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The Society: Pharmacists can help close global health care gaps

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The Pharmaceutical Journal Vol 267 No 7168 p470-481
6 October 2001


BPC 2001 summary


Pharmacists can help close global health care gaps

Large gaps are still apparent in global health care, Dr BJORN MELGAARD, health technology and pharmaceuticals division, World Health Organization, told the Conference. Many of these need to be addressed at a national or international level, but pharmacists have a part to play through their work in promoting rational drug use.

The first gap is an economic one. The percentage of the world’s population living below the poverty line (an income of $1 per day) has changed little since the 1970s. In sub-Saharan Africa and south Asia, over 40 per cent of people live in poverty. This is reflected in a health status gap, measured by infant mortality, in these areas.

Of the 1,223 new compounds launched by pharmaceutical companies between 1975 and 1997, only 11 were for tropical or “neglected” diseases. There is also a growing problem of resistance to those drugs which are available for malaria, tuberculosis, gonorrhoea and shigellosis. Even if medicines are available then people may have difficulty using them because of a lack of information. Only a quarter of medicines on sale in Asia contain package inserts.

There is also a global shortage of pharmacists to help people understand their medicines. The WHO is aware of 748 schools of pharmacy in the world. Of these, 252 are in high-income countries (mainly Europe and North America) with an average of one school per 3.2m people. Lower-income countries have far fewer schools per capita, with sub-Saharan Africa having one school per 17.4m people and China one per 25.6m. These figures are reflected in the number of working pharmacists. In high-income countries there are between 15 and 94 pharmacists per 100,000 people, in Asia one to seven pharmacists, and in Africa no more than three.

Even those medicines available may be beyond the reach of the majority of the population in low-income countries. Dr Melgaard said that the number of working hours needed to pay for a full course of tuberculosis treatment was 500 in Tanzania, 100 in Zimbabwe but only 1.4 in Switzerland. Over one-third of the world’s population lack regular access to essential drugs.

Role of the WHO

The World Health Organization has four main aims for public health: to reduce excess mortality and disability, especially among the poor; to reduce major environmental risk factors, such as tobacco use; to strengthen existing health systems; and to promote the health dimension in development policies. Dr Melgaard said that the health of a population was a major determinant of its economic capability.

Within the WHO’s essential drugs programme the main priorities are to see greater access to essential drugs, to ensure the quality and safety of available medicines, to support the rational use of medicines both by health professionals and by the public, and to ensure that medicines were integral to national health policies.

He said that pharmacists could play their part in bridging the health gaps by using their clinical skills and by teaching them to others, by promoting the professional identity and esteem of pharmacists in developing countries, by promoting and being concerned about rational drug use rather than just medicines information, and by being concerned about therapeutic outcomes rather than just drug usage.

He wants to see the concepts of pharmaceutical care and community pharmacy promoted around the world.

Dr Melgaard said that he had asked pharmacists from developing countries: “What would you tell your colleagues in Europe?” The answers included: “Empower pharmacists in our region”, “Encourage new ideas and initiatives”, “Reflect on our problems”, “Recognise the input of pharmacists from developing countries” and “Don’t make us all into businessmen”.

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Citation: The Pharmaceutical Journal URI: 20005162

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