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PRACTICE COMMENT

'Health promotion needs to be safe as well as better resourced'

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The Royal Society for Public Health has come up with a radical rethink that could transform lives for the better. Rethinking the Public Health Workforce is little short of revolutionary

It is estimated that 40,000 people are currently part of the core public health workforce. Logic might dictate that with all those people diligently beavering away we are on the cusp of living in a golden era of healthy contentment. But no - we are, apparently, at crisis point.

It would be churlish to entertain the thought that this crisis point would have anything to do with the last NHS reorganisation. After all, who could have possibly predicted that many local authorities would become strapped for cash barely two years after taking on the lion’s share of public-health provision?

It might be argued that the current 40,000-strong workforce is a mere tilt at a windmill of health inequality. If we are really serious about improving public health, it seems sensible for the Royal Society for Public Health to have recommended that 15 million of us become part of a wider public-health workforce - although why 15 million is suggested and not a lesser or greater number escapes me at the moment. My mathematical ability leads me to surmise that should these recommendations be carried out to the letter, approximately a quarter of the population will be having “healthy conversations” with the remaining three-quarters.

Pretty much anyone can sign up for the role. It doesn’t seem to matter about your level of knowledge and expertise as long as you can handle potentially thorny situations with sensitivity. However if you become one of those 15 million, it is not yet clear how you will be trained or remunerated. Presentations entitled “Opportunistic health promotion: the benefits” will doubtless appear with monotonous regularity. The imagination runs riot.

The fast-food worker will suggest “no fries with that” while the publican would count up alcohol units. No one, it seems, will be exempt from being part of the health promotion army.

The trainee hairdresser will check your body mass index and cholesterol, and your cleaner - if you have one - will sympathetically ask how you feel about the extra-large size of that empty pizza box she’s about to throw out. Even postal workers will have a key role to play - five pieces of junk mail a day through the letterbox can easily be developed into a lecture on fruit and veg intake.

And while it seems innovative to allow my garage mechanic to run a “while -u-wait” MOT test on both me and my car, is anyone tackling important issues such as professional accountability, safety and confidentiality?

Revolutions are often controversial, and the Royal Society for Public Health should be commended on this rethink. And at least there’s no earthly chance that their next report will be entitled Let Them Eat Cake. However health promotion is a complex issue and I am looking forward to hearing the detail of how this plan can actually be achieved.

Jane Warner is nurse practitioner, Somerset.

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