An examination of environmental public health organizational and workforce configurations in the Northeast/Mid-Atlantic United States: how do we determine if these configurations impact performance?

ABSTRACT

OBJECTIVE: Environmental public health (EPH) practice is a vital component of the nation's public health system. Yet, a number of national reports have found that the disjointed structure of the EPH system hinders our ability to protect the public's health. This article examines the EPH organizational and workforce configurations in the US Northeast/Mid-Atlantic region and raises questions as to how to measure whether these varied configurations impact EPH performance. METHODS: A review of national reports and state-specific documents and 39 EPH practitioner interviews. RESULTS: Study findings revealed wide ranging organizational configurations and workforce challenges in the region. Although this study depicts just one region of the country, it provides insight into the complexity and variety of EPH structures and workforce throughout the nation. This diversity presents challenges in our ability to understand, measure, and evaluate EPH performance. CONCLUSIONS: This research has implications for the future of the national EPH system. As we move toward a more "outcomes focused" government, it is essential to the future of EPH to develop better ways to accurately assess, measure, and evaluate EPH performance. These study findings, along with a discussion on how to further advance EPH performance measures, helps facilitate this necessary shift to a more measurable, outcome-based EPH system.