“Many of the public health challenges faced today are global health problems and require an understanding of the global dimensions of health and its influences. Public health professionals need an understanding of the global influences on health to be able to improve the health of the population." - Public Health Specialty Training Curriculum 2022
Demand for global public health training opportunities is high, with many registrars wishing to undertake a global health placement either in the UK or overseas. However, we know that such opportunities are not taken up equitably by registrars between or within Regional Training Programmes.
To address this, a four-nations Global Health Placements Working Group of registrars was formed which reported into the FPH Global Health Committee and was supported by the Speciality Registrars Committee. Our main aim was to improve equity of uptake of Global Health Placements (GHPs) within and between regions. We sought to understand what the reality is for our registrar body, and what the research actually says about global health experience. Two years of work followed to answer such questions: How do we make it so that opportunity is not based on where you happen to train? How do we ensure that trainees get the best experience, and that this benefits local training systems?
Firstly, a survey of over 100 registrars showed that 85% of responders were considering a GHP but only 10% had completed one. There was demand for a wide variety of organisations and topic areas with a clear preference for flexibility in location and hybrid working models. The biggest barriers to GHPs were reported to be family commitments and caring responsibilities, followed by financial implications (potential or actual). Potential inequalities were exacerbated by unclear information around funding and salary, and placements only being advertised to certain deaneries, or advertised nationally but with a requirement for office presence (e.g. in London) without specifying whether travel expenses are covered. Another common barrier was obtaining GMC and/or OOP approval.
We also found that what GHPs look like was different from our preconceived ideas: global public health opportunities that predominantly involve staying ‘within region’ are increasing. Very few involved relocating for long periods; most were hybrids of remote work with occasional shorter trips, mixes of OOP and in-programme work, and some were a part-time global health project alongside a standard UK-based placement (such as those facilitated by the FPH Projects Scheme).
The survey results also yielded further examples of GHPs to add to a growing ‘map’ of examples of previous opportunities, available on the FPH website.
Benefits of completing GHPs from real examples provided by respondents were broad. Wide-ranging technical and soft skills were gained and developed, spanning the breadth of the 2022 curriculum. Moreover, there were many examples of how these skills were applied locally on domestic work completed upon return to UK-based public health work, such as contribution to high-level strategies, policy-writing and commissioning practices.
The second significant piece of work from the Working Group is a systematic review which is soon to be submitted for academic publication. We found evidence that GHPs provide registrars with opportunities for personal and professional development, to build upon interpersonal skills, and to develop and enhance their career prospects. There are also secondary benefits for domestic institutions, but placements need to be well-planned to manage potential negative implications for both the employing and host organisations.
The Working Group has recently announced the publication of a guide “Global Health Placements: A guide for Public Health Registrars, host organisations, and Statutory Education Bodies" available on the FPH website here.
The guide has support from over 40 registrars and many consultants in public health as well as current and previous FPH leadership. As well as setting out the evidence of the benefits of GHPs through summarising the results of the survey and systematic review, it contains ‘top tips’ for registrars, potential host organisations, TPDs and Deaneries to consider when setting up such a placement in an equitable way.
It is hoped that this document will facilitate the creation of additional, and more equitable global public health opportunities, and be used as a tool to facilitate wider access to existing opportunities. We ask for your support as part of the UK FPH community in its broad dissemination and implementation.
“Understanding fully public health issues in the UK requires an understanding more broadly of Global Public Health issues […] This guide details how registrars can gain that experience and how their school can support them gain this experience. Enriched by this global experience trainees will have a more comprehensive approach to Public Health practice in the UK." - Elizabeth Mason, Chair, FPH Global Health Committee
To get involved in the next steps of the Working Group, contact our new Chair, Kaat Marynissen: k.marynissen@nhs.net.
