazards and associated exposures and health effects (CDC, 2018); and conducting health impact assessments (Association of State and Territorial Health Officials, 2011). As the environmental health workload is broadening, however, it is necessary to evaluate the capacity of EHWs.

The environmental health workforce is strained by reductions in federal funding and decreasing capacity, especially in terms of workforce training (Association of State and Territorial Health Officials, 2011, 2014), as well as a dearth of leaders who are ready to fill newly vacated positions due to high rates of turnover, retirement, and voluntary turnover from the high percentage of workers who intend to leave their positions (Herring, 2006; Sellers et al., 2015). With a fluctuating workforce and changing scope of work, it is important to understand the skills and skill gaps of the workforce, as well as to explore potential differences by level of government, as environmental health agency functions can diverge in state versus local settings. Identifying skill gaps and potential training needs--and specifying these by level of government--enables application of relevant solutions to the appropriate setting.

Prior to the 2014 Public Health Workforce Interests and Needs Survey (PH WINS), little information has been available from the perspective of individual state and local health department workers on their tasks, responsibilities, and skill gaps (Sellers et al., 2015). This article, therefore, serves to address this gap in the literature by characterizing EHWs, and comparing and contrasting the following characteristics between state health agencies (SHAs) and local health departments (LHDs): 1) main roles of EHWs, 2) tasks that EHWs report as "very important" to their daily work, and 3) self-reported skill gaps of EHWs.

Methods

Public Health Workforce Interests and Needs Survey

Sampling and broader survey methodologies have been written about extensively elsewhere (Leider, Bharthapudi, Pineau, Liu, & Harper, 2015). In brief, PH WINS was conducted in three sampling frames: 1) a nationally representative sample of permanent, central office employees in SHAs; 2) employees of the Big Cities Health Coalition (BCHC), a membership group of the largest metropolitan health departments in the country (National Association of County and City Health Officials, n.d.); and 3) a pilot frame of local and regional health department employees. For BCHC and local and regional health department frames, the data have importance for the localities in which they were collected and were not intended to constitute a nationally representative sample (Leider, Bharthapudi, et al., 2015). The analyses presented were stratify by setting/sample frame and were also weighted by sample frame: SHAs (n = 910) and LHDs (n = 1,001). The LHD setting includes staff from local and regional health departments, which includes 185 respondents from LHDs who are members of BCHC.

Population

The analyses in this article were limited to EHWs as defined in terms of those who are directly engaging in environmental health-subject matter related work, identified using a combination of two variables: program area and role classification. We determined EHWs to be those who meet either of the following criteria: those with the role classification of "environmentalist," excluding those in an administrative program (n = 1) or those in the program area of "environmental health," excluding those in the following roles: clerical personnel (n = 138), other business support (n = 21), information technology (n = 20), business support (n = 17), public information specialist (n = 11), grants and contracts (n = 10), students (n = 6), custodian (n = 3), and human resources (n = 3). Figure 1 characterizes the composition of this group in terms of role classifications.

Analyses

We conducted descriptive analyses for demographic information and work-related characteristics, as well as role classifications reported by EHWs, which were collapsed into the four categories shown in Figure 1.

We evaluated these demographic and job characteristic factors as predictors of skill gaps. We also conducted analyses for important daily work-related tasks and skill gaps, defined as those tasks that respondents reported being "somewhat" or "very important" to their daily work, but for which they reported low proficiency (unable to perform/ beginner). A composite variable totaling the number of skill gaps per individual EHW was created and used as the outcome. Poisson regression was used to determine predictors of skills gaps. We selected variables to be included in the model based on a manual stepwise selection process. We set the significance level at p

Results

Characteristics

A total of 1,911 EHWs responded to PH WINS, representing 23,229 EHWs across all settings: 910 (9%) in SHAs and 1,001 (9%) in LHDs. Based on the weighted sample in each of the two settings, EHWs were mostly White (81% SHA, 79% LHD), with a bachelor's degree as their highest educational attainment (54% SHA, 70% LHD), with slightly more males than females (53% SHA, 52% LHD) (Table 1). Roughly half of EHWs across settings hold supervisory positions (52% SHA, 43% LHD) (Table 1) and have spent

Role Categories

A substantial proportion of EHWs in each setting are environmentalists (23% SHA, 51% LHD). The proportion of EHWs reporting the role of public health manager/program manager is relatively consistent in both settings (5-6%). Figure 3 shows the breakdown of EHWs by role groupings into environmental professionals, public health professionals, laboratory/clinical professionals, and other.

Important Daily Work Tasks

Similar proportions of EHWs in both settings reported the following competencies as "very important" to their daily work, with a threshold of at least 50%: gathering reliable information, communicating to varied audiences, communicating persuasively, applying evidence-based approaches, and managing change (Table 2). Furthermore, nearly one third of all EHWs across all settings (29% or more) rated each of the 18 competencies listed on the survey instrument as "very important" to their daily work tasks (Table 2).

Skill Gaps

The greatest percentage of EHWs in both settings had zero skill gaps (42% SHA, 38% LHD), with little variation between settings (Figure 5). For those EHWs who had skill gaps, the average number of skill gaps reported was relatively similar in both settings: 4.73 in SHAs (95% confidence interval [CI] [4.12, 5.35]), 4.70 in LHDs (95% CI [4.19, 5.22]).

The top self-reported skill gaps, reported by over 30% of EHWs in both settings, were "influencing policy development" and "preparing a program budget with justification" (Figure 4). Of note, these most prevalent skill gaps were not among the top five important daily work tasks. Similar...

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