Evaluation of Epidemiology Capacity in State Health Departments, 2004-2009

The Council of State and Territorial Epidemiologists (CSTE) has conducted four national assessments of epidemiology capacity (2001-2009) in state health departments to monitor progress towards achieving Healthy People 2010 Objective 23-14. These assessments included longitudinal measures to evaluate core epidemiology functions, provided a basis for estimation of additional capacity needs, and gauged the competency of the epidemiology workforce.

From 2004 to 2009, the ratio of state-based epidemiologists per 100,000 population decreased from 0.85 to 0.72. The ideal ratio based on the 2009 ECA is 1.21 per 100,000, with the ratio being dependent on state size. The 31 smallest states (population <5 million) had a mean ratio of 1.41:100,000 but need a ratio of 2.5. The 20 states with the largest (population >5 million) had a mean ratio of 0.67 but need 1.0 per 100,000.

From 2004 to 2009, the total number of epidemiologists in all states decreased by 12.2% For the 28 states with the most complete data on program area in the 2009 ECA, the numbers decreased from 26% to 71% in all program areas except infectious diseases, in which there was a 10% increase. Two-thirds or more states reported less than substantial (<50% of optimum) surveillance and epidemiology capacity in five of nine program areas. Capacity diminished since 2006 for three of four epidemiology-related Essential Services of Public Health.

We conclude that epidemiology capacity in states is suboptimal and has decreased since 2004. Efforts to redevelop and expand capacity in the future should take into account state size.