Social Pharmacy: Public Health, Pharmacist Roles, and More
Social Pharmacy: An Overview
Social pharmacy is the discipline dealing with the role of medicines from social, scientific, and humanistic perspectives.
Scope of Social Pharmacy in Improving Public Health
Health financing: To protect vulnerable populations from financial hardships, pharmacists ensure cost-effective health care through the rational use of medical products and modern technologies. Studies show pharmacists can substantially increase health care savings by reducing medication-related problems and providing cheaper alternatives or suggesting medicines covered by insurance.
Medical products, vaccines, and technologies: With an increasingly wide range of new and analogous medical products, vaccines, and technologies, pharmacy practice continues to broaden. Pharmacists’ roles include medical products, vaccines, and medical devices, especially those demanding special knowledge regarding uses and risks. Pharmacists are responsible for ensuring the efficacy, integrity, and security of medical products, devices, and vaccines to safeguard patient health.
Health services: As medicine experts, pharmacists deliver effective, safe, and quality medicines and services to achieve optimal health outcomes. Competency and up-to-date knowledge are core to tailoring information and advice to patients.
Millennium Development Goals
- Eradicate extreme poverty and hunger
- Achieve universal primary education
- Promote gender equality and empower women
- Reduce child mortality
- Improve maternal health
- Combat HIV/AIDS, malaria, and other diseases
- Ensure environmental sustainability
- Develop a global partnership for development
Role of Pharmacists in Public Health
- Review Prescriptions
- Dispense Prescription / Non-Prescription Medicines
- Provide Patient Counselling / Education
- Hospital and Community Pharmacy Management
- Expertise on Medications
- Proficiency on drugs / pharmaceuticals
- Entrepreneurship and Leadership
- Deliver Primary and Preventive Healthcare
- Professional, Ethical and Legal Practice
- Continuing Professional Development
- Review Prescriptions: Students should professionally handle prescriptions, checking for completeness and correctness. Contact prescribers for clarifications and corrections, offering suggestions.
- Dispense Prescription / Non-Prescription Medicines: Students should dispense scheduled drugs/medicines as per the Drug & Cosmetics Act and Rules. Non-prescription medicines (over-the-counter drugs) should be dispensed judiciously.
- Provide Patient Counselling / Education: Students should effectively counsel/educate patients/caretakers about prescription/nonprescription medicines and other health-related issues, using oral and written communication skills and techniques.
- Hospital and Community Pharmacy Management: Students should manage the drug distribution system as per hospital pharmacy policies, good community pharmacy practice, and regulatory agency recommendations. Manage procurement, inventory, and distribution of medicines in hospital/community pharmacy settings.
Defining Health
Health is a state of complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity, and the ability to lead a socially and economically productive life.
Various Dimensions/Types of Health
The concept of Health refers to many types or dimensions such as:
- Physical Health Dimensions:
- A state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body.
- Refers to perfect functioning of the body.
- Indicates that all body organs are structurally and functionally normal.
- Mental Health Dimensions: Mental Health is “a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of the self and that of other people and that of the environment.”
- Social Health Dimensions: Social wellbeing implies “Quality and quantity of an individual’s interpersonal ties and the extent of involvement with the community.” Social health considers the individual member of society and their health status in relation to social conditions.
- Spiritual Health: Refers to that part of the individual which reaches out and strives for meaning and purpose in life.
- Emotional Health: Mental health can be seen as “Knowing” or “Cognition”, while Emotional health refers to “Feeling.”
- Other Dimensions: Philosophical, Cultural, Socioeconomic, environmental, educational, nutritional, curative, and preventive.
National Health Mission (NHM)
The National Health Mission (NHM) was launched by the Government of India in 2013, subsuming the National Rural Health Mission and National Urban Health Mission. Extended in March 2018 to continue until March 2020. NHM components include Maternal health, Neonatal-child health, Reproductive health, Adolescence health, and disease prevention (Tuberculosis, cardio, etc.). NHM facilities are promoted through advertisements, posters, radio, social media, and newspapers.
Aims of NHM:
- Improve the health conditions of the people.
- Awareness about Adolescence and bad habits.
- Prevention against disease.
- Improve hygienic condition.
- Awareness about natural sources.
- Maintenance of population growth.
- Provide all facilities to required persons.
NHM is divided into two parts:
- National Rural Health Mission.
- National Urban Health Mission.
Demography
Demography is the systematic/periodic study of population growth.
Demographic Cycle
- High stationary (first stage): High birth rate and high death rate, no change in population size.
- Early expanding (second stage): Death rate declines, birth rate remains unchanged, initial increase in population.
- Late expanding (third stage): Birth rate declines while the death rate continues to decrease, continued increase in population.
- Low stationary (fourth stage): Low birth rate and low death rate, stability in population.
- Declining (fifth stage): Birth rate is lower than the death rate, decrease in population.
Family Planning
Definition/Introduction: Family planning is the practice of controlling the number of children one has and maintaining the intervals between their births, particularly by means of contraception or voluntary sterilization.
Aims of Family Planning
- Control population
- Improve health (Physical, mental, and social)
- Reduce hunger and poverty
- Reduce maternal mortality
- Reduce infant mortality and morbidity
- Improve reproductive health
- Decrease STDs
- Improve the education level
Pharmacists’ Role in Mother and Child Health
Pharmacists supply various contraceptive options and prescribe/initiate emergency contraception. They also:
- Aware parents and supply vitamins and nutritional supplements, including folic acid and iron supplements, and promote cessation of alcohol and nicotine use.
- Recommend drug therapy, dosages, and duration of essential medicine during pregnancy and decide on drugs for the developing embryo.
- Make decisions regarding accessibility of critical medications in labor and delivery and provide required sterile medication products during delivery.
- Support breastfeeding (when replacement feeding is acceptable, feasible, affordable, sustainable, and safe; avoidance of all breastfeeding by HIV-infected mothers is recommended).
- Supply effective treatment to the child and drug therapy (Oral rehydration salts and Zinc therapy) and ensure no deficiencies in quality, purity, or potency of medicinal products.
- Participate in health programs and make parents aware of disease conditions, providing proper precautions.
Diseases/Illnesses Related to Substituted Milks
- Substituted milk can sometimes cause severe allergic reactions in infants, causing eczema and rashes.
- Some infants cannot digest substitute milk, causing diarrhea and increasing the risk of necrotizing enterocolitis (NEC). Due to a lack of nutritional value, it does not improve proper growth and development.
- Due to a lack of nutrition, proper immunity is not developed against infections or diseases, leading to diseases like diabetes, pneumonia, obesity, leukemia, and respiratory diseases.
- Substituted milk is easily deteriorated by bacterial or fungal growth, harming infants.
- Due to a lack of nutrition, it can also cause malnutrition.
Immunity
Immunity is defined as the ability of the immune system to produce an immune response against disease-causing organisms like bacteria, viruses, fungi, and other foreign agents.
Types of Immunity
- Innate Immunity: Non-specific defense present at birth, providing barriers to the entry of foreign agents.
- Acquired Immunity: Pathogen-specific immunity characterized by memory. The body produces a primary response (low intensity) upon first encounter and a highly intensified secondary or anamnestic response upon subsequent encounters.
Smoking increases carbon monoxide (CO) content in blood and reduces the concentration of haem-bound oxygen, causing oxygen deficiency. Smoked tobacco products include cigarettes, cigars, bidis, etc. Chewed tobacco products include chewing tobacco, snuff, dip. Tobacco addiction is caused by a dependency on nicotine and habits formed by smoking or using chewing tobacco. Some people use it as a stimulant, but high amounts cause severe problems.
Vaccines
A vaccine is a chemical substance or biological preparation that provides active acquired immunity against any disease.
Types of Vaccines
The development of more effective and safer vaccines, as well as vaccines for more serious diseases, is ongoing. Vaccine formulations affect how they are used, stored, and administered. There are four types of vaccines, categorized by the antigen (inactive microbes, toxins, surface protein) used in their preparation:
- Live Attenuated Vaccine (LAV): Prepared by weakening pathogens (virus or bacteria) under laboratory conditions. Live microorganisms provide continual antigenic stimulation, giving sufficient time for memory cell production. They cause no or very mild disease. Example: Tuberculosis (BCG), Oral polio vaccine (OPV), Measles, Rotavirus, Yellow fever.
- Inactivated Vaccine (Killed Vaccine): Prepared by killing antigens through physical or chemical processes. These killed organisms cannot cause the risk of inducing the disease and are considered more stable than LAV vaccines. Example: Whole cell pertussis, Inactivated polio virus (IPV).
- Subunit Vaccine (Purified Antigen): Contains the antigenic parts (disease-causing portion) of the antigen. Like inactivated vaccines, it does not contain live components of the antigen, only antigenic parts like surface protein, conjugated chemicals, polysaccharide, etc. Example: Acellular pertussis, Haemophilus influenza type b, Pneumococcal, Hepatitis B.
- Toxoid Vaccine (Inactivated Toxoid): Based on the toxin produced by certain bacteria (e.g., tetanus or diphtheria). The released toxin is used to prepare the vaccine, and these parts are necessary to elicit a protective immune response and produce antibodies. Example: Tetanus Toxoid (TT), Diphtheria Toxoid.
Water Pollution
Any undesirable changes in water properties by physical, chemical, and biological methods are called water pollution. Human beings have been abusing water bodies by disposing of all kinds of waste into them.
Sources of Water Pollution
- Household wastes (vegetable peels, rotten materials, and other food wastes).
- Industry wastes drained into rivers or water sources.
- Chemical fertilizers and pesticides.
Effects on Health of Water Pollution/Waterborne Diseases
- Polluted water causes metabolism defects and diseases like Gastroenteritis, Diarrhea, Cholera, dysentery.
- It also affects brain activity and can cause severe brain-related problems.
- Many infectious disease agents transfer through contaminated water (Typhoid, Giardiasis, Amoebiasis, Ascariasis, Hookworm).
- Polluted water affects normal growth and development and induces infant mortality.
Air Pollution
Sources of Air Pollution
- Smog (smoke and fog) containing oxides of nitrogen, which combine with other air pollutants. Smog causes breathing difficulties such as asthma, cough, and wheezing in children.
- Chlorofluorocarbons (CFCs) used in refrigerators, air conditioners, and aerosol sprays damage the ozone layer.
Effects on Health
- Air pollution causes serious long-term health diseases, including heart disease, lung cancer, and respiratory diseases such as emphysema.
- It can also cause long-term damage to nerves, brain, kidneys, liver, and other organs, sometimes causing birth defects.
- Acid Rain: Damages monuments like the Taj Mahal. Pollutants like sulphur dioxide and nitrogen dioxide gases react with water vapors to form sulphuric acid and nitric acid, which fall with rain, making it acidic.
Noise Pollution
Noise is undesired high-level sound. We associate loud sounds with pleasure and entertainment, not realizing that noise causes psychological and physiological disorders. Brief exposure to extremely high sound levels (150 dB or more) may damage eardrums, permanently impairing hearing ability.
Sources of Noise Pollution
- Industrial noise from machines working at high speed and intensity.
- Outdoor sources such as road traffic, jet planes, garbage trucks, and construction equipment.
Effects on Health
- Long-term exposure to loud sound causes Noise-Induced Hearing Loss (NIHL) and sleeping disorders.
- Exposure to loud noise can cause high blood pressure, heart disease, and stress.
- Trouble communicating.
- Disturbance of the balancing system.
Solid Waste Disposal
Solid wastes refer to everything that goes out in the trash. Municipal solid wastes are wastes from homes, offices, stores, schools, hospitals, etc., collected and disposed of by the municipality. They generally comprise paper, food wastes, plastics, glass, metals, rubber, leather, textile, etc.
Sewage Treatment Plant
A major component of wastewater is human excreta. This municipal wastewater is also called sewage, containing large amounts of organic matter and microbes, many of which are pathogenic. Before disposal, sewage is treated in sewage treatment plants (STPs) to make it less polluting. Treatment is done by heterotrophic microbes naturally present in the sewage in two stages.