# Saving University Environmental Health Programs

#  Environmental Public Health Leadership Institute Fellow:

# Alice L. Anderson, MS, PhD.

*Assistant Professor, East Carolina University*

310 Belk Building

East Carolina University

Greenville, NC 27858

# Mentor:

# Capt. Mike E. Herring REHS, PMH

*Senior Environmental health officer*

Centers for Disease Control & Prevention

National Center for Environmental Health

Division of emergency and Environmental Health Services

Environmental health Services Branch

# 

### Acknowledgements: 

### Peter David Stroh, 

Bridgeway Partners,

CDC Environmental Health Leadership Institute Staff, Consultants,
Partners

> ![](media/image1.jpeg){width="1.3756944444444446in"
> height="0.6368055555555555in"}

# EXECUTIVE SUMMARY:

In the summer of 2003 I became a fellow in the newly organized
Environmental Health Leadership Institute, and I became an assistant
professor of Environmental Health at East Carolina University. The
program at East Carolina University is one of the longest running
environmental health college programs of the twenty-seven accredited
programs in the nation, and has been guided through many years of change
and hazard by Dr. Trenton Davis. The program's value to the Eastern
North Carolina community that East Carolina University serves is
attested to by the events surrounding its proposed elimination in 2001.
The program curriculum was saved after an enormous outpouring of support
from North Carolina health departments, and a strategic change in its
department home. Stepping into this important position brought me a
tremendous sense of responsibility to maintain the program and to aid in
its progress toward a more sustainable future.

The University's position in maintaining a competent workforce is to
provide graduates who enter the workforce. One of the Ten Essential
Services and part of the Core Competencies of Environmental Health is to
provide and maintain this competent workforce. University training
through accredited programs is the only source of fully trained new
recruits into Environmental Health, and many of the 26 programs have
difficulties in recruiting students. Entering a department with such
important national, state, and local expectations, and with such a
volatile recent history, was a task whose importance was further
revealed through attending the Leadership Institute as well as actually
leading.

New strategies and new understanding of leadership were necessary to
keep the program at East Carolina University sustainable. Faculty
members have retired from the program the year after I joined, and
challenges to the curriculum and faculty have continued to emerge since.
Change and flux have become a constant part of recent organizational
history because of the speed and numbers of events in the region, state,
and world. The sustainable provision of a competent environmental public
health workforce has also required a new leadership approach to
coordinate our program's vision and mission with the changes in the
University.

Systems thinking is a method to understand the changing dynamics of an
organization by bringing out issues and moving the flow of change toward
progress. This approach was applied to the issue of dynamic change in
preparing the new environmental health workforce at East Carolina
University. Beginning with a logic model of program building blocks (the
stakeholders, leadership, staff, and students), the current analysis
identified the areas of potential gaps and process flow interruptions.
From this component identification, process archetypes were identified
and relationships were diagrammed. After gathering data from faculty
focus groups, discussions with other environmental health programs,
students in environmental health programs, and administrators, this
project presents an analysis of current and past strategies to maintain
sustainability in enrollment. Interventions for resolving current
problems areas identified in the systems analysis are:

> 1\. Continuous discussion of a vision of sustainable enrollment and
> service-hearted graduates,

2.  Resolving faculty dislike of and estrangement from recruiting,

3.  Curtailing new course development and offerings to stabilize
    identity,

4.  Surveying barriers to recruitment, and using social marketing
    techniques to overcome the barriers,

5.  Planing more events and presentations regarding environmental health
    careers.

# INTRODUCTION/BACKGROUND:

####### ***Problem Statement: Numbers of Environmental Health professionals have been decreasing, while the need for them has been increasing. Retirement of baby-boom professionals will surge as this group reaches retirement age, beginning in 2005. An increased deficit in workers is predicted for the future. How can East Carolina develop a sustainable enrollment of at least 40 students in the Environmental Health Program?*** 

####### ***Behavior Over Time Graph:*** 

####### Figure 1 depicts the events and trends of the Environmental Health program at East Carolina University. Many Environmental Health programs, including the one at Ferris State University in Michigan (whose program is now being cut), were started in the late 1960's with the initiation of the environmental movement. ECU's program was begun in the early 70's when Dr. Trenton Davis was hired in the Allied Health Department at ECU. Of the 26 programs now in existence, 6 are found in Environmental Health Departments, 2 in biology departments, 2 in Health and Human Performance,(including the department at ECU today) and others in Community Health, Schools of Public Health, Natural Sciences Professional Studies, Clinical Laboratory Sciences, and one other Allied Health. This has a profound effect on the sustainability of the programs, as Ferris State University and East Carolina University saw when Environmental Health programs were targeted for elimination in the Allied Health Departments. 

####### Undergraduate enrollment in the inception of ECU's program remained at 40 and higher for 10 years. Enrollment numbers dropped slightly because of budget cuts in the Reagan era, but rebounded after centralized training for Environmental Health Specialists was initiated. This gave the program's technically trained graduates an advantage in passing state RS exams. In the early 1980's the graduate program was started at ECU. It is now one of only 6 graduate programs offering accredited graduate degrees in Environmental Health. 

####### As Dr. Davis added other duties and interests to his career at ECU, enrollment rose and fell, tracking his involvement in the program. When he was actively involved either as chairperson or director, enrollment rose, and when he was called to other positions, it fell. In the mid 1990's a destructive disagreement occurred with the Allied Health department, and resources were diverted from Environmental Health to other programs. Without any resources, Environmental Health enrollment plummeted. In the early 2000's the program was transferred to the School of Industry and Technology, and Dr. Davis took up other duties with the University. Resources once again plummeted, the program was threatened with a permanent cut, and faculty positions coveted by the School of Industry and Technology were in danger. 

Finally, just prior to his retirement, Dr. Davis returned to the
Environmental Health Department, and with the help of hundreds of past
graduates, health department directors, and friends throughout Eastern
North Carolina, the program was saved. The department with all the
faculty positions intact was moved to the School of Health and Human
Performance, which was then promoted to a College. Resources were
increased again via the hiring of new faculty because of the value this
College and Department saw in the program. Environmental health is now a
program within the Department of Health Education and Promotion.
Enrollment has stayed between 30 and 40, and graduate enrollment has
jumped from 2 to nearly 20 in the last year. Further recruitment and
promotion of the program can be pursued on campus. I recommend the
creation of a logo as part of an advertising campaign to increase the
program's visibility to the student body. Figure 2 illustrates my
suggestion for a departmental logo. An interesting comment about current
enrollment interest is that now, since the surging economy of the 90's
has cooled off, students are beginning to see the value in service and
government jobs again. Quick money in business, computers, and
construction no longer seems to be a sure thing for employment.

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

####### Figure 3 illustrates the causal loops involved in maintaining sustainable enrollment in the Environmental Health Program at East Carolina University. The focusing question is: "How can stable enrollment be maintained, or how can we sustain enrollment to stabilize the program?" To answer this question, the events and processes that affected the program in the past were considered in determining a suitable archetype from the book: [The Fifth Discipline Fieldbook]{.underline}^1^. Observing the relationship between the enrollment levels and the close involvement of Dr. Trenton Davis, and recalling a conversation I had with Dr. Davis just before he retired, it appeared that the faculty members were depending on Dr. Davis to do the recruiting. Because of that, and because of the success of his efforts alone, other faculty did not feel it was necessary for them to participate in recruitment. Recruitment has not traditionally been a faculty task, and because of workload pressures and the expectation (possibly not recognized) that Dr. Davis would take care of it, team recruitment efforts were not made. This fit the example of the archetype "shifting the burden" though it was often an unconscious attitude or "mental model". Another archetype was also identified, that of "quick fixes that backfire". For the last 3-4 years, curriculum additions or deletions have been made annually. When the program was transferred to the Science and Technology department, an entire focus on Industrial Hygiene was added, and now is being blended back into the Environmental Health program. With the addition of two new faculty, classes have been changed to suit the expertise of the new members. These changes have an effect on the current enrollees, and on the entire faculty. The alterations increase the workload and stress on the faculty, students, and curriculum. Curriculum changes are a double-edged sword. For some students the program becomes more attractive, but at the same time, it loses its continuity and reputation because it has changed. 

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

####### The goal of assuring a competent workforce can only be done by the University. It is not only technical training that is provided by the University, but also training in logical, critical thinking, and ethical behavior in work and in life. East Carolina University has these goals, and particularly in the field of health, leadership, and service to Eastern North Carolina, as its overall goals. The vision for this project, discussed with faculty and administration, is of sustainable enrollment and graduates with service hearts. The quality and attitude of the graduates is as important as the numbers, since it influences the quality and consequently the desirability of the program and the graduates. We therefore are also providing another of the 10 essential services: to inform, educate, and empower the students, and the faculty of ECU. In the research that our graduate students do, we involve community partnerships, we teach and learn about monitoring health, and we certainly evaluate health programs and research in the field. Finally, the center of the diagram shown in Figure 3 is research. 

It is required that faculty and graduate students contribute to research
in the field of Environmental Health, so as it is shown in the diagram
of the 10 essential services, (Figure 4) the University program's
success in acquiring sustainable enrollment touches [all]{.underline} of
the other 9 essential services through its successful research by a
vital graduate and undergraduate population.

####### ***National Goals Supported:*** 

####### Similarly, National Core Competencies are supported in this project. Assessment skills are taught and used by a vital, growing student and faculty. Management issues are taught and practiced in the program, and are being utilized by this research project itself. Communication is the lifeblood of education, including issues listed, such as conflict resolution, and marketing. 

1\. "The underlying premise of the Healthy People 2010 is that the
health of the individual is almost inseparable from the larger community
and that the health of every community in every state and territory
determines the overall health of the Nation." ^2^ Environmental health
is a field which synthesizes public health and the health of the
physical, ecological community. It is impossible for any one discipline
or agency of government to deliver the goals and requirements needed for
a healthy nation. For that reason, it is up to the leadership in each
discipline and agency to guide the discipline to more and more
collaboration. The University setting should be an example of this
through research activity. Adequate workforce training is only possible
if University faculty and administration can cooperate on missions and
visions for the system of schools in the United States. Loss of
environmental health programs because of budget concerns, lack of
grants, and lack of enrollment must become a project for EVERYONE in the
health field. We need to support each other instead of competing for
students and dollars.

2\. In each of the governmental initiatives seeking to improve the
status of public health and environmental health (The Institute of
Medicine^3^, the CDC, American Public Health Association, National
Environmental Health association and others) there are goals and mission
statements. Throughout these goals and missions there is overlap,
redundancy, repetition, and competition for government money. What is
lost in the confusion is a coherent coordinated approach to an overall
goal, reached by working collaboratively. This is vividly apparent in
the Hurricane Katrina response debacle.^4^ Although many agencies, both
private and public were involved, the public remains skeptical of the
effectiveness of the agencies, and the situation of many people and
communities is still quite unhealthy. The communities directly affected
by Hurricane Katrina may have been unhealthy before the Katrina disaster
as well, but Katrina is still as much a centerpiece of government
failure as the 9/11 event was a centerpiece of government cooperation
and success. I think it is time to make a systems comparison between
government response to these two events to see why such different
outcomes occurred.

####### ***Project Logic Model:***

**My vision for our Environmental Health Program:**

**Impact:** ECU's Environmental Health and Safety Program is a viable,
desirable, living thing, leading East Carolina students to good jobs in
public service and safety. It will graduate 60-70 undergraduate and 10
graduate students per year

**Qualitative Results**: ECU's Environmental Health and Safety program
leaders are involved in innovative teaching and Environmental Health
Research. Our teaching staff is experienced in Environmental Health and
Industrial Hygiene professions, and we are constantly applying new
pedagogical techniques.

**Personal Growth and Development**: Our research and teaching staff are
using their creativity to discover new concepts and techniques in the
Environmental Health and Safety field, and are involving students and
the community in those discoveries.

**Pre Conditions for Change Test**:

1.  *Some senior management alignment around vision*. College
    administration is aligned with continuation of Environmental Health
    Program, but some faculty curriculum committees are opposed to EH
    being a "Foundations" course because it is "applied". This causes
    strife and detracts from the positive presentation of both parties.

2.  *Willingness of relevant stakeholders to invest time and/or
    resources for learning*. Our department chair and college dean both
    are very interested in the program and support it with faculty
    positions, equipment, supplies, and a positive, encouraging
    attitude.

3.  *Value placed on the entire learning process, not just on the
    product*. I believe that this is still a problem, because the
    administration judges success on the traditional product of research
    publications and student credit hours.

4.  *Stakeholders willing to make tradeoffs between short and long
    term*. Our stakeholders have had patience as we build the program,
    and continue to have patience for the future as we move out of the
    current building, have it renovated and move back in. It will be
    another two years of chaos and confusion, but everyone seems willing
    to take it in stride.

5.  *Openness to test commonly held beliefs and assumptions*. For many
    of the stakeholders, a new outlook on the future of ECU and
    Environmental Health are part of reality. The University system has
    a new president, East Carolina University has a new Chancellor, and
    our program has new faculty. New leaders naturally apply new ideas
    and try to put a new stamp on the organizations they are leading. It
    is a good time to be trying new ideas in every area, therefore,
    because leaders are optimistic and in an adventurous mode.

Table 1 is a list of key stakeholders, and charts their motivation for
change, and lists things that a change communicator can do to encourage
teamwork. At the bottom of table 1 is a change or no change matrix
showing the benefits of change and no change to the stakeholders.

> **Table 1. Key Stakeholder's support and interaction with change
> communicator.**

+-------------+-------------+------+------+-------------+-------------+
| Name        | Current     | Des  |      | Their       | What You    |
|             | Support     | ired |      | Motivation  | Can Do      |
|             |             | Sup  |      |             |             |
|             |             | port |      |             |             |
+-------------+-------------+------+------+-------------+-------------+
| Dan Sprau,  | +3          | +3   |      | Student     | Talk about  |
| Program     |             |      |      | Success     | Vision,     |
| Director    |             |      |      |             | encourage,  |
|             |             |      |      |             | help with   |
|             |             |      |      |             | writing     |
+-------------+-------------+------+------+-------------+-------------+
| David       | +3          | +3   |      | Successful  | Communicate |
| White,      |             |      |      | program,    | and keep    |
| Dept. Chair |             |      |      | good        | him up to   |
|             |             |      |      | enrollment  | date with   |
|             |             |      |      |             | projects    |
+-------------+-------------+------+------+-------------+-------------+
| Ed Crotts,  | +3          | +3   |      | Student     | C           |
| Instructor  |             |      |      | Success,    | ommunicate, |
|             |             |      |      | Keep his    | ask him for |
|             |             |      |      | job         | help,       |
|             |             |      |      |             | advice      |
+-------------+-------------+------+------+-------------+-------------+
| Max Zarate, | +1          | +3   |      | Being the   | Include him |
| Assistant   |             |      |      | Best        | in all      |
| Prof        |             |      |      |             | d           |
|             |             |      |      |             | iscussions, |
|             |             |      |      |             | activities, |
|             |             |      |      |             | committees  |
+-------------+-------------+------+------+-------------+-------------+
| Sharon      | +2          | +3   |      | ECU and     | Keep doing  |
| Knight,     |             |      |      | College     | successful  |
| Assistant   |             |      |      | succeeding  | projects,   |
| Dean        |             |      |      |             | publish!    |
+-------------+-------------+------+------+-------------+-------------+
| Students    | +2          | +3   |      | Interesting | Keep        |
|             |             |      |      | classes,    | contacts    |
|             |             |      |      | good job    | with Health |
|             |             |      |      | prospects,  | D           |
|             |             |      |      | EH club     | epartments, |
|             |             |      |      |             | keep        |
|             |             |      |      |             | teaching up |
|             |             |      |      |             | to date.    |
+-------------+-------------+------+------+-------------+-------------+
| **Beginning |             |      |      |             |             |
| to Identify |             |      |      |             |             |
| Costs and   |             |      |      |             |             |
| Benefits**  |             |      |      |             |             |
+-------------+-------------+------+------+-------------+-------------+
| **Benefits  |             |      | **   |             |             |
| of          |             |      | Bene |             |             |
| Changing**  |             |      | fits |             |             |
|             |             |      | of   |             |             |
| Solid       |             |      | NOT  |             |             |
| program     |             |      | ch   |             |             |
| students    |             |      | angi |             |             |
| recognize   |             |      | ng** |             |             |
| and want to |             |      |      |             |             |
| get into.   |             |      | No   |             |             |
|             |             |      | e    |             |             |
|             |             |      | xtra |             |             |
|             |             |      | work |             |             |
|             |             |      | to   |             |             |
|             |             |      | be   |             |             |
|             |             |      | done |             |             |
+-------------+-------------+------+------+-------------+-------------+
| **Costs of  |             |      | **C  |             |             |
| Changing**  |             |      | osts |             |             |
|             |             |      | of   |             |             |
| Time needed |             |      | Not  |             |             |
| to          |             |      | Ch   |             |             |
| organize,   |             |      | angi |             |             |
| plan, think |             |      | ng** |             |             |
| and meet to |             |      |      |             |             |
| discuss     |             |      | Pro  |             |             |
| long-term   |             |      | gram |             |             |
| problems:   |             |      | is   |             |             |
| program     |             |      | el   |             |             |
| director    |             |      | imin |             |             |
| time        |             |      | ated |             |             |
| needed.     |             |      | or   |             |             |
|             |             |      | a    |             |             |
|             |             |      | bsor |             |             |
|             |             |      | bed. |             |             |
|             |             |      | Jobs |             |             |
|             |             |      | and  |             |             |
|             |             |      | p    |             |             |
|             |             |      | osit |             |             |
|             |             |      | ions |             |             |
|             |             |      | l    |             |             |
|             |             |      | ost. |             |             |
|             |             |      | E    |             |             |
|             |             |      | nvir |             |             |
|             |             |      | onme |             |             |
|             |             |      | ntal |             |             |
|             |             |      | He   |             |             |
|             |             |      | alth |             |             |
|             |             |      | stud |             |             |
|             |             |      | ents |             |             |
|             |             |      | go   |             |             |
|             |             |      | el   |             |             |
|             |             |      | sewh |             |             |
|             |             |      | ere. |             |             |
+-------------+-------------+------+------+-------------+-------------+

#  

# 

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

# METHODOLOGY:

####### Focus group vision discussions

####### Survey of Undergraduate and Graduate groups of students (See Appendix A)

-   Survey of other Environmental Health programs (Informal by phone,
    and report by National Environmental Health Science & Protection
    Accreditation Council[^1]

-   Self-Study Documents and questionnaire for Accreditation (Part of
    re-accreditation requirements)

# RESULTS:

Two main components of the ECU Environmental Health Program Faculty's
vision were discovered.

1.  Being the BEST Environmental Health Program in the country

2.  Producing students who are altruistic, humanitarian, and global in
    their thinking, and who have skills to serve their communities.

Surveys of three main groups of stakeholders have shown interesting
results:

1.  Undergraduate students found Environmental Health through an
    extremely wide variety of sources including the catalogue, the
    website (a recent addition) flyers, friends, and through our
    introductory course. The most frequently mentioned (7/20) method was
    personal contact with a teacher or advisor, and (4/20)contact with a
    friend or relative.

2.  In surveys of students from past decades, students did mention ECU's
    Dr. Trenton Davis as a contact and an influence in their choice of
    Environmental Health. Many students did not continue in the field,
    but many have gone on in Environmental Health and excelled in the
    state and nationally. Dr. Davis reported on this data in his plea to
    continue the program at East Carolina University. In an informal
    survey of EPHLI fellows, taken at the December EPHLI meeting, it was
    discovered that current Environmental Health leaders entered the
    field through a wide variety of disciplines. Biology, Agronomy,
    Engineering, ECU's Environmental Health program, and the Peace Corps
    were some of those disciplines/fields. Random science job
    announcements, health department jobs and the Peace Corps were on
    the list for avenues reaching environmental health positions.

3.  Other Environmental Health programs in North Carolina, Wisconsin,
    Michigan and Ohio reported in these updates that low enrollment has
    been a problem for the last 5-7 years. The program in Michigan at
    Ferris State University has only one more year to run, and will then
    be discontinued. Faculty in that program have been reassigned, and
    the reporter mentioned that many of the health departments in
    Michigan are very concerned because their source of trained students
    will be eliminated.

**CONCLUSIONS:**

Major leadership in University Environmental Health Program in terms of
sustainability and development needs to be continued, and new leadership
needs to be constantly developed. Many programs including the one at
East Carolina University have had a single champion since the
environmental movement began in the 1970's. These people have now
retired, as have many people they have trained. The environmental health
workforce is in serious decline, and faces even more serious decline in
the future as more "baby-boomers" retire[^2]. Business jobs and
leadership have always been an emphasis at North Carolina Universities,
and have been popular majors for students because of the promise of
highly paid jobs. Service oriented jobs, such as health department jobs,
have not been as desirable because of low pay and poor advancement
opportunities. Health professions have become an emphasis at East
Carolina University now that it has a medical school. Community
medicine, and general practice are also University priorities, and
Allied Health Training is completing a new building. To maintain our
visibility and to be recognizes as an important part of this community
health effort, Environmental Health needs to be constantly advertised.
Environmental health can continue to be an important career choice for
ECU students as long as the faculty is encouraged to maintain a vision
and passion for training future Environmental Health workers, and as
long as leaders work to build teams to incorporate recruitment along
with other daily tasks. A recruitment and advertising campaign each year
would be an advantage.

# 

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# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Dr. Alice L. Anderson, East Carolina Universitiy, Greenville, NC*** 

East Carolina University's Environmental Health Program is a renowned
training center for Environmental Health Specialists throughout the US.
Since beginning my tenure at ECU, which coincided with the start of my
leadership training at EPHLI, I have discovered this. It is humbling to
be part of both important endeavors which are responsible for producing
leadership in the Environmental Health workforce for the future. I have
also discovered in the course of the leadership institute, that I lack
some skills in leadership, and have much work to do in order to maintain
and continue the progress that has been made in ECU's Environmental
Health program. I was given the position of graduate program director in
Environmental Health since I began the EPHLI program, and have been
successful in the position so far. However, I now realize that continued
success depends on skills in leadership and in managing change, which
continues to accelerate as time progresses.

A second, more practical outcome of opportunity that has occurred
because of EPHLI is that I have volunteered to be on a strategic
planning committee for the University in our department. I have put
ideas and skills learned in this institute to work in academia. This is
a more important task this year than ever before, since the North
Carolina University System has a new President

(Mr. Erskine Bowles) and East Carolina University has a new Chancellor
(Dr. John Ballard) who both desire that leadership be a main part of the
university curriculum. Finally, I have been able to make use of reading
material for the EPHLI sessions in my own classes on Program Management
and Law. ^7^ EPHLI has truly given me a whole new dimension and vantage
point for these classes, both graduate and undergraduate.

# 

# 

# 

# REFERENCES

1.  Senge, Peter, Kleiner A, Roberts C, Ross R, Smith B. [The Fifth
    Discipline Fieldbook]{.underline}:

Strategies and Tools for Building A Learning Organization. New York, NY:
DoubleDay. 1994.

2.  U.S. Department of Health and Human Services. *Healthy People 2010:
    Understanding and Improving Health*. 2^nd^ Ed. Washington, DC: US
    Government Printing Office.

3.  National Environmental Health Science & Protection Accreditation
    Council 2004-2005 Update of Accredited Programs.

4.  Hosenball, Mark. The Back-Channel Chatter After Katrina" Newsweek 27
    Feb, 2006 p 38.

5.  Buchanan, Sharunda. Revisiting Revitalization. Journal of
    Environmental Health. January/February 2006. pp. 69-70.

6.  Rowitz, Louis. [Public Health Leadership: Putting Principles into
    Practice]{.underline}. Jones & Bartlett: Boston. 2003.

[^1]:

[^2]: