Analysis of Environmental Health Program Performance and Environmentally-Related Disease in Florida

摘要

County health department, environmental health (EH) programs provide critical services that span across many subspecialty areas such as food safety and drinking water quality. A primary intent of providing these services is to prevent exposures to environmentally-related diseases. The 10 Essential Environmental Public Health Services (EEPHS) reach beyond the subspecialties to describe actions such as providing education and establishing policy that are necessary to achieve effective and efficient service delivery. There have been few efforts to conduct performance-based research for EH, and there has been no previous research to understand the association between EH program performance of the 10 EEPHS and environmentally-related disease rates. This study presented a unique opportunity to test the association between performance and disease rates using Florida county health department EH program performance self-assessment results and county level environmentally-related disease, described as enteric disease rates.;This cross-sectional study analyzed secondary data obtained from the Florida Department of Health (FDOH), county health department EH program performance self-assessments conducted between 2011 and 2014, the Florida Community Health Assessment Resource Tool Set, and U.S. Census. Bivariate correlation and regression analysis tested the relationships between EH program performance and enteric disease rates. The analysis also examined how EH program performance corresponded to community need in jurisdictions serving populations less than 100,000 and those serving populations of 100,000 and greater by pairing dichotomous performance and enteric disease risk variables in two by two tables.;Bivariate correlational analyses revealed weak correlation existed among all EEPHS and diseases. Statistical significance was noted between four EEPHS and two enteric diseases, cryptosporidiosis and salmonellosis. Regression analysis showed that performance of these four services caused minimal changes in enteric disease incidence when considering potentially confounding organizational characteristics. Observations among the two by two tables suggested that EH programs serving small and large jurisdictions primarily performed according to need or enteric disease risk, although statistical significance was only observed between performance and cryptosporidiosis in small jurisdictions.;Overall, this study showed relatively weak associations and limited statistical significance between EH program performance and enteric disease variables. Additionally, what appeared as an appropriate level of performance in response to enteric disease risk may have simply resulted from the potential influence of other community needs or, simply, disarray in EH program performance. However, there was indication that performance of the EEPHS could potentially impact enteric disease rates. FDOH EH programs may consider improving their performance of select essential services to address cryptosporidiosis and salmonellosis.;The study results may present implications for EH practice and policy by encouraging closer consideration of performance and its impact on health outcomes. Future research efforts might be strengthened by focusing on the performance of specific EH program areas such as food safety and diseases of a known source, identifying the most important health outcomes for EH programs, and understanding how community needs might influence performance. Continued efforts to establish a robust understanding of EH program performance and its relationship with environmentally-related disease and other health outcomes could support improvement in the nation's EH services delivery system and increase its positive impacts.