Identifying Needs for Advancing the Profession and Workforce in Environmental Health.

An ever-changing landscape for environmental health (EH) requires in-depth assessment and analysis of the current challenges and emerging issues faced by EH professionals. The Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health initiative addressed this need.After receiving responses from more than 1700 practitioners, during an in-person workshop, focus groups identified and described priority problems and supplied context on addressing the significant challenges facing EH professionals with state health agencies and local health departments. The focus groups developed specific problem statements detailing the EH profession and workforce's prevailing challenges and needs according to 6 themes, including effective leadership, workforce development, equipment and technology, information systems and data, garnering support, and partnerships and collaboration.We describe the identified priority problems and needs and provide recommendations for ensuring a strong and robust EH profession and workforce ready to address tomorrow's challenges.

Uncovering Environmental Health: An Initial Assessment of the Profession's Health Department Workforce and Practice.

Environmental health (EH) professionals provide critical services and respond to complex and multifaceted public health threats. The role of these professionals is continually re-emphasized by emergencies requiring rapid and effective responses to address environmental issues and ensure protection of the public's health. Given the prominence of the EH profession within the public health framework, assessing the governmental health department workforce, practice, and current and future challenges is crucial to ensure EH professionals are fully equipped and prepared to protect the nation's health. Such an understanding of the EH profession is lacking; therefore, we initiated Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health (UNCOVER EH). Through a web-based survey, we identified EH professional demographics, characteristics, education, practice areas, and aspects of leadership and satisfaction. We distributed the survey to a convenience sample of EH professionals working in health departments, limiting the generalizability of results to the entire EH workforce. The results were strengthened, however, by purposive sampling strategies to represent varied professional and workforce characteristics in the respondent universe. The UNCOVER EH initiative provides a primary source of data to inform EH workforce development initiatives, improve the practice, and establish uniform benchmarks and professional competencies.

Environmental Health Practice Challenges and Research Needs for U.S. Health Departments.

BACKGROUND: Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations. OBJECTIVES: A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments. METHODS: A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic. DISCUSSION: EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161.

Global Aquatic Hazard Assessment of Ciprofloxacin: Exceedances of Antibiotic Resistance Development and Ecotoxicological Thresholds.

Rapid urbanization represents a global megatrend that is resulting in an increasingly urban water cycle frequently contaminated by human medicines and other chemicals. Concentration of chemical consumption is occurring faster than implementation of environmental health systems and interventions, particularly in megacities of developing countries, while 80% of global sewage production remains untreated. In these urban areas, antibiotics in the environment influence development of antibiotic resistance (ABR) by pathogens. Here, we examined the occurrence of ciprofloxacin, designated a critically important antibiotic by the World Health Organization, in fresh surface water, groundwater, saltwater, treated municipal effluent, raw municipal sewage, treated hospital effluent, and raw hospital sewage around the world. We examined 260 articles reporting ciprofloxacin in these water matrices, including 111 studies from Europe, 105 from Asia, and 32 from North America. Only five and seven studies were identified from South America and Africa, respectively. Probabilistic hazard assessments were then performed to identify probabilities of exceedances of reported ABR and ecotoxicological predicted no effect concentrations (PNEC) for ciprofloxacin in water. Remarkably, across all geographic regions, 58% of municipal effluents exceeded the ABR PNEC (100ng/L) for ciprofloxacin, whereas ecotoxicity PNEC (1200ng/L) was exceeded 16% of the time. In surface water, 25% reported concentrations exceeded the ABR PNEC with 31% and 29% in Europe and North America, respectively, compared to 67% exceedance identified for Africa. Such observations highlight the importance of global scanning assessments to identify matrices and regions, including areas strategically advancing water reuse, for additional study and to prioritize locations for interventions aimed at reducing ABR development.