Tomorrow's workforce for health: Assessing the impact
Article Outline
It is interesting that during the European winter just passed, we have seen a number of separate potentially important initiatives to influence the future health workforce. In the UK, the General Medical Council, which is responsible for the statutory regulation of all medical practitioners practising in the UK, published for consultation both its revised framework for medical training – Tomorrow's Doctors1 – and its first draft guidance on the requirement for a licence to practise,2 as the first step in introducing medical revalidation. This will ultimately mean that doctors practising in the UK will be required to demonstrate their continuing competence to practise. In Europe, the European Commission published its Green Paper on the European Workforce for Health.3 This strives to describe the future health workforce, but actually only really considers the healthcare workforce. As far as public health is concerned, the opportunity to make a clear statement that all clinical professionals have an important public health role to play4 has been missed, as has appropriate recognition of the public health research and teaching workforce. An issue here is the lack of shared definitions across Europe or more widely: to ascribe a narrow health protection role to public health, whilst clearly important, is quite insufficient to embrace the wide church that is the public health workforce.
Even with an inadequately narrow definition the Green Paper does, however, remind us of some interesting demographic issues; such as the ageing of the workforce over time, with recent observed changes between 1995 and 2000, that included a reduction of 20% in the number of physicians under the age of 45 years, accompanied by an over 50% increase in those over 45. So there is a clear need for new younger recruits to take the place of those who will retire in the next decade. There also remains, of course, the fact that women make up about three quarters of the health workforce in the EU. As such, gender equality is a particularly big employment issue in the sector.
It is a matter of regret that the main focus of the Green Paper is actually healthcare rather than health (despite its title), and there is little, if any recognition of the public health roles of this workforce. At the same time the role of the entrepreneur is clearly viewed as important in the Green Paper: but why should we encourage a culture of entrepreneurism unless tied to some desirable health or social outcomes, which the proposals in the Green Paper do not mention? In the UK, the importance of the social entrepreneur was all the rage a few years ago, with its emphasis on the public good, but to promote entrepreneurism for its own sake seems a strange strategic direction for Europe to be taking at this time.
A principle expressed in the revised Tomorrow's Doctors1 is that: ‘medical students should have the opportunity to work and learn with other health and social care professionals’. At last the benefits of breaking down the barriers between health professionals are being recognised, and, perhaps, in the future, we shall see some of these barriers removed before they are erected. Presupposing, naturally, that those responsible for the standards of training of other health professionals are in agreement.
In writing this editorial it has been impossible to ignore some consideration of the impact of health professionals on health. Evidence is often difficult to find on this: the assumption by the public and professionals alike that the impact is both positive and substantial has rarely been challenged except for individual cases of negligence or malpractice. The serious concern about future numbers and quality of health professionals is clearly indicative of the perceived national and international value of the health professional workforce. But if a health impact assessment was conducted of the healthcare professions, how would they fare? A trivial question, perhaps, but do keep it in mind as you read the papers in this month's Minisymposium on Health Impact Assessment. We are delighted that colleagues leading in this area have provided a rich seam of stimulating content on the subject, brought together by our guest editors, Owen Metcalfe and Claire Higgins.5 Rigorous enquiry as to the likely impact on health of an intervention or development is so obviously common sense that it is too often taken for granted, so the evidence elicited when it is taken seriously is illuminating. As the health workforce increases in mobility around the globe, understanding the real impact on the health of countries who are net exporters or importers of these workers would be a valuable exercise.
This is an information-loaded month, for in addition to a welcome Minisymposium on Health Impact Assessment, we have the evaluation of the recently introduced regular publication of regional profile information for England, which elicited some interesting and not always predictable findings. Aligned with the information theme, we present a paper that examines the reliability of quality of life indicators in people with cancer and the migration associated problems of using computer programmes to assign ethnicity. A survey of air pollution looks at what influences annoyance and health impact, while a paper from Ethiopia explores who lives to be elderly in that country.
References
- Tomorrow's Doctors 2009: a draft for consultation. General Medical Council; December 2008;
- GMC Consultation on the Draft General Medical Council (Licence to Practise) Regulations 2009 and Supporting Guidance for Doctors. General Medical Council. Available from: https://gmc.e-consultation.net/econsult/uploads/LTP%20Consultation%202009/GMC%20Consultation%20document.pdf [accessed 22.02.09].
- Eur Commn: Brussels, COM 2008 725/3 Green Paper On the European Workforce for Health.
- . Maximizing the contribution of the public health workforce: the English experience. Bull World Health Organ. December 2007;
- . Health Impact Assessment contributing to Healthy Public Policy. Public Health. 2009;123:295
PII: S0033-3506(09)00066-3
doi:10.1016/j.puhe.2009.03.005
© 2009 The Royal Society for Public Health. Published by Elsevier Inc. All rights reserved.
