Prescribing Sustainability

In health, the most sustainable product is often the one that is never needed. The second most sustainable is the one that delivers the greatest health gain per unit of planetary burden. Health care exists to protect human health, yet it accounts for a significant share of global greenhouse gas emissions, most of it in the supply chains that produce medicines, devices and consumables. Pharmaceutical residues in rivers, antibiotic manufacturing discharges, high-impact anaesthetic gases and single-use plastics widen the problem further. Prescribing Sustainability argues that current approaches fall short: sustainability is treated as a reporting exercise, measured through metrics that ignore the health value produced, and pursued within market rules that rarely reward environmental performance. The book proposes outcome-normalised sustainability. It introduces the Care-Footprint Frontier, a framework that assesses environmental burden relative to health gain and identifies four strategic movements: Prevent, Streamline, Substitute and Decarbonise. The framework is applied to respiratory care, anaesthesia, high-cost medicines, antibiotic supply chains and care pathways. From this basis, the book develops a strategic agenda for pharmaceutical, medtech, diagnostics and digital health companies, distributors and providers, and a policy agenda built on seven levers, from green procurement and health technology assessment to extended producer responsibility and mission-oriented innovation. It addresses trade-offs with access, resilience and equity, and closes with scenarios to 2040 and a phased roadmap. Written for managers, policy makers, researchers and students, this book offers a practical path towards health systems that deliver more health with less harm.