Environmental Health Practice Challenges and Research Needs for U.S. Health Departments

A regulatory framework for bottled water quality monitoring: A case of Emfuleni local municipality

Background

The quality of drinking water has recently become of utmost concern to consumers worldwide, especially in areas where Water Service Authorities (WSAs) failed to provide safe water. To combat this challenge, government entities regulate water to ensure that safe water is provided. The Emfuleni Local Municipality (ELM) has experienced cases of water contamination by human excretion, whereby communities were affected. As a result, there was a sharp increase in bottled water (BW) use, which however gave rise to unregulated and counterfeit versions of popular brands. This situation poses threats to public health.

Aim

This study sought to determine the regulation of drinking water and to assess whether environmental health practitioners (EHPs) monitor the quality of water sources (BW and tap water) in ELM as outlined by the National Environmental Health Norms and Standards (NEHNS).

Settings

The study was conducted in the Emfuleni Local Municipality in South Africa.

Methods

A quantitative cross-sectional study design was employed in this research. Fifteen online questionnaires using a Google Forms survey were distributed amongst all EHPs servicing ELM. Secondary data that included the Integrated Development Plan (IDP) and Service Delivery Budget Implentation Plan (SDBIP) for the 2017-2020 financial years were also evaluated, specifically for water quality monitoring (tap and bottled water). The dataset was analysed using the Statistical Package for the Social Sciences (SPSS) version 29.

Results

Due to complexity in the legislation and NEHNS in relation to Municipal Health Services (MHS), bottled water was not sampled at all. A number of EHPs were also not conversant with the regulations governing BW. Moreover, NEHNS consider bottled water as food, which does not fall under the MHS.

Conclusion

There should be clarity in the legislation to ensure that bottled water monitoring is intensified to protect public health within the WSAs.

Contribution

The findings of this study could assist policy-makers to make informed decisions on water quality monitoring, as well as clarify legislative issues on bottled water.

Rebuilding Caribbean Environmental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship

After the hurricanes in 2017 in the U.S. Caribbean, it was essential to rebuild, strengthen, and sustain essential environmental health (EH) services and systems. The National Environmental Health Association, in partnership with the Centers for Disease Control and Prevention, developed an online mentorship program for newly hired and existing EH staff and health department leadership in Caribbean health departments. Participants were provided with both practical and didactic learning and were allowed to evaluate the program. Both mentors and mentees were highly satisfied with the knowledge and skills acquired, and mentees expressed it was relevant to their daily work. Based on the findings, we recommend both an online and a hybrid mentorship program for leadership- and inspector-level workforces in EH and potentially in other fields.

A SWOT analysis of contemporary gaps and a possible diagnostic tool for environmental health in an upper-middle income country: a case study of South Africa

This study evaluated the state of environmental health in the Republic of South Africa using the strengths, weaknesses, opportunities, and threats (SWOT) analysis framework. The internal and external factor evaluations were conducted by reviewing existing literature searched using a combination of keywords and boolean functions. The weighted score for the strengths and weaknesses was 0.79 and 1.04, respectively. The external factor evaluations findings revealed that environmental health has an equal amount of threats and opportunities, however, the threats outweigh the opportunities. The total weighted score for the internal and external factor evaluations was 1.83 and 2.25, respectively, which were below the average value of 2.5. The internal-external factors matrix indicated that environmental health in the Republic of South Africa needs to be refocused and re-aligned to public health protection. Failure to address the weaknesses and threats and optimise the strengths and opportunities may further weaken the provision of environmental health services.

A Literature Review on the Role of Social Determinants in Post-Disaster Public Health

Introduction: Social determinants are closely related to public health disparities, and they affect health both directly and indirectly. Furthermore, social and economic conditions are often associated with a natural disaster that impacts people’s health. Methods: This study used the Pubmed database, Science direct, and Proquest through the keywords “Determinan Sosial; Kesehatan Masyarakat; Pascabencana (Social Determinants; Public Health; Post-Disaster)”. Furthermore, the studies found are open access, not a type of review and were filtered over the last five years. The Pubmed databases found 1308 studies, which were screened based on inclusion and exclusion criteria to obtain a total of 7 studies for review. Result: The role of social support shows a significant effect on a person’s stress symptoms. Moreover, environmental factors play an important role in post-disaster public health. Therefore, policies and countermeasures in disaster recovery need to continuously focus on health issues and social relations in the long term. Conclusion: Social determinants have an important role in post-disaster public health.

Ecosystemic Theory, Practice, and Policy: Training Recommendations for Environmental Public Health

The readiness of the public health workforce to deliver the essential public health services is benchmarked against training competencies. Consequently, it is expected that the establishment of the Council on Education in Public Health competencies will continue to drive the agenda of the learning continuum, from education to practice. However, the absence of environmental health as a listed competency in the Council on Education in Public Health accreditation criteria weakens the core public health program structure originally outlined by the National Academy of Medicine (formerly known as the Institute of Medicine) and could further dissolve environmental health content from schools and programs of public health. The authors have examined the literature on environmental health and public health education, and propose 3 overarching perspectives to employ from a theory, practice, and policy viewpoint to address this disconnect as follows: The current environmental health competency gap weakens the public health workforce infrastructure by creating graduates without the necessary science-based skills to protect communities from environmental threats. This departure from environmental health devalues the profession of public health and prohibits populations from reaching their full health potential. Practitioners, educators, and the public need to play a role in transforming siloes in environmental public health theory, practice, and policy into coherent learning ecosystems on which current and future populations can confidently depend.

Advancing environmental public health in Latin America and the Caribbean

This paper highlights the important leadership role of the public health sector, working with other governmental sectors and nongovernmental entities, to advance environmental public health in Latin America and the Caribbean toward the achievement of 2030 Sustainable Development Goal 3: Health and Well-Being. The most pressing current and future environmental public health threats are discussed, followed by a brief review of major historical and current international and regional efforts to address these concerns. The paper concludes with a discussion of three major components of a regional environmental public health agenda that responsible parties can undertake to make significant progress toward ensuring the health and well-being of all people throughout Latin America and the Caribbean.

Environmental Health Workforce - Essential for Interdisciplinary Solutions to the COVID-19 Pandemic

Interdisciplinary public health solutions are vital for an effective coronavirus disease 2019 (COVID-19) response and recovery. However, there is often a lack of awareness and understanding of the environmental health workforce connections and capabilities. In the United States, this is a foundational function of health departments and is the second largest public health workforce. The primary role is to protect the public from exposures to environmental hazards, disasters, and disease outbreaks. More specifically, this includes addressing risks relating to sanitation, drinking water, food safety, vector control, and mass gatherings. This profession is also recognized in the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019. Despite this, the profession is often not considered an essential service. Rapid integration into COVID-19 activities can easily occur as most are government employees and experienced working in complex and stressful situations. This role, for example, could include working with leaders, businesses, workplaces, and churches to safely reopen, and inspections to inform, educate, and empower employers, employees, and the public on safe actions. There is now the legislative support, evidence and a window of opportunity to truly enable interdisciplinary public health solutions by mobilizing the environmental health workforce to support COVID-19 response, recovery, and resilience activities.

Environmental Health Services and Professionals Level of Engagement in Different Sectors in Eastern Ethiopia: A Mixed Methods Study Design

INTRODUCTION

Environmental health (EH) services have a long history in Ethiopia, but data on environmental health services quality and the magnitude of environmental health professionals' engagement has never been addressed. This study was conducted to assess the quality of environmental health services in different sectors and professionals' level of engagement in Eastern Ethiopia.

METHODS

Institution based cross-sectional mixed study design was implemented. A cluster sampling technique was employed to select 83 participants. Data were collected using a pretested questionnaire and an interview guide. Descriptive, bivariate, multivariate, and thematic analysis was carried out.

RESULTS

Professionals' performance in most services were reported to be average or low. Only 19.5% of participants responded as having good satisfaction in their job. The multiple logistic regression analysis showed factors associated with selected environmental health services. The odds of identifying environmental problems was associated with profession (adjusted odds ratio (AOR): 4.1; 95% confidence interval (CI): 1.3-7.6) and level of education (AOR: 3.1; 95%CI: 0.9-5.9). The factors contributing to introducing innovative solutions to EH problems were type of institution (AOR: 3.1, 95%CI = 1.6-9.3), profession (AOR: 3.4, 95%CI = 1.1-12.2), and level of support and emphasis offered (OR: 5.6, 95% CI = 2.2-11.9). Level of job satisfaction was also associated with the above-mentioned independent variables.

CONCLUSION

The current study showed low level of professionals' engagement and factors associated with the quality of environmental health services in different sectors. Therefore, Ethiopian Federal Ministry of Health and other concerned ministries, agencies, and authorities should intervene accordingly to improve the service and level of professionals' engagement.

Exploring the Benefits and Value of Public Health Department Internships for Environmental Health Students

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.

Identifying Needs for Advancing the Profession and Workforce in Environmental Health

An ever-changing landscape for environmental health (EH) requires in-depth assessment and analysis of the current challenges and emerging issues faced by EH professionals. The Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health initiative addressed this need.After receiving responses from more than 1700 practitioners, during an in-person workshop, focus groups identified and described priority problems and supplied context on addressing the significant challenges facing EH professionals with state health agencies and local health departments. The focus groups developed specific problem statements detailing the EH profession and workforce's prevailing challenges and needs according to 6 themes, including effective leadership, workforce development, equipment and technology, information systems and data, garnering support, and partnerships and collaboration.We describe the identified priority problems and needs and provide recommendations for ensuring a strong and robust EH profession and workforce ready to address tomorrow's challenges.