Pharmacy at the frontline of tackling healthcare inequalities

Tackling entrenched health inequalities is no longer the sole remit of public health teams or policymakers. Pharmacy professionals and their teams, as one of the most accessible healthcare professions, are increasingly recognised as critical partners in this mission. Whether embedded in communities, general practice, secondary care or system-level medicines optimisation teams, they are uniquely positioned to identify, mitigate and address healthcare inequities and can make important contributions to wider actions to tackle structural and social determinants of poor health outcomes.

In 2024, Todd and Ashiru-Oredope called for an updated vision for pharmaceutical public health, first defined in 2000^{​1​,​2​}; recommending that pharmacy’s action to tackle health inequalities is embedded as a core priority. This reflects the urgent need for the pharmacy profession to actively contribute to improving equity in access, experience and outcomes of care.

This call to action aligns directly with the NHS ‘Core20PLUS5’ ambition and requires pharmacy professionals to engage in more inclusive service design, equitable prescribing, data-informed outreach and culturally competent care.

The NHS Core20PLUS5 framework sets out the national approach to inform action to reduce healthcare inequalities at both the national and system level. The approach defines a target population – the ‘Core20PLUS’ — and identifies five focus clinical areas requiring accelerated improvement with a dedicated framework for adults, as well as children and young people. 

The framework focuses on the most deprived 20% of the population (Core20), highlights five key clinical areas — maternity, severe mental illness, chronic respiratory disease, cancer diagnosis and cardiovascular disease (for adults); and asthma, diabetes, epilepsy, oral health and mental health (for children). The framework also highlights inclusion health groups (PLUS) — people facing severe social exclusion, including those experiencing homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system, victims of modern slavery and other socially excluded groups (NHS England, 2021).

In this blog, I focus on reviewing recent papers published in the International Journal of Pharmacy Practice that reveal how pharmacy practice can support the mission to tackle healthcare inequalities related to clinical conditions. These studies offer vital insights into how pharmacists and pharmacy teams are already addressing inequity, and offering some insight into where further action is needed to support the aims of Core20PLUS5.

Mental health: the unmet potential of pharmacy

Pharmacists are increasingly involved in mental health care, yet their capacity to contribute meaningfully is constrained by public misconceptions, limited training and structural barriers. During the COVID-19 pandemic, pharmacists in team-based primary care settings reported increased involvement in mental health care (including medication education and management, non-pharmacologic approaches and supportive conversations and identification of resources, including referrals, wellness checks and consulting with physicians) but noted role ambiguity, insufficient support and difficulty engaging patients who lacked digital access or trust in the system^​3​.

Simultaneously, a study on consumer perceptions conducted through 15 community pharmacies found that while some of the respondents to the survey recognised the role of community pharmacists in promoting mental health, a significant proportion were unaware of available services or the pharmacist’s training^​4​. Themes identified from responses provided by members of the public on what role community pharmacists could play in supporting individuals living with mental illness were: ‘someone to talk to’, ‘medication supply and counselling’, ‘triage’, ‘education’. A few participants felt mental health was outside pharmacists’ expertise and that there was no expanded mental health role for pharmacists, limiting community pharmacy’s potential to support people with severe mental illness — a Core20PLUS5 clinical priority.

A conference abstract that was published included qualitative work exploring antipsychotic-induced weight gain, which identified the importance of addressing physical health impacts of psychiatric medications in ways that reflect patient preferences and context^​5​. These findings collectively point to the need for enhanced pharmacist training, public engagement and a co-produced model of care for mental health.

Cancer, cardiovascular health and frailty

Among the five CORE20PLUS5 clinical priorities are early cancer diagnosis and hypertension case-finding. Recent pharmacy-led work is contributing to both.

An audit in an Irish hospital assessed adherence to chemotherapy prescribing standards and found high levels of compliance, highlighting the role of pharmacists in ensuring safety and consistency in systemic anti-cancer therapy^​6​. This kind of quality assurance is essential to reduce disparities in cancer outcomes.

Similarly, a cross-sectional study using data from ‘The Irish Longitudinal Study on Ageing’ (TILDA)^​7​ revealed that sociodemographic characteristics and gender: male gender, older age and lower socioeconomic status among participants were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥55 years (RR 0.75 [0.62 to 0.91]), and female patients across all age groups. This points to inequities in cardiovascular care, an area where pharmacists can play a greater role in screening, counselling and medicines optimisation to support regular guideline adherence audits

In another intervention targeting frail older adults, the ‘DEFERAL’ study tested the feasibility of a multidisciplinary deprescribing approach to reduce potentially inappropriate antihypertensive medication^​8​. Results suggested both feasibility and clinical relevance, aligning with broader efforts to promote person-centred, rational prescribing.

In my next blog, I will focus on examples of pharmacy professionals’ contributions to tackling health inequalities across wider social, systemic and structural issues, thus furthering the aims of Core20PLUS5.

I will end the blog by highlighting recommendations from the UK-wide evidence on pharmaceutical public health, which were ”focusing on adopting a national strategic approach to pharmaceutical public health, including improving commissioning, formalising pharmaceutical public health workforce development, and promoting evidence-based pharmaceutical public health research and development”^​9​.