NEHA July/August 2023 Journal of Environmental Health

led by state employees, while others are led by local employees (ASTHO, 2014). A survey administered by NEHA found that 12 states and 5 territories operate under a centralized governance structure, 21 states have a decen- tralized structure, and 17 states have a mixed model (Tariq et al., 2019; Figure 1). Funding Limitations LHDs receive funding from federal, state, and local sources, as well as from fines, licensing fees, and inspection fees. The amount of fund- ing from each source as a percentage of total revenue varies depending on the size of popu- lation served and the governance structure of the health department. Most of the surveyed stateandlocalpublichealtho cialshave reported that current funding structures are not su cient to provide foundational public health services (Leider et al., 2015). In gen- eral, environmental health programs receive a greater percentage of revenue from fees and fines and a lower percentage from federal sources than other LHD programs (University of Washington, 2021). Because their funding is so heavily dependent on fees, local environ- mental health programs might neglect specific activities that do not generate fees and are not mandated by the state (Meit et al., 2013).

FIGURE 1

State and Local Health Department Governance Classification Map

CT RI NH MA

MD DE

Legend Centralized Largely Centralized Decentralized Largely Decentralized Mixed Shared Largely Shared

Source: Tariq et al., 2019.

lent (FTE) sta member for every 280–320 retail food inspections performed, which is a helpful measure but does not address the full menu of environmental health services. The U.S. Bureau of Labor Statistics and the National Association of County and City Health O cials (2011) found that jurisdic- tions employ environmental health sta at ratios of 3.65 and 3.91 FTE environmental specialists per 100,000 population, respec- tively. While these numbers should not be considered sta ng benchmarks themselves, they suggest that LHDs with a lower environ- mental health worker-to-population ratio are relatively understaed. Due of the complex- ity of environmental health programs, how- ever, more research and modeling are needed to understand not only current sta ng levels but also optimal sta ng levels. A 2007 survey of city and county envi- ronmental health professionals in California found some of the greatest challenges facing environmental health departments were a lack of qualified candidates and an inability to fill vacant positions. Respondents noted a need for additional employee training, espe- cially in nontechnical areas (Dyjack et al., 2007). A 2022 needs assessment of National Environmental Health Association (NEHA, 2022) members revealed that recruitment

and retention of environmental health profes- sionals remain a professional priority. The COVID-19 pandemic revealed addi- tional environmental health workforce needs. Environmental health professionals have experienced increased responsibilities due to the pandemic. Furthermore, many reported a lack of su cient sta to conduct the work needed, suggesting that there is a significant shortage of environmental health employees and limited capacity to respond to emergency situations at LHDs (NEHA, 2020). Governance Structure Variation The structure of a city or county health department varies widely throughout the U.S. Local health departments and indepen- dent environmental health agencies can be centralized, decentralized, mixed, or shared (Association of State and Territorial Health O cials [ASTHO], 2014; Tariq et al., 2019). In centralized states, the state or territorial health agency retains substantial authority over the activities of LHDs, and LHDs are primarily led by state employees. In com- parison, in decentralized states, LHDs retain most of their authority and are led by local employees. In shared states, LHDs might be led by employees of the state or local govern- ment, and in mixed states, some LHDs are

Workforce Demographics and Characteristics

The environmental health workforce includes environmental health specialists, scientists, technicians, and sanitarians. Other health department employees whose work might con- tribute to environmental health include admin- istrative sta, laboratory workers, epidemiolo- gists, and preparedness sta (ASTHO, 2014). As part of the Understanding the Needs, Challenges, Opportunities, Vision, and Emerg- ing Roles in Environmental Health (UNCOVER EH) initiative, the Centers for Disease Control and Prevention, NEHA, and Baylor University jointly administered a national survey to envi- ronmental health professionals to assess char- acteristics, demographics, practice areas, and professional satisfaction of the environmental health workforce. Key demographic findings are reported in Table 1. These demographics suggest that the environmental health workforce is slightly less racially diverse but has a more balanced male-to-female ratio than the overall U.S. workforce. Additionally, an aging workforce

July/August 2023 • Journal of Environmental Health