Clinical Pearls: Environmental sustainability in pharmacy curriculum - A PharmD student’s perspective  

September 8, 2023
By Holly Wingate 
This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think. If you would like to provide any comments or constructive feedback for our students, please email us at

Climate change: Background

While not a new concern, climate change is becoming more recognizable across the world, with extreme storms, forest fires, and more. For example, air pollution is the greatest environmental risk to health as nine out of ten people breathe polluted air every day, which kills 7 million people/year.1 The harmful effects of air pollution manifest in lung cancer, stroke, allergy, chronic obstructive pulmonary disease (COPD), asthma, and heart disease, among other health problems.1 These emissions are responsible for more than 25% of deaths from heart attack, stroke, lung cancer, and chronic respiratory disease globally.2  As we step back and look at these statistics from a health care professional lens and see the clear link between the environment and patient health, one can see the immense amount of work ahead to decrease pharmaceutical impacts on the climate and in turn, on our patients. For example, researchers estimated that health care emissions between 2009-2015 resulted in 23,000 years of life lost due to disability or early death.3 

As we shift viewpoints towards healthcare, we see that hospitals and pharmaceutical companies are two of the biggest drivers of emissions.3 Medicines are the most common intervention in healthcare, accounting for roughly 25% of carbon emissions within the NHS.4 In Canada, our healthcare systems are responsible for 5% of all greenhouse gas emissions within the country, and pharmaceuticals comprise 25% of these.4  If we consider the entire life cycle of a medicine, from design and development, marketing authorization to production, post-authorization, health technology assessment, prescription, consumption and finally waste disposal, pharmacy can have an impact at every stage.5  For example, certain inhalers account for around 3% of these emissions.5 Perhaps, if more pharmacy professionals were aware of the environmental impacts and actively encouraged environmentally friendlier alternatives, we may be able to mitigate some of these effects. 

Training the upcoming generation of pharmacy professionals

In Canada, the PharmD and Pharmacy Technician program curricula’ are mandated by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP). For PharmD programs, curriculums must include foundational content in areas such as biomedical, pharmaceutical, behavioral, social, and administrative pharmacy sciences, as well as teaching clinical sciences including clinical practice skills, and intra- and inter-professional collaborative practice skills.6  Also required is a total of a minimum of 40 weeks of practice experience, of which 32 weeks must occur near the end of the program.6 In pharmacy technician programs across Canada, foundational content requirements are similar; however, there is more focus on product distribution, calculations, and communication practices, among other skills. Alongside this, is a required minimum of nine weeks' practium.7 Additionally, curricula are based off the Canadian Pharmacy Technician Educators Association’s (CPTEA) nine educational outcomes, which include Professional, Provider of Care, Contributor to a Safe, Effective, and Efficient Practice Setting, Knowledgeable Professional, Communicator and Educator, Contributor to Quality and Safety, and Roles in Product Distribution, Health Promotion, and Intra- and Inter-Professional Collaboration.8 For PharmD programs specifically, the curriculum is free to be modified as long as CCAPP requirements are met, and curricular content demonstrates competency in the 7 educational outcomes created by the Association of Faculties of Pharmacy of Canada (AFPC).The AFPC provided these updated educational outcomes for PharmD programs in 2010, stating “The revised educational outcomes are formatted with the overall goal of graduating Medication Therapy Experts.” Emphasis is placed on the multiple roles of graduates through explicit statements within the appropriate outcome.9 These outcomes include Care Provider, Communicator, Collaborator, Manager, Advocate, Scholar, and Professional.9 

In my fourth year of my PharmD program, I frequently reflect on all I have learned in my short few years within Pharmacy. I feel my professionalism and clinical knowledge has increased substantially; however, as I look at the environment around me in which I am supposed to live and work, and see the impact from pharmaceuticals, I feel a large knowledge gap in how to improve my impact here. At present, there is no consensus or mandatory requirements among pharmacy schools in Canada, or elsewhere in the world, detailing the specific environmental sustainability competencies and skills a pharmacist should possess.3 Neither the AFPC nor CCAPP mandate any sustainability measures in PharmD or Pharmacy Technician students. As I head to graduation, I worry that this lack of knowledge may impact the upcoming generation of pharmacy professionals more than expected, as the effects of climate change on our patients becomes abundantly clear. 

My thoughts on why it is important for students to be taught environmental sustainability   

Pharmacists have a duty to their patients to be educated and up to date on therapies and healthcare treatments; however, when it comes to issues surrounding the environment there is an overall lack of training, despite a clear link between patient health and the environment. When we look at who climate change impacts the most, our most vulnerable patients are at the greatest risk of feeling its effects, and in turn, its effects on their health. Knowing the large carbon footprint of pharmaceuticals and how pharmacists are experts on how medications affect patients, they are uniquely positioned and skilled as trusted health care professionals and clinical leaders to take a leadership role in the environmental movement.10 However, overall, there is a lack of awareness among pharmacists in respect to pharmaceutical impacts on climate change, signifying an increased need for environmental training within the profession.11 This includes students, as they want to learn, and engage in prioritizing sustainable practices for their future careers.3 Training our students, who will advance to many different careers within pharmacy, will ensure that effective mitigation strategies reach all ends of the profession.12   

On a personal level, though my experiences with the world are limited, I have already felt an impact from climate change, even if I didn’t call it that at the time. Across Canada, we’re seeing and feeling extreme weather, including forest fires reaching all ends of the country with their smoke. The effects of climate change are ones that all students, regardless of background or place in the country, will experience in some sort of way, and will be the catalyst for change. This is based on the fact that education is an effective method to changing behaviour, as long as there is a deep connection or personal relevance to the issue being taught.13 Now that I have completed the classroom learning component of my pharmacy education, and as I think of my future career, I feel education in environmental sustainability would have changed how I consider medications for patients and would have been a valuable addition to the PharmD education I received. Aside from professional reasons, I think learning about how pharmacy impacts the environment, and how the environment impacts our health, would have been incredibly enlightening for me as a person. Afterall, I am going to be living on this planet for quite a few more years if I’m lucky; I’d like it to last that long for me. 

Though Canada is lacking in sustainability teachings, especially for pharmacy students, many places around the world have begun this training for students. Although not a pharmacy specific example, it shows the impact of this type of education on students in the long run. At San José State University in California, students from different colleges, including humanities, business, and sciences, were taught core themes of climate science, climate mitigation and environmental communication, in a one-year course.13 The effects on students’ behaviour after this course were then assessed through a survey, a minimum of 5 years afterwards. Findings showed that graduates reduced their individual carbon emissions by 2.86 tons of CO2 on average each year, and described a strong connection to climate change solutions, both personally and professionally.13 A majority of participants also agreed that global warming would affect their lives, that they’ve already experienced the effects of global warming, and that it will have a large impact on future generations.13 This type of educational opportunity allowed each of these students to take what they learned into their personal and professional lives, and the education translated into behavioural changes, likely due in part to the personal connection everyone shares with climate change. The effect of the course may be extrapolated to pharmacy students as the students in the study were from different backgrounds and colleges but showed similar changes in behaviour. 

There are some specific pharmacy programs which have begun incorporating sustainability into student training. For example, the University of Huddersfield in Queensgate, United Kingdom, began consciously teaching environmental sustainability in the MPharm curriculum in 2021, with the key role of delivering future pharmacists who will be best placed and ready to play their part in fighting climate change.14 After the National Health Service (NHS) made public their efforts towards becoming NetZero, pharmacy faculty at the University of Huddersfield decided that refocusing their MPharm curriculum through an environmental sustainability lens was needed, to ensure students were as prepared as possible at graduation, especially considering the huge contribution medicines have on the environment.14 This being said, no new curricular content was introduced, as what students needed to learn was already present within the existing curriculum.14 The University of Huddersfield is a great example of how pharmacy curricula across the globe can incorporate sustainability into pharmacy teachings and is a great starting place for Canadian PharmD and Pharmacy Technician programs to begin such change as well. 

How to advocate for this as a profession

Although education on pharmaceuticals, climate change and environmental sustainability are likely to be absent in pharmacy curricula for a few more years, as a profession we have an opportunity to advocate, encourage and support our students in this learning. We need to become knowledgeable and/or maintain our knowledge on the effects of climate change, how pharmacy plays a part, and know which resources are available to you and those around you. This starts with a personal reflection on climate change; knowing how it has personally impacted you in your life forms the personal connection which will encourage behavioural changes that can translate into professional practice. Professionally, you can participate in continuing education opportunities such as webinars and online courses, which focus on sustainability education. You can also reflect on how your practice could improve its’ impact on the environment. For example, knowing how a patient’s medications impact the environment is a great place to start learning. For more information about the environmental impact of inhalers specifically, please see CSHP’s recent Clinical Pearl: Environmental Impacts of Inhalers. As pharmacy professionals, we need to use our voice to advocate for more sustainable practices and paperless formats in our workplaces to minimize operational waste.15

Starting with yourself is the best actionable measure to ensure this movement continues. However, taking the opportunity while precepting, lecturing, or talking to students, to initiate conversations on environmental sustainability and encourage life-long learning early on, can make the difference in the spread of sustainability practices in pharmacy. Ensure you have resources on-hand to share with students so they can start their personal sustainability journey. Stay tuned for our Resource Spotlight for more information on these specific resources.  


  1. FIP Call To Action: Mobilising Pharmacists Across Our Communities to Mitigate the Impact of Air Pollution on Health. International Pharmaceutical Federation; 7 Sep 2021. Available from:  
  2. Urgent health challenges for the next decade. World Health Organization; 2020. Available from: health-challenges-for-the-next-decade  
  3. Mercer C. How health care contributes to climate change. Canadian Medical Association Journal (CMAJ). 2019;191(14):E403-E404. doi:10.1503/cmaj.109-5722 
  4. Mathers A, Fan S, Austin Z. Climate change at a crossroads: Embedding environmental sustainability into the core of pharmacy education. Canadian Pharmacists Journal/ Revue des Pharmaciens du Canada. 2023;156(2):55-59. doi:10.1177/17151635231152882  
  5. Pharmacy’s Role in Climate Action and Sustainable Healthcare. Royal Pharmaceutical Society of Great Britain; 2023. Available from:  
  6. ACCREDITATION STANDARDS for CANADIAN FIRST PROFESSIONAL DEGREE IN PHARMACY PROGRAMS. The Canadian Council for Accreditation of Pharmacy Programs; 2018 (Revised 2020). Available from:  
  7. ACCREDITATION STANDARDS FOR CANADIAN PHARMACY TECHNICIAN PROGRAMS. The Canadian Council for Accreditation of Pharmacy Programs; 2019 (Revised 2020). Available from:  
  8. Educational Outcomes for Pharmacy Technician Programs in Canada. Canadian Pharmacy Technician Educators Association (CPTEA); 2017. Available from: 
  9. Educational Outcomes for First Professional Degree Programs in Pharmacy (Entry-to-Practice Pharmacy Programs) in Canada. Association of Faculties of Pharmacy of Canada (AFPC); 2010. Available from:  
  10. Roy C. The pharmacist's role in climate change: A call to action. Can Pharm J (Ott). 2021;154(2):74-75. Published 2021 Feb 10. doi:10.1177/1715163521990408 
  11. Tai BW, Hata M, Wu S, Frausto S, Law AV. Prediction of pharmacist intention to provide medication disposal education using the theory of planned behaviour. J Eval Clin Pract. 2016;22(5):653-661. doi:10.1111/jep.12511 
  12. Self E. Universities must teach future pharmacists about protecting the environment. The Pharmaceutical Journal; 15 Sep 2021. Available from: 
  13. Cordero EC, Centeno D, Todd AM. The role of climate change education on individual lifetime carbon emissions. PLoS ONE 2020;15:e0206266. doi:10.1371/journal.pone.0206266  
  14. ‘Greening’ the MPharm: embedding environmental sustainability in the curriculum. The University of Huddersfield; Oct 2021. Available from:  
  15. Miller J. Pharmacy sustainability: What is our role? American Pharmacists Association (APhA); 11 Nov 2021. Available from:


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