Pharmaceutical pollution from healthcare : a systems-based strategy for mitigating risks to public and environmental health

Thornber, Kelly and Bentham, Matthew and Pfleger, Sharon and Kirchhelle, Claas and Adshead, Fiona and Owen, Stewart and Holmes, Hayden and Brown, A Ross and Farmer, Caroline and Eii, Min Na and Niemi, Lydia and Wöhler, Laura and Wilson, Edward CF and Wade, Matthew J and Tyler-Batt, Wendy and Taylor, Matthew and Sowman, Georgia and Southall, Paul and Smith, Richard and Routledge, Carol and Redshaw, John and Pitchforth, Emma and Peg, Melissa and Moore, Keith and Kirkham, George and Kasprzyk-Hordern, Barbara and Helwig, Keith and Gibb, Stewart and Fleming, Lora E and Comber, Sean and Collins, Rob and Brown, Heather and Brophy, Sinead and Brazier, Richard and Blitzer, Hannah and Barnett, Julie and Arendt, Rosalie and Alejandre, Julius Cesar and Tyler, Charles (2025) Pharmaceutical pollution from healthcare : a systems-based strategy for mitigating risks to public and environmental health. The Lancet. Planetary health. ISSN 2542-5196 (In Press)

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Abstract

Summary Human pharmaceuticals are increasingly being detected in environments around the world, with growing international calls to mitigate the ecological and human health risks posed by these novel entities. Exposure to pharmaceutical pollutants can negatively affect the behaviour, reproduction and health of wildlife, contributing towards declining ecological health and global biodiversity loss. Pharmaceuticals in the environment are also driving rising levels of antimicrobial resistance, a major public health threat. Developing strategies to mitigate these public and environmental health risks has been greatly limited by diverse and often conflicting stakeholder interests and the need to retain the major human health and socioeconomic benefits that pharmaceuticals provide. Here, we propose a multi-stakeholder, systems- based approach for high-income countries to develop transformational national mitigation strategies. Applying this to a UK case study highlighted the growing risks caused by the unsustainability of the current UK healthcare pharmaceutical system and enabled us to identify 37 synergistic intervention points that target both the tangible “easy wins” and the deep-rooted social drivers of the issue. We believe our approach will support high-income countries to minimise the public and environmental health risks associated with pharmaceutical pollution by driving long-term sustainability across the pharmaceutical life cycle, for a positive pharmaceutical future.