THE WATER PHARMACIST

Water is the gaze of the earth, its instrument for looking at time.
L’eau ainsi est le regard de la terre, son appareil à regarder le temps.

- Paul Claudel

Man as the end station, or man as the starting point?

Every year, around 1,500 tonnes of active pharmaceutical ingredients (excl. the excipients) are supplied in Belgium via pharmacies and residential care centres. Antibiotics, hormones, anti-inflammatory drugs, beta-blockers, blood sugar lowering agents, etc. require special attention. A not insignificant proportion of this pharmaceutical use is related to our Western lifestyle. For example: lots of sugary, salty and fatty food, plus overeating and too little exercise, smoking and excessive alcohol consumption. In addition, the huge pressure to work and perform in Western society also plays a role, as this causes more stress.

Most of this prescribed medication is taken and then excreted through urine. As such, the active substances inevitably end up in the environment. Because medicines are designed to act on living organisms in low doses, they also pose a risk to the environment. The surviving active particles are already causing a shocking range of undesirable side effects: fish and amphibians are becoming more feminised, fish more reckless and thus more vulnerable to predators with an impact on reproduction, abnormalities in organ development. Many of these issues have systemic characteristics. Take resistance to antibiotics for example. The excessive use and discharge of antibiotics into water creates resistance, which leads to a self-reinforcing vicious cycle in which increasing epidemics lead to more antibiotic use, resulting in even more resistance with the risk of more epidemics ...

All these medicines which have been examined are found in our surface waters. The health of our watercourses therefore teaches us a lot about the health of our society. And because of the ageing population, the evolution of the health sector, etc., more pharmaceutical substances will be released into the environment in the future, if no measures are taken. Moreover, climate change could magnify the impact of this on the environment: in times of drought, concentrations of active substances in watercourses will be higher, thereby having an impact more quickly. At times of heavy rainfall, overflows may be activated, which could also lead to further spreading of these substances. Our approach to health therefore erodes the Water capital, with society picking up the bill. Can we rethink this process, with an approach that enhances the Water capital?

Caring for water is caring for people

The healthcare system today is to a large extent a ‘reactive anthropocentric system’: we are organised to react when people fall ill. For example, hospital funding is based on the number of sick people who are admitted rather than the number of healthy people in the area. The corona crisis has already intensified the need for more funding to flow towards green and blue (water) infrastructure in public spaces for the benefit of public health (including mental well-being). The system issue that thus arises is how costs avoided in the health system can be mobilised to strive for a pollution-free environment.

Together with actors from the entire care and health chain, we want to look for innovative possibilities and opportunities that we have never thought of before, or redesign or optimise existing systems. We are contributing knowledge that can lead to a more water-friendly design of medicines. We are brainstorming together with doctors and pharmacists about how to prescribe medicines in a water-friendly way. We are looking at financial levers to place actors more ‘upstream’ of their responsibility. We are looking at how care forests can reduce the need for medication, while simultaneously promoting buffering, CO2 storage and cooling.