Determinants of health and reducing health inequity

Case scenario

Your regular patient, Meera, is looking at nicotine replacement therapy (NRT). You know she is a smoker and has attempted to quit several times unsuccessfully. This time she is considering NRT to assist, but is shocked at the price. You advise that if she sees her GP and engages with a smoking cessation support and counselling service (e.g. Quitline), she may be eligible for NRT subsidised by the Pharmaceutical Benefits Scheme. However, she is worried about the associated costs, as the GP practice no longer bulk-bills and the wait time to see a GP in your regional town is at least 4 weeks. She leaves empty-handed.

Introduction

Health can be defined in many ways and is influenced by context, culture and an individual’s belief systems. Traditionally pharmacists have used the disease or medical model as their working definition of health, where the major focus is on disease, ill health and deteriorating physical and mental function. Following a diagnosis, the disease is then treated with medicines and/or lifestyle changes.

Increasingly, pharmacists can be observed in their practice and local community to be key contributors to public health efforts, including health promotion, health prevention and health protection activities. In public health, health is defined as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.1

A compromise between these two definitions may be required to ensure pharmacists can contribute meaningfully to this broader definition of health.

Further, for some patients, health will inc