Under Theme 2 of our equality, diversity, and inclusion (EDI) strategy we are committed to supporting pharmacy teams to provide person-centred and inclusive care that takes account of the diverse needs and cultural differences of the communities they serve.
In this article, we focus on the protected characteristics of age, disability, gender reassignment and sex, and health inequalities which are related to these. We share insights about these from our regulatory work, our inspection knowledge hub, and other relevant external sources to help pharmacy teams meet our standards and think about how they can deliver inclusive care, reducing health inequalities in their communities.
We plan to look at other protected characteristic in future articles, so please look out for these, to see how different characteristics and issues intersect.
Age
In this section, we look at some areas of health inequality, for both younger and older people.
Older people
Older adults are more at risk of poor health literacy. They are more likely to be consumers of healthcare services but are also at risk of not understanding the health information and guidance that is provided to them in terms of care and medication, so pharmacy teams may want to consider how they provide information to older patients. Examples of resources tailored to older adults include information on the management of depression in older adults.
Children and young people
Public Health Wales has recently reported that the cost of living crisis is making more families and children unable to eat enough healthy food. This increases the risk of children developing health conditions such as asthma or obesity. Public Health Scotland has also reported that young people living in deprived areas experience significantly worse health outcomes, including increased levels of mental health problems (including anxiety and self-harm), sexual health and substance misuse.
In England, Core20PLUS5 – An approach to reducing health inequalities for children and young people sets out five clinical areas of focus including:
- Asthma
- mental health
- diabetes
- epilepsy
- oral health
Pharmacy teams can help reduce these inequalities by identifying patients from ethnic minority communities, people with learning disabilities, autistic people, and coastal communities (where there may be small areas of high deprivation hidden amongst relative affluence) and adapting their care to recognise the needs of these groups.
They should consider how to include young carers, looked after children, care leavers and those in contact with the justice system.
Pharmacy teams also play an important role in supporting young people with sexual health services.
Young people and contraception
One pharmacy supported prescribers to assess young people’s competence to consent to EHC (Emergency Hormonal Contraception) treatment. It did this by assessing people’s ability to understand the information provided and their ability to weigh up the risks and benefits and express their own wishes.
Disability
People can experience a wide range of disabilities, so here we have included a broad selection of topics to help pharmacy teams consider the different ways which disability may lead to potential health inequalities.
People with disabilities are more likely to have risk factors for non-communicable diseases, such as smoking, poor diet, alcohol consumption and a lack of physical activity. This is because they are often left out of public health interventions.
Healthy living pharmacies can provide a broad range of health promotion interventions to meet local need, improving the health and wellbeing of the local population, and target specific protected groups to reduce health inequalities.
Visual impairment can have adverse consequences for health and wellbeing, and its prevalence is increasing, especially among older people. People with visual impairment are likely to have limited access to information and healthcare facilities, and to receive sub-optimal treatment.
The risk of diabetic eye disease is around three times greater in South Asian people. Being aware that people may have problems with vision is an important pre-requisite for good healthcare. Pharmacies can use strategies to help patients such as tactile signage, and large print labelling to support medicines adherence.
Communicating with hearing impaired patients
A pharmacy clearly advertised a hearing loop. The consultation room was used for patients who were hard of hearing, to maintain confidentiality and protect their dignity. One used British sign language to communicate with patients and the team spoke slowly and clearly while facing patients who used lip reading.
Gender reassignment
Various sources highlight poorer outcomes and poorer access to care for trans and non-binary people, so we have included key information about services and approaches to care.
For example, nationally representative evidence from the 2021 GP patient survey in England found that trans and non-binary adults are more likely than the general population to experience long-term health conditions, including mental health problems, dementia and learning disabilities, and to be autistic. They were also more likely to be younger – just under one in four (23.6%) trans and non-binary respondents was aged 16-34 years, almost double the proportion among other respondents (13.4%).
The Faculty of Sexual and Reproductive Healthcare (FSRH) have issued a statement which provides guidance on contraceptive choices for transgender and non-binary people and their partners where there is a risk of pregnancy, and offers general sexual health advice for these groups.
The need to improve access to and delivery of NHS gender identity healthcare services for adults and young people in Scotland is outlined in the Scottish Government’s NHS gender identity services: strategic action framework 2022-2024. The Scottish Government has commissioned Healthcare Improvement Scotland to develop national standards for gender identity healthcare services for adults and young people. Look out for more information about this framework in future updates.
Sex
Pharmacy teams have an important role to play in helping both men and women to access care to support their needs, and to be aware of the key issues for each group.
Women’s health
The Women's Health Strategy for England states that women live on average for longer than men, but spend more of their life in poor health, often limiting their ability to work and participate in day-to-day activities. It highlights how pharmacy teams are uniquely placed to provide support and expert advice on medicines, as well as wider health advice and support to women at all stages of their lives.
In Scotland, the Women’s Health Plan outlines a long-term action to provide and promote a ‘Women’s Health’ Community Pharmacy service.
In Wales, the Women’s Health in Wales A Discovery Report: Foundations for a Women’s Health Plan recommends identifying and embedding techniques and behaviours that ensure women’s and girls’ voices are heard in every interaction they have with the NHS.
A recent review commissioned by the NHS Race and Health Observatory found evidence of women from ethnic minority backgrounds experiencing ‘stereotyping, disrespect, discrimination and cultural insensitivity’ when using maternal and neonatal healthcare services.
The progesterone-only contraceptive pill has been available to women to purchase over the counter in pharmacies since 2021, and access to wider oral contraception through pharmacies is currently being piloted, increasing choice for women in the ways in which they can access contraception.
Pharmacy teams should consider how to overcome communication barriers for different groups. For example, at our recent roundtable, we heard about the challenges for women relying on family members as interpreters, particularly for sensitive healthcare advice. Pharmacy teams can play an important role in supporting women to overcome these barriers and access inclusive care.
We have highlighted issues relating to women’s health – for example, the key role pharmacy professionals play in safely dispensing sodium valproate, an anti-epileptic medication, given that children born to women who take valproate during pregnancy are at significant risk of birth defects and persistent developmental disorders.
Due to changes in the law pharmacists are now legally required to dispense all medicines containing sodium valproate in the original manufacturer’s packaging, rounding up or down to the nearest quantity prescribed.
In addition, community pharmacists are now able to offer women additional support with their epilepsy medication through the New Medicine Service to provide specific advice when they start a new medicine, which will include responding to their concerns about their wider health needs.
Hearing women’s voices
The First Do No Harm independent medicines and medical devices safety review of how the healthcare systems responded to reports about harmful side effects from medicines and medical devices (sodium valproate, pelvic mesh implants and hormone pregnancy tests) emphasised that women ‘struggled to be heard’ and were often ‘not believed’.
Men’s health
Pharmacy teams play a vital role in signposting men who may be concerned about their health and the trusted relationship between patients and their pharmacy teams can support the identification of warning signs, helping men to get an earlier diagnosis.
For example, prostate cancer is the second most common cancer globally, and the most common cancer in men in the UK. Although it affects all men, Black men of African and African Heritage are 2-3 times more likely to develop this cancer than their white counterparts. The death rate is twice as high. African and African-Caribbean men are more likely to develop prostate cancer at a younger age.
A report by Professor Frank Chinegwundoh MBE highlighted these inequalities and how a blood test for PSA (prostate specific antigen) available to men over the age of 45 might save a life.
The Prostate Cancer Toolkit produced by the Centre for BME Health (designed for community champions and organisations) is a useful resource for healthcare professionals as it highlights how cultural factors affect Black men’s interaction with prostate cancer screening and health related services.