Why Sustainable Healthcare?

Air pollution is estimated to kill 30,000 people in the UK every year (1). This occurs in many ways including exacerbations of respiratory disease, and new onset heart attacks and strokes. During periods of high air pollution, paediatric admissions to Ninewells increase significantly (2). Air pollution has also been linked to low birth weight and dementia (1). For more information about protecting patients please see the Clean Air Hub link below.

In addition, severe weather events are becoming increasingly common (3). In October 2023 Storm Babet caused significant harm throughout Tayside and these events will become more likely over time.

The changing climate is also altering infectious disease patterns, with tropical illnesses like malaria and dengue moving into new areas such as the south of France (4). The spread of Lyme disease across Scotland is also partly due to the changing climate (5).

The way healthcare is currently being provided is contributing to the climate crisis. The NHS accounts for 4-5% of the country’s total carbon footprint, of which 25% is medicines and chemicals, and NHS Scotland is aiming to become a net-zero health service by 2040 (6). As well its large contribution to the carbon footprint, many of the medications that we prescribe end up in the natural environment where they are causing damage. Up to 50% of medication is not taken as intended (7) and every year in the UK £300 million of dispensed medication is unused and discarded (8). A large proportion is disposed of in landfill, or down sinks and toilets. Even when medication is taken as intended, 30 – 90% is excreted as an active substance in the urine (9), and sewage treatment plants are only able to remove 80% of this (10). This means that a lot is passing into wastewater and the environment. Fluoxetine, sertraline and their biometabolites have been found to accumulate in fish and it is altered their behaviour (11). Synthetic oestrogens can inhibit reproduction in amphibians and fish (12). There is no current evidence that this is damaging human health but it is extremely concerning as pharmaceuticals have been found in rivers throughout Scotland, something which is being monitored by SEPA (13).

We can all do something about this. Have a look at the various action areas to find out what you and your practice team can do.

Sustainable healthcare is better for our patients, our staff, our finances AND our planet.

1. Air pollution applying to all our health 

2. Fitton, CA. et al. (2023) Respiratory admissions linked to air pollution in a medium sized city of the UK: A case crossover study. Aerosol Air Qual. Res. 23, 230062

3. Van Daalen et al. (2024) The 2024 Europe report of the Lancet Countdown on health and climate change: unprecedented warming demands unprecedented action. The Lancet 9:7, 495-522.

4. Institut Pasteur. 2024. Climate and Health: Anticipating tomorrow’s vector-borne diseases in France. 

5. UK Health Security Agency. 2023. Health Effects of Climate Change in the UK: 2023 report. Chapter 8. 

6. NHS Scotland climate emergency and sustainability strategy: 2022-2026

7. World Health Organization. 2003. The World Health Report 2003 – Shaping the Future. 

8. NHS England. 2015. Pharmaceutical waste reduction in the NHS. 

9. Kümmerer, K. 2009. The presence of pharmaceuticals in the environment due to human use: present knowledge and future challenges. J. Environ. Manage. 90, 8:2354–2366

10. Healthcare Without Harm Europe. 2014. How doctors can help reduce pharmaceutical pollution

11. Martin JM et al. 2020. Antidepressant exposure causes a nonmonotonic reduction in anxiety-related behaviour in female mosquitofish. Journal of Hazardous Materials Letters. V1, 100004.

12. Arnold, KE et al. 2014 Medicating the environment: assessing risks of pharmaceuticals to wildlife and ecosystems. The Royal Society

13. Pharmaceuticals in the water environment