Pharmaceutical pollution is a One Health and Planetary Health concern that impacts water quality, contributes to biodiversity loss, and links to the development of antimicrobial resistant organisms in the environment. In 2021, the UK Government committed to develop climate-resilient and sustainable low-carbon health systems by signing the historic COP26 Health Programme in Glasgow, in line with the UK’s net zero targets by 2040. NHS England’s Greener NHS initiatives focus on decarbonising the NHS but limited plans are set to reduce pollution from prescribed pharmaceuticals. Recently, NHS Scotland also published its own climate emergency and sustainability strategy which acknowledges the need to reduce pharmaceutical pollution in addition to reducing carbon emissions from pharmaceutical use.

The policy document proposes the need for ‘eco-directed and sustainable’ prescribing of pharmaceuticals as an upstream intervention to reduce pharmaceutical pollution. While total elimination of antimicrobial contamination of the environment is not possible because therapeutic use of antibiotics inevitably leads to the excretion of these compounds and their metabolites through urine and faeces, the recommendations call for co-directed and sustainable prescribing means maximising the use of non-pharmacologic interventions; optimising medicine use; discussing the environmental impact of pharmaceuticals during patient consultation; and deciding on the best patient-centred healthcare intervention through shared decision making between patients and healthcare providers.

Fifteen policy recommendations in the areas of public health; promotion of greener and sustainable healthcare; environmental considerations in healthcare decision making; and extended environment risk assessment of pharmaceuticals are proposed in the said policy brief which were developed during a series of high-level consultations with experts and relevant stakeholders from government, industry, academia, and civil society organisations.

Julze said: “The issue of pharmaceutical pollution is oftentimes forgotten by our policymakers when they talk about strategies for climate change and environmental degradation. This is mainly due to the low awareness of our leaders about this health and environmental problem. We hope that through these policy recommendations, we will help build awareness about pharmaceutical pollution and ways to resolve this among our leaders at the UK Parliament.”

Emily added: “The launching of this policy brief is an exciting step closer to seeing the UK Government recognise that reducing environmental pollution is a means of preserving public health, as well as benefitting the natural world. It’s been a great experience to have worked on this document and to have co-led these interdisciplinary and constructive discussions between a wide range of stakeholders – a true representation of the successful collaboration between policy, industry, academia, healthcare, and civil society.

The policy brief on ‘Eco-directed and Sustainable Pharmaceutical Prescribing in the United Kingdom’ can be accessed here.