Epidemiology work force has grown, but not enough, says CDC

Oct 31, 2003 (CIDRAP News) – State health departments have more than doubled their corps of epidemiologists working on infectious diseases and terrorism preparedness in the past 2 years, but the number is still too low, according to the Centers for Disease Control and Prevention (CDC).

Surveys showed that epidemiologists working in those areas increased from 366 in 2001 to 848 this year, a 132% increase, the CDC reports in today's Morbidity and Mortality Weekly Report. The 2003 number includes expected new hires as well as actual additions.

The numbers come from two surveys conducted by the Iowa Department of Public Health and Iowa State University, the first between September 2000 and August 2001 and the second from October 2002 through June 2003.

All but three of the 50 state health departments reported adding or expecting to add infectious disease (ID) epidemiologists in the 2-year interval. Illinois has the largest staff of ID epidemiologists this year, with an expected total of 54, followed by Missouri, with 48, and Virginia, with 45.

Maryland had a 2000% increase in its ID epidemiology staff in the 2-year period, jumping from one person to 21, the biggest relative rise. Both Connecticut and Pennsylvania increased their staffs from 1 to 18 people. The nationwide staff additions were spurred by about $1 billion in new federal funds to improve preparedness for terrorism, disease outbreaks, and other public health threats, the report notes.

Despite these increases, the CDC says, "In 2003, the number of qualified persons employed in microbial threat preparedness remains dangerously low." The agency cites a recent Institute of Medicine report to support that statement.

The surveys also identified several difficulties that persist in spite of the staff increases. Sixty-six percent of health departments had trouble finding time for planning, 55% had problems in establishing disease surveillance systems, and 57% reported difficulty in hiring qualified ID epidemiologists.

Another survey reported in today's MMWR provides additional evidence of a shortage of trained epidemiologists. The survey showed that as of November 2001, 42% of epidemiologists working in state and territorial health departments had no formal training in epidemiology. The survey was conducted by the Council of State and Territorial Epidemiologists (CSTE) shortly before the new federal funds for terrorism and public health emergency preparedness began flowing to the states.

The survey results indicate "a large training gap in the public health workforce," the report states. It says that professionals such as nurses, sanitarians, and health educators accounted for about a third of the epidemiology corps.

Since the time of the survey, some steps have been taken to increase the supply of trained epidemiologists, the article notes. For example, CSTE, in cooperation with the CDC and the Association of Schools of Public Health, recently launched an epidemiology fellowship program. But the current work force needs more opportunities for continuing education, the report adds.

At the time of the survey, 1,366 people worked as epidemiologists in the 41 states and three territories that responded. That probably represented a decrease from the number reported in a CSTE survey of 51 state and territorial epidemiolgists in 1992, the report says. The earlier survey reported 1,608 ID epidemiologists, but the methodology and response rate differed from those in the 2001 survey.

Of the 1,366 epidemiologists reported in the 2001 survey, 652 (47.7%) worked in ID programs. Most of the responding states and territories reported "full/almost full" or "substantial" capacity in ID epidemiology. But fewer than half of the jurisdictions said the same for most other epidemiology program areas, including bioterrorism, environmental health, maternal and child health, injury, occupational health, and oral health. About half of the jurisdictions reported full or substantial capacity in the chronic disease area.

"Epidemiology capacity remains inadequate for performing the 10 essential public health services," the report concludes.

CDC. Terrorism preparedness in state health departments—United States, 2001-2003. MMWR 2003 Oct 31;52(43):1051-3 [Full text]

CDC. Assessment of the epidemiologic capacity in state and territorial health departments—United States, 2001-2003. MMWR 2003 Oct 31;52(43):1049-51 [Full text]

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