Physiotherapist turned public health director Edward Kunonga talks to Catherine Turnbull
When Edward Kunonga worked as a physiotherapist with individual patients he felt he was working downstream, rescuing people in the river, one by one.
‘I am sure I speak for many clinicians when I say that whenever you see patients daily a picture of the trends and patterns of the type of people affected (by age, gender, ethnicity, timing and in some cases the places where they are coming from) begins to form in your mind.’
Now director of public health for South Tees, Kunonga trained in physiotherapy at the University of Zimbabwe and worked in a large hospital in the south of Zimbabwe in Bulawayo before relocating to Middlesbrough General Hospital as a basic grade physio.
Within a year he moved to a senior 2 position. In this rotational role he covered surgical and medical wards and intensive care then worked in the spinal injuries unit, outpatients and the musculoskeletal area.
His final clinical post was as a specialist senior physiotherapist running the hand unit at James Cook University Hospital, which he left in 2006. ‘When I was in the unit I knew that every Monday morning there would be people waiting for me, who had undergone hand surgery over the weekend – a combination of hand fractures, flexor-tendon injuries and cuts and the majority of them were alcohol-related,’ he says.
‘So I wanted to know how to go upstream and stop these preventable injuries happening. So that’s been my driver around my interest in public health – understanding how I can make a difference to more than one person at a time.’
He studied for a masters in epidemiology with the London School of Hygiene and Tropical Medicine. In 2005, he sat and passed the Faculty of Public Health (of the Royal College of Physicians) membership exam before embarking on a four year postgraduate specialist training in public health with the Northern Deanery (NHS Education as it was then). In 2012 Edward completed an MBA with the Leicester University.
‘Most of us go into healthcare with the desire to make a difference. As a clinician you do make a difference, one patient at a time,’ he says. ‘In public health you have the opportunity to impact on populations, and make a difference for many people at the same time.
‘In my role I work across two local authorities – Middlesbrough Council and Redcar and Cleveland Borough Council where the joint population is 280,000.
‘They are the people I need to make a difference for. And when we get it right, it is a lot more rewarding.’
Physios, he believes, have the perfect transferable skills for lead roles.
‘You need to develop a different skill set, building on your physiotherapy experience – being able to diagnose what the issue is, develop a plan, monitor and implement, and go back and evaluate whether it has worked.
‘This is what physiotherapists do on a daily basis and the additional training can build on these skills.
‘If you look at the demand being placed on the NHS by an ageing population, the burden from musculoskeletal conditions, frailty, multiple morbidity, respiratory and cardiovascular diseases are areas where we can take a lead.’
He is however, concerned about physios getting bypassed in to leadership positions by other professionals.
In my role I work across two local authorities with a joint population of 280,000, so that’s my patient. They are the people I need to make a difference for. And if we get it right, it is a lot more
But those leadership roles won’t come with a physio title next to them.
‘I want to see more physiotherapists being more visible and championing issues such as the physical activity challenge, work that needs to be done around obesity, diabetes - all those conditions are amenable to physiotherapy intervention. And actually we should be leading the charge.
‘We are the professional group that goes into a high level of detail on human movement and exercise. We talk about physical activity being the miracle drug and we are supposed to be the leading experts.’
The challenge of physical activity is more acute in the North East than some areas of the country, with physical activity not high on the priority list in deprived areas.
‘The work we have been doing locally is looking at the environment, working with the people who make decisions and removing some of the barriers so that the physical activity message becomes more relevant.’
He supports the CSP’s Love activity, Hate exercise? campaign, but believes the campaign needs to be more visible. ‘The campaign needs to be more streamlined, more disciplinary, and joining forces with other campaigns, such as Public Health England’s One You. We need to think about how we can align campaigns, because the public may find the messages confusing.’
He also welcomes the commitment made in the NHS Long Term Plan for first contact physiotherapy in primary care, with physios working as autonomous practitioners.
Public health training
For physiotherapists interested in public health and making a difference to the population, within their practice Kunonga suggests resources such as the Royal Society of Public Health, All Our Health Public Health England approach and the recently published UK Allied Health Professions Public Health Strategic Framework (2019-2024).
‘You can deliver public health as part of your day-to-day physiotherapy role. The next level would be, if you are interested in health system design and health populations, you would move out of your existing clinical role.
‘If you are interested in pursuing specialist training, Health Education England each year has a national recruitment for specialist training in public health – a five year postgraduate training scheme.
‘There are also regionally coordinated public health practitioner schemes and your local postgraduate deanery, Public Health England Centre or local director of public health will be able to advise.
‘Public health interest is a broad spectrum from those ranging from embedding it into the daily physiotherapy practice and making every contact count to being a system leader with four years training.’
Kunonga recently sat the British Society for Lifestyle Medicine’s diploma and is one of the first cohorts in the UK.
‘Lifestyle Medicine is about how we use behaviour and lifestyle change to prevent, to manage or in some cases to reverse long-term conditions.
‘There is overwhelming evidence of the role that lifestyles play, in long-term conditions and one of the most effective interventions is physical activity.’
There are a number of senior healthcare leaders in allied health professions from black and minority ethnic groups however more work is needed to ensure the leadership of key public sector organisations is representative of the communities they serve, Kunonga says.
‘The recent publication of the NHS Interim People plan highlights this as a priority and it will be great to see this being turned into action.
‘Without diversity in professional groups and communities we miss opportunities for diversity of views and approaches,’ he says.
‘Physiotherapists need to step up, to achieve professionally diverse leadership. We see doctors, nurses and OTs stepping up to system leadership positions and I ask myself, PHYSIOs where are we?
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