ties with limited resources and too few staff (the median size is 14 full-time equivalents). Although local public health services are often discussed within the framework of the 10 Essential Public Health Services, the services actually provided vary widely from state to state, from urban to rural areas, and are especially adapted to address local priorities and concerns. Despite considerable variation, however, more than two-thirds of local health departments provide the following core services: adult and childhood immunizations; communicable disease control; community outreach and education; epidemiology and surveillance; environmental health regulation such as food safety services and restaurant inspections; and tuberculosis testing (NACCHO, 2001).

The past decade has been a period of significant challenges and transitions in local public health. For many LHDs, resources for some traditional services have been shrinking at the same time that challenges and demands have been increasing. More people lack health insurance and are looking to “safety net” providers for health care. Rapidly growing immigrant communities are creating a need for new services or for providing traditional services in a different way. Many LHDs are shifting from “personal health care” services to “population-based” services. In the aftermath of bioterrorism, health departments have greatly increased disease surveillance activities and are now at the center of many of the federal, state, and local emergency planning activities. With these challenges and changing circumstances, there is increasing urgency for an assessment of how new public health professionals are educated and how the current workforce can be trained for new skills. The education and training of the public health workers poses a difficult challenge to local health departments, one for which they will require the engagement and support of many partners, most notably the schools that educate health and public health professionals.

Training and Education in Local Health Departments

LHDs have serious and urgent needs for preparing new public health professionals and for upgrading the skills of current public health professionals (NACCHO, 2001). They face an on-going need to train new and current workforces in how to respond to emerging areas, changing diseases, new priorities, and new technologies. Because LHDs are experiencing significant changes in the types of services they provide and the roles they are expected to fulfill, education and training are needed to prepare new and current local public health staff to meet these changing expectations.

As discussed earlier, the vast majority of current public health workers do not have formal public health training. Many have training in a primary health profession, such as nursing or environmental health, and



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