All pharmacies have an opportunity to do more to improve public health, based on local needs. As health needs vary across each locality and every pharmacy has different capacity, this will require you to reflect on the individual circumstances in your pharmacy.

Pharmacy is an integral part of the public health system, and has an important role to play in providing public health services. This role is likely to become increasingly important in future, as well as being a source of new income streams.

The first step in developing your public health role is to engage with the public health infrastructure locally €“ and to do this it is important to understand the frameworks and terminology used by public health experts.

What is public health?

The Faculty of Public Health defines public health as: 'The science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society'.

Where other healthcare services are aimed at individuals, public health is focused on populations. Epidemiology €“ the study of the factors that determine and influence the frequency and distribution of disease, injury and other health-related events €“ is an important part of public health as it provides the information that helps us to target our activities.

Medicines management teams have often been based in public health departments because their role has traditionally been focused on populations of patients rather than individuals. Pharmaceutical public health is a relatively new term that is used to describe 'the application of pharmaceutical knowledge, skills and resources to prevent ill-health, prolong life, promote wellbeing and protect and improve health for a population'. Linking this with epidemiology, the Pharmaceutical Needs Assessment (PNA) is an important part of public health activity, identifying the needs of local populations and planning the services that will meet those needs.

Another important element of pharmaceutical public health is health promotion. Health promotion is often described as three overlapping activities:

Health protection describes the activities that are prescribed by laws, regulations or codes of practice in order to reduce ill-health. In pharmacy, this might include the requirement to supply medicines in child-proof containers or the restrictions applied to the supply of products that can be abused.

Health education describes the activities that help improve knowledge and change beliefs and attitudes towards health-related behaviours. This includes the health promotion campaigns that most community pharmacies become involved with, as well as the activities of health trainers and health champions.

Health prevention describes the activities that help to reduce the onset or development of diseases or illness. In pharmacy, this could include screening services, such as diabetes or chlamydia screening, and immunisation services such as flu or hepatitis B for drug users.

Health prevention is often further subdivided into:

Primary prevention €“ helping people to identify risk factors and encouraging them to adopt healthy behaviours (e.g. cardiovascular risk assessment)

Secondary prevention €“ minimising the development of existing unknown disease by identifying early signs and symptoms, and encouraging engagement with medical services (e.g. diabetes screening)

Tertiary prevention €“ preventing the deterioration, relapse or complications of existing disease (e.g. adherence counselling or screening for statin use in patients with diabetes).

While these three domains of health promotion overlap, there is also substantial overlap with the individual medical services that pharmacies provide to patients.