Our Work


Since 2001, CSTE has conducted seven periodic Epidemiology Capacity Assessments (ECAs) to monitor the numerical strength and functional applied epidemiology capacity in state and territorial health departments.

The 2021 ECA was completed by the State and Territorial Epidemiologists from all 50 states, the District of Columbia, and four territories. This report represents the most complete and comprehensive national data on epidemiology workforce needs.


Key Findings


  • Major gaps exist in the applied epidemiology workforce despite recent growth due to surge staffing for the COVID-19 pandemic response.
  • An additional 2,196 epidemiologists are needed to deliver public health services in state and territorial health departments alone based on current operations, which would be a 53% increase in staffing. This does not account for epidemiology work force needs at the local or tribal levels.
  • Since 2017, infectious disease, chronic disease and maternal and child health all experienced a decrease in epidemiologists. The applied epidemiology workforce is concentrated primarily in infectious disease and COVID-19 response.
  • Most salary increases in career-level categories did not surpass the 7.9% inflation rate from 2017 to 2021, and many states struggled to stay competitive because their salaries ranged well below the national average.
  • Departments continue to rely heavily on federal funding for epidemiology activities and personnel.
  • Capacity to monitor and investigate health problems remains high, but evaluation and research capacity lag behind.
  • Similar to 2017, the greatest training priority remains data analytics.

For more details, please see the 2021 ECA Two-Pager Report and the ECA Executive Summary.

Background of the ECA


In 1995, CSTE spearheaded a national epidemiology workforce assessment effort and compiled a guide to aid states in assessment of their epidemiologic capacity. CSTE followed up this effort in 1997 with an assessment piloted in 10 states and in 2001 with the first ECA. The ECA was the first national assessment of core epidemiology capacity in state and territorial health departments. CSTE administered additional ECAs in 2004, 2006, 2009, 2013 and 2017. CSTE also conducted an epidemiology enumeration assessment in 2010 to determine the epidemiology workforce in both state and local health departments.

Uses of ECA Data


ECA data are paramount in CSTE’s advocacy efforts. Data from ECAs have been shared as Congressional hearing testimony in support of greater targeted funding for capacity development. ECA results help illuminate the status of state epidemiology efforts and assist our member states with targeting improvements in epidemiology capacity within their health departments. Future ECAs will attempt to continue capturing information about workforce capacity.

Local ECA with Big Cities Health Coalition


In 2017, CSTE first collaborated with the Big Cities Health Coalition (BCHC) to conduct a local Epidemiology Capacity Assessment to assess numeric and functional capacity in BCHC jurisdictions. An aggregate report of the 2017 findings can be found here. BCHC is a forum for leaders of America’s largest metropolitan health departments to exchange strategies and work together to promote and protect the health and safety of the 62 million people they serve. In 2021, the ECA was tailored for big city health department use and administered to the 30 BCHC jurisdictions. A total of 26 jurisdictions participated and highlighted the need for additional epidemiologists and to bolster capacity across a number of program areas. An aggregate report of the 2021 findings can be found here.

Key Findings

  • Big city health jurisdictions are heavily focused on infectious disease and COVID-19 response with less capacity in other program areas such as mental health, occupational health and genomics.
  • All program areas experienced a decline in the number of epidemiologists since 2017 except for the new program area of COVID-19 response.
  • Across BCHC jurisdictions, over a third of funding for epidemiology activities and personnel is provided by local sources with fewer federal dollars available than are to states.
  • Most jurisdictions have substantial capacity for monitoring health status and diagnosing and investigating health problems, whereas less than half have substantial capacity for research and evaluation.
  • Similar to 2017 and the state ECA, the highest training priority for BCHC jurisdictions remains data analytics.

ECA Reports


Resources