Decreased staff to impact health programs
Lauren Baker walks into a restaurant prepared for potential code violations. As cooks shuffle around stoves and trays of food, she washes her hands, puts on gloves and a hair net, takes out her checklist and begins going through the kitchen poking food with a digital thermometer, looking for improper food handling and items stored out of place.
Baker is an environmental health specialist in Chatham County, one of eight counties in Georgia’s Coastal Health District. The job has become increasingly demanding as the workload rises while staff is in decline due to a tight budget and recruitment difficulties.
“There are not enough hours in the day nor are there enough people,” said Baker.
Most inspectors must do five inspections each working day to keep up, said Todd Jones, Chatham County’s environmental health director. This is usually possible in the Savannah area. “But in a rural area with 30 minutes between towns, you may only do one to three inspections per day,” Jones said.
Part of the job of an environmental health specialist is to educate business owners on how to keep their establishments up to code, which takes more time – a luxury specialists don’t have. “We lose the educational piece. We don’t want it to be about just getting your numbers in, but that’s what we’ve had to do,” said Jones.
While environmental health specialists work largely out of public view, they take on the responsibility of preventing health hazards that encompass everything from bed bugs to water quality. Environmental health is currently struggling to keep up with state and local mandated regulations because of financial and workforce problems.
“We don’t have the resources and we are in a field that is highly under-recognized,” said Baker. “There are people that work within other departments of the health department that have no idea what we do, which is really frustrating.”
Environmental health expands role at county level
In Savannah alone, there are between 1240 and 1290 restaurants depending on openings and closings, with only nine environmental health staff conducting inspections. The state mandates that each restaurant be inspected twice a year, though the local county health board in Chatham requires quarterly inspections.
There are also between 200 and 215 tourist accommodations that must be inspected twice a year. Other state-mandated programs include on-site sewer and septic monitoring, public swimming pool inspections and rabies monitoring.
But that’s not all they do. In addition to the state mandated programs, environmental health specialists in the Coastal health district are responsible for a wide range of duties: mosquito control, bedbug monitoring, inspections of tattoo parlors and tanning salons, garbage ordinance, childhood lead prevention programs, inspections of beach waters for dangerous bacteria, indoor air quality inspections and a new role in emergency support functions as part of the National Response Framework (NRF) for disasters.
“The reason that environmental health gets called on for a lot of stuff is that we’re one of the few agencies in the state that has someone placed in each county,” said Todd Driver, district environmental health director for the Coastal health district.
If emergency shelters are established under any circumstance – hurricanes, tornadoes, floods or fires – environmental health staff will be involved to assure the safety of food and the water supply in the shelters. In an emergency situation, environmental health would also evacuate the special needs population of the district.
“While the responses are intermittent, the training is not intermittent,” said Doug Skelton, M.D., director of the Coastal health district. “There have been a lot of training activities that involve our people.”
“For the environmental health worker, that’s another thing that takes up a lot of their time on a day to day basis, especially for the managers but also the people below them that work in the field,” said Driver. If environmental health is involved in a disaster, other mandated programs could fall to the wayside for an indefinite period of time.
Doing more with less
Full-time environmental health positions in Georgia went down from 447 to 398 between 2010 and 2011. There are currently five vacant positions in the Savannah office of the Coastal health district alone.
When environmental health workers are not replaced, other staff has to take on those duties. “When that work is absorbed by another staff member, the quality of work goes down because the staff is under so much pressure to get the state-mandated jobs done,” said Driver. “It affects public health at that point.”
In the last year on a state level there was a 40 percent turnover rate in the environmental health profession, said Jones. He expects in the state office alone – this year and in the next two years – that five out of 10 employees are going to retire. Those positions may not be filled due to both finances and lack of qualified applicants.
“At this point, we’ve been able to sustain ourselves by doing more with less,” said Jones. “We’ve been depleted to little more than mandated services. No longer are some counties and districts able to assist homeowners with well testing, septic evaluation, food service training, insect/vector control, and general public health education. Environmental health specialists are now simply restaurant, motel, pool and septic inspectors that collect revenues for these limited services. In other areas of the state, programs such as West Nile surveillance, injury prevention, radon or mold/IAQ can no longer be performed.”
Although additional environmental specialists are needed to fill gaps in the workforce, the combination of low pay and the need for a high level of education make it difficult to find the right person for the job.
“The education level of the staff members here has to be extremely robust,” said Jones. “It’s really tough to recruit a college educated, four-year science degree graduate to come into public health at basically $26,000 a year,” he said. Entry-level salaries have stayed the same since around 2003.
Environmental health inspectors have to be proficient not only in science, but also general engineering practices for pool safety and proper septic tank and well construction. They also inspect community gardens for dangerous lead levels and enforce new no-smoking laws.
The high turnover rate is not surprising. Promotions for workers like Lauren Baker have been delayed because of the strapped budget. Environmental health specialists in the Georgia Coastal health district are paid less than their counterparts in other states as well as other agencies in Georgia, such as the Environmental Protection Agency (EPA) and the Department of Natural Resources (DNR), who are one pay grade higher despite working with similar environmental compliance issues.
It also takes a lot of money and time to get a new environmental health employee ready to go out in the field on his own. On-the-job training for one environmental health specialist costs between $44,000 and $46,000 over three years, according to Jones. Some employees use the training as a stepping-stone and move on to higher paying jobs.
“We are marginally adequate with very dedicated environmental health professionals,” said Skelton. “There are more things that we could do, and things that we are doing now that we could do better with a few more staff.”
Regulation and Education
When it comes to code enforcement, Lauren Baker said, “Nothing really surprises me anymore.” She’s seen road kill being butchered in kitchens, cigarettes burning on counters and dishwashers and walk-in coolers that didn’t work – all violations that are potentially dangerous to consumers. Other staff occasionally run into angry managers, raw sewage being piped into ditches and even crystal meth labs in motels.
Environmental health inspectors have to make restaurant managers and workers throw out large batches of food that violate inspection ordinances. With bed bug infestations, an entire floor of a hotel or motel can be shut down.
“No inspector’s goal is to make you clear out all of your product. If it can be saved, I’ll work to save it, because that’s a lot of money,” said Baker. “If it’s ultimately between your dollar and the public’s health, I’m going to choose the public’s health and err on the side of caution,” said Baker.
“A lot of restaurant managers think we are the bad guy,” said Trista Best, another environmental health specialist in Savannah. “Really we want to work for them, too, because if they make someone sick they could lose their business.”
Environmental health workers are as much educators as they are regulators when it comes to protecting public health. “My philosophy has always been 50 percent education and 50 percent regulation,” said Jones. “We do have mandated things that are black and white, but you are not doing your job as an environmental health specialist if you are not giving them the ‘why’ behind the regulation.”
Importance of prevention
Defunding environmental health or leaving vacant positions unfilled could cost the public. “With each level of removal from public oversight comes a higher level of risk. Our rate of food borne illness in Savannah is extremely low, and I attribute that to the regulatory and educational practices that we employ,” said Jones.
“Environmental health in itself is prevention. To quantify or place a metric on prevention is virtually impossible,” he said.
On the coast, where restaurants, beaches and hotels are vital to the tourist industry, maintaining a clean reputation is important. “Environmental health is a critical part of the infrastructure for economic development in this area,” said Skelton.
Jones compared environmental health to other preventions like vaccines and seat belts that the public is now accustomed to. If those prevention measures disappeared, the public would likely see a rise in health hazards.
“It would be safe to say that there would be an increase in illness if we weren’t completely around,” said Driver.
- Photo courtesy of the Coastal Health District in Savannah, Ga. Editor's Note: This article is the latest in a series developed by the Public Health News Bureau, a project funded by Healthcare Georgia Foundation. The Bureau provides information about the state’s public health system that is distributed via the Partner Up! For Public Health advocacy campaign.