National Environmental Health Association

Environmental public health (EPH) operates at the intersection of the environment and human health. The purpose of our project was to determine the factors that governmental EPH professionals consider when making decisions about their programs and workforce, including matters of structure, staffing, and funding for local EPH departments. A survey informed by focus groups and interviews was administered to EPH professionals that showed a high proportion of respondents (76%) work in food safety or food protection programs, and at least 50% of respondents reported they spent time on duties in four other programs. Regarding the duties performed in the other EPH programs, the survey showed that 66% of staff and 73% of managers considered performing 3–4 inspections per field day to be somewhat or extremely reasonable. Across all programs—except emergency preparedness—there was general agreement among staff and managers that a bachelor’s degree in a field of science should be the minimum education necessary for staff. More than 50% of respondents recommended either state or national registration as a minimum requirement for the seven core programs. The dynamic nature of the EPH profession is demonstrated by the range of program activities that EPH professionals conduct on both a seasonal and year-round basis. The combination of a bachelor’s degree and a credential could allow for flexibility in performing duties of multiple programs and allow for transferability of skills between EPH departments. There are important commonalities across EPH programs that provide a basis for guidelines that can be widely accepted and scalable to the size and setting of EPH departments.

Background: MemorialCare Medical Group (MCMG) designed and implemented an advanced health care practitioner (AHP)-led home-visit primary care program to address the needs of a frail older adult population, who struggled with arriving for in-office care. We sought to perform a preliminary analysis to determine the program's efficacy. Methods: We conducted a retrospective review of patients enrolled in the program through tabulation of total costs of care, inpatient visits (IPVs), emergency department visits (EDVs), and 30-day readmissions (30DRs) 1-year pre-enrollment and postenrollment. Results: For the prior year and postyear windows, per-member per-month total cost of care decreased 21.4% ($5,883.44-$4,622.31), reflecting a gross savings of $2,693,480.32. Mean IPVs (2.42-1.56), EDVs (1.53-0.93), and 30DRs (0.27-0.13) were reduced. Conclusions: Initial analysis of an AHP-led in-home primary care program for frail seniors shows promise for improved outcomes with a clear decrease in the total cost of care.

This second article in a series of three on land reuse highlights brownfields redevelopment in the U.S., focusing on regulatory frameworks, public health, policy, and sustainable development. The main regulatory agency in the U.S. involved in brownfields is the U.S. Environmental Protection Agency (U.S. EPA). Many other state and federal agencies have brownfield or brownfield-supporting programs. Apart from the Agency for Toxic Substances and Disease Registry, few agencies have programs fully dedicated to public health protection related to brownfields. Sustainable development, defined in this article as development that minimizes use of nonrenewable resources, is recognized as a component of redevelopment and is generally promoted by U.S. EPA and through other sustainable development initiatives. A broader focus on sustainable development and public health improvement could reduce the inequity and health disparities typically seen in areas with distressed environments. Such a focus could be implemented globally to improve population health and the environment over the long term.

This first article in a series of three on land reuse highlights sustainable brownfields redevelopment in Europe. Sustainability is a key European concept. Europe's densely populated urban areas are facing specific challenges that include urban sprawl and environmental pollution. Redeveloping brownfields, or reusing the abandoned built landscape, can positively impact the economic, social, and environmental health security of cities. Many European Union (EU) cities benefit from policy and financial assistance in renovating their urban areas. This article reviews the EU's policy and funding frameworks that support sustainable brownfields redevelopment. Brownfield site problems are common to many countries in Europe and around the world, and this article aims to share knowledge and resources that support the transformation of these abandoned or underused areas into public or private uses.

Internships are an essential component of preparing prospective college graduates for entering the practice-based field of environmental health (EH). EH professionals continually encounter events or hazards of high complexity and impact, and many experienced EH professionals are expected to retire within the next several years. Efforts are needed to ensure a supply of highly qualified and prepared graduates is available to sustain and strengthen the EH workforce. The National Environmental Public Health Internship Program (NEPHIP) addresses this need by supporting health department internships for EH students of academic programs accredited by the National Environmental Health Science and Protection Accreditation Council. We conducted an assessment to examine former NEPHIP intern and mentor experiences and perspectives on 1) how well the internships prepared interns for careers in EH and 2) to what extent the internships provided value to the host health department. Overall, the internships appeared to provide EH students with a well-rounded professional and practice-based experience, while health departments benefited from hosting interns with a foundational knowledge and college education in EH. Promoting the value of public health department EH internships could encourage more students and graduates to seek internship or employment opportunities with health departments, ultimately strengthening the EH workforce.

Background:Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations.Objectives:A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments.Methods:A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic.Discussion:EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161

Baylisascaris procyonis, the raccoon roundworm, is a zoonotic ascarid of importance to human and animal health. Wildlife rehabilitators who care for raccoons may be at an increased risk for exposure to the parasite, especially if proper precautions are not taken. In a wider effort to evaluate awareness regarding B.procyonis in the wildlife rehabilitation community, an online survey (38-39 questions) including questions about B.procyonis knowledge and attitudes was developed and administered to wildlife rehabilitators. To assess precautions taken among raccoon rehabilitators, participants who rehabilitated raccoons (n=447) answered additional questions about use of personal protective equipment (PPE) and infection control practices (ICPs). Reported use of gloves was variable, but hand hygiene was generally consistent. Masks and gowns were seldom used. Part-time or infrequent volunteers and rehabilitators located in the Central, Midwest and Southeast were significantly less likely to report consistent use of PPE. A total knowledge score from the survey was used to predict the likelihood of reporting the use of particular ICPs/PPE. Knowledge score had a highly significant but small effect on the likelihood of prophylactic use of anthelmintics, anthelmintics use for B.procyonis specifically, cleaning appropriately, and using species-dedicated housing. Risk factor analysis was performed on data from a prior serologic survey to evaluate factors associated with exposure to B.procyonis and inconsistent handwashing after contact with live raccoons and their faeces; practising rehabilitation in B.procyonis hyperendemic regions and practising rehabilitation in the western region were significant risk factors for being seropositive. These data further demonstrate that correct PPE/ICPs are critical in mitigating the risk of B.procyonis exposure among raccoon rehabilitators and among other captive species.