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Facing (exhaust)ion

A 2023 report has identified some of the greatest environmental threats to health in the UK.

We are all products of our surroundings, meaning that when our surroundings aren’t doing well, neither are we. 

With climate change having a more significant impact year on year, the UK Government has laid out its goals in a 25 Year Environment Plan to try and improve our impact on the planet. Targets include clean air, clean and plentiful water, thriving plants and wildlife and reducing the risks of harm from environmental hazards. It is hoped that these goals will not only stand up to climate change but also protect the health of the population. But is enough being done? 

The environment is already having both short and long-term impacts on our health, according to the State of the environment: health, people and the environment report. From air pollution to antimicrobial resistance, the Environment Agency’s findings (last updated 26 January 2023) indicate improvements to our environment need to be implemented sooner rather than later. 

Up in the air

So how is the environment impacting our health? Air pollution is the single greatest environmental threat to health in the UK, as found by the State of the environment report. 

In fact, it contributes to up to 36,000 deaths in the UK each year, according to the British Heart Foundation (BHF), and an estimated five per cent of total mortality in England can be attributed to small particulate matter PM2.5 alone. “All of the organs in the body seem to be affected in some way by breathing in air pollution,” says professor Frank Kelly, director of the Environmental Research Group at King’s College London (KCL).

The State of the environment report found that aside from the short-term impacts on health, such as wheezing and coughing, the long-term effects “shorten tens of thousands of lives every year and reduce average life expectancy by several months”. Air pollution plays a long game too, thought to be associated with dementia, heart disease, stroke, cancer and impacting children’s development before and after birth.

“When poor quality air is inhaled, the air pollutants can travel deep into the bloodstream through the lungs, and to the heart,” says Joanne Whitmore, senior cardiac nurse at the BHF. “This can increase the risk of developing heart and circulatory diseases.” 

And that’s not all. Joanne explains the impact this can have on the heart specifically: 

  • Damage blood vessels by making them narrower and harder. This can:
    • Make it more difficult for blood to flow freely
    • Make blood more likely to clot
    • Increase blood pressure because the heart is pumping faster to move the blood that can’t flow properly.
  • Increase the strain on the heart muscle by working harder than it should
  • Affect the heart’s electrical system, which controls the heartbeat, possibly causing abnormal heart rhythms
  • Potentially cause small changes to the structure of the heart. This can be similar to changes seen in the early stages of heart failure.

“For people with existing heart and circulatory conditions, this damage can increase their risk of events like a heart attack or stroke,” she adds.

Looking down the barrel of a car exhaust pipe, the findings are bleak – and air pollution is not the only issue we are facing.

Resistance is futile?

The World Health Organization (WHO) lists antimicrobial resistance (AMR) among the top 10 threats for global health – and this threat is increasing. Indeed, according to the State of the environment report, AMR microbes are becoming “more common in the environment due to contamination, meaning infectious illnesses may become harder to treat”.

In Europe, antibiotic-resistant infections kill at least 25,000 people every year, according to the Government’s Review on Antimicrobial Resistance, commissioned in July 2014. This could rise to 390,000 by 2050 and “by then, antimicrobial resistant infections may be the leading cause of death worldwide”.

AMR is a significant cause for concern because it means that certain microbes, including bacteria, parasites, viruses and fungi, are becoming resistant to effective treatment and prevention, thus infections and illnesses in humans are likely to increase. “Through genetic changes, antimicrobial resistance can occur naturally over time. The overuse of antimicrobials in humans and livestock has accelerated this process”, the report explains, with resistant microbes being spread into the environment mainly by sewage and agricultural waste. Some worrying AMR trends in the report link:

  • Bacteria to rising resistance to tuberculosis drugs
  • Viruses to rising resistance to HIV antiretrovirals and influenza antivirals
  • Protozoans to rising resistance to antimalarial drugs
  • Fungi to rising resistance to antifungal drugs.

Findings from the 2023 UN Environment Programme report Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance agree, touching on the devasting impact of AMR, and not just for humans. “Antimicrobials have been essential in reducing the burden of infectious disease in humans, animals and plants for decades. However, their effectiveness is now in jeopardy because several antibiotic, antiviral, antiparasitic and antifungal treatments no longer work because of AMR.”

Read further analysis of the Bracing for Superbugs report.

Things are heating up

Climate change is thought to be contributing to changing environmental factors in the UK, including increased temperatures and droughts – and this too is having an impact on health.

For example, non-melanoma skin cancer (NMSC) cases in Wales increased by 7.1 per cent between 2016-19. This is the highest rate across the UK, according to Public Health Wales (PHW).

Furthermore, “heat related deaths may increase from 2,000 to 7,000 per year by the mid-2050s”, according to the State of the environment: health, people and the environment report.

With the population facing hotter temperatures and further exposure to harmful UV rays, pharmacy teams are an essential touch point in their communities to remind their customers of the importance of sun safety. This includes checking the UV index, covering up and wearing sun cream, and – especially for elderly customers – staying hydrated. Read more on sun safety here.

Mental burden

It’s not only the quality of our environments that have an impact, but accessibility to nature and open spaces also impacts health. Indeed, people with good access to the natural environment were estimated to be 22 per cent more likely to be physically active, which reduces risk of obesity, diabetes and heart disease, according to the State of the environment report. In England obesity alone is responsible for more than 30,000 deaths and is estimated to cost society £27 billion every year, according to the report.

Yet, physical health is not suffering alone. “The physical and mental health of everyone depends on quality green and blue space, and it reduces the burden on the NHS,” says Emma Howard Boyd, chair of the Environment Agency. “At a time when there is such widespread recognition of these essential facts, we should value work to protect and enhance the natural world highly.” 

The State of the environment report takes a two-pronged look at mental health – which it describes as the “largest single cause of disability in the UK”. It first looks at how the process of climate change impacts mental health. Concerns “can be caused or affected by pollution, flooding and climate change”. Further impacts laid out by the report include:

  • Acute impacts of extreme weather events
  • Disruption to the social, economic and environmental systems that support mental health, particularly in vulnerable communities
  • Chronic stress, anxiety and guilt about future climate change impacts, both locally and globally.

And not only are we worrying about our damaged environment, but reduced exposure to the natural world negatively impacts mental health too. 

Highlighting the mental benefits of being out in nature, the report cites a study of 19,000 subjects in England that found spending two hours or more a week in or around open green spaces showed a significant increase in the likelihood of people reporting good health or high wellbeing. Access to outdoor spaces is hugely beneficial to mental health, as was highlighted throughout the Covid pandemic. In 2021 the Mental Health Foundation’s (MHF) theme for Mental Health Awareness Week was ‘Connect with Nature’. It found that being in nature was one of the most effective and popular ways people tried to protect their mental health throughout the pandemic, with 45 per cent of people finding that being in green spaces had been vital for their mental health.

Addressing concerns

These examples are just the tip of the iceberg of the widespread physical and mental impacts that the environment can have on health. They highlight the importance of the aims set out by the Government to improve the UK’s environment. Hopefully they will be delivered, and furthered. In the meantime, pharmacy teams can play a role in supporting their customers health:

Air pollution

“It is important to regularly check the air pollution level. If the level is high or very high, it can increase the risk of feeling unwell and developing health problems,” explains Joanne. “To check the level of air pollution, you can visit the UK Government’s Defra Air website  to see a daily pollution forecast or check weather apps, as most show a daily pollution forecast.” Joanne also recommends:

  • Walking or cycling instead of driving a vehicle or using public transport. This is because the air quality is poorer in vehicles
  • When walking or cycling, try to find routes away from busy roads or use cycling paths
  • In areas that could have poorer air quality (like cities and towns), try to reduce the amount of time spent outside during ‘rush hour’ (the busiest times of day to travel)
  • Some research has suggested that eating a balanced diet with plenty of fruit and vegetables could help protect you from the negative impacts of air pollution.


To help with issues surrounding AMR, pharmacy team members can look at becoming antimicrobial stewards. More on updating your understanding of AMR.

Mental health

Encourage customers to get out into nature, including to exercise. “Green spaces like parks, gardens or forests – or blue spaces like the beach, rivers and wetlands… can help you reduce your risk of mental health problems,” according to the MHF.

Protecting nature can also be beneficial to mental health. “This can be as simple as recycling, to walking instead of driving, or even joining community conservation or clean-up groups. Taking care of nature can help you feel that you're doing your part, and that can make you feel more positive all round,” adds the MHF.


There is much too that individuals and organisations can do to start making a positive change to their environments. Indeed, the pharmacy is certainly somewhere that is able to lead by example in its community. Teams could get involved by:

  • Being a part of recycling schemes
  • Selling sustainable stock
  • Canvassing for green policies in the local area.
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