What's in the box?

Community and acute care pharmacy have buying choices to help the climate, but how can procurement support?

by Ethar Alali


Medicines come in all shapes and sizes. Traditional procurement and regulation has concentrated on the efficacy and cost of medicines. In the case of generics, manufacturers with different blister packaging and boxes are considered the same. A prescription of one, is substitutable for the other.

While this is clearly true in its purity, there is a invisible problem that health services are only now beginning to understand through their sustainability initiatives.

Box Sizes: The Climate Impact

The relationship between volume and surface area is a staple of applied mathematics. If you double the sides of a cube, you multiply the volume by 8 but the surface area only by 4. In card, that quadrupling of surface area, quadruples the energy and water required to process even recycled card.

The difference doesn't stop there. An 8-fold volumetric increase means a conveniently sizes space has 8x less items in it. Yet crucially, it doesn't reduce the freight and logistics cost due to the fixed weight of container, vehicle and pallets.

Traditional health-economics has ignored these effects, despite the fact it adds as much as 2kg CO2 per km on each lorry load per pallet (180kg on the average logistics journey from warehouse to site). Requiring more pallets and even more lorries.

Health-climate-economics ensures these factors are included by accounting for the volume consumed by the box in transit. A traditional procurement will consider the above two boxes of Atorvastatin 40mg as equivalent. So a typical "Do Nothing" solution would not change to a better, more climate friendly supplier. While the application of a health climate evaluation, would consider the manufacturing and transit impacts of the drugs on the carbon footprint, patient respiratory conditions and heatstroke in turn.

How do you evaluate it? Several evaluations must apply.

Step 1: Box & Blister Pack

Boxes are cut from nets on large industrial machines. They are also printed beforehand and currently use virgin cardboard. The are of the box should be calculated to determine the energy for print, cut and stock pulp usage. These figures are available in aggregate through the kWh and wattage of the machines, associated manufacturing overheads (heat, light etc) etc. Step 2: Packing, Freight & Distance Freight emits a substantial amount of emissions simply moving things around. Shipping and Rail freight have a significantly lower carbon footprint than air freight, which also carried less cargo. The volume of packaging may vary but container spaces are fixed. Allowing you to calculate the amount of space boxes take and how many containers are needed for the load. Step 3: Logistics