Abstract
OBJECTIVES: The Council of State and Territorial Epidemiologists (CSTE) has periodically assessed the epidemiological capacity of states since 2001, but the data do not reflect the total US epidemiology capacity. CSTE partnered with the Big Cities Health Coalition (BCHC) in 2017 to assess epidemiology capacity in large urban health departments. We described the epidemiology workforce capacity of large urban health departments in the United States and determined gaps in capacity among BCHC health departments. METHODS: BCHC, in partnership with CSTE, modified the 2017 State Epidemiology Capacity Assessment for its 30 member departments. Topics in the assessment included epidemiology leadership, staffing, funding, capacity to perform 4 epidemiology-related Essential Public Health Services, salary ranges, hiring requirements, use of competencies, training needs, and job vacancies. RESULTS: The 27 (90%) BCHC-member health departments that completed the assessment employed 1091 full-time equivalent epidemiologists. All or nearly all health departments provided epidemiology services for programs in infectious disease (n = 27), maternal and child health (n = 27), preparedness (n = 27), chronic diseases (n = 25), vital statistics (n = 25), and environmental health (n = 23). On average, funding for epidemiology activities came from local (47%), state (24%), and federal (27%) sources. Health departments reported needing a 40% increase from the current number of epidemiologists to achieve ideal epidemiology capacity. Twenty-five health departments reported substantial-to-full capacity to monitor health problems, 21 to diagnose health problems, 11 to conduct evaluations, and 9 to perform applied research. CONCLUSIONS: Strategies to meet 21st century challenges and increase substantial-to-full epidemiological capacity include seeking funds from nongovernmental sources, partnering with schools and programs of public health, and identifying creative solutions to hiring and retaining epidemiologists.