BPC 2001 summary

Pharmacists have an important role in preventing disease, says Princess Royal

Motorbikes might not have been expected to feature in the address by the Princess Royal on 25 September when she talked about the importance of preventing disease but, as she explained, they are crucial in delivering medicines to parts of the world inaccessible by other means.

She started her address by considering definitions of health care: “People have their own concept of what being healthy is.” She alluded to the World Health Organization definition that to be healthy an individual has to be in a complete state of physical, mental, spiritual and emotional well-being. In more practical terms that can be translated into access to food and water, being safe and having shelter. The Princess Royal pointed out that, from her work with the Save the Children Fund, people who live in poverty lack even these basic essentials.

It is now acknowledged that unless health is tackled as part of poverty there will be no chance of reaching the ambitious targets of reducing maternal and child mortality which in some countries are static or rising. In the poorest countries a number of factors make this difficult. The Princess Royal mentioned rising populations, debt repayments, low social spending and poorly resourced health sector reforms among the factors.

Only 20 years ago, Unicef and the Save the Children Fund supported initiatives for vaccines to be purchased, delivered, stored and given effectively to prevent children dying. In many countries targets of 80 per cent were reached and, for whooping cough and measles vaccinations, this compared favourably with some parts of the United Kingdom.

“Commitment waned, polio eradication became the new target and less than half of children under five are now vaccinated against preventable diseases,” she explained. Staff running these programmes need to be trained, housed and paid, and parents need access to affordable health services. Basic cover has declined in Africa, Asia and parts of Latin America since the 1990s.

But the problems with these programmes pale into insignificance compared with the problems faced by populations who have no access to clean water. One billion people have no access to clean water; 2.3 billion adults have no access to sanitation. “We need additional political commitment and the development of safe water supplies and sanitation facilities should be a priority.

The Princess Royal mentioned a recent WHO/Unicef 2000 report on water and sanitation which revealed that, in Africa and Asia, women walk an average 6km a day to collect water, carrying a weight of 20kg on their heads (equivalent to the air luggage allowance). The average person uses 135 litres a day of water in the UK, compared with only 10 litres in the developing world. Half of all the world’s hospital beds are occupied by patients suffering from water-borne diseases.

The Princess Royal then explained how valuable pharmacists could be, yet so few work in countries where their expertise is most needed. There are few pharmacists, for example, in hospitals in sub-Saharan Africa, and services are run by pharmacy technicians. More significantly, few pharmacists work with governments to shape and guide pharmaceutical policies and the logistics of distribution.

She gave some stark examples of the result: malaria kills more children than HIV/AIDS; it is too expensive for most countries to treat tuberculosis properly. In South Africa, more than 150 children are born each day with HIV and yet access even to the cheapest remedies is beyond them. The availability of expensive drugs in the developed world to prolong the lives of people with AIDS is a cruel mirage for them.

The Princess Royal acknowledged that there have been debates on the price of medicines and, in the treatment of HIV, some progress has been made through discounts and donations. But she argued that there should be recognition by pharmaceutical companies that equity in the pricing system could create new markets rather than compromise short-term profits.

As well as the price of drugs, the Princess Royal also emphasised the importance of strengthening health systems in many parts of the world. And new global trade rules must be shaped to protect the poor and vulnerable, and the long list of neglected diseases that are specific to the poor world “must move up the political agenda, otherwise the crisis will deepen.” She urged pharmacists to travel because they had a role in training local workers .

The Inter-agency Pharmaceutical Co-ordination Group has produced guidance that has had an impact on private donations of medicines. In the past, transport, distribution and administration costs were not funded by the donor and precious funds had to be shifted from other health care services. Under the IPC guidance, all transport and distribution costs have to be funded by donors or international agencies.

This led the Princess Royal to describe the work of Riders for Health, a small charity that uses motorbikes to deliver vaccines to places off the beaten track, which not only understands the importance of delivery and storage of vaccines, but also maintains the means of transport.

She remarked that her work with the Save the Children Fund has revealed that there are many similarities between the developing world and the UK, and there is much to done here, by pharmacists. She mentioned the special needs of children that need to be addressed, such as accurate assessment of children’s doses of drugs.

She then turned her attention to the important role that pharmacists play in the National Health Service. Increasingly there is evidence of team-working in primary care with pharmacists, GPs and nurses working together. There also needs to be greater collaboration between the team and patients so that they benefit from better prescribing. She gave the example of pharmacists offering domiciliary advice for the elderly as something that they could do well.

She then passed on an observation she made through her work with the Trust for Carers, that it is often the pharmacist who notices when a young person frequently comes to pick up a prescription for a relative: often these young carers do not know that support and benefits are available for them, until the pharmacist spots them.

“Pharmacists have a wealth of contributions to make to the community and you need to be be reminded what a good job you do. And in collaboration with other health care professionals, your job will be seen to be more and more crucial. My thanks go to a profession which has supported the community to high standards,” she ended.

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