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The great public health revival

Community pharmacy has great potential to deliver better public health, but we must be aware that the products we sell in our pharmacies could ultimately make it more difficult for us to help people live healthier lives, says Terry Maguire...

We are emerging out of lockdown into the spring sunshine, bleary-eyed and exhausted but eager to live our lives again and to be safe. It will soon be time for an inquest into what has happened since March 2020, what we got right and what we could have done better.

Community pharmacies will be lauded for their efforts but, for me, the real hero of the pandemic will be Public Health.

Public health delivered significant successes, designing and communicating rules on effective handwashing, social distancing and other behaviours, running track and trace systems and finally rolling-out vaccination. These measures could have been much more effective had politics allowed.

For the past 40 years, as we have been increasingly seduced by the miracles of clinical medicine, we have almost forgot the importance and benefits of public health. The Covid-19 pandemic has changed all that and we will witness the science of public health’s return to its proper place at the centre of healthcare.

Covid-19 appeared out of nowhere (well, China, actually) to infect, hospitalise and kill millions across the globe and it has the potential to cause problems for decades to come.

The UK’s health systems were largely defenceless at the outset, except for their public health response. What is perhaps less appreciated is that the morbidity and mortality from Covid-19 was more devastating in the UK because a significant proportion of the population, particularly those in the lower socio-economic groups, were smokers, were obese, had poor nutritional status and were relatively inactive.

Age, the largest risk factor, we cannot alter, but the other risk factors, especially obesity, can be modified. If our population had not been 60 per cent overweight and 25 per cent obese, hospitalisations and deaths would have been far fewer.

What seems to have been largely ignored is that 100,000 people in the UK died from smoking related illnesses in the same year as 120,000 died of Covid-19. There were no news conferences or daily briefings on smoking and no laws to keep us safely distanced from it.

What is clear is that greater effort is needed to improve all determinants of poor health if we wish to avoid the severe impact from another global pandemic. In this community pharmacy can have a central role.

Healthy Living Pharmacies is a great programme for harnessing the social capital that exists within the community pharmacy network. Pharmacy has huge potential to deliver better health, not only through the supply of medicine, but by simply supporting healthy lifestyles - getting people to stop smoking, lose weight and become more active.

This is already being recognised in national pharmacy contracts. In Northern Ireland, for example, our Living Well service is effecting change by getting people to make healthier choices. Clinical medicine can too easily miss this point.

Smoking cessation is the most successful pharmacy public health intervention and must serve as a template for the development of more services. The combination of general advice and service delivery can indeed impact public health, but pharmacists will need to be meaningfully engaged and incentivised to deliver.

I often meet pharmacists who, while aspiring to promote better health, fail to see that what they are doing in their practice is not truly in the public health interest but more in the commercial interest of themselves or others.

It can be a difficult path to negotiate. Over a decade ago, because of my interest in smoking cessation, I became involved with a company developing a nicotine delivery system it wanted to license, only to find the company was owned by one of the major tobacco firms.

My ideology, perhaps too naive at that time, caused me to withdraw because I believed the company had ulterior motives. Over time I discovered it did. Likewise, I was circumspect with vaping products as Big Tobacco was at the centre of that business too.

A two-page promotional article from Philip Morris International appeared in a pharmacy magazine recently and I immediately recognised the real agenda. Big Tobacco is now trying to present itself as the solution rather than the problem of tobacco harm. In marketing and supplying a new range of products the company is seeking the support, and to exploit the credibility, of pharmacy. This hypocrisy is as startling as it is offensive.

Public health, focused on disease prevention, will be a central pillar of UK healthcare as we follow our road maps out of lockdown. In this future the community pharmacy network has significant potential, but we need to be clear that the products we sell in our pharmacies - be they sugar-based soft drinks, confectionary, vaping devices or novel, smoke-free tobacco-heating systems - will provide a barrier to our meaningful involvement in the great public health revival.

Terry Maguire is a leading community pharmacist based in Northern Ireland.




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