Environmental sustainability of healthcare system in the era of One Health: a pharmaceuticals residues point of view

This study aims to investigate the environmental impact of pharmaceuticals across their life cycle—from produc- tion to disposal—in the context of increasing concerns about sustainability in healthcare systems. Utilizing a narra- tive review approach, data from recent scientific literature and policy documents were analyzed to assess the extent of pharmaceutical pollution, its ecological consequences, and the effectiveness of current mitigation strategies. The analysis revealed that pharmaceutical residues, particularly non-metabolized active pharmaceutical ingredients, have been shown to contribute to aquatic pollution and biodiversity loss in multiple studies, with evidence of effects on certain species and ecosystems. Emissions from pharmaceutical production account for approximately 4.4% of global carbon emissions, while inadequate disposal practices exacerbate environmental contamination. Moreover, specific drug classes, such as non-steroidal anti-inflammatory drugs, antibiotics, hormones, and anticancer agents, pose heightened ecotoxicological risks, including endocrine disruption and antimicrobial resistance. The study highlights promising mitigation strategies, including solvent recovery technologies, green packaging, advanced wastewater treatments, and innovations such as biodegradable drugs and AI-driven telemedicine. Case studies from companies such as Merck, Sanofi, and AstraZeneca demonstrate the feasibility of integrating sustainability into pharmaceutical operations. The findings underscore the urgent need for regulatory frameworks that incorporate environmental criteria into health technology assessments, in alignment with the EU Green Deal and Agenda 2030. These insights contribute to the One Health perspective, emphasizing the interdependence between environmental protection, public health, and pharmaceutical innovation.