545941 research-article2014
RSH0010.1177/1757913914545941GUEST EDITORIALGUEST EDITORIAL
Guest Editorial
Public health workforce around the globe Reading through the rich mix of content in this special issue, I was intrigued by a number of things. One was the scaling up of a community health workforce in one country, which is able to reach a staggering 75% of the 160 million population, against a backdrop of a massive deficit in the medical, nursing and midwifery workforce. Another was a system in which the direction of travel – in order to meet the daunting challenge of the long-term conditions burden and a public health system ‘in disarray’ – is seeking transformation to a ‘culture of health’ with a central role for the ‘Community Chief Health Strategist’. I will leave you, the reader, to discover just which of the health systems are taking steps in these directions. It is obvious that the challenges of public health differ across the globe. Generally, lower income countries struggle with the more basic problems of keeping populations free from infectious diseases, while higher income countries tend to have the infrastructure to prevent many infectious diseases, and can respond quickly when there are outbreaks, but face problems of lifestyle and growing older populations with complex needs. And these countries’ systems do not exist in isolation from each other. Globalization has brought opportunities for trained health workers to leave their homes and find better paid jobs elsewhere – leaving lower income countries with gaps in provision in already fragile health systems. How do we deploy the public health workforce to respond? This was a question the Editorial Board of the journal thought could be a worthy topic, and we set about commissioning papers from around the world. You will find in this issue a collection of papers from different regions, each of which takes some kind of view of the public health workforce. What struck us early on was that we were faced with significant definitional
problems. Just what do we mean by the public health workforce anyway? The paper from Malawi1 describes a community midwife assistant workforce operating within the context of the Essential Health Package, which resembles primary and secondary healthcare in a different context, and in other nations would be considered to be outside public health per se. The Spanish public health workforce2 tends to be deployed in occupational health, environmental health and food safety, and fascinatingly includes medics alongside pharmacists and veterinarians. While in Quebec, Canada,3 the spirit of the 1970s collective action is being reawakened so that community organisers work alongside other public health actors such as doctors, epidemiologists and health promotion workers, to reduce health inequalities from the ground up. Vivian Lin’s discussion of universal health coverage and the public health workforce explores this definitional issue in the context of major worldwide initiatives, and draws our attention to the focus on population health interventions being secondary to that on individual healthcare interventions a problem many of us in public health experience at regional and local levels as well. From the papers we have here, the United Kingdom stands out as having the most regulated and centrally organised public health workforce. There is a paper describing the development of a public health ‘skills passport’ in England,4 together with a paper reporting an evaluation of a regional public health practitioner registration,5 part of a UK-wide drive to register practitioners such as nutrition advisors, smoking cessation coordinators and environmental health officers. Both papers mention the Public Health Skills and Knowledge Framework,6 a set of skills and knowledge for each of four ‘core’ and five ‘defined’ areas of public health practice – with descriptions of what this
means at nine different career levels. While the public health workforce must of course respond to local needs, what has struck me most is that learning, country by country, has the potential to be multidirectional. What can the higher income countries learn from the marshalling of an army of community health workers, deployed on the ground to support health needs? Can others learn from ‘task shifting’? Might the UK framework described above be useful for those systems that are seeking greater standardisation? We have merely dipped our collective toes in the waters of the public health workforce, in this issue. The papers here were not gathered systematically, and we weren’t able to include all the countries we would have liked – indeed what you see here is skewed towards developed countries. But hopefully, we have shone some light and exposed some interesting differences in approach, facilitating learning in several directions. Eugenia Cronin Consultant in Public Health Member of the Perspectives in Public Health Editorial Board
References 1. Bell J, Evans J, Phoya A, Humphrey T. Developing a new public health cadre to meet the demands of midwifery care in Malawi. Perspectives in Public Health 2014; 124(5): 248-249. 2. Murphy M, Fernandez A, Daponte A. The Spanish public health workforce. Perspectives in Public Health 2014; 124(5): 257-258. 3. Parent AA. New public health actors in Quebec, Canada. Perspectives in Public Health 2014; 124(5): 249-250. 4. Sasiak A, Parsons R, Rowles K. A passport to ‘Public Health’ success. Perspectives in Public Health 2014; 124(5): 255-256. 5. 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. 6. PHORCaST. The Public Health Skills and Knowledge Framework (PHSKF) 2014. Available online at: http://www.phorcast.org.uk/page. php?page_id=313 (Last accessed 10th July 2014).
242 Perspectives in Public Health l September 2014 Vol 134 No 5 Downloaded from rsh.sagepub.com at University of Manitoba Libraries on June 23, 2015
RSH0010.1177/1757913914545941GUEST EDITORIALGUEST EDITORIAL
Guest Editorial
Public health workforce around the globe Reading through the rich mix of content in this special issue, I was intrigued by a number of things. One was the scaling up of a community health workforce in one country, which is able to reach a staggering 75% of the 160 million population, against a backdrop of a massive deficit in the medical, nursing and midwifery workforce. Another was a system in which the direction of travel – in order to meet the daunting challenge of the long-term conditions burden and a public health system ‘in disarray’ – is seeking transformation to a ‘culture of health’ with a central role for the ‘Community Chief Health Strategist’. I will leave you, the reader, to discover just which of the health systems are taking steps in these directions. It is obvious that the challenges of public health differ across the globe. Generally, lower income countries struggle with the more basic problems of keeping populations free from infectious diseases, while higher income countries tend to have the infrastructure to prevent many infectious diseases, and can respond quickly when there are outbreaks, but face problems of lifestyle and growing older populations with complex needs. And these countries’ systems do not exist in isolation from each other. Globalization has brought opportunities for trained health workers to leave their homes and find better paid jobs elsewhere – leaving lower income countries with gaps in provision in already fragile health systems. How do we deploy the public health workforce to respond? This was a question the Editorial Board of the journal thought could be a worthy topic, and we set about commissioning papers from around the world. You will find in this issue a collection of papers from different regions, each of which takes some kind of view of the public health workforce. What struck us early on was that we were faced with significant definitional
problems. Just what do we mean by the public health workforce anyway? The paper from Malawi1 describes a community midwife assistant workforce operating within the context of the Essential Health Package, which resembles primary and secondary healthcare in a different context, and in other nations would be considered to be outside public health per se. The Spanish public health workforce2 tends to be deployed in occupational health, environmental health and food safety, and fascinatingly includes medics alongside pharmacists and veterinarians. While in Quebec, Canada,3 the spirit of the 1970s collective action is being reawakened so that community organisers work alongside other public health actors such as doctors, epidemiologists and health promotion workers, to reduce health inequalities from the ground up. Vivian Lin’s discussion of universal health coverage and the public health workforce explores this definitional issue in the context of major worldwide initiatives, and draws our attention to the focus on population health interventions being secondary to that on individual healthcare interventions a problem many of us in public health experience at regional and local levels as well. From the papers we have here, the United Kingdom stands out as having the most regulated and centrally organised public health workforce. There is a paper describing the development of a public health ‘skills passport’ in England,4 together with a paper reporting an evaluation of a regional public health practitioner registration,5 part of a UK-wide drive to register practitioners such as nutrition advisors, smoking cessation coordinators and environmental health officers. Both papers mention the Public Health Skills and Knowledge Framework,6 a set of skills and knowledge for each of four ‘core’ and five ‘defined’ areas of public health practice – with descriptions of what this
means at nine different career levels. While the public health workforce must of course respond to local needs, what has struck me most is that learning, country by country, has the potential to be multidirectional. What can the higher income countries learn from the marshalling of an army of community health workers, deployed on the ground to support health needs? Can others learn from ‘task shifting’? Might the UK framework described above be useful for those systems that are seeking greater standardisation? We have merely dipped our collective toes in the waters of the public health workforce, in this issue. The papers here were not gathered systematically, and we weren’t able to include all the countries we would have liked – indeed what you see here is skewed towards developed countries. But hopefully, we have shone some light and exposed some interesting differences in approach, facilitating learning in several directions. Eugenia Cronin Consultant in Public Health Member of the Perspectives in Public Health Editorial Board
References 1. Bell J, Evans J, Phoya A, Humphrey T. Developing a new public health cadre to meet the demands of midwifery care in Malawi. Perspectives in Public Health 2014; 124(5): 248-249. 2. Murphy M, Fernandez A, Daponte A. The Spanish public health workforce. Perspectives in Public Health 2014; 124(5): 257-258. 3. Parent AA. New public health actors in Quebec, Canada. Perspectives in Public Health 2014; 124(5): 249-250. 4. Sasiak A, Parsons R, Rowles K. A passport to ‘Public Health’ success. Perspectives in Public Health 2014; 124(5): 255-256. 5. 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. 6. PHORCaST. The Public Health Skills and Knowledge Framework (PHSKF) 2014. Available online at: http://www.phorcast.org.uk/page. php?page_id=313 (Last accessed 10th July 2014).
242 Perspectives in Public Health l September 2014 Vol 134 No 5 Downloaded from rsh.sagepub.com at University of Manitoba Libraries on June 23, 2015
