The Pharmaceutical Journal
Vol 275 No 7373 p556
29 October 2005

Society summary

A move to improve pharmacy's role in public health

A PharmacyHealthLink presentation on public health has resulted in a commitment from the Council of the Royal Pharmaceutical Society to help promote the future public health role of the profession.

The presentation was given at the Society’s October Council meeting by Jim McEwen, PHL chairman, and Roger Walker, a trustee and director, who set out their belief that current interactions between pharmacists and the public do not maximise pharmacy’s opportunities to improve public health.

Introducing the presentation, Professor McEwen said that pharmacy and public health have the potential to work closely together on improving the public’s health. PHL has already collaborated on the Department of Health’s pharmaceutical public health strategy document for England, “Choosing health through pharmacy” (PJ, 9 April, p409). One lesson learnt from working on that document is that those in public health need to learn more about what pharmacy can contribute.

Professor Walker introduced himself as a pharmacist who has worked in public health for the past 10 years. He said that pharmacists are comfortable with certain aspects of public health, such as giving advice on sexual health, smoking cessation and substance misuse, but the boundaries need to be moved forward.

But there are problems in doing this, he said. First, the service opportunity presented by “Choosing health through pharmacy” is not underpinned by a robust research base. A research evidence base has been compiled by PHL and the Society, but the evidence for what pharmacy has achieved and delivered is minimal and has to be addressed.

Secondly, pharmacists have little formal training in public health and few work at a senior level within public health. Yet working with public health is important for pharmacy’s future survival and development, he suggested.

Another problem is that pharmacists tend to work in isolation. Working as part of a team underpins public health and pharmacy is not always comfortable in that environment.

A further problem is that pharmacy interventions in the public health agenda focus on issues of access or process, rather than tackling underlying causes of health inequalities.

Professor Walker said that little is known about how the poor, the socially excluded and those living in disadvantaged areas use and benefit from pharmacy services. There is little evidence that pharmacy health promotion activities target those most at risk.

He added that most determinants of people’s health lie outside the domain of the health services. It has been estimated that over 70 per cent of what determines people’s health lies in their demographic, social, economic and environmental conditions. Although they stray into the area of giving lifestyle advice (smoking, diet, drug abuse, sexual behaviour, alcohol, exercise), pharmacists rarely venture into factors with a wider influence on public health.

Pharmacy has to get away from its focus on medicines, he suggested. “Medicines and their administration are the commonest health care intervention on a day-to-day basis, but there is a wider agenda out there,” he said.

“I think we have a challenge getting over what is public health to the wider workforce. It is a perspective based on groups of people and populations. It is underpinned by inquiry, multidisciplinary research, looking at the evidence base and identifying the health needs. Then the action: mobilising resources to improve health. So it is not what we can do as an individual, but what we can do as part of a group working with others.”

Professor Walker said that the potential for creating specialists in public health pharmacy was “a real live issue”. It had been developed with the UK Voluntary Register for Public Health Specialists (see Panel), which Professor McEwen chaired. Pharmacists fitted comfortably into the voluntary register’s agenda. What was required was a closer liaison between the Society and the voluntary register to take the agenda forward for pharmacists.

Professor Walker asked whether the profession wanted to recognise the defined specialist in public health pharmacy. Would the Society become involved in assessing those individuals, or would it leave it to the voluntary register? There was an open invitation for dialogue between the Society and the voluntary register.

There were issues around prospective training programmes, said Professor Walker. Collaborative programmes with the Faculty of Public Health were a possibility. It could be useful to have workshops for those who lead public health within the schools of pharmacy, to establish some consistency.

Pharmacy needs to pick up the good models, develop those that work and drop those that look a bit dodgy, he said. There is a great desire to find out what pharmacy should be doing in public health. Guidance is required and the Society had a clear role in that.

A final point, said Professor Walker, is that pharmacy has little expertise in public health. The one little gem that it does have is PHL, which drafted the Department document and has worked on almost every public health initiative undertaken across the pharmacy agenda. It is “a nucleus of support and enthusiasm” to help take the agenda forward, he said.

He added that people in public health have a real willingness to work with pharmacy. “I think we have to grasp their hand and work with them and take this agenda forward.”

Winding up the presentation, Professor McEwen commented that, as a newcomer to the field of pharmacy, he had been impressed by the profession’s enthusiasm for grasping the difficult and uncertain area of public health.

Miriam Armstrong chief executive, PHL said that, when PHL and the Society reviewed the research evidence base, a number of local schemes were excluded because they did not meet the systematic criteria for entry — perhaps because they had not been fully evaluated or were not at the right level. Pharmacists undertaking new ways of working that go into the area of social capital should perhaps engage with universities or others who can help them design the evaluation, so that their studies can be included in any future systematic review.

The Society’s Director of Practice and Quality Improvement, David Pruce, said that the Society’s own work stream on public health complemented the work of PHL. The Society had worked with PHL for many years and he hoped the Council would support the idea of building on the existing links.

Speaking after the presentation, the Society’s President, Hemant Patel, said: “We now have a great opportunity to work with the Government to improve the health of the nation, and for this reason we must embrace public health and see it as a vital part of pharmacy’s future. The Government and the health care professions are now convinced that prevention of ill health is better than cures. Over the coming months, I am sure we will see a greater focus on community development and public health to improve and link with primary care where investment will continue to be poured.”