Public health workforce around the globe

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reading through the rich mix of content in this special issue, i was intrigued by a number of things. one was the scaling up of a community health workforce in one country, which is able to reach a staggering 75% of the 160 million population, against a backdrop of a massive deficit in the medical, nursing and midwifery workforce. another was a system in which the direction of travel - in order to meet the daunting challenge of the long-term conditions burden and a public health system 'in disarray' - is seeking transformation to a 'culture of health' with a central role for the 'Community Chief Health Strategist'. i will leave you, the reader, to discover just which of the health systems are taking steps in these directions.it is obvious that the challenges of public health differ across the globe. Generally, lower income countries struggle with the more basic problems of keeping populations free from infectious diseases, while higher income countries tend to have the infrastructure to prevent many infectious diseases, and can respond quickly when there are outbreaks, but face problems of lifestyle and growing older populations with complex needs. and these countries' systems do not exist in isolation from each other. Globalization has brought opportunities for trained health workers to leave their homes and find better paid jobs elsewhere - leaving lower income countries with gaps in provision in already fragile health systems.How do we deploy the public health workforce to respond? this was a question the editorial Board of the journal thought could be a worthy topic, and we set about commissioning papers from around the world. You will find in this issue a collection of papers from different regions, each of which takes some kind of view of the public health workforce.What struck us early on was that we were faced with significant definitional problems. Just what do we mean by the public health workforce anyway? the paper from Malawi1 describes a community midwife assistant workforce operating within the context of the Essential Health Package, which resembles primary and secondary healthcare in a different context, and in other nations would be considered to be outside public health per se. the Spanish public health workforce2 tends to be deployed in occupational health, environmental health and food safety, and fascinatingly includes medics alongside pharmacists and veterinarians. While in Quebec, Canada,3 the spirit of the 1970s collective action is being reawakened so that community organisers work alongside other public health actors such as doctors, epidemiologists and health promotion workers, to reduce health inequalities from the ground up.Vivian lin's discussion of universal health coverage and the public health workforce explores this definitional issue in the context of major worldwide initiatives, and draws our attention to the focus on population health interventions being secondary to that on individual healthcare interventions - a problem many of us in public health experience at regional and local levels as well. …