The Wider Public Health Workforce

Improving the public’s health is going to be critical in reducing these costs and the importance of this is rightly recognized in the National Health Service(NHS) Five Year Forward View. A key part of how we will achieve this is to embed healthy lifestyles throughout communities, making public health ‘everybody’s business’. At The Royal Society for Public Health (RSPH), our focus is on developing the skills and knowledge of the ‘wider public health workforce’. RSPH and PHE have acknowledged the importance of engaging this workforce for supporting a “radical upgrade in prevention” by enabling a far greater number of people to gain access to vital health support and advice, including those from ‘hard-to-reach’ groups

The wider workforce is defined as ‘any individual who is not a specialist or practitioner in public health, but has the opportunity or ability to positively impact health and well-being through their (paid or unpaid) work’. (CfWI and RSPH)[U1] (CfWI, 2014) The estimated headcount for the wider workforce is 20.2 million people (this includes those who provide unpaid care and support). There are 57 occupation groups that reflect the wider workforce. Within these groups, there are 185 working occupations. The wider workforce has been categorized by level of engagement in public health: Active, Interested and Unengaged[U2]. The categorization of occupations was determined by the workshop participants’ experience, knowledge, and informed views.

Using national data from the Office for National Statistics’ Labour Force Survey (ONS, 2014a), the CfWI estimates that there are approximately 15 million people in England employed in occupations that have the opportunity or ability to impact health and wellbeing through their work. The occupations included in this estimate of the wider public health workforce were confirmed through workshops. In addition, the UK Census (ONS, 2011) suggests that there are approximately 5 million people providing unpaid care and support to family or friends due to disability, illness or poor mental health. This gives us an approximate range of between 15 to 20 million people in the wider public health workforce. The stakeholder workshops categorized occupations as either: active, interested or unengaged with public health.

There is now a strong body of evidence to suggest that the early adopters in the wider workforce delivering public health are indeed the fire services, health trainers, pharmacists, allied health professions and parts of the social housing sector. While these are certainly not the only groups making a significant contribution to health and wellbeing, these diverse groups may be a good place to start to develop the wider workforce on a larger scale. Many of the occupations identified as part of the wider workforce are those that have direct and regular contact with members of the public. Our initial estimation indicates that almost half (48%) of the wider workforce may have the opportunity to build trusted relationships through repeated interactions with the public. This could either be through an established client list (e.g. hairdressers, midwives, teaching assistants) or close links to a local community (e.g. elected officials, librarians, police officers).

What is evident is that there are potentially millions of people who work in occupations that have the opportunity to positively influence health and wellbeing. Five million people provide unpaid care and support to family and friends, taking further pressure off the health and social care systems. While we have made some attempt to identify those occupations that are actively involved in public health, the scale of the workforce identified highlights the enormous potential for thinking outside the core public health workforce for public health service delivery.

The wider workforce has the capacity to accelerate the radical upgrade in prevention through their broad reach into communities and their enthusiasm to develop asset-based and personalized approaches. They work across the system in health, social care, education, voluntary and community sectors and across the life course. Workforces such as the fire service, allied health professionals, social housing, health trainers, teachers and community pharmacists are making a significant impact already in improving the health and well-being of individuals and communities. There is a growing body of evidence that demonstrates the strength of the connection between health and the wider workforce and how critical it is in the current economic climate that the ‘system’ considers working with the wider workforce to prevent and address health inequalities. The wider workforce is key to integration, early intervention and supporting independence, yet the value of this workforce is not fully realized because of their limited voice in local and national strategic planning.

Development and training interventions – to improve the quality of wider workforce interventions and recognize its achievements, including a wider workforce public health skills framework and incorporation of public health principles and practice into pre and post-registration education across the health and social care platform.