Begley Andrea, Pollard Christina Mary
School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth, 6845, WA, Australia.
Department of Health in Western Australia, 189 Royal Street, East Perth, 6004, WA, Australia.
BMC Public Health. 2016 Aug 25;16(1):881. doi: 10.1186/s12889-016-3544-5.
The disease burden due to poor nutrition, physical inactivity and obesity is high and increasing. An adequately sized and skilled workforce is required to respond to this issue. This study describes the public health nutrition and physical activity (NAPA) practice priorities and explores health managers and practitioner's beliefs regarding workforce capacity to deliver on these priorities.
A workforce audit was conducted including a telephone survey of all managers and a postal survey of practitioners working in the area of NAPA promotion in Western Australia in 2004. Managers gave their perspective on workforce priorities, current competencies and future needs, with a 70 % response rate. Practitioners reported on public health workforce priorities, qualifications and needs, with a 56 % response rate.
The top practice priorities for managers were diabetes (35 %), alcohol and other drugs (33 %), and cardiovascular disease (27 %). Obesity (19 %), poor nutrition (15 %) and inadequate physical activity (10 %) were of lower priority. For nutrition, managers identified lack of staff (60.4 %), organisational and management factors (39.5 %) and insufficient financial resources (30.2 %) as the major barriers to adequate service delivery. For physical activity services, insufficient financial resources (41.7 %) and staffing (35.4 %) and a lack of specific physical activity service specifications (25.0 %) were the main barriers. Practitioners identified inadequate staffing as the main barrier to service delivery for nutrition (42.3 %) and physical activity (23.3 %). Ideally, managers said they required 152 % more specialist nutritionists in the workforce and 131 % specialists for physical activity services to meet health outcomes in addition to other generalist staff.
Human and financial resources and organisational factors were the main barriers to meeting obesity, and public health nutrition and physical activity outcomes. Services were being delivered by generalists rather than specialists, which may reduce service effectiveness. Although conclusions from this research need to take into account the fact that the audit was conducted in 2004, the findings suggest that there was a need to equip health services with an adequately skilled workforce of sufficient capacity to deliver an effective public health response to the obesity epidemic, particularly addressing poor nutrition and physical inactivity.
由于营养不良、缺乏身体活动和肥胖导致的疾病负担很高且呈上升趋势。需要有规模适当且技能娴熟的劳动力来应对这一问题。本研究描述了公共卫生营养与身体活动（NAPA）的实践重点，并探讨了卫生管理人员和从业者对于实现这些重点所需劳动力能力的看法。
2004年进行了一项劳动力审计，包括对西澳大利亚州所有从事NAPA推广工作的管理人员进行电话调查以及对从业者进行邮政调查。管理人员就劳动力重点、当前能力和未来需求发表了他们的看法，回复率为70%。从业者报告了公共卫生劳动力重点、资质和需求，回复率为56%。
管理人员认为首要的实践重点是糖尿病（35%）、酒精和其他药物（33%）以及心血管疾病（27%）。肥胖（19%）、营养不良（15%）和身体活动不足（10%）的优先级较低。对于营养方面，管理人员认为人员短缺（60.4%）、组织和管理因素（39.5%）以及财政资源不足（30.2%）是提供充分服务的主要障碍。对于身体活动服务，财政资源不足（41.7%）、人员配备（35.4%）以及缺乏具体的身体活动服务规范（25.0%）是主要障碍。从业者认为人员配备不足是营养（42.3%）和身体活动（23.3%）服务提供的主要障碍。理想情况下，管理人员表示，除其他通才人员外，他们还需要劳动力中专科营养师数量增加152%，身体活动服务专科人员数量增加131%，以实现健康目标。
人力和财政资源以及组织因素是实现肥胖、公共卫生营养和身体活动目标的主要障碍。服务由通才而非专科人员提供，这可能会降低服务效果。尽管本研究的结论需要考虑到审计是在2004年进行的这一事实，但研究结果表明，有必要为卫生服务配备一支具备足够能力的技能娴熟的劳动力队伍，以有效应对肥胖流行问题，特别是解决营养不良和身体活动不足的问题。
