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Health Care 2030: Predicting trends in future chemical pollution at the first SOLUTIONS workshop

April 20, 2015
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Group picture of the participants at the SOLUTIONS Workshop “Health Care 2030”. Image: David López Herráez.

By Dirk Bunke, Werner Brack and David López Herráez.

How does the availability and use of water resources, population demography, agriculture, healthcare, climate and so on affect the patterns of global chemical pollution?  And is it possible – at least to a certain degree – to predict future emerging pollutants?

The EU SOLUTIONS project aims to address these questions by modelling future scenarios for freshwater chemical pollution, to help develop assessment tools and abatement options for emerging pollution challenges. The project’s first task was to identify and examine patterns and trends in current chemical pollution. Following this initial analysis, SOLUTIONS scientists are working with external experts in dedicated workshops to discuss economic, technological and demographic trends in society, in order to identify links with new and emerging pollutants.

intro.pollutionThe first SOLUTIONS workshop: Health Care 2030

SOLUTIONS held the first of four workshops on the topic in Frankfurt a.M. on 23rd and 24th February 2015. The first workshop – entitled “Health Care 2030” and organized by Dirk Bunke from the Öko-Institut (Institute for Applied Ecology), Germany – focused on chemical substances related to human health care.

Following the presentation of model on future climate change and its consequences for future health care by Michael Depledge from the University of Exeter, the “Health Care 2030” workshop discussed potential changes in human disease patterns and pharmaceutical use considering projections by the Intergovernmental Panel on Climate Change (IPCC). At present, climate change is one of the most intensely discussed factors to potentially affect our future environments. Climate-related environmental alterations are expected to be associated with an increase in chronic diseases already common in the Northern Hemisphere – such as cardiovascular, respiratory and mental illnesses – potentially leading to a greater need for chemical medications, such as vasodilators, anticoagulants, anti-inflammatories, antidepressants and analgesics, which then will potentially be circulated into the environment.

Changes in climate are also expected to prompt an increase in pathogens and invertebrate vectors (such as mosquitos) for disease. As new disease threats emerge, higher pharmaceutical use seems inevitable, and is likely to include medical drugs not commonly employed at present, such as antiprotozoals for malaria, amoebiasis and others. Further factors expected to affect future pharmaceutical consumption are global societal health trends (increased prevalence of obesity, diabetes, cancer and depression), increased production and access to drugs (e.g. in newly industrialized countries), novel chemical treatments, biodiversity loss and emerging diseases.

In terms of predicting future freshwater chemical pollution, such developments need to be viewed in the context of other environmental changes, such as fluctuations in river flows as a result of droughts, floods and storms, which can disturb historical ‘legacy’ pollutants from sediments.  Similarly, an increase in surface water temperature can also alter the environmental fate of emitted chemicals, influencing their mobility and bio-accumulation.

Workshop presentations and discussions: chemical pollution from healthcare and agriculture

Following presentations at “Health Care 2030” workshop given by Christian Brandt (University Clinical Center Frankfurt) and Engelbert Schramm (ISOE, Institute for Social-Ecological Research, Frankfurt), workshop participants discussed the current and future role of health care systems – especially hospitals – as sources of environmental pollution. In general, health care personnel are educated about how to correctly dispose of waste in hospitals with largely well-structured waste management plans, thus reducing the risk of contamination of other patients and the environment. Nevertheless, infectious microorganism agents from gut flora and multi-drug resistant bacteria do represent a serious threat to the environment, and this may become more serious in the future if current trends in the use of antibiotics continue.

This threat posed by chemical pollution is enhanced by industrial livestock farming involving high and potentially improper antibiotic use.  Drug emissions from hospitals are of local relevance but are easily exceeded by diffuse emissions from households, thereby posing spatial challenges for pollution management. Another key issue is the increasing requirement for cleaning and disinfection to safeguard hospital hygiene, for example in the cleaning of surfaces and surgical instruments. In this respect, and taking into account global population growth, the emissions of chemicals from household cleaning products are also expected to increase in coming decades.

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Annual prescribing rates by therapeutic group in males from England and Wales in the year 1998. Image: Royal Commission on Environmental Pollution report on “Demographic Change and the Environment” February 2011; Information used under UK Open Government Licence v3.0.

Identifying and managing the causes of future chemical emissions: Health Care 2030

As a result of discussions at the SOLUTIONS workshop, the key drivers of future “Health Care 2030” chemical emissions were identified as: i) an increase in pharmaceutical production and consumption; ii) environmental politics (i.e. how pollution is managed by policy); iii) demographic change; and iv) developments in human health systems and veterinary practices. Participants at the workshop discussed possible “options to act”, suggesting palliative measures to manage the impact of drugs released into the environment.

Hans-Christian Schäfer (Deutsche Bundesstifung Umwelt) reported on several technological approaches to minimize drug emissions. This involves the advancement of effluent treatments (e.g. the removal of micro-pollutants via sludge or charcoal absorption, membrane filtration, and the advanced oxidation or UV-photolysis of molecules). Similarly, Schäfer outlined societal incentives to encourage the pharmaceutical industry to achieve a business model combining entrepreneurial interests, higher efficiency of pharmaceuticals and a sustainable “benign by design” model of drug production.

Taking into account the uncertainties associated with future developments in chemical use and emissions from the pharmaceutical industry, the best option for action may be optimisation in small steps along the whole supply chain: from the design and production of a certain pharmaceutical, to its legal authorization and environmental regulation, and finally its consumption and use. Education may help to avoid bad practices in drug use such as the disposal of pills and tablets via toilets or sinks.

Klaus Kümmerer (University Leuphana Lüneburg) presented innovative strategies for sustainable drug design, including practical examples of the “benign by design” approach. Such drug-design safeguards against environmental degradation by avoiding persistent and toxic transformation products. Further important tasks in the future will include the promotion of behavioral changes such as: increasing public exercise; reducing exposure to hazardous substances and pathogens; and raising awareness on the correct use and dosage of pharmaceuticals, for example this environmental product labelling in Sweden.

intro.qualitySumming up and looking forward: Food 2030

The intense and productive exchanges which took place at the workshop created new insights in future developments of “Health Care 2030”. For all workshop participants it was worthwhile to look beyond a single own research field, in order to gain an interdisciplinary approach to chemical pollution management. Within the SOLUTIONS project, the results of the workshop will be used to develop a better understanding of future chemical pollution trends and patterns, to predict the consequences of chemical risks to the aquatic environment, to propose specific substances and substance groups for environmental modeling and monitoring, and finally to develop management options for future emerging pollutants.

The next workshop of the series will focus on “Food 2030: Trends in production and consumption”. The workshop will address a broad range of topics from antibiotics in animal farming and trends in agricultural use of pesticides to the impacts of convenience food. Once again the key question is how these trends influence the quality of our freshwaters – a key challenge for both science and society.

Attendees:

Attendees from following institutions participated in the first workshop of the series:

Dirk Bunke, Susanne Moritz and Lea Strigl from Öko-Institut (Institute for Applied Ecology – Germany); Werner Brack and David López Herráez from the Helmholtz Center for Environmental Research – UFZ; Michael Depledge from University of Exeter Medical School; Klaus Kümmerer from the Leuphana University Lüneburg; Christian Brandt from University Clinical Center Frankfurt; John Munthe and Eva Brorström-Lundén from the Swedish Environmental Research Institute – IVL; Guy Engelen and Frank Sleeuwaert from the Flemish Institute for Technological Research – VITO; Hans-Christian Schäfer from Deutsche Bundesstiftung Umwelt – DBU; Engelbert Schramm from the Institute for Social-Ecological Research Frankfurt; Jaroslav Slobodnik from Environmental Institute – Slovakia; Thomas ter Laak from Watercycle Research Institute – The Netherlands; and Lonneke van Leeuwen from the Dutch National Institute of Public Health and the Environment – RIVM.

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