I recently wrote the following short article for the pharmacy students society in University College Cork. (The Cover picture is the “Human Exposome” (see below)
As a profession that may not be directly involved in creating plumes dirty black smoke on a daily basis, or destroying the habitats of wildlife, but instead has an important role in treating the vulnerable, it can sometimes seem like pharmacy has nothing to do with what is being widely accepted as the existential crisis of our time: climate change and biodiversity loss. But can we really sit back and do nothing?
Delivering modern healthcare is not a carbon neutral activity, with the sector responsible for an estimated 4% of Ireland’s greenhouse gas emissions. Medications are no small part in that, with ever more energy intensive manufacturing processes, leading to carbon hotspots in critical care medicine and debates about CFCs and other pollutants in Inhalers which have continued since I was in college (a long time). We are a Carbon and Nitrogen intensive profession. Just look at all those complicated structures in organic chemistry – C and N are also the largest components of greenhouse gases.
Our health is dependent on our environment, and our environment is dependent on how we deliver health. Emissions from human activity are linked with respiratory conditions, cognitive impairment and autoimmune disease among others. A London coroner recently ruled that an child’s death from complications of Asthma were due to the failure of her local council to reduce nitrate pollution to legal levels.(See Guardian article here)
Climate change and climate migration are also having indirect effects on us, with the spread of infectious diseases (we are seeing more drug resistant TB) and extremes of temperature lead to more cardiac conditions, sunburn and melanomas, and heat stroke.
A concept called the human “exposome” has been suggested: complex interactions between climate change, infectious agents, environmental pollutants and other stressors combine to affect our health, individually and as populations. (see Karlson et al. )
Decisions on pharmaceutical care has evolved with time. Originally we asked does it work (efficacy). In the 1960s our eyes were opened to ask, was it safe (safety). After recessions in the 1970s and 1980s we started to ask is it cost effective, and pharmacist in particular were good at answering those pharmacoeconomic questions. We now have to ask: is it sustainable? We need to start looking at the carbon footprint of what we do ( Have a look at Berners-Lee’s “How Bad Are Bananas” for lighthearted guidance here). As well as the carbon question we need to ask how are we getting rid of what is left. It is thought that all drinking water in the US state of Iowa includes traces of antidepressants at this point. It all has to go somewhere!
As the country starts to look at more sustainable business practices to see if we can stem this tide of human made environmental damage, there should be no free pass for healthcare, and pharmacy can play it’s part. We hold the key to convincing patients that the best inhaler for them is the best inhaler for the planet: and we will teach them to use it effectively. We can reduce our packaging footprint. Everything antimicrobial stewardship pharmacists do helps the environment, both by reducing antimicrobial consumption and optimising care. Every medication deprescribed comes with a carbon saving.
But we need to go further than making small changes, which although they do add up, might leave us short on the overall trajectory of stopping the planet from warming by more than 1.5ºC before the middle of the century. As a society we need to make changes to how we live, and more importantly, how we do business. We can’t keep consuming finite resources and accept that the worlds homeostatic mechanisms will absorb this: Sooner or later there will be too much lactic acid buildup in the world’s coronary arteries (CO2 in our atmosphere) and we won’t have any reserves left to survive the intensive care that will be needed to nurse our world back to health.
But we are not without hope. People are beginning to speak out the world over and demand change from government and industries. Educational and other institutions have moved their money and partnerships away from the worst polluting companies. Cities have started having the conversations about which come first: people or motor vehicle. Students across the world have united in groups like Friday’s for Future and Extinction Rebellion. A green wave has hit politics across Europe, and Cork has some of the most effective Green and Environmentalist city councillors.
I will leave you with this cartoon by Joel Pett, which first appeared in USA today a decade ago. The message hasn’t changed:
You can read the article here in the Apothecary Times along with some other thoughts and ideas on sustainability.