The current situation in Australian is that health workforce policy – including the field of public health is – effected through a combination of government purchasing from the health sector, and market-based education from the education sector. In theory, public health programs exhibit all the characteristics of a public good, and are dependent largely on government investment. As such, it is reasonable that government should be purchasing public health education, in order to produce the workforce required. There is, however, little coordination between the Commonwealth and the states/territories in coordinating their investments, or in projecting workforce requirements.
Beyond PHERP, the public health capabilities and capacity of the health workforce have also been improved through other kinds of government investment (such as through the recently established schools of rural health) and through the efforts of the professional and academic institutions (i.e. incorporating public health content and skills into the curriculum of the clinical workforce). However, the effectiveness of including some public health curriculum into undergraduate medical, nursing, and health sciences education is largely unknown.
Unfortunately, there is little systematic information available about the outcomes and career trajectories of most MPH students and other graduates. For example, it is not known the extent to which such students are seeking career change, or just upskilling. It is also not known the extent to which graduates have proactively shifted into working more full time in the field of public health, or are merely using their public health knowledge and skills in existing positions. Anecdotal information suggests that 'all of the above' are occurring, with the expansion of employment opportunities in a wide range of relevant settings, including Divisions of General Practice, local government, non-government organisations. In 2004 a survey was undertaken of 655 current and alumni MPH students in Victoria. Most students agreed that the MPH training was relevant to their jobs and prepared them for public health positions. However, only 71 per cent of students thought that the MPH prepared them for practice, while half of this number said that it prepared them for research [19]. A series of ANAPHI case studies [20] suggested that PHERP-funded institutions have contributed significantly to developing a workforce capable of addressing such public health challenges as emerging diseases such as SARs, chronic disease, indigenous health and socioeconomic health inequalities [21].
In the absence of a strong government role and leadership in planning and purchasing in a 'public good' field like public health, it becomes the role of the profession to create a market demand, or to reflect on how best to meet the public interest and needs. The articles in this series demonstrate the efforts of the profession and the educators to improve workforce capacity to work in disadvantaged communities (Harris et al) and in low and middle income countries (Patel & Phillips), to institute innovation in education (Bullen & Neuwelt, for New Zealand) and shape the pathways through education (Bennett et al), and to undertake their own planning (Rumbold and Bennett, Fleming et al).
Such a market-based system provides for diversity, as well as problems of sourcing needed expertise (Madden et al). Yet, traditional workforce planning methods of deterministic projections have not been effective in addressing workforce needs (Bolton & Segal). There have been attempts to develop methods for estimating workforce needs [22] as well as workforce planning models specifically for public health [7] – though neither has been sufficiently robust for broader adaptation and uptake.
Within the current policy context, there are some workforce needs which can be anticipated (Lilley & Stewart), while the extent of new public health challenges such as climate change may be less predictable (Ellis et al). In the face of very uncertain futures, currently being impacted on by the greatest global economic downturn to have occurred in the last 50 years, the question for government is how to ensure a sufficiently flexible and adaptive workforce, and how to provide sufficient incentives to academic institutions and the relevant professions to assure a high standard and quality of education in the public interest and for a more capable public health workforce for the future.