ADVANCEMENT OF THE PRACTICE
Environmental Health Department Structure: Literature Review and Recommendations
Gina Bare, RN Alyssa Wooden, MHS Jesse Bliss, MPH, PhD David Dyjack, DrPH, CIH National Environmental Health Association
Profile of Local Environmental Health Departments
/@A?.0A Local governmental environmental health programs play a critical role in safeguarding public health. Environmental health professionals administer a wide range of professional services, including food safety, septic systems, childhood lead poisoning prevention programs, air quality, water quality, healthy housing, and vector control. Despite the centrality of the environmental health workforce to modern life, a national standard or guidance does not exist for how local environmental health departments should be structured, staed, and funded. This article aims to provide foundational information to support an eort to describe the characteristics of a minimum viable governmental environmental health department and provide recommendations on optimal structure, stang, and funding.
Structure and Services Vary by Jurisdiction
Environmental health services are provided by several distinct government agencies and private organizations working together. In 2019, 84% of LHDs had an environmental health program and 74% of LHDs employed environmental health workers (NACCHO, 2020). While the majority of environmen- tal health programs provide a similar set of core services—including indoor air quality, environmental monitoring and epidemiol- ogy, risk assessment, water quality, and food protection—some environmental health services are more commonly provided than others. Urbanicity is a major factor in deter- mining which services are provided, as most services are more likely to be provided by urban LHDs than those in rural areas (NAC- CHO, 2020). Staffing Challenges Persist Many LHDs are significantly understaed (de Beaumont Foundation & Public Health National Center for Innovations, 2021). There is no clear association, however, between stang levels and LHD perfor- mance, and stang needs dier between LHDs depending on such factors as services provided, number of regulated facilities, pop- ulation density, and population risk status (NACCHO, 2011). The Voluntary National Retail Food Regulatory Program Standards from the Food and Drug Administration (2022) specifies the funding, staing, and equipment required for a food inspection and surveillance program. The standards call for LHDs to employ one full-time equiva-
Introduction Environmental health professionals are employed at local health departments (LHDs) or independent agencies through- out the U.S. They are responsible for ensur- ing food safety, air and water quality, and the safety of the homes and neighborhoods in which we live. Studies have shown sig- nificant associations between increased LHD activities and expenditures and decreased rates of environmental health-related dis- eases (Bekemeier et al., 2015; Fan et al., 2021). Despite the essential contributions of the environmental health workforce, there is an absence of national guidance for jurisdic- tions on the specific environmental health services that should be provided or the level of stang or funding needed to fulfil these services. The lack of a national model makes it dicult for public health ocials to jus- tify requests for additional staing, fund- ing, equipment, and other resources—leav-
ing the nation’s health, safety, and financial security at risk. Background The environmental health profession com- prises the second largest portion of the pub- lic health workforce after nursing (National Association of County and City Health Ocials [NACCHO], 2020). In most cases, governmental environmental health ser- vices reflect local and state statutes, laws, and regulations. Funding for these services is largely local, generally derived from fee- for-service arrangements and supplemented by general funds and appropriations. The absence of a standardized nationwide fund- ing scheme creates ambiguity among elected ocials and decision makers when con- structing an environmental health services program that reliably protects and promotes the health, safety, and economic prosperity of their communities.
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