Assessment of Epidemiology Capacity in State Health Departments — United States, 2013

BACKGROUND:  Epidemiology is the science that underlies public health practice. It is important for each state to have sufficient epidemiology capacity to 1) monitor population health status to identify and solve community health problems, 2) diagnose and investigate health problems and health hazards in the community, 3) evaluate effectiveness, accessibility, and quality of personal and population-based health services, and 4) conduct and evaluate research for new insights and innovative solutions to health problems. Since 2001, the Council of State and Territorial Epidemiologists (CSTE) periodically has conducted standardized national assessments of state health departments’ core epidemiology capacity, most recently in 2009-2010.

METHODS:  During August–September 2013, CSTE sent a web-based questionnaire to the State Epidemiologist in each of the 50 states and the District of Columbia. The assessment inquired into workforce capacity and technological advancements to support surveillance. Measures of capacity included total number of epidemiologists, self-assessment of the state’s ability to carry out four of the essential public health services (listed above) most relevant to epidemiologists, and program-specific epidemiology capacity relating to 10 program areas. Self-assessment of ability/capacity used a 6-category scale ranging from none (0%) to full ability/capacity (100%).

RESULTS:  All 50 states and the District of Columbia responded. Most of the measures of capacity were at their highest level since assessments began in 2001: the number of epidemiologists (2,752,  10% increase since 2004’s previous highpoint), the percentage of state health departments with substantial-to-full (>50%) capacity for three of the four capacities listed above, and the percentage with substantial-to-full epidemiology capacity for eight of 10 program areas. However, more than 30% of states reported minimal-to-no (<25%) epidemiology capacity for five program areas, including injury (33%), occupational health (55%), oral health (59%), substance abuse (73%) and mental health (80%).  Further, 33% of states still lacked automated electronic laboratory reporting, only 29% routinely used cluster detection software, and <50% routinely geocoded reportable disease data. 

CONCLUSIONS:  Overall state-level epidemiology capacity and the epidemiology capacity in many program areas have increased markedly since 2009 to the highest levels yet measured. Nonetheless, the majority of health departments still have little to no capacity in some program areas and lack important technologic capacity. State, federal, and local agencies should work together to address underdeveloped surveillance and epidemiology capacity, particularly in mental health, substance abuse, oral health and occupational health, by reaching a consensus on optimal levels and developing a strategy to achieve them.