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evolution in France
pharmacist as a
health educator •••
evolution • In France by Andre Quevauviller
T
o gain a clear insight into what the French pharmaceutical profession is doing to promote health education, walk along any busy suburban street when it is thronged with homecoming workers and housewives doing their shopping. The community pharmacy often makes a relatively drab showing among the glittering windows of the large shops and supermarkets and people hurry past, shunning the smell of medicaments which hangs about its portals and possibly, also, hesitating to mix with the crowd of clients waiting to be served. But go inside and listen.
Andre Quevauviller, the first "professor of hygiene and health education" in postgraduate circles in France, is now teaching this subject at the Faculty of Pharmacy in Paris. A PhD, he is known in the scientific world for his pharmaceutical research, in particular in the field of "pathopharmacodynamy." His appointment as professor of hygiene was the outcome of his activities as inspector of dangerous, unhealthy and uncomfortable commercial and in dustrial buildings in the suburbs of Paris. He also teaches at the French National Health and Social Education Center and helps with promotional activities of the National Anti-alcoholic Committee. Professor Quevauviller (right below) reviews the APhA project with this Journal's editor, G. B. Griffenhagen, in the Paris office of the French Pharmacists Comm ittee on Health Education which Quevauviller heads.
Supplements such as these are provided by t he Pharmaci st s' Comm ittee f or Health and Social Education for the informatio n of the pha rma cist. Each supplem ent covers a specific chronic disease or health problem.
You will catch echoes of the seamy side of life of the whole district, the hardships and deficiencies of mother and children, father and his intermittent drinking bouts, difficulties and anxieties of all kinds confided simply and spontaneously, without false modesty. The pharmacist is trusted not only because he is a knowledgeable man but also because he is above all a sympathetic listener. In this way, little by little, slowly but surely, the entire pharmaceutical profession through each one of its members has come to devote itself to the health education of the public. I ts activities are based on a variety of methods. For many centuries the French pharmacist has filled a social role by professional vocation. Once his activity was primarily individual. But today social evolution, therapeutic progress and the accelerated rhythm of modem life necessitate the instruction and education of the public to render most effective hygiene and preventive medicine. The pharmacist answers the call of the public health authorities and the important sanitary organizations by acting effectively in the heart of the health community protecting health and fighting against the great social plagues. His ability derived from the diversity of his knowledge and the confidence which he inspires give him an authority before the public which allows him to fulfill his role with tact, discretion and impartiality. During the third Conference of the International Union for Health Education of the Public, held in Rome in May 1956, the commission appointed to examine methods of recruiting personnel recognized, as a result of the persuasiveness of our French delegates, that the pharmacist had tremendous
and still underestimated educational potentialities which need to be emphasized. The commission accordingly passed a recommendation to the effect(a) that qualified representatives of the pharmaceutical profession should be called upon to take an active part in the work of the International Union for Health Education; (b) that a campaign should be undertaken among pharmaceutical bodies in all countries with a view to increasing the awareness of pharmacists of the educational potentialities of their work and inducing them to develop these to the utmost of th eir ability.
It is worth noting that the French Public Health Code, in Volume V relating to pharmaceutics, sets forth in article R. 5015-6Pharmacist s are under the obligation to lend their assistance to the medicosocial services and to collaborate in the activities of the public authorities aimed at protecting and preserving the public health.
The code thereby recognizes the qualifications of the pharmacist in the field of health education and places a moral obligation on him in this respect. This is not the first time that the public authorities have sought to make use in their health activities of pharmaceutical training since article 776 of the same code calls for the inclusion of a pharmacist in departmental health councils. Furthermore, as was pointed out in the report on the objects of the decree of July 26, 1909, relating to the re-organization of pharmaceutical studiesThe law on public health makes the presence of a pharmacist compulsory in all district health commissions.
The health educational activities of the practicing pharmacist, however, must materially be assisted and con-
IA PROOf. R8IITIfRf
_ WPftl( AU PRIl81H(f
"i 14, #
PIfYlNJIGN _AlIl _
WPfllf tfSflWllA_
V~..,,,,,I~IIt"'MII"" COIIIpICte_I~
~el..
The French posters, prepared by pharmaceutical organizations, are bold, colorful and dramatic to educate the public on health matters. Typical are these posters distributed by the French Pharmacists' Committee on Health and Social Education. The poster at top left draws attention to the necessity of polio vaccination and the one at bottom left outlines the signposts which warn of diabetes.
P..Il_yelil"
..(ilft(.~re(;u
:
r...,...
51Q~
+1
1.a~,",~1_
.~_~
""" ...I~~_r h. Dlphte,le .. [ Ie
Tet.>_
1.eo1:folt""doiall'on$ ~I~~-«fies.
•I=-" ==-7~~~--
£tnIUll¥.tU tU'fC'.,ttUI IK C8JSUt If 't'll PIAl_Kill
6~-:" __
.....
!
j
In the Salon de L'Enfance the French Pharmacists' Committee on Health and Social Education set up an exhibit (above) describing the accidents which can happen to children, the dangers of intoxication and the problems caused by sunburn, windburn, insect bites and the other disadvantages of vacations. The committee also distributes pamphlets and booklets for the benefit of the public. These range from cancer information to children's accidents to the dangers of poisoning(below).
tinually renewed by post-graduate training. It is for this reason that in 1950 the various French pharmaceutical organizations began to publish articles relating to health education and first aid in the professional press. Very soon the need for co-ordination and uniformity of data became evident. As a result, the French Pharmacists' Committee for Health and Social Education came into being as a fully independent body with the support of the National Council of the Order of Pharmacists (membership composed of all pharmacists), the National Federation of Pharmacy Syndicates (membership composed of pharmacy owners) and all other national pharmaceutical groups. Since 1959, this committee has developed and distributed educational posters dealing with cancer, poliomyelitis, tetanus and tuberculosis. It has taken part in numerous congresses and exhibitions, including the International Health Show, the French Pharmaceutical Conference and the Children's Exhibition. Through the Bulletin of the National Order of Pharmacists a post-graduate health education course is carried to the 15,000 dispensing pharmacists in France, covering such subjects as atmospheric pollution, road accidents, accidental poisoning, excessive addiction to tobacco , diabetes, mental illnesses and poliomyelitis, among others.
-...
~
~
J""";
I1J)J
1M
l'enfant et les accidents
#
U~
c,ntfJl'--
~? The French pharmaceutical profession as a whole thus is supplied simultaneously and at an appropriate time, usually co-inciding with a particular health education campaign, with the latest and most authentic information. This activity is co-ordinated with the main national organizations for health and social welfare as well as with the Ministry of Health. In some in-
stances the cost of producing the posters is paid by the government or private health agencies and in other cases the cost either is shared or paid for exclusively by the Pharmacists' Committee on Health Education which receives financial support in the amount of $40,000 per year from all French national pharmaceutical organizations. The French pharmaceutical wholesalers Vol. NS4, No. 10, October 1964
499
SI VOUS EN PRENEZ SOIN, VOU5 POURRE t ~ . LpELSU SUITEIULR'SSE f\ '~
MAIS . ..
A LA RECE PTION
NE FAITE.S PAS
COMME
~. . . . . . ~
LUI ...
FOIS ,~
The posters have received rather good reception by the practici ng pharmacists. While some pharmacists chuck them in the garbage can upon their receipt, most keep them safe f or future use. Professor Queva uviller estim ates t hat 80 perce nt utilization is f oun d in the ru ral areas, but that in the larger metropolitan areas, the use drops to around 20 percent.
recently have instituted an organized procedure of distributing the posters to all pharmacies, thereby saving shipping costs. The French Pharmacists' Committee for Health and Social Education with the particular assistance of the Order of Pharmacists established procedures to, first of all, safeguard posters and other material against taking on a purely commercial character- a very real danger in these times of rapid economic evolution-which would have extremely harmful effects on the feeling of trust to which the pharmaceutical profession is entitled. Secondly, the committee concerned itself with the selection of the most appropriate health education themes for these displays. The first procedure thus was designed to heighten the prestige of the profession and the second was to make full use of this prestige to further the cause of public health. Campaigns against social scourges constitute a major part of the French health education program. Alcoholism, mental diseases, tuberculosis, venereal diseases and cancer are, of course, the most immediate problems. The public must be given accurate information, supported by statistics and charts, as to the extent of the ravages caused and the results of early diagnosis and treatment. Fortunately, French pharmacists did not wait for the organization of the health education movement in their profession before taking part in these campaigns-either by collecting funds or by giving up large areas of their pharmacy windows to health educational material. They supplement this participation by waging a personal and unrelenting battle against the inaccuracies which certain sections of the daily press serve up to their readers. It is worthwhile mentioning briefly the example of a highly interesting initiative shown by our colleagues in the Isere, a southeast department, in 500
organizing a campaign against cancer. This campaign took the form of window displays and articles in the local press calling the attention of the public to the necessity of early diagnosis. After several months of this campaign, the hospitals and radiological centers in Grenoble noticed a marked decline in the number of incurable cases among the persons attending consultations. Such educational campaigns can have a distinctly beneficial effect on the health of the community if the public is alerted and encouraged to seek medical advice in time. Remarkable results similarly have been noted, for instance, with vaccination campaigns. Everyone knows of the prejudices existing against immunization in many minds, especially in those of the ordinary man in the street, and of the neglect suffered by these preventive measures even in countries with well developed medical services. ' It is a question of public opmlOn. In this connection the French pharmacists, at a word from their institutions, have rendered valuable service by means of posters, of pamphlets distributed to their patrons and of the spoken word. Some, for instance, noted the date of purchase of antipoliomyelitis vaccine by their clients so as to be able to send them a postcard a year later, reminding them of the need for a booster injection. As far as toxicology is concerned, the community pharmacist particularly is competent to take action and loses no opportunity to open the eyes of the public to the dangers of the indiscriminate use of medicaments. I t is a fact that nowadays remedies once regarded with the respect due to the mysterious and the unknown are a part of our daily lives like any other household article. Health education must, therefore, cover the proper use of medicine. Is there anyone better qualified, by professional vocation, to perform this educational mission than the
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
pharmacist? It would be impossible to keep count of the number of serious or mild cases of poisoning that have been averted by pharmacists' explaining to their clients the strict regulations governing the sale of certain medicaments in France or by impressing upon them the precautions to be observed in using any kind of medicament, even those reputedly harmless. But in addition to his role in the dispensary, the pharmacist can also act as a health educator outside the community pharmacy. He owes it to himself to proclaim his message of health from the platform, through the radio microphone or by way of the television screen. He can also lead discussion groups or give running commentaries on health films. Another possibility, less obvious but perhaps more effective, is open to him by taking part in the life of the city. Here he could find plenty of opportunities for spreading the doctrine. As a man of culture, he should take part in public life and manifest his presence in municipal, provincial and national assemblies, all of which offer the pharmacist a first-rate rostrum for the spread of health education. The French National Assemblies count 16 pharmacists among their members and this is not enough. They are far more numerous on departmental and municipal councils. Hence one can see the power and privilege of action represented by the French pharmacists' corps for health education, power that inspired the unanimous desire voted at the third International Conference on Health Education held in Rome in 1956. Now under the care of the French Pharmacists' Committee for Health and Social Education, and in collaboration with all the major national health organizations, they organize campaigns against the great social scourges and each day they inform and educate the healthy and sick so that they profit fully from hygiene and preventive medicine and from the rules of a sound life. T o inform, to convince and to edu cate for preserving h ealth-that is the social role of the pharmacist. • bibliog r aphy 1.
2. 3. 4.
5.
Boilleau, Henriette, and Froidevaux, Etienne, "The Pharmacist: An Educator ... and a Friend," Internat 'l J. of Health Educ., 7, 18-23 (Jan.-March 1964). Quevauviller, Andre, "Le Pharmacien et l'Education Sanitaire," Bul. de l'Ordre des Pharmaciens, no. 71,19-41(Nov. 1960). Ibid., "For the Pharmacist: Tremendous Educational Opportunities," Internat'l J. of Health Educ., 6, 56-64 (April-June 1963). Rolland, Pierre, and Joffard, M., "Role Educatif Du Pharmacien," Bul. de l'Ordre des Pharmaciens, no. 11, 80-84(29 Trimestre, 1951). Rolland, Pierre, "Du Role Pratique Du Pharmacien Dans l'Education Sanitaire Populaire," Bul. de l'Ordre des Pharmaciens, no. 9,43- 51(3 9 et 4 e Trimestres 1950) .
health educator •••
evolution • In France by Andre Quevauviller
T
o gain a clear insight into what the French pharmaceutical profession is doing to promote health education, walk along any busy suburban street when it is thronged with homecoming workers and housewives doing their shopping. The community pharmacy often makes a relatively drab showing among the glittering windows of the large shops and supermarkets and people hurry past, shunning the smell of medicaments which hangs about its portals and possibly, also, hesitating to mix with the crowd of clients waiting to be served. But go inside and listen.
Andre Quevauviller, the first "professor of hygiene and health education" in postgraduate circles in France, is now teaching this subject at the Faculty of Pharmacy in Paris. A PhD, he is known in the scientific world for his pharmaceutical research, in particular in the field of "pathopharmacodynamy." His appointment as professor of hygiene was the outcome of his activities as inspector of dangerous, unhealthy and uncomfortable commercial and in dustrial buildings in the suburbs of Paris. He also teaches at the French National Health and Social Education Center and helps with promotional activities of the National Anti-alcoholic Committee. Professor Quevauviller (right below) reviews the APhA project with this Journal's editor, G. B. Griffenhagen, in the Paris office of the French Pharmacists Comm ittee on Health Education which Quevauviller heads.
Supplements such as these are provided by t he Pharmaci st s' Comm ittee f or Health and Social Education for the informatio n of the pha rma cist. Each supplem ent covers a specific chronic disease or health problem.
You will catch echoes of the seamy side of life of the whole district, the hardships and deficiencies of mother and children, father and his intermittent drinking bouts, difficulties and anxieties of all kinds confided simply and spontaneously, without false modesty. The pharmacist is trusted not only because he is a knowledgeable man but also because he is above all a sympathetic listener. In this way, little by little, slowly but surely, the entire pharmaceutical profession through each one of its members has come to devote itself to the health education of the public. I ts activities are based on a variety of methods. For many centuries the French pharmacist has filled a social role by professional vocation. Once his activity was primarily individual. But today social evolution, therapeutic progress and the accelerated rhythm of modem life necessitate the instruction and education of the public to render most effective hygiene and preventive medicine. The pharmacist answers the call of the public health authorities and the important sanitary organizations by acting effectively in the heart of the health community protecting health and fighting against the great social plagues. His ability derived from the diversity of his knowledge and the confidence which he inspires give him an authority before the public which allows him to fulfill his role with tact, discretion and impartiality. During the third Conference of the International Union for Health Education of the Public, held in Rome in May 1956, the commission appointed to examine methods of recruiting personnel recognized, as a result of the persuasiveness of our French delegates, that the pharmacist had tremendous
and still underestimated educational potentialities which need to be emphasized. The commission accordingly passed a recommendation to the effect(a) that qualified representatives of the pharmaceutical profession should be called upon to take an active part in the work of the International Union for Health Education; (b) that a campaign should be undertaken among pharmaceutical bodies in all countries with a view to increasing the awareness of pharmacists of the educational potentialities of their work and inducing them to develop these to the utmost of th eir ability.
It is worth noting that the French Public Health Code, in Volume V relating to pharmaceutics, sets forth in article R. 5015-6Pharmacist s are under the obligation to lend their assistance to the medicosocial services and to collaborate in the activities of the public authorities aimed at protecting and preserving the public health.
The code thereby recognizes the qualifications of the pharmacist in the field of health education and places a moral obligation on him in this respect. This is not the first time that the public authorities have sought to make use in their health activities of pharmaceutical training since article 776 of the same code calls for the inclusion of a pharmacist in departmental health councils. Furthermore, as was pointed out in the report on the objects of the decree of July 26, 1909, relating to the re-organization of pharmaceutical studiesThe law on public health makes the presence of a pharmacist compulsory in all district health commissions.
The health educational activities of the practicing pharmacist, however, must materially be assisted and con-
IA PROOf. R8IITIfRf
_ WPftl( AU PRIl81H(f
"i 14, #
PIfYlNJIGN _AlIl _
WPfllf tfSflWllA_
V~..,,,,,I~IIt"'MII"" COIIIpICte_I~
~el..
The French posters, prepared by pharmaceutical organizations, are bold, colorful and dramatic to educate the public on health matters. Typical are these posters distributed by the French Pharmacists' Committee on Health and Social Education. The poster at top left draws attention to the necessity of polio vaccination and the one at bottom left outlines the signposts which warn of diabetes.
P..Il_yelil"
..(ilft(.~re(;u
:
r...,...
51Q~
+1
1.a~,",~1_
.~_~
""" ...I~~_r h. Dlphte,le .. [ Ie
Tet.>_
1.eo1:folt""doiall'on$ ~I~~-«fies.
•I=-" ==-7~~~--
£tnIUll¥.tU tU'fC'.,ttUI IK C8JSUt If 't'll PIAl_Kill
6~-:" __
.....
!
j
In the Salon de L'Enfance the French Pharmacists' Committee on Health and Social Education set up an exhibit (above) describing the accidents which can happen to children, the dangers of intoxication and the problems caused by sunburn, windburn, insect bites and the other disadvantages of vacations. The committee also distributes pamphlets and booklets for the benefit of the public. These range from cancer information to children's accidents to the dangers of poisoning(below).
tinually renewed by post-graduate training. It is for this reason that in 1950 the various French pharmaceutical organizations began to publish articles relating to health education and first aid in the professional press. Very soon the need for co-ordination and uniformity of data became evident. As a result, the French Pharmacists' Committee for Health and Social Education came into being as a fully independent body with the support of the National Council of the Order of Pharmacists (membership composed of all pharmacists), the National Federation of Pharmacy Syndicates (membership composed of pharmacy owners) and all other national pharmaceutical groups. Since 1959, this committee has developed and distributed educational posters dealing with cancer, poliomyelitis, tetanus and tuberculosis. It has taken part in numerous congresses and exhibitions, including the International Health Show, the French Pharmaceutical Conference and the Children's Exhibition. Through the Bulletin of the National Order of Pharmacists a post-graduate health education course is carried to the 15,000 dispensing pharmacists in France, covering such subjects as atmospheric pollution, road accidents, accidental poisoning, excessive addiction to tobacco , diabetes, mental illnesses and poliomyelitis, among others.
-...
~
~
J""";
I1J)J
1M
l'enfant et les accidents
#
U~
c,ntfJl'--
~? The French pharmaceutical profession as a whole thus is supplied simultaneously and at an appropriate time, usually co-inciding with a particular health education campaign, with the latest and most authentic information. This activity is co-ordinated with the main national organizations for health and social welfare as well as with the Ministry of Health. In some in-
stances the cost of producing the posters is paid by the government or private health agencies and in other cases the cost either is shared or paid for exclusively by the Pharmacists' Committee on Health Education which receives financial support in the amount of $40,000 per year from all French national pharmaceutical organizations. The French pharmaceutical wholesalers Vol. NS4, No. 10, October 1964
499
SI VOUS EN PRENEZ SOIN, VOU5 POURRE t ~ . LpELSU SUITEIULR'SSE f\ '~
MAIS . ..
A LA RECE PTION
NE FAITE.S PAS
COMME
~. . . . . . ~
LUI ...
FOIS ,~
The posters have received rather good reception by the practici ng pharmacists. While some pharmacists chuck them in the garbage can upon their receipt, most keep them safe f or future use. Professor Queva uviller estim ates t hat 80 perce nt utilization is f oun d in the ru ral areas, but that in the larger metropolitan areas, the use drops to around 20 percent.
recently have instituted an organized procedure of distributing the posters to all pharmacies, thereby saving shipping costs. The French Pharmacists' Committee for Health and Social Education with the particular assistance of the Order of Pharmacists established procedures to, first of all, safeguard posters and other material against taking on a purely commercial character- a very real danger in these times of rapid economic evolution-which would have extremely harmful effects on the feeling of trust to which the pharmaceutical profession is entitled. Secondly, the committee concerned itself with the selection of the most appropriate health education themes for these displays. The first procedure thus was designed to heighten the prestige of the profession and the second was to make full use of this prestige to further the cause of public health. Campaigns against social scourges constitute a major part of the French health education program. Alcoholism, mental diseases, tuberculosis, venereal diseases and cancer are, of course, the most immediate problems. The public must be given accurate information, supported by statistics and charts, as to the extent of the ravages caused and the results of early diagnosis and treatment. Fortunately, French pharmacists did not wait for the organization of the health education movement in their profession before taking part in these campaigns-either by collecting funds or by giving up large areas of their pharmacy windows to health educational material. They supplement this participation by waging a personal and unrelenting battle against the inaccuracies which certain sections of the daily press serve up to their readers. It is worthwhile mentioning briefly the example of a highly interesting initiative shown by our colleagues in the Isere, a southeast department, in 500
organizing a campaign against cancer. This campaign took the form of window displays and articles in the local press calling the attention of the public to the necessity of early diagnosis. After several months of this campaign, the hospitals and radiological centers in Grenoble noticed a marked decline in the number of incurable cases among the persons attending consultations. Such educational campaigns can have a distinctly beneficial effect on the health of the community if the public is alerted and encouraged to seek medical advice in time. Remarkable results similarly have been noted, for instance, with vaccination campaigns. Everyone knows of the prejudices existing against immunization in many minds, especially in those of the ordinary man in the street, and of the neglect suffered by these preventive measures even in countries with well developed medical services. ' It is a question of public opmlOn. In this connection the French pharmacists, at a word from their institutions, have rendered valuable service by means of posters, of pamphlets distributed to their patrons and of the spoken word. Some, for instance, noted the date of purchase of antipoliomyelitis vaccine by their clients so as to be able to send them a postcard a year later, reminding them of the need for a booster injection. As far as toxicology is concerned, the community pharmacist particularly is competent to take action and loses no opportunity to open the eyes of the public to the dangers of the indiscriminate use of medicaments. I t is a fact that nowadays remedies once regarded with the respect due to the mysterious and the unknown are a part of our daily lives like any other household article. Health education must, therefore, cover the proper use of medicine. Is there anyone better qualified, by professional vocation, to perform this educational mission than the
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
pharmacist? It would be impossible to keep count of the number of serious or mild cases of poisoning that have been averted by pharmacists' explaining to their clients the strict regulations governing the sale of certain medicaments in France or by impressing upon them the precautions to be observed in using any kind of medicament, even those reputedly harmless. But in addition to his role in the dispensary, the pharmacist can also act as a health educator outside the community pharmacy. He owes it to himself to proclaim his message of health from the platform, through the radio microphone or by way of the television screen. He can also lead discussion groups or give running commentaries on health films. Another possibility, less obvious but perhaps more effective, is open to him by taking part in the life of the city. Here he could find plenty of opportunities for spreading the doctrine. As a man of culture, he should take part in public life and manifest his presence in municipal, provincial and national assemblies, all of which offer the pharmacist a first-rate rostrum for the spread of health education. The French National Assemblies count 16 pharmacists among their members and this is not enough. They are far more numerous on departmental and municipal councils. Hence one can see the power and privilege of action represented by the French pharmacists' corps for health education, power that inspired the unanimous desire voted at the third International Conference on Health Education held in Rome in 1956. Now under the care of the French Pharmacists' Committee for Health and Social Education, and in collaboration with all the major national health organizations, they organize campaigns against the great social scourges and each day they inform and educate the healthy and sick so that they profit fully from hygiene and preventive medicine and from the rules of a sound life. T o inform, to convince and to edu cate for preserving h ealth-that is the social role of the pharmacist. • bibliog r aphy 1.
2. 3. 4.
5.
Boilleau, Henriette, and Froidevaux, Etienne, "The Pharmacist: An Educator ... and a Friend," Internat 'l J. of Health Educ., 7, 18-23 (Jan.-March 1964). Quevauviller, Andre, "Le Pharmacien et l'Education Sanitaire," Bul. de l'Ordre des Pharmaciens, no. 71,19-41(Nov. 1960). Ibid., "For the Pharmacist: Tremendous Educational Opportunities," Internat'l J. of Health Educ., 6, 56-64 (April-June 1963). Rolland, Pierre, and Joffard, M., "Role Educatif Du Pharmacien," Bul. de l'Ordre des Pharmaciens, no. 11, 80-84(29 Trimestre, 1951). Rolland, Pierre, "Du Role Pratique Du Pharmacien Dans l'Education Sanitaire Populaire," Bul. de l'Ordre des Pharmaciens, no. 9,43- 51(3 9 et 4 e Trimestres 1950) .