Chapman J, Congdon P, Shaw S, Carter Y H
Centre for Infectious Disease, Institute of Cell and Molecular Science, Queen Mary, University of London, 4th Floor, 51-53 Bart's Close, St Bart's Hospital, West Smithfield, London EC1A 7BE, UK.
Public Health. 2005 Jul;119(7):639-46. doi: 10.1016/j.puhe.2004.10.020.
Recent organizational changes reflect the need to be more responsive to local populations and have included fostering a closer structural relationship between primary care and public health. In light of this, we explore the distribution of the specialist public health workforce and the relationship with population deprivation and need.
Questionnaire survey to all directors of public health working in primary care trusts (PCTs) and strategic health authorities (SHAs) in England to determine the number of specialists in public health working in either PCTs or SHAs. All identified specialists were given the opportunity to self-define in a further questionnaire survey. Whole-time-equivalent staffing, per head of population, was analysed against socio-economic deprivation, measured by the DETR 2000 Index of Multiple Deprivation. The analysis was conducted at the SHA level.
The survey was undertaken whilst public health in the UK was undergoing immense change. This presented specific challenges in identifying specialists in public health working within PCTs and SHAs. Seven hundred and eighty-three specialists working in PCTs and SHAs were identified. On average, in England, there are 1.69 specialists in public health per 100,000 population, with some variability at SHA level (range = 0.8-2.89). Findings indicate an overall positive association between capacity at SHA level and socio-economic need, although some discrepancies between need and provision are apparent.
The general positive association between capacity and deprivation should offer some reassurance to policy makers, researchers and patients alike. However, further efforts are needed to redistribute specialists in some areas to address organizational capacity and equity issues.
近期的机构变革反映出需要对当地居民做出更积极的响应，其中包括在初级保健和公共卫生之间建立更紧密的结构关系。有鉴于此，我们探讨了专业公共卫生工作人员的分布情况以及与人口贫困和需求之间的关系。
对在英格兰初级保健信托基金（PCT）和战略卫生当局（SHA）工作的所有公共卫生主任进行问卷调查，以确定在PCT或SHA工作的公共卫生专家数量。所有确定的专家都有机会在进一步的问卷调查中自行定义。根据2000年环境、运输和区域部多重贫困指数衡量的社会经济贫困状况，分析了人均全职等效人员配置情况。分析在SHA层面进行。
该调查是在英国公共卫生正在经历巨大变革的时期进行的。这在确定在PCT和SHA工作的公共卫生专家方面带来了特殊挑战。共确定了783名在PCT和SHA工作的专家。在英格兰，平均每10万人中有1.69名公共卫生专家，在SHA层面存在一定差异（范围为0.8 - 2.89）。研究结果表明，SHA层面的能力与社会经济需求之间总体呈正相关，尽管需求与供应之间存在一些明显差异。
能力与贫困之间的总体正相关应该会让政策制定者、研究人员和患者都感到些许欣慰。然而，需要进一步努力在一些地区重新分配专家，以解决机构能力和公平问题。
