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Asian Journal of Dental and Health Sciences

Open Access to Dental and Medical Research

Copyright  © 2024 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

The Role of Pharmacists in Health Promotion

Pallav Dave *

Regulatory Compliance Analyst, Louisville, KY,40223, USA

 

 

Introduction 

The role of health promotion in addressing emerging public healthcare concerns cannot be denied. Communicable and non-communicable diseases are on the rise across the globe contributing significantly to the rising healthcare burden and straining healthcare systems. The rise in the number of communicable and non-communicable diseases necessitates preventative measures to address them. Health promotion is recognized as instrumental in disease prevention. The UN High-Level Meeting on Universal Health Coverage (UHC) recognizes health promotion as one of the approaches that can help to achieve UHC.¹ It emphasizes the importance of prioritizing health promotion and disease prevention through implementing working public health policies, good governance of health care systems, health communication, education, and health literacy.^1,2 The significance of health promotion in disease prevention cannot be understated. Various health promotion measures are adopted across the healthcare systems to improve public health. The importance of health promotion in disease prevention is not a new concept. Its role in addressing public health issues and prevention of diseases has been established since the 19^th century.³ Health promotion as a concept was first coined by Henry E. Sigerist in 1945. According to Sigerist, health promotion entails a number of measures all of which are classified as tasks of medicine. The tasks include promotion of health, prevention of illness, restoration of the sick, and rehabilitation.³ All these tasks are instrumental in achieving health for all and improving the health of all communities. 

The importance of health promotion in promoting health for all and achieving people’s well-being is cemented by the Ottawa Charter for Health Promotion. The Ottawa Charter was born out of the first-ever international conference on health promotion that was held in 1986.⁴ According to the charter, health promotion is a process that enables people to have more control over their health. It is also done to improve health.⁴ The charter recognizes five action areas for health promotion namely building health public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting healthcare services more towards the promotion of health and prevention of illness.^4,5 The action areas can be achieved through strategies such as advocating, enabling, and mediation. 

In addition to being a process, health promotion can also mean the actions taken by individuals and relevant stakeholders to lead a healthy lifestyle.⁶ These measures need to be taken in a healthy environment to prevent the likelihood of secondary conditions. Secondary conditions in this case are the social, medical, emotional, family, and community problems that may make it difficult for an individual to have total control of their health.⁷ For instance, social problems such as racism and discrimination in the healthcare system may make it difficult for an individual to have access to equal opportunities for care. In the community, problems such as lack of community parks, social amenities, and lack of safety may make it difficult for people to engage in physical activity and lead to increased risk of chronic conditions such as obesity and diabetes.⁷ Some of these measures that can be taken to ensure individuals attain optimal health are being at the forefront when it comes to addressing their health needs, providing education to individuals on how to take care of their health needs, and optimizing opportunities that enable individuals to take care of their health needs and engaging in activities that can promote good health. 

Despite the significance of health promotion in promoting good health, it is an area that is underutilized and not given as much priority. A lot of effort is directed towards disease management underpinning the potential of health promotion in disease prevention. One of the reasons why health promotion is underutilized is because of the lack of adequate healthcare personnel with the needed expertise to engage in different health promotion measures and strategies.^8,9 Currently, healthcare systems across the world are grappling with serious healthcare provider shortages.¹⁰ The problem is so big in some countries that most have resulted to outsourcing from other countries which creates more challenges for these countries because they are understaffed as well. With such shortages, prioritizing health promotion becomes a challenge. This explains the need to expand the role of healthcare providers to ensure more engagement in health promotion. 

One of the groups that can be used to alleviate the problem is community pharmacists. Because of their close involvement with patients, they can be instrumental in advocating for different health promotion initiatives such as prevention, increasing individual knowledge on health, and public health planning and promotion. Therefore, the aim of this review is to explore how community pharmacists can be involved in different health promotion strategies to achieve health promotion goals. It also explores the challenges and barriers pharmacists face towards health promotion and why addressing these barriers is instrumental in achieving positive outcomes. 

Health Promotion Measures and Strategies and the Role of Pharmacists 

Building Public Health Policy

Different actions and strategies can be taken to attain positive change with regard to disease prevention and health promotion. As per the Ottawa Charter, one of the activities that can be taken to promote health is building public health policy. As a measure of health promotion, building public health policy recognizes that health promotion goes beyond health care. Health promotion also involves creating health policies that can help to achieve the desired goals of healthcare.⁴ Building health policy ensures that policymakers are knowledgeable of health consequences that result from the decisions that they make regarding healthcare.⁵ It also ensures that they accept their responsibilities and are more accountable for these decisions. Having health policies in place is vital in implementing health actions. They are the basis for health interventions and their subsequent implementation.¹¹ Without proper health policies in place, coming up with health interventions and implementing them becomes difficult. A number of diverse approaches can be taken to come up with health promotion policies. They include legislation, fiscal measures, taxation, and organizational change.⁵ 

Although pharmacists have little involvement when it comes to developing legislation, taxation, or fiscal measures, they can be involved through participation and advocacy. Pharmacists can also play a critical role in advocating for organizational change to promote health. For instance, they can advocate for capacity building in organizations to support actions that can promote health such as the need to eat healthy lunches and the need for gym and other social amenities to promote physical activity.  Pharmacists can also be involved in building knowledge skills and infrastructure that can facilitate health promotion.¹² They can also partner with organizations to advocate for actions that promote health. When these actions are sustained over time, they can become more sustainable and lead to permanent changes in organizations. 

When it comes to developing legislation, pharmacists can actively participate through the local boards of health to national programs. Pharmacists are experts in medication use which makes them informed on how medication can be used in health promotion. Because of their expertise, they should be involved in the development of legislation and regulations relating to public health.¹³ Pharmacists can also be involved in oversight of these programs. Pharmacists can also make their voices known when it comes to developing fiscal measures that aim at health promotion. For instance, they can suggest fiscal measures that they feel can work and call for their implementation. They can also advocate for sound legislation and regulations regarding disease prevention and management. 

Creating Supportive Environments

An additional measure that is considered instrumental in health promotion is creating supportive environments. The need to create supportive environments as a measure to promote public health is acknowledged in the Ottawa Charter.⁴ According to the Charter, creating supportive environments that are considered safe, stimulating, and satisfying is instrumental because it leads to positive health outcomes.⁴ Research has shown that supportive environments are associated with positive health outcomes.¹⁴ Supportive environments in this case are environments that make it easier for an individual to make the easier choice pertaining to their health. They can include healthy cities, healthy communities, healthy municipalities, healthy workplaces, and health-promoting schools among others.¹⁵ 

Pharmacists can play an instrumental role in creating supportive environments. They can do this by advocating for healthy communities, being more involved in building healthy communities, and educating people on the importance of these communities in promoting good health. Creating supportive environments entails putting measures in place to encourage good health such as building spaces that allow people to engage in physical activities, striving for a better built environment with green spaces and walkways, and ensuring people have adequate access to food by ensuring proximity to grocery stores. Pharmacists can advocate for better-built environments in their communities. Research has linked the built environment with the likelihood of developing chronic diseases because it limits physical activity.^16,17,18 For instance, walkable neighborhoods and the availability of parks have been linked to increased engagement in physical activity and subsequent reduction in the risk of developing obesity and diabetes.¹⁷ The reason why creating supportive environments is linked to better health outcomes is because such environments encourage people to take charge of their health. They feel safer and as such are more likely to take charge of their health leading to positive outcomes. 

Disease Control and Prevention

Pharmacists can also play a crucial role in disease control and prevention. One of the ways through which pharmacists can be involved in disease prevention is through immunization. Immunization is recognized as an instrumental aspect of disease prevention more so for communicable diseases.^19,20,21 The perceived benefits of vaccination include reducing the spread of infections, reducing morbidity and mortality associated with infections, and preventing outbreaks.¹⁹ For instance, vaccination played an instrumental role in helping control further spread of COVID-19. In the United States, pharmacists can order, prescribe, and administer immunizations under the temporary federal PREP Act.²² Besides, the involvement of pharmacists in immunization has shown to have a positive impact on immunization uptake and overall outcomes.^23,24 Therefore, involving pharmacists in immunization can increase uptake and promote good health. 

In addition to administering immunization, pharmacists can be involved in screening programs to help identify undiagnosed medical conditions. Screening is recognized as an important measure of disease prevention more so chronic diseases such as hypertension, diabetes, and cancer.^25,26,27 Pharmacists can be involved in different steps of the screening pathway as stipulated by WHO.²⁸ For instance, they can identify the population that is eligible for screening because of their close involvement with patients. They can also invite patients to carry out tests and do the testing. Pharmacists can also refer patients to primary healthcare providers after getting results from conducted tests. Pharmacists can also work collaboratively with other healthcare providers during community screening programs.

Health Education

An additional way that pharmacists can be involved in disease prevention and control is by educating patients on behaviors to mitigate diseases and modelling these behaviors. Some of these behaviors include handwashing, immunization, wearing masks, engaging in regular physical exercise, and eating healthy and nutritious food.¹³ Pharmacists are in a good position to both educate patients and model these behaviors. Because of their frequent encounter with patients, they can use these opportunities to educate patients on healthy behaviors. They can also refer patients to available resources and services that involve health promotion. 

The role of pharmacists in health education cannot be understated. Over the years, pharmacists have played instrumental roles in developing, promoting, and implementing health education programs.²⁹ Because of their proximity to patients and availability, they are well-positioned to educate patients on different aspects of health promotion including the need for exercise regimens, the importance of adhering to prescribed medication, medication safety, and the importance of a good diet in promoting good health. Health literacy is recognized as instrumental in leading to positive health outcomes.^30,31  It equips patients with the needed skills and abilities to better manage their health. Under the Ottawa Charter of Health Promotion, developing personal skills is one of the actions of health promotion. WHO recognizes that health literacy is not just a personal resource. Within populations, health literacy can lead to better social benefits such as mobilizing entire communities to address the social, economic, and environmental determinants of health.³² Health People 2030 recognizes health literacy as a social determinant of health because it affects the healthcare that is delivered and subsequent patient outcomes.³³ This is particularly the case when people are not able to access healthcare resources and use these resources to make health-related decisions. The inability to access these resources affects people’s ability to make decisions about their health which explains why lack of health literacy is associated with negative outcomes. 

Research has shown that pharmacists-led education interventions are instrumental in leading to positive health outcomes.^34,35 Jaam et al. established that pharmacists-led education interventions provided to healthcare providers helped to reduce medication errors.³⁵ Safe medication administration is a vital aspect of health promotion because it leads to positive health outcomes. In addition to providing education to patients, pharmacists can be involved in developing health education programs within their institutions and the community in general. 

Promoting Medication Safety

Pharmacists can also play a role in health promotion by promoting medication safety efforts in both the communities and institutions at large. The importance of medication safety in achieving the goals of health promotion cannot be denied. If individuals are to have more control over their health, then they need to know how to take their medications effectively and minimize the likelihood of medication errors. The role of pharmacists in ensuring medication safety cannot be denied.^36,37 It is one of their key responsibilities in ensuring patient safety. In their role, pharmacists can ensure patients have access to crucial medication and vaccinations aimed at promoting health, ensure patients have access to medical information, ensure patients are prescribed the right medication, improve medication adherence by educating patients on the importance of taking their medications, medication management, and provide health and wellness services.³⁸ One of the ways that pharmacists can ensure medication safety to promote good health is through providing medical information to patients. Providing information on safe and effective medication use can have a positive impact on patient safety by reducing the likelihood of adverse reactions. Educating the patients on the importance of medication adherence can also promote good health. This is particularly the case for patients who are self-medicating and managing their chronic illnesses. Pharmacists can also provide health and wellness services by engaging in services such as blood pressure and diabetes screening. Such services more so when implemented at the community level can play a crucial role in promoting public health. Pharmacists can work in collaboration with other healthcare providers and organize community health campaigns to offer such services. 

Collaborating with other Stakeholders to Strengthen Community Actions

                    Strengthening community action is recognized as instrumental in health promotion. WHO defines strengthening community action as empowering communities to get more involved in their health.⁴ There are different measures that can be taken to empower communities to be more involved in their health. They include providing people with help and support to manage their conditions, providing access to health information, carrying out health campaigns to educate community members on the importance of good health, providing funding, carrying out health fairs, carrying out health camps, and partnering with other stakeholders to promote health. The significance of strengthening community action in promoting health is acknowledged in research. Laverack and Mohammadi, note that strengthening community action helps to build community capacity and ensure they prioritize their health. It also entails providing funding for various community activities.³⁹

Pharmacists can engage in different activities to strengthen community action. Some of these include participating in health camps, engaging in health fairs, providing support to community members, providing education to community members, and engaging in health campaigns. To enhance positive outcomes, pharmacists can work collaboratively with other healthcare providers and stakeholders. Research has shown that community-based partnerships are instrumental in health promotion. For instance, Plump et al. established that community-based partnerships can improve the outcomes of chronic disease management because they enhance self-management.⁴⁰ Community-based organizations have also been established to be instrumental in improving chronic care.⁴¹ Community-based organizations promote health because they allow community members to access and navigate neighborhood health resources. Such resources are recognized as instrumental in helping people self-manage their chronic illnesses. 

Challenges and Barriers to Pharmacists Involvement in Health Promotion

Recognizing the existing barriers and how they can affect pharmacists’ involvement in health promotion is vital towards achieving positive results. There are numerous barriers that exist which can make it difficult for pharmacists to play a role in health promotion. Structural barriers such as time restraints and workload can make it difficult for pharmacists to engage in health promotion.^9,42 For instance, health education and engaging in health camps is engaging and time-consuming. Performing these roles together with their duties can be difficult. Inadequate knowledge and skills in health promotion can also act as a barrier.⁴² For instance, pharmacists cannot provide health education on how to manage chronic diseases if they are not adequately equipped to do so. Lack of knowledge can affect pharmacists’ confidence to provide health education and lead to low engagement in health promotion.

Lack of coordination with other healthcare providers can also make it challenging for pharmacists to be involved in health promotion. Different researchers identify it as one of the barriers reported by healthcare providers towards health promotion.^43,44,45(Nsengimana et al., 2022; Geense et al., 2013). Coordination among healthcare providers is important in health promotion because they play different roles all of which are instrumental in leading to positive outcomes. Playing isolated roles can affect patient outcomes and affect the overall quality of health promotion. 

Other barriers that can affect pharmacists’ involvement in health promotion are lack of organizational support, lack of patient motivation to change, and lack of financing of health promotion programs. Finding funding for health promotion programs is not a simple task. According to Geense et al., a lot of health programs are not financed or only financed for a short duration of time.⁴⁵ Providing health promotion programs without financing is challenging because they are expensive. Lack of organizational support can also be a hindrance to health promotion. Health promotion requires coordinated efforts with stakeholders and policymakers to be effective. Additionally, the lack of patient motivation to change can demotivate pharmacists in their efforts towards health promotion. Addressing these barriers and challenges can lead to positive outcomes in health promotion. It can ensure pharmacists take up more active roles in promoting public health beyond providing immunization and medication management. 

Conclusion

                    Health promotion is regarded as instrumental in promoting good health. Despite the role it plays in promoting good health, it remains an area that is significantly underutilized. One of the reasons why health promotion is underutilized is because of the lack of adequate healthcare personnel with the needed expertise to coordinate different health promotion measures and strategies. With the current shortages being experienced in healthcare, engaging in health promotion becomes difficult because of workload and lack of time. Expanding the role of pharmacists to be more involved in health promotion roles and measures can lead to a significant difference. They have close contacts with patients which provides them with a significant opportunity to advocate for and engage in health promotion initiatives. Pharmacists can engage in different actions to promote health. Some of these include disease prevention and control, being part of developing public health policies, engaging in different community actions, providing patient education, creating supportive environments, and being at the forefront of leading medication safety. These measures and initiatives are recognized as effective in health promotion. To gain the full benefits of these measures, there is a need to identify the existing challenges and barriers and address them. These challenges act as barriers that make it difficult for pharmacists to be involved in health promotion. Some of these barriers are structural barriers such as time restraints and heavy workload, and organizational barriers such as lack of support and inadequate funding, poor coordination with other healthcare providers, and lack of patient motivation to change. Addressing these barriers and challenges can lead to positive outcomes in health promotion because pharmacists can be able to perform their roles more effectively.

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