A health department is a biosurveillance organization and, as such, requires the expertise of many of the professions listed in Table 1.1 (Chapter 1). Although physicians working in health departments play a large role, epidemiologists, as well as specialists in laboratory medicine, play a prominent and expanding role.
Until the 1970s, virtually all epidemiologists were physicians. Physicians working in health departments generally have both a medical and public health degree, and they may specialize in particular fields, such as sexually transmitted disease or vector-borne disease. From their medical training, they have expertise in the diagnosis and treatment of disease, and their public health education trains them in the methods of outbreak detection, investigation, and characterization. Many hold administrative positions that require them to concentrate on business-related issues rather than disease investigations.
Epidemiologists have expertise in the recognition of disease outbreaks in populations (epidemics). Epidemiologists receive training that is distinct from medically trained physicians, who are trained to recognize disease in an individual rather than a population. The training of an epidemiologist may include courses on questionnaire design, infectious disease epidemiology, and epidemiological methods. Their training also includes substantial coursework in statistical analysis, because recognition of outbreaks is accomplished largely by examination and interpretation of data, rather than of individual patients (although substantial knowledge of communicable and infectious diseases is also required).
Laboratorians receive different levels of training. A microbiologist often has a doctoral degree. Medical technologists, who conduct laboratory tests, typically hold a bachelor's degree with a major in medical technology or in one of the life sciences, or they have a combination of formal training and work experience (American Medical Technologists, n.d.).
Though nearly 300,000 medical technologists currently work in the United States today (American Medical Technologists, n.d.), only a small and insufficient percentage work in public health, as evidenced by the introduction of the Medical Laboratory Personnel Shortage Act of 2005 (Shimkus, 2005) The technologists provide support for epidemiological studies and are a critical component of the disease surveillance resources of the public health infrastructure. Their work is important for disease surveillance, reporting, and recognition of infectious or toxic agents in populations and their environments. We discuss laboratories and the personnel who work in them in detail in Chapter 8.
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