The Marriage of Global Health and Sustainability

Universal sustainability is an economic and social discipline that seeks to marry economic growth, competitiveness, and innovation with larger societal goals for economic, social, and environmental progress (1). By its nature, sustainability is interdisciplinary and requires the participation of industry, government, educational institutions, and nongovernmental organizations (NGOs). For the pharmaceutical industry and its stakeholders, sustainability plays a role not only in individual company activity, but also in collective efforts, such as in global health, where public, private, and public–private partnerships play a crucial role in advancing sustainable healthcare.

To gain a perspective on these issues, Pharmaceutical Technology conducted a roundtable with Jane Griffiths, PhD and company group chair of Johnson & Johnson’s Janssen for Europe, the Middle East and Africa (EMEA), and Emma Waters, MD and specialty registrar at the Sustainable Development Unit (SDU) at the UK government’s National Health Service (NHS). Griffiths is responsible for the EMEA region of Janssen, the pharmaceutical division of Johnson & Johnson, and is also chair of the Johnson & Johnson Global Pharmaceuticals Sustainability Council. In her position with the UK NHS, Waters is helping the SDU establish metrics for measuring sustainable development and to coordinate the SDU’s work with pharmaceutical companies to develop guidance for uniform carbon foot-printing of pharmaceuticals and medical devices. Both Griffiths and Waters will be speakers atSustaiNext EU, a conference addressing the goals and ways to achieve universal sustainability, which will be held June 21–22, 2012, in Dublin, Ireland. Griffiths and Waters are part of a specialized track on global health and sustainability. Other sessions at SustaiNext EU will address the interrelationships between sustainability and transportation, education, agriculture and food, and global society.

SustaiNext EU is supported by the Sustainability Collaborative, a cross-functional coalition of representatives from industry, academia, government, and NGOs. The Sustainability Collaborative was created in 2009 to stimulate partnerships and connections between academia, business, government, nonprofits, and communities in pursuit of universal sustainability. It now has more than 800 participants, which include representatives from organizations, such as Dublin City University, Rutgers University, Drexel University, Advancing Sustainability in Higher Education, Johnson & Johnson, BD, SIMS, Sustainable Brands, Best Foot Forward, and Source 44.

PharmTech: What role does sustainability play in addressing the goals of global health initiatives overall and with respect to specific objectives, such as increasing access to medicines? Can you offer examples from an industry perspective and/or from your own organization?

Griffiths (Johnson & Johnson): As perhaps the highest profile social issue facing the pharmaceutical industry, it’s only natural that access to medicines is one of the most important elements in our sustainability strategy. A large percentage of the world’s population lives without access to basic medicines that can significantly reduce the impact of disease, improve the quality of life, and in some cases, save lives. A number of factors can affect access to medicines. In many areas, such as sub-Saharan Africa, the medical infrastructures are not well developed. As a result, many other challenges still stand in the way even when we provide low-cost medicines, such as the ability to get the medicines registered for sale, the lack of a medical education infrastructure to help ensure proper use of medicines, efficient distribution of medicines, and even questionable business ethics.

We have a responsibility as a healthcare company to work with nongovernmental and governmental organizations to create better access to medicines. Licensing to local manufacturers is one pathway that has helped increase access, which we have done with some of our HIV/AIDS medicines. In other cases, it may be through working with organizations, such as the TB Alliance, to help accelerate the development of our tuberculosis (TB) treatments to address the increase in drug-resistant strains of TB.

Another issue that crosses social and business lines is the cost of our current healthcare systems and the role we play as producers of healthcare products. Obviously, the cost of a product is only part of the total healthcare cost, but there is a lot of pressure on us to reduce cost. It’s inevitable that for a sustained healthcare system, the whole system needs to become more cost-effective, but on the other hand, there needs to be enough budget to continue to research and develop better and more effective products. In some cases, there might be other options than the use of healthcare products but that means a paradigm shift in society. We’ve been working with the NHS on assessing opportunities in the pathways of diseases, for example, Type 2 diabetes. We all know that obesity is a major cause of Type 2 diabetes, and that in many cases, lifestyle choices relate to obesity. Therefore, it’s interesting to see whether the healthcare industry can offer prevention rather than a cure, which obviously has a significant impact on the cost of healthcare. Such options, however, need a holistic approach, much in line with universal sustainability, including the food and transport industry.

Waters (NHS SDU): It is known that climate change will have a significant negative impact on health (2). However, it is also known that many strategies to reduce climate change also will have significant benefit to health (i.e., health co-benefits). For instance, enabling active transport, such as walking or cycling, will obviously have health benefits in addition to reducing greenhouse-gas (GHG) production. Low-carbon patient healthcare pathways and, when appropriate, community healthcare or telehealthcare also can improve health outcomes. Schemes, such as smoking cessation, which improve public health and reduce the need for patients to access healthcare, also will reduce carbon emissions. Finally, the World Health Organization and member states are committed to reducing health inequalities (3). However, it is recognized that climate change has the potential to increase health inequalities, both within countries and internationally (4). Therefore, climate- change mitigation is essential to help prevent increases in health inequalities.

PharmTech: How does sustainability factor into the pharmaceutical supply chain? Where do you see areas of greatest impact, such as in green-manufacturing processes for pharmaceutical products, green procurement practices for pharmaceutical ingredients or products, or distribution activity? Can you offer examples from an industry perspective and/or from your own organization?

Griffiths (Johnson & Johnson): With healthcare spend accounting for anywhere from 6 to 16% of GDP [gross domestic product] in developed countries, it follows that healthcare has a very large associated environmental footprint. Our largest customers, (e.g., government accounts and large hospital networks), where the environmental impact can be seen at a macro level, are starting to take notice of that environmental footprint and are reaching out to their suppliers to help them minimize waste, save energy, eliminate toxics, and reduce water consumption. The benefits spread beyond the environment as they can save them money as well. We need to continue to develop greener products that are more environmentally friendly, not only for our customers but all along their value chain.

For J&J, we have a product stewardship program known as Earthwards that guides and assists development teams in each of the sectors to deliver greener products. For pharmaceuticals, developing greener products begins with having a full understanding of what happens to our pharmaceuticals once they enter the environment; incorporating green-chemistry principles into our chemical synthesis and processing; leaning our packaging and incorporating more sustainable packaging materials; and ensuring that our suppliers also take great care to minimize their impacts to the environment and the communities in which they are located.

While we expect that we will have chemical-based pharmaceuticals with us for some time, in the longer term, we believe the move to biologic-based treatments will address many of the concerns around chemicals in the environment. However, biologics have their own set of environmental effects, such as significant water use and cold-chain distribution, which we need to address over time. We are confident, however, that overall we are moving into a period where healthcare products will have less of an impact on the environment.

Waters (NHS SDU): It is known that globally, pharmaceuticals contribute a large proportion of healthcare GHG emissions. For instance, research carried out by the NHS Sustainable Development Unit (SDU) found that in 2010, an estimated 22% of the National Health Service (NHS) for England’s GHG emissions were attributable to pharmaceuticals (5). It is essential that healthcare providers take action to reduce their carbon emissions, and the UK’s NHS has committed to an ambition of reducing its carbon dioxide (CO₂) equivalent emissions by 80% by 2050. Due to the significant proportion of GHG emissions that are attributable to pharmaceuticals, it is obviously essential that the all parts of the pharmaceutical supply-chain and end-of-use factors are considered when reducing GHG emissions. However, for many pharmaceutical products, there is only limited data available regarding their complete life-cycle CO₂ equivalent footprint. For this reason, the NHS SDU is currently working with industry partners, international health providers, and an environmental consultancy firm to develop uniform international guidance to aid in the development of CO₂ equivalent foot-printing for the complete life cycle of pharmaceuticals. It is hoped that the resulting guidance will highlight to the pharmaceutical industry and healthcare providers areas of high GHG emissions and allow them to work together to reduce carbon emissions.

PharmTech: From your perspective, where do you see the greatest progress to date in achieving sustainability with respects to the pharmaceutical industry and/or global and national health policy? Looking ahead five to 10 years, what might be some future goals or aspirations in this area?

Griffiths (Johnson & Johnson): The greatest progress to date is the ongoing discussion around this topic. This might seem strange, but the fact that all the stakeholders in our industry are now actively engaged with identifying and discussing opportunities to make healthcare more sustainable has moved it away from being a ‘flavor of the day’ to a embedded part of our strategies. Obviously, there were immediate steps that we were able to take, such as making our processes more lean and reducing waste and energy use, in some cases quite dramatically.

In the longer term, say 10 years from now, I think technological advances, such as the continued development of early diagnostic technologies and chronic disease intervention, personalized medicine, telemedicine, and preventive therapies, such as next-generation vaccines, all stand to help reduce the footprint of care while increasing the quality of care. However, healthcare companies, systems, and governments that can commercialize prevention, that is, getting patients to really place a value on their health and preserve it, will be the most successful going forward. Elimination of preventable diseases, especially chronic and disabling diseases, really should be our goal, and we really can’t afford not to achieve that goal.

Waters (NHS SDU): Currently, multisectorial collaborations, such as the international collaboration to create uniform carbon foot-printing guidance already described, and collaborations between industry and healthcare providers to create low-carbon patient-care pathways are making important contributions toward the ambition to reduce pharmaceutical related GHG emissions. Ultimately, the SDU envisages that sustainable healthcare will involve a move toward a service-based model of healthcare where providers support the system through providing services around fewer products rather than the current more product-based system.

References

1. R.L. Lattimer, “Universal Sustainability: The Economy and Competitiveness 2012,” Sustainability 5 (1), 1–3 (2012).


2. Costello et al., The Lancet373 (9676), 1693–1733 (2009).

3. WHO, Rio Political Declaration on Social Determinants of Health (Rio de Janeiro, Brazil, Oct. 21, 2011).

4. Marmott et al., The Marmot Review, Feb. 2010, 78–79.

5. NHS, NHS England Carbon Footprint (NHS Sustainable Development Unit, 2012).