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New Report Identifies Shortage Of Epidemiologists In Big City Health Departments

A new report by the Big Cities Health Coalition (BCHC) has found that 28% of their jurisdictions do not have a lead epidemiologist to oversee epidemiology activities. Altogether, the cities in the Coalition represent 62 million persons or about 1 in 5 Americans. A total of 26 of the 30 Coalition Health Departments responded to the survey of epidemiology capacity carried out from January to May 2021.

Shortfall

To reach full epidemiology capacity, the big city health departments would need to increase staff by 602 (47%) over the number of 1,284 epidemiologists now serving. Since the time of the last report in 2017, the number of epidemiologists has increased 18%, much less than the increase needed to reach full capacity as measured now.

According to Chrissie Juliano, executive director of the BCHC,  “The headline really is that big city health departments are in dire need of additional epidemiologist staffing,”. Speaking with  Infectious Disease Special Edition she added “The shortfall puts the nation’s efforts to combat future and current pandemics at risk.”

Specific Programs

The health departments have multiple specific program areas and epidemiologists are scattered throughout these topic areas. As might be expected, 100% of the health departments have program areas in preparedness, infectious disease, and also COVID-19 response. Of the sixteen program areas asked about, the infectious disease and the COVID-19 areas were the most likely to have a formal lead epidemiologist (88% and 96% respectively). Maternal and child health is a frequent program area, however, only about two-thirds of these programs have a lead epidemiologist. Other common program areas are chronic disease, environmental health, vital statistics, and informatics, and proportionally fewer of these have an epidemiology lead. There are relatively few mental health, occupational health, and genomics programs in these big city health departments.

As an indication of the impact of the COVID-19 pandemic, there are almost as many epidemiologists now engaged in that program area (614) as there are in the other 15 program areas (670). Despite this increase, the report identifies COVID-19 response and infectious disease as the two areas in greatest need of more epidemiologists (127 and 174 respectively). Other strongest needs are in the areas of informatics, chronic disease, and  general epidemiology.

Epi Capacity

When queried about their capacity to conduct key epidemiologic activities of different kinds, 92% of the 26 jurisdictions reported  capacity as substantial to full for monitoring health status, 76% as substantial to full for diagnosing and investigating problems, and 40% as substantial to full for research and evaluation.

Vacancies

The big city health departments reported having 176 vacant positions overall with the intent to fill 142 of these as civil service positions or  with contractors. But these numbers reflect only about a quarter of the 602 positions needed for the departments to operate at full epidemiologic capacity.

The health departments were asked open-ended questions to identify the most critical issues they face. Among the themes which emerged are: human resources and hiring issues including staff burnout, data modernization challenges, funding problems, and training priorities.

Recommendations

The Big Cities Health Coalition report makes the following recommendations:

1. Provide cross-training that enables epidemiologists to shift across program areas as needed, particularly during public health emergencies.


2. Enhance skills in data analytics to support data modernization efforts.


3. Streamline onboarding training to assist with surge and/or temporary staffing and alleviate the burden on existing staff while preparing new staff to qualify for FTE positions if interested.

4. Update salary scales to be competitive with other industries.


5. Collaborate with Human Resources staff and health department leadership to be able to hire temporary and permanent staff in a timely manner.


6. Recruit additional epidemiologists, especially for emerging program areas (i.e., genomics) and with advanced knowledge and skills for research and evaluation.


7. Develop a plan to build epidemiology capacity and staffing internally to reduce reliance on contractors and reduce costs in procurement, decrease project delays and increase institutional knowledge.


8. Foster relationships with universities and schools of public health to harness the pipeline of incoming epidemiologists.


9. Facilitate opportunities for students to be exposed to public health practice at a health department.


10. Explore opportunities for academic institutions to support health departments for special projects or subject matter expertise, particularly during an emergency response.


11. Ensure reliable access to the peer reviewed literature 

 

To access the full report, visit:  https://bit.ly/3Ird5vn

 


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