Review and comparison of public health dental, environmental, and nursing workforce enumerations in Ontario: How do we compare nationally and internationally?

Purpose: To determine how the Ontario public health dental, nursing, and environmental health workforces compare nationally and internationally, and assess recommended ideal per capita ratios for these three public health professions. Methods: The most recent enumerations of the public health workforce reported in the Ontario Ministry of Health and Long-term Care's 2007 report was used to calculate per capita ratios for the 3 professions in Ontario. The grey and published literature were reviewed for enumerations and recommended ideal worker levels in other Canadian provinces and nations. Only studies and reports published after 2000 and reporting in full-time equivalents (FTE) were included. FTEs were converted to per capita ratios using census estimates. Results: Twenty-five studies and reports were found containing enumerations of public health nurses, dental and environmental workers in FTE and 5 reports contained recommended workforce levels for these 3 professions. Nine reports were from Canada, 1 from Australia, and the rest from the US. Ontario exceeded Texas and Missouri LHDs in terms of public health nurses and environmental health workers. Although Ontario had a comparatively high per capita ratio of public health dentists among Canadian provinces, Ontario ranked lower when allied dental health professionals were considered. However, differences in reporting method, study methodology, organization structure of public health systems, and taxonomy limited comparisons. Current recommendations for ideal workforce levels lack justification and are not applicable to Ontario. Recommendations: High-quality enumerations and evaluation methods or models are needed to assess the adequacy of the present and future public health workforce.