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Community pharmacies are key to bridging the gap in the provision of health services in the most deprived parts of the country

When George Orwell published ‘How the Poor Die’ in 1946, life expectancy in England was 64 years for males and 69 years for females. Move forward 66 years and the life expectancy for a baby born in 2012 is 79 years for males and 83 years for females. Yet the health dividends remain unequally distributed between the different social classes.

According to a recent paper in the Lancet, life expectancy in England ranges from 74.9 to 83.1 years in men and from 79.5 to 86.4 years in women depending on the region and socio-economic group. Deprivation accounted for 91 per cent of the difference in premature deaths in men and 79 per cent in women.¹

A web of mutually reinforcing strands traps the poorest in ill health. According to the Lancet, known risk factors explain about 40 per cent of ill health in England. These include:

• Unhealthy diets (responsible for 10.8 per cent of disease burden)
• Smoking (10.7 per cent)
• High BMI (9.5 per cent)
• Hypertension (7.8 per cent)
• Alcohol/drug use (5.8 per cent).

Reductions in deaths from cardiovascular disease and some cancers drove the improvements in life expectancy in England.¹ Other studies confirm improvements in some conditions and risk factors in recent years that help increase national longevity. An analysis of the Health Survey for England, for instance, suggested that between 2003 and 2011³:

• Stroke mortality declined by 42 per cent
• Deaths from ischaemic heart disease fell by 40 per cent
• Average blood pressure declined by 3.0/1.4mmHg
• The proportion of the population that smoked fell from 19 to 14 per cent
• Daily fruit and vegetable consumption increased by 0.2 portions
• Salt intake decreased by 1.4g a day.

While this is obviously good news, it is the more affluent people who are more likely to make longevity-promoting lifestyle changes. The Lancet paper reported increased mortality from liver disease, drug and alcohol misuse, and neurological conditions between 1990 and 2013. All of these are found to be commonest in the most deprived areas.¹

GP provision

Ironically, given the high levels of unmet need in deprived parts of the country, affluent areas attract more GPs. According to the King’s Fund, GP provision in 65 per cent of spearhead areas (those targeted as the most deprived) was less than the national average in 2008.

“The evidence suggests that GPs are disproportionately distributed in more affluent areas despite the number of doctors increasing,” the report remarks.⁴

Marked contrast

The under-representation of GPs in deprived areas is in marked contrast to community pharmacist provision. According to research from Durham University, access to a community pharmacist is better in areas of highest deprivation than in more affluent regions.

The study based the distances on the postcodes for all community pharmacies in England. The researchers used walking as a marker of access to eliminate barriers due to, for example, people’s car ownership or the affordability of public transport.⁵

The authors estimated that 89.2 per cent of the population could access a pharmacy within a 20-minute walk. In urban areas, the figure stood at 98.3 per cent, falling to 79.9 per cent in “town and fringe” and 18.9 per cent in rural areas.

In the 10 per cent of areas of lowest deprivation, 90.1 per cent of the population can access a community pharmacy within a 20-minute walk, compared to 99.8 per cent in the 10 per cent of areas of highest deprivation.⁵

As the accessibility of community pharmacies is greatest in areas of highest deprivation, they may have an important role to play in reducing inequalities in priority public health conditions in England, say the authors. Orwell would have approved.

Ironically, given the high levels of unmet need in deprived parts of the country, affluent areas attract more GPs