545945 research-article2014
RSH0010.1177/1757913914545945FEATUREFEATURE
Feature
Public health specialist workforce training Professor Sian Griffiths gives a personal perspective on specialist workforce training for public health, looking at examples from both the UK and Asia, and discusses the need for future reform and for public health education to be everybody’s business. Uk Public Health Specialist Workforce Training
specializing. This specialist public health model is adapted to be multidisciplinary – and specialists come from a wide variety of backgrounds to enter a common scheme of training which provides structured competency-based training over a period of years. While equivalent Specialist status is granted by the Faculty of Public Health (FPH),2 the public health arm of the professional system based on royal colleges, registration remains divided between those who are and who are not medically qualified – a source of continuing debate.
The adage that ‘public health is everybody’s business’ can both be a help and a hindrance in developing the public health workforce. As everybody’s business, teaching and development can be tucked into other people’s business, for example, in medical student curricula or primary care. In the UK, the General Medical Council (GMC),1 the professional medical regulation authority, recommends that all medical students should be able to ‘apply to medical practice the principles, method and knowledge of population health and the improvement of health and healthcare’, The Public Health going on to list 11 relevant areas of Workforce In Asia study. While this provides wide exposure, Such debate does not apply to the US it does not, however, take away from the style–based training in which Schools of need for depth in specialist knowledge. Public Health play a key role, and the Across the world, attitudes to the Association of Schools of Public Health3 importance of public health in medical set curriculum standards and define training vary, as does support for its practice, with the Masters of Public inclusion in the curriculum. It is common, Health playing a more prominent role. however, among teachers for medical In Asia, the systems are mixed and students to prefer the cut and thrust of becoming more so. Asia faces massive genomic advances and individual patient social, demographic and economic care, seen to have more prestige and changes as countries transition to more glamour, to that of the more complex affluent and urbanised societies. Infectious problems of improving population health disease is no longer the primary burden and reducing health inequalities. This as problems associated with increasing prejudice is reinforced obesity rates, tobacco across medical systems, smoking and loneliness in To be fit for for instance, in research old age continue to grow. purpose, the funding. But why does Poorer communities in Asia public health this matter? In the UK, workforce needs are those most likely to be the traditional route to affected by climate change, to be specialist practice is and pollution and appropriately through an adapted environmental sustainability trained and medical education model supported. But are pose urgent population of specialist training, that health challenges. the models of is, that those wanting to To be fit for purpose, the training, practice public health as public health workforce particularly of specialists first have needs to be appropriately specialists, general undergraduate trained and supported. appropriate? training before But are the models of
training, particularly of specialists, appropriate? Workforce shortages, especially in rural areas, call for new ways of thinking and working. The UK model of clinically based training has left its legacy in Asia, but former colonies have not necessarily moved away from the clinical model and followed the same trajectory of multidisciplinary change. For instance, in Hong Kong, the HK College of Community Medicine, the FPH equivalent, does not follow the FPH lead and bestow specialist status on fellows who are not doctors. At the same time, the universities have not only expanded their Masters in Public Health programmes but introduced Bachelors programmes and extended the option of general education courses.4 So who is a specialist – the College fellows or the university trained Masters/ PhD students? And why is this important? The rationale for expanding the range of training in Hong Kong was based on the increasingly obvious analysis that not only were health needs growing but that health services needed to become more public health aware and focus on prevention rather than provision of care. Life expectancies in countries such as Japan and Singapore are the longest in the world, and at the same time, urbanization across Asia is leading to more sedentary lifestyles and growing affluence to shifts in diets rich in sugars and fats. The severe
September 2014 Vol 134 No 5 l Perspectives in Public Health 243
Feature acute respiratory syndrome (SARS) outbreak alerted the world to the ever present threat of new emergent infectious diseases and the need for global surveillance. To be responsive to such population health needs, the skill mix of public health professionals needs to develop and diversify in order to effectively tackle such challenges, particularly as there are shortages at all levels in workforces in many Asian countries.
Reforming Public Health Workforce Education Frenk et al.5 have suggested that the production of health workers depends on both instructional and institutional reforms, and reforms in both areas are important and essential. With this in mind, a few years ago, BRAC University called a meeting in Savar, Bangladesh, to suggest an agenda for reform of public health education which included the need for: • A common conceptual foundation for public health education; • defined core content for public health education that builds on the theory of knowledge and encompasses three types of learning: informative,
formative and Perhaps it is not only transformative; public health but public Perhaps it is not • development of an only public health health education that online library of but public health needs to be everybody’s ‘illustrative’ and business – within an education that ‘representative’ overarching governance needs to be teaching cases; framework which allows everybody’s • identification of a for reformed instructional business common, or core, set content and institutional of competencies; organisation to meet • development of an open-source, local needs. To quote the GMC1, all UK shared resource on innovative medical students should all be able to approaches to public health ‘discuss from a global perspective the education; and determinants of health and disease and • creation of a network for pedagogic variations in healthcare delivery and excellence and innovation in public medical practice’. Words are not health education, including instructor- enough – and while good statements led, self-directed, student-to-student, exist, their value needs to be reflected in team-based, field-based, exchange prioritized action to improve and and information and communication develop public health skills and technology (ICT)–facilitated.6 knowledge at a global level and within healthcare and other settings, The Savar statement reflects the global particularly in resource poor environments facing the greatest need for concerted attempts to support threats, some of which are within Asia. public health specialist development through global exchange, use of ICT, openness and sharing of resources. It Sian M Griffiths also recognises that three levels of Emeritus Professor, Chinese education are needed – professional, University of Hong Kong para-professional and for the people. But Visiting Professor, IGHI, Imperial while this sets an agenda, there is still College, London much to do.
References 1.
2.
General Medical Council (GMC). Tomorrows Doctors 2009. Available online at: http://www. gmc-uk.org/education/undergraduate/ tomorrows_doctors_2009.asp (Last accessed 12th July 2014). Faculty of Public Health. Available online at: http://www.fph.org.uk/ (Last accessed 12th July 2014).
3. Association of Schools of Public Health. Available online at: http://www.asph.org/ (Last accessed 12th July 2014). 4. CUHK SPHPC. Available online at: http://www. sphpc.cuhk.edu.hk/ (Last accessed 12th July 2014). 5. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T et al. Health professionals for a new
244 Perspectives in Public Health l September 2014 Vol 134 No 5
century: Transforming education to strengthen health systems in an interdependent world. The Lancet 2010; 376(9756): 1923–58. 6. Evans T, Ahmed SM. Chapter 8: Developing the public health workforce in Asia. In SM Griffiths, JL Tang, EK Yeoh (eds) Routledge Handbook of Global Public Health in Asia. Abingdon: Routledge, 2014, pp. 101–12.
RSH0010.1177/1757913914545945FEATUREFEATURE
Feature
Public health specialist workforce training Professor Sian Griffiths gives a personal perspective on specialist workforce training for public health, looking at examples from both the UK and Asia, and discusses the need for future reform and for public health education to be everybody’s business. Uk Public Health Specialist Workforce Training
specializing. This specialist public health model is adapted to be multidisciplinary – and specialists come from a wide variety of backgrounds to enter a common scheme of training which provides structured competency-based training over a period of years. While equivalent Specialist status is granted by the Faculty of Public Health (FPH),2 the public health arm of the professional system based on royal colleges, registration remains divided between those who are and who are not medically qualified – a source of continuing debate.
The adage that ‘public health is everybody’s business’ can both be a help and a hindrance in developing the public health workforce. As everybody’s business, teaching and development can be tucked into other people’s business, for example, in medical student curricula or primary care. In the UK, the General Medical Council (GMC),1 the professional medical regulation authority, recommends that all medical students should be able to ‘apply to medical practice the principles, method and knowledge of population health and the improvement of health and healthcare’, The Public Health going on to list 11 relevant areas of Workforce In Asia study. While this provides wide exposure, Such debate does not apply to the US it does not, however, take away from the style–based training in which Schools of need for depth in specialist knowledge. Public Health play a key role, and the Across the world, attitudes to the Association of Schools of Public Health3 importance of public health in medical set curriculum standards and define training vary, as does support for its practice, with the Masters of Public inclusion in the curriculum. It is common, Health playing a more prominent role. however, among teachers for medical In Asia, the systems are mixed and students to prefer the cut and thrust of becoming more so. Asia faces massive genomic advances and individual patient social, demographic and economic care, seen to have more prestige and changes as countries transition to more glamour, to that of the more complex affluent and urbanised societies. Infectious problems of improving population health disease is no longer the primary burden and reducing health inequalities. This as problems associated with increasing prejudice is reinforced obesity rates, tobacco across medical systems, smoking and loneliness in To be fit for for instance, in research old age continue to grow. purpose, the funding. But why does Poorer communities in Asia public health this matter? In the UK, workforce needs are those most likely to be the traditional route to affected by climate change, to be specialist practice is and pollution and appropriately through an adapted environmental sustainability trained and medical education model supported. But are pose urgent population of specialist training, that health challenges. the models of is, that those wanting to To be fit for purpose, the training, practice public health as public health workforce particularly of specialists first have needs to be appropriately specialists, general undergraduate trained and supported. appropriate? training before But are the models of
training, particularly of specialists, appropriate? Workforce shortages, especially in rural areas, call for new ways of thinking and working. The UK model of clinically based training has left its legacy in Asia, but former colonies have not necessarily moved away from the clinical model and followed the same trajectory of multidisciplinary change. For instance, in Hong Kong, the HK College of Community Medicine, the FPH equivalent, does not follow the FPH lead and bestow specialist status on fellows who are not doctors. At the same time, the universities have not only expanded their Masters in Public Health programmes but introduced Bachelors programmes and extended the option of general education courses.4 So who is a specialist – the College fellows or the university trained Masters/ PhD students? And why is this important? The rationale for expanding the range of training in Hong Kong was based on the increasingly obvious analysis that not only were health needs growing but that health services needed to become more public health aware and focus on prevention rather than provision of care. Life expectancies in countries such as Japan and Singapore are the longest in the world, and at the same time, urbanization across Asia is leading to more sedentary lifestyles and growing affluence to shifts in diets rich in sugars and fats. The severe
September 2014 Vol 134 No 5 l Perspectives in Public Health 243
Feature acute respiratory syndrome (SARS) outbreak alerted the world to the ever present threat of new emergent infectious diseases and the need for global surveillance. To be responsive to such population health needs, the skill mix of public health professionals needs to develop and diversify in order to effectively tackle such challenges, particularly as there are shortages at all levels in workforces in many Asian countries.
Reforming Public Health Workforce Education Frenk et al.5 have suggested that the production of health workers depends on both instructional and institutional reforms, and reforms in both areas are important and essential. With this in mind, a few years ago, BRAC University called a meeting in Savar, Bangladesh, to suggest an agenda for reform of public health education which included the need for: • A common conceptual foundation for public health education; • defined core content for public health education that builds on the theory of knowledge and encompasses three types of learning: informative,
formative and Perhaps it is not only transformative; public health but public Perhaps it is not • development of an only public health health education that online library of but public health needs to be everybody’s ‘illustrative’ and business – within an education that ‘representative’ overarching governance needs to be teaching cases; framework which allows everybody’s • identification of a for reformed instructional business common, or core, set content and institutional of competencies; organisation to meet • development of an open-source, local needs. To quote the GMC1, all UK shared resource on innovative medical students should all be able to approaches to public health ‘discuss from a global perspective the education; and determinants of health and disease and • creation of a network for pedagogic variations in healthcare delivery and excellence and innovation in public medical practice’. Words are not health education, including instructor- enough – and while good statements led, self-directed, student-to-student, exist, their value needs to be reflected in team-based, field-based, exchange prioritized action to improve and and information and communication develop public health skills and technology (ICT)–facilitated.6 knowledge at a global level and within healthcare and other settings, The Savar statement reflects the global particularly in resource poor environments facing the greatest need for concerted attempts to support threats, some of which are within Asia. public health specialist development through global exchange, use of ICT, openness and sharing of resources. It Sian M Griffiths also recognises that three levels of Emeritus Professor, Chinese education are needed – professional, University of Hong Kong para-professional and for the people. But Visiting Professor, IGHI, Imperial while this sets an agenda, there is still College, London much to do.
References 1.
2.
General Medical Council (GMC). Tomorrows Doctors 2009. Available online at: http://www. gmc-uk.org/education/undergraduate/ tomorrows_doctors_2009.asp (Last accessed 12th July 2014). Faculty of Public Health. Available online at: http://www.fph.org.uk/ (Last accessed 12th July 2014).
3. Association of Schools of Public Health. Available online at: http://www.asph.org/ (Last accessed 12th July 2014). 4. CUHK SPHPC. Available online at: http://www. sphpc.cuhk.edu.hk/ (Last accessed 12th July 2014). 5. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T et al. Health professionals for a new
244 Perspectives in Public Health l September 2014 Vol 134 No 5
century: Transforming education to strengthen health systems in an interdependent world. The Lancet 2010; 376(9756): 1923–58. 6. Evans T, Ahmed SM. Chapter 8: Developing the public health workforce in Asia. In SM Griffiths, JL Tang, EK Yeoh (eds) Routledge Handbook of Global Public Health in Asia. Abingdon: Routledge, 2014, pp. 101–12.
