2006 Community Health Services
System Staffing Summary Report
Introduction
The following report summarizes the results of 2006 staffing information for the
Community Health Services (CHS) System, which is submitted by Minnesota’s
local health departments to the Minnesota Department of Health. Local health
departments categorized staff by job classification and area of public health
responsibility. Areas of public health responsibility refer to health services,
healthy communities, infrastructure, environmental health, disaster preparedness,
and infectious disease. Complete explanations of the job classifications and areas
of public health responsibility are in appendixes A and B.
In 2006, there were 75 local public health reporting entities (referred to in this
report as local health departments) in Minnesota. Local health departments are
organized into 53 Community Health Boards (CHBs). CHBs decide for
themselves the jurisdictional level at which they will report their data. For
examples, a multi-county CHB could have each county in the CHB report as an
individual county or could choose to report collectively as one CHB. Of the 75
local health departments: 28 are single-county CHBs, 9 are multi-county CHBs,
34 are single counties within multi-county CHBs, and 4 are city CHBs.
The CHBs are split into geographic regions that are used for analysis. Appendix C
contains a map of the regions.
The analysis is based on the 75 local health departments, except for the per capita
staffing analysis. The lowest unit of per capita analysis used in this report is the
county level, therefore the four city CHBs (Bloomington, Edina, Minneapolis, and
Richfield) were calculated as part of Hennepin County.
The report is broken down into three sections:
•
•
•
Statewide results
Regional comparisons
Conclusion
The appendices include:
•
•
•
Areas of Public Health Responsibility
Definitions of the Job Classifications
Map of the CHS System
2006 Local Health Department Staffing Summary Report
Page 1 of 17
Statewide Workforce Results
In 2006, the CHS System employed 2803 FTEs (54 FTEs per 100,000 people), an
increase of 47 FTEs (or two percent) from 2005. No single local health department
(LHD) accounted for a significant portion of the increase. Twenty-four LHDs had a
decrease in the number of FTEs and 36 LHDs had an increase in FTEs.
The CHS System is supported by a variety of job classifications (Figure 1). Ninety-six
percent of LHDs employed public health nurses, accounting for 30 percent of the CHS
System workforce. Together, public health nurses and other nurses represented 40
percent of the workforce. The other largest job classifications included administrative
support (14 percent) and paraprofessionals (10 percent). Fourteen FTE epidemiologists
were in the CHS System workforce in 2006. Yet, only two local health departments
outside the metro region employed epidemiologists.
Figure 1. FTEs by Job Classification and Number of LHDs
with FTEs in each Job Classification
Number of
Percent of
Number of
Percent of
LHDs with
LHDs with
FTEs
Total FTEs
FTEs in job
FTEs in job
Job Classifications
classification
classification
Public Health Nurse
839
30%
72
96%
Administrative
404
14%
73
97%
Support
Other Nurse
293
10%
66
88%
Paraprofessional
273
10%
49
65%
Environmental
130
5%
31
41%
Scientist & Specialist
Public Health
118
4%
12
16%
Program Specialist
Public Health
116
4%
50
67%
Educator
Health Administrator
114
4%
73
97%
Administrative/
109
4%
53
71%
Business Professional
Public Health
82
3%
35
47%
Nutritionist
Epidemiologist
14
1%
9
12%
Other*
311
11%
58
77%
Total
2803
----------*includes health planner/researcher/analyst, interpreter, licensure/inspection/ regulatory specialist, medical and public health social
worker, mental health counselor, occupational safety and health specialist, dental worker, physical therapist, physician, servicemaintenance, technicians, and other public health professionals
2006 Local Health Department Staffing Summary Report
Page 2 of 17
Figure 2. Total FTEs by Local Health Departments
25
20
Number of Local Health Departments
20
15
15
15
10
9
8
5
4
4
0
<5
5-15
15-25
25-35
35-45
45-55
>55
Number of FTEs
Figure 2 shows the total number of FTEs by LHD. Nineteen LHDs (25 percent) had less
than 15 total FTEs. The median number of FTEs was 24 with a range of three FTEs to
361 FTEs. The largest LHD accounted for 13 percent of the all FTEs and employed more
FTEs than the 30 smallest LHDs combined. All but two of the LHDs employing more
than 55 FTEs were located in the metro region.
Figure 3. FTEs per 100,000 by Local Health Departments
30
24
Number of Local Health Departments
25
20
14
15
14
11
10
7
5
1
0
< 25
25-50
50-75
75-100
100-125
>125
FTEs per 100,000
2006 Local Health Department Staffing Summary Report
Page 3 of 17
Figure 3 represents the FTEs per 100,000 people. Twenty-five LHDs (35 percent) had
fewer than 50 FTEs per 100,000. The median number of FTEs per 100,000 for local
health departments in Minnesota was 71 with a range from 13 to 381 FTEs. The 12 LHDs
with the highest number of FTEs per 100,000 were located outside of the metro region.
Each of those LHDs provided home health services, which accounted for anywhere from
25 percent to 83 percent of total FTEs.
Figures 4 and 5 show the median number of FTEs working in LHDs in selected job
classifications by population size. To control for the effect of providing home health
services, Figure 4 presents LHDs that did not provide home health services and Figure 5
presents LHDs that provided home health services.
Figure 4. Median Staffing for LHDs by Size of Population Served
(LHDs that DID NOT provide Home Health Care Services)
Serving < 35,000
Serving 35,000-75,000
Serving > 75,000
11 FTEs, including:
24 FTEs, including:
80 FTEs, including
1 Health Administrator
2 Health Administrators
2 Health Administrators
2 Administrative Support
5 Administrative Support
10 Administrative Support
2 Other Nurses
3 Other Nurses
3 Other Nurses
3 Public Health Nurses
12 Public Health Nurses
22 Public Health Nurses
1 Administrative
1 Administrative
Professional
Professional
1 Health Educator
3 Health Educator
5 Environmental Health
Scientist/Specialist
1 Health Planner
2 Nutritionist
N=11
N=10
N=12
Figure 5. Median Staffing for LHDs
by Size of Population Served
(LHDs that provided Home Health Care Services)*
Serving < 35,000
Serving 35,000-75,000
24 FTEs, including:
39 FTEs, including:
1 Health Administrator
1 Health Administrators
3 Administrative Support
7 Administrative Support
3 Other Nurses
3 Other Nurses
7 Public Health Nurses
11 Public Health Nurses
1 Administrative
1 Administrative
Professional
Professional
1 Health Educator
1 Health Educator
4 Paraprofessionals
10 Paraprofessionals
N=29
*No LHD that served a
population over 75,000
provided home health
services.
N=9
2006 Local Health Department Staffing Summary Report
Page 4 of 17
Figure 6 shows the number of FTEs statewide working in each area of public health
responsibility. Not all LHDs had FTEs in each area. Below are brief summaries
examining the number and type of staff in each area of public health responsibility.
Figure 6. FTEs working in each Area of Public Health Responsiblity
Infectious Disease, 126
Disaster Preparedness, 140
Environmental Health, 191
Health Services, 1122
Infrastructure, 342
Healthy Communities, 881
Infectious Disease
In the CHS System, 126 FTEs (five percent) were reported as working in the area of
infectious disease. Nurses, including public health nurses and others, accounted for 56
percent of the staff in the area of infectious disease. Other professions included support
staff (16 percent), health planners (four percent), and public health educators (three
percent). It is important to note that one local health department accounted for 12 percent
of FTEs in the area of infectious disease. Two LHD had no FTEs in the area of infectious
disease.
Disaster Preparedness
Disaster preparedness FTEs accounted for five percent of all FTEs (140 FTEs) in the
CHS System. Twenty-one percent of disaster preparedness FTEs employed were public
health nurses. Other professions in the area of disaster preparedness included
environmental scientists and specialists (14 percent), health planners (12 percent) and
administrative support (11 percent). One LHD had no FTEs in the area of disaster
preparedness.
Environmental Health
Environmental health was staffed by 191 FTEs, or seven percent of the CHS workforce.
Almost 60 percent of those FTEs were environmental scientists and specialists. The
remaining occupations represented included licensure/inspection/regulatory specialists
(six percent) and health educators (four percent). It is important to note that two local
2006 Local Health Department Staffing Summary Report
Page 5 of 17
health departments accounted for 35 percent of all FTEs in environmental health. Eleven
LHD had no FTEs in the area of environmental health.
Infrastructure
Local health departments classified 342 FTEs as working in the area of infrastructure,
which accounted for 12 percent of all FTEs. Forty-one percent of FTEs were
administrative support. Health administrators (16 percent) and administrative/business
professionals (15 percent) also accounted for a high percent of FTEs. Seven of the
fourteen epidemiologists were classified as working in the area of infrastructure. One
LHD had no FTEs in the area of infrastructure.
Healthy Communities
Healthy Communities was staffed by 881 FTEs, or 31 percent of the CHS workforce.
Public health nurses accounted for 42 percent of FTEs in this area. Other staff in the area
of healthy communities included administrative support (12 percent), public health
nutritionists (nine percent), health educators (eight percent), and other nurses (eight
percent). One LHD had no FTEs in the area of healthy communities.
Health Services
The area of health services employed 1122 FTEs, encompassing 40 percent of all FTEs
in the CHS System. Over 400 FTEs worked in home health services, which accounted for
36 percent of all health services FTEs and 14 percent of all FTEs. Nurses, including
public health nurses and others, accounted for 49 percent of FTEs in health services.
Other staff included support staff (12 percent) and paraprofessionals (six percent). Sixtytwo percent of all other nurses and 42 percent of all public health nurses worked in health
services. All LHD employed FTEs in the area of health services.
Regional Comparisons
Figure 7 shows the total number of FTEs and the population breakdown for each region
in the state. The population in each region varies from less than 200,000 residents to
nearly 3 million residents. The metro region serves 54 percent of the population while
employing 42 percent of FTEs compared to the southeast, which serves nine percent of
the population while employing 15 percent of the FTEs.
Figure 7. 2006 Regional FTEs and Population as a Percent of the Total
Total
Percent of
Percent of
Population 1
Total
Region
Total FTEs
Total FTEs
Population
Central
362
13%
703,521
13%
Metro
1177
42%
2,821,779
54%
Northeast
162
6%
321,177
6%
Northwest
177
6%
199,109
4%
Southeast
407
15%
486,556
9%
Southwest/
South Central
360
13%
512,480
10%
West Central
157
6%
186,484
4%
2803
---5,231,106
---Total
2006 Local Health Department Staffing Summary Report
Page 6 of 17
Figure 8. 2006 FTEs per 100,000 by Region
100
90
89
80
84
84
FTEs per 100,000
70
70
60
50
51
40
50
42
30
20
10
l
tra
l
W
es
th
So
ut
hw
es
t/
So
u
tC
en
Ce
nt
ra
as
t
So
ut
he
N
or
th
w
es
t
st
th
ea
N
or
Ce
nt
ra
M
et
ro
l
0
Region
The number of FTEs per 100,000 people by region ranged from 42 FTEs per 100,000
people in the metro region to 89 per 100,000 people in the northwest region (Figure 8).
Some LHDs outside the metro provided home health services, which contributed to the
higher number of FTEs per 100,000 in greater Minnesota.
Figure 9 shows the number of FTEs working in each area of public health responsibility
by region. The area of health services accounted for the most FTEs in each region. For
example, in northwest region health services accounted for 61 percent of all FTEs. The
area of health services had between 33 and 46 percent of total FTEs for all other regions.
Central
Metro
Northeast
Northwest
Southeast
Southwest/
South
Central
West
Central
Total
Figure 9. Number of FTEs working in each Area of Public Health
Responsibility by Region
46
132
34
16
51
42
21
342
113
362
46
38
151
125
45
881
17
60
4
7
16
17
6
126
14
108
19
2
23
20
6
191
13
82
7
6
10
16
6
140
Health Services
158
434
53
108
156
141
72
1122
Total
362
1177
162
177
407
360
157
2803
Infrastructure
Healthy
Communities
Infectious Disease
Environmental
Health
Disaster
Preparedness
2006 Local Health Department Staffing Summary Report
Page 7 of 17
Conclusion
The information presented in this report provides an overview of local health department
staffing level, job classifications, and amount of staffing devoted to each of the six areas
of public health responsibility during 2006. In addition to providing a current picture of
Minnesota’s local public health workforce, looking at the annual Community Health
Services System Staffing Summary reports over time can provide a way to look at trends
and changes over time.
2006 Local Health Department Staffing Summary Report
Page 8 of 17
Appendix A:
Areas of Public Health Responsibility
2006 Local Health Department Staffing Summary Report
Page 9 of 17
Areas of Public Health Responsibility
Assure an Adequate Local Public Health Infrastructure
This area of public health responsibility describes aspects of the public health
infrastructure that are essential to a well-functioning public health system – including
assessment, planning, and policy development. This includes those components of the
infrastructure that are required by law for community health boards. It also includes
activities that assure the diversity of public health services and prevents the deterioration
of the public health system.
Promote Healthy Communities and Healthy Behaviors
This area of public health responsibility addresses the promotion of positive health
behaviors and the prevention of adverse health behaviors – in all populations across the
lifespan. It also includes activities that enhance the overall health of communities.
Prevent the Spread of Infectious Disease
This area of responsibility focuses on infectious diseases that are spread person to person,
not diseases that are initially transmitted through the environment, such as food, water,
vectors and/or animals. It also includes the public health department activities to detect
acute and communicable diseases, assure the reporting of communicable diseases,
prevent the transmission of disease (including immunizations), and implement control
measures during communicable disease outbreaks.
Protect Against Environmental Health Hazards
This area of responsibility addresses aspects of the environment that pose risks to human
health (broadly defined as any risk emerging from the environment), but does not include
injuries. This area also summarizes activities that identify and mitigate environmental
risks, including foodborne and waterborne diseases and public health nuisances.
Prepare For and Respond To Disasters, and Assist Communities in Recovery
This area of responsibility addresses activities that prepare public health to respond to
disasters and assist communities in responding to and recovering from disasters.
Assure the Quality and Accessibility of Health Services
This area of responsibility assesses health care capacity and access to health care. It also
addresses identification and reduction of barriers to health services. It describes public
health activities to fill health care gaps, reduce barriers and link people to needed
services.
2006 Local Health Department Staffing Summary Report
Page 10 of 17
Appendix B:
Definitions of Job Classifications
2006 Local Health Department Staffing Summary Report
Page 11 of 17
Job Classifications
The 2007 Staffing Glossary includes brief definitions and decision guidelines for the
titles in the expanded Bureau of Health Professions listing. The listing was
developed over the course of the enumeration project conducted by Columbia
University School of Nursing Center for Health Policy. These definitions have been
slightly modified to better describe with Minnesota’s public health workforce;
modifications have been noted. For the complete report, go to:
www.nursing.columbia.edu/chphsr/pdf/enum2000.pdf
Health Administrator
This single category encompasses all positions identified as leading a public health
agency, program or major sub-unit. This includes occupations in which employees set
broad policies, exercise overall responsibility for execution of these policies, of direct
individual departments or special phases of the agency’s operations, or provide
specialized consultation on a regional, district or area basis. Examples of occupations
include department heads, bureau chiefs, division chiefs, directors, deputy directors,
CHS administrator, public health nursing director, and environmental health director.
This does NOT include managers, supervisors, or team leaders.
Administrative/Business Professional
Performs work in business, finance, auditing, management and accounting. Individuals
trained at a professional level in their field of expertise prior to entry into public health.
Examples of occupations include office manager and accountants.
Administrative Support (Including Clerical and Sales)
Occupations in which workers are responsible for internal and external communication,
recording and retrieval of data and/or information and other paperwork required in an
office. Examples of occupations includes bookkeepers, messengers, clerk-typists,
stenographers, court transcribers, hearing reporters, statistical clerks, dispatchers,
license distributors, payroll clerks, office machine and computer operators, telephone
operators, legal assistants, secretaries, clerical support, WIC clerks, and receptionist.
Environmental Scientist and Specialist
Applies biological, chemical, and public health principles to control, eliminate,
ameliorate, and/or prevent environmental health hazards. Examples of occupations
include environmental researcher, environmental health specialist, food scientist, soil
and plant scientist, air pollution specialist, hazardous materials specialist, toxicologist,
water/waste water/solid waste specialist, sanitarian, and entomologist.
Epidemiologist
Investigates, describes and analyzes the distribution and determinants of disease,
disability, and other health outcomes, and develops the means for their prevention and
control; investigates, describes and analyzes the efficacy of programs and interventions.
Includes individuals specifically trained as epidemiologists, and those trained in another
2006 Local Health Department Staffing Summary Report
Page 12 of 17
discipline (e.g., medicine, nursing, environmental health) working as epidemiologists
under job titles such as nurse epidemiologist.
Health Planner/Researcher/Analyst
Analyzes needs and plans for the development of public health and other health
programs, facilities and resources, and/or analyzes and evaluates the implications of
alternative policies relating to public health and health care. Includes a number of job
titles without reference to the specific training that the individual might have (e.g. health
analyst, community planner, research scientist).
Interpreter
Individuals who translate information in one language to another language for public
health purposes. (This is not an official EEO-4/CHP/BHPr+ definition.)
Licensure/Inspection/ Regulatory Specialist
Audits, inspects and surveys programs, institutions, equipment, products and personnel,
using approved standards for design or performance. Includes those who perform regular
inspections of a specified class of sites or facilities, such as restaurants, nursing homes,
and hospitals where personnel and materials present constant and predictable threats to
the public, without specification of educational preparation. This classification probably
includes a number of individuals with preparation in environmental health, nursing and
other health fields.
Medical & Public Health Social Worker
Identifies, plans, develops, implements and evaluates social work interventions on the
basis of social and interpersonal needs of total populations or populations-at-risk in order
to improve the health of a community and promote and protect the health of individuals
and families. This job classification includes titles specifically referring to social worker.
(This category has been modified from the original occupational title and includes
“Mental Health/Substance Abuse Social Worker.”)
Mental Health Counselor
Emphasizes prevention and works with individuals and groups to promote optimum
mental health. This occupation may help individuals deal with addictions and substance
abuse; family, parenting, and marital problems; suicidal tendencies; stress management;
problems with self-esteem; and issues associated with aging, and mental and emotional
health. It can also provide services for persons having mental, emotional, or substance
abuse problems and may provide such services as individual and group therapy, crisis
intervention, and social rehabilitation. May also arrange for supportive services to ease
patients, return to the community. It includes such titles as community health worker and
crisis team worker. This category excludes psychiatrists, psychologists, social workers,
marriage and family therapists, and substance abuse counselors.
Occupation Safety & Health Specialist
Reviews, evaluates, and analyzes workplace environments and exposures and designs
programs and procedures to control, eliminate, ameliorate, and/or prevent disease and
injury caused by chemical, physical, biological, and ergonomic risks to workers.
Occupations include industrial hygienist, occupational therapist, occupational medicine
2006 Local Health Department Staffing Summary Report
Page 13 of 17
specialist and safety specialist. It also includes a physician or nurse specifically identified
as an occupational health specialist.
Other Nurse
Helps plan, develop, implement and evaluate nursing and public health interventions for
individuals, families and populations at risk of illness or disability. Other nurses include
nurses with the following titles: RN, NP, and LPN. A nurse that has a baccalaureate or
higher degree with a major in nursing and meets the requirements stated in Minnesota
Rules Chapter 6316 should be classified as a “Public Health Nurse.” (This is not an
official EEO-4/CHP/BHPr+ definition.)
Other Public Health Professional
This includes positions in a public health setting occupied by professionals (preparation
at the baccalaureate level or above) that do not fall under the specific professional
categories. (This category has been slightly modified from the original occupational
title.). Examples of occupations include physician assistant, laboratory professional,
EMS professional, intern, speech therapist, and public relations/media specialist.
Paraprofessionals
Occupations in which workers perform some of the duties of a professional or technician
in a supportive role, which usually require less formal training and/or experience
normally required for professional or technical status. This includes research assistants,
medical aides, child support workers, home health aides, library assistants and clerks,
ambulance drivers and attendants, homemaker, case aide, community outreach/field
worker, and advocate.
Public Health Dental Worker
Plans, develops, implements and evaluates dental health programs to promote and
maintain optimum oral health of the public; public health dentists may provide
comprehensive dental care; the dental hygienist may provide limited dental services
under professional supervision. This category is specific in its inclusion of only
employees trained in dentistry or dental health, but abnormally broad in that it neglects
the professional/technician distinction and includes the entire range of qualifications,
from dental surgeon to dental hygienist.
Public Health Educator
Designs, organizes, implements, communicates, provides advice on and evaluates the
effect of educational programs and strategies designed to support and modify healthrelated behaviors of individuals, families, organizations, and communities. This title
includes all job titles that include health educator, unless specified to another specific
category, such as dental health educator or occupational health educator.
Public Health Nurse
Plans, develops, implements and evaluates nursing and public health interventions for
individuals, families and populations at risk of illness or disability. This title only
includes public health nurses who meet the requirements stated in Minnesota Rules
Chapter 6316. Public health nurses must have a baccalaureate or higher degree with a
major in nursing. (This category has been modified from the original occupational title.)
2006 Local Health Department Staffing Summary Report
Page 14 of 17
Public Health Nutritionist
Plans, develops, implements and evaluates programs or scientific studies to promote and
maintain optimum health through improved nutrition; collaborates with programs that
have nutrition components; may involve clinical practice as a dietitian. Examples include
community nutritionist, community dietitian, nutrition scientist, and registered dietician.
Public Health Physical Therapist
Assesses, plans, organizes, and participates in rehabilitative programs that improve
mobility, relieve pain, increase strength, and decrease or prevent deformity of
individuals, populations and groups suffering from disease or injury.
Public Health Physician
Identifies persons or groups at risk of illness or disability, and develops, implements and
evaluates programs or interventions designed to prevent, treat or ameliorate such risks;
may provide direct medical services within the context of such programs. Examples
include MD and DO generalists and specialists, some of whom have training in public
health or preventive medicine. This job classification does not include physicians
working in administrative positions (health administrator or official) and some in
specialty areas (epidemiology, occupational health).
Public Health Program Specialist
Plans, develops, implements and evaluates programs or interventions designed to identify
persons at risk of specified health problems, and to prevent, treat or ameliorate such
problems. This job classification includes public health workers reported as public health
program specialist without specification of the program, as well as some reported as
specialists working on a specific program (e.g. AIDS Awareness Program Specialist,
immunization program specialist.) Includes individuals with a wide range of educational
preparation, and may include individuals who have preparation in a specific profession
(e.g., dental health, environmental health, medicine, and nursing).
Service-Maintenance
Occupations in which workers perform duties which result in or contribute to the
comfort, convenience, hygiene or safety of the general public or which contribute to the
upkeep and care of buildings, facilities or grounds of public property. Workers in this
group may operate machinery. This includes chauffeurs, laundry and dry cleaning
operatives, truck drivers, bus drivers, garage laborers, custodial employees, grounds
keepers, drivers, transportation, and housekeeper.
Technicians
This classification includes occupations that require a combination of basic scientific or
technical knowledge and manual skill that can be obtained through specialized postsecondary school education or through equivalent on-the-job training. Examples include
computer programmers, drafters, survey and mapping technicians, photographers,
technical illustrators, technicians (medical, dental, electronic, physical sciences),
inspectors, environmental health technician, nutritional technician, detox technician,
EMS technician, hearing and vision technician, laboratory technician, and computer
specialist.
2006 Local Health Department Staffing Summary Report
Page 15 of 17
Appendix C:
Map of the CHS System
2006 Local Health Department Staffing Summary Report
Page 16 of 17
2006 Local Health Department Staffing Summary Report
Page 17 of 17