Discussion paper examines potential for a multi-disciplinary public health workforce in Ireland

Dr Jenny Mack

Developing a multidisciplinary public health workforce in Ireland, with career pathways for public health professionals from medical and non-medical backgrounds, is an important consideration for health service reform and planning for current and future public health threats.

That’s according to a new discussion paper, commissioned by the Institute of Public Health (IPH), which explores potential options for a multidisciplinary model of public health in Ireland.

The discussion paper was commissioned in the wake of the 2018 Crowe Howarth report, which set out a new vision for public health in Ireland and has paved the way for the reform of existing structures.

The COVID-19 pandemic placed public health at the centre of public policy and this new paper further builds on plans to reform and strengthen the current model of public health in line with the Essential Public Health Functions (EPHFs) – identified by the World Health Organization (WHO) as a minimum requirement for delivering resilient and sustainable public health systems.

In 2021, IPH established an Advisory Group, chaired by Professor Ivan Perry, and commissioned Crowe, a consultancy firm, to develop this discussion paper.

This new report explores options to develop a multidisciplinary public health workforce, including the potential to develop and enhance employment and training paths for public health professionals from both medical and non-medical backgrounds.

This report examines public health systems in nine other countries – Wales, Australia, Canada, Finland, Israel, the Netherlands, New Zealand, Slovenia, and Switzerland – and also sought the views of stakeholders already working within existing structures in Ireland, as well as insights from international experts in the public health field.

The discussion paper highlighted the following key messages:

  • Stakeholders in Ireland identified a problem of “trapped talent” with skilled graduates and practitioners unable to enter career pathways in public health beyond the routes available for medical graduates. This has resulted in “lost talent”, with staff moving to other disciplines or working in public health abroad.
  • The paper highlighted the success of the Welsh multidisciplinary public health model, which has been supported by modernised public health legislation and strategy, integration with local government, and a registration system for a wide range of public health practitioners.
  • International leaders and academic experts in the field of public health said a multidisciplinary workforce could be developed through a strategic roadmap, inter-disciplinary competency frameworks for skills development, a registration system for public health professionals, as well as a regulatory body, accreditation, and professional development.

The discussion paper concludes that, to be prepared to address current and future challenges, the public health workforce will need sufficient breadth of skills, diversity and capacity to meet these demands, to address the socioeconomic and environmental determinants of health, and to work across sectors, borders, professional disciplines, agencies, and specialities. 

Dr Jenny Mack, consultant in public health medicine at the Institute of Public Health, said, “Like many other countries, the public health system in Ireland is experiencing unprecedented demands. Current and future public health challenges are highly complex and include the burden of chronic disease linked to unhealthy food environments, physical inactivity, tobacco, and alcohol; the need to address the social determinants of health, such as housing, isolation, and poverty; and the pressing issues of climate change, biodiversity loss, and the risk of further pandemics.

“Responding to these challenges will require a ‘Health in All Policies’ approach and modernised public health legislation focused on prevention and wellbeing, but also a strong, concerted effort across many public health disciplines and specialities. It is promising to see multidisciplinary public health workforces gaining recognition internationally, and this will be an important component of public health service reform; a reform which needs to consider the prevention of disease and health inequalities as a national priority”.

Professor Ivan Perry, Chair of the Advisory Group, said: “The decision in 2021 to appoint Consultants in Public Health Medicine to lead multidisciplinary teams at national level and within Regional Departments of Public Health, has highlighted the urgent need to address the training, registration, career pathways and leadership opportunities for multidisciplinary public health team members – public health professionals with qualifications and expertise beyond medicine.

“This report draws on the perspectives of a wide range of stakeholders in Ireland and on international experience in the development of a multi-disciplinary public health workforce. I am extremely grateful to everyone who has contributed to the report and to the Institute of Public Health in Ireland for their leadership on this issue. I hope that the findings and considerations will complement and extend the ongoing work of the Public Health Reform Expert Advisory Group and contribute to strategy and workforce planning within the Health Service Executive”.

The paper is intended to support ongoing work to reform the Irish public health system, including the Public Health Reform Expert Advisory Group, Healthy Ireland Strategic Action Plan 2021-2025, Sláintecare, as well as strategy and workforce planning within the Health Service Executive. 

It comes as the Department of Health works with WHO to map out the current delivery of EPHFs in Ireland. Early results indicate a high level of public health expertise to support delivery of EPHFs, however there are also barriers, including issues with workforce resourcing and support.

Separately, the Public Health Reform Expert Advisory Group, chaired by Professor Hugh Brady, is expected to publish a report on learnings from the COVID-19 pandemic response, pandemic preparedness into the future and strengthening other public health functions this year.