#  Meeting The Environmental Challenges Of The Future By Redesigning The Workforce Of Today 

# 2006 - 2007 

# 

#  Environmental Public Health Leadership Institute Fellow(s):

#  Janet D. Williams, B.S. 

*Division Director, Saint Louis County Department of Health*

*111 S. Meramec*

*Clayton, MO. 63105*

*314-615-8907*

[*jwilliams@stlouisco.com*](mailto:jwilliams@stlouisco.com)

# CAPT Patrick O. Bohan, USPHS (RET), RS, MS, MSEH

*Assistant Professor, Department of Environmental Health Sciences, East
Central University*

# Acknowledgements:

### **Dr. Dolores J. Gunn, MD**

*Director, Saint Louis County Department of Health*

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

# EXECUTIVE SUMMARY:

The foundation of a robust environmental health program is the ability
to recognize and link environmental indicators to risk and exposure that
are associated with environmentally related diseases in order to reduce
those diseases. This means having a workforce of environmental health
professionals who are technically diverse, committed, flexible and
working in an organization not organized or driven by "silos". Simply
stated, the technical diversity of staff is paramount to the improved
environmental health of a community.

Environmental health professionals that do not have the ability to
recognize and identify the presence of negative environmental indicators
that often occur in a single event are in effect, working inefficiently.
Contributing factors may be the lack of awareness of the diversity in
the environmental field and the structure of a "silo"-driven
organization. This corresponds to an inefficient use of resources at a
time when public health resources are stretched thin and sometimes
scarce.

This discussion will center on the use of several tools to bridge the
gap between technical diversity and a holistic, programmatic approach to
environmental health.

Some of the tools used are the establishment of a new job class at a
corresponding higher pay range, which requires certification as a
Registered Environmental Health Specialist (REHS), monetary incentive
for existing staff when REHS certification is obtained and cross-
training of field staff. While this approach may not seem new or unique,
it is important to point out these activities are being accomplished at
the local level in a State where registration or certification of
professionals working in environment public health is not required.

# INTRODUCTION/BACKGROUND:

In 1923 C.E.A. Winslow developed the following definition of public
health and has been paraphrased here "tis a long sentence .....Public
health is the science and art of preventing disease, promoting
efficiency through organized community efforts for the sanitation of the
environment, control of community infection and the education of the
individual in the principles of personal health and the development of a
machinery which will ensure every individual in the community, a
standard of living adequate for the maintenance of health."

From this definition came a better understanding of Public Health and
encouraged support for the formation of public health departments
nationally. In the State of Missouri, there are currently 114 public
health agencies delivering a vast array of services including
environmental public health. The level of these programs can range from
single program areas (limited food, water and sewage programs) to those
agencies with comprehensive environmental public health and program
services. The Saint Louis County Department of Health represents one
agency addressing environmental public health in a comprehensive manner.

Saint Louis County is located on the eastern side of Missouri and
encompasses a population of over 1.1 million persons spread over 525
square miles. Our urban community is bordered near the Mississippi River
by the City of St. Louis, on the western edge by St. Charles County and
on it's southern section by Jefferson and Franklin Counties. While
Jefferson and Franklin counties represent mostly rural areas, St.
Charles County is one of the fastest growing counties in the State and
is a mix of urban and rural communities. Together these five counties
represent over one-third of the State of Missouri's total population.
Thus, Saint Louis County is able to establish itself in a leadership
position and the actions taken by our county regarding environmental
public health issues tend to have a broad impact on the region.

Saint Louis County has the largest accredited organized health
department in the State located in the most populated county. This issue
is tantamount when one looks at the impact public expectations regarding
environmental issues has on our ability to provide the technical
expertise needed to address those issues.

The Division of Environmental Protection (EP) in the Saint Louis County
Health Department (DOH) employs more than 150 persons of the total 500
department members. Our program areas represent the marriage of the
traditional public health programs (food, water and sewage) with the
natural resources programs (air pollution, water quality, landfills and
solid waste). In total, the division has regulatory responsibility for
the following program areas: food, on-site sewage, pools and spas,
tobacco enforcement, tattoo establishments, daycare, lodging, dairy
farms and manufacturing plants, animal and vector control, air pollution
enforcement, permitting, and air monitoring, asbestos management, solid
waste (including permitting and inspections of landfills and recycling
centers), lead poisoning and prevention, indoor air quality, radon and a
fully accredited environmental laboratory.

It is this comprehensive nature that lends itself to the greater
expectation by the public of our ability to address complex
environmental issues they feel may be impacting their health. While this
expectation is generally an outcropping from the public, our elected
officials share this expectation.

As with other government organizations, we are silo-driven. Each program
area represents its regulatory function and funding matrix, and never
shall the two meet. This concept keeps us from providing the holistic
approach to the many complex environmental issues we are facing. While
staff is technically diverse or subject matter experts in individual
areas, they are at times, unaware of the negative environmental
indicators that are present in a single event or at a single facility,
which may be outside their area of expertise.

Our programmatic facility inventory is impressive; FY 2005 saw more than
5200 food establishments permitted, 852 on-site sewage activities, 954
pool and spa permits, 150 permitted lodging establishments, 1100
permitted tobacco establishments, 750 permitted facilities with Stage
I/II air permits (service stations and quick shops), 689 daycare
establishments, 5 permitted landfills, 2 demolition landfills and
several recycling facilities and plan review. Inspections are conducted
as regulated by ordinances sometimes monthly, annually and some more
than three times per year.

At more than one-third (1/3) of all permitted facilities, there exist an
opportunity to conduct multiple inspections at one visit by a single
inspector. As illustrated in Table 1, this means the average quick shop
or service station may have six (6) separate program permits issued;
food, tobacco, solid waste, stage I/II, air permit and on-site sewage,
traditionally conducted by the subject matter expert on separate visits.
Complaint investigations are also conducted as a single focus area. Not
only does this represent an inefficient and ineffective use of staff
resources, it certainly does not offer the facility owner/operator the
customer service represented in a single point of contact. In a time of
dwindling resources, increased workloads, expectations and complex
issues, a better approach to organizational structure and workforce
development is warranted.

TABLE 1

+-------------+-------+----+--------+---------+------+------+-------+
|             | Food  | Po | T      | Stage   | Air  | S    | On    |
|             |       | ol | obacco | I/II    | Pe   | olid | -Site |
|             |       |    |        | Vapor   | rmit | W    | S     |
|             |       |    |        | R       |      | aste | ewage |
|             |       |    |        | ecovery |      |      |       |
+-------------+-------+----+--------+---------+------+------+-------+
| Food        | -     |    | -      | -       |      | -    | -     |
| Es          |       |    |        |         |      |      |       |
| tablishment |       |    |        |         |      |      |       |
+-------------+-------+----+--------+---------+------+------+-------+
| Lodging     | -     | -  | -      |         | -    | -    | -     |
|             |       |    |        |         |      |      |       |
+-------------+-------+----+--------+---------+------+------+-------+
| Quick Shop  | -     |    | -      | -       | -    | -    | -     |
+-------------+-------+----+--------+---------+------+------+-------+
| Landfill    |       |    |        | -       | -    | -    | -     |
+-------------+-------+----+--------+---------+------+------+-------+
| Dairy Farm  | -     |    |        |         |      | -    | -     |
+-------------+-------+----+--------+---------+------+------+-------+
| Daycare     | -     | -  |        |         | -    | -    | -     |
|             |       |    |        |         |      |      |       |
+-------------+-------+----+--------+---------+------+------+-------+
| School      | -     | -  |        | -       | -    | -    | -     |
|             |       |    |        |         |      |      |       |
+-------------+-------+----+--------+---------+------+------+-------+

Permit type by establishment type

Not all inclusive of every program area in the Division

Of the 150 Division personnel previously mentioned, twenty-two (22) are
assigned to the Food and Environmental program, ten (10) in Air
Pollution program and seven (7) in the Solid Waste program. These
program areas represent the major focus of the effort to diversify
and/or improve the technical ability of our staff.

To achieve this diversity we have embarked on an initiative to re-class
positions, which will require the successful candidate to be
R.S/R.E.H.S. registered. While this initiative may seem insignificant to
most, it is being accomplished in a State (Missouri) that has no
registration requirement for environmental public health professionals.
Of the eight (8) surrounding states; Nebraska, Kansas, Iowa, Illinois,
Kentucky, Tennessee, Arkansas and Oklahoma, fewer than two require NEHA
registration.

With the successfully gained buy-in from executive administration,
vacant positions mentioned were re-classed to a higher level position
titled Environmental Specialist which requires the successful candidate
to be NEHA registered as a R.S. or R.E.H.S. The pay classification
represents a 20% increase above the base pay of the current
Environmental Public Health position. These new positions will operate
across program areas, focusing on the needs of individual facilities not
individual program areas.

Current program staff is encouraged to obtain the NEHA registration,
have their current positions re-classed and are awarded a 5% increase in
their pay upon successfully passing the exam. An additional 3-4% may be
awarded if they pass the exam within months of their annual merit date.
The department has purchased and made available the necessary study
materials and provided an opportunity for staff to cross train in other
program areas. This affords each staff member the opportunity for a
self-directed career ladder that is not dependent on vacant positions or
funding. Increased staff efficiencies through the conduct of multiple
permit inspections in a single visit have provided the funding mechanism
to sustain this project.

We must ensure staff has the knowledge, skills, abilities and technical
diversity necessary to meet the expected challenges. According to Health
People 2010, "protecting the environment has been a mainstay of public
health practice since 1878." As our environment changes due to global
climate changes, new technologies and emerging threats, our staff must
maintain the technical diversity and skill set to meet these new
challenges. The incentive provided with national registration, assures
professionals will maintain the necessary awareness of the skill sets
needed to exceed expectations.

***Problem Statement:***

Saint Louis County is a growing community in need of a workforce of
environmental professionals who are technically diverse, committed,
flexible and working in a non silo-driven organization. The technical
diversity of staff is paramount to the improved environmental health of
our community.

####### 

#######  

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

# ![](media/image2.wmf){width="8.020833333333334in" height="4.395833333333333in"}

# 

#  

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

![](media/image3.wmf){width="5.645833333333333in"
height="4.020833333333333in"}

####### 

# ![](media/image4.wmf){width="5.895833333333333in" height="3.6458333333333335in"}

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

This project will address a number of the 10 Essential Environmental
Health Services; specifically

-   Monitor the environmental health of the community

    i.  Improved awareness of environmental issues in a holistic manner
        across program areas

-   Diagnose and Investigate environmental health problems and hazards
    in the community

    i.  Investigation of complaints

    ii. Conduct of risk assessments to evaluate environmental risks

-   Inform, Educate and Empower

    i.  When risk factors are identified through investigations, the
        community will be informed and educated regarding risks and
        behavior modifications needed

-   Enforce laws and regulations that protect public health and safety

    i.  Conduct inspections and provide enforcement actions when and
        where necessary to assure compliance

-   Assure a competent workforce through improved opportunities for
    development and learning

    i.  Staff have knowledge, skills and abilities to perform holistic
        responsibilities

    ii. Opportunities to achieve certification as R.S. or R.E.H.S
        (registered environmental health specialists)

    iii. Cross-training of staff through environmental division

![](media/image5.png){width="3.75in" height="3.8125in"}

Figure 1:

####### 

####### 

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

This project provides support for the [CDC Health Protection
Goal]{.underline} of "Healthy People in Healthy Communities" by assuring
through technical diversity of our staff, the improved awareness of
environmental threats to our communities. This awareness will start the
process of planning, policy direction, action, education and behavior
change if needed. Without awareness the risk, action to reduce or
eliminate that risk is improbable.

Support for the goals in the [National Strategy to Revitalize
Environmental Public Health Services]{.underline}, especially Goal V
"Develop the Workforce". This project is centrally focused on the
workforce through the improving the technical knowledge base of staff,
increasing their awareness of the holistic approach to environmental
public health, utilizing the information gained to assess for
environmental risks, take any necessary action and/or initiate policy
change as needed.

While the core competencies of staff has been established, revisiting
those competencies through involvement with and application of the
[Environmental Health Competency Project]{.underline} report can be used
as a foundation for the cross-training and pollination of staff through
our various program areas.

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

+------------+-------------+----------+--------------+---------------+
| Resources  | Activities  | Outputs  | Short & Long | Impact        |
|            |             |          | Term         |               |
|            |             |          | Outcomes     |               |
+------------+-------------+----------+--------------+---------------+
| -          | -   Create  | -   \#   | -            | -   Early     |
|  Personnel |     new job |     re   |    Increased |               |
|     Admi   |             | -classed |              |   recognition |
| nistration | description |     p    | efficiencies |     of        |
|            |             | ositions |     in       |               |
| -          | -           |     r    |     wor      | environmental |
|  Executive |    Re-class | equiring | kload/output |               |
|     Admi   |             |     REHS |              |    conditions |
| nistration |   positions |          | -            |     requiring |
|            |             | -   \#   |  Technically |               |
| -          | -   Develop |          |     diverse  |    monitoring |
|   Division |     funding | Existing |     staff    |     or action |
|     of     |     matrix  |          |              |               |
|     Env    |     formula |    staff | -            | -   Increased |
| ironmental |             |          | Organization |               |
|            | -   Develop |   taking |     focused  |  surveillance |
| Protection |     cross   |     exam |     on       |               |
|     (DEP)  |             |          |     holistic | opportunities |
|            |    training | -   \#   |     approach |     regarding |
|    Program |     program |     New  |     to       |               |
|            |             |          |     e        | environmental |
|   Managers | -           |    hires | nvironmental |     issues    |
|            |    Purchase |     with |     public   |               |
| -   DEP    |     NEHA    |     REHS |     health   | -   Leaders   |
|     staff  |     REHS    |          |              |     able to   |
|            |     study   | -   \#   | -   Sel      |     identify  |
| -   NEHA,  |             |     mu   | f-actualized |     and       |
|     AFDO,  |   materials | lti-prog |     career   |     manage    |
|     CDC,   |             | rammatic |     ladder   |     complex   |
|     FDA    | -   Develop |     ins  |     for      |     issues    |
|            |     and     | pections |     staff    |               |
| -   State  |             |          |              | -   Greater   |
|     Env    |   implement | -   \#   | -            |               |
| ironmental |             |     and  |   Leadership |  efficiencies |
|     Or     |   sustained |     type |              |     leading   |
| ganization |             |     of   |  development |     to        |
|            | Recruitment |          |     based on |     improved  |
| -   LPHA   |     plan    |  reports |     e        |     customer  |
|            |             |     g    | nvironmental |     service   |
| -          | -           | enerated |              |               |
|    General |   Establish |     for  |    diversity | -   Increased |
|     Public |     En      |          |              |     value     |
|            | vironmental | analysis | -   Evidence |               |
| -          |     Intern  |     of   |     based    |    perception |
| Integrated |             |          |     decision |     for       |
|     data   |    position |    envir |     making   |               |
|            |             | onmental |              | professionals |
| collection | -           |     co   | -   Regional |     and field |
|     system |   Incentive | nditions |     model    |     of        |
|            |     program |          |     for      |               |
|            |     for     |          |     e        | Environmental |
|            |             |          | nvironmental |     Public    |
|            |    existing |          |     public   |     Health    |
|            |     staff   |          |     health   |               |
|            |     who     |          |     capacity | -   Increased |
|            |     achieve |          |              |     public    |
|            |     cer     |          | -   Shift    |     advocacy  |
|            | tifications |          |     from     |     for       |
|            |             |          |     reactive |               |
|            |             |          |     to       | environmental |
|            |             |          |              |     issues    |
|            |             |          |    proactive |               |
|            |             |          |     e        | -             |
|            |             |          | nvironmental | Environmental |
|            |             |          |     health   |     mutual    |
|            |             |          |              |     aid       |
|            |             |          |  inspections |     ability   |
|            |             |          |              |     with      |
|            |             |          |              |               |
|            |             |          |              |   surrounding |
|            |             |          |              |     LPHA for  |
|            |             |          |              |               |
|            |             |          |              |   emergencies |
|            |             |          |              |               |
|            |             |          |              | -             |
|            |             |          |              | Environmental |
|            |             |          |              |               |
|            |             |          |              |    indicators |
|            |             |          |              |               |
|            |             |          |              | -   Consensus |
|            |             |          |              |     of        |
|            |             |          |              |               |
|            |             |          |              |    priorities |
|            |             |          |              |     for       |
|            |             |          |              |               |
|            |             |          |              | environmental |
|            |             |          |              |     issues    |
+------------+-------------+----------+--------------+---------------+

####### 

# 

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

[Goal:]{.underline} Reduce risk of illness associated with
environmentally related conditions by assuring a holistic approach to
environmental public health via a technically diverse staff in the
Division of Environmental Protection.

[Health Problem]{.underline}:

The foundation of a robust environmental health program is the ability
to recognize and link environmental indicators in an effort to decrease
the risk and exposure associated with environmentally related diseases.
This means having a workforce of environmental professionals who are
technically diverse, committed, flexible and working in a non
silo-driven organization. The technical diversity of staff is paramount
to the improved environmental health of a community.

Lack of technically diverse staff has contributed to the increase in
health problems in the community because staff is working inefficiently
and do not have the ability to recognize all of the negative
environmental indicators that often occur in a single event. This may be
due to lack of public health education, awareness of the diversity in
the environmental field and the structure of a silo-driven organization.

[Outcome Objectives]{.underline}:

By December 31, 2010 increase from 5% to 90% the number of registered
environmental health sanitarians (REHS) in the Division of Environmental
Protection.

By December 31, 2010 increase from 1% to 100% the number of coordinated
multi-disciplinary inspections.

[Determinant:]{.underline}

The current organizational structure of the Saint Louis County Division
of Environmental Protection is silo- driven. Also there is no funding
structure available to support or encourage staff obtaining or
maintaining a REHS certification. Without technical diversity, the
inability of staff to identify conditions, which may support a decrease
in the incidence of environmentally related illnesses, would continue.

[Impact Objective]{.underline}:

By December 31, 2007, the Saint Louis County Division of Environmental
Protection will have the start of an organizational structure to support
the re-classification of personnel, obtaining and maintaining the REHS
(registered environmental health specialist) certification and a
multi-disciplinary training program established.

[Contributing Factors:]{.underline}

1.  Current position classifications are silo and programmatically
    driven.

2.  Current organizational and grant funding do not support the
    multi-disciplinary inspection approach.

3.  Staff may not view this paradigm shift as appropriate career ladder
    advancement.

4.  Staff lacks a clear understanding of the tenets of Public Health
    and, more specifically, environmental public health.

[Process Objective:]{.underline}

By June 30, 2006, re-classify all vacant environmental public health
sanitarian, solid waste specialist and air quality inspector positions
to environmental specialist positions.

[Activity:]{.underline}

1.  Develop new job description for environmental specialist which
    incorporates the above mentioned program areas.

2.  Present new job description through approval process for
    classification and pay recommendation.

3.  Develop and implement promotional and re-classification pay plan for
    staff that obtains the REHS certification.

By December 31, 2006 develop cross-training program for re-classified
environmental specialists.

[Activity:]{.underline}

1.  Work with division managers on components of training program that
    will meet specific program needs and comply with grant funding
    requirements while meeting training goals.

2.  Develop protocol for moving staff through various program areas
    during cross training process.

By February 1, 2007 establish, offer and proctor NEHA REHS exam in-house
for qualified and interested staff.

> [Activity]{.underline}:

1.  Purchase additional REHS training materials for central and
    satellite offices.

2.  Notify staff of availability of training materials.

3.  Gauge number of staff interested in taking REHS exam by February
    2007.

4.  Contact NEHA for availability of proctor for Saint Louis County.

5.  Host exam in-house for staff.

By December 31, 2007 increase from 5% to 30% the number of registered
environmental health specialists (REHS) in the Division of Environmental
Protection, specifically, food and environmental, air pollution and
solid waste programs areas.

> [Activity:]{.underline}

1.  Continue to work with staff on obtaining REHS certification.

2.  Network and recruit qualified staff from surrounding States.

3.  List Environmental Specialist job opening on "continuous hire" list
    for County job openings.

4.  Increase number of (new FTE) Environmental Specialist positions by
    two each fiscal year.

By December 31, 2008 increase by 50% annually the number of registered
environmental health specialists (REHS) in the Division of Environmental
Protection

## Activity:

1.  Alter organizational structure from silo program areas to
    comprehensive core functions centered structure.

2.  Work with grant funding agencies to incorporate environmental
    specialist concept into allowable cost structure to support holistic
    approach to organization.

3.  Establish new Environmental Intern position in Division to hire
    junior and senior level students from schools with accredited
    environmental health programs for internships.

.

####### 

# Next Steps:

As is noted in the "Limits to Growth" diagram, one of the most limiting
factors to the success of this project is the availability of qualified
candidates. As was noted previously, the State of Missouri and the
majority of the eight (8) surrounding do not have the requirement for
NEHA certification and registration of environmental public health
professionals. This has resulted in vacant positions staying vacant
longer, adding to the workload of current staff and feeding into some
staff 's mindset i.e those that don't qualify or don't want to support
the paradigm shift, that technical diversity is nothing more than
another of management's pipedream.

Some next steps that can be taken are:

1.  Recruit students from colleges with environmental public health
    areas

2.  Establish an internship program for junior and senior college
    students to facilitate interest in environmental public health and
    our agency

3.  Continue to work with staff to see the vision for technical
    diversity

4.  Develop and encourage current staff to become NEHA registered

5.  Develop new job descriptions for management staff that will continue
    the organizational restructuring in line with our ability to
    diversify skill sets and eliminate "silos"

6.  Discuss model with other local public health agencies in the area so
    they may utilize this process to get staff nationally registered.
    This will result in greater demand in our area and may result in
    larger pool of qualified candidates.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Janet D. Williams***

Wow, what a whirlwind time......... My involvement in this project has
assisted me in developing new skills and refining existing ones. I
finally have a name for the thought process I've always used in decision
making (it's called systems thinking). The opportunity to learn more
about the why's of what we do and the how to do it better can only make
me a better professional. And if I'm better at what I do, the impact
upon the organization will be better. I know there are others like me
who believe there are no boundaries for environmental public health and
are as passoniate about excellence as I am.

While this process has been time consuming it has refreshed me. I know
more about the work going on nationally to improve the conditions we all
fret about i.e workforce development, staffing, resources, our value in
the field, etc. and am reinvigorated to continue to do all I can to make
a difference in environmental public health.

The other value I have from this training is the opportunity to meet all
the other wonderful and talented professionals from across the United
States. The friendships and relationships that have been developed gives
me the opportunity to expand my horizions and have at hand a ready cache
of "fellows" on which to bounce my many ideas upon. I have learned a lot
about my style of learning and managing and believe I am now more
emotionally aware of the impact I have on others, both personally and
professionally.

All in all participation in this project has made me a better person and
a better manager.

# ABOUT THE EPHLI FELLOW(s)

Janet D. Williams is currently employed as the Director, Division of
Environmental Protection for the Saint Louis County Department of
Health. She holds a Bachelors of Science degree in Chemistry/Biology
from the University of Missouri Kansas City and is working towards
completing her Masters degree.

Ms. Williams started her career as a field inspector in Kansas City and
has worked in environmental public health for more than twenty years,
working at local and state public health agencies. She holds memberships
in a number of professional organizations including the National
Environmental Health Association, Missouri Milk Food and Environmental
Association, American Public Health Association and others. She was
named Sanitarian of the Year, and has served as president of the
Missouri Society of Professional Sanitarians (prior name).

She has been recognized for her achievements in public health and has
been a speaker at several conferences including the annual NEHA
educational conference.