Medicines, such as antimicrobials, are widely used in healthcare and are undoubtedly one of the most important elements of healthcare service and delivery. However, recent research shows that the manufacturing, procurement, and consumption of pharmaceuticals have negative impacts on climate and the environment, which in turn, affects global public health. Data from the National Health Service (NHS) suggest that the acquisition of pharmaceuticals is responsible for 25% of the NHS’s total greenhouse gas emissions. Aside from this, pharmaceutical residues that are excreted via urine, faeces, and improper disposal reach aquatic environments through wastewater.
Recent research conducted in the UK indicates the presence of some pharmaceuticals in various environmental matrices. In 2022, researchers from the European Centre for Environment and Human Health based at the University of Exeter published a study revealing the presence of ciprofloxacin in English and Welsh wastewater and aquatic environments. In the same year, researchers from the Water Research Group based at Glasgow Caledonian University (GCU) led Scotland’s first baseline study on the scale of pharmaceutical pollution in the country and revealed the presence of nine pharmaceuticals in Scottish water environments: antimicrobials (clarithromycin, erythromycin, ciprofloxacin), pain relievers (ibuprofen, diclofenac), birth control pill (ethinylestradiol), antacid (ranitidine), and medicines for heart problems (propranolol) and type 2 diabetes (metformin). Aside from the environmental risks of these pharmaceuticals affecting the survival, reproductive ability, and behaviour of wildlife, the presence of these pharmaceuticals in the environment also contributes to antimicrobial resistance – a major global health issue.
Data on pharmaceutical consumption and the presence of pharmaceuticals and their risks to the environment and antimicrobial resistance inform the development of policies, surveillance activities, and interventions to help improve pharmaceutical usage, reduce pharmaceuticals in the environment, and mitigate its negative impacts. For example, the Centre of Expertise for Waters based at the James Hutton Institute has supported the development of policy recommendations in implementing eco-directed sustainable prescribing, including the need to build the capabilities of healthcare providers to practice a more environmentally sustainable prescribing practice. Additionally, the British Society for Antimicrobial Chemotherapy developed the UK Antimicrobial Registry that captures real-world antimicrobial consumption data which would be helpful in improving clinical practices and patient outcomes. Using environmental and prescribing data, the One Health Breakthrough Partnership (OHBP) and the Scottish Environment Protection Agency have also developed the UK’s first open-access data visualisation tool that could help in analysing information to make data-driven, substance-specific, and location-specific interventions on pharmaceutical prescribing, infection control, antimicrobial stewardship, regulation, etc. to reduce the environmental and human health risks (i.e. antimicrobial resistance) of pharmaceutical pollution.
Changing prescribing practices of healthcare providers has a critical role to transform the healthcare system into a more sustainable one that is fit for all. The OHBP is spearheading transdisciplinary research to develop the UK’s first eco-directed sustainable prescribing framework that integrates environmental sustainability with the clinical and cost-effectiveness of pharmaceuticals. This Medical Research Council-funded project would help reduce pharmaceutical pollution by enabling prescribers to improve medicine prescribing by making an environmentally informed selection of pharmaceuticals that are of comparable medical efficacy, safety, and effectiveness. The co-creation of an eco-directed sustainable prescribing framework would also help inform the development of ‘blue-green prescribing’ – an innovative and sustainable approach to prescribing pharmaceuticals (i.e. antidepressants). Being developed by the Blue-Green Prescribing Research at GCU, this environmentally sustainable approach to prescribing uses nature-based social prescriptions and less environmentally harmful antidepressants which could be prescribed to people with common mental health conditions (e.g. anxiety, depression). To inform how primary healthcare professionals could be best supported in implementing blue-green prescribing, the Blue-Green Prescribing Research is inviting primary healthcare professionals (e.g. GPs, nurses, community pharmacists, pharmacy technicians, community link workers, healthcare assistants, etc.) to answer the Blue-Green Prescribing Survey that would capture their views about an acceptable blue-green prescribing model that would work for them and their patients.
During the COP26 in 2021, the UK has pledged to transform its healthcare system to a more climate-resilient and environmentally sustainable one. These initiatives are building blocks and prescriptions to help deliver this commitment in line with the publication of NHS England’s Net Zero Strategy and NHS Scotland’s Climate Emergency and Sustainability Strategy. With the theme for this year’s World Health Day – ‘Health for All’ – these initiatives are testaments to the importance of multistakeholder cooperation to provide more sustainable, fairer, and stronger healthcare futures that promote the health of all people and our planet. Human and planetary health is at the core of the climate and environmental crisis and providing universal access to healthcare means providing quality and environmentally sustainable health interventions that would protect the well-being of humans and the planet.