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Preparing public health at the front lines: effectiveness of training received by environmental health inspectors in the Caribbean

Environmental health departments in the Caribbean continue to contend with environmental 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 survival due to bottlenecks in public sector hiring that reduce the attractiveness of entering the profession. Interestingly, academic trainers and practitioners differ on the importance of certain knowledge sets, such as legal and court procedural skills and 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 contribute perspectives to the public health modernization discourse. Formal training programs 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.