Medicine

NHS funds; in the bin, down the sink and flushed away  

Around 2.7 million prescription items are dispensed daily in the UK, an average of 18.7 items per person per year [1]. The World Health Organisation (WHO) estimates that only 50% of people follow their prescriptions correctly [2], through non-adherence, lack of compliance or other factors, meaning that medication is often left unused. The result is that the NHS spends an estimated £300 million a year on unused medication [3], of which half is believed to be avoidable.

Given this national problem, a current research project within the Centre for SMART is investigating solutions for preventing overprescribing and underusing of prescription items within the UK.

As part of the current investigation, a public survey was conducted to better understand ordering habits, reasons for unused medication and current attitudes towards disposal. The survey revealed that the main reasons for unused medication were; the medication going out of date, the patient’s medication changing, patients choosing to stop taking items or patients recovering from ailments. Overall the survey showed that there is a need to assess patients’ requirements more regularly without adding cost and inconvenience to the NHS.

Over prescribing can cause an increase of waste; patients may over order items with a ‘just in case’ attitude, or automatically reorder all items on repeat without checking if they finished the previous batch. One survey stated; “When medication is relied upon, a user has no choice but to stockpile for their own safety,” indicating that the issue may not solely be user oriented, but rather an undesirable feature of the current system. This ‘rainy day’ attitude of the public can lead to stockpiling prescription items, which eventually have to be disposed of, creating a problem in its own right. Incorrect disposal can lead to a wide array of environmental issues. Discarding unused medication down the drain or toilet can contaminate local water, as the active pharmaceutical ingredients (APIs) can pass through the filters at waste water treatment plants (WWTPs) [4].

Furthermore, discarding through general waste can lead to issues such as accidental consumption by children or wildlife, may lead to people raiding the waste streams to sell on the drugs illegally and landfill leaching can contaminate the water system. [5]

Returning unused medication to pharmacy is considered best practice within the UK, and often seen as the environmentally conscious approach. However with a lack of high temperature incinerators in the UK, the unused medication often travels long distances to be destroyed [6]. Compounding the matter, incineration of medical waste can produce highly toxic chemicals [7], with costs of disposal escalating up to £1,900 per tonne. [8]

This overall problem has not gone unnoticed; the Sustainable Development Unit (SDU) of the NHS, aims to deliver high quality and improved public health without exhausting natural resources or causing severe ecological damage [10] and their future plans seek to minimise waste resulting from unused medication, by improving repeat dispensing and encouraging cost effective prescribing.

The problem is complex and any potential solutions are, as yet, unclear. What is for certain is that, confusion over the correct method of disposal, along with consistent over dispensing and underusing of pharmaceutical items within the UK is generating harmful waste, whilst depleting scarce NHS funds.

 

References

  1. https://www.england.nhs.uk/wp-content/uploads/2015/06/pharmaceutical-waste-reduction.pdf
  2. https://www.bma.org.uk/collective-voice/committees/patient-liaison-group/resources/dispensed-but-unopened-medications
  3. https://www.bma.org.uk/collective-voice/committees/patient-liaison-group/resources/dispensed-but-unopened-medications
  4. https://pubs.acs.org/doi/abs/10.1021/es203987b
  5. https://www.sciencedirect.com/science/article/pii/S030438940800784X
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026718/
  7. http://www.pharmanet.com.br/pdf/blister.pdf
  8. https://www.journalofhospitalinfection.com/article/0195-6701(95)90058-6/pdf
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395800/
  10. https://www.sduhealth.org.uk/

(Image) https://www.pexels.com/photo/colors-colours-health-medicine-143654/

Posted on 30 August 2018 By Jordanna Marsh
Glamping
Sustainable Tourism
 
In this latest blog, we take a look at what it means to travel sustainably, providing some top tips and leading sustainable destinations!
 
International tourist arrivals have increased from 25 million globally in 1950, to 278 million in 1980, 527 million in 1995, 1.32 billion in 2017 and are expected to reach 1.8 billion by 2030. At the same time:
Thousands of people may arrive in a tourist destination every day, and this destination may lack any proper recycling facilities.
Although there are hotels that are recycling water, they still have to use millions of litres of potable water per year being, at the same time, often located in water scarce regions.
Beef consumption is the most water-consumptive practice by travelers.
 
This is compounded by the fact that, every year, 40 million tons of carbon pollution is dumped into the atmosphere, and, although 70% of the earth’s surface is water, only 3% is potable. Even though the above may not be solely related to tourist activities, tourist activities do contribute to all of them. The way regions and countries develop their tourism industry does produce significant impacts on natural resources, consumption patterns, pollution and social systems. This has led to a growing interest in sustainable (or responsible) tourism, defined as “tourism that respects both local people and the traveller, cultural heritage and the environment”. It seeks to provide people with an exciting and educational holiday that is also of benefit to the people of the host country. Sustainable tourism is all about small things prospective tourists can do to make their holiday more eco-friendly. Here are some of our top tips:
 
Plastics: carry and use your own cloth bag each time you go shopping or select a plastic re-usable bag and use it until worn out; avoid buying plastic bottles of water, in particular in countries where there is no way of disposing of them, by bringing your own bottle with you after having removed all packaging and have left it back home (but always consider purifying water before you consume it); avoid using disposable utensils, etc.
Packaging: give preference to products with minimal or no packaging at all.
Waste: This goes without saying: do not litter and try to avoid excessive waste, and recycle where possible.
Water Conservation: Take quick showers using as little water as possible, use kettles and pans of the right size to avoid excessive cooking water, and avoid using hotel laundry (they typically wash clothes per guest separately), etc. 
Local Economy: It is really important to support the local economy wherever possible by buying local produce or souvenirs, eating at local restaurants and, if possible, selecting organic food 
Responsible Travel: Travelling can be made much more sustainable via a number of small changes. Whilst flying is often unavoidable, it is easy to prioritise airlines which offer carbon offsetting. When you arrive at your destination, try to use public transport whenever possible and ideally cycle or walk. After all, one of the main reasons for visiting exotic holiday destinations is to soak up the incredible landscapes available! If you have to use a car, try to cluster activities into only one trip by car instead of multiple errands. Avoid using congested routes and if possible rent a hybrid or electric car. 
Sustainability Credentials: support travel providers and organizations who support sustainable tourism; ask about accommodation providers’ sustainable practices (do they: compost? have low-flow toilets? have a recycling program? harvest any rainwater? consume any renewable energy? support fair trade? have a well-defined environmental policy? etc. In particular in the UK, look for hotels approved by the Green Tourism Business Scheme (https://greenglobaltravel.com/, https://sustainabletourism.net/).
 
Sustainable tourism got your attention? If so why not check out our favorite top 5 UK sustainable holiday destinations!
 
Loveland Farm, Devon: their own vegetables, their own organic meat, award-winning compost loos and the campsite’s energy is being sourced from a recycled woodchip 110 kW biomass boiler and 5 kW solar panels. 
St Cuthbert’s House, Northumberland: support of the local industry to help and sustain local economy (e.g. food, art). 
Bangor’s Organic, Cornwall: an 11 kW wind turbine to generate electricity to the house, organic produce and breakfasts, a free hook-up for electric cars, all in a Soil Association certified bed and breakfast. 
Argyll Hotel, Island of Iona: ethical business with limited impact on the Iona environment ensuring at the same time that the latter will remain intact for the next generations. 
Calgary Self Catering, Calgary Bay: a Green Tourism Gold Award holder that recycles its waste, sources sustainable energy, and keeps their impact on nature to a minimum. 
 
 
Posted on 02 May 2018 By George Skouteris
Fish_skin
Food Waste: Cash in Trash
 
Sustainable fashion is increasingly popular among consumers, and companies are responding by focusing on technical innovation, improved efficiency and related mission orientation.  In 2017, 42 out of 100 brands revealed that their suppliers are shifting to a circular economy.  The fashion industry is looking for more sustainable sources in creating their designs, even adopting the use of biomaterials such as food waste. Let’s meet 4 companies that are into sustainable fashion.
 
1. Sport Clothing from coffee grounds:
4 years of research and development has led to a patented process that removes the phenol, ester and oil from coffee grounds and turns them into yarn. The yarn can be used in a variety of different products, from outdoor and sport performance apparel to household items. Thanks to the coffee grounds, the fabrics offers up to 200% faster drying time compared to cotton. Moreover, the micro pores on the yarn absorb odours and protect against UV rays.
Due to the increasing demand for this invention, a partnership with local coffee shops has developed to collect their used coffee grounds. These spent grounds provide a sustainable and efficient source of raw material. As their advertising says: ‘Drink it, Wear it!’ [1]
 
2. Coffee ink:
The only printing company in the world using ink made from used coffee grounds to produce dyes for screen printing can be found in California. Coffee is a natural pigment, and it turns out that used coffee does the same job as unbrewed grounds. The incredible technique, which involves mixing the used grounds with vinegar (as a fixative) followed by straining and cooking down the liquid until matching the thickness of the commercial ink, enables printing on a variety of fabrics, creating rich graphics that stand up to wash and wear. Slightly more than 2 litres can print 200 t-shirts.  They even offer a customized t-shirt with your own spent grounds.  This company is smart and sustainable, as there is no waste from chemical discharge and vinegar is by far cheaper than ink. [2]
 
3. Bags and shoes from discarded fish skin:
By 2030 we will be producing 185 million tons of fish globally. Of this 50% is considered food and 50% waste which will equate to 92.5 million tonnes of waste per year. As only 30% can be converted into fish meal for animal feed, 65 million tons will remain unaccounted for and the likely outcome is that it will be dumped into the sea. [3]
Fashion brands have found a stylishway to use this by-product of the fishing industry by converting it into furniture, bags and belts. Fish leather is an ideal use for such applications, as not only can it be visually striking, but it is also the second strongest leather known, thus providing an ideal end of life solution for otherwise discarded fish waste. [4] 
Fish leather manufacturers also promote the use of fish skin as a sustainable alternative to increasing cow leather production as well as creating jobs in areas of production such as Iceland.[6]. Yet there are a number of concerns about the eco-credentials of manufacturing accessories from fish leather and there is need for a detailed comparison with cow leather to fully validate this claim. Despite this, the fact remains that fish leather does add substantial value to what is otherwise a waste product, giving this area significant potential.
 
4. Shoes from Corn:
Corn is usually thought of as a food or food additive, but corn has uncountable uses and it can be found in many products that are part of our daily routines. The most valuable part of the corn plant is the grain, but what happens to the discarded part? A vegan shoe company based in Spain has developed shoes from organic vegetable matter using the inedible parts of corn. The shoe sole is made of recycled natural latex rubber from floors, which in addition to being sustainable and  comfortable due to its flexibility and shock absorbing capacity, is also supercool. [7]
 
Hopefully these fascinating examples have caught the attention of our more fashion loving readers who have an interest in sustainability. Want to keep up to date? Here are some great sources to follow:
 
 [1] S. Café Sustainable Performance. (2015). Brand Story [online] Available at: http://www.scafefabrics.com/en-global [Accessed 22 Feb. 2018].
[2] Domestic Stencilworks. (2018). Coffee Printing. [online] Available at: https://www.domesticstencilworks.com/collections/coffee-printing [Accessed 22 Feb. 2018].
[3] THE WORLD BANK. (2013). FISH TO 2030. Prospects for Fisheries and Aquaculture. [online] Available at: http://documents.worldbank.org/curated/en/
458631468152376668/pdf/831770WP0P11260
ES003000Fish0to02030.pdf [Accessed 22 Feb. 2018].
[4] Braw,E. (2014). Prada, Dior and Nike are finding a fashionable new purpose for fish skins. [online] The guardian. Available at: https://www.theguardian.com/sustainable-business/sustainable-fashion-blog/2014/oct/16/fish-skins-fashion-leather-prada-nike-dior  [Accessed 22 Feb. 2018].
[5] The Fish Leather Company (2015). Fish Leather A Non-Wastage Material. [online] Available at: http://thefishleather.co/fish-leather-eco-friendly-non-wastage-material/ [Accessed 22 Feb. 2018].
[6] Atlantic Leather (2016). PIONEERING FORCE IN THE MIDDLE OF ICELAND! [online] Available at: http://www.atlanticleather.is/thestory/ [Accessed 22 Feb. 2018].
[7] Slowwalk (2018). Vegan shoes - Slowwalk creates the shoes of corn skin. [online] Available at: https://www.slowwalk.es/en/vegan-sneakers [Accessed 22 Feb. 2018].
 
 
 
Posted on 19 April 2018 By Lucia Azanedo