As a nation we smoke too much, drink too much alcohol and don’t do enough exercise. The reasons why we continue to do this despite the health risks is complex, but what is clear is that people in deprived areas are more likely to die of cardiovascular disease, certain cancers and liver disease – conditions closely associated with unhealthy lifestyles. While it’s easy to say we should just cut down on unhealthy behaviours and live better, this is proving to be more easily said than done.
One of the factors we know influence a person’s health is their access of healthcare services. Unfortunately, studies have shown that this isn’t equitable across the country and it’s yet another thing that the more deprived miss out on.
In the majority of cases, access to healthcare services such as GP surgeries or walk-in centres tend to be worst in the poorest areas, and best in the most affluent. This observation was first made by former GP Julian Tudor Hart, who said that: “the availability of good medical care tends to vary inversely with the need for it in the population served.”
One exception to this, however, are community pharmacies – the ones you find on every high street – run by big companies down to smaller, independent outfits.
In England alone there are about 12,000 of them, open to all without the need to make an appointment and many are open late nights and weekends.
Over the last few years, the role of the community pharmacist has rapidly expanded from supplying medication to more of an emphasis on delivering health services. Many community pharmacists can now help people to quit smoking, lose or manage weight, and screen you to see if you’ve been drinking too much, within GP-style consultation rooms in the pharmacy.
In research we published in the BMJ Open we found that these community pharmacies could play an even bigger part in how healthcare is delivered – not just to those in deprived areas, but the rest of us too.
We analysed the postcodes for all community pharmacies in England and the co-ordinates of each postcode for the population. These were then matched to a deprivation index as well as to the type of area, so whether it was urban, town and fringe, hamlet or an isolated dwelling. We found that 89.2% of the population could get to a community pharmacy within 20 minutes’ walk. As you might expect, access was greatest in urban areas compared to town and fringe and rural settings.
In contrast to Tudor Hart’s inverse care law, almost 100% of households in the poorest areas lived within a 20-minute of a pharmacy. So for community pharmacies, a positive care law exists – with access to healthcare greatest in areas of greatest need.
Given that more people die from cardiovascular disease, certain cancers and liver disease – often as a result of smoking, obesity or alcohol misuse in areas of high deprivation compared to more affluent areas – this could be a ready-made way of reaching these groups.
Developing services that target at-risk groups is challenging for a number of reasons, and one major factor is the lack of access. Community pharmacies, therefore, appear to be uniquely placed in our society to deliver healthcare services targeted to patients that need them the most.
In terms of planning for the future, this is very significant and should be used by those making healthcare policy – and more should be done to let people know what services already exist and to ask why can more not be made available?