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Paul Johnstone, History of the Faculty’s role in global health, Journal of Public Health, Volume 44, Issue Supplement_1, November 2022, Pages i85–i87, https://doi.org/10.1093/pubmed/fdac070
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The Faculty of Public Health (FPH) is the UK membership organization for public health specialists setting standards for training, examination and practice. It is also a source of knowledge and guidance advocating for public health nationally and globally. Many members have been engaged in global and European work and have gained experience both in contributing and learning about public health. Indeed, the events of the last 2 years and recent months remind us again that diseases and the public’s health do not recognize national boundaries. For many years, the Faculty has been a well-recognized global and European player in strengthening public health systems through training, sharing and advocating improvements in health. But this was not always been the case. This is a personal perspective on the origins of the Faculty’s international committee in the 1990s and how it has developed into a core part of the Faculty’s business.
I entered UK public health training after working in a number of low- and middle-income countries as a volunteer and then with the UK Government as a technical adviser. When I saw my first refugee camps in the 1980s with Afghans in Pakistan and later for Medecins Sans Frontieres in Sudan, I immediately understood that my previous training as a General Practitioner and paediatrician was insufficient to make a difference and that I needed to work for populations and not individuals. Indeed, I can say with some confidence that I learnt as much about public health in those days as in subsequent formal training.
When I started my training in public health and joined the FPH vocational training scheme,1 I wrote to then Faculty President June Crown and asked if the Faculty would be interested in supporting a group of us to explore its role in global health and opportunities for trainees like me to learn from other countries. By good fortune, others were also saying the same, and in 1996, the President asked me and Professor Stephen Horsley (who was then Director of Public Health in Cumbria and previously Regional Medical Officer for the North West Region) to form a working party to make recommendations to the Faculty Board.
It seems incredible now, but there was some resistance to committing the Faculty to international work. So, having a clear purpose and specific contribution clearly articulated was essential. This was helped by drawing on wider policy developments across the Faculty at the time which focused on three revised overarching aims; advocacy/policy, education/training/standards and professional affairs. We conducted a survey of all members for suggestions and ideas, which we published in 1997. Ten percent of members were already working and living overseas, and along with UK members, many welcomed the development. Message: the Faculty was already an international organization, so why were not we doing more?
Starting this new initiative was very rewarding. Professor Horsley chaired the new working party and I was its vice chair. We were supported by Caroline Wren who helped us enormously as our coordinator and secretary. We invited interested members and shared our progress with the rest of the Faculty via its newsletter at the time (ph.com).
In addition to the survey, we took evidence and advice from a number of leading lights in the field. We were keen to engaged with the UK Government’s Department for International Development (DFID) in the early days and had fantastic support from David Nabarro who, as DFID’s health director at the time, gave substantial evidence for our report. We were also supported by Neil Squires, then a DFID adviser, who has remained engaged with the Committees work. In addition, we were strongly supported by Sandy Macara, President of the BMA, a number of other Royal Colleges and Shelia Adam Deputy CMO at the Department of Health.
Engaging with Europe in a systematic way was high on our agenda too. Following the signing of the Maastricht Treaty in 1992, the European Union agreed paving the way to greater European integration. The accession of more countries from Eastern Europe, and with an evolving European Commission, presented opportunities to expand public health, and Professor Horsely and I visited Brussels and met the relevant Director Generals and forged new links. We were really pleased to have Professor Martin McKee from the London School of Hygiene and Tropical Medicine as a member of the group as well as giving evidence and presentations at our inaugural events and Professor Mark McCarthy who subsequently led a subgroup to focus on Europe and in supporting consultations.
Our report recommended (and subsequently implemented):
an international Faculty Adviser to promote our PH qualifications abroad to strengthen Public Health systems in partner countries (this led to working with sub-Saharan Africa, Eastern Mediterranean and Chinese partners);
an annual session on global health at the annual FPH conference; and an additional annual ‘winter workshop’ to focus on specific topics;
establish the European Working Group, to engage with Brussels and European Public Health Association and support trainee placements;
a joint fellowship with Voluntary Services Overseas for trainee placements for 12 months (which supported a number of trainee attachments);
to recruit regional advisers from current overseas members to act as advisers on their country of residence for the Faculty and a link for placements (this was popularly in a number of countries) and
better use of web technology to share progress and a contribution to the newsletter (and subsequently as guest editors in 2004 with Andrew Furber).
All our recommendations were accepted by the Faculty Board in 1996, and we were able to move quickly to an Implementation Group in 1997 and we ran several events starting in Lancaster later that year. Our 6-month workshops in the early years provided an engine room to engage further support and included such topics as working with the NGO sector, Iraqi health, globalization and health, migration and health. Forging international links with Tropical Health and Education Trust and International Health Exchange were important initiatives, and we were pleased that all our activities attracted international speakers and were over-subscribed.
From the Implementation Group, the Faculty Board asked us to set up the Faculty International Committee and I was privileged to be its chair it from 2001 to 2004. We established a trainee interest group (led by Sarah Anderson) and a database for overseas placements as well as a European Interest Group. Overseas placements were a challenge and we needed to persuade Deaneries (which funded the Faculty training programme) who were often reticent to approve and support placements. But, we were able to overcome this as they proved popular with trainees with clear beneficial outcomes for all.
Under the presidencies of Professor Jim McKwen and Professor Sian Griffiths, the International Committee gained further strength and became one of the Faculty’s Standing Committees (and still is today). We facilitated meetings with the presidents of the professional Public Health bodies of New Zealand, Hong Kong, Australia, with Gulf States and with the World Health Organization with whom we signed an MoU to work jointly on training, CPD and widening the professional membership (noting the Faculty vocational training was exclusively for doctors in those days!). We worked with India, Pakistan and were active with Hong Kong. Indeed Sian, Mahmood Adil and I were invited to share our work of the Faculty by the Hong Kong Health Authority in March 2003. We had a fantastic reception and our hosts made us feel very welcome with speaking engagements across Hong Kong. But, it was clear our hosts were increasingly distracted during our visit especially on the last night at a banquet in the Hong Kong Racing Club! Unknown to us, at the time, their concern was about a new virus from mainland China, and by the reports of doctors and other clinical staff at the Prince of Wales Hospital, falling sick with respiratory symptoms, which was later diagnosed as SARS. Some of our Hong Kong colleagues with whom we had been meeting over the time of our visit were indeed unwell with it, fortunately recovering! With some sound advice from the Health Protection Authority (from the late Angus Nicholl who was also a committee member), we survived the following days in quarantine and were relieved we were not the first people to bring SARS to Britain! A salutary reminder, however, that diseases know no boundaries and our health is bound up globally.
Some 25 years after that initial working party report, the Faculty’s International Committee’s role in global health is core business. Many trainees and consultants have had the opportunity to experience and learn from overseas public health work. We have led in strengthening training and public health systems across Europe, sub-Saharan Africa and the Middle and Far East. As a trainee back in the 1990s, it was a great privilege to work with many leading lights in the field and to see its work move from strength to strength under the leadership of subsequent Faculty Presidents, International Registrars and Chairs. Indeed, to highlight two most recent developments: we led in the World Federation of Public Health Associations/EUPHA statement on ‘Public Health for the Future of Humanity: One planet, One People, One Health’ (16th World Congress on Public Health Statement) on the need for global solidarity and social justice to tackle climate change, the pandemic,2,3 and the Faculty was awarded a distinction for its role in supporting Association of Schools of Public Health in the European Region, which is chaired by Professor John Middleton another past president. The challenge of the climate crisis, sustainability, need for peace and risks of new emerging infections, all require global health skills and standards of practice, which is now a core function of the Faculty. In the coming years, the Faculty’s role in global health has never been more important.
Acknowledgements
The author thanks Sian Griffiths, Neil Squires and Stephen Horsley for supporting comments.
Paul Johnstone, Honorary Professor in Global Public Health
References
Tahzib F.