While reducing carbon emissions in health care is being addressed in many parts of the world, experts say there are broader environmental issues beyond greenhouse gas emissions. Today, sustainability in health care also includes pharmaceutical waste, antimicrobial resistance, fragile supply chains, and environmental contamination, which are reshaping the understanding of environmental responsibility in medicine.

The World Health Organization estimates that if health care were a country, it would be among the top five greenhouse gas emitters in the world due to its high energy use and extensive supply chains. Reducing emissions is not enough to address systemic problems that are putting planets and people at risk.

Another growing problem involves the issue of managing wastes from the pharmaceuticals, including old prescription drugs. In India, tons of antibiotics and other drugs end up in domestic garbage dumps or are disposed of in sewage systems, ending up in rivers and underground water sources. According to recent studies, more than 80% of people in some areas dispose of their drugs improperly, leading to environmental pollution. Most of these have been found to lead to AMR through the distribution of drug residues in the environment.

As the consequences of climate change intensify, it is also putting pressure on health care systems. Medical supply chains are impacted by extreme weather events, such as heatwaves, and disruptions to monsoons that occur outside of normal climatology, impacting both medical supplies as well as infrastructure built for normal meteorological conditions. The stakes are increased for India, which serves as a major hub for the manufacturing and distribution of generic pharmaceuticals, as any disruption in production or distribution can have repercussions on it being able to distribute medicines globally.

There is starting to be a response from policymakers. Drug regulatory authorities have recently introduced guidelines for the proper disposal of expired medicines, and initiatives such as Kerala’s medicine take-back programme are being viewed as potential models for wider adoption in India. There have been calls for more extensive efforts to treat sewage effluents and pharmaceutical pollution by bodies such as WHO and United Nations Environment Programme.

Sustainable health-care delivery requires considering the entire life cycle of medicines from production and use to disposal and integrating environmental responsibility into every stage of policy, distribution, and delivery.