# *Retention of Navy Environmental Health Officers (EHOs) in the U.S Navy*

# 2005 - 2006

# Environmental Public Health Leadership Institute Fellow:

# Rohini Suraj, REHS/RS, MSEH 

##### Force Health Protection /Environmental Health Officer

######### U.S. Marine Corps Forces Command

*1468 Ingram Street*

*Norfolk VA 23511*

*757-819-4315 or 757-836-1687*

# Mentor(s):

### **CAPT Michael Herring, MPH, REHS**

*Mentor*

*Center for Disease Control and Prevention*

*CAPT Mike E. Herring, REHS, MPH*

## Atlanta, Georgia

Telephone: 770-488-7351

Email: <MHerring@cdc.gov>

# Acknowledgement:

### **CAPT Mike Henderson; MSC, USN**

*Environmental Health Specialty Leader*

*Navy Environmental Health Center*

*620 John Paul Jones Cir Ste 1100*

*Portsmouth VA 23708-2103*

Telephone: (757) 953-0698

E-Mail: <hendersonm@nehc.med.navy.mil>

#  

# EXECUTIVE SUMMARY:

The current turnover rate among junior Environmental Health Officers
(EHOs) in the U.S. Navy is 67%^1^. This number includes retirement
losses, which is an accepted loss. During the last year, the EHO
community had the second highest overall loss rate among Health Science
Officers in the Navy's Medical Service Corps (MSC)^2^. Coincidentally,
the EHO community also had the highest deployment rate (46%) within the
MSC communities^3^.

The objective of this project is to promote retention of EHOs in the
U.S. Navy, focusing specifically on junior EHOs who are completing their
first tour of duty - through the creation of an EHO Service Members and
Family Mentorship Program, a Military Life Awareness Campaign for EHOs
and their families, and a comprehensive out-briefing program with the
EHO Specialty Leader. The goal is to reduce the loss rate among this
highly trained Public Health workforce to less than 5 % per year.

# 

# INTRODUCTION/BACKGROUND:

The objective of this project is the retention of Environmental Health
Officers (EHO) in the U.S. Navy, specifically junior EHOs who are
completing their 1^st^ tour. The EHO community is among the top Navy MSC
community with the highest loss/turnover rate. The goal of this project
is to reduce the turnover/loss rate among Junior EHOs to about 5% per
year.

During the late 1980's and early 1990's, the Navy's Environmental Public
Health workforce - the EHOs, were not being selected for promotion. Due
to the rules and regulations for military promotions, each officer has
two chances promotion grade. If they are not selected, they have to
leave the service within six months. Very few of the EHOs who were not
selected for promotion, remained in the public health field; many others
chose different career paths.

In 1993, the EHOs onboard decided that they could no longer face the
promotion losses and had to take action. As a result the Navy
Environmental Health Board (NEHB) was formed. The NEHB's role was to
represent the EHO community and help plan/guide their careers paths so
that the community will not suffer much more promotion losses. The
requirement for EHOs during that time frame was a basic Bachelor's
degree in any field of study. When the promotion losses continued,
however, the NEHB decided that the basic criteria for new EHOs would be
increased to an MS or an MPH degree in Environmental Health. This change
has had a positive impact on the promotion of EHOs, and this trend has
continued in the ensuing years. It also kept the more experienced EHOs
in the Environmental Public Health field. The change in requirement has
also made EHOs who are promotion eligible, much more competitive because
they have a

Master degree and many years of experience in their field of work. The
Navy, however, is having a difficult time in retaining EHOs, especially
the younger and more highly educated ones, especially in light of the
ever-increasing operational tempo. The junior EHOs who are approaching
the end of their 1^st^ tour and commitment to the Navy, are faced with a
difficult decision --whether to remain on active duty or leave the
service. The ones with families are often helped with this decision when
faced with family pressure to leave the service. Even though many of
these EHOs are claiming a high level of job satisfaction, they however,
continue to leave. Thus, it not job dissatisfaction that causing them to
leave. Once they depart, whether or not they remain in the Environmental
Public Health field, its doubtful that they will remain in the
Environmental Public Health field.

# Problem Statement: 

Why has the Navy not been able to retain EHOs after their 1^st^ tour,
especially when these EHOs claim a high level of job satisfaction?

*Behavior Over Time Graph*

![](media/image1.wmf)

####### **Figure 1: *Behavior Over Time Graph***

####### **Mentors**: No mandated programs, even though junior EHOs have asked for mentors.

**Causal Loop Diagrams and applicable archetypes:**

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####### **Figure 2: *Causal Loop Diagrams and applicable archetypes*** 

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**Shifting the Burden**

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####### **Figure 3: *Shifting the Burden***

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####### ***10 Essential Environmental Health Services:***

The 1988 IOM report, *The Future of Public Health*, proclaimed public
health to be in disarray and prompted national discussion about the
status of public health, including the public health workforce^4^. The
report stated that public health encompasses three core functions:
*assessment* of information on the health of the community,
comprehensive public health *policy development*, and *assurance* that
public health services are provided to the community^5^. These functions
have been defined further and expanded into 10 essential public health
services^6^. See Figs 4 & 5.

![](media/image2.png){width="3.75in" height="3.8125in"}

**Figure 4: *Ten Essential Environmental Public Health Services and
Three Functional Areas.***

Source: Public Health Functions Steering Committee, Members Fall 1994
(July 1995).

Navy EHOs' position is similar to that of a Director for a local Public
Health Department. EHOs are often stationed at a naval hospital or with
the Marines. They manage all Environmental Public Health programs for
the base or unit they operate from, providing public health support to
the entire military population that falls under that base or unit,
respectively. This population can vary from several hundred to tens of
thousands of personnel and their family members. EHOs also deployed with
forces to support both war and peacetime operations e.g. Humanitarian
missions. Whether at their home base or when deployed, EHOs are the
vital link in the Navy and Marine Corps' Environmental Public Health
Programs.

EHOs are required to function in all three areas identified in the IOM
report, Assessment, Policy Development, and Assurance. EHOs also use the
Ten Essential Environmental Health services routinely to provide health
protection to the forces. These services are critical in preventing
disease among the military population. Without adequately trained and
sufficient number of EHOs onboard, all three of the IOM's report
functions areas and the ten essential services will suffer and so too
will the military population who are especially vulnerable to
Environmental Public Health risks, when deployed in endemic and disaster
affected areas.

![](media/image3.jpeg){width="4.125in" height="4.260416666666667in"}

Figure 5: *Ten Essential Environmental Public Health Services*

***National Goals Supported***

The IOM's report called for (1) development of a workforce ready to
address emerging public health problems, both in terms of practice and
leadership; (2) professional development for those already operating the
system; and (3) expansion of the pool of personnel prepared to perform
the essential public health services ^4^. The CDC streamlines these
initiatives into four Health Protection Goals^7^, while *Healthy People
2010^5^* expand upon the IOM report into four primary areas and 30
objectives. The National Strategy to Revitalize Environmental Public
Health Services has six goals, each with several objectives.

This project support the IOM report, CDC's *Health Protection,* *Healthy
People 2010* goals, and the National Strategy to Revitalize
Environmental Public Health, in the following manner:

1.  **Development of a Workforce**: Create a stable force of EHOs
    onboard, who are highly trained and ready to address current and
    emerging public health issues around the world.

2.  **Professional development**: Create programs for EHOs and their
    family members to address profession growth and adjustment to
    military life, respectively. Training EHOs families so that they
    will understand more about military life and the support services
    available, in addition to the functions preformed by their loved
    ones. The goal is to seek the support of the families so that EHOs
    will remain in their careers.

3.  **Expansion of the pool of personnel prepared to perform the
    essential public health services**: Since the change in the training
    basic requirements for EHOs i.e. graduate degree requirement, the
    Navy has looked towards its medical recruiters to find potential
    EHOs at graduate Schools of Public Health. This, however, has not
    proven to be an easy task. Since 1998, the requirements for EHOs are
    very stringent and extremely specific as to the type of courses and
    accreditation of the school, which limits the number of qualified
    candidates. The Navy requires EHOs to have courses in Epidemiology,
    Biostatistics, Food & Water Sanitation, and Risk Assessment and Risk
    Communication, and this not does always fit into the Schools of
    Public Health curricula plan. This has led the Navy to work with
    several schools of Public Health to improve their curricula to meet
    its needs. Even if the Public Health students at these schools do
    not join the Navy, they will be better equipped to perform the ten
    essential services in a global environment. This is in direct
    support of the IOM recommendation, CDC *Health Protection*, *Healthy
    People 2010* goals, and the National Strategy to Revitalize
    Environmental Public Health Services

Directly as a result of this project, the NEHB members formed a subgroup
in 2005, and decided on the Navy's EHO Core Competencies. These
competencies were based directly on the CDC's *Environmental Health
Competency Project: Recommendation for Core Competencies for Local
Environmental Health Practitioners*^8^. Prior to the release of the EHO
Core Competencies, there were no guidelines for the community to base
their training and skills. Now EHOs can target their training and
professional development at the core competencies that they are lacking
or need to improve.

***Project Logic Model:***

See attached file.

![](media/image4.wmf)

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####### **PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:**

####### ***Program Goal:***

The following goals are proposed for the EHO Community:

1.  Develop Service Member & Family Mentorship Program for current EHOs
    and their families who are struggling with military life and may be
    on the threshold of considering leaving the Navy.

2.  Create an awareness campaign implemented for families of EHOs
    joining the Navy. This will focus on life in the military and
    provide list of resources that are available to military families to
    help ease the hardships of military life.

3.  Create avenues for professional development for the EHOs, so that
    they can perform the ten essential environmental public health
    services in addition to obtaining their Core Competencies and
    professional skills.

4.  All current junior EHOs (with families) considering leaving the Navy
    shall have opportunities to include their families in the out
    briefing process and provide feedback how their experience with the
    service could have been better and what would cause them to remain
    in the service.

####### 

####### ***Health Problem:*** Without an adequate number of EHOs onboard in the Navy, Force Health Protection and Public Health will suffer. 

####### ***Outcome Objective:*** Retain EHOs onboard to meet the Navy's Environmental Public Health needs.

####### ***Determinant:*** No greater than 5% of junior EHOs leaving the Navy at the completion of their 1^st^ tour. 

####### ***Impact Objective:*** Limit the loss of junior EHOs to 5% per year.

***Risks:*** When EHOs leave the Navy and there are no replacements,
environmental public health programs suffer. This leads to increased
public health risks for both military and civilian populations.

####### ***Contributing Factors:*** Even though the Navy is working hard at retaining its Environmental Public Health force and has worked directly with several graduate Schools of Public Health to refine their curricula to meet the Navy's needs, it is having a difficult time keeping the billets filled, due to lack of qualified candidates. The Specialty Leader is currently considering returning to an undergraduate degree in Environmental Health as the basic requirement. Lowering the degree requirement, while a quick fix to will bring more replacements onboard, does not stop the loss. The primary reason for loss among junior EHOs is from family pressures, since frequent deployments are especially stressful on their families. Some of this stress stems from the following: 

1.  Lack of awareness by the members of the EHO families, on the impacts
    of military life.

2.  Frequent deployments cause extreme emotional and financial hardship
    on families.

3.  Reintegration of military member back into their family requires
    patience and often results in increased stress.

Another factor is the economy. Junior EHOs are being offered more
incentives by private companies, without the need to leave their
families for prolong deployments. The military often become a training
platform and recruitment pool for these companies. This is an inverse
relationship, since if the economy is doing better, the military has a
difficult time recruiting people, especially highly trained ones. When
the economy is not doing well, however, recruiting becomes somewhat
easier.

***Training**:* The need for formal training has decreased since 1998,
when the basic entry requirement for EHOs was upgraded to a Master
degree in Environmental Health. Previous to 1998, the Navy offered a two
year out-service Master degree program as a training incentive to keep
experienced EHOs onboard. This was a great incentive, since the Navy
paid for tuition at a school of the EHO choice and books, in addition to
paying EHOs their regular salary and housing allowance. This allowed
EHOs without Master's degree, to attend graduate school fulltime. Since
1998, however, the number of EHOs without a graduate degree has been
decreasing and the pool of candidates for this incentive is getting
smaller each year. The only incentive that remains for some EHOs, is a
PhD in Public Health. This, however, is a limiting factor since there
are only two of the 87 EHO positions required a PhD degree and only one
training slot per year, that's available annually to the community. The
Navy is also recommending that all EHOs obtain the Registered
Environmental Health Specialist certification from the National
Environmental Health Association. There are ample opportunities
available for EHOs to attend annual conferences and courses offering
continuing education credits towards maintaining their certifications
and professional development.

***Family Issues:*** Most EHOs are married. In the past there were more
male EHOs, however, the number of female EHOs are increasing. This is
affecting the retention of EHOs, since husbands appear to have a more
difficult time leaving their jobs and moving to a different location, to
support their wives' career. Additionally, as female EHOs begin to have
children, they feel more compelled than their male counterparts, to get
out of active military service, even though they claim a level of job
satisfaction.

####### ***Process Objectives***

1.  Meet with the NEHB in March 06, to gain support for project and
    implementation.

2.  Once project goals are accepted, proceed to implementation of
    objectives before the close of this fiscal year (Sept 06).

# METHODOLOGY:

####### ***Events and Activities***

The next meeting of the Navy Environmental Health Board (NEHB) is
schedule for 16-17 Mar 2006. During this meeting, the proposed program
goals & process objectives would be presented for acceptance and
implementation by the close of FY06 (Sept 06). Since the start of this
project, two meetings of the NEHB were cancelled. The board only meets
twice each year and with both meeting being cancelled in 2005, there was
no opportunity to get its approval for the proposed programs. The Mar
2006 meeting will be the first opportunity to present the project to the
board.

The following objectives will be presented for implementation before the
close of this fiscal year (FY06).

1.  Develop Service Member & Family Mentorship Program

2.  Create an awareness campaign implemented for families of EHOs.

3.  Create avenues for professional development for the EHOs, so that
    they can perform the ten essential environmental public health
    services in addition to obtaining their Core Competencies and other
    professional skills need to do their jobs.

4.  Create an out-brief/feedback program with the EHO Specialty Leader,
    for all junior EHOs considering leaving the Navy.

# NEXT STEP:

This project is not yet completed. It's a work in progress mainly due to
the challenges of getting stakeholders to the table, during the high
operations tempo of military deployments and fulfilling the current
mission. This has led to several cancellations of the NEHB, which was
set up to monitor the progress/career of the EHO community and to ensure
that EHOs are as successful as other Health Science Officers in the U.S.
Navy's Medical Service Corps. However, due to current tempo of military
activities/missions and with many of the members of the board deployed,
added to a lack of travel funds to get the remaining members together
for two to three days, the meeting has been postponed to March 2006. At
that time the project will be presented to the board and approval will
be sought for immediate implementation of the proposals.

# 

# EXPECTED OUTCOMES:

At the NEHB meeting, there will be the expected pushback from senior
EHOs, who have already decided on a quick fix - lowering the entry
requirement back to an undergraduate degree in Environmental Health.
These EHOs were the same ones, who opposed the change back in 1998, but
stronger heads prevailed and the change was approved. These senior EHOs
have benefited from the push for a Master's degree, since they were all
promoted upon obtaining their Master's degree, however, they have retain
their belief that it was a bad move for the community. The supporters of
the change back in 1998, have since retired. This will not be an easy
task, since the senior EHOs dominate the NEHB, but they are the
minority. Thus, it will be up to the Junior and mid-level EHOs to buy in
and convince the senior level EHOs that the community will benefit from
this project.

There is a better chance that some of the recommended proposals will be
accepted in a modified format. The senior EHOs know they should have a
mentor program, since they were told by the Navy's Medical Service Corps
to have such a program. This, however, has not been done. This project
proposes a mentorship program for both active duty members and their
families members and will fill the mentorship void. The expectation is
that this portion of the project will be accepted, but the focus will be
on the active duty member, not their family members. However, once the
mentorship program is approved, individual mentors can reach out to the
families and help them. Once this is successful, there will be more
buy-in from the senior EHOs. This will take several years and will help
the new EHOs now coming onboard. The program can be very successful or
hugely unsuccessful based on the level of effort by individual mentors.
This project will be a working project for a long time with some
successes and setbacks along the way, but the hope is that it will help
retain EHOs onboard.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Rohini Suraj's*** 

####### *Personal & Leadership Development:* I was excited upon my selection to be part of the first class of the Environmental Public Health Leadership Institute. I did not know what to expect or what the outcome would be, but I had high hopes that the program would be enlightening and useful in my environmental public heath career. The entire program surpassed my expectations and my leadership skills are much more honed and improved because of the knowledge I gained. Working on my project, helped me focus on improving my community to keep highly trained people in the field of environmental public health. I found out that these goals were in line with the National, CDC and IOM goals. This validates my thoughts about my community and proved to me that I have developed as a leader to be able to see the big picture. 

Networking with state and local health officials from various health
departments throughout the U.S. improved my outreach and give me instant
recognition among this group of professionals. This will help when I
need to contact them in the future or in worse case scenario, if there
is a national disaster, we will all need the instant rapport to get
things done.

I was surprised by the depth of the curriculum, and the length that the
University of St Louis went to make this program interesting and
successful. Even though I did not attend the last two sessions due to
unfortunate events, I and all the others students in the course looked
forward to each session. The skills I received from the program,
including the self study sessions, and self analysis are helping me
become a better person and in turn a much more effective leader. These
are skills that will stay with me for my lifetime. Thanks you EPHLI,
CDC, the Mentors, and University of St Louis for pulling it all
together. Also a Navy's Bravo Zulu to Nicole Kozma for making it all
happen!

# 

# 

# ABOUT THE EPHLI FELLOW(s)

Biographical sketch for the LCDR Rohini Suraj, MSC, USN.

LCDR Rohini Suraj, MSC, USN, has a M.S. in Environmental Health (Jan
1994), Hunter College, City University of New York (CUNY), a Bachelor
degree in Biology, *with* Honors, *cum laude* (Jan 1990), Baruch
College, CUNY, a Diploma in National Security Strategy, Naval War
College (Jun 2003), and a Certificate in Financial Planning Old Dominion
University (Jun 2005). She also holds the REHS/RS certification from the
National Environmental Health Association.

She has work in the Environmental Public Health field for 16 years. The
first five of which was spent working in the Environmental Health
Division of New York City Dept of Health. During the last 11 years, LCDR
Suraj has worked as an Environmental Health Officer in the U.S. Navy,
protecting the health and welfare of Navy and Marine Corps forces.
During her career she has traveled extensively, and seen and dealt with
a variety of environmental public health issues, some of which not
normally seen in the U.S.

LCDR Suraj has received several civilian and military awards. Among them
are:

## The Hunter College Alumni Achievement Award for her contribution to Public Health. The award was presented to her at the Hunter College Urban Public Health Program\'s 30th Anniversary celebration on May 31, 2001, in New York City, NY. 

## Dean's List, Baruch College (CUNY), 1987-89

## Member of the Golden Key National Honors Society

## Navy Commendation Medal (3 awards)

## Meritorious Unit Commendation Medal (2 awards)

## National Defense Medal (2 awards)

## Global War on Terrorism

## Armed Forces Service Medal

## Navy Overseas Service Ribbon (3 awards)

## NATO Medal

##  Navy Expert Pistol Medal

##  

She has several publications:

## *Roisin M. Rooney, MSc* / *Jamie K. Bartram, PhD* / *Elaine H. Cramer, MD, MPH* / *Stacey Mantha, MSc* / *Gordon Nichols, PhD* / *Rohini Suraj, MPH* / *Ewen C.D. Todd, PhD*, **A Review of Outbreaks of Waterborne Diseases Associated with Ships -- Evidence for Risk Management**, Public Health Reports. Jul -- Aug 2004; Vol 199.

## Suraj & Robinson, **Foodborne and Waterborne Illness Trends**, Naval Medical Surveillance Report. Apr-Jun 2000.

## Robinson & Suraj, **Foodborne and Waterborne Illness Trends**, Naval Medical Surveillance Report. Jan-Mar 2000.

## Suraj, **Preventive Medicine Aspects of Moldova MEDCEUR**, Fleet Public Health Bulletins. Jan 1998 

And belong to the following organizations:

**PROFESSIONAL AFFILIATIONS**

## **Member of**: 

## 

## National Environmental Health Association (NEHA)-- Registered Environmental

## Health Specialist/ Registered Sanitarian

## Tidewater Environmental Health Association 

## Association of Medical Service Corps Officers of Tidewater 

#  

# REFERENCES

1\. Henderson, CAPT Mike, MSC, USN, Navy Environmental Health Specialty
Focus Review to Commander, Medical Service Corps, U.S. Navy, 3 Aug 2005.

1.  
2.  

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2.  U.S. Navy Bureau of Medicine and Surgery Information System (BUMIS).
    Report for the Environmental Health Community Specialty Leader,
    2005.

3.  Henderson, CAPT Mike, MSC, USN. E-Mail Communication on Loss Data,
    02 Feb 2005.

4.  Committee for the Study of the Future of Public Health, Division of
    Health Care Services, Institute of Medicine. *The Future of Public
    Health*. Washington, DC: National Academy Press; 1988.

5.  US Department of Health and Human Services. *Healthy People 2010:
    Understanding and Improving Health and Objectives for Improving
    Health*. 2nd ed. Vol 1. Washington, DC: US Government Printing
    Office; November 2000.

6.  Public Health Functions Steering Committee, Members, Fall 1994 (July
    1995).

7.  Center for Disease Prevention and Control. Health Protection Goals.
    Atlanta GA: Department of Health and Human Services (US) CDC;
    Oct 2005. <http://www.cdc.gov/about/goals/default.htm>

8.  CDC. Environmental Health Competency Project: Recommendation for
    Core Competencies for Local Environmental Health Practitioners.
    Atlanta GA: Department of Health and Human Services (US) CDC; 2001