Better Health For All

In May 2023, the Faculty of Public Health (FPH) arranged a virtual network event where colleagues from public health, the wider health system and academia came together as a community of practice to discuss how equality, diversity and inclusion (EDI) principles and practice are being adopted in their organisations and areas of work.

A Key Public Health Issue

Increasing the diversity and inclusivity of the public health workforce is widely seen as desirable by UK Public Health organisations, and has been identified as a necessary action to address health inequalities. In their BMJ article “A diverse public health workforce is more important than ever”, Kazim Beebeejaun and Kerry Littleford identify three key reasons as to why greater workforce diversity and inclusivity is a key public health issue. Firstly, cultural competence is essential in gaining a rich understanding of the perspectives, needs, and concerns of marginalised communities. Cultural competence rooted in lived experience is a powerful tool for positive change. A workforce with real world experience that reflects the diverse society it is serving is key to tackling the challenges ahead.

Secondly, a more diverse workforce is more innovative. Covid-19 shone a light on decades of existing health inequalities amongst ethnic minorities and the need to urgently address critical gaps in capabilities of the health system to tackle ethnic health inequalities. Different perspectives informed by the lived experience of the health workforce can prevent tunnel vision, and bring to light problems or solutions that would not otherwise have been considered. Moreover, inclusive working environments can help to create a sense of psychological safety and belonging, enabling public health professionals to be more open and honest in sharing their experiences and ideas, and in turn to think more radically and innovatively when designing strategies and interventions[1, 2].

Thirdly and most importantly, building trust requires consistency in our values as a profession. We cannot advocate for our core values of equity and social justice in health without tackling inequalities within our own community. Certain populations have historically been systematically excluded or represented minimally from professional occupations such as public health, and ongoing inequality of opportunity continues to limit access. If current and future decision makers are drawn only from certain areas of society, how do we expect to build genuine trust with marginalised communities?

Sharing Experience and Gaining Momentum

Whilst there is clearly a strong argument for greater workforce diversity and inclusivity in public health, much of the current work in this area is occurring in siloes. In May 2023, members met in a virtual networking event to share ongoing projects, areas of good practice and future aspirations. These included:

• FPH Equality & Diversity Special Interest Group. The group is co-chaired by Public Health Registrars Kerry Littleford and Kazim Beebeejaun and reports to the Equality & Diversity Committee. The current priorities of the SIG include evaluating differential attainment throughout recruitment and training, and exploring mentoring and training opportunities for those currently undertaking specialty training. 
• FPH Fair Training Project. This project is being undertaken by Rachel Fardon and Amoolya Vusirikala, Public Health Registrars. The Fair Training Project is a programme of work organised by the FPH following earlier work on recruitment to the specialty training programme and examines the public health specialty training journey through a diversity and inclusion lens. It includes three sub-projects focusing on the demographic makeup of Registrars and Registrar’s progress through training, specifically examining for differential attainment in examinations and ARCP outcomes.
• Exploratory research project: Removing structural barriers to representation in recruitment, progression and retention. This project is undertaken by Dr Asta Medisauskaite, Senior Research Fellow, UCL Medical School; Researcher in Residence, OHID London region. This project is set to review metrics to monitor how equitable and inclusive the health and care workforce is & identify interventions that improve diversity in the workforce. To get in touch, email Asta Medisauskaite at a.medisauskaite@ucl.ac.uk or OHID representative, Robert Pears, Public Health Consultant at robert.pears@dhsc.gov.uk
• Public Health Speciality Registrar Committee Reasonable Adjustments Working Group. This project was presented by Ruth Hoggett, Public Health Registrar. The Working Group has recently explored the experiences of Public Health Registrars around the reasonable adjustments process. This has informed the production of a report providing best practice recommendations on key roles, responsibilities and clear pathways for requesting, implementing and monitoring reasonable adjustments.
• Scottish Public Health Registrars Disability Forum. The work of the Forum was presented by a Public Health Registrar. The Forum provides peer support and advocacy for Public Health Registrars who are neurodiverse or registrars with a disability. The Forum is attended by the regional disability specialty advisor. Recent work includes plans for an inclusive leadership series. 
• Growing a Diverse Public Health Workforce. This work was presented by Amarjot Gill, Future Leaders Fellow. The secondment, offered by the School of Public Health in Yorkshire & the Humber, aims to understand and implement steps towards achieving maximum diversity in Public Health programmes (specialty and practitioner). The focus is on increasing equality, diversity and inclusion in these programmes through three key areas: recruitment (broadening access, reviewing pathways), whole school approach (identifying national health needs) and CPD development (regular EDI training).
• ADPH London: Diversifying the Workforce and Encouraging Systems Leadership: This workstream is led by Dr Nike Arowobusoye and Dr Natalie Daley, Consultants in Public Health, and forms a part of the Public Health: Tackling Racism and Inequality Programme. The workstream will take a systems approach to tackling health inequalities with recognition of addressing the lack of diversity within the public health workforce (entry to senior level). It will lobby, monitor, review and provide training to dismantle norms and go beyond unconscious bias training, working towards cultural shifts associated with inclusive practices. 
• Exploring the lived experiences of Public Health registrars with disabilities in workplace learning settings. This project is undertaken by Fiona Simmons-Jones as part of her academic work for her Masters in Medical Education with the University of Cambridge. An invitation to take part in this research through sharing lived experiences has recently been circulated by the FPH, following academic ethical approval. For more information on this planned research project please contact Fiona Simmons-Jones at fms50@cam.ac.uk.
• The Lancet Series on racism, xenophobia, discrimination and health presented by Delanjathan Devakumar, Professor of Global Child Health and Consultant in Public Health.

A Call for Action; This is a matter of leadership!

Meeting attendees emphasised the importance of moving beyond verbal commitments to workforce diversity and inclusivity, and instead providing leadership at the highest levels across the health system to drive visible and meaningful change.

Identified areas for action included:

• Providing opportunities to learn from one another’s experiences.
• Ensuring parity of esteem across protected characteristics in all EDI focused work.
• Recognising the value of storytelling and using lived experiences to initiate change.
• Improving the collection and sharing of EDI data to enable progress to be monitored.
• Addressing recruitment practices.
• Developing videos for the FPH and other organisations and institutions to showcase ongoing work in this area.
• Developing workforce EDI training materials and toolkits that go beyond unconscious bias.
• Decolonising Public Health training programmes and curricula.

The community of practice will meet again in September 2023 to co-ordinate our action to address public health workforce diversity and inclusivity. We would welcome any interested colleagues also working in this area to join us. Please contact the FPH’s Assistant Academic Registrar, who is supervising the Fair training programme at samia.latif@ukhsa.gov.uk.

Written by: Rachel Fardon, Samia Latif, Kazim Beebeejaun and Kerry Littleford

REFERENCES

1. Coronado, F., et al., Understanding the Dynamics of Diversity in the Public Health Workforce. J Public Health Manag Pract, 2020. 26(4): p. 389-392.

2. Böbel, S., et al., Diverse and inclusive leadership teams in public health schools: the change agents for sustainable and inclusive public health education. South Eastern European Journal of Public Health, 2023.

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