Tackling health inequalities through the development of the wider public health workforce

The public’s health faces a range of challenges; we are living longer but not healthier, ¹ inequalities are widening, those who need support the most are least able to access it and vulnerable communities and groups are trapped in cycles of ill health and poverty. As a nation, we risk being left behind in terms of collective and individual growth and opportunity.

While we face all of these challenges, and while there are drivers of ill health, these do not mean that ill health is unavoidable and predetermined. ² One key, often under-utilised, lever we can effectively pull is to empower and upskill the wider public health workforce ³ to improve the health of the nation. ⁴ The wider public health workforce is defined as ‘all staff engaged in or who want to engage in public health activities, who identify public health as being an important part of their role but are not employed within the core public health workforce’. We know that over 7.75m professionals sit under this definition with varying levels of engagement and activity within these professions that could be harnessed. A recent report from the Royal Society for Public Health (RSPH) identified further 1.5m professionals who could be active members of the wider public health workforce.

A highly skilled workforce has the potential to intervene and improve the public’s health by engaging in activities that either systemically or individually promote, protect or improve health. These can be brief interventions such as Making Every Contact Count, ⁵ through to developing and delivering different routes to access services and through building the levels of capacity required to deliver essential functions to keep the population well.

OPEN IN VIEWER

To better understand what features of a healthcare system are central in narrowing health inequalities, the Health Foundation and the Yorkshire and Humberside Academic Health Science Network were commissioned to work with an expert panel in developing an actionable insight document. ⁶ The case studies section of the Actionable Insight document sets out how a wider public health workforce can make a significant contribution towards narrowing health inequalities, including gaps in access and experience and outcomes from healthcare.

This fact was on display in a powerful way during the Covid-19 pandemic. Lay people and members of the community played a pivotal role in getting Covid-19 vaccine messages across to their communities, debunking myths, increasing confidence and strengthening trust. The latter is mission critical, given Professor Kevin Fenton’s observation that trust has been shown by the pandemic to be a social determinant of health in its own right. The wider public health workforce, as representatives of more diverse communities, is crucial in building trust between the healthcare system and the communities that it serves. If we are to prevent or indeed mitigate a future public health emergency, such as the one recently experienced during the Covid-19 pandemic, our emergency preparedness processes must include building trust as a central policy.

While recognising that health inequalities are driven for the most part by the Social Determinants of Health (SDOH), it is clear that the healthcare system has a significant sphere of influence by leveraging its role as the largest employer in the country. ⁷ We have worked with National Health Service (NHS) England’s National Healthcare Inequalities Improvement team to understand the role that the Core20PLUS Connectors are playing ⁸ as part of a wider Core20PLUS5 delivery ecosystem, in getting public health messages into communities that otherwise would not have access to effective and culturally sensitive information. The Core20PLUS Connector Programme funds integrated care systems (ICSs) and place-based initiatives to recruit, mobilise and support influential community connectors to take practical action to improve health and reduce inequalities in their area.

By enabling this workforce to share messages around cancer screening, vaccination, health checks and how to access healthcare, we are able to tap into trusted, local people who can most effectively deliver those messages. Alongside this, we are exploring the value of providing training and qualifications to this group to both support them to develop their skills and knowledge and giving them a range of transferable qualifications that could set them on a career journey that both increases their skills and also opens up opportunities to better employment. ⁹

By developing consistent approaches and skills in the workforce, ¹⁰ we can ensure that there is a highly skilled, locally relevant and trusted workforce ¹¹ to promote better health. The Core20PLUS Connectors are part of the nearly 1.5 million people who are part of the wider public health workforce who have told us that with better routes, career pathways and educational products will be able to help improve the health of the nation. By giving people the ability to tackle inequalities rather than just identify or understand inequalities, we can help communities to build their capacity, capability and social capital.

Another part of the delivery ecosystem are Core20PLUS Ambassadors. ¹² Ambassadors are people working within the NHS who are committed to narrowing healthcare inequalities and ensuring equitable access, excellent experience and optimal outcomes for all – particularly Core20PLUS ¹³ populations who are more likely to experience healthcare inequalities. These include people living in areas of high deprivation, ¹⁴ ethnic minority communities, ¹⁵ and inclusion health groups. ¹⁶

We are harnessing the potential of the wider public health workforce through empowering and enabling them via groups such as the Core20PLUS Connectors. This means that the coming years could see a change in reach and impact towards improving the public’s health, in turn promoting health-driven prosperity in areas and populations where it is needed most.