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BPharm PhD FRPharmS HonFFPH
Consultant in Pharmaceutical Public Health
National Public Health Service for Wales
Professor of Pharmacy Practice
Welsh School of Pharmacy
As a profession, pharmacists are comfortable in dealing with medicine-related issues but cautious about stepping outside their professional cocoon and tackling wider public health issues. Beyond giving lifestyle advice on topics such as smoking, diet, substance misuse, sexual health, alcohol and exercise, most venture no further. To address this, pharmacists need to understand better the principles of public health and the partnerships required, and identify what and where pharmacists can contribute.
What is public health?
There are many different definitions of public health in use, although one frequently used is as follows: “The science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals.”(1)
As a corollary to this, public health pharmacy has been defined as the application of pharmaceutical knowledge, skills and resources to public health,(2) whatever the definition of public health used. This approach has proved useful to some but misled others to believe that public health pharmacy is a discipline in its own right. This is incorrect. Public health is a multiprofessional discipline to which pharmacy can make a valuable and unique contribution with its strong focus on medicine-related issues, or in a broader context. Pharmacy cannot effectively contribute if it chooses to work in isolation.
Should pharmacy decide to restrict its public health contribution to medicine-related issues, and given that taking a medicine is the most common intervention in healthcare, it will always be in a position to impact on public health, albeit in a restricted capacity. To impact on the wider determinants of health, there is a need to recognise that more than 70% of what determines an individual’s health lies outside the domain of health services in their demographic, social, economic and environmental conditions (see Figure 1). To neglect these wider public health issues and their impact on the health of the individual is to diminish the contribution of pharmacy. For example, there is limited opportunity to optimise the health of patients with asthma by counselling them on the correct use of their inhaler when wider public health issues are influencing treatment outcome. The individual may continue to smoke, have a poor educational background, be unemployed or live in relative poverty and poor housing, all of which impair good disease management. An awareness of the relevant, wider influences is critical, as each carries a significant health burden in its own right. This can be simply illustrated by looking at the recognised adverse impact of unemployment and poor housing on health (see Box 1).
Contribution of pharmacy
Typical of the public health roles identified for pharmacy are those set out in Box 2. To play a part in the public health agenda in an effective way, there is a need for pharmacy to shift to partnership working and put appropriate training in place. Undergraduate, postgraduate and continuing professional development programmes are required to provide the necessary educational support, while training programmes for some to develop specialist expertise and leadership in public health are also required. Integral to all these developments is the need for evidence-based research, to assess the contribution of pharmacy to public health.
To neglect the potential contribution of pharmacy to public health is to diminish the contribution of the profession to the health of the population. Embracing public health is a challenge to which we must all respond positively.