When Lauren Baker enters a restaurant, she’s looking not for a meal, but for potential code violations.
As cooks shuffle around stoves and trays of food, she washes her hands, puts on gloves and a hairnet, and takes out her checklist. Then she begins going through the kitchen, poking food with a digital thermometer, looking for improper food handling and items stored out of place.
Baker is an environmental health specialist in Chatham County, one of eight counties in Georgia’s Coastal Health District. The job has become increasingly demanding: Even as the workload has risen, staffing has decreased due to a tight budget and recruitment difficulties.
“There are not enough hours in the day, nor are there enough people,” Baker said.
Most inspectors must do five inspections each working day to keep up, said Todd Jones, Chatham County’s environmental health director. In greater Savannah, the most populous part of the county, such a pace is usually feasible. “But in a rural area with 30 minutes between towns, you may only do one to three inspections per day,” Jones said.
In addition to doing inspections, part of the job of an environmental health specialist is educating business owners on how to keep their establishments up to code. But that takes additional time – a luxury the specialists don’t have. “We lose the educational piece,’’ Jones said. “We don’t want it to be about just getting your numbers in, but that’s what we’ve had to do.”
While environmental health specialists work largely out of public view, they take on the responsibility of preventing health hazards that encompass everything from bedbugs to unsafe water. These workers are currently struggling to keep up with state and local regulations because of financial and workforce problems.
“We don’t have the resources, and we are in a field that is highly under-recognized,” said Baker. “There are people that work within other departments of the health department that have no idea what we do, which is really frustrating.”
A vital job, and few people to do it
In Savannah alone, there are more than 1,200 restaurants, with only nine environmental health staffers conducting inspections. The state mandates that each restaurant be inspected twice a year, though the local county health board in Chatham requires quarterly inspections.
There are also 200 to 215 tourist accommodations that each must be inspected twice a year. Other state-mandated programs include on-site sewer and septic monitoring, public swimming pool inspections and rabies monitoring.
In addition to the state-mandated programs, environmental health specialists in the coastal health district are responsible for a wide range of duties: mosquito control, bedbug monitoring, inspections of tattoo parlors and tanning salons, childhood lead prevention programs, inspections of beach waters for dangerous bacteria, indoor air quality inspections and a new role — emergency support functions for disasters.
“The reason that environmental health gets called on for a lot of stuff is that we’re one of the few agencies in the state that has someone placed in each county,” said Todd Driver, district environmental health director for the Coastal Health District.
Whenever emergency shelters are established for hurricanes, tornadoes, floods or fires, environmental health staff will be involved to ensure the safety of food and the water supply in the shelters. In an emergency situation, these workers also supervise the evacuation of the special-needs population of the district.
“For the environmental health worker, that’s another thing that takes up a lot of their time on a day-to-day basis, especially for the managers but also the people below them that work in the field,” said Driver. If environmental health is involved in a disaster, other mandated programs could fall by the wayside for an indefinite period of time.
A staff stretched to the limit
Full-time environmental health positions in Georgia dipped from 447 to 398 between 2010 and 2011. There are currently five vacant positions in the Savannah office of the Coastal Health District alone.
When environmental health workers are not replaced, other staffers have to take on their duties. “When that work is absorbed by another staff member, the quality of work goes down because the staff is under so much pressure to get the state-mandated jobs done,” said Driver. “It affects public health at that point.”
Statewide, there was a 40 percent turnover rate in the environmental health profession last year, said Jones. When employees retire, those positions may not be filled due to both financial constraints and lack of qualified applicants.
“At this point, we’ve been able to sustain ourselves by doing more with less,” said Jones. “We’ve been depleted to little more than mandated services. No longer are some counties and districts able to assist homeowners with well testing, septic evaluation, food service training, insect/vector control, and general public health education.’’
Environmental health specialists are now simply restaurant, motel, pool and septic inspectors who collect revenues for these limited services, he said. In other areas of the state, programs such as West Nile virus surveillance, injury prevention, radon or mold/indoor air quality inspections can no longer be performed.
And recruiting new employees is obviously difficult when the job requires an unusually high level of education but offers low pay.
“The education level of the staff members here has to be extremely robust,” said Jones. “It’s really tough to recruit a college-educated, four-year science-degree graduate to come into public health at basically $26,000 a year,” he said. Entry-level salaries have stayed the same since about 2003.
Environmental health inspectors have to be proficient not only in science, but also in general engineering practices for pool safety and septic tank and well construction. They also inspect community gardens for dangerous levels of lead and enforce new no-smoking laws.
The high turnover rate is not surprising. Promotions for workers such as Lauren Baker have been delayed because of the strapped budget.
It also takes a lot of money and time to get a new environmental health employee ready to go out in the field alone. On-the-job training for one environmental health specialist costs roughly $45,000 over three years, according to Jones. Some employees use the training as a steppingstone and move on to higher-paying jobs.
Duties that are often unpleasant
When it comes to code enforcement, Baker said, “Nothing really surprises me anymore.” She has seen road kill being butchered in kitchens, cigarettes burning on counters, and dishwashers and walk-in coolers that didn’t work – all violations that were potentially dangerous to consumers. Other staffers have occasionally run into angry managers, found raw sewage being piped into ditches and even uncovered crystal meth labs in motels.
Such outrageous violations are not the norm, of course. Most businesses in the hospitality industry try to maintain decent standards. But even a few lax practices by generally well-meaning owners and employees can add up to a risk for the public.
Occasionally, environmental health inspectors have to make decisions that are hard on individual businesses. They make restaurants throw out large batches of food that violate inspection ordinances. When there is a bedbug infestation, they may have to force the shutdown of an entire floor of a hotel or motel.
“No inspector’s goal is to make you clear out all of your product. If it can be saved, I’ll work to save it, because that’s a lot of money,” said Baker. “If it’s ultimately between your dollar and the public’s health, I’m going to choose the public’s health and err on the side of caution.”
Defunding environmental health, or simply letting some positions go unfilled, could cost the public in the long run. “With each level of removal from public oversight comes a higher level of risk,’’ Jones said. “Our rate of foodborne illness in Savannah is extremely low, and I attribute that to the regulatory and educational practices that we employ.”
On the coast, where restaurants, beaches and hotels are vital to the tourist industry, maintaining a reputation for cleanliness is important.
Jones compared environmental health efforts to other means of prevention, like vaccines and seat belts, that the public is now accustomed to. If such preventive measures were to disappear, the public would probably see a rise in health hazards.
“It would be safe to say that there would be an increase in illness if we weren’t around,” said Driver.
This article is from the Public Health News Bureau, a project funded by Healthcare Georgia Foundation that is staffed by graduate students from the health and medical journalism concentration at the University of Georgia’s Grady College of Journalism.