Abstract

Background: Non-communicable diseases and persistent infectious threats continue to cause substantial premature mortality. Over 85% of the global population lives within walking distance of a pharmacy, positioning pharmacists as highly accessible primary-health providers. Aims: To review evidence on pharmacists’ public-health activities, propose a four-domain service framework, and identify barriers limiting scale-up, particularly in low- and middle-income settings. Methods: A conventional narrative review was conducted. Targeted manual searches of PubMed, Scopus, Web of Science, Google Scholar, professional‐association websites and reference lists retrieved English-language publications from January 2015 to April 2025. Extracted data on context, interventions and outcomes were narratively synthesised across preventive, diagnostic, therapeutic and digital domains. Results: Preventive programmes led by pharmacists increased vaccination coverage by 51% and achieved 20-43% verified quit rates in smoking-cessation trials according to 97 studies. Pharmacy point-of-care testing reduced inappropriate antibiotic use by up to 65% and accelerated triage for malaria, influenza and streptococcal infections. Chronic-disease services consistently lowered systolic blood pressure by ≈6 mmHg, reduced HbA1c by 0.6-1.0% and cut 30-day readmissions (hazard ratio 0.62). Major barriers comprised restrictive scope-of-practice regulations, limited reimbursement pathways, insufficient public-health training and under-developed digital infrastructure. Conclusions: Robust evidence confirms that pharmacists enhance immunisation uptake, medication safety and chronic-disease outcomes; however, fragmented policy and financing environments constrain reach. Harmonised legislation, sustainable payment models and competency-based education are essential to convert pharmacists’ unparalleled accessibility into equitable population-health gains.