Development and improvement of public health physician system in China

Objective To examine basic situation and job responsibilities of public health physicians (PHPs) and to explore major obstacles to the improvement of the PHPs system in China.

Methods We collected previous data relevant to the implementation of PHPs system from Statistics and Information Center of National Health and Family Planning Commission and China Health Statistics Yearbook for quantitative analysis; we also conducted a semi-structured interview among 52 randomly selected PHPs and a focus group discussion in 10 experts for qualitative analysis in 2017.

Results The number of PHPs presented a downward trend from 2003. In China, the total number of certified PHPs was 89 000 in 2016. Among the four categories of medical practitioners, the proportion of PHPs declined from 8.2% in 2002 to 3.4% in 2016. There were 46 078 PHPs working in centers for disease control and prevention (CDCs) at various administration levels in 2016, accounting for 51.9% of total number of PHPs in all medical institutions across China. Among all the PHPs in CDCs, 50.2% (23 131) had education of undergraduate and above; 14.5% (6 681) had vice senior professional titles; and 33.4% (15 390) had the professional working experience of 30 years or more. Based on the results of content analysis, the job responsibilities for all the PHPs covered following five categories: disease prevention and control, health promotion, health risk factor surveillance, general public health practice, and preventive medicine. The major problems for the improvement of PHPs system included the lack of social positioning and information prescription right, relatively lower professional capability of PHPs, and the gap between the requirement and existing number of PHPs.

Conclusion The professional qualification and post competency of public health physicians should be ascertained clearly; the information prescription right should be entrusted to public health physicians; and the establishment of profession title for chief public health physician and general public health practitioner should be explored in China.