Gigi Wong, new Coalition adviser on pharmacy is a Clinical Pharmacy Specialist for Quality with Lower Mainland Pharmacy Services (LMPS) in Vancouver, BC, who strives to increase awareness of the pharmacy impacts on planetary health, and to inspire action towards more sustainable health care systems. Her focus is on increasing awareness of pharmaceuticals in the environment and its impact on non-target organisms. Over the years, Gigi has dedicated herself to serve this cause.
Discover below how Gigi highlights the harmful impact of pharmaceuticals on wildlife, specifically how drugs in the environment affect species like fish and birds, which fuels her passion for environmental stewardship. She emphasizes the urgent need for health care to integrate planetary health into every decision, while also recognizing the barriers and opportunities for creating positive change in the system.
Read the full blog below.
Q1: What inspires you to be involved in making health care more sustainable?
To answer this, I need to provide context. Pharmaceuticals are found in the environment and impact non-target organisms (wildlife) such as fish and birds. There are studies on estrogen in trace amounts (parts of billion) that mimics environmental concentrations that drive fish to extinction. Bird populations have been decimated by one drug in a short 15 years, a striking example of collateral damage of drug use in society.
Although medications are intended for therapeutic use, they will also likely become chemical contaminants to our shared environment. I strive to raise awareness on this to inspire action. Intrinsic motivation is a great source of strength. My other area of interest is in minimizing preventable medication waste in hospital drug systems.
Nature is my source of inspiration to make health care more sustainable. Wildlife in particular, specifically small birds like songbirds and hummingbirds. With their tiny bodies it is likely they are negatively impacted by the cocktail of pharmaceuticals in our environment. Perhaps antidepressants impact their behaviour, which impacts feeding and mating and ultimately the species survival? These ponderings make me sad. This sadness fuels the stewardship marathon-efforts.
Q2: What do you believe is the most significant change health care should undertake?
I believe that the most significant change should be to integrate planetary health into every decision made by every staff member, and in every department. Reputable international groups have put forth sound justifications for action and numerous supporting documents highlighting the dire projections of our collective trajectory. Climate change events and impacts are on the news regularly. If this fight is important, make it a priority. Align your actions.
Q3: What are the biggest barriers?
Since beginning my efforts to reduce medication waste in 2010, I've encountered numerous barriers at various stages of taking action. Below, I’ve outlined these phases, highlighting key barriers and effective strategies for overcoming them.
Phase 1: Getting started
| Barriers | Comment | Strategies to Overcome It |
| Lack of awareness | Leaders/staff are unaware of the linkage between healthy environment and human health, or how health care contributes to planetary decline. This knowledge gap delays action. | Educate leaders in your organization.Find the professional groups and organizations the leaders are interested in. At these, arrange webinars, academic seminars to health care professionals, in-services, present at conferences, or write articles. |
| Lack of desire | Desire is driven by values. Leaders/staff don’t seem to care, because they don’t seem to share the same values. | Engage leadership at the highest level. Speak up at the staff meetings, such as town halls, or other opportunities. Vote for the leaders that align with your greening health care values. Integrate into your strategic plan. |
| Lack of Courage to Act | Unsure if what you do will make things better. Or even worse, you fear that the improvement idea will actually make things worse, and this may hurt your confidence, ego or both.Worried about making mistakes. | Read about initiatives that inspire you.Start with a small project, something you can commit to.Adopt a healthy perception of “failures” - they are necessary to the path to finding what works. Learning some basic Quality Improvement principles. A path to improvement is a continuous learning process |
Phase 2: Deciding how to take action
| Barriers | Comment | Strategies to Overcome It |
| Lack of tools | Want to do something about the problems, yet not sure how. | Focus on system-changes, if possible. There are many groups that have resources related to greening health care. Especially since 2022, resources have been developed more rapidly. Resource spotlight: |
| Analysis Paralysis | Occurs when there are many concurrent ideas (action ideas, or problems to solve). There are pros and cons to all ideas. Unable to decide which project idea to do.
| Focus on the things that are in your direct sphere of influence. Note that your sphere is dynamic - for as you evolve in skillsets and connections, your influence will expand too. Thoughtfulness is needed of course, do your due diligence and background homework, but accept that learning is an ongoing process. Make a graph with impact (Y-axis) vs effort (x-axis) to identify the things that are easy and high impact things first. Consider timelines and align them, as it may be synergistic; or go where the most excitement and energy is as you may have critical mass for the paradigm shift there. Explore various mapping tools, some are very powerful and useful. Resource spotlight: |
Phase 3: Lack of support
| Barriers | Comment | Strategies to Overcome It |
| Discouraged by the “small” impact | / | There is always something that can be learned from any project no matter how small. |
| Unsupported by peers, supervisor, and/or site leadership | When your altruistic attempts are being stifled by others, especially your direct superiors, this is testing to the spirit. Hang in there! | Find allies or join a network with like-minded people in the discipline/ area of interest. They may not be in your direct workplace. These people may be a group with your professional organization, community of practice, or some professional group. Even having one person you can talk to and take you seriously, can make a big difference. |
| Not yet “officially” supported by the department | / | Explore whether the organization has staff town halls or the like and communicate this, or other departments that have started to hire into jobs related to sustainability in health care. |
Phase 4: Reaching capacity
| Barriers | Comment | Strategies to Overcome It |
| More ideas than capacity to lead | More projects, initiatives, working groups, committees, and task forces than you have capacity for. | Be more selective about the projects to lead. Option to be part of the team without leading it. Shift some of your contribution to be consultative. Other ways to help: link key contacts with each other, support training of staff for specific systems or programs; put up signage, collect data, arrange for space to work. If you can’t help at all, at the very least, don’t get in the way of others trying to advance this work! |
Q4: What opportunities do you see in this field?
There are many opportunities to take action in the health care system and be a steward for planetary health. When each of us works in our sphere of influence (which I’ve learned can also grow as one’s skills, knowledge and network expands) we can mend the gaps in our shared tapestry.
-End of Blog-
The Coalition thanks Gigi for her expertise and continued excellence in the field of pharmacy, and sustainable prescribing.
Feeling inspired and want to get involved? Check out our Sustainable Prescribing page HERE to learn more and get started.
Learn more about sustainable prescribing with Gigi in “Pharmaceuticals in the Environment: Impacts on non-target organisms” on YOUTUBE.
