In my well-thumbed 1972 edition of The Doomsday Book by Taylor (1972), he cites both British physicist John Tyndall, who suggested in 1861 ‘that world temperatures depended on the amount of carbon dioxide present in the atmosphere’, and British climatologist Dr CEP Brooks, who observed in 1949 that ‘[s]ince the beginning of the twentieth-century glaciers have been wasting away rapidly or even catastrophically.’
However, despite these early and subsequent warnings, it is clear from what many describe as our present-day climate change emergency that little has been done to address the onset of climatic havoc. But to what extent has the world of pharmacy paid heed to and/or acted upon the bleak climatic landscape we now survey?
Noting that the NHS is committed to meeting the targets of the Climate Change Act 2008, which includes reducing its carbon footprint by 80% by 2050, Maughan et al (2016) considered the economic cost and carbon footprint associated with prescribing long-term flupentixol decanoate long-acting injections. They found that a reduction of £300 000 could be achieved across England by improving prescribing behaviour, which equates to a saving of £250 per patient per year and 170 000 kg carbon dioxide equivalents. Psychiatrists, they concluded, ‘need to review their prescribing practice of long-acting injections to reduce their impact on the NHS financial budget and the environment.’
Bartolo et al (2021) remind us that the types of active pharmaceutical ingredients detected in the environment ‘include but are not limited to antibiotics, anti-inflammatories and analgesics, hormones, antihypertensives, and anticonvulsants.’ Bartolo et al (2021) also highlight the term ‘green chemistry’, coined in 1991 and defined as ‘the utilisation of a set of principles that reduces or eliminates the use or generation of hazardous substances in the design, manufacture and application of chemical products.’ Further, Bartolo et al (2021) comment that ‘[t]he implementation of green practices, within the pharmaceutical sectors, is already included within the curriculum of different universities.’
Evidence that climate change can influence the movement of infectious disease is provided by Hauser et al (2021) who cite evidence linking a changing climate with difficulties in treating infections resulting from increased antimicrobial resistance. For instance, temperature resistance has been observed among bacteria exposed to a changing and warming environment, with studies suggesting that ‘due to similar mechanisms of resistance such as biofilm formation, temperature and antibiotic stress on bacteria can cause a sort of cross-resistance’ (Hauser et al, 2021). The authors further advise that a heightened awareness of such relationships among health professionals can help prepare them for the impacts of climate change on the evolution of infectious diseases.
However, to assume that all participants in the health sector have a unity of purpose in addressing the challenges of climate change is to court an unduly optimistic approach. Thus, based on a German study undertaken by Quitmann et al (2022) derived from 29 semi-structured qualitative expert interviews in relation to greenhouse gas emissions, hospital stakeholders, whether patients or employees, ‘felt less responsible for climate change mitigation. They saw providing the best possible medical care to be the top priority in hospitals and were often concerned that patients' health could be jeopardised by climate change mitigation measures.’
In the context of climate change mitigation measures, it is worth emphasising that irresponsible reporting in promoting the need for such measures is counterproductive. This was recently demonstrated when the BBC's climate editor Justin Rowlatt–according to the Corporation's Executive Complaints Unit–not only incorrectly stated in a Panorama documentary that weather-related deaths were increasing, but also wrongly ‘claimed “without qualification” that Madagascar was on the brink of the world's first climate-induced famine…’ (Kanter, 2022). This should not invite the inference that challenging claims about climate change amounts to denialism; after all, denialists are seldom motivated by evidence but by a sense of conviction. Therefore, cultivating a sceptical attitude to whatever scientific evidence may be presented is to be encouraged.
As McIntyre (2021) makes clear, it is axiomatic in scientific communication that one cannot convince a science denier with facts by themselves because ‘most science deniers don't have a deficit of information, but a deficit of trust. And trust has to be built, with patience, respect, empathy and interpersonal connections.’ This applies to all areas of life and healthcare… including pharmacy.