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The Essential Functions of Local and State Environmental Public Health: How Do We Sustain and Rebuild Capacity?
Tom Butts, MSc, REHS
L ocal and state environmental health departments are at the front line of detecting and responding to environ- mental health risks. Their responsibilities in- clude surveillance of disease vectors such as mosquitoes and ticks, monitoring water and air quality, regulating waste management, inspecting housing conditions, controlling the spread of zoonotic diseases, and assur- ing food safety. We as environmental health professionals and these departments act as a bridge between scientific research, public policy, and community health. I reflect on the collaboration that existed and benefited communities I worked in when I started as an environmental health spe- cialist after college. There were a couple of resources provided by the state health depart- ment that were invaluable at the time but no longer exist. The first was access to a state analyti- cal chemistry laboratory where, with a phone call, we could drop o a sample of an unknown suspect chemical from an illegal hazardous waste dumping incident. We were met by THE state chemist and in a short time, we would get a call describing the contents of the sample. We could then work with our local fire department, law enforcement, and state hazardous waste agency to find ways to have the responsible parties properly manage that waste or to have the local authority miti- gate the hazard. Over time the free access was changed to a pay-for-your-sample system (the laboratory became cash-funded). Other resources from federal agencies—such as U.S. Environmen- tal Protection Agency on-scene coordinators with the ability to have contractors do the
ing, and Medicine in Washington, DC, it was shared that the U.S. has lost a lot of its capac- ity to track insects (NPR, 2023). According to Erin Staples, a medical epidemiologist with the Centers for Disease Control and Preven- tion, every state in 1927 had an entomolo- gist working to control insect populations and malaria. In 2022, there were just 16 state entomologists, which means that our abil- ity to monitor viruses such as West Nile is sparse. She went on to say, “We’re not getting great information because we haven’t main- tained our infrastructure.” The workshop focused on arboviral threats, which are mosquito-borne and tickborne viruses that can cause harm to humans. Trop- ical diseases that were once considered far away from the U.S. are now creeping into new areas of the U.S. In 2023, the U.S. saw locally transmitted cases of malaria and a skin dis- ease from tropical parasites. A Zika outbreak occurred in Florida and Texas in 2016–2017, and dengue has spread locally in the U.S. every year for more than one decade. The spread of vectors and zoonotic diseases is a growing concern due to climate change and urbanization. Local health departments conduct surveillance for vectorborne diseases such as West Nile virus and Lyme disease, implement control measures such as mosquito abatement, and educate the public about pre- vention. State health departments coordinate these eorts, provide resources, and oer expertise. Limited funding and stang chal- lenges can, however, hinder these activities. A lack of focus (and funding) on preven- tion and preparedness puts communities at risk as new threats emerge. It seems we often are in catch-up mode. I also see the siloing
The capacity and authority of local and state environmental public
health agencies in the U.S. have faced challenges and reductions.
dirty work—became a regularly used resource. This change was probably a net positive in terms of risk mitigation from an incident, but it changed local–state relationships and roles. The other resource that was indispens- able early in my career was access to a state entomologist. This fountain of knowledge was also accessible with a quick phone call and saved countless hours of research when confronted with bug-related challenges large or small. This resource was key as West Nile virus spread across the county in the early 2000s. That capacity gradually slipped away as the entomologist retired and the role became a smaller and smaller part-time responsibility and less accessible. I was not surprised but was disappointed just the same when I listened to an NPR story about the ever-shrinking number of state entomologists and the lack of focus on prevention and pre- paredness (NPR, 2023). During a 2-day workshop held at the National Academies of Sciences, Engineer-
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Volume 86 • Number 8
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