California's county and city environmental health services delivery system.

The purpose of the authors' research was to assess the current status of county and city environmental health service delivery in California with the aim of providing a foundation for informed decision making about environmental health service delivery. Standardized interviews were conducted from March 2005 to May 2005 with 55 (88 percent) of the 62 county and city directors of environmental health; their jurisdictions represented 90 percent of the state's population and 94 percent of the landmass. Relevant databases and other publicly available information germane to project goals were also evaluated. The directors who were interviewed reported a total of 2,477 professional environmental health staff employed in county and city agencies, complemented by 520 support personnel. Percentages of respondents reporting technical-training needs were greatest for Certified Unified Program Agency (CUPA) activities (60 percent), dairy programs (57 percent), and septic-system programs (55 percent), while nontechnical training was desired in conflict resolution (55 percent), written/oral communication (49 percent), and problem solving (49 percent). Sixty-seven percent (67 percent) of directors reported difficulty in recruiting qualified applicants. Fifty-six percent (56 percent) were familiar with the 10 essential services of environmental health, while only 11 percent collected and reported health outcome measures to demonstrate agency effectiveness. The study team concluded that at the local level, environmental health services are largely provided as a reflection of local need; however, this tendency toward customization leads to stakeholder confusion about the purpose and value of environmental health services. The authors offer seven recommendations for improving environmental health services in California. Many of these recommendations can be generalized to the nation at large.