Better Health For All

Equity and fairness in post-graduate training are essential for a number of reasons. When done well, they help to attract and retain the best, diverse and brightest talent. When everyone has a fair chance to succeed, more people will be motivated to pursue a career in public health. This is essential for ensuring that the public health workforce is able to meet the growing demands of a complex and ever-changing world. 

Equity and fairness in post-graduate training also ensures that the specialist public health workforce is representative of the population it serves. This is important because it allows public health professionals to better understand the needs of the communities they work with and to develop more effective interventions. When everyone has the same opportunity to reach their full potential, society as a whole benefits. 

Our report on Fairer Training Culture highlights the disturbing level of discrimination present in the recruitment process for public health training in the UK, particularly in relation to ethnic differences at the Assessment Centre. This is unacceptable and we must work together to eliminate discrimination from all aspects of public health training.

In this blog we provide an update on our progress thus far and our continued actions to address the situation. 

In October 2022, we noted the first step to develop a Fairer Training Culture with the publication of an in-depth report examining recruitment processes in detail. This report highlighted some concerning issues of differential attainment in the recruitment process, particularly in relation to ethnic differences in tests used at the Assessment Centre, but it has also galvanised activity and debate across the system. 

In the 2023 recruitment round (starting November 2022) NHSE’s Recruitment Executive Group:

• Revised the Situational Judgement Test (SJT) with a broader, more diverse, group of question setters and reviewers, to make sure they are fairer questions. This should also allow the availability of more example questions for candidates to look at in advance.

• Moved all available information on recruitment from the Faculty of Public Health (FPH) and Health Education England (HEE) to a single site. This ensures improved consistency of information and allows us to develop better information for all applicants.

• Continued to train assessors to reduce bias in the selection centre.

HEE’s merger into NHS England’s Workforce, Training and Education Directorate has delayed a proposed review of available numerical reasoning and critical reasoning tests for the assessment centre, but they will be trying to ensure this happens this year.   

The way in which ethnicity of applicants and appointments is monitored was improved to increase the number of categories in this round. Whilst positive, this means that we do not have a comparison to measure the impact of changes, though we will be able to do so better in the next round.

FPH’s Equality and Diversity Special Interest Group has been working closely with NHSE’s Recruitment Executive Group to publish an options appraisal of future actions, develop an action plan, and prioritise next steps.

The FPH itself is also currently developing an anti-racism strategy and action plan.

Further changes are planned for the 2024 recruitment round starting November 2023, including:

• Separating the scoring for the Assessment Centre (AC) from the Selection Centre so there is no carry-through of any potential biases at AC into final scores.

• Further developments in the information hub, including links to regional recruitment events.

• In the South-East, trainees themselves are leading the development of targeted support to disadvantaged groups.

We will continue to report on developments in this area, as well as reporting on other aspects of a fair training culture such as exam success rates later in the year.

In summary, we are encouraged to see the progress that has been made to improve equity and fairness in the recruitment process for public health training. However, there is still more work to be done. 

We call on all stakeholders to work together to create a system where everyone has the same opportunity to succeed in public health training. This includes: 

• Continuing to review and revise recruitment processes to reduce bias. 
  
  
• Providing training and support to assessors to reduce bias. 
  
  
• Collecting data on the ethnicity of applicants and appointments to track progress over time. 
  
  
• Developing targeted support to disadvantaged groups. 

We urge you to join us in the journey for greater equity and fairness in public health training. Together, we can make a difference. 

Please continue to contact the FPH or ourselves directly if you have any ideas or suggestions for how we can improve equity and fairness in public health training. We look forward to hearing from you. 

Professor Kevin Fenton CBE FFPH
FPH President

Dr. David Chappel FFPH
FPH Academic Registrar

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Fatai Ogunlayi, Hadjer Nacer, Fatumo Abdi Abdillahi, Diane Ashiru-Oredope, Victor Joseph, Aliko Ahmed on behalf of FPH Africa SIG

Black History Month, celebrated in October in the UK, is an annual celebration of the impact  and contributions that Black people have had on British culture and heritage. The theme for this year’s Black History Month is “Saluting our Sisters,” highlighting the remarkable contributions of Black women in British history and communities.

In this blog post, we celebrate some of the Black pioneers, especially Black women, who have had significant impact on health and wellbeing for people in the UK. These pioneers, despite facing the challenges of racism and discrimination, persevered and made significant contributions to public health in the UK.  The efforts of these pioneers have not only impacted the health and wellbeing of Black communities, they have also improved the health and wellbeing of the UK and global population. They paved the way for a more equitable and inclusive society.

Mary Seacole

Mary Seacole is now a commonly celebrated iconic figure in Black history but this wasn’t always the case and her story highlights the importance of documenting and celebrating the rich history of Black people in the UK. Seacole, a British-Jamaican nurse, is known for her contributions to public health and nursing in the Crimean War during the 1850s. Seacole who was initially rejected to serve as a nurse because of her race funded herself to travel to Crimea where she established the British Hotel as a place of respite for British soldiers. Prior to the Crimean war, Seacole was involved in public health response to the cholera and yellow fever epidemics in Jamaica and cholera epidemic in Panama.

Following her death in 1881, Seacole’s contribution to UK history faded into near “oblivion” for almost a century, but through societal efforts, she is now rightfully remembered and celebrated and was voted the greatest Black Briton in 2014.²

Dame Elizabeth Anionwu

Professor Dame Elizabeth Anionwu, of Nigerian/Irish heritage, is a health visitor and the first sickle-cell and thalassemia nurse specialist in the UK. She helped establish the first nurse-led UK Sickle & Thalassaemia Screening and Counselling Centre.

Anionwu, whose upbringing was scarred by racism and abuse has said that she is motivated by the need to see “gaps in service for BME patients and health professionals addressed. In addition to her clinical public health work, substantial amount of Anionwu’s time was spent tutoring Black and Minority Ethnic communities in London. In the late 1990s, she established the Mary Seacole Centre as a way to promote diversity in nursing education, research, and training. Following her retirement, Anionwu has continued to promote the work of Mary Seacole by serving as a life patron of the Mary Seacole Trust. Anionwu was honoured with the Order of Merit in 2022 and a Damehood (DBE) in 2017.

John Alcindor

Dr John Alcindor was born in Trinidad and attended medical school at Edinburgh University in Scotland, graduating in 1899. Alcindor led pioneering research on influenza and tuberculosis in the early 20th century. His research set the groundwork for the correlation between poverty, low-quality food, and poor health. Alcindor was keen to use his skills to help the war efforts during the First World War but like Mary Seacole before him, he was also denied by Royal Army Medical Corps because of his race – something that has been described as a “both racist and self-defeating” Alcindor would later sign up as a British Red Cross volunteer to support the war efforts and was later awarded a Red Cross Medal for his life-saving work.  Alcindor would continue to be an activist for racial equality and his contributions to public health in the UK were instrumental in advancing the cause of health equity and fighting against racial disparities.

The above are just some few examples of black people who made significant contributions to improve the health of the UK population and many more continue to do so to this day.

We must also remember that whilst we celebrate the far-reaching contributions that Black people have made to public health in the UK over the centuries, there is much work to be done to dismantle the structures that maintain disparities in health & wellbeing. For example:

• Black women are almost four times more likely to die in pregnancy or childbirth than White women.
  
• Black babies have almost double the stillbirth rate of White babies in England & Wales
  
• Black African and Caribbean women are up to two times more likely to receive a late stage diagnosis for a number of cancers than White British women.

Black women in the UK experience health at the intersection of racism and gender inequality, and a racial justice lens is essential to understanding and addressing the racial disparities in their health outcomes.

We welcome the Faculty of Public Health’s leadership in advocating for a public health approach to tackle racism as a core area of work.

We must continue to dismantle structures of racism and inequalities that exist in our society. We do this by first shining a light on it, recognise it as a public health crisis and work collectively to achieve this goal. Everyone has a role and we can all take personal actions to be inclusive in our daily lives. 

Throughout Black History Month 2023, we will continue to celebrate the outstanding contributions of Black people in the UK, with a focus on women, who lead the way and break barriers to advance the public health agenda in our society.  You can find out more about them via the social media posts available here:

• Post 1 – October 16^th
• Post 2 – October 23^rd

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Welcome to the first blog of this new series from the President of the UK Faculty of Public Health.

I am so pleased to be able to communicate with you through this medium and hope to use it to share updates on the Faculty’s work, my thoughts on current public health issues, and to engage with our members and the wider public. It is so important that the Faculty remains a strong and credible advocate for the public’s health; a champion for impactful public health programmes; and a thought leader on the current and future challenges and opportunities for our profession.

But first, let me take this opportunity to thank our FPH members and our wider public health colleagues for your dedication and continued hard work through very challenging times. Public health professionals are at the forefront of protecting and improving the health of our communities and play a vital role in preventing disease, promoting health, and reducing inequalities. I am inspired by your dedication and continued accomplishments at home and abroad as you work to make meaningful and positive differences in the lives of others.

As we emerge from the acute phase of the COVID-19 pandemic whilst adapting to health system transformations and grappling with the cost-of-living crisis, we face significant challenges in all domains of public health practice – from responding to prevalent and emerging infectious diseases, to dealing with the rising tide of NCDs, responding to widening inequalities, rebuilding community-centred approaches to improving health, tackling climate change, and encouraging a greater health system and cross-governmental focus on prevention and population health. There is much work to be done, and working alongside our partners, we will relentlessly champion better, well-funded public health policies and programmes with a laser focus on improving health and reducing inequalities.

As I approach the mid-way point of my Presidency, I am proud to reflect on what we have achieved together so far. As part of our revamped FPH priorities, the Board has identified 11 priority focus areas aligned to 5 strategic priorities. These priorities align with, and build upon, the FPH’s 2020-2025 Strategy and provide an opportunity to engage and mobilise all our members as we work to raise the profile of public health and the vital work that public health professionals perform.

First, we are committed to supporting the development of a high quality, resilient, diverse and inclusive public health workforce. A workforce that is fit for the future, clear and confident in our training and career development pathways. A workforce where our wellbeing and work-life balance is supported and prioritised. We will continue to advocate for the wellbeing of our members; provide support to members who are struggling; and work with employers to support the wellbeing of their public health staff. We are redefining and streamlining career development opportunities for our members and in the past year, we have conducted a review into fair training culture; developed a new curriculum and CPD diary, and launched a new workstream on membership wellbeing. In the year ahead, we will continue to work to ensure that public health training is fair and inclusive and harmonise the Faculty’s Membership and Fellowship accreditation.

Second, the Faculty is revamping our approach to strategic partnerships, prioritising deeper collaboration with UK public health bodies and Royal Colleges while developing new relationships with organisations allied to public health. Over the past 18 months we have launched a new collaborative membership offer with the Chartered Institute for Environmental Health; developed a new dual accreditation programme with the Royal College of General Practitioners; and have actively built on joint learning and development opportunities with the UK Health Security Agency, the Local Government Association, and Public Health Scotland. Our ambition is to both broaden and strengthen the public health family whilst identifying innovative areas for collaboration and impact.

Third, the Faculty will be a clear and unequivocal advocate for the public’s health, at a time when so many are struggling with poorer health, economic insecurity, and increasing societal polarisation. Over the past year we have championed the public health role within ICSs; supported intersecting policies on health, sustainability and climate change; advocated for stronger policy action to support the public’s health; developed new programmes on poverty and the cost-of-living crisis, including advocacy on child nutrition, and have continued our strong advocacy on climate change, anti-racism, drug policy, tobacco control and many other areas. In the next year, we will advocate for robust, evidence-informed public health policies and programmes, raise the profile of public health and the vital work of public health professionals, and build partnerships with other organisations to amplify our voice.

Fourth, we have launched new FPH programmes focused on raising the profile of public health professionals as well as connecting conversations on the future of public health. The world is changing rapidly, and public health needs to not only keep up, but be a step ahead. I am so proud to have launched the Faculty’s new ‘The Future of Public Health’ distinguished lecture series and new SIGs on Digital Health and Artificial Intelligence among others. Our new ‘What is Public Health’ multi-year campaign launched in September 2023 aims to increase the understanding and visibility of the critical work performed by health professionals, promoting the vital and varied contributions of the public health workforce. All of this is supported by a stronger digital and social media presence, a new membership portal, and refreshed FPH website coming in November, all geared towards improving the experience of how members engage with FPH to support their career journeys.

Fifth, I am proud of the work that the FPH does internationally – through our various Special Interest Groups and in partnership with other organisations. I see this as an important part of the FPH’s contribution to global public health and we are expanding the Faculty’s activities in this arena. In the past year, we have signed an international MOU with IAPH; led work with WHO to support global public health system capacity; and launched a new disasters and humanitarian response SIG to support both domestic and international efforts in emergency settings. There is more to do with our global public health partners as we share our expertise and knowledge with public health professionals in other countries and support the training, development and accreditation of public health professionals globally.

Finally, one of the highlights of my first year has been the increasing involvement of our members in the work of the Faculty with so many colleagues agreeing to serve in various roles. This is a positive sign of the vibrancy and visibility of the FPH and I want to encourage more of our members to become involved by joining one of our Special Interest Groups (SIGs); serving on one of our many committees; volunteering to be an FPH examiner, or mentoring and coaching to help support the current and next generation of public health practitioners.

Without doubt, serving as the President of the Faculty of Public Health is one of the most exciting and humbling opportunities I have had in my career. I am keen for others to join me in ‘paying it forward’ and giving back to the profession that we love and are passionate about. I am confident that together, we will continue to make a real difference to the health of our communities and look forward to working with you to build a better future for all.

Professor Kevin Fenton CBE FFPH
FPH President

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Current situation in Yemen

Yemen is nearly in its ninth year of war which has destroyed much of the infrastructure in the country including health facilities. After eight years of prolonged conflict in Yemen, the country’s health system continues to fall short of meeting the population’s needs. Only 54% of health facilities are fully functioning, while 46% are only partially operating or entirely out of service. 

Some of the health facilities have been used either as shelters by Internally Displaced People (IDP) or by the warring factions as military bases. This has resulted in many of the health workforce either leaving the country, moving to a new area, or taking other jobs to support themselves and their families.

Mentoring programme

Three partners were involved in this project: Yemen Special Interest Group (SIG), Faculty of Public Health, Peoples-Praxis, and the Health Professionals for Yemen (HPY-UK). The latter was a newly registered charity organisation in the UK.

The programme had two aims:

-offer mentoring support for public health professionals in Yemen who were either  studying or working in public health and needed support to develop their careers in public health

-encourage applicants to use the public health resources free of charge on the Peoples Praxis’ website.

A leaflet was produced in both Arabic and English announcing the programme launch on the 2^nd February 2023. It was sent to individuals through WhatsApp networks inside and outside Yemen. Interested practitioners were encouraged to apply online via Peoples Praxis website. All applications were added to the Peoples-Praxis’ ‘MentorCity’ platform database. Two weeks later more than 60 people applied for the programme. This took all the partners by surprise, and they had to figure out how to handle the situation and who to include in the programme or put on hold. The vacancies in the Mentor City platform were only 5!

Yemen Public Health Praxis group was set up and a lead coordinator identified. To manage the large number of applicants a traffic light system was created:

Green group: – ready to join the mentoring programme,(strong candidates as judged by profiles and areas of interest)

Amber group: not quite ready and so had to wait until there were vacancies in the programme,(profile not completed fully, not clear on areas of interest for mentoring)

Red group:  not eligible or further info was needed from participants before making further decisions.

Additional funding was secured and we were able to increase the number of places on MentorCity for the Yemen group to 10.

Mentor City Platform is an online facility it has a dashboard where you can see what groups exist, mentors, mentees and who is matched with whom. It also has the capability of sending individual emails to mentors and mentees or organising Zoom meetings individually and in groups.

The whole Mentoring City Platform system was new to partners, mentors, and mentees alike. So there was a lot of learning for all concerned as outlined below.

What worked well

Key lead partners met monthly, spending an hour on average in every meeting. Most attendees in these meetings are either mentors in different countries or trustees in the Peoples-Praxis. These meetings were organised and chaired by the chair of Peoples-Praxis. Additional tasks and follow-up actions would be identified and reported back into this monthly meeting.

The Mentor City platform has a search for the profiles of both mentors and mentees which helps the matching process. People who have not completed their profiles are recognised easily and encouraged to update their profiles. The system keeps email exchange messages in one place and mentors could quickly check their messages.

What were the challenges

The initial message to mentees informed them that they would be matched to a mentor once their application is completed and that they would be matched to a mentor who will get in touch with them. This task was delegated to one of the Peoples-Praxis’ team which did not work. Mentees waited a long time to be contacted, and when they did not hear what was happening, some contacted the Yemen lead who happened to have his WhatsApp number from the first leaflet for the programme. After several months this process was updated and changed mid-September 2023. Mentees were now encouraged to contact their own mentors for their sessions. This process is still in progress and needs to be evaluated.

All other communications by individual emails, WhatsApp, or Google Meet were not in the system. Mentors were encouraged to contact applicants through Mentor City platform or via Zoom. A few messages were sent to a whole group inviting them to a meeting but no response was received by the lead or mentor. This is understandable given the time zone differences between mentor and mentees which could be 9 or 11 hours.

A common challenge for the Yemen group was the concept of mentor and mentee. Most of the candidates have had didactic education. Mentoring is based on building a relationship between mentors and mentees, and in this programme with the aim of supporting mentees in their public health careers. In future, we may change our terminology from the unfamiliar concept of mentoring to offering support for professional skill development in the field of ‘global health’.

Unexpected outcomes

Although, there is a feedback form each mentor and mentee should fill out and send back to Peoples-Praxis. The feedback is about the sessions and the relationship between mentors and mentees. This process has not been well used and did not pick up soft successful anecdotal stories about the mentoring programme. Below are a few examples.

Individuals

While the Yemen lead was talking to one of the participants on WhatsApp, he asked him, “How did you know about the programme”? The mentee said, “I was on a demonstration for Peace in Yemen in Aden and a colleague gave me a copy of the announcement and said this is for you”.

One participant described how she valued her own mentor who has supported her with what she was looking for. Her mentor was in Australia, and she was in Yemen. The Yemen lead received this message via WhatsApp.

One participant joined the Yemen SIG as a result of his involvement with the mentor programme. He described to the Yemen SIG group how he valued the support he got and was going to pursue his PhD career.

One participant contacted the Yemen lead and told him that he was not interested in the mentoring programme but would like advice on suitable Primary Health Care (PHC) courses. A few links for courses of his choice were sent to him. He wrote back and said that he found these courses extremely helpful. He then wanted some advice on a research topic for his dissertation. This case is still unfinished.

Taiz Health Institute

The Yemen lead and the Dean of the Taiz Health Institute formed a new group in Taiz to explore how can the Yemen Public Health Praxis support the institute in rebuilding the health training after the institute building was destroyed by the war. One of the team members in Taiz needed a mentor to support him with his research and he was immediately connected with a mentor to support him.

Taiz Health Institute has a plan for future courses they want to run. However, they don’t have the financial resources to do so. After various discussions and communication about the introduction of a public health course, they agreed, designed, and advertised the course to the public. There were zero applicants and one of the reasons cited was that ‘public health’ will not get them employment or bring cash for the trainee after she/he finishes the training. A challenge for many Low and Middle Income (L&MI) countries.

Yemen Dental Public Health

The Yemen Public Health Praxis had a few applicants who had dental health training or were graduates of dental health studies. The chair of Peoples-Praxis suggested creating a Yemen Dental Public Health Group. The chair of Yemen SIG contacted the PH Dental SIG to see if there were opportunities for collaboration.  The response was positive, and we had our first meeting exploring what needs to be done. A few months later, a team of five (in Yemen, Germany, and UK) formed the first Yemen Dental Public Health Team. Their task was to conduct a literature review on dental health in Yemen which will guide the group on what to do next. The story goes on.

PH resources

The Yemen lead has identified two online public health courses that would be potentially useful to Yemeni candidates. The first provided by Peoples-Praxis would be more useful if translated into Arabic. The second was developed by the International Academy of Public Health (IAPH) https://iaph.org/en/learning-paths/all-courses/. is available in both Arabic and English.

Recently the Yemen lead met with IAPH management team and explored the potential cooperation between the partners. It was agreed they would work on one of the Praxis courses, and explore the technical issues and the possibility of translating the material into Arabic. A memorandum of understanding would follow for partners to agree on the scope of work.

In conclusion

This blog summarises learning points from a recent collaborative pilot mentor project using the online Mentor City platform The Yemen Praxis project has been running now for seven months and we have learnt a great deal about who is interested in joining a mentoring programme , and what they want out of the programme. We’re conscious about our terminology of the unfamiliar concept of mentoring to offer support for professional skill development in the field of ‘global health’.

We were able to offer some support to some participants but unfortunately not all. We have had significant positive unexpected outcomes, and we hope we will learn more about other new unexpected outcomes as we move forward.

Although bombing in Yemen has stopped that does not mean the country has achieved peace. The need for support and mentoring in one form or another will be needed for years to come. It’s up to the mentoring team to continue with the learning, understanding, and adapting to what works and what doesn’t. We are pleased we have had some positive feedback from some of the mentees that this programme is working for them.

Taher Qassim

Dr Ann Hoskins

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