Specialist capacity in public health: are we hitting the target?

The aim of this study was to audit specialist public health capacity in one strategic health authority (SHA), and to compare capacity with the targets suggested by the Faculty of Public Health (FPH).

A census of all public health specialists and specialists in training, working within the geographical boundary of one SHA, was performed in late 2004. The number of whole-time-equivalent (WTE) public health specialists was quantified using a variety of methods, including the public health network database, informal networks, existing written reports, personal knowledge and telephone interviews. The number of specialists was compared with the targets suggested by the FPH and with other regions.

There were 12 WTE public health specialists per million population in the SHA, and the FPH's target was 25 WTE per million population. There was a particular shortage of specialists in academic public health.

There was a marked shortfall in specialist public health capacity in the SHA compared with the FPH's targets. Comparisons with the FPH's targets were difficult; the FPA used WTE as the metric, while the local public health network database provided information in terms of numbers of specialists and WTE data were time consuming to obtain. Comparisons with other regions were of limited use as the workforce data were not comparable. The FPH's targets were found to have little resonance outside the world of specialist public health, and so are unlikely to be helpful in securing local investment in specialist public health capacity. The service needs to be marketed, and new ways of inter-organizational and collaborative working and of expanding the wider public health workforce need to be examined in order to deliver effective public health.