From Competencies to Capacity : Assessing the National Epidemiology Workforce

In November 2001, the Council of State and Territorial Epidemiologists (CSTE) conducted the first comprehensive nationwide assessment of core epidemiology capacity in state and territorial health departments. The assessment found that approximately 42% of 1,366 epidemiologists lacked formal training in epidemiology, indicating a large training gap in the public health workforce.1 The CSTE Epidemiology Capacity Assessment (ECA) was revised and again administered in 2004, this time to focus on the infrastructure of public health surveillance programs, core epidemiology capacity, and training opportunities for epidemiologists employed in health departments. Results revealed that 29% of epidemiologists lacked formal training or academic coursework in epidemiology, and the assessment indicated a need for additional training in several key areas: design and evaluation of surveillance systems, design of epidemiologic studies, design of data collection tools, data management, evaluation of public health interventions, and leadership and management training.2 However, 94% of respondents reported providing or funding training or education to enhance the competence of epidemiologists during the 12 months preceding the 2004 assessment.3 The findings from the 2001 and 2004 assessments prompted CSTE to focus its workforce initiatives on strengthening public health epidemiology. Four priority areas for building workforce capacity and enhancing the competency of epidemiologists were identified: Measuring epidemiology capacity and filling the need for trained epidemiologists within the public health system; Establishing public health competencies and addressing the training gap; Identifying unique barriers to recruiting and retaining applied epidemiologists; and Addressing funding gaps and leadership issues.4 CSTE collaborated with the Centers for Disease Control and Prevention (CDC) to build epidemiology workforce capacity through the CDC/CSTE Applied Epidemiology Fellowship program, convened the ECA workgroup to revise the epidemiologic assessment tool for 2006, and supported a team assigned to the National Public Health Leadership Institute. In addition, CDC and CSTE convened a workgroup of epidemiology experts—comprising representatives from state and local health agencies, schools of public health, private industry, and CDC—to develop Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs) for local, state, and federal public health epidemiologists. The objectives of the AECs are to define the discipline of applied epidemiology and describe what skills four different levels of practicing epidemiologists working in government public health agencies should have to accomplish required tasks.5 The AECs were created within the framework of the Core Competencies for Public Health Professionals, developed by the Council on Linkages Between Academia and Public Health Practice (COL).6 The expert panel modified the eight skill domains of the Core Competencies to address the unique elements of epidemiologic practice. The panel, which first convened in October 2004, developed the AECs in four tiers. Each tier focused on epidemiologists with increasing levels of experience and responsibilities (Figure 1).5 The panel approved the final competencies in 2006 after a validation period and with broad input from practicing epidemiologists and public health organizations. Figure 1 Functional responsibility and educational and experiential criteria of epidemiologists from the CDC/CSTE AECsa