Planetary Health & Pharmacy
Health and the Climate Crisis
Climate change is a major global crisis threatening virtually every aspect of human health, from the physical and social health determinants of individuals to the infrastructural and societal features of health systems (World Health Organization, 2021). Severe weather events such as heatwaves and storms endanger critical environmental health determinants including good air quality and access to clean water. These events also increase malnutrition, mental health issues, and the risk of illness and premature death from diseases spread through food, water, and disease-causing vectors, as well as non-communicable diseases and pre-existing health conditions. Further exacerbating present health inequalities, the climate crisis also jeopardizes access to medical care and social supports. The catastrophic impact of climate change continues to be observed beyond the individual, threatening healthcare facilities and health systems at large.
Health System Related Emissions
Despite the impact of climate change on human health, health systems contribute to approximately one tenth of carbon dioxide emissions in many industrialized countries (World Economic Forum, 2022). The manufacturing of healthcare equipment, the use of non-renewable energy in hospitals, medical devices with low energy-efficiency, health-care related travel emissions, and various pharmaceuticals are just a few examples of how health systems routinely contribute to global carbon dioxide emissions.
Pharmacy specific emissions and relevance to pharmacy (25% of health system emissions)
In Canada, approximately one-quarter of all health system emissions are produced by the pharmaceutical industry (Eckelman et. al, 2018). Some medicines, such as anesthetics and inhalers, contribute significantly to carbon emissions. For example, the anesthetic gas desflurane has a twenty-fold impact on climate change compared to adequate alternatives. Similarly, inhalers containing propellants are a major contributor to climate change within the pharmacy industry, yet they remain the most prevalent type of inhaler (World Economic Forum, 2022). Pharmaceuticals further contribute to climate change via their presence in water systems, which may occur through human excretion, waste from drug manufacturers, and inappropriate disposal, resulting in harm to both human and environmental health.
Pharmacy's contribution to pollution
Pharmacy’s contribution to climate change is aggravated by its contribution to pollution. A 2022 study discovered water on every continent to be polluted by pharmaceuticals, with over a quarter of the examined regions measuring potentially toxic concentrations of pollutants such as propranolol, used to treat high blood pressure, and ciprofloxacin, an antibiotic (University of York, 2022). The improper disposal of waste near riverbanks, poor wastewater infrastructure, and methods of drug manufacturing were identified as major contributors to pharmaceutical pollution.
Incorporating disaster plans and advising on medication management during heat waves
Pharmacists and pharmacies can adapt to climate change by incorporating disaster plans that will allow for care provision to continue during emergencies. A successful disaster plan should advise on drug supply disruptions at the pharmacy, lines of communication with public health and government authorities, relevant staff education, and knowledge dissemination to the public about the emergency (Saskatchewan College of Pharmacy Professionals, 2020). Disaster plans should also confront what to do in case of staff absences or pharmacy closure, and pharmacies should make provisions in the context of the emergency to reduce the disaster’s effects on pharmacy staff. The urgent and unpredictable nature of disaster necessitates that pharmacies remain updated on guidance from regulatory bodies and health authorities, as well as prepare for disruptions to drug supply chains by sourcing from alternate distributors, suggesting drug substitutes, and ensuring sufficient inventory of medications relevant to the specific emergency.
As climate change continues to increase the occurrence of heat waves, pharmacists can also adapt by advising patients during such events (Health Canada, 2021). Pharmacists can help by directing patients to relevant health resources, advising patients if their medications may worsen the effects of heat-related conditions, and guiding patients to seek medical attention, if necessary, by recognizing symptoms of heat-related illness. Pharmacists can also instruct patients on appropriate medication management, such as the correct handling of heat-sensitive prescriptions.
By simultaneously reducing its contribution to climate change and pollution, as well as by preparing for and adapting to extreme weather events, pharmacy can perform a meaningful role in the climate crisis.
World Health Organization - Climate Change and Health, 30 October 2021. Retrieved from https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
World Economic Forum - Here's How Healthcare can Reduce its Carbon Footprint, 24 October 2022. Retrieved from https://www.weforum.org/agenda/2022/10/cop27-how-healthcare-can-reduce-carbon-footprint/
University of York - Global study finds the extent of pharmaceutical pollution in the world’s rivers, 14 February 2022. Retrieved from https://www.york.ac.uk/news-and-events/news/2022/research/global-study-pharmaceutical-pollution-rivers/
Eckelman MJ, Sherman JD, MacNeill AJ (2018) Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLoS Med 15(7): e1002623. https://doi.org/10.1371/journal.pmed.1002623 Retrieved from: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002623
World Economic Forum - Asthma inhalers use gases that contribute to global warming. These new ‘green’ inhalers could help, 21 March 2022. Retrieved from https://www.weforum.org/agenda/2022/03/asthma-inhalers-emit-greenhouse-gases/
Saskatchewan College of Pharmacy Professionals - Emergency Preparedness Resource Kit for Pharmacists and Pharmacy Technicians, 19 October 2020. Retrieved from https://saskpharm.ca/document/3607/REF_Emergency_Preparedness_Kit.pdf
Health Canada - Extreme heat and human health: For pharmacists and pharmacist technicians, 16 June 2021. Retrie6ved from https://www.canada.ca/en/health-canada/services/publications/healthy-living/extreme-heat-human-health-pharmacists-technicians.html