By Meagan Robinson Maynor, DrPH, MPH, Senior Program Manager, Epidemiology, Evaluation and Metrics, Association of Maternal & Child Health Programs (AMCHP)
Introduction
Maternal and child health (MCH) epidemiology has been defined as “the systematic collection, analysis, and interpretation of population-based and program-specific health and related data in order to assess the distribution and determinants of health status and needs of the maternal-child population for the purpose of planning, implementing, and assessing effective, science-based strategies and promoting policy development” (Phillips, Sappenfield, Handler, & Kogan, 2012). Epidemiologists often gather and interpret data to generate reports and information briefs on MCH topics and populations, including birthing persons, women, infants, children, adolescents, children and youth with special health care needs, families, and communities. Epidemiologists use the data for grant reporting and applications; program assessments; responses to leadership and legislative requests and actions; and to distill information for public review and use. MCH epidemiologists also engage with public health and its cross-sector partners to implement and evaluate programs to promote health, develop data-driven policies, and provide the foundations for meaningful collaborations with communities.
The public health landscape has greatly evolved due to the global pandemic impacts as well as a deserved focus on social justice and health disparity crises. As the public health landscape evolves, so must the functions and practices of public health practitioners, including MCH epidemiologists.
The Current State of the State-Level MCH Epidemiology Workforce
From 2017 to 2021, the number of epidemiologists in state health departments increased 23 percent, largely due to the need to respond to COVID-19; simultaneously, there was also evidence that the epidemiology workforce experienced substantial understaffing, especially in core program areas such as MCH epidemiology (Arrazola & Auer, 2022). According to the 2021 Epidemiology Capacity Assessment (ECA), a national assessment that evaluates trends in applied epidemiology workforce size, funding, and epidemiology capacity at state health departments, the number of MCH epidemiologists in the epidemiology workforce decreased and MCH epidemiology capacity concurrently decreased. Although maternal and child health epidemiology is the third largest epidemiology program area according to the 2021 ECA, MCH epidemiology positions accounted for only 7 percent (N=292) of epidemiology positions in the field (Figure 1). Since 2017, public health MCH has experienced a 9 percent decrease in epidemiology positions (from 321.2 positions in 2017 to 292.2 in 2021) while ranking fifth among public health program areas that need additional epidemiologists. The ECA assessed that 135 MCH epidemiologists are needed.
Figure 1. Full-time equivalent epidemiologist positions, by program area – Council of State and Territorial Epidemiologists Epidemiology Capacity Assessment, United States, 2021
Note. The table was created to depict the number of epidemiologist positions by program area. From “Assessment of Epidemiology Capacity in State Health Departments — United States, 2021” by J. Arrazola and S. Auer, Morbidity and Mortality Weekly Report (pp. 485), 2022, US Department of Health and Human Services, Centers for Disease Control and Prevention.
These workforce losses and shortages underscore the need to showcase the value and utility of MCH epidemiology and ensure that the field invests more in MCH epidemiologists. This also means that the work of epidemiologists needs to be budgeted for and integrated across health department programs. MCH epidemiologists also must be provided opportunities for skill-building and professional development to ensure their evolving needs, capacities, roles, and responsibilities are supported.
MCH Epidemiology in Practice
In 2023, the Council of State and Territorial Epidemiologists (CSTE) published the updated Applied Epidemiology Competencies (AECs), which align with the revised Core Competencies for Public Health with a particular emphasis on data science; communication science; pandemic preparedness; and diversity, equity, inclusion, and accessibility (DEIA) (Council of State and Territorial Epidemiologists, 2023) (Council on Linkages Between Academia and Public Health Practice, 2021).
The purpose of the AECs is to “define the role of an epidemiologist and serve as a resource for workforce development activities.” The CSTE plans to create an accompanying toolkit that will include evaluation tools, job description templates, career portfolios and training plans, interview questions, and other resources to help enhance the workforce and provide support for recruiting and retaining epidemiologists (Council of State and Territorial Epidemiologists, 2023).
Updates to the AECs are timely for MCH epidemiology because the field is becoming intertwined with social epidemiology and life course epidemiology.[1], [2] The updated competencies have a dedicated focus on health equity and DEIA. These competencies incorporate skills relevant to applying DEIA when identifying populations; designing, analyzing, and interpreting epidemiologic surveillance data; and implementing public health actions to ensure epidemiology leads with health equity.
Examples of competencies in practice include:
- AEC Competency Tier 3: 1.1.1, the identification of systematic and structural barriers that perpetuate health inequities;
- AEC Competency Tier 3: 1.3.1, evaluating cultural, environmental, historical, social, and structural factors that contribute to the health of populations; and
- AEC Competency Tier 3: 3.5.1, applying investigative methods that address the needs of the population (e.g., including application of principles of ethics, DEIA, and justice).
Applied competencies in MCH epidemiology provide a roadmap for enhancing workforce knowledge, skills, and abilities and developing current and future MCH epidemiology leaders.
Developing MCH Epidemiology Leaders
The Health Resources and Services Administration’s Maternal and Child Health Bureau developed the MCH Leadership Competencies to define the knowledge, skills, and values essential for leaders in the MCH field (Maternal and Child Health Bureau, 2023). Along with other competency frameworks in the public health field, the MCH Leadership Competencies were revised in 2023 to be more inclusive, appropriate, and reflect expanding knowledge in public health practice regarding health equity and DEIA.
The MCH Leadership Competencies should not only be a tool to guide professional development in the Leadership and Systems Thinking Skills Domain of the AECs, but also to provide guidance across the spectrum of AECs domains where MCH epidemiologists use data, perform analyses, and interpret findings to evaluate the impact of policy, program, and services on achieving epidemiology and MCH program goals and communicating those findings as subject matter experts to a variety of audiences. Along with the AECs, the MCH Leadership Competencies can be used to strengthen the leadership abilities and applied skills of MCH epidemiology professionals now and cultivate the future workforce.
Conclusion
As the public health landscape continues to evolve and the MCH knowledge base widens, MCH epidemiologists and the workforce pipeline must have adequate training, organizational supports, and professional competency frameworks in place to ensure epidemiologists are prepared and competent to inform, address, and assess the needs of MCH populations. Frameworks such as the Applied Epidemiology Competencies and the MCH Leadership Competencies align with the core public health functions, including monitoring, assessment, assurance, research, evaluation, and policy development. These frameworks can work in tandem to support the learning and application of new skills among current professionals and standards of training for new MCH epidemiology leaders.
Public health MCH programs have been experiencing the adverse effects of not having adequate staff to help ensure essential public health services that trained MCH epidemiologists can more than adequately perform. As a result, AMCHP is calling for alignment among public health MCH leaders to champion and invest in MCH epidemiologists as vital experts in the MCH public health workforce. We must work to develop equitable opportunities to recruit and retain a diverse array of MCH epidemiologists. A sustained, diverse MCH epidemiology workforce is needed to optimize the wellness and well-being of our MCH populations and address inequities and disparities adversely driven by the interaction of individual, social, and structural determinants of health. AMCHP plans to collaborate with our members and MCH organizational partners to address and implement strategies to reverse MCH epidemiology shortages. We hope that you will join us in this beneficial mission.
AMCHP Collaborators:
Cheryl L. Clark, DrPH, RHIA, Associate Director, Epidemiology, Evaluation and Metrics, AMCHP and Mikayla Charles, MPH, Program Analyst, Epidemiology, Evaluation and Metrics, AMCHP
References
Arrazola, J., & Auer, S. (2022, April 1). Assessment of epidemiology capacity in state health departments — United States, 2021. Morbidity and Mortality Weekly Report, 71(13), 484–488. doi:http://dx.doi.org/10.15585/mmwr.mm7113a2
Council of State and Territorial Epidemiologists. (2023). 2023 Applied Epidemiology Competencies. Atlanta, Georgia. Retrieved from https://www.cste.org/group/CSTECDCAEC
Council on Linkages Between Academia and Public Health Practice. (2021, October 21). Core Competencies for Public Health Professionals.Retrieved from Public Health Foundation: http://www.phf.org/corecompetencies
Maternal and Child Health Bureau. (2023). Maternal and Child Health Leadership Competencies. U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, Maryland. Retrieved from https://mchb.hrsa.gov/programs-impact/focus-areas/building-mch-leaders-mch-workforce/leadership-competencies
Phillips, G., Sappenfield, W., Handler, A., & Kogan, M. D. (2012, Dec). Promoting a trained MCH epidemiology workforce in state public health agencies through strategies developed from continued partnerships. Maternal and Child Health Journal, 16 Suppl 2(0 2), 376–380. doi:https://doi.org/10.1007/s10995-012-1095-7
[1] Social epidemiology is an epidemiology branch that focuses on the effects of social-structural factors on states of health.
[2] Life course epidemiology is an epidemiology branch that focuses on the study of long-term effects on later health or disease risk of physical or social exposures during gestation, childhood, adolescence, young adulthood, and later adult life.
