Healthcare relies on a vast industrial system that consumes large amounts of energy and materials and generates substantial amounts of greenhouse gas emissions. This reality, often overlooked in discussions of care quality and access, framed the opening message delivered by Marie-Céline Jamoye, a strategic adviser to the medical council and sustainable development coordinator at CHC MontLégia in Liège, Belgium.

Globally, the climate impact of healthcare rivals that of major industrial sectors. “At the global level, the healthcare sector weighs twice as much as aviation in terms of greenhouse gas emissions,” Jamoye said. Overall, healthcare is estimated to account for approximately 5%-8% of the total global greenhouse gas emissions.

Jamoye emphasized that the central challenge is reducing the carbon footprint of healthcare while maintaining high standards of quality and access. “The more we increase the quality and accessibility of care, the more energy we consume,” she said. Belgium illustrates this challenge: Despite high standards of care, similar health outcomes are achieved in other countries with lower energy consumption, and demographic trends are expected to further intensify pressure on the system. “This impact is expected to increase because of population aging, with an increase in medication needs, a rise in chronic diseases, and the development of new treatments that are extremely energy intensive.”

François-Xavier Sibille, MD, geriatric medicine specialist from the Department of Geriatric Medicine at CHU UCL Namur in Yvoir, Belgium, highlighted that climate change is already affecting population health. “It already has direct effects, notably in terms of food insecurity, mental health, cardiovascular and respiratory diseases, trauma, and infectious diseases,” he stated.

This creates a dual responsibility for the healthcare system. They contribute to greenhouse gas emissions and bear the clinical burden of climate-related diseases.

Medicines Drive Emissions

Within the healthcare sector, the pharmaceutical sector is the most energy intensive. Jamoye cited French data to illustrate the scale of pharmaceutical production. The manufacturing of 3 billion boxes of medicines involves approximately 32,000 tons of active pharmaceutical ingredients, 187,000 tons of excipients, and 121,000 tons of packaging.

Transportation further adds to this environmental burden. Approximately 9% of pharmaceutical sector-related emissions are attributed to transport, with air freight accounting for approximately 40% of that share.

Sibille described this as a double constraint. “Healthcare is a producer and emitter of greenhouse gases. Therefore, it must also contribute to efforts to mitigate environmental change. And on the other hand, it will also face risks of supply chain disruption.” He emphasized the importance of what he termed a “chosen transition” rather than a reactive transition.

Prescribing More Thoughtfully

Reducing emissions begins with the decision to prescribe. “The easiest solution is not to use medicines when they are not necessary,” Sibille said, highlighting the issue of overprescription.

Antibiotics remain a key concern in Belgium and worldwide. Other commonly used drugs require reassessment. “The use of antiplatelet therapy — aspirin in primary prevention, especially in older patients — is known not to have positive effects and even carries risk for bleeding,” Sibille said.

Nonpharmacologic approaches play an important role. These include preventive strategies, dietary interventions, and physical activity. From an environmental perspective, the least-polluting medicine is the one that is not consumed.

Simultaneously, underprescription can also cause harm. Inadequate treatment may lead to complications that ultimately require additional medications. Adverse effects contribute to this risk. “Patients are increasingly older, taking multiple medications, with multiple health conditions, and therefore, they will have all these interactions, with the risk of developing prescribing cascades,” Sibille said. These cascades occur when one drug is prescribed to treat the side effects of another drug without identifying the original cause.

Therefore, shared decision-making is essential in this context. Dialogue with patients can lead to deprescribing, which is defined as the reduction or discontinuation of treatment under the supervision of a healthcare professional. “It is really the mantra less is more. We give less but for better results,” Sibille said.

Toward Eco-Prescribing

The goal is to improve prescriptions for both patient outcomes and environmental impacts. The concept of eco-prescription is applicable here.

“It is about rational use of medicines and ensuring appropriate use of medicines,” said Géraldine Paulus, a clinical pharmacist specializing in oncology at CHC MontLégia. “It is also about prescribing less, always considering the benefit-risk balance of the prescription. And it is about limiting the carbon impact of prescriptions, particularly by reducing environmental contamination due to medicines.”

Sibille summarized the challenge and said, “The current use of medicines is not desirable, neither for patients, nor for our societies, nor for the environment.” He defined appropriate prescribing as “a prescription that treats effectively, but also safely, while controlling economic and environmental costs and respecting patient preferences.”

This story was translated from MediQuality, part of the Medscape Professional Network.