Readying the Applied Epidemiology Workforce for the Future of Public Health Practice
Public health leaders in all settings must be intentional in implementing strategies that strengthen our epidemiology workforce and prepare epidemiologists for the future of public health practice.
As public health professionals, we are currently working in an incredibly dynamic era of public health practice. Not only was the field moving forward into “Public Health 3.0,” which calls for us to work more collaboratively across sectors to address upstream determinants of health, but we have now been confronted with a massive global pandemic that is serving as a significant driver of change. Never has it been more crucial for public health leaders to implement strategies to develop a strong epidemiology workforce that is adaptable to future public health practice. As a subgroup of the larger public health workforce, epidemiologists are key professionals that fulfill core public health science functions. Given the increasing availability of data and the growing recognition that data should drive public health decision making, continued assessment and implementation of workforce development strategies aimed at epidemiologists is essential.
I was a practicing epidemiologist at a state health department when it came time to select a dissertation research topic during my doctoral studies in 2019. I partnered with the national professional association for applied epidemiologists, the Council of State and Territorial Epidemiologists (CSTE), to explore readiness of state health department epidemiologists to work in emerging areas of public health practice. We analyzed data from the Public Health Workforce Interests and Needs Survey (PH WINS), surveyed the designated state epidemiologist in all 50 states and the District of Columbia, and conducted focus groups with epidemiologists working in state health departments to craft recommendations aimed at improving applied epidemiologist readiness to work in emerging areas of practice.
What We Learned
Epidemiologists identified having organizational support, access to training, learning from others, availability of best practices, dedicated time, and supplemental epidemiology program staffing as key facilitators to improving their ability to work in emerging areas of practice. Correspondingly, epidemiologists identified lack of staffing, time, training, knowledge, organizational support, organizational strategy, and siloed programs as key barriers. Epidemiologists reported not being involved at all in some key areas of practice, such as policy development.
What We Can Do to Improve Future Readiness
There are actions that public health leaders in health departments can take now to improve epidemiology skill sets for the future. This includes providing epidemiologists with dedicated time to work in emerging areas of practice, including time to attend trainings, cross-train within the organization, and to participate in communities of practice, such as those hosted by CSTE. While epidemiologists need to develop and maintain technical skills, public health leaders should also provide opportunities for epidemiologists to develop cross-cutting strategic skills, which support a more nimble and prepared workforce for the future. Finally, public health leaders should promote awareness of the skills epidemiologists offer within their organization to increase their engagement in public health initiatives. Epidemiologists should be engaged early in the planning process so that their expertise in data collection and analysis can be leveraged to improve the value of data collected and the use of that data for public health action.
The pandemic response has reinforced the needs and exacerbated the challenges identified through our research. In particular, the pandemic has made visible the effects of underfunding public health services. It is very difficult for health department leaders to support enhanced training and capacity building initiatives within their organizations when they do not have enough staffing to carry out daily essential functions. The most recent Epidemiology Capacity Assessment (ECA) conducted by CSTE in 2021 found that major gaps exist in the applied epidemiology workforce despite recent growth due to pandemic response surge staffing. Health departments need increased, sustainable, and flexible funding to support epidemiology practice. Categorical or restricted funding reinforces programmatic siloes, making it more challenging to promote cross-training and to adapt activities and job skills to emerging areas. A new federal funding opportunity (CDC OE22-2203) has recently been made available to health departments to support workforce infrastructure needs broadly and we are hopeful this type of flexible funding will be sustained long after the pandemic, as the public health workforce had significant needs long before.
The pandemic also reinforced the need for a robust and flexible epidemiology workforce with both specialized and strategic skill sets. Typically accustomed to working behind the scenes, the pandemic shined a spotlight on the work of epidemiologists — “epidemiology” even became a household term and an increasing number of people decided to pursue epidemiology as a future career. According to the Association of Schools & Programs of Public Health (ASPPH), public health graduate programs saw a 40% increase in applicants in the first year after the start of the pandemic, with epidemiology being the top area of study. At the same time there is renewed interest in entering the public health workforce, according to recent survey data, the existing workforce is experiencing significant stress, fatigue, and serious mental health impacts exacerbated by the extended pandemic response. We must act now during this remarkable time period for our profession to strengthen epidemiology workforce capacity for the future. Our research resulted in recommendations across the workforce development continuum, from updating the Applied Epidemiology Competencies (currently underway), to enhancing health department relationships with academic institutions (ie, cultivating the pipeline), investing in training and fellowship programs, increasing on-the-job training, fostering partnerships, and implementing organizational change principles. It will take public health leaders in all settings working together intentionally to strengthen workforce capacity and readiness for the future of public health practice.
Read the Report in the Journal of Public Health Management and Practice:
- A review of the applied epidemiology workforce in the United States: past, present, and future
- Training Needs and Awareness of Emerging Areas of Public Health Practice Among Epidemiologists Working in State Health Agency Central Offices in the United States, 2017
- Use of Job Classifications, Career Ladders, and the Applied Epidemiology Competencies to Support Recruitment, Retention, and Practice of State Health Department Epidemiologists
- Elizabeth R. Daly, DrPH, MPH, is the Director of Infectious Disease Programs at the Council of State and Territorial Epidemiologists. She previously worked as an infectious disease epidemiologist at the State of New Hampshire for nearly 20 years. Dr. Daly conducted research on the readiness of applied epidemiologists to work in emerging areas of public health practice during her doctoral studies at the University of North Carolina at Chapel Hill.
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