Sustainable healthcare is not as clear-cut as it seems

Sustainable healthcare is thought of as the provision of future approaches to health, care and wellbeing in an increasingly environmentally and financially sustainable manner, and one which also makes intelligent use of our abundant social and human resources.

Proponents of the sustainable healthcare approach point out that in our current place in time, and for the future – our future, the future of the generations after us, and the for earth’s future itself – we need to ensure that the healthcare institutions need to make minimal impact on the environment, so that there is an environment for future generations, and not one that has been plundered of its resources.

The thinking behind the sustainable healthcare approach is that in operating with a minimal-impact focus, there is an added benefit in doing so, because operating costs can supposedly be minimised as well. There is a perceived amount of overlap in these two areas, and avoiding unnecessary environmental harm while reducing waste can also save money. One quoted instance of this is how the use of ultra-low energy lighting in hospitals requires less power demands, which means an efficient distribution of electricity at the power plants, and ultimately this all can be traced all the way back to making less environmental impact whilst saving on electrical costs.

But how much of this interest in sustainability is genuine, and how much of this is merely a governmental facade to mask or sidestep the issue of reduced health budgets?

Yes, ultra-low energy lighting can minimise running and environmental costs, but is the manufacturing process of the lighting itself sustainable? And will the ultra-low energy lighting pay for itself over its lifespan?

Let’s consider this example. Suppose it costs £20,000 to replace the outdated lighting systems in a hospital with the new flash lighting. Throw in an added £5,000 for labour costs. Assume the new lighting lasts 20 years before it needs to be replaced. Will the £25,000 costs be significantly made up over the twenty years to warrant its installation in the first place?

Whether or not it is possible to do so, it is arguable that even if it isn’t, it is more PR-friendly for organisations to be viewed in the public eye as sustainable, and they will rush to choose measures which may be seen to be sustainable, rather than carefully evaluate their options. This only opens things up to abuse as suppliers will merely jump on the bandwagon and market products under the guise of being sustainable.

Take for example, the case with Salford City Council. Years ago, when the trend for recycling was at its peak, the council unceremoniously dumped five wheelie bins in every household without consultation. The move was supposedly to encourage recycling. But what resulted was a stealthy method to cut the frequency of bin collections from once every week to fortnightly, as well as cut the number of waste collection workers by forcing residents to sort out the recycling. But where did the money for four extra bins per household come from, apart from through higher council tax charges, and did the extra financial cost, as well as the added time of a rubbish truck emptying five bins instead of one, thereby causing road congestion, save costs in the long run? Probably not. In the rush to be seen as being eco-friendly, it is ironic that it cost more to be viewed as so, rather than to not be eco-friendly at all. The extra cost went into buying a perception. We must not make the same mistake with sustainability.

Proponents of sustainability in healthcare suggest that health is also won or lost outside formal health and social care settings. The hospitals and other care organisations do not govern the lives of individuals. Individuals themselves can empower themselves to live better lives, by making better choices so as to require less medical care and ultimately make less demands on the healthcare system and the environment. Sustainable healthcare, they say, means a thorough examination of how we are living – how we eat better, how we move our own bodies more, how we develop new ways of protecting and improving health. It is about empowering the individual to lead a pro-active lifestyle.

Another idea put forth is that the quality of resilience needs to be imbibed in people, families and communities, especially when you consider the increasingly frequent extreme weather. Is this a subtle way of saying “in times of harsh weather conditions – like extreme cold or heat, instead of getting in touch with your GP, just tough it out?”

It is suggested that what is needed is a collective effort in supporting and growing effective networks within communities so that the health system works to provide support and services alongside people rather than just to people. How does this help the system to be sustainable? The claim is that pre-existing logistical setups are already in place and aid can be delivered swiftly to recipients – the cost of setting up a delivery system is negated by using one that is already in existence.

The proposed sustainable health strategy is based on three principles, and launched jointly by leaders from the NHS, the social care system, local government, and Public Health England.

Firstly, a healthy society depends on a healthy environment: clean air to breath, green spaces for children to play in, safe places to walk and cycle, and a radical reduction in our greenhouse gas emissions.

Secondly, the health and care system is increasingly aware of the benefit of helping to develop resilient communities: resilience that is fundamental to health and wellbeing, both in times of relative stability, and in times of crisis.

Thirdly, the health and care system can take every opportunity to work with people to prevent the preventable and manage the manageable. This means helping us all improve our understanding and control over our own health, illnesses and opportunities and to take pro-active steps over our health, within our homes and communities. The traditional model that exists at this time is of citizens being well, then falling ill, before being treated and getting better is increasingly outdated. This, in essence, is passing on the responsibility for our own health to the state. We need to make increasingly wiser choices over our health and manage ourselves with the support and guidance of the health and care system using improved information, integration, collaboration and technology.

However, this third principle requires a cultural shift for public, patients and particularly professionals. We have business models that are built on the foundations of people getting ill. We pay insurance premiums, private medical treatments, and existing business models rely on poor health to function rather than improved health. What would happen to hospitals and staff if people lived better? We would have a surplus and would have to close them down. Cynics could be forgiven in thinking that sustainability is the guise under which the NHS meets budgets through cuts. The existing models we have depend on certain numbers of people being ill in order to function. But in the light of diminished financial resources, this rethink may come sooner and seen more positively. We may need more diverse business models for providers of care. We could reward care providers for the amount they reduce death rates or health inequalities or survival times or for simply improving the experiences of patients. But will this only complicate matters by only shifting traditional costs elsewhere?

Those who hold responsibility in commissioning healthcare are increasingly choosing to focus on outcomes as the marker for remuneration. There are many examples already in existence in our society already, where care is less focussed on a hospital setting and more in the community. This can be through more programmes which are community based ones. Or it is suggested we could rely on interventions in partnership with the voluntary sector, or – through the use of technological opportunities – even care in the home. And the societal focus of rewarding providers of care for outcomes rather than just activity might uncover methods that are more creative, cost effective, and appropriate ways of keeping people informed, independent, and healthy. It is a way of allocating resources to encourage positive needs. Cynics may suggest that this is a subtle way of shifting government responsibilities lower down to the community, in light of budget cuts, but it remains to be seen whether individuals in need get help more sooner within their community, and the redistribution of care resources down the chain to the community, which is already in place, rather than wait for government initiatives to filter through after legislation and debate, means that a community-based system is more responsive and more agile.

Devolving responsibility and dividing care provision requires overall coordination to ensure facets run smoothly. If what was amalgated under a traditional NHS is now devolved to various third parties, who will be in charge of overall co-ordination? Will the cost of overall co-ordination actually prove to be more expensive in the process? In the latter case, probably not – but why? Because the responsibility for co-ordination will probably fall to a computer system, and any failings of this system will be explained away by traditional excuses we ascribe to technology; and without having a person to blame anyway, we will have to grin and bear it. Be resilient.

This move towards reaching a sustainable health service is partly technological, but other factors such as the economic, social and cultural also come into play. It will only be achievable through various shared values – honesty, partnership, social involvement. Business models and technology widely used outside in other facets of society have to be used creatively in order to deliver a safer, fairer future. One of the challenges is that sustainability and commerce do not easily mix, and the transition must be carefully managed. Sustainable models are efficient and usually low-cost, and as a form of revenue and unemployment do not offer as much as commerce-based models. And as organisations such as the health service move towards a lean, agile and efficient mode of service, unfortunately it is a likelihood that such sustainable models mean that individuals employed in traditional sectors may require re-training to find continual employment.

This strategy for the future has been shaped and supported by partners across the system, not just by a single organisation. This is vital because, although we know much about what needs to be done, we really are not yet certain how to do it together, ensuring our collective efforts add more value than the sum of our individual approaches. Society as a whole needs to move forward together, inching our way collectively so that we can all adapt to the various stages of the transition. Binding all of these approaches into a sustainable approach focusses us on the truth that a liveable community for our children is more important than a growing economy.

The health and care system should not entertain the thought that it is separate from the challenges (and opportunities) that are presented by a rapidly changing world. A future-focused health and care system is the most obvious representation of a collective effort for the common good. But the scale and pace of this move is needs to be realistic and functional, and it extends beyond specific health areas alone. Moving towards a sustainable health model is not just about making the NHS more efficient and environmentally-friendly. It is about creating a sustainable world for future generations through its constituents, and fostering shared capabilities so not only is the sense of community and a shared world an attainable vision, but working demands are shared to minimise wastage and tax on the environment. The NHS is one such constituent to institute this change in thinking and move it forward.

Healthcare is a fine example of a sector to set clear examples of our collective responsibility to the future. In the current financial climate of constraint there is opportunity for this evolution of healthcare to go forward. What is being proposed is good for the purse, good for our families, and good for the future. Ultimately this reduces the cost of state healthcare, empowers individuals to take charge of their own, and whatever resources are available are delivered to those who need it in an efficient way.

What does all this mean for the NHS? Among other things, it means the health service must:

1) Operate sustainably, minimising its impact of the environment. This means the physical infrastructure of the NHS has to be sourced from means that are as environmentally-friendly as possible.

2) Continue to source its needs from sustainably-beneficial agencies. An example of this is that if the NHS has two pharmaceutical companies offering the same drug at similar prices, it engages the one with more environmentally-friendly policies. This is to promote the use of sustainable measures to its partners.

3) Impart knowledge through the use of community-based programmes to encourage personal responsibility for health. The NHS can support local programmes, for example by setting up stalls in school fairs to promote health advice or encourage people to do health testing, among other things, so that tests that are routinely conducted at hospitals or GPs are done elsewhere, resulting in time savings, and also encouraging individuals to maintain responsibly from their health by having constant local reminders within the community framework.

4) Conduct constant research in order to find better medicines – “better” not necessarily in the sense that the cost is lower, but better in the sense that they can be constructed from more natural sources, and hence require less demands on the environment during production. In this, the NHS may have to turn to various alternative therapies such as homeopathy, Chinese medicine, or preventative therapies such as the Alexander Technique.

5) The NHS also has to collaborate with partner agencies that can provide long-term non-medication solutions. For example, research on mental health has suggested that while medication for serious health issues has benefit, milder forms of mental health are equally well-addressed with cognitive therapy rather than medication, and cognitive therapy also has more lasting impact and a lower chance of relapse than medication. In the long run it is not conceivable that a sustainable health service would cultivate a society that is less dependent on medication as a quick-fix remedy, but one that encourages its citizens to closely reflect on how they are living their lives in order to live free of medication as far as possible.

The challenge in implementing all this, as we have previously mentioned, is that as organisations and processes become more streamlined, cost-effective and environmentally-friendly, economies which depend on growth – essentially, ALL of them – and government which raise finance from taxation – again, ALL of them – start to suffer. Sustainable organisations employ less people. And the more sustainable an organisation becomes, the less people it employs. Even the large organisations that focus on saving the environment have a majority of their workforce consisting of volunteers. This means a huge chunk of the government budget attained from working tax is lost, and a equally worrying time-bomb is large numbers of unemployed with no financial means of securing a living property.

Taxes on working profits will fall, because the silent partner is sustainable schemes is low cost. Would you pay more for the same product or service, if the product carries a promise to invest sustainably? Would you pay more for Fairtrade products? Most, apart from those with more disposable income, would probably go cheaper, given that society will have to live with financial constraints for years to come. The tax on a lower-cost product is less than that on a higher-cost product, which means the government has less revenue.

We arrive at a situation where the government has less funds to distribute, organisations that have less funding but have to find ever more ingenious ways to use or grow that forever-dwindling income. At the same time we have a situation where the numbers of jobless will continue to grow, many will remain on low-wage jobs, while property continues to spiral out of reach. It is not an economically-sustaining situation. It begs the question – are we only pushing the demands on the environment that we made, while we were focussed on growth, back to the economy again?

A sustainable health service, and living sustainably, is essentially a dismantling of the economy that we have come to build.

The future is uncertain. It is scary and will require careful negotiation. We’re sure we need to live sustainably and make less demands on the environment, but we haven’t quite worked out fully how to transition there, nor what we will do when we really get there.

What antibiotics in agriculture are really about

There is widespread concern over the use of antibiotics in the agricultural world and what is wider bearings are. The general consensus is that the use of antibiotics in agriculture needs to be minimised dramatically by farmers, as there are fears that drug-resistant bacteria could pass up the food chain through consumption and environmental contamination.

The concerns take on many forms. Firstly, just as humans can develop resistance to medicines after prolonged use, there is the concern that long-term antibiotic use in agricultural settings may create antibiotic resistance in the animals and crops which receive these antibiotics. Secondly, even if these crops and animals themselves do not develop resistance to antibodies themselves, the prolonged consumption of the vegetables or meat from these farm animals could breed resistance in humans who consume them. There may also be other side effects we are as yet unaware of.

Antimicrobial drugs, which include antibiotics, antifungal and antiparasitical drugs, are commonly used in farming. They are used to prevent damage to crops, kill parasites, as well as keep livestock healthy. The long term aim of antimicrobial drugs in the context of farming is to maximise crop production and livestock farming. A field of crops lost to infestation is months of work for nothing. A farmer with a field of cows suffering from disease has lost not just capital but production possibilities as well. As with the case of mad-cow disease in the 1990s, farmers who had their cows put down not only lost the money they had invested in buying and breeding these cows, but also on the sale of milk and beef.

And in many cases, the losses from a brief period of crop infestation or animal disease could significantly affect a farmer’s income, or make such a dent in their livelihood that it either forces them to take on additional debt to cover the losses, or be so insurmountable that it forces them out of business.

There might be those that argue against the use of antibiotics but the truth is that they are necessary. They are one form of insurance for a sector that has to combat various problems, including the uncertainties of weather. When, for example, your crops – your livelihood – are subject to the whims of weather, infestation, and perhaps human vandalism and theft, you have to take steps to minimise risks on all fronts. You cannot simply just leave things to chance and hope for divine favour or faith – that would merely be masking a lack of responsibility.

Pests and viruses do not restrict their infestation to selected fields. Left unchecked, they would merely spread from unprotected fields and livestock, and then infect further unprotected areas. Antibiotics are medical city walls that keep away marauding invaders, and prevent them from invading territories and conscripting the local population into their armies to do further damage.

Resistance to the antibiotics, antifungal and antiparasitical drugs used in agriculture is collectively known as antimicrobial resistance (AMR).

An independent body chaired by the British economist Jim O’Neill looked specifically at antibiotic use in the environment and agriculture. Among other things, this body examined the ways in which regulation and financial measures such as taxation and subsidies could play in reducing the risks associated with the agricultural use of antimicrobials and environmental contamination.

The data from the report suggests the amount of antimicrobials used in food production internationally is at least the same as that in humans, and in some places is higher. For example, in the US more than 70% of antibiotics that are medically important for humans are used in animals.

What does that all mean? It means that drugs normally for humans are already used in animals. If human beings consume the meat of the animals over prolonged periods, their bodies can develop tolerance to the antibiotics because they were used in the animals. If human beings later have a need for these antibodies, in the medicines for humans, these forms of medication will have little or no effect. And as we have seen before, ineffective long term medication may only create addiction to drugs and pain relief medication.

The report included peer-reviewed research articles in which 72% of the 139 articles found evidence of a link between antibiotic consumption in animals and resistance in humans. There is enough impetus for policy makers to argue for a global reduction of antibiotics in food production to a more appropriate level.

But while the evidence suggests that we should reduce the usage of these antibiotics, antimicrobial usage is unfortunately likely to rise because of the economic growth and for increasing wealth and food consumption in the emerging world.

A considerable amount of antibiotics are used in healthy animals to prevent infection or speed up their growth. This is particularly the case in intensive farming, where animals are kept in confined conditions. An infection in these confined spaces could easily spread between organisms. Further to this, some animals receive antibiotics so that natural limiters to size are killed off in order that their growth is accelerated. If you sell meat by weight, it makes sense that you try to produce as big as animal as you can so that you can maximise your profits.

The report mainly highlighted three main risks that had connections with the high levels of antimicrobial use in food production. There was the concern that drug-resistant strains could be transmitted through direct contact between humans, particularly in the case of farmers, and animals on their farm. Secondly, the transmission of the drug-resistant strains could also result due to the contact during the preparation of the meat, or the consumption of it. Thirdly, the excrement of the animals might contain the drug-resistant strains and the antimicrobials and therefore pass into the environment.

There was also concern raised about the possibility of contaminating the natural environment. For example, if factories that manufacture these antimicrobials do not dispose of by-products properly, these may pollute the natural environment such as water sources. Already we have seen that fish near waste-treatment plants, which treated urine tinged with chemicals from birth control pills, developed abnormal characteristics and behaviour.

The review made three key recommendations for global action to reduce the risks described. The first was that there should be a global target for the minimisation of antibiotic use in food production to a recognised and acceptable level in livestock and fish. There were also recommendations that restrictions be placed on the use of antibiotics in the animals that are heavily consumed by humans.

Currently there are no guidelines surrounding the disposal of antimicrobial manufacturing waste into the environment and the report urged the quick establishment of these in order that pollution of the environment could be minimised and the disposal of by-products and active ingredients be regulated.

The report also urged for more monitoring on these problematic areas in concordance with agreed global targets, because legislation without means of enforcement is useless.

Is it possible that the production of antimicrobials can be limited? One cannot help but be cynical. As long as we inhabit a world where sales drive rewards, it is inconceivable that farmers would slow down their production on their own initiative. We would definitely need legislation and some form of method to ensure compliance.

But what form of legislation should we have? Should we focus on imposing penalties for non-compliance or incentives to encourage the reduced use of antimicrobials?

Some may argue that the latter is more effective in this case. If farmers are offered financial subsidies so that they receive more money for the price of meat, for example, they would be more inclined to reduce the usage of antimicrobials. But how would these be monitored? Could the meat for sale could be tested to ensure the density of antimicrobials falls under established guidelines, for example, so that if the farrmer has been relying on the use of antibiotics to increase the size of livestock, he is latterly being recompensed for the reduction in size arising from the reduction of the antibiotics?

Unfortunately the difficulty is in reconciling both the need as well as the established economic system for growth in one hand, with the sustainability factor in the other. How is farm produce sold? When you buy a bag of salad, a cut of meat, or a bottle of milk, all this is sold by weight or volume. You may buy eggs in carton of six, but they are also graded by size and weight. For the direct manufacturer – the farmer – size, volume and growth are what bring about greater profits – although these profits may barely be just above the threshold for subsistence. And after making allowances for damage due to weather, theft, low market demand and all other variables that threaten an already low-profit industry, asking a farmer to reduce the use of antimicrobials is akin to asking him not to take measures to protect his livelihood. If the use of antimicrobials bothers you, then you have to compensate the farmer not to use them, by being willing to pay higher prices for farm products.

Why do organic or free range eggs cost twice the price for half the size? Aha!

While antimicrobials are also used on free range produce, and the case of organic farming is not entirely relevant here, the same issue is being highlighted here. You are paying more for the process than the product, and in doing so the extra payment that you make is towards the farmers for farming practices you are seeking to promote.

A farmer can get more produce by rearing battery hens, but if you are concerned over animal welfare, you pay extra per animal for the farmer to rear it with more space and hence more welfare for the animal. Your free range chicken costs more not because it is bigger, or necessarily healthier, but because it has been afforded more space, which you consider to be ethical. Farmers may switch to organic farming if there is enough demand for this, and for some this may even be more favourable, because having to produce fewer hens, but fetching the same price as battery hens, may, in the grand scheme of things, be seen by the farmer as a more favourable solution.

In trying to promote less use of antimicrobials, we have to make up the farmer’s perceived loss of earnings. So it is not incorrect to say that if we are concerned about the use of antimicrobials in agriculture, we have to pay more for our farm produce. Are you prepared to do that? For families with high disposable income, the increase may only represent a small additional fraction. But for families on smaller incomes, the increase may be too steep to be feasible. In other words, while the need for a reduction in agricultural antibiotics is recognised, in practical terms it may only remain an aspirational ideal except to those who can afford it.

Can be people be convinced – even if the cost is high – that in the long term it is better for human health? If the continued use of antimicrobials means that human medication in the future may become less effective as our resistance is tempered, should we, despite our reservations about the cost – make the leap towards maintaining a sustainable future? And if low-income families cannot afford to pay more in the cost of their weekly shop to get less, ridiculous as it might sound – should higher income earners step in to fill the shortfall?

It is strange how the wider discussion about the use of antimicrobials in society leads to a discussion about income distribution and political sensitivities.

What has arisen in the course of that evaluation, however, is the fact that expecting citizens alone to fully contribute towards the production shortfall arising from a reduced use of antimicrobials by paying more for their farm produce is not going to work. While some can afford to, many cannot, and those that can may not necessarily want to pay for those that cannot. There are also other measures to reduce the use of anti-microbials.

Governments could also introduce legislation to prevent environmental contamination through antimicrobial products and by-products, and harsh penalties for doing so. At the moment there are no rules in place, it is of increasing concern that such legislation is developed quickly.

Governments could also offer tax subsidies and support for farmers who continue to reduce antimicrobials usage. These could be introduced at the end of the first year, when farmers need most support at the initial stages of conversion, then at thirty months, and at further longer-spaced periods. Subsidies or incentives could an arithmetic progression at the end of one year, two-and-a-half years, four-and-a-half years, seven years and so on, so there is continued incentive to maintain reduced antimicrobial usage.

The only problem is, where would the money for these subsidies come from? If the government receives less tax from farm produce transactions because less has been sold, and it has also received less from antimicrobial companies in the form of tax, because it has made them limit their production, where will it make up the shortfall? Through an environment tax on its citizens?

Therein lies the problem.

The conundrum is this: the threat of antibiotic resistance in the future means we have to lower the level of antimicrobials we currently use. Yet if we do so, we are looking at reduced economic output. And as long as we have an economic system that is reliant on growth and increased production, asking to slow down production is economic suicide.

You may ask: “What about if we have a re-evaluation of an economic system, and create one that is based on sustainability?”

I am sorry to say it but that is wishful, idealistic thinking.

The problem with switching to a sustainable-based economy can be described as such.

Imagine there is a children’s party. At this party there is a table with a gigantic bowl of sweets. The children who are first to arrive eagerly stuff their faces and pockets with sweets, and as the party progresses, the bowl gradually looks emptier and emptier. The parents present chastise their kids if they continue to head for the sweet bowl, remonstrating with them to leave some for the kids who have not yet arrived from the party. Some of these children, perhaps the older ones, might reduce their trips to the bowl and the number of sweets they take. But some children will continue to plunder the bowl of its sweets before it all runs out and stuff their faces, recognising the sweets are a dwindling resource and if they want to eat them they’d best take as many as they can. And a third group, while recognising the sweets will soon run out, are equally keen to get hold of as many as they can, not to eat the sweets, but because they realise that when one of the latecomers arrives and find there are no sweets left, their parents may offer them incentives to trade to appease the desperate child. “Charlie didn’t get many sweets because he was late. If you let Charlie have two of the sweets you already have, I’ll buy you an ice-cream later.” This third group recognises not just the impending scarcity, but contribute to it by stockpiling their own resources to use for later leverage. And they may even make the loudest noises about how everyone should stop taking sweets, only so that they can make the biggest grabs when no one is looking.

Who are the losers in this situation? The obvious ones are the one who arrived late at the party. But the not so obvious losers are the ones from the first group, who amended their behaviour to ensure that there were still sweets left for the later groups to come. In being principled, holding on to ideals, they became lesser off materially, and the only consolation was the knowledge they had made the effort to leave some sweets for the late group – whether or not the latecomers actually got any or not is another question. The sweets ran out eventually.

The problem with thinking about sustainable economic measures is that the first to make an attempt to switch on ethical or aspirational grounds will be among the ones to lose out, because subsequent groups will still make a grab for whatever is left. Some will make a grab to get as much of the remaining resource, while others will make a grab so that when there is scarcity – and scarcity drives up prices – they have plenty of the resource to benefit. So while everyone is making the right noises about economic sustainability, everyone is just holding back for someone to make the first move.

So this is what antibiotics in agriculture really tells you: Too much can create problems later due to antibiotic resistance and improper disposal. We need to cut down on the use of antimicrobials. But reduced antimicrobials means reduced output, and we must be prepared to pay higher prices for less produce to compensate the farmer for that to work, in order that they may earn a living. The government can introduce penalties to govern the disposal of antimicrobial-related products to limit the damage on the environment alongside incentives to limit the use of antimicrobials. But it will have problems funding the incentives. Because what it is proposing is economic slowdown, in order to have an economy at all in later generations – but the current generations are too concerned with their own interests and survival, and stealthily making a grab for the remnants after the first few leave the economic arena.

How long-term medication harms – but why nothing may be done about it

In looking at mental health, we have previously examined the idea that while medication offers short-term relief, long-term change is brought about through lasting measures such as cognitive therapy. We have also seen that medication is more effective in individuals with more severe forms of mental health, while milder forms can also be dealt with through non-medicative measures. We can summarise by saying that the role of medication is to offer immediate relief, but over a long term, to stabilise the individual to a state where pressures or stressors can be managed to a point where they do not cause stress, but give the individual opportunity to live with them, while examining the root cause of their problems.

The underlying causes are usually non-medically related; they can be extrinsic factors such as the working enviroment or lifestyle. Medication is hence insufficient to deal with these because they cannot impact on them. The focus on the root of the problem is one that patients on medication need to ultimately address. Unfortunately patients taking prescription medicines often make the assumption that if a certain pharmaceutical drug has been prescribed to address a particular problem, then more of it, even within limits, can eventually help resolve it. That is only a mistaken assumption. Overdosing on medication does not address the root of the problem. It only lulls the body into a relaxed state, blinding us to the immediate surroundings, so while we feel calm, relaxed or “high”, this feeling is only temporal.

Medications and the prescription of medication are reactive, not proactive. They treat symptoms that have manifested, but do not treat the cause of the symptoms.

These views of medicine are not just limited to mental health problems; they can extend into physical realms. Take eczema for example. A doctor may prescribe creams containing hydrocortisone and paraffin for you to manage the itchy, red flaring skin conditions that usually see in eczema sufferers. However, these creams may only offer you temporary relief. As soon as you stop taking them, your eczema may return. Advocates of TCM, or traditional Chinese Medicine, suggest that eczema results from an overactive liver, and the trapped “heat” in the body, when it is seeking release, manifests itself as flared red patches over the skin. Creams such as paraffin or other barrier creams may be viewed actually as being counterproductive, because they only prevent the internal heat from escaping and make the eczema worse. Have you ever encountered anyone who, upon applying the cream for ezcema, reported it only worsened the itch? If you visit a TCM practicioner, you will probably be prescribed a cream with some menthol formulation for external use, oral medicine for your eczema, and the advice that in order to deal with the root cause of your eczema, you have to make changes in your diet – specifically, not to over-consume food such as fried food or chocolate, and to avoid alcohol and coffee.

It would be great if the immediate and short-term relief brought about by medication could be extended for long periods. If you were suffering from serious illness such as severe depression, the difference you feel would be very noticeable at the onset of medication. However, medication is only a short-term stress suppressant, buying time in order for longer-term (usually non-medical) measures to take effect. It is not the intention of any prescriber – be it a GP or pharmacist – that any patient be on medication for a prolonged period of time. While it might be good financially to have such patients, it is unethical to keep patients unwell to have a constant income stream and a source of revenue. In this situation the health of the patient has become secondary to the financial benefit he or she can bring, and it is against the ethics of the medical profession.

It is unwise to be on medication for long periods. First and foremost, the body adapts to the doseage and in time the effects that the medicine initially brought are diminished, to the point that either a higher doseage of the medicine is required, or the patient is switched to another new type of medicine which is more potent. In both cases, if medication is seen to be the cure, rather than just to buy immediate relief, then the patient will merely keep taking the medicine in the hope that one day it will completely cure his or her problems, and the potential for addiction to a higher doseage results. This is how all addiction begins, and it is unfortunate if patients who take medication find that it has not only dealt with their initial symptoms, but layered it with a secondary problem of addiction to painkillers.

Addiction is only one of the problems brought about by use of long-term medication. There is the possibility, too, that the body also adapts to new chemicals and is slowly malformed. But the negative impact of medication remains unnoticed until it reaches the tipping point and consequences are made apparent with a catastrophic event. With smoking, for example, constant exposure to the chemicals damages the lungs and malforms them, but often people only sit up and try to take corrective action when irreparable damage has set in and lung cancer has developed. Medication is on the opposite end to the scale as smoking and is taken at the onset to cure rather than harm, but it has the potential to change the human body when taken over prolonged periods.

But the changes are not necessarily just experienced by patients on medication alone. Research scientists from the University of Exeter found that, for example, certain species of male fish were becoming transgender and displaying female characteristics and behaviours, such as having female organs, being less aggressive, and even laying eggs. The fish had come into contact with chemicals in water near waste-treatment plants. Chemicals contained in birth-control pills, mixed with urine flushed down the toilet, were cited as a particular source of contamination.

When it comes to mental health problems, the best approaches are a mixture of medication and therapy. Give that medication is meant to be short-term, it is hence, important that therapy be as effective as possible in order for patients to entrust it to fully healing them, rather than depending on medication. This is of course more appropriate in instances of mental illness rather than physical illness that involve pain-relief. Nevertheless, in the latter case, where medication is for physical pain relief, some have suggested therapies such as hypnosis and acupuncture as long-term substitutes for pain medication.

It is worth the NHS examining such therapies in order to study the scientific evidence behind them, to glean any insight that could either be applied elsewhere to other treatments, or to find more cost-effective, longer-lasting treatments that will contribute to the NHS being a sustainable health service. Already, at the present time, the current model of the state being a mere provider and source of medicines and advice to its citizens cannot carry on. The cost of patient care will rise and drain its resources, and it would be more cost-effective to spend resouces to encourage citizens to actively take responsibility for their own health, and hence lessen the burden on the health service, rather than merely look towards it as a provider of medication.

There are also other reasons why the NHS has to prime itself for a move towards being a sustainable health service. It has to limit its carbon footprint in order to minimise the impact it has on the environment.

The prescription of long-term medication can ultimately have its impact traced back to the environment. Constituents of medication are either obtained from natural ingredients from foods grown on land, or manufactured in factories, which again, commandeer land use. The process of turning them into medication requires power and electricity, which either use up fossil fuels and produces fumes and greenhouses gases that result in global warming and instances of extreme weather, or renewable energy in the form of wind farms that still use up land, or solar energy from solar cells whose manufacture might have been through unsustainable means. Waste from manufacturing processes, or from the manufacture and the disposal of the medical product enters landfill or pollutes natural resources.

Land is a limited resource. More specifically, land that can grow useful crop is a limited resource. And so even if the current level of pharmaceutical manufacturing remains the same – perhaps, by some freak balance where the number of people being newly prescribed medication is equatable to the number of deaths – the land, along with the space available for landfill can never be refreshed on that basis. It might not make an immediate difference to you, but every individual has a civic responsibility, as a global citizen, to preserve the earth to make it habitable for future generations, to avoid killing off the human race.

Essentially, we need to lower our dependency on medication to avoid this impact on the environment. So that future generations have a habitable environment.

The problem is in convincing pharmaceutical companies to embrace this thinking. These companies depend on sales and if sales were to fall, so would profits and the price of shares. Pharmaceutical companies are accountable to their shareholders, and need to raise their share prices and create growth. The moment they start thinking about sustainability, they are looking to reduce their growth, and their share price would stagnate. Would you invest in a company with stagnant growth? Thought not. And if a company reports less profit, the government would have raised less revenue through tax and has to make up the shortfall somehow.

Being on long-term medication harms the body, among other things by creates changes in the body and fostering dependency. Ultimately it has significant bearing on the environment. The challenge is for us to wean ourselves off long-term medication, only using it in the short term while we address the root causes of our problems through therapy. On a wider scale, we need to create new business models because current ones actually depend on a sizeable number being unwell, in order for the economy to function. Surely that last statement is not ethical in itself and must raise incredulity – that in this day and age we are not trying to heal people, but maintain a threshold of well and unwell people that is economically beneficial!