The Pharmaceutical Journal
Vol 270 No 7237 p283
22 February 2003

Society summary

Society to develop public health strategy

The Royal Pharmaceutical Society's Council has decided to develop a strategy for pharmacy's involvement public health, including the possibility of establishing a pharmacy specialism in public health.

The Council made its decision on 4 February after hearing a presentation by Professor Siān Griffiths, president of the Faculty of Public Health Medicine and the recently appointed chairman of PharmacyHealthLink (the new name for the Pharmacy Healthcare Scheme — see PJ, 8 February, p179).

Professor Griffiths told the Council that the definition of public health used by the Faculty of Public Health Medicine is a short, sharp one that points out that public health is everybody's business — "the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society".

One problem for those working in public health, she said, is the difficulty of putting boundaries on it. People are starting to talk about three domains of public health, and elements of pharmacy fit into each domain.

The first domain is health protection and prevention. It includes disease and injury prevention, communicable disease control, environmental health and emergency planning.

The second domain is health and social care. It covers quality, clinical effectiveness, efficiency, service planning, audit and evaluation, and clinical governance.

The third domain is health improvement. This involves employment, housing, family, community, education, inequalities, exclusion and lifestyles. Within this domain, public health professionals are increasingly working with local government, local communities, local businesses and voluntary organisations. Socio-economic, cultural and environmental conditions all impact on public health — as pharmacists in areas of deprivation see in their daily practice.

Professor Griffiths said that a key skill in public health is reviewing the evidence to see what is worth while, and the United Kingdom Public Health Association is doing just that. There is strong evidence of involvement by pharmacists, with the literature showing that pharmacists have contributed in areas such as smoking cessation, coronary heart disease prevention, drug misuse, immunisation, oral health, head lice and emergency hormonal contraception.

The multidisciplinary nature of public health has a major implication for professional development, said Professor Griffiths. The Faculty of Public Health Medicine is hoping to turn itself into a Faculty of Public Health so that it can train people from different backgrounds together rather than leave them in silos.

Another issue is professional regulation. A voluntary register is being created for those in public health who are not already on a professional register.

A further issue is strategic development. This raises questions such as where pharmacy fits within public health, where public health fits within pharmacy, and what is the direction of travel in this area.

In 2000, the Chief Medical Officer for England produced a report that lists three categories of people involved in public health. These are the accredited specialists who spend all their time in public health, the practitioners whose work integrates with public health practice, and those with a public health interest such as social workers and voluntary organisations. Professor Griffiths said that to those three categories she would add local people, who are often the biggest champions of public health issues.

A number of areas of specialist practice occur within the multidisciplinary public health framework. They include:

• Surveying and assessing the population's health and well-being

• Promoting and protecting the population's health and well-being

• Developing quality and risk management within an evaluative culture

• Working collaboratively for health

• Developing health programmes and services and reducing inequalities

• Developing and implementing policy and strategy

• Working with and for communities

• Strategic leadership

• Research and development

• Ethically managing self, people and resources

What is not clear, said Professor Griffiths, is how pharmacy fits in. For example, what would be the specialist pharmacist's contribution to "promoting and protecting the population's health and well-being"?

Professor Griffiths said that one of the challenges of working in a multidisciplinary endeavour is that no individual fits into any particular box. To break down the silos between the different professional groups one needs to find some common approaches. Specialists in public health share the same standards, competencies, language, etc, so that there are no barriers to prevent them moving into different areas of public health. How would pharmacy feel about sharing the same specialist competencies and standards, and what would that mean?" It is something for the Society to think about.

The reason why there is not one register for public health is that many people would not want to give up their professional identity as doctors, dentists, nurses or pharmacists. However, they do need some way of sharing, learning and training together because of the implications for workforce development, workforce planning and support and training for the future.

The setting up of the Council for the Regulation of Healthcare Professionals was changing existing relationships, Professor Griffiths said. All the regulators are changing their shapes. There will be more working across the professions, engaging with the public and being clearer, and it will be interesting to see how it goes forward.

The Society might want to discuss a number of issues. For example, is there a strategy for pharmacy in public health? Or for public health in pharmacy? What does pharmacy in public health look like and who should be doing it? The Government is committed to public health, Professor Griffiths said, and all health professions have a role in it. But how is it best done? Can they all do it together? And what has to be done to move pharmacy forward?

Asked how pharmacists would become accredited as specialists in public health, Professor Griffiths said that the professions need to recognise a common framework that they can all work within, and then each registering body would decide how to apply the common standards. At the moment there is nothing to debar pharmacists from the faculty's training schemes, she added. All they need is a degree of experience.

Answering a further question, Professor Griffiths agreed that, although public health is seen as relevant to the wider community, it is also important in hospitals and across the hospital/community interface.