In the course of my 20 year public health career, I experienced five different organisational change programmes resulting in a change of employer. Sometimes it was a ‘lift and shift’ without too much difficulty, and other times a more radical change with years of challenge and a sense of going backwards. Even the simpler reorganisations were associated with periods where morale was low, and a sense of inevitability and frustration pervaded the working environment. As public health in England goes through another reorganisation, I have been wondering why a career in public health seems to be so unstable and how to help my clients and former colleagues to stay upbeat and able to do their own best work.
Public health has often been at the periphery of the health system in the UK and seems to be quietly forgotten about much of the time, even though it underpins every single health service encounter and all aspects of the health of the population. Every ten years or so there is a public health crisis and the question of ‘where is public health?’ is raised: public health is found to be ‘in the wrong place’ and then moved to the ‘right place’. A career in public health is an amazing opportunity to influence outcomes and policy at a local, national or international scale, and to work closely with politicians. This can be both exciting and challenging: politicians may be less considered in their decision making than their civil servant advisors, so being closer to the seat of power seems to leave public health more vulnerable to reactive decision making.
I think another factor is a general lack of understanding of what public health is, what public health specialists can provide, because the skills set of a public health leader are so varied and complex.
- A strategic planner
- a commissioner
- a service provider
- a disaster responder
- a system leader
- a health economist
- a transport/ housing/education planner
- an epidemiologist
- a social reformer
- an exceptional negotiator and mediator… being all things under one job title causes its own problems as an outsider looking in struggles to understand the complexity of the role.
Despite these challenges, it is possible to weave a career path for yourself which is rewarding and satisfying. Try to accept that public health is a more unstable choice of career rather than struggle against it, and learn the skills you need to progress your own career forwards no matter the external circumstances. All public health leaders are hugely qualified and able to take on a wide range of roles and functions, and have always worked across multiple organisations and systems. Remember how good you are and how important your work is, and what a privilege influencing outcomes at scale is: public health is one of the few careers which combines an evidence base with scope for creativity and flair, and you can use this to good effect in your own career planning. If you need help with a career needs assessment, vision, options appraisal and action plan, come to me and I will help you to find the energy and clarity you need to find a way forward no matter the political environment.
Dr Fiona Day (MBChB, FFPH, Dip Occ Med, Executive Coach) is a FMLM approved Executive Coach and offers world class coaching for senior doctors, medical and public health leaders. Find out more at www.fionadayconsulting.co.uk; to explore working with Fiona please book a confidential half hour Career Consultation here.