Demonstrators protesting about climate change

Practice

The Climate Emergency: how can pharmacy be more sustainable?

In September 2019 doctors superglued themselves to the doors of the Department of Business, Energy & Industrial Strategy, part of a global protest which saw 7.6 million people take to the streets, protesting for the right to sustainability and demanding government action on climate change.  

The climate crisis is evolving at ever-faster rates, leading us towards irreparable ecological breakdown and the largest ever public health crisis.  

Pharmacists are health scientists whose entire practice is predicated on evidence. Evidence-based medicine determines how we treat our patients and we spend a lifetime sourcing it to further improve how we manage those in our care. So why are so many of us turning a blind eye to the largest dataset ever established in human history? 

The evidence that climate change is due to human activity has reached a ‘gold standard’ or ‘five-sigma’ level of certainty: a statistical gauge indicating that there is a one-in-a-million chance that the signal would appear if there was no warming. Decades of science support this: 

  • 1959: the American Petroleum Institute (API) was warned that an increase in C02 would cause the polar icecaps to melt and flood New York
  • 1965: US President Lyndon Johnson’s Science Advisory Committee stated that “pollutants have altered on a global scale the CO2 content of the air with effects that could be deleterious from the point of human beings.” 
  • 1981: Exon management were warned that “CO2 emissions will later produce effects which will be catastrophic for a substantial fraction of the Earth’s population.”
  • 1992: Rio Earth Summit – countries commit to the world’s first international agreement to stabilise greenhouse gases
  • 2013: A study published in the journal Climatic Change revealed that 90 companies were responsible for producing two-thirds of the carbon that has entered the atmosphere since the start of the industrial age. The same year the United Nations’ Intergovernmental Panel on Climate Change (IPCC) concluded that it is “extremely likely” (95 percent probable) that human activities have been the main cause of climate change since the 1950s”.
  • 2015: 195 nations signed the Paris Agreement “to combat climate change and to intensify the actions and investments needed for a sustainable low carbon future.” 
  • May Day 2019: the UK Parliament declared a climate emergency.

But it’s not enough. We (you, me, and all our patients) are still on course for a global temperature rise which will see millions of people displaced, injured or dying through rising sea levels, starvation and disease by the end of the century. The head of the UK environment agency has warned that within 25 years water shortages in the UK will be a threat to life, and yet by the time the UK has reached this stage, vast swathes of Asia, the Middle East and even Central Europe are expected to be uninhabitable. 

We need to assess medications for their ecological impact as well as their immediate effect on patients

The WHO have estimated that we will see a movement of tropical diseases such as malaria and dengue fever, along with mass migration of people escaping climate poverty. The health costs will be extraordinary. DEFRA estimated in 2012 that the cost of annual additional patient days in the UK due to increased temperatures from climate change would be £51 million in the 2020s, £183 million in the 2050s, and £404 million in the 2080s. In psychological terms the costs will be unimaginable.

This is not sustainable. But we can be, and so can healthcare.

Simon Stevens, Chief Executive of NHS England, recently announced that the NHS will accelerate plans to tackle climate change via reduced carbon output and that staff should feel emboldened to discuss the measures needed to tackle climate change. There is a lot to achieve. The NHS is the largest public sector contributor of carbon emissions(25 percent of the total) and responsible for 5.4 percent of the UK’s total. 

So what can we do? We can change pharmacy

We need to assess medications for their ecological impact as well as their immediate effect on patients. 

Anaesthetic gases represent up to 5 percent of the carbon-footprint of acute NHS Trusts and while all of the halogenated anaesthetic gases (sevoflurane, isoflurane and desflurane) are significant pollutants, damaging the ozone layer and acting as potent global warming agents, they vary in the degree of their effect. As a comparison, CO2 emissions from one hour of desflurane are the same as driving a car for 230 miles, and more than seven times as impactful as one hour of sevoflurane use.  Sevoflurane also has a shorter atmospheric lifespan of 1.4 years, compared to desflurane which will continue to exert its effect for more than 21 years.

The hydrofluorocarbons (F-gases) in metered dose inhalers are greenhouse gases with a global warming potential thousands of times greater than CO2. Although they contribute a small proportion of the UK’s greenhouse gas output, it’s significant. If there was a rigorous adherence to previously set F-gas reduction targets, the result would be a 0.5C reduction in global temperature by the end of the century. The use of MDIs is purely down to habit. There is no overall patient benefit compared to dry powder inhalers which are used far more extensively in other countries with no effect on patient care or outcome.

The NHS Sustainable Development Unit encourages all patients to return inhalers to a pharmacy for safe disposal or recycling. So far GSK Complete the Cycle scheme has recycled 1.2 million inhalers, equivalent to taking over 5000 cars off UK roads.

We can change our hospitals

The pharmacy at Poole Hospital NHS Trust has recently committed to using only recycled paper which will save approximately 75,000 litres of water per year. This followed a move by their sister organisation, Dorset County NHS Foundation Trust, which has switched wholesale, and NHS Scotland which moved over in its entirety in 2011. The change is cost neutral now but will save money in the future as bleached stock is subject to price rises which the recycled line escapes. More importantly, a national switch would mean the NHS could reduce CO2 emissions by over 5,000 tonnes per year – equivalent to over one thousand cars removed from the road.

This is one small element of moving a Trust to sustainability. Praise should go to Newcastle NHS Foundation Trust who recently became the first in the world to declare a climate emergency, closely followed by Bristol NHS Trusts. Newcastle was the first Trust in Europe to implement reusable sharps boxes, they source electricity from 100 percent renewable suppliers, have removed single-use plastics from cafes and restaurants, and have outlined a commitment to be carbon neutral by 2040.

We can stand up and be heard

As health workers we should make a stand to protest this catastrophe, vocally and clearly, at every conceivable step, whether our actions are physical, financial or clinical. The British Medical Association, the Royal College of Nurses, the Royal College of Medicine, the Royal College of General Practitioners and the Royal College of Emergency Medicine have all declared a climate emergency and divested from petrochemical companies. However, pharmacy organisations have so far been quiet on this front. 

Richard Horton, editor of The Lancet, wrote an editorial this month in support of the Extinction Rebellion Doctors & Health Professionals. He concluded that “it might be an exaggeration to say health workers have 14 days to save the world. But not much.”

The UKCPA have recently reviewed their organisational environmental impact and have reported on where more sustainable changes have been made, along with pledges to make further improvements.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement: 

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. The author is a member of Medact who are currently running climate justice and fossil fuel divestment campaigns, and a member of Extinction Rebellion Doctors & Health Workers.

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