The geographical distribution of specialists in public health in the United Kingdom: is capacity related to need?
OBJECTIVE
Recent organizational changes reflect the need to be more responsive to local populations and have included fostering a closer structural relationship between primary care and public health. In light of this, we explore the distribution of the specialist public health workforce and the relationship with population deprivation and need.


METHODS
Questionnaire survey to all directors of public health working in primary care trusts (PCTs) and strategic health authorities (SHAs) in England to determine the number of specialists in public health working in either PCTs or SHAs. All identified specialists were given the opportunity to self-define in a further questionnaire survey. Whole-time-equivalent staffing, per head of population, was analysed against socio-economic deprivation, measured by the DETR 2000 Index of Multiple Deprivation. The analysis was conducted at the SHA level.


RESULTS
The survey was undertaken whilst public health in the UK was undergoing immense change. This presented specific challenges in identifying specialists in public health working within PCTs and SHAs. Seven hundred and eighty-three specialists working in PCTs and SHAs were identified. On average, in England, there are 1.69 specialists in public health per 100,000 population, with some variability at SHA level (range = 0.8-2.89). Findings indicate an overall positive association between capacity at SHA level and socio-economic need, although some discrepancies between need and provision are apparent.


CONCLUSIONS
The general positive association between capacity and deprivation should offer some reassurance to policy makers, researchers and patients alike. However, further efforts are needed to redistribute specialists in some areas to address organizational capacity and equity issues.
Chapman
J
J
Centre for Infectious Disease, Institute of Cell and Molecular Science, Queen Mary, University of London, 4th Floor, 51-53 Bart's Close, St Bart's Hospital, West Smithfield, London EC1A 7BE, UK. j.l.chapman@qmul.ac.uk
Congdon
P
P
Shaw
S
S
Carter
Y H
YH
D004739:England; D005843:Geography; D019538:Health Care Surveys; D006286:Health Planning Councils; D006301:Health Services Needs and Demand; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration; D011361:Professional Competence; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D011634:Public Health; D011635:Public Health Administration; D011795:Surveys and Questionnaires; D000078329:Workforce