Public health
The growing inequalities in the benefits derived from health care between
social classes, and the differing
approaches to dealing with public health throughout the United Kingdom were among
the topics
discussed at sessions on 17 September. Gareth Jones, editor of Hospital Pharmacist,
reports
Pharmacists reduce health inequalities
Peter Counsell: inequalities in health care between the social classes
are increasing |
Whatever is being done to modernise and improve wider health care should
be stopped, according to Mr Peter Counsell, deputy regional director
of public health for Yorkshire and the Humber. He made these surprising
comments because he believes that the more deprived groups in society
are not benefiting from the current approach. The gap in the standardised
mortality rate between social classes I and V is increasing. Those with
good health are experiencing the benefits of services, whereas those
with the worst health are not. “The benefits and the improvement
in health, over the past century particularly, haven’t been universally
experienced,” Mr Counsell said.
He went on to say that we have to be sensitive that what we do does not
cause detriment to the most vulnerable groups in the population. “All
the work that has been done with the welfare state and the NHS has succeeded
in widening the gap in health care between the social classes,” he
said.
The Department of Health has recently published “Tackling health
inequalities: a programme for action”, and Mr Counsell reviewed
this in the context of another recent publication, “A vision for
pharmacy”. The headline targets of “Tackling health inequalities” deal
with reducing the gap in mortality in children under the age of one year
and across the whole population. Mr Counsell mentioned four of the 12
national headline indicators where pharmacists have a key role to play:
five portions a day of fruit and vegetables, influenza vaccinations for
the elderly, smoking cessation in manual worker groups and reducing teenage
pregnancies by providing emergency hormonal contraception. He mentioned
the project at Greenlight
Pharmacy in Camden, London, where pharmacists
are screening for diabetes and providing education for minority ethnic
groups (PJ, 12 April, p505).
Mr Counsell is pleased to see the move towards treating patients as consumers.
An example of this is the support for increasing numbers of out-of-town
pharmacies. But he is concerned that people who do not have much money
to spend, or transport to get to out-of-town hypermarkets do not enjoy
these services. “If this leads to the closure of local community
pharmacies then we are going the wrong way,” he added. Internet
health services are great for those who have access, but he believes
that we should be sensitive to the most deprived people who cannot access
health care this way. “In a consumer society, wealth gives you
choice, and equity must be assured,” he said.
Mr Counsell concluded by saying that community pharmacies are blessed
with two key assets in relation to public health: the skills of a trained
pharmacist and easy access within the community.
Support staff role
Support staff have a role in the contribution that community pharmacy
makes to public health, said Terry Maguire, vice-chairman of PharmacyHealthLink.
The accessibility of pharmacies is a major strength, and for the vast
majority of the population who access pharmacy services, the first person
they meet is one of the support staff. It is therefore important that
the skills and training they have support what pharmacists are trying
to achieve.
Support staff could ask about smoking as part of their questioning before
recommending non-prescription medicines. There is clear evidence that
health care workers asking about smoking can lead to people making an
attempt at smoking cessation within a year.
Pharmacists are poor at documenting and recording interventions and outcomes,
said Mr Maguire, and he believes that may also provide a role for the
support staff.
He gave an example of a training scheme in Northern Ireland for support
staff to become lay health workers. Their main role is to understand
what agencies are available locally, and then refer individuals when
they think they need help with housing issues, domestic problems and
more medical issues.
Pharmacists are not “plumbed in”
Professor Roger Walker, a consultant in pharmaceutical public health
in Wales, said that pharmacists’ public health role is recognised,
but the challenge is to make sure that pharmacy is integrated into the
overall public health system.
The first director of pharmaceutical public health in Wales was appointed
in 1994. A national public health service was developed in 2001. Pharmacy
is now part of this national service, alongside the medical and dental
services, with the appointment of consultants in pharmaceutical public
health.
Professor Walker said that they currently work in the areas of pharmacoepidemiology,
health protection, pharmacovigilance, medicines management, policy and
strategy, and education and research. They will, for example, contribute
to the public health dimension of the new pharmacy contract or establish
a process to quantify hospital admissions associated with iatrogenic
disease.
Public health is a community issue
Public health is not just a health issue, said Alison Strath, principal
pharmaceutical officer with the Scottish Executive Health Department. “It
is about our community, and that’s why I think community pharmacists
have a part to play,” she added.
Smoking cessation, emergency hormonal contraception, care of older people
and treatment of substance misuse are all examples of how pharmacists
can contribute to the public health agenda.
Earlier this year, “Pharmacy for health” was launched by
the chief pharmaceutical and chief medical officers for Scotland. It
looks at undergraduate and postgraduate education in public health, working
with other practitioners and promoting public health so that pharmacists
see it as an integral part of their job.
“
Have a heart Paisley” is a national demonstration site in Paisley
near Glasgow, and is an example of pharmacy public health in action.
Pharmacists have undertaken to provide health promotion services advising
on diet and physical activity. They have carried out glyceryl trinitrate
audits to help patients better manage their care and also advise on smoking
cessation.
|
