A Glasgow research team are looking to reduce pharmaceutical pollution and waste through ‘blue-green prescriptions’ in Scotland and to NHS Scotland’s wider net zero ambitions. Lead researcher Julze Alejandre shares their work to build a national blue-green prescribing model and calls for contributions from across the healthcare sector to provide a variety of perspectives.

Glasgow Caledonian University (GCU) PhD researcher and Scottish government Hydro Nation scholar, Mr Alejandre is leading the development of Scotland’s first ever ‘blue-green prescribing’ programme for mental healthcare.

The work focuses on building a sustainable approach to reducing pharmaceutical pollution through prescribing environmentally friendly medicines and integrating nature-based social prescribing like ‘blue prescriptions’ – utilising blue spaces to support good health.

Following the launch of the Climate Emergency and Sustainability Strategy for NHS Scotland last year, the Royal Pharmaceutical Society (RPS) Scotland welcomed the report, calling for longer-term developments that include climate change as part of a realistic medicines approach.

Now, Mr Alejandre explains that while vital to delivering good healthcare, medicines waste or overuse can contribute to global warming and wider public health crises:

“Medicines are widely used in healthcare and an important element of healthcare service delivery. But its use has negative effects on the climate and the environment. It also contributes to antimicrobial resistance which is one of the major global health problems of the 21st century.

“Blue-green prescribing is a response to pharmaceutical pollution. It will help reduce pharmaceutical pollution at source by providing people with environmentally sustainable health interventions.”

GCU’s Water Research Group previously led the first study looking into the scale of pharmaceutical pollution in Scotland – recommending action to reduce the environmental risk for nine medicines entering water streams. These included antimicrobials, birth control pills, medicines for heart problems and type 2 diabetes, and antacids and antimicrobials.

The research suggests that these medicines in Scottish water environments had a negative impact on not just the environment but may also contribute to antimicrobial resistance.

One example of greener prescribing in Scotland is the updated guidance for inhalers in 2022 promoting person-centred care and advising that – where appropriate – more environmentally friendly inhalers are adopted.

Similarly, this blue-green prescribing model considers person-centred care, looking to all aspects of health and wellbeing and placing the patient’s needs first. This means if a medicine is the most appropriate and best-suited treatment for a given person’s circumstances, that would not be changed.

Mr Alejandre has been researching the relationship between nature and human health for six years and contributed to policy recommendations on implementing environmentally sustainability pharmaceutical practices in Scotland.

These policy recommendations included supporting healthcare providers to practice blue-green prescribing, priorities echoed by RPS Scotland. The national body representing pharmacists called for more shared decision-making with patients and a switch to prescribing guidance that includes environmental impact.

Julze explained that blue-green prescribing may be particularly suitable for some people needing mental health support:

“With blue-green prescribing, people who have common mental health conditions such as anxiety or depression could be prescribed with and have opportunities to access community-based blue space activities such as kayaking, swimming, or even surfing through social prescribing programmes.

“If needed, they could also be prescribed with medications or antidepressants that are less environmentally harmful but are still clinically safe and effective.”

Climate Change Professor Stephen Peake told healthandcare.scot that community infrastructure including esplanades near the sea or rivers can support active travel for physical health – like green spaces – and improve mental wellbeing.

Having worked as a researcher, senior parliamentary intern for One Health and Planetary Health in Westminster, Mr Alejandre adds that his experience in blue space activities also improved his own mental health.

NHS Lothian’s first ever Environmental Sustainability Fellow, Dr Golden, says that NHS Scotland has an opportunity and responsibility to lead on net zero and it is important that individuals do not feel isolated in tackling climate change.

Reflecting on the global conference bringing world-leaders together to commit to taking action on climate change, Mr Alejandre said the role of healthcare in tackling global warming must be advanced.

He added that the need for environmentally sustainable healthcare will contribute to good health in Scotland and across the world:

“Glasgow hosted the monumental COP26 where over 50 countries pledged to make their healthcare system climate-resilient and environmentally sustainable, including the UK. This year, as we celebrate the 75th World Health Day with theme Health for All, we are again reminded of this COP26 commitment that providing universal access to healthcare means providing quality and environmentally sustainable healthcare interventions that protect human and planetary health.

“Blue-green prescribing is a health innovation that feeds into this agenda by helping transform our healthcare system to a more sustainable one. However, its implementation in Scotland requires changes in the prescribing practices of healthcare providers.”

The GCU team are inviting healthcare workers to help shape this blue-green prescribing model, by sharing what works for them and their patients in a survey looking to capture the perspectives of GPs, community link workers, nurses, healthcare assistants, pharmacists and technicians.

As part of the Scottish government’s blue-green prescribing research, supported by the One Health Breakthrough Partnership, the Blue-Green Prescribing Survey will run until the 30^th of April 2023

Read more: Working together for climate action and good health; Disposable gloves to protect patients and the planet; Realistic medicine to help the climate; A question of action

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