Pillars of Governmental Environmental Public Health: A Guide to Scalable Environmental Public Health Programs from the National Environmental Health Association, July 2025.
Pillars of Governmental Environmental Public Health A Guide to Scalable Environmental Public Health Programs
Authors Gina Bare, RN, National Environmental Health Association
Thuy N. Kim, MPH, PhD, University of Minnesota School of Public Health Craig W. Hedberg, PhD, University of Minnesota School of Public Health Nicole Dutra, MPH, National Environmental Health Association Christopher Walker, MSEH, REHS, National Environmental Health Association David Dyjack, DrPH, CIH, National Environmental Health Association Acknowledgements The authors gratefully acknowledge the environmental public health professionals who participated in focus groups, key informant interviews, and the national field survey. Their generous contribution of time, expertise, and insights made this guide possible. We also thank the members of the Delphi panel who helped identify the core EPH programs, and the National Environmental Health Association Board of Directors for their support of this project. Funding acknowledgement: Phase I of this two-phase project was supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) under federal award #NU38OT000300-04-07 in the amount of $25,000 or approximately 11% of the entire project. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. government.
Contents
Introduction.............................................................................................................................................................................. 4
Background............................................................................................................................................................................... 6
Characteristics of a Successful Environmental Public Health Department..............................................................7
Core Environmental Public Health Programs..................................................................................................................9 Food Safety and Protection................................................................................................................................................................................14 Swimming Pools and Recreational Water Safety.......................................................................................................................................17 Onsite Wastewater...............................................................................................................................................................................................19 School Safety and Inspection.............................................................................................................................................................................23 Early Childcare and Daycare..............................................................................................................................................................................26 Zoonoses and Vector Control.............................................................................................................................................................................28 Emergency Preparedness...................................................................................................................................................................................31 Potable Water.........................................................................................................................................................................................................34 Lead Prevention......................................................................................................................................................................................................37 Body Art....................................................................................................................................................................................................................40 Non-School Institutions and Licensed Establishments.............................................................................................................................43 Secondary Environmental Public Health Programs.....................................................................................................43 Climate Health........................................................................................................................................................................................................44 Air Quality................................................................................................................................................................................................................45 Healthy Homes.......................................................................................................................................................................................................45 Hazardous Materials.............................................................................................................................................................................................46 Other Considerations for Secondary EPH Programs.................................................................................................................................47 Strategic Considerations for Program Enhancement...................................................................................................48 Building on Common Foundations ..................................................................................................................................................................48 From Guidelines to Implementation................................................................................................................................................................49 The Evolving Landscape of Environmental Public Health........................................................................................................................49 A Call to Action......................................................................................................................................................................................................49
Conclusion...............................................................................................................................................................................49
References. .............................................................................................................................................................................50
Appendices.............................................................................................................................................................................55
3
Introduction
Environmental public health (EPH) professionals play a crucial role in safeguarding public health and ensuring the well-being and prosperity of our communities. Local governmental EPH programs employ a sig- nificant number of dedicated professionals who work tirelessly to pro - tect the food we consume, the air we breathe, the water we drink, and the environments in which we live, work, and play. The importance of local governmental EPH programs cannot be overstated, as they con- tribute to the overall health of the public and serve a vital function in national security. Research has consistently demonstrated the positive impact of local health department (LHD) activities and investments on reducing the inci- dence of EPH-related diseases (Bekemeier et al., 2015; Fan et al., 2020). Moreover, senior leadership at both state and local health departments has recognized the essential nature of EPH services (Leider et al., 2015). Despite the crucial role EPH professionals play in promoting and protect- ing public health, national guidance on the optimal structure and organi- zation of local EPH departments is absent. The absence of a standardized framework for local EPH departments poses significant challenges for EPH officials seeking to secure the nec - essary resources, including staff, funding, and equipment, to effectively carry out their duties. Without clear benchmarks and guidelines, EPH programs struggle to justify their needs, potentially compromising the health, safety, and prosperity of the communities they serve. To address this gap, this guide presents scalable program guidelines that can be adapted to meet the diverse needs, resources, and organizational struc- tures of EPH departments across different jurisdictions, while maintain- ing essential standards for protecting community health.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
How This Document Was Developed The Pillars of Governmental Environmental Public Health was developed through a comprehensive research collab- oration between the National Environmental Health Asso- ciation (NEHA) and the University of Minnesota (UMN) School of Public Health. This framework emerged from an extensive study conducted in 2024 that surveyed hun- dreds of environmental public health professionals across 45 states, the District of Columbia, and Puerto Rico. The research was built on previous work in 2023 that identified 11 core EPH programs through a Delphi panel of senior EPH professionals, followed by focus groups and key informant interviews to capture qualitative insights. This research was specifically designed to gather perspectives from EPH professionals, capturing insights on program structure, staffing standards, educational requirements, credentialing needs, and workload expectations across multiple program areas. The resulting guidelines pre- sented reflect the collective wisdom and practical expe - rience of hundreds of EPH professionals who understand the day-to-day realities of protecting public health while working within diverse organizational structures and resource constraints. Scalable Guidelines Approach The recommendations provided are intended as scalable guidelines rather than rigid requirements. Most jurisdic- tions possess unique EPH challenges, resources, demo- graphics, and governmental structures. What works in a large urban government agency might not be suitable for a
small, rural jurisdiction with different priorities and poten- tially fewer resources. The scalable guidelines presented here offer a flexible framework that can be adapted to: • Jurisdictions of varying sizes. • Agencies with different levels of resources and staffing. • Communities with distinct environmental health priorities based on culture, geography, climate, industry, and population characteristics. • Diverse governance structures, including county, city, district, or combined jurisdictions. • Inconsistent regulatory authorities granted under state and local laws. The purpose of this guide is to provide EPH directors, man- agers, supervisors, and field staff with evidence-based recommendations that help them develop, implement, and sustain effective programs. These guidelines serve as a starting point for program assessment and advo- cacy efforts, offering benchmarks for staffing, education, training, certification, outcome measures, and equipment needs that can be adapted to match specific departmental and community circumstances. EPH leaders can consider these guidelines as a starting point for program develop- ment and assessment, adapting the recommendations to match their specific circumstances. Rather than present - ing a one-size-fits-all approach, this guide provides evi - dence-based parameters that can be scaled up or down based on department and community needs, regulatory responsibilities, and available resources.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Background
EPH is a crucial facet of public health that focuses on the interplay between the intersection of environment and human health. It encompasses a wide array of programs and services designed to protect and enhance the health and well-being of communities. These programs iden- tify, assess, and mitigate environmental factors that can adversely impact human health. The environment plays a significant role in shaping our health outcomes. Exposure to environmental hazards can lead to a range of health effects from acute illnesses to chronic diseases and premature death. According to the World Health Organization, an estimated 24% of the global disease burden and 23% of all deaths can be attributed to environmental factors (Prüss-Üstün et al., 2016). By addressing these environmental determinants of health, EPH professionals contribute to the preven- tion of disease, the promotion of health, and the overall well-being of communities. EPH professionals comprise a diverse and highly skilled workforce, including specialists, scientists, technicians, and sanitarians. They possess expertise in a wide range of disciplines, such as epidemiology, toxicology, risk assess- ment, and environmental science. The EPH workforce is the second-largest profession within the public health workforce, after nursing (NACCHO, 2019). Despite their crucial role, EPH professionals often face numerous chal- lenges such as insufficient staffing, limited resources, and a lack of standardized guidelines for the structure and funding of EPH departments. Local EPH departments play a vital role in protecting and promoting public health at the community level. They are
responsible for providing a wide range of services, includ- ing food safety inspections, water quality monitoring, haz- ardous waste management, vector control, and emergency preparedness, response, and recovery. These services are essential for preventing the spread of infectious diseases, reducing exposure to environmental hazards, and ensuring the overall health and safety of communities. Studies have consistently demonstrated the positive impact of local EPH department activities and investments on pub- lic health outcomes. For example, Bekemeier et al. (2015) found that increased local health department food safety and sanitation expenditures were associated with signifi - cant reductions in enteric disease rates. Similarly, Fan et al. (2020) highlighted the critical role of EPH professionals in responding to the COVID-19 pandemic, emphasizing the importance of effective public health and safety nets in mit- igating the impact of public health emergencies. Despite the clear evidence of the value of EPH services, local EPH departments often struggle to secure the nec- essary resources and support to carry out their essential functions effectively. The lack of national standards and guidance for the structure, staffing, and funding of EPH departments creates significant challenges for local public health officials in advocating for the resources necessary to protect the health of their communities. This guide recognizes the importance of EPH and the need for a stronger, more resilient EPH system. Further, it provides national benchmarks and recommendations for the structure, staffing, and funding of local EPH depart - ments—a roadmap for strengthening the EPH workforce to ensure communities have access to essential services.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Characteristics of a Successful Environmental Public Health Department
A successful environmental public health department works to protect public health through prevention activities, respon- sive services, and community engagement while maintaining adaptability to emerging challenges. Based on findings from focus groups, interviews, and surveys with EPH profession- als, the following characteristics are commonly observed in well-performing environmental public health departments across various sizes, structures, and program configurations. Silent Success Through Prevention The hallmark of a well-functioning EPH department is often what does not happen—disease outbreaks pre- vented, environmental hazards mitigated, and injuries avoided. This “silent success,” sometimes referred to as “negative space,” represents the primary mission of EPH— prevention. When an EPH department functions optimally, the community might be largely unaware of its daily activ- ities, as the absence of environmental health crises often reflects effective performance. Science-Based Decision-Making EPH departments that perform well generally ground their operations in scientific evidence, using data collection, sur - veillance, and analysis to identify trends, determine prior- ities, and guide resource allocation. These departments typically maintain suitable data systems to track environ- mental conditions, monitor health outcomes, and evaluate program effectiveness, with decisions based on quantifi - able and relevant metrics. Equitable Service Delivery Excellence in EPH often involves identifying and address- ing disparities in environmental health conditions across populations and communities. High-performing depart- ments frequently assess the distribution of environmen- tal health burdens, target resources to areas of greatest need, and work to ensure services are accessible, cultur- ally appropriate, and designed to reduce health inequities.
A successful environmental public health department works to protect public health through prevention activities, responsive services, and community engagement while maintaining adapt- ability to emerging challenges.
This expanded model emphasizes education, technical assistance, and partnership with regulated entities to achieve compliance through collaboration rather than rely- ing primarily on fines and citations. Effective Partner Relationships The development and maintenance of strong relation- ships represents a core competency of many successful environmental public health departments . These relation- ships span regulated establishments, community partners, healthcare providers, academic institutions, and other governmental agencies. Strong relationships foster trust, enhance communication, facilitate information exchange, and extend the department’s impact beyond what can be achieved through direct service provision alone. Workforce Excellence and Development Effective EPH departments often invest in their workforce through comprehensive training, continuing education, and professional development opportunities. They cultivate environmental health professionals who possess technical expertise and skills in communication, customer service, cultural competence, and adaptability. These departments frequently create pathways for career advancement and knowledge transfer to ensure continuity of expertise. Integration and Coordination Effective EPH departments often integrate their services and coordinate across program areas. This integrated approach recognizes the interconnected nature of environ- mental health challenges and enables more efficient use of resources, reduces duplication of efforts, and provides more seamless services.
Balance of Regulatory and Consultative Approaches
While enforcement of environmental health regulations remains essential, many departments increasingly balance traditional regulatory roles with consultative approaches.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Adequate and Sustainable Resources Successful EPH departments work to secure and maintain the resources—funding, staffing, equipment, and facili - ties—necessary to fulfill their core functions. They often diversify funding sources, develop fee structures that reflect service costs, and effectively communicate their value to secure appropriate budget allocations. These departments typically maintain the capacity to respond to routine demands while remaining prepared for emergen- cies and emerging threats. Continuous Quality Improvement Excellence in EPH frequently involves ongoing assessment and improvement. Effective departments often establish meaningful performance measures, regularly evaluate their effectiveness, identify opportunities for enhancement, and implement changes based on evaluation findings. This culture of continuous improvement enables departments to adapt to evolving science, community needs, and envi- ronmental challenges. Public Trust and Transparency By maintaining transparent operations, clear communica- tion about environmental health risks and regulations, and demonstrated commitment to protecting public health, effective EPH departments often earn the trust of their
communities. This trust facilitates cooperation during rou- tine operations and proves valuable during emergency response situations when public compliance with health guidance becomes important. The characteristics outlined above provide a framework for EPH departments to assess their current operations and identify opportunities for growth. While specific program implementations will vary based on community needs, regulatory requirements, and available resources, these foundational elements are commonly observed across well-functioning jurisdictions of various sizes. Additional Resources This guide also includes information on the 10 Essential Environmental Public Health Performance Standards and the Public Health Accreditation Board (PHAB) as appen- dices at the end of the document to provide additional context and guidance for program development and assessment. Additionally, EPH departments may find value in utilizing community health assessment (CHA) and community health improvement plan (CHIP) pro- cesses to identify local environmental health priorities and align program development with broader community health needs. Furthermore, a comprehensive reference section includes resources that were consulted during the development of this guide.
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Environmental Public Health A Guide to Scalable Environmental Public Health Programs
Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Protecting Families and Communities
Secondary EPH Programs
Secondary EPH Programs
11 Core EPH Programs
Staffing Benchmarks
Educational and Training Requirements
Equipment Needs
Success Metrics
In addition to the 11 core EPH programs, local EPH departments can also provide secondary programs that address specific EPH concerns within their jurisdictions. These secondary programs (e.g., climate health, air qual- ity, healthy homes, hazardous materials) could be con- sidered core programs by some departments based on the unique needs and priorities of the communities they serve (NEHA, 2022). The determination of which programs might be consid- ered core or secondary likely varies across jurisdictions, as EPH challenges and community needs can differ significantly from one area to another. For example, a jurisdiction with a history of poor air quality or indus- trial pollution might prioritize air quality monitoring and enforcement as a core program, while another jurisdiction could focus on healthy homes due to elevated rates of childhood asthma. To effectively identify and prioritize core and secondary EPH programs, local EPH departments can collect and analyze data on the EPH status of their communities, assess community needs and priorities, review appli- cable regulatory requirements, and engage with inter-
Core Environmental Public Health Programs Core EPH programs represent the most common and essential services that local EPH departments typically provide to protect and promote the health and well-be- ing of the communities they serve. These programs are designed to address the most pressing EPH concerns and are considered foundational to the mission of EPH. The 11 core EPH programs identified in research con - ducted by NEHA, in cooperation with UMN, include food safety and protection, potable water, swimming pools and recreational water safety, onsite wastewater, lead prevention, zoonoses and vector control, emergency pre- paredness, school safety and inspection, early childcare and daycare, body art, and non-school institutions and licensed establishments. When local EPH departments focus on these core pro- grams, they can work to provide comprehensive services essential to safeguard public health. Delivery does require adequate staff, funds, and resources, which vary signifi - cantly across jurisdictions.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
ested partners. This data-driven, community-informed approach can help ensure that EPH departments allocate their resources and efforts toward the programs that will have the greatest impact on protecting and promoting public health. When local EPH departments tailor their core and second- ary EPH programs to the specific needs of their communi - ties, they can develop a comprehensive, responsive, and effective EPH strategy that addresses the most pressing concerns and promotes health equity.
In the sections that follow, we define each core EPH pro - gram based on comprehensive research conducted jointly by NEHA and UMN. Through focus groups, interviews, and a national field survey with participants from hundreds of diverse local EPH departments, we provide meaningful outcome measures, staffing benchmarks, educational and certification requirements, essential equipment needs, and common funding sources for each program. This evi- dence-based information enables EPH departments to develop strong, sustainable programs tailored to their communities’ unique needs.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Core Environmental Public Health Programs at a Glance: Key Findings and Recommendations
The following table provides an overview of 10 of the 11 core EPH programs identified through our research. This summary synthesizes key findings from focus groups, inter - views, and surveys with EPH professionals nationwide to present essential information for each program area. The 11th program area, Non-School Institutions and Licensed Establishments, is not included in this table due to the sig- nificant variability in how jurisdictions define and organize these facilities, which is discussed in detail later in this guide. All recommendations in this table are designed to be scalable based on jurisdiction size, community needs,
available resources, and regulatory requirements. The information shown reflects consensus levels among surveyed professionals and indicates strong field sup - port for these evidence-based benchmarks. Jurisdictions should view this information as a starting point for pro- gram development rather than rigid requirements and adapt the recommendations to their specific circum- stances and priorities. The detailed program descriptions that follow in this guide will expand on each of these elements and provide the context and rationale behind these recommendations.
PROGRAM
RECOMMENDED WORKLOAD 3–4 inspections per field day
EDUCATION AND CREDENTIALS
EQUIPMENT
KEY METRICS
Food Safety and Protection
• Bachelor’s in science • REHS/RS credential • CP-FS credential
• Thermometers and pH meters • Test strips and sampling kits • Food Code book • Cameras
• Number of
foodborne illness outbreaks
• Number of
foodborne illnesses
• Number of inspections • Number of critical violations
• Hairnets and hats • Mobile technology and inspection forms
Swimming Pools and Recreational Water
3–4 inspections per field day
• Bachelor’s in science • Certified Pool Operator • REHS/RS credential
• Pool chemistry test kits
• Number of inspections completed • Number of
• Tape measures • Optical scanners • Laboratory access • Cameras • Mobile technology and inspection forms • Soil augers and rock hammers • Tile probes and levels • GPS units and CAD software • Sludge judge sampler • Cameras • Mobile technology and inspection forms
critical violations • Closure frequency
Onsite Wastewater
4–5 activities per week
• Bachelor’s in science • REHS/RS credential • Installer training programs
• Contaminated wells ratio • Permit review timelines • System failure reports
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
PROGRAM
RECOMMENDED WORKLOAD 2–3 inspections per field day
EDUCATION AND CREDENTIALS
EQUIPMENT
KEY METRICS
School Safety and Inspection
• Bachelor’s in science • REHS/RS credential
• Infrared
• Repeat violations • Staff hazard identification • Technical consultations
thermometers • Air quality monitors
• Light meters • Playground
inspection kits
• Cameras • Mobile technology and inspection forms
Early Childcare and Daycare
3–4 inspections per week
• Bachelor’s in science • REHS/RS credential • Playground safety certification • IPM training
• Thermometers
• Number of
and light meters
critical violations • Outbreak control timeframes • Facility closure rate
• Flashlights • Sanitizer test strips • Educational materials • Cameras • Mobile technology and inspection forms
Zoonoses and Vector Control
Variable by disease burden
• Bachelor’s in science • REHS/RS credential • Vector control technician training • IPM training
• Traps and
• Training hours per inspector • Number of human disease cases • Vector index thresholds
collection tools
• PPE • Lab supplies and microscopes • Adulticides and larvicides • Mobile technology and documentation forms • Cameras • Communication systems • Emergency power sources • Specialized response equipment • Laboratory access
Emergency Preparedness
As needed basis
• Bachelor’s in science or other degree • REHS/RS credential • ICS 100, 200, 700, 800 • EHTER courses • Bachelor’s in science • REHS/RS credential • Drinking water operator certification
• Number of staff with required certifications • Response time • Plan review currency
Potable Water
3–4 field activities per week
• Water quality kits and
• Number of
well inspections
sampling supplies
• Safety of
water samples
• Cameras • Measuring tapes and rulers
• Number of waterborne
illnesses associated with drinking water
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
PROGRAM
RECOMMENDED WORKLOAD
EDUCATION AND CREDENTIALS
EQUIPMENT
KEY METRICS
Potable Water continued
• Mobile technology and inspection forms • Educational materials
• Number of
educational events • Number of voluntary well water samples submitted • Number of plan reviews completed
Lead Prevention
2–3 field activities per week
• Bachelor’s in science • REHS/RS credential • Lead risk assessor certification
• XRF analyzers • Dust wipe
• Blood lead level reductions • Number of
sampling supplies
properties deemed lead safe
• PPE • Educational
• Environmental assessment
demonstration kits
completion rates
Body Art
3–4 inspections per week (Based on part-time employee. See program specific staffing details.)
• Bachelor’s in science • REHS/RS credential • Bloodborne pathogen training
• Thermometers • pH meters • Flashlight • Test strips • Cameras • PPE
• Number of
high priority violations cited per establishment unlicensed or expired licensed artists per establishment unlicensed artists found who then underwent the process to get licensed adverse events directly attributed to body art per establishment
• Number of
• Number of
• Number of
• Number of complaints
received per 50 establishments
Note. Workload recommendations assume staff perform duties other than field work, such as training, meetings, report writing, complaint fol - low-up, enforcement action, quality assurance, and plan reviews, and are generally not in the field 5 days a week. Assumptions also include that EPH professionals have transportation to sites as needed, basic office supplies, inspection forms, and hands-on training opportunities. It should be noted that some jurisdictions take alternate approaches to requiring degrees. It should further be noted that the 11th core program area, Non- School Institutions and Licensed Establishments, is not included in this table. See full discussion in the program descriptions section. CAD = com- puter-aided design; CP-FS: Certified Professional–Food Safety; EHTER = Environmental Health Training in Emergency Response; FTE = full-time employee; ICS = Incident Command System; IPM = integrated pest management; PPE = personal protective equipment; REHS/RS = Registered Environmental Health Specialist/Registered Sanitarian.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Food Safety and Protection
Program Overview and Core Services/Activities
PROGRAM
RECOMMENDED WORKLOAD 3-4 inspections per field day
EDUCATION AND CREDENTIALS
EQUIPMENT
KEY METRICS
Food Safety & Protection
• Bachelor’s in science • REHS/RS credential • CP-FS credential
• Thermometers and pH meters • Mobile technology and inspection forms • Test strips and sampling kits • Food Code book • Cameras • Hair nets/hats
• Number of
foodborne illness outbreaks
• Number of
foodborne illnesses
• Number of inspections • Number of critical violations
Characteristics of a Successful Food Safety Program
The Voluntary National Retail Food Regulatory Program Standards from the Food and Drug Administration (FDA) provide a framework for many food safety programs. In addition to these standards, some departments might want to consider additional areas that the Program Standards do not currently address, such as comprehensive food handler education, alternative enforcement approaches, program sustainability, and succession planning. Program success is generally measured by reducing vio- lations over time, which corresponds to illness prevention. For many jurisdictions, however, the methods for achiev- ing these outcomes are evolving from traditional enforce- ment-focused approaches toward consultative models that emphasize education, technical assistance, and rela- tionship-building with regulated entities. The consultative approach encompasses several key ele- ments: providing and requiring education for food han- dlers, assisting establishment operators in implementing effective control measures, collaborating with operators during outbreak investigations, and fostering positive rela- tionships with both operators and the general public. This shift represents a fundamental change in how EPH profes- sionals interact with the regulated community. Some jurisdictions have implemented hands-on techni- cal assistance programs where EPH staff guide operators in adopting policies and practices that reduce violations. These consultative approaches have shown promis- ing results in pilot programs, with at least one federally
Definition Food safety and food protection EPH programs involve inspection, permitting, plan review, and complaint and outbreak investigation of food establishments. These establishments include but are not limited to brick-and- mortar restaurants, mobile food units, temporary food events, commissary kitchens or shared kitchens, and food manufacturing and distribution facilities where applicable to promote the safe preparation, production, and service of food in sanitary food facilities; to protect the health of food handlers and consumers by encouraging safe and sanitary on-the-job working conditions; and to ensure consumers have access to proper menu labeling.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
funded initiative demonstrating significant decreases in priority violations. Other jurisdictions have engaged exter- nal consultants to provide specialized technical assistance to operators. As consultative approaches become more widespread, comprehensive evaluation of their effectiveness in reduc- ing both violations and foodborne illness becomes increas- ingly important. Such evaluation can occur at both local and national levels to determine best practices and inform broader adoption of these innovative program models across the field.
The development of meaningful outcome measures is an emerging challenge for consultative visits, as these have not yet been well-established in the field. Consultative approaches present measurement difficulties because they are more conceptual than traditional violation-based inspections and are often co-mingled with standard reg- ulatory activities. Programs implementing consultative models could benefit from innovative metrics that cap - ture the preventive value and educational impact of these interactions, potentially including measures such as vol- untary compliance improvements, operator knowledge gains, or reductions in repeat violations following consul- tative interventions. As the field continues to evolve toward more collabora - tive and educational approaches, developing effective outcome measures for these activities can help demon- strate program value and effectiveness beyond traditional enforcement metrics. The following metrics were derived from the national field survey data.
Meaningful Outcome Measures
PURPOSE
METRIC
Program effectiveness
• Number of critical violations identified per 1,000 food establishments per year * • Number of complaints received per year *
Staffing
Workload management
• Average number of inspections per facility type per year
Public health protection
• Number of foodborne illness outbreaks per year • Number of foodborne illnesses per year
* EPH professionals who participated in focus groups, key informant interviews, and/or the national field survey consistently identified this metric as moderately to extremely useful. FDA reports that most agencies responsible for the over- sight of restaurants and other retail food facilities have adopted some version of the FDA Food Code . Additionally, many food safety programs also use the FDA Voluntary National Retail Food Regulatory Program Standards as a foundation for program evaluation. Risk factor analyses that examine trends in violation citations and foodborne illness patterns can inform targeted interventions, such as training programs for EPH staff and educational programs for food workers and operators. Common program effectiveness measures include track- ing violation patterns by facility type, which helps iden- tify systemic issues and target resources appropriately. Performance and workload evaluation measures typically encompass the number of inspections completed, as well as time efficiency metrics for inspection completion.
Food safety programs commonly use FDA Standard 8 (280–320 inspections per full-time employee [FTE] per year) as general guidance for staffing rates, though actual inspection volumes vary significantly across jurisdictions. Survey data from local departments show a median of 331 routine inspections per FTE annually (range 184–333), with some programs reporting as low as 280 inspections per FTE while others conduct up to 580 inspections per FTE. These benchmarks are specific to 1 FTE in food safety pro - grams and might need to be adjusted when EPH profes- sionals also perform duties in other programs. Workload calculations could account for non-food safety responsibil- ities, which might result in lower inspection targets. Addi- tionally, essential duties such as reporting, responding to
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
operator inquiries, and public communications could be factored into staffing determinations. Daily inspection expectations typically range from 2–3 inspections per day on the low end to 4–5 inspections on the high end, based on departmental experience and oper- ational needs. These expectations can remain adaptable, however, as inspection methods and community needs evolve to ensure an appropriate balance between inspec- tion quality and quantity. Based on a typical 48-week work year (allowing for vacations, holidays, and sick time) and 3 inspections per field day, full-time inspectors would need to be in the field 2–4 days per week depending on departmen - tal demands, with 2–3 field days being more common. This schedule allows time for administrative duties, plan reviews, complaint investigations, and other program responsibilities. Several facility characteristics can significantly affect inspection duration and daily productivity: • Facilities with special or lengthy food preparation processes (e.g., ethnic cuisines, smoking, curing, sushi preparation) • Establishments with attached grocery, deli, or butcher components requiring extended inspection time • Inspections requiring translation services or cultural consultations • Mix of full-service restaurants versus fast food or chain establishments • Type of inspection conducted (violation-focused versus consultation-based visits) There is growing interest in consultative inspection approaches that emphasize education and prevention over traditional violation-based methods. One jurisdiction adopted a successful inspection model that allocated 0.1 FTE to traditional inspections and 0.75 FTE to consultation services, and the model resulted in a significant reduction in facility-related outbreaks. This consultative model shows promise for food safety and other communicable disease prevention programs, though implementation might require additional staff training or partnerships with external con- sultants to provide specialized technical assistance. Education/Training/Certifications For food safety programs, a bachelor’s degree in science combined with Certified Professional–Food Safety (CP- FS) credential provides foundational preparation for suc- cessfully executing food safety duties. A strong science background offers a solid foundation on which to build specialized EPH expertise and technical competencies.
The Registered Environmental Health Specialist/Regis- tered Sanitarian (REHS/RS) credential was also recog- nized as a valuable credential across all program areas. Our research found that jurisdictions could face challenges in workforce recruitment due to limited candidate pools, particularly in areas experiencing outmigration of col- lege-educated individuals to other states. One suggested approach to address these challenges is for jurisdictions to make EPH positions competitive through appropriate compensation and professional development opportu- nities rather than reduce educational standards for sci- ence-based programs. While the consultative approach emphasizes education and customer service, a scientific foundation remains crucial for program staffing. EPH professionals need to understand and translate the public health significance underlying reg - ulations. Although strong customer service skills enhance communication, they cannot replace scientific knowledge.
Equipment Needs
Common equipment suggested for this program includes transportation or personal vehicle mileage reimburse- ment, thermometers, pH meter, test strips, hairnets, lab coats (for manufacturing facilitates), sampling kits, tem- perature discs, humidity meters, phones with cameras, computers or tablets, Food Code book, access to transla- tion services, and inspection sheets or forms. Participants indicated that they expect the operators to have much of this equipment and will ask that they demonstrate their use. Some departments have portable printers to print the inspection report or educational materials while on the premises during an inspection. Funding Sources/Barriers Food safety programs are typically funded through per- mitting and inspection fees or general fund appropriations. Some jurisdictions also generate revenue through food
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
handler permits for individual workers, which require reg- ular renewal. Fee-funded programs that achieve self-suf- ficiency can provide more reliable revenue streams and can offer protection from staffing and service reductions during budget constraints. Approaches to fees vary across jurisdictions. Some are set through state statutes with local regulatory imple- mentation, some use commissioning boards with estab- lished processes for fee determination, others implement sliding scales based on establishment gross receipts, and some conduct periodic fee assessments tied to population growth and program costs. Gradual fee increases tend to be more acceptable to the reg- ulated community than substantial periodic adjustments.
For example, annual modest increases could generate less resistance than larger increases every 3–5 years. Similarly, incremental staffing increases of 0.5 FTE can be more man - ageable for both budgeting and workforce development. External factors can influence fee structures and program operations. Competition with neighboring jurisdictions might constrain fee-setting flexibility, with some fees remaining static for extended periods. Lack of reciprocity agreements or memoranda of understanding between adjacent health agencies can create additional burdens for mobile food vendors, who need to obtain separate permits and inspections for each jurisdiction where they operate. These factors can result in fee structures driven by exter- nal competitive pressures rather than internal program needs and community requirements.
Swimming Pools and Recreational Water Safety
Program Overview and Core Services/Activities
PROGRAM
RECOMMENDED WORKLOAD
EDUCATION AND CREDENTIALS
EQUIPMENT
KEY METRICS
Swimming Pools and Recreational Water
3–4 inspections per field day
• Bachelor’s in science • Certified Pool Operator • REHS/RS credential
• Pool chemistry test kits
• Number of inspections completed • Number of
• Tape measures • Optical scanners • Laboratory access • Cameras • Mobile technology and inspection forms
critical violations • Closure frequency
Definition An EPH swimming pools and recreational water safety program conducts health, safety, and structural assess- ments of recreational water venues such as public swimming pools and beaches to identify and mitigate imminent health and safety threats. Program activities include evaluating pool areas and surrounding infrastruc- ture such as decks, handrails, ladders, and fencing for compliance with safety standards. These programs also respond to sewage or toxic chemical spills affecting rec- reational water sources and conduct water quality test- ing to monitor bacterial contamination levels and ensure safe recreational water conditions for public use.
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Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Characteristics of a Successful Swimming Pools and Recreational Water Safety Program A swimming pools and recreational water program gener- ally conducts damage and health and safety assessments of public swimming pools, spas, hot tubs, splash pads, lazy rivers, and other recreational water venues, as well as public beaches that can pose imminent health and safety threats. This oversight generally includes the areas sur- rounding pools and water sources such as decks, handrails, ladders, and fencing. These programs can also respond to program-specific sewage or toxic chemical spills and con - duct water quality testing of recreational water sources to determine levels of bacterial contamination.
aim for specific reduction targets, such as a 2% decrease for violations of disinfectant levels and a 10% decrease for other violations. Given the typically smaller number of pools compared to restaurants, tracking violation trends is a relatively accessible activity to monitor program prog- ress, and many programs are already implementing this approach. Violations severe enough to warrant facility clo- sure are also important to track as they could represent key indicators of program performance
Staffing
Meaningful Outcome Measures
PURPOSE
METRIC
Program effectiveness
• Percentage of required pool inspections completed during
peak operating season (May–August) annually
Workload management
• Average number of pool/recreational water inspections completed per inspector during peak season (May–August) annually * • Percentage of inspections completed at target rate • Number of critical violations identified per 100 pool inspections annually * • Number of disinfectant violations per 50 facilities per year • Number of in-compliance facilities per number of facilities per year • Number of facility closures per year
Staffing needs for swimming pools and recreational water safety programs are predominantly seasonal, with peak demand occurring in spring as facilities prepare for the swimming season. Even programs with dedicated year- round FTE positions require additional staffing during facility opening periods to accommodate the inspection workload, particularly for outdoor facilities. During colder months, workload generally decreases and focuses pri- marily on indoor facilities that maintain year-round oper- ations. This seasonal variation creates unique staffing challenges that differ from other EPH programs with more consistent year-round demands. For programs that reported needing additional FTEs beyond their current capacity, the suggested number of recreational water facilities/swimming pools, if the budget is not a con- straint, would be an average of 180 inspections annually per 1 FTE (range 60–417). This wide range reflects varia - tions in facility complexity, inspection requirements, and local program scope across different jurisdictions. Programs could consider flexible staffing models that can accommodate seasonal peaks through temporary staff, overtime provisions, or cross-training with other EPH programs to ensure adequate coverage during cru- cial opening periods while maintaining cost-effectiveness during lower-demand months.
Public health protection
* EPH professionals who participated in focus groups, key informant interviews, and/or the national field survey consistently identified this metric as moderately to extremely useful. Though not specifically discussed in the survey, the Model Aquatic Health Code (MAHC) was established by the Cen- ters for Disease Control and Prevention (CDC) in 2014 and guides jurisdictions to help develop and update their pool codes based on current science and best practices. Based on this code or others like it , programs might find value in tracking the rate of in-compliance pools as a measure of success. Research has shown that some agencies
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