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President’s Page
THANK YOU TO THE IOWA PHARMACY FAMILY
As I reflect on the last year as president of the Iowa Pharmacy Association, the first thing that comes to mind is a sense of pride. Here’s why…
During the pandemic, I witnessed so many amazing actions by our profession with members stepping up to help our patients and communities. I observed evidence of this through our educational support for patients during the changing environment, adaptation of services to add testing at many sites, numerous additional staff that became certified for vaccine administration to meet the community needs, or assisting the rest of the medical community as the therapeutic landscape seemed to change every week. Across the state, your efforts, actions and willingness to persevere through this pandemic has been incredible to witness, and for that, I feel proud to be part of the Iowa Pharmacy family.
The past year, I have had the pleasure of working with an awesome team of people at IPA, members of the IPA Board, and all of you. Some of my most memorable days as IPA President surround the 2022 Legislative Session, including visiting the Iowa State Capitol to attend a subcommittee meeting and assisting with activities around the proposed PBM legislation. What a challenging yet exciting time to be representing and fighting for fair and transparent payment practices!
Today, there is still great activity and energy around PBM reform, both in Iowa and across the country. I can’t help but think we are on the verge of additional wins on this topic. It was fantastic to witness the IPA membership rally and demonstrate strong grassroots support when IPA staff called for it from the capitol. Although we didn’t get everything we wanted this session, we did get a bill across the finish line that has laid the groundwork for meaningful regulation, future discussions and negotiations. We will maintain our good working relationship with the Iowa Insurance Division to make sure our voice is heard through a more formal mechanism of oversight.
As pandemic restrictions continue to ease and we are able to meet in person again, it becomes evident just how special the Iowa Pharmacy family is. While Zoom meetings kept us going during a tough time and allowed us to stay connected, seeing people in person is truly a different level of engagement and brings us a defined sense of purpose. As a member of IPA and the pharmacy profession, you continue to make a difference every day – for fellow IPA members, for your patients, for the communities you serve.
The saying, “What is right for the patient is right for the profession,” rings so true here in Iowa, and I couldn’t feel more proud to say that I am a part of that. I am so grateful for all of the relationships I have developed with pharmacy professionals across the state during my time as president. I thank each of you for all that you do! ■
Christopher Clayton, PharmD, MBA
IPA President Director of Pharmacy & Population Health, Buchanan County Health Center
Left: IPA Board Retreat November 2021; Right: Providing opening remarks at PharmaCE Expo 2022
UNDERSTANDING DISPARITIES TO IMPROVE HEALTH EQUITY
AUTHOR: Emmeline Paintsil, PharmD, MSLD, BCPS, Director of Professional Affairs, Iowa Pharmacy Association (IPA)
Health equity, inequity, disparities and social determinants of health – You may have heard the buzz of these terms at work in department meetings, while glossing through your inbox, and even scrolling on social media. Much like the conversations around diversity, equity, inclusion and justice, there are many misconceptions around what these terms mean. Public health crises, such as the HIV/AIDS pandemic, opioid epidemic, and recent COVID-19 pandemic, have continued to highlight inequities of the health care system that have unfortunately resulted in disparities in health outcomes for underserved and vulnerable patient populations. As healthcare providers, we often neglect to understand how health disparities impact the care we provide to our patients and their ability to be fully present and engaged at the center of that care.
Health equity has been defined as “the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” Many types of disparities exist in this world, including economic and social disparities. In the context of health and healthcare, the Office of Disease Prevention and Health Promotion’s Healthy People 2020 defines health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
To better understand the context of disparities, it is important to understand more about Iowa’s population. An estimated 1.35 million people live in rural areas (43% of the population), while roughly 1.8 million people live in urban areas. (Nationwide, 14% of the total U.S. population lives in a rural area.) In Iowa, approximately 15.5% belong to a racial or ethnic minority population (approximately 33%, or more than 100 million people in the U.S., identify themselves as belonging to a racial or ethnic minority population). Approximately 50% of Iowa’s population is women, which is similar to the U.S. population. Approximately 8% of Iowans under the age of 65 have a disability (26% of adults in the U.S. have some type of disability). While these demographic elements are not thought to be related to health, research has found a complex relationship that exists between health and factors such as socioeconomic status, environmental and psychological safety, access to health care services, and legislative policies. These factors, which influence an individual’s or population’s health, are known as determinants of health.
Social determinants of health are non-medical factors that impact health and wellbeing. They are commonly grouped into five domains: economic stability; education access and quality; neighborhood and built environment; social and community context; health care access and quality. The U.S. Department of Health and Human Services defines social determinants of health as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Social determinants of health, such as unequal access to health care, contribute to wide health disparities and inequities and impede opportunities for individuals to achieve optimal health.
To put this into context, about one in ten people in the United States do not have health insurance. People without insurance are less likely to have a primary care provider, and they may not be able to afford the health care services and medications they need. Strategies to improve insurance coverage are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses.
Health insurance is not the only barrier to care. We often see geography impacting health due to patients living too far away from health care providers that offer the services they need. According to the recent U.S. Census, Iowa’s population is approximately 40% rural and approximately 606,000 residents live in a primary care shortage area. In rural Iowa, pharmacies are the backbone of the health care system. Without a local pharmacy, services such as dentistry, family medicine, and general medicine struggle to maintain viability. Since 1996, the number of pharmacies supporting rural Iowa communities has decreased drastically. Currently, 69.7% of Iowa’s 99 counties have two or less pharmacies. Rural health disparities across the state continue to impact patient care. The further a patient must travel to receive the care and medications they need increases the risk of disease state complications and hospital admissions, placing an increased burden on our health care system.
The pharmacy profession has and continues to help bridge the gap for patients needing preventative care and acute and chronic treatment through point-of-care testing, medication therapy management, and
