Geoffrey Harding

Social Inequalities and Health

This chapter will illustrate that health and disease are not simply biologically determined phenomena and that the chances of becoming ill are frequently related to a person’s social circumstances. That is to say, illness and disease are not simply associated with physiological changes but are also influenced by where we live, and how we live, work, and eat, and also by our relationships with other people. We shall examine the evidence which shows that disease has a social, as well as a biological basis — in fact, that disease is socially patterned. By this we mean that certain groups of people in society are more likely to suffer from certain ailments than others. Generally those people most susceptible to such ailments are those who have the fewest material resources, and whose access to decent housing, adequate transport and employment opportunities is most restricted.

Is Pharmacy a Profession

In addressing the question ‘is pharmacy a profession?’ it will first be necessary to appreciate what we mean by the term profession. This chapter aims to offer such an appreciation. When reading this chapter, it will be beneficial to reflect upon what it means to be a pharmacist, what it means to be a health professional, what is the position of pharmacists within the community and what is their relationship with other health workers.

Social Factors and Health

In this chapter we shall consider how disease may from one perspective be considered as having specific biological causes, whilst from another perspective it may be seen as having social, economic and environmental causes. First we will need to consider how we can best measure health within a given population or subsection of that population.

Social research methods

When carrying out any type of research a series of choices must be made in response to some preliminary questions which should be asked at the early stage of any such work. These questions include: What is the area of study or investigation? What type of question or problem is the research aiming to address? What research design is most appropriate to this research question? What would be the most appropriate method or methods? What would be the most relevant research tools? How will the data be analysed and interpreted?

Sociological Understanding of Health and Illness

This chapter examines the way in which individuals experience and exhibit symptoms, and explores the factors that influence their responses to symptoms. It also illustrates that patients’ experience of symptoms does not inevitably lead to their seeking help from a health care professional. The way in which people respond to symptoms is often more complex than might at first be imagined. For instance, it may be assumed that a simple correlation exists between the severity of symptoms and the decision to consult a health professional.

Pharmacists and Health Promotion

Since the early 1960s community pharmacies have been recognised as being ideally located within the community for the provision of health education (Gatherer, 1966). Both the Nuffield Report and the Government White Paper Promoting Better Health have envisaged a development of the role of pharmacists in the community, with pharmacists becoming more involved in advising patients about prescribed and purchased medication and providing advice and education on general health matters. Evidence suggests that this role is complementary to that of general practitioners, with little overlap of roles (Simpson, 1979) and indeed there seems to be a mutual appreciation among pharmacists and general practitioners of their professional functions and their input to health care (Harding and Taylor, 1989a, 1989b).

Health Education and Health Promotion

It is now recognised that many people take positive action to preserve their health, which is not simply a matter of responding to symptoms. Consequently it can be argued that it is now more appropriate to speak in terms of ‘health behaviour’ rather than ‘illness behaviour’. In their book, Sociological Approaches to Health and Medicine, Morgan et al. (1985) defined health behaviour as: ‘ … behaviour in relation to the adoption of officially recommended health actions, such as following a ‘healthy’ diet, giving up smoking, or using preventive services.’

The Development of Pharmacy: Setting the Scene

In this chapter we will attempt to illustrate that the role of the pharmacist has been evolving in recent years and that pharmacists are now expected by both the public and the government to provide a wider range of services than in the past. We have not attempted to provide here a detailed historical account of the development of pharmacy from its earliest history through to the present day (a brief outline of the history of pharmacy can be found in Chapter 7), nor do we provide an exhaustive account of pharmacists’ day-to-day activities. Such information is already available elsewhere (Stone and Curtis, 1989).

Social Science and Pharmacy

In recent years the role of the pharmacist has undergone significant changes. As the number of available proprietary medicines has increased, the day-to-day activities of pharmacists have as a consequence altered so that for he, and increasingly she, the actual process of compounding and formulating medicines has become less demanding on their time than in the past. A corollary of this development has been the opportunity for pharmacists to promote themselves as primary health care professionals, from whom medical advice may be sought, prior to, in addition to, or instead of visiting a medical practitioner.

Lay Health Beliefs and ‘Help-Seeking’ Behaviour

In 1983 the National Pharmaceutical Association (NPA) introduced a campaign to raise the profile of the pharmacist in the community. The ‘Ask your pharmacist, you’ll be taking good advice’ campaign was designed to encourage the public to consult their pharmacist for health advice and for the treatment of minor symptoms. The decision-making process leading to people seeking professional health care or advice, as we have seen in chapter three, is not ‘triggered’ simply by the onset or the severity of symptoms. What is more significant is how the symptoms are perceived and interpreted. Furthermore, actions taken in response to symptoms are mediated by other factors such as the ‘costs’ and ‘benefits’ of seeking help, and the responses of friends, colleagues and relatives, to an individual’s illness.