Preparing public health at the front lines: effectiveness of training received by environmental health inspectors in the Caribbean
| Author | Kalim U. Shah |
| Published date | 01 September 2022 |
| Date | 01 September 2022 |
| DOI | http://doi.org/10.1177/0020852321994914 |
| Subject Matter | Articles |
Article
Preparing public health
at the front lines:
effectiveness of
training received by
environmental health
inspectors in the
Caribbean
Kalim U. Shah
University of Delaware, USA
Abstract
Environmental health departments in the Caribbean continue to contend with environ-
mental determinants of health related to an increasingly complex array of challenges,
including climatic change, disasters, pollution, bioterrorism, and global pandemics.
Building the human resource capacity to meet these challenges requires access to
modernized, context-relevant training, especially for environmental health inspectors
who interface with the public. This study focuses on the standardized Three-Step
training program delivered by education institutions across the Caribbean, which is
the primary training required by ministries of health for entry into the environmental
health inspectorate. A total of 22 focus groups were completed in five countries—
Barbados, Guyana, Jamaica, Saint Lucia, and Trinidad and Tobago—with 94 participants
drawn from the education institutions delivering training and the inspectors who have
received the training. Findings suggest: program strengths in core academic content;
weaknesses in faculty experts to deliver advanced subjects; opportunities for enhancing
field-training experiences in collaboration with ministries; and threats to program sur-
vival due to bottlenecks in public sector hiring that reduce the attractiveness of enter-
ing the profession. Interestingly, academic trainers and practitioners differ on the
importance of certain knowledge sets, such as legal and court procedural skills and
Corresponding author:
Kalim U. Shah, Joseph R. Biden Jr. School of Public Policy and Administration, University of Delaware, 111
Academy Street, Newark, DE 19716, USA.
Email: kalshah@udel.edu
International Review of Administrative
Sciences
!The Author(s) 2021
Article reuse guidelines:
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DOI: 10.1177/0020852321994914
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2022, Vol. 88(3) 826–842
International
Review of
Administrative
Sciences
epidemiological data analysis. As ministries of health in these countries contemplate
ways to modernize the inspectorates, these findings can guide how ministries and
education institutions work together to modernize the Three-Step training program.
Points for practitioners
Environmental health inspectors interfacing with the public are well placed to contrib-
ute perspectives to the public health modernization discourse. Formal training pro-
grams must be periodically and frequently recalibrated to societal needs and the state
of the art in subject area knowledge. Strengthening the local teaching institutions’
capacity to deliver relevant educational programs will translate into better-prepared
frontline professionals. Formal training lags in integrating some emergent subject areas,
such as climate change and environmental health determinants.
Keywords
Caribbean, environmental health, frontline workers, health inspectors, public health,
standardized training
Introduction
The modernization of public services in the Caribbean continues to be a challenge,
with slow, uneven gains over the last decade. Across the various island nations,
while public management systems may exhibit certain similarities of postcolonial
parallels, successes in adopting, for example, features of new public management
are largely dependent on heterogeneous government structures that have evolved,
the ways that government systems operate, and the state of the economy, among
other factors (Bissessar, 2002). This challenge is perhaps nowhere better exhibited
than in the field of public health services (Jules and Fryer, 2016).
This study is concerned with the subgoal of the United Nations Sustainable
Development Goal 3 (SDG3): “substantially increase health recruitment, develo p-
ment, training and retention of the health workforce in developing countries, espe-
cially in least developed countries and small island developing States.” The focus is on
environmental health, which is the assessment and management of environmental
influences on human health. This entails the study of food safety and hygiene, occu-
pational health and safety, community health, the built environment, and poll ution
control. The World Health Organization (WHO, 2020) currently estimates that 23%
of all global deaths could be attributed to environmental issues, such as air pollution,
poor sanitation, exposure to radiation, and other environment-related causes.
Three major functions for environmental health practice are assessment, policy
development, and assurance (CDC, 2011). Practice requires an understanding of
the connection between environment and health to know what needs to be done to
prevent some of the worst impacts of environmental exposures, as well as valuing
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Shah
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