BACKGROUND: The National Association of County and City Health Officials (NACCHO) and the Council of State and Territorial Epidemiologists (CSTE) conducted a survey to better understand the needs, strengths, capabilities, and variability of the epidemiology workforce at local health departments. The purpose of the survey was to develop strategies to increase epidemiology capacity and trainings that meet the needs of local epidemiologists, defined as investigators who study the occurrence of disease or other health related conditions or events in defined populations.
METHODS: A survey was sent out to a representative sample of 529 local health departments on April 9, 2015 through Qualtrics, an online survey system. Survey participants were reminded to complete the survey via e-mail, and the survey closed after three weeks in the field on April 30, 2015.
RESULTS: The survey was completed by 142 local health departments with a 27% response rate. The results indicated that epidemiology services at most local health departments are funded by local (44%), state (24%), and federal (16%) sources. The majority of local health department epidemiologists focus on infectious disease, but additional capacity is needed to meet programmatic needs. Estimates suggest that local health departments need at least 25% more infectious disease epidemiologists to address current priorities. The greatest gaps in current versus necessary capacity exist in substance abuse, mental health, occupational health, injury prevention, and oral health, where local health departments need 4 to 11 times the current capacity. Most local health departments can adequately provide the basic public health services of monitoring health status and diagnosing and investigating health problems, but may not be able to perform more complex evaluation and research functions. Local health department epidemiologists have many training needs, but the most desired topics for future training include program evaluation, quality improvement, and using technology to analyze and collect data through informatics, social media, and statistical packages.
CONCLUSIONS: Epidemiology capacity, expertise, skills, and knowledge are highly variable across local health departments, but several trends are evident. Local health department epidemiologists focus on infectious disease, outbreak investigations, and day-to-day duties such as data analysis and ongoing surveillance. Epidemiologists at local health departments are constrained by time and resources and operate in roles that continue to expand, therefore local health departments should continue to invest in developing their epidemiology workforce.