Life cycle thinking

Impact of the healthcare sector

The goal and scope of a Life Cycle Assessment (LCA) is influenced by the stakeholders involved. Sometimes it is advantageous to analyse just the production of a active pharmaceutical product (API) (cradle-to-gate); this informs the decisions of chemists and chemical engineers. Other times a broader perspective from the healthcare industry is required to optimise care for patients and reduce environmental impact. Ideally, stakeholders within the broader value chain (healthcare professionals, consumers, various other industry representatives) will all participate. By doing so, a comprehensive understanding of the entire pharmaceutical product process can be gained, from its creation to its disposal. This inclusive approach enables a thorough examination of the product's life cycle. This page considers the supply and use of pharmaceuticals in health care. Pharmaceuticals in the environment (after use) is covered separately.

Life cycle assessment of the Dutch healthcare sector 

A Dutch assessment has attributed 7% of the nation's climate change impact to the healthcare sector, as well as 8% of blue water consumption, 7% of land use, and 4% of waste by mass (Steenmeijer et al., 2022). The data was further interpreted by sector origin and geographical origin of the impacts. The former is represented below, showing the pharmaceutical sector makes the largest contribution to the impacts of the broader healthcare sector. The majority of the water, land and waste impact occurs outside the Netherlands due to imports. This information can be used to identify hot-spots where intervention can be focused. It was found that the climate change impact is strongly linked to energy use and so renewable energy is advantageous for lower environmental impact. Agricultural products are responsible for most the water and land use. The most significant contribution to waste was mining for raw materials.

Environmental impact of the UK National Health Service (NHS)

The climate change impact of the UK National Health Service (NHS) in England has been calculated (Tennison et al., 2021). There is a general reduction in impact over time, mostly helped by the care sector itself, not the pharmaceuticals and other supplies it relies on. Cleaner energy was the lead cause of this reduction in climate change impact. The impact of travel, pharmaceuticals, and other contributions from the supply chain have stayed quite similar and occasionally increased over time, although on a 'per capita' basis a reduction has occurred because the population of England is 17% greater now than in 1990 when the dataset begins.

In 2022, the NHS became the first health system to enshrine net zero targets into law. The issuance of the 'Delivering a Net Zero National Health Service' report as statutory guidance signifies a pivotal moment for NHS England, its trusts, and integrated care boards as they work towards this shared aim (NHS, 2022). The objective is to achieve net zero emissions by 2040 for emissions directly controlled by the NHS, with an interim goal of an 80% reduction by 2032. Additionally, for indirect emissions influenced by the NHS, the target is to reach net zero by 2045, with an 80% reduction target by 2039. The infographic shows the major emissions gasses that the NHS is directly responsible for ('NHS Carbon footprint') and 'NHS Carbon Footprint Plus' where the emissions are an indirect consequence of the NHS.

Challenges in effecting change

The scope of environmental impact assessments should extend the complete healthcare pathway. The main challenges are related to data unavailability when conducting a comprehensive LCA, where the lack of primary process data to construct Life Cycle Inventories is attached to barriers such as confidentiality, Intellectual Property Rights, and business competition which makes data sharing unlikely without an incentive and an objective, independent third party to perform the analysis. Moreover, the lack of harmonisation of Life Cycle Inventory Assessment methodologies with different goals and for different markets is an issue that requires resolution (De Soete et al., 2017). 

In broader terms, the high costs associated with environmental footprinting and implementing sustainability improvements pose significant challenges, especially under the prevailing budget constraints that affect both generic and innovative new medicines. These financial limitations significantly influence government and healthcare policies, often leading to cost-cutting measures that can affect the availability and approval of new treatments based on their cost-effectiveness rather than just clinical efficacy.

For medicines seeking marketing authorisation, the Environmental Risk Assessment (ERA) traditionally focuses on the API's end-of-life environmental impact. However, there is a growing push to also consider the carbon footprint and manufacturing practices, particularly those of non-EU suppliers, to promote greener pharmaceutical manufacturing. This includes efforts to influence EU policies to integrate considerations of environmental fate and manufacturing practices into the licensing process.