The Pharmaceutical Journal
Vol 275 (Supplement) F17
October 2005

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FIP Congress 2005

What does promoting public health mean to health care professionals?

Health professionals who want to help promote public health policy should adopt a “6S” strategy, Anna Ritsatakis, former head of the World Health Organization’s Centre for Public Health Policy, told the congress.
Her 6S strategy involves:

• Supporting patients and families

• Sentinels for equity in health

• Smoothing the way through knowledge

• Setting an example

• Securing a healthy workplace

• Seeking a healthier and fairer future

Supporting patients and families requires the provision of continuity of care through effective feedback and giving families support as they take responsibility for their own health care. Pharmacists need to make sure that they provide patients with clear instructions in terms that they can understand.

Being sentinels for equity in health means compiling evidence and picking up patterns in health trends, ensuring that everyone gets equal treatment and meeting the special needs of patients who had them.

Smoothing the way through knowledge means pharmacists must ensure that they provide enough information to patients to allow them effective participation in their own health decisions regarding treatment, rehabilitation, lifestyles, etc.

To set an example, pharmacists must plan and use resources effectively, and assess the health impact of policies for procurement of supplies and disposal of waste, said Dr Ritsatakis. They also need to report on and discuss progress of public health policies with their patients, and live a healthy lifestyle. For example, it is incumbent on pharmacists not to smoke, she said.

Pharmacists also have a duty to secure a healthy workplace. They should facilitate healthy lifestyles among their staff, ensure that their jobs are as stress free as possible and be aware of gender issues when employing staff.

Finally, in seeking a healthy and fairer future, pharmacists need to make sure that themselves and their staff are highly trained, highly motivated team workers and community leaders.

Earlier in her presentation Dr Ritsatakis said that there was now a better understanding of equity in health in many countries as a result of the 1982 WHO “Health for all” strategy. One of the most important results arising from the strategy was that the values underpinning public health policy are clearly stated and discussed. “First and foremost,” she said, “special efforts were made to improve the health of the underprivileged. Greater efforts were made to improve participation in decision-making both at the level of individual care and in health policy development.”

The main characteristics of the WHO policy was its recognition that health can only be protected and promoted through collaboration with other sectors such as agriculture, the environment, housing, education and transport. By the time the WHO policy was updated in 1998, more emphasis was given to health as a human right and to sustainability in health, and the update that is taking place currently emphasises the need for solidarity in health, she said.

Whereas the WHO “Health for all” strategy had considered lifestyles, the environment and health care, more recently there has been more interest in the effects of poverty, lack of education, social networks and stress on public health, Dr Ritsatakis said. But she acknowledged that working with other sectors has been more difficult than expected. Not enough people have the necessary training and skills for intersectoral collaboration.

“There are public health issues that must be addressed,” concluded Dr Ritsatakis. “Pharmacists could be a tremendously strong force in pushing forward public health policy.”

A Scottish perspective

Later in the session, Scott Bryson, specialist in pharmaceutical public health, Glasgow, UK, gave the congress his view of public health from a professional perspective, focusing particularly on public health priorities in Scotland.

He said that Scotland’s health statistics were not attractive. Life expectancy for men was the lowest in Western Europe after Portugal and that for women was the lowest of all European countries. Public health priorities were, therefore, to deal wath smoking, heart disease, alcohol consumption, mental illness, drug misuse, cancer and oral health.

The key to public health delivery in Scotland, as far as pharmacy is concerned, is the new community pharmacy contract, which will be introduced in 2006. The essence of the new contract is that it will result in improvements in pharmaceutical care, increased access to health care and a reduction in GP workload. It will also support public health initiatives by focusing on health protection, disease prevention, lifestyle change and education and empowerment of patients, said Dr Bryson.

He said that the purpose of public health policies were to act on the wider determinants of health, to take a population perspective, to enable people and communities to increase control over their own health, to protect against risks to health, to support high quality, evidence-based and cost-effective service provision, and to promote equity, fairness and inclusiveness.

All of these could be achieved if health professionals become more engaged with the prospect, he said. Although the special relationship between pharmacist and patient is nothing new, what is new is a political will to improve public health.

Crucial to the implementation of public health messages is pharmacists’ unique position of being able to supply medicines and offer advice with a focus on the individual patient. “Each prescription represents an opportunity for pharmacists to convey and develop the public health message,” Dr Bryson said.