It is widely recognised that the climate crisis is not only an environmental issue, but also a health crisis. Rising global temperatures, extreme weather events, pollution, and biodiversity loss are already affecting planetary health and impacting human wellbeing. What is less well known is that healthcare itself is a significant contributor to this crisis. Around the world, the delivery of healthcare produces greenhouse gas emissions, consumes vast amounts of energy and resources, and generates large volumes of waste through clinical and non-clinical activities. Medicines, their associated supply chains, and the potent volatile gas propellants found in some inhalers account for much of this footprint. Globally, if healthcare were a country, it would be the fifth largest polluter.

Human health depends on a thriving planet

In Ireland, pharmacy practice, like much of the healthcare sector, has not been prioritised in sustainability efforts, driven by the belief that environmental action might compromise patient care. When in reality, the opposite is true, as human health depends on a thriving planet, and improving the sustainability of care often goes hand in hand with improving patient outcomes. In our daily professional practice, there are ample opportunities to reduce the ecological footprint generated by wasted medicine. Every day we encounter unused medicines, representing not only financial waste but also potential environmental harm through inappropriate disposal, or appropriate disposal via incineration. Wasted medicines represent missed opportunities to deliver optimised care. Targeted changes in practice can also achieve both environmental and clinical gains. For instance, targeting overuse of salbutamol propellant inhalers and optimising respiratory care, not only improves patient health but also reduces emissions of potent greenhouse gases thousands of times more potent than carbon dioxide, delivering a tangible win for both planetary and patient health.

As pharmacists, we are trusted voices in our communities. We know our patients, we understand their needs, and we are often the first point of contact for health advice. This puts us in a unique position to lead on environmental sustainability in our communities. Small actions, multiplied across our profession, can have a big impact. Optimising medicines to avoid unnecessary waste, guiding patients towards low-carbon inhaler options when appropriate, or improving how we segregate and manage waste are all steps that can benefit both our patients and the planet. This is about delivering the best possible care, while protecting the world in which that care takes place.

Pharmacists are delivering high-quality care under intense pressure. Medicines shortages, administrative burdens, and ever-increasing demands from patients and regulators are part of our daily reality. We work within a health service that can feel fragmented, where policies are made without considering the practicalities of implementation. We adapt, we problem-solve, and we keep delivering for our patients. But when it comes to environmental sustainability, individual goodwill is not enough. That is why we need to make sustainability both practicable and implementable by giving pharmacists the tools and system support they need, to make positive differences.

RCSI research

At RCSI, I am undertaking research dedicated to embedding environmental sustainability into healthcare, with a focus on community pharmacy. My background as a community pharmacist gives me an understanding of the pressures, the pace, and the realities of working in a busy dispensary. Our work is about listening to pharmacists across Ireland, identifying the barriers and enablers to change, and developing practical, tested tools that work in the real world. This is not about adding more to your workload, but instead it is about finding solutions that fit into your workflows to make your practice more sustainable and impactful.

If sustainability in pharmacy is to become a reality, it must be embedded into the fabric of our daily practice, not treated as an optional extra or an afterthought. This means leadership at every level from national policymakers setting ambitious and achievable targets, to professional bodies providing clear guidance and support, to local champions driving change in individual pharmacies. It requires professional recognition that elevates sustainability to a core responsibility of our role, signalling that it is integral to high-quality care rather than a peripheral concern. And it demands contractual arrangements that reward and incentivise quality sustainable care, rather than focusing solely on dispensing volume, so that environmental stewardship is built into how our services are funded and measured. Ultimately, this is about improving the health of the people we serve today, safeguarding the health of those communities already experiencing the harshest impacts of climate change, and preserving the planet for future generations. Our research to date has revealed that the desire and ambition is already there; what we need now is the collective will, the structural support, and the decisive action to bring about lasting and transformative change.

If you are interested in environmentally sustainable practice in community pharmacy or would like to discuss ways in which to contribute to research focused on environmentally sustainable pharmacy practice contact stephenjwalsh@rcsi.ie.

Stephen James Walsh MPSI is a community pharmacist whose experience in both support and supervising roles, combined with advanced qualifications in Health Policy and Management, has led him to undertake a PhD in environmentally sustainable pharmacy practice, applying his insight and expertise to drive meaningful improvements in the profession.