Back in 2012, the Pharmaceutical Journal carried an article on how pharmacists might reduce their climate footprint in the face of the global health threat of climate change. Its author, now professor emerita Angela Alexander MBE, was asked to speak at this year’s Pharmacy Show about sustainability and pharmacy. There are plenty of practical ideas in her 2021 vision. 

For years, climate change was just something scientists talked about, but we have all seen the effects; fires from the rising heat and devastation from floods after intense rainfall, including in the UK. 

Globally, the number of reported weather-related natural disasters has more than tripled since the 1960s. The world is warming and we know why – the increase in greenhouse gases in the atmosphere. We also know how to stop it. We must wean ourselves off fossil fuels and minimise single use plastics.

Climate change will affect your business. Catastrophes like flooding will prevent normal operations. There will be changes to primary production and supply chains. The Government has imposed restrictions to achieve a net zero target by 2050 and has recently announced support to help achieve this. 

Consumers are demanding change. A 2019 Nielsen study found that 73 per cent of consumers would switch products if their choices would have a more positive environmental impact. Consumer goods from brands with a demonstrable commitment to sustainability outperform those that don’t.

Almost all plastic is made from fossil fuels, accounting for 4 per cent of the world’s annual petroleum production

So, there is a business case for lowering your carbon footprint. And of course, we are all now part of a greener NHS, with a responsibility to deliver a net zero NHS. Medicines and other chemicals are responsible for at least 20 per cent of the NHS carbon footprint; the national overprescribing review published last month highlighted the link between pharmaceuticals and climate change. 

Pharmacists are a trusted profession. We owe it to our customers to help them understand the health effects of climate change and reduce their own carbon footprints. Particulate pollution from fossil fuels has a more devastating impact on life expectancy than smoking, or even war. 

Air pollution is a bigger killer than HIV/AIDS, tuberculosis and malaria combined, according to the Air Quality Life Index Annual Update. The problem is made worse by climate change, with high temperatures leading to wildfires that increase air pollution, raising the levels of ozone and other pollutants that exacerbate cardiovascular and respiratory disease. Pollen and other allergen levels are also higher in extreme heat. These can trigger asthma, which affects around 300 million people. 

More than 70,000 excess deaths were recorded in Europe in the Summer 2003 heatwave. Rising sea levels and extreme weather events destroy homes, medical facilities, and other essential services. More than half of the world’s population lives within 60 km of the sea. Our oceans provide the largest natural carbon sink for greenhouse gases, but plastic waste creates problems. 

As the planet gets hotter, the plastic breaks down into methane and ethylene, perpetuating the cycle. Almost all plastic is made from fossil fuels, accounting for 4 per cent of the world’s annual petroleum production. Another 4 per cent is burned in the refining process.

Look at any pharmacy shelves and single use packaging is the norm, but it needn’t be. Some companies now provide refills, using around 60 per cent less plastic than the original. In many towns, refill shops are popping up to provide both food and toiletry refills directly into customers’ chosen containers. Pharmacies should not miss out. Boots is already offering such a service in Covent Garden. 

How many pharmacies are stocking the kind of environmentally-friendly products on stands at The Pharmacy Show? Scence toiletries, recently featured on BBC1’s Shop Well for the Planet, are plant-based, and wrapped in compostable and recyclable paper-based packaging. All matters produces powder-to-foam hand and body wash. Users just add water to the dry powder sachets in refillable bottles, avoiding excess plastic and saving on transport costs. 

All matters also produces a menstrual cup (formerly OrganiCup) as an easy, healthy and green alternative to disposable period products. Plastfree and Organyc were both displaying pads and tampons which are 100 per cent cotton, plastic-free and biodegradable. 

Why not try highlighting environmentally friendly products and see if sales increase? Shoppers say sustainability influences what brands they buy, but they also say they often don’t notice claims on product packaging. Gathering them in one place would make it easier for customers to identify them. Be sure to promote your new initiatives through public relations and social media. Appoint a green champion to lead the change.

We also need to consider the road miles in the supply chain. It is better for you to deliver efficiently using an electric vehicle than for your patients to drive to collect. How would that affect your business? Several pharmacies are already using electric vehicles or e-cargo bikes for deliveries. There are grants for both, so make sure you do your homework and see what is available. 

Can the dispensing process be more sustainable? Prescriptions may be transmitted to pharmacies electronically, but all EPS did was transfer printing costs from the practice to the pharmacy. Can you achieve a safe process without printing the token? Pharmacies using the Titan PMR system operate without the printing costs.

Shoppers say sustainability influences what brands they buy, but they also say they often don’t notice claims on product packaging

Sustainability is also important in clinical decision making. The NICE decision aid on inhalers asks patients how important it is to them that their inhaler has a low carbon footprint and that it can be recycled. Breath-actuated and pressurised monitored dose inhalers both contain propellant, so have a higher carbon footprint than a dry powder inhaler. Inhalers are now chlorofluorocarbon-free, but the hydrofluorocarbons which replaced them are still powerful greenhouse gases, with a climate change effect up to 3,800 times greater than carbon dioxide. 

The Pharmacy Quality Scheme (PQS) includes action in this area. Between 1 September 2021 and 31 January 2022 pharmacies have to:

• Declare all patient-facing staff have been trained on the reasons why used, unwanted and expired inhalers should be returned to the pharmacy for safe disposal, and the adverse effects on the environment when inhalers are disposed of in domestic waste  
• Be able to evidence that they have spoken (not written) with all patients, carers or representatives for whom they have dispensed an inhaler about the environmental benefits of returning inhaler devices for safe and environmentally friendly disposal.

The updated Competency Framework for all Prescribers, published by the RPS, requires prescribers to “consider the impact of prescribing on sustainability, as well as methods of reducing the carbon footprint and environmental impact of any medicine.” These might include: proper disposal, recycling schemes, avoiding overprescribing and waste through regular reviews, deprescribing, dose and device optimisation.

Lastly, we should also think about our personal impact. Think about changing your personal bank account and pension funds to ones based on green criteria. Check these out here. Look at your personal energy usage for heating and transport. You can also lobby others, individuals and organisations, to make changes, so they know environmental issues are important to you. You are not alone. Some organisations that can help can be found in the box.

Whatever small steps you can make, do it now. It will all make a difference to avert the Code Red that has been declared for humanity.