Evaluation Capacity Assessment
The Epidemiology Capacity Assessment Workgroup is pleased to share the results of the 2019 Epidemiology Capacity Assessment Survey. The full length report can be found here, and a short summary of key findings and recommendations can be found here. This report provides an important snapshot into epidemiology capacity in Ontario prior to the COVID-19 pandemic. A web version of the Executive Summary can be found below.
This report summarizes the results of the 2019 Epidemiology Capacity Assessment project conducted by the Association of Public Health Epidemiologists in Ontario (APHEO). The project purpose was to enumerate the applied epidemiology workforce in the public health sector in Ontario, and to assess the extent to which current capacity meets public health mandates. The project was conducted in recognition of the value of such information for evidence-informed decision-making at a time of planned restructuring of the public health sector in the province.
The assessment was conducted via an eleven-question online survey (Appendix A), distributed to organizations with a public health mandate from the Ontario government, including 35 public health units, one provincial public health agency (Public Health Ontario), and two First Nations health authorities. Organizations were provided inclusion criteria (Appendix B) to determine which staff to include in the enumeration; one response per organization was requested. The survey was open for a period of approximately three weeks in November and December 2019.
Thirty-five of the 38 (92.1%) invited organizations responded to the enumeration survey, while two local organizations and Public Health Ontario did not respond. The summarized survey results are organized into seven parts in this report.
Part 1: Structure of workforce The majority of Ontario’s local public health organizations (31 of 35, 88.6%) have a centralized epidemiology structure. Of those, two-thirds have epidemiology and analytical staff that support all program areas, while the remainder have staff with specific portfolios or support specific program areas. One other organization had a decentralized structure, with epidemiology and analytic staff in program areas. Two of the remaining three organizations had a hybrid, while the other noted that their structure includes formal service agreements for epidemiology consultancy services with neighbouring health units.
Part 2: Staff enumeration In total, there were 166.8 epidemiology and analytic staff full-time equivalents (FTEs) in 34 responding local public health organizations across Ontario (mean: 4.9, median: 3.8, range: 0.5-25.0 FTE per organization). There
were 33 unique job titles reported, with the most common being Epidemiologist (97.1% of organizations), Health or Data Analyst (41.2%), and Manager or Supervisor (41.2%).
Fourteen of the local public health organizations surveyed had only one Epidemiologist FTE. In addition, one organization had less than one Epidemiologist FTE, while another had no Epidemiologists. The number of Epidemiologist FTEs per organization differed by peer group, with ‘mainly urban centres with moderate or high population density‘ tending to have more Epidemiologist FTEs compared to ‘mainly rural’ or ‘sparsely populated urban-rural mix’ areas.
Part 3: Local capacity to meet needs Insufficient capacity is a broad challenge affecting a variety of organizations serving populations of varying sizes. Two-thirds of organizations (23 of 35) reported being unable to meet their organizations’ needs with their current capacity. This varied by peer group, from 42.9% of ‘mainly urban’ organizations to 78.6% of ‘urban-rural mix’ organizations indicating insufficient capacity to meet needs. Organizations with sufficient capacity reported having more Epidemiologists (median: 2.0 vs. 1.0 FTE per organization).
Reasons for insufficient capacity included: insufficient FTEs, large volume of requests for data and support, complex data needs, management duties, vacant positions, and funding and political uncertainty. Insufficient capacity led to problematic outcomes including: inability to fully meet public health mandate, core activities not prioritized, or limited time to keep up with emerging issues, knowledge translation work or professional development.
Suggestions to improve epidemiology capacity included: additional FTEs, training for, and support from, non-epidemiology and analytic staff, technological solutions, improvements in data quality and management, organizational strategies for population health assessment and surveillance activities, and centralization of certain population health assessment and surveillance activities.
Part 4: Impact of external requests on capacity to meet local needs Sixty percent of organizations indicated external requests affect their ability to meet their own epidemiology needs. Organizations provide epidemiological support to a wide range of external partners, including from the health system, academics, government and local community organizations. Reasons for the impact included increasing volume or resource-intensity of requests, external partners having insufficient capacity or expertise, or external requests being prioritized higher than routine work.
Despite some challenges, some organizations noted there are benefits to working with external partners, including building relationships, building capacity and knowledge exchange, and shared priorities and efficiencies.
Part 5: Impact of requests for non-traditional epidemiology work About half of organizations said work outside the scope of traditional population health assessment and surveillance functions had an impact on their ability to meet their
own epidemiological needs. Examples of such requests included organizational or operational initiatives, provincial Ministry of Health reporting requirements, data visualization and knowledge translation beyond the typical scope of population health assessment and surveillance, technical projects, committee and engagement work, or research projects. Organizations noted an increasing volume of requests or resource intensity of such requests, insufficient capacity in other domains, or a reliance on the epidemiology skill set.
Some organizations do not experience impact from such requests because they get few requests, there are other staff or teams to do this type of work, or they ensure epidemiology and analytic staff only support work that is within scope. Some benefits of responding to such requests include the short-term impacts that can be outweighed by long-term improvements, and acknowledgment that epidemiology and analytic staff can make valuable contributions to these projects.
Part 6: Future scope of epidemiological work Some organizations anticipate changes for the future scope of epidemiological work in Ontario, including: that the scope and mandate of public health is growing and evolving, an increased emphasis on collaboration and reducing duplication, a need to improve data quality and data systems, a need for linking data systems, and evolving technology which presents both opportunities and challenges for public health.
For the local role, organizations anticipate the scope will include: local data collection, analysis, interpretation and decision-making, supporting local partners, greater collaboration between public health organizations, and specialization of epidemiology and analytic staff portfolios.
For the provincial or central role, organizations anticipate the scope will include: indicator development and standardized reporting, provision of data, tools and resources to local organizations, the development of provincial surveillance systems, specialized or technical support for local public health organizations, and provision of standardized analytical software.
Organizations identified potential challenges and concerns with the prospect of centralizing some analytical functions in the province, including: loss of local data contributions in decision-making, needs of smaller organizations being outweighed by needs of larger ones, disruption of existing relationships, and the cost associated with any removal of public health units that are currently embedded into regional government structure if there were plans to amalgamate.
Part 7: Training needs Organizations noted future training needs for epidemiology and analytical staff to continue to adapt to the needs of their organizations. Key areas include knowledge translation and data visualization, spatial analysis, data science and artificial intelligence, advanced epidemiological methods, effective public health practice, ‘soft skills’, health economics, data governance, and project management.
Discussion and limitations
This report provides the first-ever snapshot of the epidemiology capacity in the public health system in the province of Ontario, and a picture of the state of public health epidemiology in Ontario prior to the COVID-19 pandemic. The results point to both the important role that Epidemiologists play in population health assessment and surveillance activities, but also the critical collaboration of a wide range of job positions that together conduct and contribute to this foundational body of work in public health practice. The survey results also highlight the broad issue of insufficient epidemiology capacity that impacts a majority of local public health organizations across a variety of regions and characteristics. Key themes also emerged around issues with provincial data infrastructure and the opportunities and challenges posed by rapidly advancing technology. This enumeration provides useful evidence at a time of planned structural change to the public health system, and more broadly, serves as a baseline assessment for the public health epidemiology capacity in Canada’s largest province prior to the COVID-19 pandemic.
Some limitations of the survey include: a lack of inclusion of provincial level perspective, some varied interpretations of the enumeration inclusion criteria, or the meaning of some survey questions. Results also reflect the views and opinions of the individuals participating in the survey, and may not reflect the views of the whole organization. It is also important to reflect on the potential influence of the current public health system context when interpreting the results.
Recommendations and next steps
Based on the enumeration survey results, APHEO recommends:
Efforts should be made to ensure that local public health organizations have sufficient epidemiology and analytic staff and resources to ensure that organizations can meet the requirements for population health assessment and surveillance in their public health mandate.
Public Health Ontario (PHO) and the Ministry of Health should continue to strengthen efforts to engage local public health epidemiology and analytic staff in various population health assessment and surveillance initiatives.
Local public health organizations should adopt a formalized framework or business process to plan and prioritize population health assessment and surveillance activities.
Public health organizations need to ensure they have capacity in foundational areas that complement epidemiological work, including roles that may be new in the public health field (e.g. program evaluation, continuous quality improvement (CQI), knowledge translation, health informatics, data science).
APHEO and PHO should organize training opportunities in emerging and growing areas such as data visualization, spatial analysis, data science and artificial intelligence.
Organizations should ensure all staff have a foundational set of public health core competencies.
Epidemiology and analytic staff should have access to and training on modern analytic tools (e.g. GIS, data visualization and business intelligence software).
The province should proactively invest in efficient and effective provincial data infrastructure for the public health system.
PHO should create new and build upon existing opportunities for epidemiology and analytic staff to collaborate and share resources across the province.
PHO should continue and enhance efforts in centralized population health assessment and surveillance activities, including providing tools and resources to local public health organizations to build upon this work in a more efficient way (e.g. providing syntax for Snapshots).
PHO should enhance their support for projects requiring specialized technical expertise that is often outside of the capacity of local public health organizations (e.g. health economics, spatial analysis).
This 2019 enumeration survey provides a baseline measurement of the epidemiology capacity in the province of Ontario. It will be important to repeat the enumeration in the future in order to monitor how capacity may be impacted as the state of public health in Ontario continues to evolve. In particular, the APHEO Epidemiology Capacity Assessment Workgroup recommends conducting a capacity assessment following any restructuring of the public health system in Ontario, and after sufficient resolution of the emergency response to the COVID-19 pandemic has been reached.
This project will inform APHEO’s on-going work to advocate for and support its members, and continue in its mission to advance and promote the discipline and professional practice of public health epidemiology in Ontario.