title: Examining the front lines of local environmental public health practice: a Maryland case study.
abstract: OBJECTIVE
  Local environmental public health (EPH) is the foundation of a nation's environmental protection infrastructure. With increasing pressure to demonstrate the ability of EPH activities to effectively protect health, the Johns Hopkins Center for Excellence in EPH Practice, as part of the Centers for Disease Control and Prevention's (CDC's) EPH capacity-building effort, developed the Profile of Maryland Environmental Public Health Practice. This profile offers an examination of front-line local EPH strengths, needs, challenges, and provides recommendations to strengthen the EPH infrastructure.
  
  
  METHODS
  A multistep process was conducted, including site visits to all of Maryland's 24 local EPH agencies and a questionnaire addressing administrative structure, communication, funding, workforce, crisis management, technology, and legal authority, completed by local EPH directors.
  
  
  RESULTS
  The Maryland Profile revealed a dedicated and responsive workforce limited by a neglected, fragmented, and underfunded EPH infrastructure. Recommendations regarding leadership, workforce, training, technology, communication, and legal authority are offered.
  
  
  CONCLUSIONS
  This research has implications for the national EPH infrastructure. Recommendations offered are consistent with the CDC's findings in A National Strategy to Revitalize Environmental Public Health Services. These findings and recommendations offer opportunities to facilitate the advancement of an EPH system to better protect the nation's health.
authors: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. bresnick@jhsph.edu
authors: Beth
authors: B
authors: Resnick
authors: Joanna
authors: J
authors: Zablotsky
authors: Keeve
authors: K
authors: Nachman
authors: Thomas
authors: T
authors: Burke
mesh_terms: D004189:Disaster Planning; D040381:Education, Public Health Professional; D004782:Environmental Health / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D009111:Local Government; D008396:Maryland; D019982:Organizational Case Studies; D011635:Public Health Administration / Q000191:economics / Q000592:standards*; D040442:Public Health Informatics; D015980:Public Health Practice / Q000191:economics / Q000592:standards*; D011795:Surveys and Questionnaires; D023481:Terrorism