This document outlines the role of pharmacists in public health. It discusses what public health is, the history and development of public health organizations in the US, traditional public health programs, health guidelines, disease prevention strategies, health measurement, communicable disease control, chronic disease management, maternal and child health, nutrition, oral health, environmental health, mental health, substance abuse issues, and the role of public health research. The document emphasizes that pharmacists are highly accessible healthcare professionals who can help address many public health issues through counseling patients, identifying early signs of disease, providing immunizations, and conducting smoking cessation programs.

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Pharmacist in Public Health

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Public health is a societal effort to protect, promote, and
restore the public’s health.
The programs, services, and institutions involved emphasize
the prevention of disease and the health needs of the
population as a whole.
The goals: to reduce the amount of disease, premature
death, and disease-produced discomfort and disability in the
population.
Public health is thus a social institution, a discipline, and
a practice.

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HISTORY
The first public health organizations in America
developed
- in the late 18th century
- in the port cities along the Eastern coastline,
- largely in response to early infectious disease threats
such as the 1793 yellow fever epidemic in Philadelphia.

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 Prior to World War II, traditional programs formed
the bulk of public health work:
- disposal of sewage,
- provision of pure water,
- communicable disease control, and
- the care of mothers and infants.
 Health education was the main weapon of attack.
 This changed, with the advent of antibiotics and the
expanded development of vaccines, both of which
reduced the danger of infections.

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HEALTH GUIDELINES
The first set of national health targets was published in
1979 as Healthy People:
The Surgeon General’s Report on Health Promotion
and Disease Prevention
The Guide to Clinical Preventive Services, developed
by the United States Preventive Services Task Force
(USPSTF), is an evidence-based review of over 100
interventions to prevent 60 different medical conditions.

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HEALTH GUIDELINES

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HEALTH GUIDELINES

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HEALTH SERVICES PROGRAMS
Public health nurses provide the bulk of the personal
health services, both in clinics and in the home; they deal
with the care of people ranging from newborn infants to
elderly patients with multiple medical conditions.
Their primary concern is to apply the principles of prevention to the
patients, to promote health or to retard the progress of a disease where
a return to health is not possible.
Environmental health specialists are responsible for
the control of disease by environmental techniques.
 Animal control officers serve to control endemics within
a broad number of animal species.

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EPIDEMIOLOGY
Epidemiology is the study of the distribution and
determinants of health-related events in specific
populations and the applications of this field in the
control of these events.
Epidemiology relates to the interaction of hosts and their
environment, with attention to those particular agents in the
environment that are causal factors of disease.

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Pharmacists should fulfill not only a referral role for
patients suspected of having a particular illness, but
also can collaborate with the local health departments
or health planning agencies in epidemiology.
The arrival of an unusual number of people with diarrheal
disease for OTC products may be the result of an outbreak of
food-borne disease.

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Pharmacoepidemiology, a subspecialty of epidemiology
that is pertinent to pharmacy, involves the safety or risk
assessment of a new drug, starting with its early use and
continuing through its longer use cycle.
It involves generating information about pharmaceutical
outcomes and monitoring associated risks, particularly in
the postmarketing environment

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DISEASE PREVENTION
Primary prevention is helping people maintain their
health or improve the quality of their lives through a
healthy lifestyle.
An example of primary prevention is the control of infections
through immunization.

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Secondary prevention is the early diagnosis and
treatment of an already existing disease.
For example, the use of penicillin in the treatment of a
streptococcal infection prevents the onset of rheumatic fever.

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Tertiary prevention largely consists of rehabilitation.
Most chronic diseases cannot be cured, but their progress
can be retarded with maximum benefit to the patient.
Much can be done, for instance, with rheumatoid arthritis to make
patients more comfortable and more productive in their daily lives.

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HEALTH MEASUREMENT
All events that are measurable must be related to the
population in which they occur, usually known as the
population at risk.
Events to be measured must be reduced to a
common factor of population.
The crude birth rate is only a crude measurement of births
because the population at risk includes all the men, women,
and children in the geographical area of concern; most of this
population cannot bear children
The fertility rate is a far more accurate measurement of births.

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Death rates follow the same pattern as birth rates,
ranging from the crude death rate to age and sex-specific
rates.
The most commonly used indicator of health services is
the infant death, or mortality, rate.

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Incident rates show the number of new cases of a
disease that occur in a population during a period of time,
usually one year.
Prevalence rates provide the number of new and old
cases that are present in a community at a particular
point in time.

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HEALTH EDUCATION
The objective of health education is to provide the
individualized information necessary for patients to modify
their behavior, all in an effort to live a healthier life.
Pharmacists actively promote good health practices through their
own personal example, and by reaching out to provide professional
information to the public.

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COMMUNICABLE DISEASE CONTROL
accomplished in large measure by the environmental
control of food, milk, water, and sewage.
Although some serious communicable diseases have
been practically eradicated, others such as tuberculosis
(TB) and syphilis are still common and are now
appearing in drug-resistant forms.
Certain viral diseases, including acquired immunodeficiency
syndrome (AIDS), West Nile virus, and Severe Acute Respiratory
Syndrome (SARS), remain resistant to eradication, or sufficient
treatment modalities have not been identified, to date.

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CHRONIC DISEASE MANAGEMENT
Because the control of infectious diseases has
resulted in a longer life expectancy, chronic
diseases have become the primary causes of
mortality in this country
Accidents and cardiovascular, oncologic, and
neurovascular conditions are the
current primary causative factors of mortality.

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MATERNAL AND CHILD HEALTH
Mother and child health was the first public health
program of the 20th century.
Infant and child mortality rates were exceptionally
high, largely because of diarrhea and respiratory
diseases; many of the latter were propagated by non-
pasteurized milk, an ideal medium for bacterial
proliferation

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NUTRITION
Good nutrition, including a diet that is low in
saturated fats and contains five or more servings of
fruits and vegetables each day, plays a key role in
maintaining good health.

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ORAL HEALTH
Tobacco use increases the risk of gum disease. In
the US, 30,000 people are diagnosed with mouth
and throat cancer each year, and 8,000 die of these
cancers.
A large proportion of Americans suffer from tooth
decay or periodontal disease.
Untreated tooth decay remains a problem.
About one-third of persons across all age groups
have untreated decay.

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ENVIRONMENTAL HEALTH
Air, food, water, and the earth can all become sources
of illness, in the home, public, or work environments.
With increased industrialization, air, in Western, as
well as developing countries, now contains noxious
substances that are either direct results of combustion
or produced by photochemical change.

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MENTAL HEALTH
It has been estimated that aproximately 10% of
the population in this country are affected with
some form of emotional disorder requiring
treatment.

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ALCOHOL/SUBSTANCE ABUSE
Abuse of alcohol, tobacco, and other substances,
in general, is a worldwide public health problem of
enormous dimensions the US, between 450,000
and 600,000 premature deaths annually
are related to these substances, representing
nearly one third of all deaths.

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PUBLIC HEALTH RESEARCH
Participate in public health research programs,
especially those concerned with drugs and their
control.
In general, investigation of community disease is
based on two methods, retrospective and prospective
surveys.

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SUMMARY
Pharmacists are the most accessible and highly trusted
health care professionals.
The pharmacist routinely sees the patient at the time of
a prescription refill, which can be an opportune time to
discuss public health issues; pharmacists can also use
this time to identify early signs and symptoms of disease,
if counseling and patient assessment are performed.
New opportunities in this venue include provision of
immunizations and performing smoking/tobacco
cessation programs.