The carbon emissions of prescribing practices

By Cristina Richie.

Health care has a carbon footprint, which contributes to climate change and climate change health hazards, like severe weather, flooding, tornadoes, drought, and anxiety. Carbon emissions come from health care structures and health care activities. Health care structures like hospitals and clinics rely on high-carbon use building materials, heat and cooling, water and energy sourcing, and food services. Other adjunctive structures that contribute to health care carbon include patient transportation to and from hospitals, doctors communing to work, and shipment of products to health care facilities. Health care activities, also referred to as health care delivery, which contribute to carbon include medical developments, techniques, and procedures, diagnostic tests, single-use instruments, and pharmaceuticals. “Environmental Sustainability and the Carbon Emissions of Pharmaceuticals,” focuses on the carbon emissions of health care activities—in keeping with previous work on Green Bioethics and sustainable reproductive technologies.

Globally, the pharmaceutical industry carbon emissions are more than 50% higher than the automotive sector. Pharmaceuticals are an accessible entry point for action on health care carbon reduction, as many people are familiar with prescriptions and may take one or more regular prescription. However, not all prescriptions are clinically necessary or indicative of best medical practices. Particularly during extraordinary national situations, reconfiguration of health care priorities may lead to questionable prescribing practices.

The COVID-19 pandemic put enormous pressure on the health care resources of national health services like the United Kingdom’s National Health Services (NHS). As money, time, and energy were diverted to the urgent crisis, other “non-essential” health care needs like mental health were postponed or disrupted. Prior to COVID, the NHS had come under fire for long wait times for mental health services like Cognitive Behavior Therapy (CBT). As patients waited, at times for years or months for low-carbon, highly effective treatments like CBT, they were prescribed drugs to mask—not treat—the symptoms of their mental health issues. The prescribing practices associated with mental health services are a case study in excess carbon emissions from pharmaceuticals.

Many treatments, including those for mental health, have a proliferation of lower carbon options that have higher success rates and fewer side effects than pharmaceuticals. While it is easier to prescribe a drug than facilitate access to a highly trained therapist, best medical practices include thorough psychological evaluation prior to prescribing drugs. To be sure, the prescription may be seen as a temporary solution as people with mental health problems wait for an available therapist, but many prescription drugs do not address the underlying issues causing mental distress. Standards of care require the most efficacious and timely clinical plan, with the minimal amount of pharmacological intervention. Failure to adhere to these standards does a disservice to patients.

Moreover, prescribing pharmaceuticals prior to thorough clinical evaluation has normative significance for environmental ethics. When drugs are the default treatment plan—even if a lower carbon alternative like CBT is better—excess carbon emissions are expended as the higher carbon treatment is pursued first. This initial carbon expenditure is compounded by the carbon requirements of daily drug use, which is also excessive compared with therapy sessions. As additional people seek mental health services and this prescribing practice is repeated, the environmental effects are compounded, resulting in a bloated carbon footprint at the expense of planet and patient.

Clean health care and mental health will be among the key societal challenges post-pandemic. Not only for the UK, but for the world. As the NHS and other national health care systems balance the commitments they have made to lower the carbon emissions of health care and the recovery process from COVID, the inevitable influx of mental health problems presents both an opportunity for carbon reduction and a risk of carbon inflation. Rebuilding a more sustainable, clinically-sound health care system is the only path forward. This will likely require more trained mental health providers. Reciprocal health care support systems that can be accessed by international residents—beyond a European Health Insurance Card or Global Health Insurance Card—are another place to relieve the financial, staffing, and carbon burden of the NHS. For instance, expatriates who pay into national health services should have the option to keep seeing their psychologist or therapist in their home country (virtually) with the NHS acting as a third-party payer. This would prevent gaps in treatment while waiting for an NHS appointed therapist and decrease the risk of premature pharmacological intervention. Dedicated funding and campaigns for mental health care should not be tainted with pharmaceutical money or interests. Rethinking prescribing practices—particularly around mental health—must be a cornerstone of sustainable health care.


Paper title: Environmental Sustainability and the Carbon Emissions of Pharmaceuticals

Author: Cristina Richie

Affiliation: Philosophy and Ethics of Technology department at the Delft University of Technology

Competing interests: none

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