The new challenge facing us and NEHA's response.

Up until maybe five years ago, we had a pretty good handle on the challenges facing our profession. Budgets for environmental health were tight and getting tighter. Discussions were occurring whose aim was to privatize various public services, including some within environmental health. Focus-group work that we were conducting was uncovering evidence of a growing culture of indifference within our ranks. We were hearing more and more about the need to develop better interpersonal and communication skills among our practitioners. Every NEHA member seemed to feel it was important for the visibility of environmental health to be raised in order to increase public respect and attention. And so on.

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What was particularly interesting about these challenges was that they had all been with us for some time. We understood them, and we were methodically working to make impressive progress through them. Given the lasting power of these challenges, we felt fairly secure that we knew what our agenda would be well into the future.

It was therefore difficult at first to appreciate the early indications that, indeed, a completely new and different challenge to our profession was arising.

From the outpost of academia, we began hearing, in surprisingly concerned voices, about declining attendance in accredited schools of environmental health. More specifically, from 1992 to 2003, enrollment in accredited environmental health programs declined by 42 percent, and the number of students graduating from these programs declined by 58 percent. What began as a whisper quickly developed into very loud concern over what these numbers could mean to the future practice of our profession.

As we were just beginning to appreciate the significance of this development and what we might do about it, some new and highly disturbing information about the other end of our professional "pipeline" began to trickle in. As with the news concerning enrollment, what we were hearing first came in as a scattering of barely detectable opinions. Soon, however, those isolated comments grew in number and substance and became yet another loud voice of concern.

This second wave of news dealt with the growing numbers of environmental health professionals who were nearing and reaching retirement age. It is now estimated that 40 to 50 percent of the state and local environmental health workforce will be eligible to retire in five to seven years. What made this development particularly striking, however, was the rate at which the concern was growing. And it didn't take long to understand why.

As state after state began to come to terms with monstrous budget deficits thanks to the recession, many began offering attractive early-retirement options. This event seemed to accelerate a natural process that was already under way--the retirement of many of the people who had given our profession its substance, its leadership, and its very face for years.

Whoa! At both ends of our profession, the front door and the back door, events were taking place that did not bode well for us. It is now pretty clear that we have a whole new challenge on our hands unlike any I've ever seen. So to the list I offered at the beginning of this piece, we must now add the challenge of the health and sustainability of our very workforce.

On the front end of our profession, we're not getting the numbers of qualified new people that we need. At the very time that the pipeline into our profession is beginning to dry up we're seeing an ever-increasing volume of professionals leaving our profession--and along with them go irreplaceable years of invaluable experience and knowledge.

This is serious stuff, especially when one considers what our profession is being asked to do in these early years of the new millennium.

Developing a capability to play a meaningful role in terrorism response and emergency preparedness is the obvious agenda item at the top of our list. Add to that the need to better understand and protect our communities from the impact of such new public health problems as West Nile virus, disease-resistant organisms, new strains of old diseases, and emerging health concerns such as E. coli, SARS, monkey pox, and hantavirus, etc. And we haven't even mentioned the other, nontechnical political and economic expertise that our profession needs in this era of budget deficits and the requirement that we do more with less.

As the demand on our expertise goes up, our numbers, our knowledge, our experience, and even our new and energetic blood all seem to be on the decline. To say the least, we can now confirm that we have yet another and significant challenge facing us.

It is important that NEHA's family be aware of this situation; hence my discussion. Since we all bear some responsibility for finding ways through this challenge, it is important that the challenge be identified so that we can know what we are up against.

It is also important that the NEHA membership know that NEHA has engaged the challenge and has taken specific steps to minimize the problems it is creating.

On the front end of the problem, we have endeavored to foster stronger and healthier relationships with academia and the organizations that represent both environmental health programs and faculty. At the same time, we have been heartened by a similar move on their part to forge stronger institutional ties with NEHA. It is a given that we can't serve the needs of this profession if we can't build and sustain a productive relationship between the institutions that prepare people to practice in this profession and the profession itself.

NEHA has served as a clearinghouse to facilitate the exchange of materials among those wishing to draw younger people into this profession. In addition, we have extended remarkably inexpensive ways for students to be a part of NEHA and to get a feel for what this profession is all about. NEHA also has participated in large mailings to graduating students that enthusiastically welcome them into their new careers. In these mailings, we have extended our hand to help in whatever ways we can. And, of course, for years we have generously provided financial assistance for deserving students to study environmental health through our scholarship program.

These gestures represent some of the measures that we have undertaken to help draw more students into the ranks of environmental health. I anticipate that this slate of activity will only increase in the years ahead as we make an increased effort to address the meager numbers showing up at the front end of our professional pipeline.

On the back end of the profession, our first obligation has been to say thank you to the many wonderful people who have given environmental health so many years of service and dedication. Our thank-yous and expressions of gratitude have been many.

While we can't prevent this large class of talented people from leaving environmental health, we can do more to prepare those currently working in this profession to assume the leadership positions that are becoming vacant--and we are.

NEHA played a huge role, for example, in the new Centers for Disease Control and Prevention (CDC) Emerging Leaders program this past year. In fact, we played a prominent role in identifying many of these promising professionals. Once identified, however, these special people need special encouragement. We have worked with CDC to extend that encouragement. As we consider what needs to happen next, we are pressing CDC to grant NEHA an even more significant role in this program. Our interest is in making the experience of emerging leaders as meaningful as possible for all involved.

On a related but different track, NEHA is also involved in the brainstorming discussions now taking place in connection with the new CDC initiative to build a leadership institute program especially for environmental health. However this program takes shape, NEHA wants to play a central role. We are doing everything that we can to gain such a role.

Although it might seem on the surface to be a cosmetic change, the policy decision to rename and refocus our environmental management section (into Environmental Health Leadership Development) was anything but. Within the association we have made a commitment to change the educational programming that we offer through this section to now focus much more on leadership development. We see that it is our responsibility and the responsibility of environmental health management throughout the country to think specifically in these terms. Our intention here is to help our existing management ranks develop the new leaders that are needed to replace the trove of talent now leaving us.

Our board of directors has also taken policy action to maintain the high standards that exist for defining what competence means in the practice of environmental health. For example, we have just recently reaffirmed the role of the R.E.H.S./R.S. credential to avoid any confusion over how this credential relates to other specialty credentials offered by NEHA. In an age when employers might be tempted to cut back on the qualifications required for the practice of environmental health (for financial reasons or to draw more people into this field), NEHA has taken the strong position that competence is not to be sacrificed or diluted.

In addition, NEHA is also participating with CDC--the nation's lead federal agency for public and environmental health--in various workforce development initiatives and programs. Anything that we can contribute to stem the problems occurring at each end of the environmental health pipeline becomes action deserving of our consideration.

My point in writing this has been threefold.

First, for anyone reading the Journal, we are talking about your profession and what is going on within it. It is important to be aware of how one's profession is evolving and where within it both problems and opportunities are occurring. Every practitioner in this field of practice has a stake in the health of this profession. If we can't sustain it and keep it strong, it could very well be the ground beneath your feet that will soon start to crumble. Everyone involved in environmental health is bound to be affected by these changes. We are working to minimize whatever downsides there may be to them.

Second, it is equally important to know that NEHA, your professional society, is active on a number of different fronts to respond to these new challenges. We are an association of very modest means. Within the limits of the resources we have, however, we have people playing active roles in many of the efforts now under way.

Finally, I think it is important for the profession as a whole to understand that standing up for the future well-being of environmental health is one of the major though often unspoken benefits that NEHA provides. Usually when we have a discussion about membership dues, we get the question, "What do I specifically get in return for my money?" We are often compelled to answer that question in tangible ways. For example, we talk about the Journal, membership discounts, and so forth.

Nevertheless, I would strenuously argue that having a voice, a partner, and an advocate beside you is another benefit that is every bit as important as the tangible benefits are. We represent your best interests as a practicing professional in this field. To the extent that we can influence environmental health for the better, we hope that every person practicing in this field will benefit.

Please tell that to the next nonmember you talk to--and encourage him or her to join. The larger our NEHA family is, the more we can do on behalf of this wonderful profession of ours. And with today's challenges being what they are, the actions we take to respond are as important as they could ever be.

Nelson Fabian, M.S.