The Holistic Community Pharmacy within Ecocivilisation MARTINA PUC 1 The Holistic Community Pharmacy within Ecocivilisation 1st edition Author: Martina Puc Reviewed by: Katja Hleb Published by: COVIRIAS, Parmova 14, SI-1000 Ljubljana April 2021 Published in .pdf format. Published on website covirias.eu. Pictures Nr. 4 & 5 on Ecocivilisation are courtesy of V. Bulc. Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID 60674563 ISBN 978-961-95129-4-4 (PDF) 2 Table of Contents Foreword Page 5 1 The Holistic Community Page 6 Pharmacy is aligned with Ecocivilisation 2 What can we learn from an Page 13 alignment of Holistic Community Pharmacy with Ecocivilisation for a Healthcare system? 3 Conclusion Page 19 3 Table of Pictures Picture 1. Presentation of the value chain including Community Page 7 Pharmacies assumed by the legislation. Picture 2. Presentation of the actual value chain including community pharmacies. Page 8 Picture 3. Presentation of a Holistic Community Pharmacy© on the way of transformation to a network organization. Becoming a hub. Page 8 Picture 4. Presentation of the Ecocivilisation model by V. Bulc. Page 10 Picture 5. Presentation of the Ecocivilisation model with a being in Page 12 focus by V. Bulc. Picture 6. Presentation of an interpretation of health as a wave. Page 16 Picture 7. Presentation of an escalation of health misbalance Page 18 correlation with a need for professional help 4 Foreword Every single Community Pharmacy should contribute to the local community in one way or another. Why should otherwise a local community allow or even wish its existence? What is this contribution and how big it is depends as much on the implementation of its purpose as on the characteristics of local community itself, namely its value system, structure etc. A Holistic Community Pharmacy1 purpose is to contribute to the improvement of health of a local community population. How does this concept fit in the contemporary local communities is a question we already have some answers for from the cases of its practical implementations in Slovenia. These cases confirmed the challenges are mainly in the developmental level of professional organizations and in the presence of or lack of their support, in the extent of owners and management commitment and in the availability of competent staff members. Of course this question deserves thorough analyses. Additionally, the same importance lies in the question of, how does the concept of the Holistic Community Pharmacy© fit in the society models of tomorrow, taking in the consideration large transformations in near future. A year of 2020 was a year of change for so many people in many different ways. In a way it brought to a surface even some positive events. One of them has been Ecocivilisaton Talks2 by Violeta Bulc. They intrigued me to rethink my concept of Holistic Community Pharmacy© in the light of the model of Ecocivilisation by V. Bulc. In this essay the alignment of two is presented. It serves us as a rethinking tool of our attitudes towards and expectations from health and healthcare stakeholders. The purpose of this writing is therefore to rethink how to achieve a better health of people. 1 The Holistic Community Pharmacy concept is defined by its authour M. Puc in Holistic Community Pharmacy: Declaration of fundamental principles of Holistic Community Pharmacy, 2017 and her other work. References on holistic pharma cy are on that particular concept and are hereinafter marked as proprietary concept. 2 The #EcocivilisatonTalks is a platform for open discussions, searching and unfolding weak signals pointing towards a new civilizational paradigm which has been started to call #Ecocivilisation. More information is available on https://www.ecocivilisation.eu/en/home/. 5 1 The Holistic Community Pharmacy is aligned with Ecocivilisation 4 The Holistic Community Pharmacy2 is aligned with Ecocivilisation3 The role of an industry can be The concept of a Holistic Community presented by its placement in the Pharmacy© includes a formation of a value chain. The value chain is new value chain, a business model, a speaking already loud and even more structured consultancy process, the position of a single link in it. The integrated quality assurance system, classic regulatory view presented in knowledge management system, Picture 1 is placing a wholesaler as an KPI’s, awarding system and intermediate between pharmaceutical cooperation with therapists, including industry and community pharmacies to medical doctors, product vendors and avoid the direct influence on their local community. A Holistic Community choice among products. However, in Pharmacy© is building an identity of a practice we can see a completely hub, becoming more independent from different situation with direct the logistic of products as presented in communication of the industry with Picture 3 (see Page 7). end users, changing the role of community pharmacies as presented in Picture 2 (see Page 7). PRODUCER WHOLESALER COMMUNITY PHARMACY Picture 1. Presentation of the value chain including Community Pharmacies assumed by the legislation. 2 M. Puc. 2017. Holistic Community Pharmacy: Declaration of fundamental principles of Holistic Community Pharmacy. COVIRIAS: Ljubljana. 3 V. Bulc. 2020. Ecocivilisation. 7 PRODUCER MEDIA C W OMMUNITY HOLESALER PHARMACY Picture 2. Presentation of the actual value chain including community pharmacies. The purpose of the Holistic Community Pharmacy© is to add value to visitor’s health4 with a holistic structured consultancy and health products. DATABASES ON MEDICAL HEALTH & HEALTH DOCTOR PRODUCTS END HEALTH PRODUCTS WHOLESALER INDUSTRY USER COMMUNITY PHARMACY RESEARCH ON MEDIA EDUCATIONAL HEALTH & RELATED PROGRAMS PRODUCTS COMMUNITY HEALTH CARE PROGRAMS Picture 3. Presentation of a Holistic Community Pharmacy© on the way of transformation to a network organization. Becoming a hub. 4 Focus of a Community Pharmacy on people is emerging worldwide; however even in those cases the common orientation is on patients. However, practice has shown that medicines, even prescribed ones, are many times picked up by somebody else but patient, and not necessarily the person who is taking care of the patient, which is even more the case in the times of pandemic in 2020. In addition, the welcoming attitude towards visitors paves the ground for respectful relationship for both sides. 8 It is of an upmost importance for further actions and behavior of any Community Pharmacy, how health is defined. Aiming at just the absence of symptoms is not in line with the Holistic Community Pharmacy© concept, but is broadly accepted within Standard5 and Legal6 Community Pharmacy. A Holistic Community Pharmacy© aims to holistic wellbeing of a visitor as much as possible in line with the definition of WHO set out in the preamble to its Constitution7, followed by the non-selection and non-discrimination approach to every visitor8. 5 Standard Community Pharmacy is the second one of the three levels of Community Pharmacies. Besides basic legal requirements it follows the purpose of managing prescribed therapy, with selective professional approaches like Pharmaceutical care for chosen individual patients in a separate consultancy- process, attitude and space wise. 6 Legal Community Pharmacy is the basic one of three levels of Community Pharmacies. It follows the minimum legal requirements to operate, focusing on logistic of distribution of medicines. 7 “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ 8 “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” 9 How does a concept of a Holistic Having in mind the understanding of Community Pharmacy© resonate with health in such a broader way, it is a model of a future society, namely the important to nurture it as a treasure Ecocivilisation? Does it bring added component of the land in value for the future society? Ecocivilisation model, since it goes along with awareness of the co- A close look to the dimensions of dependence of human beings with awareness in Ecocivilisation model other treasures of the land resulting in reveals it is mirroring the description of health of everything and everybody. health in the definition of health by Can anybody be healthy in an WHO in a more structured way. unhealthy environment? Picture 4. Presentation of the Ecocivilisation model by V. Bulc. 10 Collaboration of a Holistic Community The most important relationship for a Pharmacy© with a local society with a Holistic Community Pharmacy© is the purpose to nurture health of humans one with a visitor. Holistic Community as one of the treasures enables Pharmacy© values should be reflected adequate relationships to ensure in the welcome, in the communication enough good food and facilities for and the design of a dedicated space to exercise for example. Within the communication. holistic structured consultancy it means that healthy living style of a A visitor should sense the welcome visitor is addressed and that in the from the attitude of personnel and the decision criteria for a selection of messages from the dedicated space. products values are incorporated with The communication of health care an awareness of resources for health. providers with patients which is based The main principle for selection of on respect of both side’s values and products in a Holistic Community knowledge for the purpose of a whole Pharmacy© is professional criteria wellbeing of a person in question based on objective broad knowledge brings more added value and positive and understanding, which is results. The design of the space incorporating values of OIKOS, should support such communication UBUNTU, EB, AROHA, OSTI JAREJ and respect the land. and IKIGAI as shown on the Picture 5 (see Page 11). Questions to be Therefore the Key Performance addressed are how a certain product is Indicators of a Holistic Community contributing to the whole health of an Pharmacy© are for example a individual (sustainable resource, side measurement of Holistic Community effects, and ingredients) and the Pharmacy© impact on visitors environment (packaging, production, compliance with a prescribed therapy, distribution) with knowledge and a an evaluation of performance of deep understanding of contribution of structured holistic consultancy, the all beings (myself, relationships with overall wellbeing improvement of others, viruses, microorganisms, fungi, visitors. algae, plants, animals) and land (soil, water, air, climate) to our health. 11 Transformation challenges lie for In short, the level of awareness of the example in the level of awareness of society about the proper role of a the owners and the employed Holistic Community Pharmacy© and pharmacists, the level of awareness of how to utilize it for different purposes professional societies and chambers in order to establish new collaborative and legal institutions as the regulatory relationships is one such challenge bodies and of the producers and that aspires for full implementation. distributors, to name some. Picture 5. Presentation of the Ecocivilisation model with a being in focus by V. Bulc. 12 2 What can we learn from an alignment of Holistic Community Pharmacy with Ecocivilisation for a Healthcare system? It is important to discuss the The existing WHO definition of understanding of health and the individual health10 is nested well in this purpose of healthcare organizations concept, however unmeasurable it and professionals having in mind all looks like. Nevertheless, we can see dimensions of Ecocivilisation. from the WHO definition of public health, that it is more concentrated on Circular economy is in a way physical aspects and the maximizing a broad variety of manifestations of it11. Where is interconnections of a business with a awareness? Where is reciprocal minimum loss. We can say it is an influence on the environment? Where application of wisdom of life since the are healthy relations? Where is life itself is interconnected not just with personal growth? We should talk about other lives but also with resources and healthy living when we take care of us, social environment and it depends on others and environment if we are in relationships and awareness. line with the Ecocivilisation concept Ecocivilisation is then the highest practicing respectful relationships. awareness of all interconnectivities and respects them in all aspects of How far are we ready to go with this? their being9. 9 Besides animals, plants, bacteria and viruses, algae and fungi should be added as kingdoms of their own. 10 “The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. 11 WHO defines Public Health as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society”. Comparable terms for public health are social medicine and community medicine; the latter has been widely adopted in the United Kingdom, and the practitioners are called community physicians. The practice of public health draws heavily on medical science and philosophy and concentrates especially on manipulating and controlling the environment for the benefit of the public. It is concerned therefore with housing, water supplies, and food. Activities to strengthen public health capacities and service aim to provide conditions under which people can maintain to be healthy, improve their health and wellbeing, or prevent the deterioration of their health. Public health focuses on the entire spectrum of health and wellbeing, not only the eradication of particular diseases. Many activities are targeted behavioural counselling, or health advice. 14 There is a gap between the concept of health on individual level, including the inclusion of its affirmation as a human right, and its impoverishment on the big scale of states and other communities12 as a public health. 12 In 1984, WHO brought in a new conception of health, not as a state, but in dynamic terms of resiliency, in other words, as “a resource for living”. This revised definition of health defined it as “the extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment. Contemporary philosophy of health has been quite focused on the problem of determining the nature of the concepts of health, illness and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atom; metal and rain are value-free and descriptive. To say that a person has a certain disease or that he or she is unhealthy is thus to objectively describe this person. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities”. Thus, health referred to the ability to maintain homeostasis and recover from insults. Mental, intellectual, emotional and social health referred to a person’s ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living. WHO states that it remains firmly committed to the principles set out in the preamble to the Constitution which adopted by the International Health Conference held in New York from 19 June to 22 July 1946, signed on 22 July 1946 by the representatives of 61 States and entered into force on 7 April 1948. Later amendments are incorporated into this text. It states that: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all. Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development. The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures. The Determinants Of Health Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors by public health movements such as access and use of health care services also have far reaching impact. The determinants of health include: • The social and economic environment • The physical environment • The person’s individual characteristics and behaviours. The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants—or things that make people healthy or not—include the above factors, and many others: Income and social status: higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. Education: low education levels are linked with poor health, more stress and lower self-confidence. Physical environment: safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions Genetics: inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health. Gender: Men and women suffer from different types of diseases at different ages. Social support networks: greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all affect health. 15 The public health definition is the one The fight itself and higher body needing more in depth discussion from temperature are signs of a good health the Ecocivilisation perspective. – a proper reaction in certain circumstances. Is therefore better to The fundamental gap is in the better speak about health as an ability to understanding and having more clarity cope with a dis-balancing situations- about the individual health. From the i.e. stress? Is therefore public health WHO definition we can understand it proportion of individuals able to cope also as a static quality with a constant with various stress situations? Is then value. For example, it means when our a healthcare system a support system body systems reacts to an infection for coping with various stress with higher temperature, that is the situations – greater misbalances? sign of a disease we should treat. On the other hand, if we understand a state of one’s health as a wave in time with a sine like curve, than we understand also that our immune system and the whole being is able to fight the infection. h (health) Illness- Therapist Range for assistance self-care needed t (time) Picture 6. Presentation of an interpretation of health as a wave. 16 6 human dimensions (Bulc, 2020) are: The V. Bulc Ecocivilisation system o Energy suggest each system to start from a o Spiritual purpose through values with o Physical relationships with all other beings in o Intellectual collaboration with respect to the land o Social and and other treasures while being at the o Emotional dimension higher level of awareness. Any dis-connection or exclusion Having in mind all said, the healthcare among them is instability from within system should start from an causing waves in another axis (z) in awareness of every individual which the presentation on the previous page should be supported from all systems (Picture 6). building values (in that perspective with focus on Osti Jarej) and Awareness is the glue among them. interdependence with land and Higher awareness is giving one more treasures, other beings, etc. coming to agility. the support for all dimension of human health: Traditional society and/or state systems are focusing on each of them o (Sleep, rest and wellness, food…) more or less exclusively – in an Treasures → Energy isolated manner in line with functional o (Church, religion, sacred, organization. However, in connected…) Consciousness → Ecocivilisation we are going towards Spiritual higher level of presence. For example o (Sports organizations, plants, we can connect human activities with parks) → Physical dimensions in a following way: o (Educational organizations, research, learning…) → Energy → Food chain Intellectual Spiritual → Church, religion o Society, events; Relationships → Physical → Medical doctors, Hospitals Social and for ill, Sport institutions for healthy o Family, personal relationship, art; Intellectual → School, academia, Belonging → Emotional research Social → Art institutions, events… Emotional → Family, friends 17 Ability to resist disharmony in any of It means that a Holistic Community dimensions could be then supported. Pharmacist © as a consultant and a With increased disharmony more visitor are equal with regard to their specialized support is needed, communication. The purpose of however always including all holistic consultancy is clear, how to dimensions in line with personal improve or at least maintain the state values and beliefs, together with of health of a visitor with the product choice and consent to the therapy. selection (when necessary a recommendation of a therapist visit or As a response to outer or inner dis- modification of a lifestyle). The balancing factors we can use help structure of every consultancy is from various professionals. defined, learned and trained, along The relationship within Holistic with supervision and documentation of Community Pharmacy© is based on the cases. In such a way, new form of the assumption that people who are a pharmacist identity can be coming are visitors and should be established and a more in depth welcomed. Community Pharmacists relationship with visitors maintained. are consultants. They communicate with each other from the ego state of an adult (Berne, 1958). There should be no patronizing, no pleasing just for the sake of it. There are no kings or queens in a Holistic Community Pharmacy©. Health Institution / professional group interventions Therapist / Medical doctor, physiotherapist, psychologist, energy Community pharmacy / healer…/ help in Help with the interpretation of interpretation of manifestations and performance of Family, Significant other, disharmony and specialised care wellness performance, selection specialised of home carers other products for self-use One-self / modification personal care / of a lifestyle performing personal care Picture 7. Presentation of an escalation of health misbalance correlation with a need for professional help 18 3 Conclusion 4 In conclusion, a new start of rethinking, what kind of a world we would like to live in together with a well thought basic assumptions, how we understand what health is and what should be the role of community pharmacists and other stakeholders of a new healthcare system we would like to be able to lean on, has already begun. covirias.eu info@covirias.eu 9 20