1. JOE GIBSON, DIRECTOR OF EPIDEMIOLOGY MARION CO. PH DEPT., INDIANAPOLIS, IN Local Health Department Epidemiology Capacity, 2009

2. Data Sources: 2008 LHD Profile Study Conducted by NACCHO 1 response per Local Health Department (LHD) Survey in field July-October, 2008 Sent to top executive of every LHD 83% overall response rate “Does your LHD currently employ staff in this classification?” Listed “Epidemiologist”, asked “# of FTEs currently employed” 72% response to this item 2

3. Data Sources: 2009 Epidemiology Capacity Assessment CSTE & NACCHO collaboration Slight variations from CSTE’s State ECA questionnaire 1 response per epidemiologist Survey distributed through one epi. at each LHD with any epi, based on NACCHO’s 2008 LHD Profile Study 472 point epidemiologists were contacted Responses received from 297 local epidemiologists, representing 33 states 3

4. LHD-level Response Rate LHD Size LHDs answeringLHD with ECA (Pop. Served)"Have any epis?“ 1 response 2 <25,00073761%716% 25,000-49,99942472%1328% 50,000-99,99933781%1930% 100,000-249,99927984%5036% 250,000-499,99910378%2734% 500,000-999,9998695%2937% 1,000,000+3793%1849% Total200372%16333% 1 % of 2008 Profile respondents 2 % of 2008 Profile respondents with “Any epis?” = Yes 4

5. Epi-level Response Rate LHD Size ECA Approx. ECA (Pop. Served)RespondentsResponse 1 <25,000728% 25,000-49,9991561% 50,000-99,9992151% 100,000-249,9995644% 250,000-499,9993933% 500,000-999,9997051% 1,000,000+8727% Total29537% 1 (ECA respondents) / (epi FTE reported in Profile) 5

6. Local Health Dept. Size & US Population Coverage 6

7. Epidemiologists Having MPH or PhD in Epidemiology 7

8. % of LHDs with any Epidemiologist 8

9. Epidemiology FTE per 100 LHD FTE 9

10. LHD Epidemiologists per Population 10

11. Epidemiologist Employment Characteristics Con->5 yrsRetire inHas acad. tractor in LHD <5 yrsappointment MPH or PHD5%73%12%21% No grad. epi. degree12%71%20%3% <25,00028%93%4%0% 25,000-49,9999%53%20%9% 50,000-99,9998%55%5%4% 100,000-249,99913%81%14%7% 250,000-499,9995%58%24%9% 500,000-999,9997%62%22%3% 1,000,000+2%84%14%31% Total7%73%15%14% 96% of represented epidemiologists were full-time 11

12. Programs Covered: Composite Epidemiologist (time spent per program) 12

13. Programs Covered: over 50% Epi. FTE IDBio TerrNon-epi Duties Masters or more53%10%2% Bachelor or less56%14%14% <25,00038%11%28% 25,000-49,99942%13%12% 50,000-99,99958%15%14% 100,000-249,99963%17%10% 250,000-499,99954%13%0% 500,000-999,99964%8%4% 1,000,000+48%8%4% Total54%11%7% None >50% effort on Occ. H, Oral H., or Subst. Abuse 0%-5% had >50% effort on MCH, Chronic, EnvH, Injury, Other Epi 13

14. % with Any Funding per Funding Source Fed. OtherAny BTCDCFed.Fed.StateLocalOther Masters or more2917539426510 Bachelor or less3722647435214 <25,00046540100273534 25,000-49,999551344049614 50,000-99,9993427448446521 100,000-249,9993914237386518 250,000-499,9993911843455010 500,000-999,9993912740336211 1,000,000+162263649626 Total3219542426012 14

15. Highlights ~2 out of 3 had MPH or PhD in epidemiology 30-40% in small to mid-size LHDs (25,000-250,000) 70-80% in large LHDs (250,000+) ~0.9 epi FTE per 100 LHD FTE, ~0.5 MPH/PhD epi FTE ~Twice that in 1,000,000+ LHDs: 1.7 & 1.3, respectively ~0.4 epi FTE per 100,000 pop, ~0.25 MPH/PhD epi FTE Increased with LHD size, 0.2 to 0.6 overall; 0.0 to 0.5 MPH/PhD 15

16. Highlights Very small LHD much more likely to contract for epi Retirements will shift epi balance toward MPH/PhD Academic appointments rare except in largest LHDs Infectious Disease work dominates epi work Followed by bioterrorism work Non-epi work especially likely for smaller LHD epis Small LHDs depend on federal funds for epi Especially dependent on bioterrorism federal funds Very smallest LHD less likely to have local or state funds for epi 16