Guest Article: Prescriptions for a more sustainable, fairer, and stronger healthcare future for all – people and planet

By: Julze Alejandre, PhD candidate and Scottish Government Hydro Nation scholar, Glasgow Caledonian University; Senior Parliamentary Intern, UK Parliament House of Lords and British Society for Antimicrobial Chemotherapy

Medicines 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 can have negative impacts on climate and the environment. 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. The presence of these pharmaceutical residues in water environments pose ecotoxicological risks and affects the survival, reproductive ability, and behaviour of aquatic organisms such as amphibians, fish, and other wildlife. Pharmaceuticals in the environment are also associated with the potential development and spread of antimicrobial resistance – a major global health issue. Some medicines are degraded by wastewater treatment facilities, however, not all are removed even with the use of costly and energy-intensive advanced treatment technologies.

In response to this, the One Health Breakthrough Partnership (OHBP) in collaboration with several local and international stakeholders, is leading research initiatives that inform the evidence-based implementation of multisectoral and systems-wide recommendations that will not only mitigate the environmental impacts of the healthcare sector but will also help realise a more sustainable, fairer, and stronger healthcare future in Scotland.

In 2022, Glasgow Caledonian University and OHBP led Scotland’s first baseline study on the scale of pharmaceutical pollution in the country. The study revealed the presence of nine pharmaceuticals in Scottish water environments at levels that can have potentially negative impacts on the environment and could contribute to the development of antimicrobial resistance. These are 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). In collaboration with the Scottish Environment Protection Agency, this baseline study informed the development of an open access data visualisation tool with environmental and pharmaceutical prescribing data that could help in analysing information to make data-driven, substance-specific, and location-specific interventions (e.g. pharmaceutical prescribing, infection control, regulation, etc.) to reduce the environmental and human health risks (i.e. antimicrobial resistance) of pharmaceutical pollution.

To inform the contextual implementation of environmentally sustainable healthcare interventions to reducing pharmaceutical pollution, OHBP supported the development of research perspectives and policy recommendations in implementing eco-directed sustainable prescribing in Scotland which was commissioned by Scotland’s Centre of Expertise for Water. OHBP has also spearheaded a transdisciplinary research to develop the UK’s first eco-directed sustainable prescribing framework that integrates environmental sustainability with clinical and cost effectiveness of pharmaceuticals. This Medical Research Council-funded project would help reduce pharmaceutical pollution in Scotland by enabling prescribers to improve medicine prescribing by making environmentally informed selection of pharmaceuticals that are of comparable medical efficacy, safety, and effectiveness. To better inform the development of this eco-directed sustainable prescribing framework, OHBP is recruiting focus group participants to explore public awareness on pharmaceutical pollution and their views on sustainable ways to help reduce this.

The co-creation of an eco-directed sustainable prescribing framework would also help inform the development of another OHBP-supported research project – the Blue-Green Prescribing Research based at Glasgow Caledonian University. ‘Blue-green prescribing’ is an innovative and sustainable approach to prescribing pharmaceuticals (i.e. antidepressants) to also help reduce the presence of antidepressants in water environments. Blue-green prescribing uses nature-based social prescriptions (blue space or water-based activities) 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.

OHBP’s initiatives are building blocks and prescriptions to help achieve NHS Scotland’s Climate Emergency and Sustainability Strategy and help deliver the transformation of a more sustainable, fairer, and stronger Scottish healthcare system and Wellbeing Economy. With the theme for this year’s World Health Day – ‘Health for All’ – OHBP’s initiatives are testaments for the importance of multi-stakeholder collaboration in promoting 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.

A similar version of this article is also published on the website of the British Society for Antimicrobial Chemotherapy.

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