Abstract
To identify effective strategies for improving epidemiology capacity in state chronic disease programs, staff epidemiologists and program directors from 25 states were interviewed using a structured questionnaire by phone or in person. Respondents reported three chief barriers to chronic disease epidemiology capacity: lack of institutional commitment and support for chronic disease epidemiology; lack of professional opportunities to engage with peers, colleagues, and scientists; and lack of trained epidemiology staff and resources to support chronic disease functions and activities. Epidemiology capacity in states would be improved by expanding the role and scope of staff placement programs; assisting states in establishing formal collaborations with academic institutions; and providing technical assistance to staff currently employed in states through training, consultation, and networking.
As chronic diseases evolved to become a leading cause of death and disability in the United States, federal, state, and local public heath agencies responded by developing prevention and control programs.1 In 1986, the Centers for Disease Control and Prevention (CDC) sponsored the first national conference on chronic disease prevention and health promotion. Two years later, CDC created the Center for Chronic Disease Prevention and Health Promotion. Today, the Center has a budget of approximately $1 billion annually, supporting state health department programs in breast and cervical cancer, diabetes, tobacco, cardiovascular disease, nutrition, and arthritis, among others.
In 1991, CDC began helping state health agencies establish new chronic disease epidemiology positions consistent with the philosophy and recommendations of the Institute of Medicine's Future of Public Health report2 that assessment is a core public health function. Healthy People 2010 reconfirms this vision in an objective to "increase the proportion of Tribal, State, and local public health agencies that provide or assure comprehensive epidemiology services to support essential public health services."3(p23-17)
Since 1991, CDC has provided staff or salary support to 25 states through what is known as the State-Based Epidemiology for Public Health Program Support (STEPPS) program. Thirteen states have received a CDC-employed epidemiology assignee. Twelve additional states have received funds to support the salary and benefits of a non-Federal-employed chronic disease epidemiologist, with eight of these states receiving support through funds awarded by a cooperative agreement from CDC to the Council of State and Territorial Epidemiologists (CSTE). The support generally lasts for four years, with an understanding that the state will begin funding the position at the end of that period.
In 2000, CDC, CSTE, and the Association of State and Territorial Chronic Disease Program Directors developed a strategic plan, "Developing State-based Chronic Disease Epidemiology Capacity Nationwide."4 The central objective of the plan is to establish a "State Chronic Disease Epidemiologist" position in each state health department by 2004.5 Although these three organizations have worked to increase state-based chronic disease epidemiology capacity, substantial gaps remain. According to a recent assessment, 17 states and the District of Columbia have no designated state chronic disease epidemiologist to ensure that essential chronic disease epidemiology functions are performed within the agency.6
In 2001, an evaluation of the STEPPS program was conducted as part of the cooperative agreement between CDC and the CSTE. The CSTE contracted, in Spring 2001, with the University of Wisconsin Madison Department of Population Health Sciences to conduct an evaluation of the chronic disease epidemiology placement activity and capacity in state health departments. The primary goal of the evaluation was to generate recommendations that would assist in the implementation of action steps in the strategic plan. The evaluation focused on the third strategy of the strategic plan, "Developing recommendations to help state health departments integrate chronic disease epidemiology functions and positions into their organizational structure."4 This paper describes key results and recommendations for the development of state-based chronic disease epidemiology capacity nationwide.7