New ECA Report Shows U.S. Has Shortfall of Health Detectives

New report shows U.S. has shortfall of health detectives, posing serious threats in future health emergencies

The ability of the U.S. public health system to protect us from current and emerging health threats is at stake.

October 7, 2024 — Today the Council of State and Territorial Epidemiologists (CSTE) and the Big Cities Health Coalition (BCHC) released the 2024 Epidemiology Capacity Assessment (ECA), which comprises two reports, one focused on states and the other on big cities.

The reports provide a comprehensive analysis of the applied epidemiology workforce in health departments across United States. The 2024 ECA reflects data from all U.S. states, the District of Columbia, and all territories. Comprehensive data are also available on the epidemiology capacity of 35 of the nation’s largest urban health departments. 

The reports reveal that applied epidemiology workforce and capacity needs in health departments remain unmet and are at risk of declining further. Epidemiologists play a critical role in public health by detecting and responding to numerous issues such as injuries and infectious and chronic diseases in our communities.

Key findings from the 2024 ECA include:

The number of epidemiologists has increased since the last assessment in 2021, but jurisdictions anticipate losing a significant number of epidemiology staff with the end of pandemic funding, leaving the U.S. unprepared to respond to looming threats, including H5N1 and Oropouche.

• With the end of COVID-19 funding, states anticipate losing over 1,000, or one-fifth, of their epidemiology workforce. Territorial and big city health departments also anticipate a significant loss of epidemiology staff.  
• Today, even before pandemic funding goes away, an estimated 3,400 additional epidemiologists are needed in state, territorial, and big city health departments to fully meet public health needs. 

The need for additional applied epidemiology staffing remains across all program areas in public health jurisdictions.

• The greatest number of applied epidemiology positions needed varies across states, territories, and big cities, with infectious disease and informatics being the greatest needs in states and big cities.
• States also have needs in chronic disease, maternal and child health, and environmental health; big cities in sexually transmitted infection; and territories in vector-borne/zoonotic diseases and healthcare acquired infections/antibiotic resistance.
• Almost 1,000 vacancies remain in state health departments, not including the number of positions needed to reach ideal epidemiology capacity. Even if all vacant state-level epidemiology positions were filled the number of positions would increase by only 37%, and still far short of the positions needed to fully deliver public health services. 

Across every state and territory, federal funding continues to pay for the vast majority of epidemiology activities and personnel. 

• Applied epidemiology workforce and capacity needs in health departments remain unmet and are in danger of declining without sustained federal funding.
• More than 80% of epidemiology activities and personnel in states and around one-third of funding in big cities is federally funded. Epidemiology activities in territories are almost solely funded by federal dollars.  

The report includes recommendations for policy makers, funders, health department leaders, academic partners, and other key sectors across six domains: data modernization and informatics; funding; collaboration and engagement; workforce pipeline; hiring, recruitment, and retention; and training. 

“Our applied epidemiology workforce is our greatest public health asset whose work identifies health threats and saves lives across communities every day. The 2024 ECA underscores the urgent need for more investment in public health infrastructure and in epidemiologists as a key sector of the workforce,” said Janet Hamilton, MPH, CSTE executive director. “By investing in the epidemiology workforce, we can better protect the health and well-being of all Americans. The most important way to do that is to continue to ensure sustained federal funding—but we all have a part in working together to address the needs of the people who work on the frontlines of public health to keep us healthy and safe.”  

“Epidemiologists are detectives who investigate threats to our communities’ health, so we need them every day, not just when emergencies strike,” said Chrissie Juliano, MPP, BCHC executive director. “Even at the height of the COVID-19 pandemic, big city health departments did not have the funding they needed to hire the necessary complement of epidemiologists. As emergency dollars end or are rescinded, the shortfall of these public health data experts threatens to grow even further.” 

The ECA is the most complete and comprehensive national data on the U.S. applied epidemiology workforce. For over 20 years, CSTE has reported on staffing, vacancies, funding, training needs, and other key domains, serving as the voice for applied epidemiologists, the cornerstone of the U.S. public health workforce. Data for the 2024 ECA were collected earlier this spring. 

For more information and to download the full reports, please visit https://eca.cste.org/.

This publication was supported in part by the CDC cooperative agreement number 1 NU38OT000297-02. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

###

About CSTE: CSTE is an organization of member states and territories representing public health epidemiologists and is the professional home for applied epidemiologists representing multiple levels of public health practice. CSTE works to ensure thriving and healthy people and communities everywhere and to advance public health policy and epidemiologic capacity and also provides information, education, and developmental support of practicing epidemiologists in a wide range of areas as well as expertise for program and data efforts. For more information visit www.cste.org.

About the Big Cities Health Coalition: The Big Cities Health Coalition (BCHC) is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 61 million people they serve. Together, these public health officials directly affect the health and well-being of nearly one in five Americans. For more information, visit bigcitieshealth.org.

CSTE Media Contacts: Amy Burnett Heldman, aheldman@cste.org; Matthew Cone, mcone@cste.org

Big Cities Health Coalition Media Contact: Elizabeth Green, egreen@bigcitieshealth.org