FIP Congress 2006
|
Claire Anderson spoke at a session organised by
the Pharmacy Information Section and the Academic Pharmacy Section.
She reports it here
|
 The World Congress of Pharmacy and Pharmaceutical Sciences,
the 66th International FIP Congress, was organised by the International
Pharmaceutical Federation in association with the Federal
Council of Pharmacy of Brazil.
It took place in Salvador da Bahia from August 26 to 31, 2006
|
Pharmacist advocates of public health
Greg Duncan, lecturer in pharmacy practice, Victoria College of Pharmacy,
Melbourne, Australia, introduced his talk about public health issues
around the world as they relate to pharmacy, by stating that there is
an inherent conflict between the concepts of public health and pharmaceutical
care.
He said we have to reconcile population needs with individual needs.
Public health, he said, emphasises the prevention of disease and the
health needs of the population. New-style public health seeks to address
health inequalities by advocating for population-based policies that
improve the health of the population equitably.
All but two countries
have signed the declaration on human rights, which states that health
systems should contribute to a fair and healthy society.
Mr Duncan defined pharmaceutical public health as the application of
pharmaceutical knowledge, skills and resources to the science and art
of preventing disease, prolonging life, promoting, protecting and improving
health for all through organised efforts of society
He went on to
consider some of the issues surrounding pharmaceutical public health.
These include
application of essential medicines concepts, and even though we have
TRIPS (property rights) agreements around the supply of medicines,
there is still difficulty in translating these agreements into action.
Issues
like antibiotic resistance and counterfeit medicines are challenged,
he said by limited resources. Work at macro and micro levels
Pharmacists need to be working in public health at a macro level. To
date 60 countries have developed medicines policies. Mr Duncan said
that we must identify the priority needs of a population at a point
in time. He told the audience that all 12 local pharmacists had been
killed by the December 2004 Indian Ocean tsunami in Bande Aceh in Indonesia
and that two pharmacists — one from France and one from New Zealand — were
working there. They had spent most of their time sorting out donated
medicines, only 5 per cent of which were useful. This is a major issue
that needs addressing globally, Mr Duncan emphasised.
At a micro level pharmacists are involved in health promotion and disease
management. Areas of involvement include promoting health lifestyles,
safe use of medicine and waste medicine disposal campaigns, immunisation,
screening and so on. Mr Duncan told the audience that we need to look
at these activities in a public health context. In many ways, he said,
we are already practising public health, for example, in providing primary
care services in developing and emergency settings.
Pharmacists also need to take up advocacy roles both in their communities
and nationally. This, he explained would be driven by concerns for social
justice, and support might vary and could include financial, representative,
and active leadership roles. He concluded by stating that the real challenge
is that no single professional action of pharmacists will matter at a
population level unless major socioeconomic and environmental determinants
of health are addressed.
We need to advocate for broad social and environmental change. The fundamental
conditions and resources for health, he told the audience, are peace,
shelter, education, food, income, stable ecosystem, sustainable resources,
social justice and equity. Improvement in health requires a secure foundation
in these basic prerequisites.
Public health in the pharmacy undergraduate curriculum — the Nottingham experience
 Claire
Anderson, professor of social pharmacy, University
of Nottingham, UK, talked about public health in the pharmacy school
curriculum.
She told the audience that currently there is little coverage in
many pharmacy curricula.
She explained that, at Nottingham, they start with
the basics and than go on to get students to think about many of
the issues that
Greg Duncan had mentioned (see above). She said that the promotion
of health and the prevention of disease are now seen as a priority
for health services in many countries. The pharmacist’s role,
too, needs to develop to reflect this shift in emphasis away from
simply treating those who are ill.
The World Heath Organization
has recently stated that public health competencies, especially
as they
relate to the management of chronic disease, will be of increasing
importance to the 21st century global health care workforce.
Pharmacists need to be thinking about populations, not just individual
patients. Population, as it is used in this context, refers to
patients associated with a particular provider, clinic or health
care system.
This is one way in which population-based care differs from traditional,
individual patient care.
A population approach, she explained,
does not detract from individual needs, but adds another dimension,
because
individuals benefit from the information developed for the populations
to which they belong.
Considerations of cost-effectiveness also increase, in that patients
with a specific chronic condition are prioritised so that interventions
are targeted toward those members most likely to benefit. So we
need to give pharmacists skills in health needs assessment, skills
for
implementing and evaluating evidence-based interventions thus reducing
risks and delaying complications, and skills that enable measurement
of outcomes for all patients, thus avoiding the trap of focusing
solely on the individual patients who come forward for care.
We still seem to teach public health from a biomedical approach
and there is little teaching on advocacy, community development,
social
capital and so on.
The most recent national vision documents for pharmacy state that
pharmacists should have a public health role. “Choosing health
through pharmacy” — the English pharmaceutical public
health strategy — states that the undergraduate curriculum
should include an overview of the three domains of public health:
strategies for preventing disease and promoting health, the wider
determinants of health, and the health psychology elements of behaviour
change.
Professor Anderson then described Nottingham pharmacy school’s
public health curriculum and in particular talked about two assignments
that the students complete.
In year two, following teaching on health promotion and use and
evaluation of health promotion resources, students are placed in
groups of six
to produce a health promotion poster for display in a pharmacy.
They are given a topic and a target group to research, for example,
smoking
cessation for pregnant women, emergency contraception for students
and dental health for parents of young children. They are expected
to understand and be able to explain to an assessor, the evidence
base behind the messages on their poster.
In year four they again work in groups; this time they choose the
eight people they wish to work with. They are told that their local
primary care organisation has some money to promote sexual health
and they are invited to give a presentation about the role of the
pharmacist in sexual health and what services they might offer.
They are assessed on the presentation they give and by an examination
question.
Professor Anderson concluded by calling for a shared consensus
on what constitutes the public health syllabus in schools of pharmacy.
She asked the audience to consider integrating public health teaching
into their clinical teaching and encouraged sharing or teaching
materials
and experience. |
|
The
Pharmaceutical Journal