Pharmaceutical pollution from health care : 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, Lara and Wilson, Edward C F and Wade, Matthew J and Tyler-Batt, Wendy and Taylor, Matthew and Sowman, Georgina and Southall, Paul and Smith, Richard and Routledge, Carol and Redshaw, John and Pitchforth, Emma and Pegg, Melissa and Moore, Keith and Kirkham, George and Kasprzyk-Hordern, Barbara and Helwig, Karin and Gibb, Stuart and Fleming, Lora E and Comber, Sean and Collins, Rob and Brown, Heather and Brophy, Sinead and Brazier, Richard E and Blitzer, Hannah and Barnett, Julie and Arendt, Rosalie and Alejandre, Julius Cesar and Tyler, Charles R (2026) Pharmaceutical pollution from health care : a systems-based strategy for mitigating risks to public and environmental health. The Lancet. Planetary health, 10 (1): 101404. ISSN 2542-5196

Abstract

Human pharmaceuticals are increasingly 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. In this Personal View, we propose a multistakeholder, systems-based approach for high-income countries to develop transformational national mitigation strategies. Applying this approach to a UK case study highlighted the growing risks caused by the unsustainability of the current UK health-care 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 in minimising the public and environmental health risks associated with pharmaceutical pollution, by driving long-term sustainability across the pharmaceutical lifecycle, for a positive pharmaceutical future. [Abstract copyright: Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.]