• In India, it is believed that becoming a public health professional does not require specific competencies and thus anyone can do this work.
• This can be explained from the fact that many medical experts such as cardiac surgeons are heads of health services at national, state or district levels who have no training in public health.
• During the pandemic, many doctors with no training in public health provided expert advice on public health issues.
• This false belief comes from not being able to differentiate between public health as a discipline and the public health sector. 
• Public sector health ‘workers’ working in State/Central government only provide grassroots-level services and thus are not public health professional.
• Thus, there is urgent need to recognize Public Health Worker as a separate profession that requires a specific set of competencies.

Public Health

• Public health is the science and art of promoting, protecting, and improving health and wellbeing through organised efforts of society.
• It encompasses all influences throughout life and, because the diversity is crucial, must be multidisciplinary.
• Public health approach aimed at working with communities or health systems.

Requirements of Public Health Worker

• Four ‘A’ s to describe public health workers-
• academics,
• activism,
• administration and
• advocacy.
• Academics:
• It refers to a good understanding of evidence generation and synthesis by having a good grounding in epidemiology and biostatistics.
• It is the brain behind the discipline.
• These competencies are crucial for monitoring and evaluating programmes, conducting surveillance, and interpreting data and routine reporting.
• Activism:
• It is the heart behind the discipline.
• Public health is inherently linked to ‘social change’ and an element of activism is core to public health.
• Public health requires social mobilisation at the grassroots level by understanding community needs, community organisation, etc.
• Administration:
• It refers to administering health systems at different levels: from a primary health centre to the district, State, and national level.
• This includes implementing and managing health programmes, addressing human resource issues, supply and logistical issues, etc.
• It includes microplanning of programme delivery, team building, leadership as well as financial management to some extent.
• A good understanding of the principles of organisational management and health administration is key for acquiring this competency.
• Advocacy:
• Public health is a complex issue that requires cooperation between different levels of government in order to change the status quo.
• It requires clear enunciation of the need, analysis of alternative set of actions and the cost of implementation or non-implementation.
• It requires 4 competencies: good communication and negotiation skills, health policy, health economics, health advocacy and global health.

Public Health services in India

• Public Health workers in India are trained through:
• a 3-year MD (Doctor of Medicine) in Community Medicine: It is exclusively reserved for doctors (the extra year is devoted to provision of medical care) and
• a 2-year Masters in Public Health: It is open to non-medical persons as well.  
• Trainees in public health are placed in communities and at various levels of the healthcare system in addition to receiving classroom instruction.
• The trainees develop a systems approach and a long-term perspective that are the foundations of this discipline.
• A clinical approach is focused on individuals, while a public health approach is broader in scope and aims to address larger issues.
• In India, public health has been medicalised as it was largely a medical college-driven discipline.

Issues in Public Health professional in India

• Resistance of the professionals:
• Despite the fact that none of the core public health functions need a medical qualification, public health has been medicalised in India as it was historically a medical college-driven discipline.
• The resistance of the medicalised public health fraternity is why public health professionals continue to need a medical degree.
• It also denies nursing, dental, and other health care professionals from contributing more to public health.
• Lack of Skills:
• Because of their inclination to work at the community level, many doctors and other health professionals become well-versed in public health.
• However, they do not pursue careers as public health professionals because they might lack the necessary skills.
• Clinicians with backgrounds in epidemiology and biostatistics would not be qualified to work in the field of public health professionals because they lack not only other crucial and essential knowledge but also the proper perspective.

• Lack of training:
• A year of distance learning or even a brief training programme cannot produce a public health professional in the same way that it cannot produce a doctor or a cardiologist.
• Furthermore, the practise of public health is dominated by medicine, which inevitably introduces bias into how its primary goal is understood.
• Public health is too often out of reach of where the real needs are.
• Political interference, which is frequently seen as interfering by experts, prevents the Public Health Workers from being free to identify issues with public health, set priorities, and offer solutions.

Suggestions

• Health professionals, the government, and the general public must recognise public health as a distinct set of skills and accord it the weight it rightfully bears.
• A major advance is the recent proposal from the Health Ministry to establish cadres for public health professionals and health management at the State, district, and block levels.
• The quality of the public health training being offered must also be considered.
• Today''s conditions for successful public health strategies allow for key disciplines to collaborate in the public and private sectors, laying the groundwork for citizen action.
• Separate the public health functions of public health workers and public health professionals by creating an independent organization capable of spreading awareness on the differences of the functions of both groups.
• Public health research must be encouraged and funded at all levels in order to provide more clarity between public health worker and public health professional.

Public health needs to be led by genuine, knowledgeable, lifetime and committed enthusiasts, from whatever background. However, more needs to be done to attract the best and the brightest people into this discipline, which is very important for the nation’s health.