545568 editorial2014



Global public health workforce Welcome to this bumper issue of Perspectives where we consider public health from a global aspect. As the world population undergoes demographic, social, economic and epidemiological change, challenges facing each country in some cases are the same, but in some, they are specific and unique to that population. By providing a kaleidoscope of case studies of local evidence from around the world, scenarios are presented where there is opportunity to learn from others. The papers published here help us achieve a better understanding of the external environment in which we are working and really speak to the core aspects of the Royal Society for Public Health in the commitment to improve public health and make a difference to society as a whole. We are fortunate to welcome submissions from the United Kingdom, India, Australia, Spain, Canada, Malawi, United States and Bangladesh, and we thank Dr Eugenia Cronin for recruiting such a rich international resource and for guest editing this special issue. While most countries are following a strategy of inclusivity for health care and reducing social inequalities as in Canada, it is interesting to note that recent reforms in Spain specifically exclude a portion of the population; irregular immigrants and even some Spanish citizens will only have limited access to health services, presenting a new challenge to public health professionals. Added to this is the fragmented nature of a decentralized structure of public health and the lack of a national public health workforce as there are no national databases or registries. These emerging challenges in Spain necessitate a reappraisal of the organization of public health professionals, the preparation of public health workers as well as the development of workforce planning tools to assure that future needs can be met. There is a somewhat similar situation in the United States where public health is a federated enterprise that includes national entities such as the Centers for Disease Control and Prevention, the Food and Drug Administration, state and local governmental health departments and non-governmental organizations at the national, state and community levels. These are organized around single or multiple health-related issues but make for an uncoordinated national public health workforce response. Notwithstanding, similarities are also seen in the United Kingdom where restructure has complicated the professional and career landscape by introducing a panoply of different employers, such as the 152 local authorities across England and many organizations from the voluntary sector, each with their own employment structures, needs and priorities. However, a solution has been proposed in the form of a ‘skills passport’ as recognition of the need for a tool to help employees navigate and plan careers in, and across, this complex environment. Skills passports are a record of a person’s training, education and vocational experience, usually held on a central hosted website, offering a structure and mechanism for personal career and workforce development. Another UK initiative is seen in the form of a proposed assessment and registration of public health practitioners, and an evaluation of such a programme is presented in this issue from Wessex.1 Other case studies are provided of Community Health Workers where for some, such as those from India,2 there is a challenge with regard to the dropout rate, whereas in Bangladesh, there is a promising initiative demonstrating good recruitment and retention leading to improved health system performance and health outcomes. In Malawi, the Community Midwife Assistant programme aims to replace traditional birth attendants with a more skilled workforce and reduce maternal mortality, especially in remote areas. Again, the challenge here is to implement a decentralized model of delivery at primary health care level, but this investment demonstrates a country wide commitment to skills development and quality of care. Currently, while working in France, I have been exposed to this country’s efforts with regard to population health. The French government has just given the go ahead for a year-long study to provide current statistics on the wellbeing of French people, in order to redirect public resources towards better-suited public health programmes which will also complement the European Health Examination Survey. The study, titled ‘Esteban’ (Health study on the environment, bio-monitoring, physical activity and nutrition),3 will be carried out by the French Institute for Public Health Surveillance (INVS) and report in 2016. One of the main goals of the study will be to record the frequency of cardiovascular disease, and although important at a national level, it will also provide statistics to compare with other European countries. Finally, we are fortunate in this issue to publish some key practice papers presented at the Public Health England Conference (2013) demonstrating the breadth and depth of activity across the United Kingdom. We thank Professor Anthony Kessel from Public Health England for his introduction and context setting. This issue of Perspectives neatly demonstrates the global nature of public health and the worldwide similarities that the workforce is facing. Clearly, we operate in a challenging environment where maybe, and hopefully, we can learn from each other. Professor Heather Hartwell Honorary Editor References   1. Rahman E, Wills J. An evaluation of a Public Health Practitioner (PHP) registration programme: Lessons learned for workforce development. Perspectives in Public Health 2014; 124(5): 259-267.   2. Bhatia K. Community health worker programs in India: A rights based review. Perspectives in Public Health 2014; 124(5): 276-282. 3. Thomas K. France Launches Nationwide Public Health Study, April 2014. Available online at: http://www.euractiv.com/sections/health-consumers/francelaunches-nationwide-public-health-study-301602 (Last accessed 8th July 2014).

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Global public health workforce.

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